Studying the Barrier: Leo Kanner and Autism

The word "autism" was first coined in 1910 in reference to symptoms of schizophrenia by the man best known for studying that particular condition, Eugen Bleuler. Bleuler a Swiss psychiatrist, was explaining intense self-admiration by schizophrenics: "autistic withdrawal of the patient to his fantasies, against which any influence from outside becomes an intolerable disturbance". When the condition of autism was first introduced in Leo Kanner's 1943 article, Autistic Disturbances of Affective Contact, the re-use of the word led to confusion and misconceptions among child psychiatrists. However, confusion may have already been present. Of the eleven case studies Kanner describes in his article, he mentions in his discussion, "One still resides in a state school for the feebleminded, and two had been previously considered as schizophrenic."

Leo Kanner, unlike his contemporary, Hans Asperger, emigrated to the United States before the start of World War II. Six years after arriving in America, in 1930, Kanner was selected to set up the first child psychiatry service at Johns Hopkins Hospital in Baltimore, Maryland. By 1943, when he published his article, he was already established as Director of Child Psychiatry after founding the department at Johns Hopkins. His first textbook, on child psychiatry as well, was the first English language textbook on the topic.

As you will read in the next section, Hans Asperger remained in Europe during the time he was writing his own observations on a case study of several children. While his work remained in relative shadows until over a decade after his passing, not so were Kanner's. Spared from the fighting in Europe, Kanner's works on autism were also written in English, allowing for wider distribution among psychologists. The term "autism" still carried the image of schizophrenia (autism was referred to as "infantile schizophrenia" well into the 1960's), and often led to misconceptions. The condition has a pernicious nature, its causes many and largely theoretical. As an example, I present one of the more well-known and controversial theories: the "Refirgerator Mother."

The concept of Refrigerator Mothers assumed that the cause of a child's autism (as well as schizophrenia) was the mothers (or parents) of the affected children were emotionally frigid or distancing to the child. The theory was attributed to Kanner, who observed in his 1943 article that the parents seemed emotionally frigid, and supported the observation in a 1949 paper, where he used an analogy of children being "left neatly in refrigerators which did not defrost." He reiterated a refrigerator analogy in a 1960 inverview.

The structure for the theory is found in Kanner's observations, but its conception and dissemination fall to a number of leading psychoanalysts of the time, including Bruno Bettelheim, from the University of Chicago. The theory gained footing throughout the medical community into the mid-1960's until its first major opponent, Bernard Rimland wrote "Infantile Autism: The Syndrome and its Implications for a Neural Theory of Behavior" in 1964, directly attacking the theory. Leo Kanner wrote the foreward for the book, lending Rimland his credibility and also signalling an apparent change of opinion, though in a 1969 speech Kanner would declare that he never put blame on parents and pointed out in his original paper that autism was an "innate" condition.

Three years after Rimland's book, Bettelheim came out with his own book, "The Empty Fortress: Infantile Autism and the Birth of the Self" soon after Rimland's, using his experiences in the Dachau concentration camp to support the Refrigerator Mother theory. While giving the theory a few more years of acceptance, the book came up against not only Rimland's own credibility, but against the man whose research gave birth to the diagnosis. The very same man whose subsequent observations may have been the genesis of the entrenched theory itself.

Rimland's book was the first sign of a change in the general opinion in the psychological comminuty. At the same time these books were being published, another change was sweeping through the community's views of autism, as the condition began to be spoken of in contrast to schizophrenia. As the separation of the two conditions widened, much of the theoretical proof was pulled away from parenting issues and more support was given to a genetic predisposition to autism and autistic spectrum disorders. Which returns us to 1943:

"One other fact stands out prominently. In the whole group, there are very few really warmhearted fathers and mothers. for the most part, the parents, grandparents, and collaterals are persons strongly preoccupied with abstractions of a scientific, literary, or artistic nature, and limited in genuine interest in people. Even some of the happiest marriages are rather cold and formal affairs. Three of the marriages were dismal failures. The question arises whether or to what extent this fact has contributed to the condition of the children. The children’s aloneness from the beginning of life makes it difficult to attribute the whole picture exclusively to the type of the early parental relations with our patients."

This excerpt from Kanner's article, while the genesis for the Refrigerator Mother theory, now can suggest a trend in the genetics of the subject. The subjects' parents and grandparents in that paragraph exhibit what could be forms of autism or a similar disorder on the spectrum, and studies have been conducted to explore the heritability of autism.

The argument continues to this day, though proponents of the Refrigerator Mother theory are now deep in the minority in the United States. It has more popularity in Europe, and in South Korea is accepted much like it was in the States at its height. Its persistence in the psychological community is not odd; it is yet another case study in nature versus nurture . As it stands, though not in support of the theory, focus on parenting (especially mother-child bonding) is still seen as a valid treatment to combat autistic symptoms.

Leo Kanner continued to work in the field of child psychiatry after retiring from his position at Johns Hopkins University in 1959, serving as editor for the Journal of Autism and Development Disorders from 1971 to 1974. He passed away in April of 1981, a year after Hans Asperger. In his lifetime, Leo Kanner saw his legacy emerge. He had an active part in raising awareness of autism; he could return to his original case studies and understand and clarify to a growing, curious audience the hidden or missing pieces. Our next subject, Doctor Asperger, would not see his own studies reach such wide recognition in his lifetime, but would play as important a role in the awareness and understanding of a spectrum that reached beyond just these two contemporaries' discoveries.

Page 3

Find the Door: Hans Asperger and the "Little Professors"

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