Autism

A terrifying aspect of the psychosis called primary infantile autism is its quietness: since the baby is conveniently quiet, since such babies are "good" babies, parents think everything is fine. Either the baby "was born quiet" or, though noisy and annoying at first, he stopped crying, just as the pediatrician said he would, when his crying was ignored. At two years the baby does not talk. Well, the parents are told, some babies are late talkers. Sometimes the full horror is not perceived until a nursery school teacher says the child seems "retarded" and does not get on with other children. Deprived of social stimulation, the child has "obeyed" his parents' wishes -- he has grown indifferent to society. The wish that the child be quiet has become the magic jest -- the child is quiet forever.

[ Jules Henry, Pathways To Madness, Random House, New York, 1965, 1971, p. 289. ]

But a mother who is available (not a "quiet" mother), who finds it hard to stay away, will be there often, even without a peep from the baby. Science knows nothing about the quiet babies that have been born to supremely available mothers; because those babies are compelled to join the human race by the loving energy of their mothers, they never come to the attention of doctors or psychologists. Finally, even a noisy baby born to a quiet mother may become autistic, never become human, because he never got the necessary social stimulation. Mrs. Jones* in this book and Mrs. Portman in my "Culture Against Man" are withdrawn mothers who do not go to their babies. In such situations the pediatric folklore advises against spoiling the child by too much attention, counsels the mother to teach the baby "who is boss," diagnoses prolonged crying as mere "fussing," unworthy of concern, and explains that the baby is only "crying for attention." All this supports the mother who stays away from her baby. No other culture has invented so many excuses for keeping a mother away from her infant.

[ Jules Henry, Pathways To Madness, Random House, New York, 1965, 1971, p. 288. ]

A mother's availability to her child is always affected by her relationship with her husband, and in pathology, her availability to the child may be incompatible with her availability to her husband. As we saw in the Jones case, if a man needs his wife as his mother, he will not tolerate her being the child's. Since, in general, people do not know that isolation alone can impair the mind, only tradition, as in tribal society, or love, as in our own, makes a parent available to an infant for the necessary length of time. A father interested only in himself -- "available only to himself"-- who thinks only of his own need, can compel a troubled mother to withdraw from her child. In my experience one of the most striking qualities of the mothers of autistic children is that they are not bizarre, and although their later* children may be troubled, they are far from psychotic. The relationship between husband and wife, however, was bad; and in all but the Wilson family, the relationship was miserable during the time when the child was becoming autistic. But I think that Mrs. Wilson concealed the reality of the relationship in the early days.

[ Jules Henry, Pathways To Madness, Random House, New York, 1965, 1971, p. 290. ]

* Domestic desertion -- leaving a child to cry unattended -- is often impossible in tribal societies because tribal peoples do not tolerate a mother's leaving her child alone this way, and because there are usually plenty of people around to take care of a baby if his mother has to be away. Thus private enterprise regarding babies, and the shutting up of families away from one another in apartments and houses so that the cries of their children cannot be heard by outsiders, is a gift to us from civilization -- and so, of course, therefore, is autism.

[ Jules Henry, Pathways To Madness, Random House, New York, 1965, 1971, p. 41. ]

Norma went to play with a friend. The Wilson's and I sat in the parlor, and Mrs. Wilson did 90 percent of the talking. She spoke with enormous intensity about Donald, their autistic child -- mostly about her guilt. She said she had neglected him, and this neglect seemed to stem from about the second or third year of his life. She did not go in when he cried; she paid no attention; she left him alone in his playpen. She said that under these circumstances one could never expect a child to grow up normally. He never had a chance to see anything, to interact with anybody, to learn how to deal with human beings. She grasped at straws in an effort to explain his condition according to causes other than neglect, but she really felt that fundamentally it was all her fault. She described, for example, the time when she and her husband went off for a couple of days and left Donald with a sitter, and when they came back his face was all black and blue. The sitter said Donald had fallen off the toilet seat but Mrs. Wilson did not think that would have done it. She doesn't know what happened, but ever since then he stopped singing. Before that he used to sing beautifully. He used to stand up in his crib, shake the crib and sing.
She said a doctor had told her Donald needed to have his tonsils and adenoids removed; and when she took him to the hospital the anesthetist clapped the mask over his face and then the operation was performed. After that Donald began to run back and forth.*

* Autistic children have bizarre, stereotyped movements. A common one is to run back and forth, always in the same way, and often even along the same pathway.

[ Jules Henry, Pathways To Madness, Random House, New York, 1965, 1971, p. 297. ]

[ Note: Please be advised that quotations F., G. and H. may contain certain references and comparisons which some people may find disturbing. Please skip now to quotations I. and beyond if you may happen to be one of those persons. ]

I have not been the only one to whom this parallel between camp experience and a child destroyed by his earliest experiences has occurred. It seems to force itself on the mind if one thinks and cares deeply for the victims of the holocaust. Another of Paul Celan's poems, "Death Fugue" ("Todesfuge"), bears this out. It was this poem which immediately established him as Germany's -- and probably Europe's -- most important poet of his generation. To convey the ultimate desperation reigning in the death camps, he evokes the image of a mother destroying her infant.

     Black milk of dawn we drink it at dusk
     we drink it at noon and at daybreak we drink it at night
     we drink and we drink.

are the poem's first lines; and later on

Black milk at dawn we drink you at night
we drink you at noon death is a master from Germany ^[1]

When one is forced to drink black milk from dawn to dusk, whether in the death camps of Nazi Germany, or while lying in a possibly luxurious crib, but there subjected to the unconscious death wishes of what overtly may be a conscientious mother -- in either situation, a living soul has death for a master.

[ SURVIVING - and Other Essays, by Bruno Bettelheim, Alfred A. Knopf, New York, 1979, pp. 110-11. ]

Observing the mortal anxiety which regularly underlies the symptomatology of these children, I was, for a time, much taken by Pious's views on the role of mortido in schizophrenia.^[1] But his views did not fully agree with our observations at the Orthogenic School. In my ruminations, checking ideas against observations, it occurred to me that once before I had not only witnessed, but had also partly described, the whole gamut of autistic and schizophrenic reactions -- observed not in children, but in adults in the German concentration camps. These reactions, in many aspects different from person to person, were all responses to one and the same psychological situation: finding oneself totally overpowered. Characterizing this situation were its shattering impact on the individual, for which he was totally unprepared; its inescapability; the expectation that the situation would last for an undetermined period, potentially a lifetime; the fact that, throughout its entirety, one's very life would be in jeopardy at every moment; and the fact that one was powerless to protect oneself.

[ SURVIVING -- and Other Essays, by Bruno Bettelheim, Alfred A. Knopf, New York, 1979, p.115. ]

     The difference between the plight of prisoners in a concentration camp and the conditions which lead to autism and schizophrenia in children is, of course, that the child has never had a previous chance to develop much of a personality. However, the youngster who develops childhood schizophrenia seems to feel about himself and his life exactly as the concentration camp prisoner felt about his: deprived of hope, and totally at the mercy of destructive irrational forces bent on using him for their goals, irrespective of his. Under such conditions the egos of most people are unable to give protection against the devastating impact of the external world; they are unable to exercise their normal task of assessing reality correctly or predicting the future with reasonable accuracy, thus making it impossible to take steps to influence it. Such egos appear not worthy of investment with vital energy by the total personality. Most of the very limited vital energy remaining available to a person under extremely debilitating conditions remains at the disposition of the id, and too little is available to the ego for it to exercise adequate influence and control over either the inner life or external reality.
     One must not disregard the crucial difference between the life of a prisoner in a concentration camp and that of a child who becomes schizophrenic; however, their emotional responses to externally entirely different situations are strangely similar. To develop childhood schizophrenia, it is sufficient that the infant is convinced that his life is run by insensitive, irrational, and overwhelming powers, who have total control over his existence and do not value it. For the normal adult to develop schizophrenic-like reactions, this actually has to be true, as it was in the German concentration camps.
     In our work with schizophrenic children, we found again and again that their schizophrenic symptomatology was not just a reaction to parental attitudes such as rejection, neglect, or sudden changes in mood. In addition, specific events, different for each child, has convinced these children that they were threatened by total destruction all of the time, and that no personal relations offered any protection or emotional relief. Thus the psychological cause of childhood schizophrenia is the child's subjective feeling of living permanently in an extreme situation -- of being totally helpless in the face of mortal threats, at the mercy of insensitive powers motivated only by their own incomprehensible whims, and of being deprived of any intimate, positive, need-satisfying personal relationship. Three examples may serve to illustrate.
     One set of parents, for reasons of their own, and with no basis other than the child's reactions to the complete neglect to which they subjected him, decided that their son was feebleminded. Since he supposedly did not understand conversation, they spoke freely in front of him about how he ought to be put away, and how he should never have been born. His subsequent autistic withdrawal led to his being sent to an institution for feebleminded children where he was also badly neglected and often deprived of meals as a punishment. This added to his conviction that his parents wished to kill him through starvation.

[ SURVIVING -- and Other Essays, by Bruno Bettelheim, Alfred A. Knopf, New York, 1978, pp. 117-18. ]

     Basically, what such a child needs is a mother free of the self-centered emotional demands so many mothers make, so that he can benefit from mothering without having to respond to it; so that he is free to respond in his own good time and his own schizophrenic way. Thus he can begin to reestablish his autonomy.
     For the child must be able to recapture autonomy not only in the treatment room, and not only in regard to his emotions. To begin life anew, the total, extreme situation which destroyed his autonomy must be replaced with a total living situation which he can master. As he was overwhelmed by his environment, now he must be able to control it within reason, and to control it successfully. This means the environment must be simple; it must not offer complex challenges, nor make complicated demands. The need of such children for consistency and their desire for simple routines must be stressed. Basically, the child has to feel as safe, protected, and in command of his environment as the happy infant may feel in his cradle.
     We cannot put a schizophrenic child in a cradle, not only because he is no longer an infant, but also because it would violate whatever feeling of self-respect he might have acquired, deprive him of whatever negative autonomy he might have achieved through his symptoms, and restrict his freedom of movement and expression. Instead, we must provide the child with an environment that creates only those slight challenges and stimuli which are compatible with the utter security an infant should know in his crib. We must protect the child from any hostility coming from the external world, particularly from his parents; we must provide maximum need-satisfaction; and we must demand very little socialization, so that the demands of the environment are cut down to a minimum while the pressures of his impulses become reduced. When living under such conditions, even a very weak ego can begin to function more adequately.

[ SURVIVING -- and Other Essays, by Bruno Bettelheim, Alfred A. Knopf, New York, 1979, pp. 122-23. ]

In regard to the origin of childhood schizophrenia, it can be said that the mother's pathology is often severe, and in many cases her behavior towards her child offers a fascinating example of an abnormal relation.

[ SURVIVING - and Other Essays, by Bruno Bettelheim, Alfred A. Knopf, New York, 1979, p. 114. ]

Returning to childhood schizophrenia, it should be mentioned that, much to our surprise, we found quite a number of schizophrenic children who, at the crucial point in their rehabilitation when they were ready to reintegrate their personalities, also began their new life symbolically, so much so that they underwent again the experience of being born. [5] One autistic boy told his therapist about it at the moment he was symbolically giving rebirth to himself through hatching from an imaginary egg. He said, "I laid myself as an egg, hatched myself, and gave birth to me. You know, that happens to very few people." [Note that this autistic/schizophrenic boy has unconsciously identified himself in the female, maternal role, as being a hen laying an egg, and then hatching it. -- jmm]

[5] I detailed one such case, illustrating both the severity of the extreme situation which led to a child's schizophrenic withdrawal and the process of her symbolic rebirth, in Truants from Life, and another in The Empty Fortress.

[ SURVIVING -- and Other Essays, by Bruno Bettelheim, Alfred A. Knopf, New York, 1979, p. 124. ]

If the demands of the authority figures are consonant with the culture, if the child observes that the demands are approximately the same as those made by his parents on others or on themselves, he will not feel the precepts of the authorities as arbitrary or unjust. If however, the authority is irrational or driven by anxiety, or if the modes of punishment become ends instead of means, the child may begin to protect himself by deceiving himself and his parents, by concealing what is going on within him. He may use verbalisms to avoid punishment and learn the use of "as if" performances to deceive the authority, deceiving himself in the process.
If the child's signals for the need for tenderness, approval, or affection are met with marked anxiety, being made fun of, being taken advantage of, or being hurt, instead of the tenderness he requires, what Sullivan [Harry Stack] calls the "malevolent transformation" takes place. This is a basic confusion in the relation of stimulus and response, much like turning on the hot water faucet and receiving a cascade of ice cold water. In the shower, it may result only in a mistrust of plumbing, but in an area as vital as the need for tenderness, approval, and affection, it results in much more distressing consequences. It results in the conviction that one lives among enemies and can expect no satisfaction of needs outside oneself. An additional consequence of the development of the malevolent transformation is that it vitiates the trust in others so necessary for the progressive experience of unthwarted personality development. It also results in others being repelled by the child's attitude so that the child is never able to benefit from experience with potentially kind and friendly people.

[ Earl G. Witenberg, American Handbook of Psychiatry (Ch. 40 - The Interpersonal and Cultural Approaches), Second Edition, Basic Books, Inc., New York, 1974, pp. 848-49. ]

The mechanism by means of which the infant's signals may cause anxiety in the mother may be readily imagined and will, of course, depend upon the existing personality of the mother and her state of mind at the moment. A mother beset by anxiety about a current marital problem will be anxious in the interchange with the infant. A mother with low self-esteem in regard to her womanliness will find her baby's needs threatening, since they cause her to face the very area of her anxiety. But the means by which the anxiety of the mother can cause anxiety in the infant are less easy to explain. If the infant is newborn with an as yet poorly developed perceptual apparatus, it will be difficult to understand by what means he will perceive the anxiety of his mother. In order to explain such perceptions, Sullivan [Harry Stack] postulates the existence between the infant and the mother of a quality called "empathy." By this he means the emotional contagion by which the infant may become aware of the emotional state of his mother without the mediation of any of the sense organs.
Given anxiety in the mother, the infant becomes anxious and experiences the state Sullivan terms insecurity. Thus, lack of security is the result of interpersonal deficit as the presence of security is the result of interpersonal adequacy. The presence of the tension of needs is a sign of physiological disequilibrium; the presence of the tension of anxiety is a sign of interpersonal difficulty. As satisfaction is to the tension of needs, security is to the tension of anxiety. The perception of this tension of anxiety causes the infant to become uncomfortable and to signal this discomfort, but for the infant there is no relief because the mother has no way of relieving it. Severe psychopathology results from intense anxiety early in life. Severe anxiety does not convey any information about experience. It erases any experience or occurrence that may have preceded or accompanied it.

[ Earl G. Witenberg, American Handbook of Psychiatry (Ch. 40 - The Interpersonal and Cultural Approaches), Second Edition, Basic Book, Inc., New York, 1974, p. 846. ]

The infantile ego contributes to the mother-baby configuration its own main preoccupations, which are self-preservation, security, the reduction of tension and anxiety, so that there may be a comfortable basis for life and growth. Such a baby in interaction with a good mother will, of course, suffer some anxiety, some frustration, but these will be of moderate amount and will be neutralized by mother's support and her own security, so that the child is free to develop and differentiate. It would seem that the infant whose mother is emotionally ill in the fashion described will itself experience increased anxiety because of increased need and also by empathy or resonance with the mother or by internalizing her. This child, whether or not it has a constitutional liability to anxiety, will be subjected from the beginning recurrently to greater quantities of anxiety than children of good mothers are required to carry. Not only is the child influenced by the mother's anxiety and tensions and difficulties, but the child's evidence of tension and anxiety in response to the mother will, of course, increase the mother's tensions, perhaps to the point at which she no longer is able to function even as a good caretaker of the young animal, the baby. This mutual augmentation of tensions or building-up of reciprocal anxieties would seem to be a factor in disturbing the growth of the infantile ego in such a manner that it becomes liable to schizophrenia [ autism ]. The term "aphanesis," [ i.e., autism ] as defined by Ernest Jones, would seem to apply to the state into which these infants must have gone repeatedly. This is a state in which all sensory avenues are open, and at the same time all avenues of activity and discharge are closed. The child is incapable of any effective behavior, muscular or mental, to remove the bombardment, the painful stimuli. The device upon which the child would appear to hit is that of going out of contact, becoming somnolent, withdrawn. This, if mistaken by the mother for relaxation and sleep, can permit the child some relief from the mother's tensions. It would seem to us that this sort of event, oft-repeated, must be the prototype of the catatonic [ autistic ] episodes of later life.

[ Lewis B. Hill, M.D., "Psychotherapeutic Intervention in Schizophrenia," The University of Chicago Press, 1955, 1973, pp. 138-9. ]

Jessy, the 8-year-old daughter of Clara Claiborne Park, would step around a spot of light on the floor for hours, or incessantly run a chain through her fingers. She would sit and stare through people as though they were not there. A word she learned one day would fade from her memory the next.
That was more than 40 years ago, when autism was barely understood, much less recognized, as a standard diagnosis. It was considered schizophrenia, or, to some professionals who embraced the term "refrigerator mother," a deep-seated decision to closet consciousness from an unbearable family situation, including an emotionally [and sexually] frigid mother.

[ Dennis Hevesi, Obituaries (Clara Claiborne Park, 86), The New York Times, July 15, 2010, p. B15. ]

Yet even the closest mother-infant relationships are embedded in a dense social environment, as in this description of !Kung hunter-gatherer infants in Botswana, which Hrdy quotes:

" From their position on the mother's hip they have available to them her entire social world.... When the mother is standing, the infant's face is just at the eye-level of desperately maternal 10- to 12-year-old girls who frequently approach and initiate brief, intense, face-to-face interactions, including mutual smiling and vocalization. When not in the sling they are passed from hand to hand around a fire for similar interactions with one adult or child after another. They are kissed on their faces, bellies, genitals, sung to, bounced, entertained, encouraged, even addressed at length in conversation long before they can understand words."

The mother does not have to assign the care of the baby to an older child, nor does the grandmother have to take over for there to be enough support to make life easier and more pleasant for the mother. The fact of a mother at home alone with an infant or toddler is a new one in human experience, and it may not be "natural" for either.
This becomes clearer with careful measurement. Ann Cale Kruger, a developmental psychologist who analyzed !Kung responses to crying, found that in timed, coded behavioral observations someone other than the mother helped respond to a baby's cry in most cases. Even the longest crying bouts, those over thirty seconds (!Kung infants aren't left to cry very long), evoked a nonmaternal effort half the time. However, she also found that the number of longer crying bouts in which the mother was not involved was zero. These findings confirmed that although mothers are not alone in meeting the challenges of baby care, they can have a uniquely important role.

[ "It Does Take a Village," by Melvin Konner, in his New York Review of Books review (December 8, 2011, p. 38), of "Mothers and Others: The Evolutionary Origins of Mutual Understanding," by Sarah Blaffer Hrdy. Belknap Press/Harvard University Press. ]