For how likely was it that she could escape it? Alone, without professional guidance, what possible qualifications could a mother have for working with her psychotic child herself?
It is necessary now to introduce this word, and with it the subject of nomenclature. For we were finding out that there was no agreement on the right label for Elly. ‘Autistic’ meant to Dr Blank, and now to us, the sum of the specific elements of Kanner’s syndrome, all of which appeared in Elly. To many others, however, the word still held its broad root meaning of ‘totally self-absorbed’. This was the way the celebrated Bruno Bettelheim seemed to use the term, and he applied it freely to children who by Kanner’s criteria did not seem autistic at all. [5] He also used, as did many others, another term: childhood schizophrenia. This seemed to apply not only to Elly and her kind — if she had a kind — but to a wider range of children who exhibited a few of Elly’s symptoms with many others of their own. We began to be aware that there were rival ways of classifying — that professional psychiatrists could argue whether Kanner’s syndrome was a distinct condition, a sub-species of childhood schizophrenia, or synonymous with it. Some begged the question by calling it ‘a typical development’. Some denied it existed at all. Yet all these were at least in agreement that the condition should be classified as mental illness or psychosis. A smaller group of observers, including the Dutch psychiatrist Van Krevelen, considered it the result not so much of illness as of a constitutional defect, to be classified not under schizophrenia but under oligophrenia, or feeble-mindedness. This minority opinion, however, hardly penetrated to us — it was only faintly suggested in the reprints Dr Blank had referred us to. The weight of American opinion was overwhelmingly in favour of describing the condition as a psychosis. The application of that word to Elly had been ratified by the most objective of agencies, our insurance company. The expense of Elly’s hospital diagnoses had been, in part, covered by insurance because her trouble was no mere behaviour difficulty, not even a neurosis, but a genuine psychosis. Elly had met the standards; the form had it down in black and white. For what it was worth, Elly was psychotic. And no one was working with her but her mother.
The situation was preposterous on its face. The very dentist, when I brought in a terrified Elly for an open cavity, suggested that she would be easier to manage if someone else accompanied her. (Someone else did and she wasn’t. ) Everyone knows — I know myself — that the mother may be the last person who can handle a child. And this popular wisdom is today massively reinforced by professional opinion. The last people who ought to be able to work with a ‘disturbed’ child are its parents, for who, after all, disturbed it? The disturbance, after all, did not come out of nowhere. Nobody could be expected to believe that.
Babies, we are told, are infinitely vulnerable. Before they can sit or crawl they may feel the coldness of rejection. Their parents may injure them by neglect; they may injure them by fulfilling their needs too quickly. [6] A child’s first years are all important — psychologists tell us this in many ways in many places, and if we do not read psychology we get their message from the mass media, vulgarized but not essentially falsified. Dr Spock is a psychiatrist, and he has tried to tell us that babies are tough, but we have been rendered too nervous to listen. We hear on every hand that what we do in the first months of life — it may be six, or twelve, or twenty-four — may mark our child for ever. Who are we to qualify this account of our responsibility? Even the parents of normal children move with a certain knowledgeable edginess. What goes through the minds of parents who know they have a child whose development has gone wrong? Bettelheim writes that parental rejection is an element in the genesis of every case of childhood schizophrenia he has seen. [7] Beata Rank sets out as her ‘main hypothesis’ that ‘the atypical child has suffered gross emotional deprivation’, and adds that ‘the younger the child, the more necessary is it for us to modify the mother’s personality’. [8] Even the wise and humane Erikson, though he remarks that the rejecting mother is the ‘occupational prejudice’ of child psychiatrists, reiterates in the same study that a ‘history of maternal estrangement may be found in every [italics mine] history of infantile schizophrenia’ [9]
In this respect it made little difference whether what ailed Elly was called schizophrenia or autism. Kanner’s original hypothesis was consistent with the psychiatric consensus. He considered that the parents must play a lage part in the genesis of infantile autism. Certainly (like Erikson) he took account of a possible constitutional predisposition in the child; he reported that many autistic children (unlike Elly) were manifestly unresponsive from earliest infancy. But in his discusion of aetiology he devoted far more attention to the role of the parents. In the process he discovered some curious facts, facts that, since they in some sense affected how we thought of ourselves as we lived with our situation, it is necessary to summarize here.
I have already said that my husband and I are typical of the parents of autistic children. I must now make clear what this entails. Early in his work Kanner was struck, not only with how similar one autistic child was to another, but at the unexpected similarity of their parents. The fathers of the first eleven cases Kanner saw included four psychiatrists, one lawyer, one chemist, one plant pathologist, one professor of forestry, one advertising man, one engineer, and one successful businessman. Of the eleven mothers, nine were college graduates. Hardly an average group, one would think; yet as Kanner collected more cases he found that the pattern varied very little. Almost without exception, the parents of his autistic patients seemed unusual both in their intellectuality and in their professional achievement. Naturally it occurred to him that he might simply be registering characteristics shared by all the parents who brought patients to an outstanding child psychiatrist at a famous research centre. Accordingly, he checked his impressions. He took out the file of each of his autistic patients, and the file directly next to it in his cabinet. These control files represented a random cross-section of his practice — children suffering from the full variety of conditions a modern child psychiatrist sees. Kanner compared the two sets of parents. He found that statistics bore out his impressions. The ‘autistic’ parents, as a group and individually, had more years of education and significantly higher professional competence. Moreover, they differed in another particular, especially from the parents of schizophrenic children. The incidence of recorded mental illness among them and even among their families, was unusually low. Whereas schizophrenic patients had in their families more mental illness than is found in the populaton as a whole, the autistic patients had less.
Kanner began to study more closely the parents who had produced, out of such apparently strong material, such pathetically deviant children. He began to dissolve the idea of ‘professional achievement’ into the less measurable characteristics which make achievement possible. He found in these parents, in addition to intelligence, an unusual degree of energy and persistence, as well as a capacity to control both events and their reactions to them. As he observed them in his interviews, where they might be expected to be under considerable stress, he found them a very reserved group. The capacity of these parents for detachment and objectivity seemed to him extraordinary. It is not surprising that he was led to try to relate these unique group characteristics to the unique condition he was trying to understand.
5
‘Joey, a Mechanical Boy’,
6
Morrow and Loomis, describing a psychotic child (in many ways similar to Elly) remembered by its parents as an infant who was ‘not demanding’, add that ‘one may assume that this recollection reflects the likelihood that his demands were not appropriately met. By excessive anticipation of his needs, the parents denied him the right to demand.’ (‘Symbiotic Aspects of a Seven-Year-Old Psychotic’, in Gerald Caplan, editor,
8
Intensive Study and Treatment of Pre-school Children Who Show Marked Personality Deviations, or “Atypical Development”, and their Parents’, in Caplan, op. cit.
9
‘Early Ego Failure: Jean’, in