The 1930s stand as a period in medical history before the formal recognition of autism as a distinct clinical entity. At this time, the world of psychiatry and child psychology operated without standardized diagnostic frameworks like the later Diagnostic and Statistical Manual of Mental Disorders (DSM). Developmental differences in children, which today would be categorized under the autism spectrum, were filtered through the limited understanding of mental health conditions prevalent during the era. The management of these unexplained developmental differences depended entirely on existing, broader diagnostic labels, leading to approaches far removed from modern, targeted support.
Pre-Kanner: The Absence of Clinical Terminology
The term “autism” was not new in the 1930s, but its meaning was entirely different from today. Swiss psychiatrist Eugen Bleuler had coined the word in 1911, using it to describe withdrawal and detachment associated with schizophrenia. Clinicians, therefore, used the term to denote self-absorption or retreat into an inner world, not a unique developmental syndrome. The first formal description of the condition we now call autism did not appear until 1943, with the work of American psychiatrist Leo Kanner. Kanner began his observations in 1938, but his seminal paper was published later. Before Kanner’s publication, no specific, unifying label existed for the constellation of traits that characterize autism.
Common Misclassifications of Autistic Behaviors
Lacking a specific diagnosis, children exhibiting what we now recognize as autistic behaviors were routinely classified under existing, broader psychiatric and developmental labels. The most frequent misclassification was “childhood schizophrenia” or “childhood psychosis.” Clinicians observed profound social withdrawal, apparent lack of affective contact, and unusual movements, interpreting these traits as early manifestations of psychotic detachment.
Another common category was “intellectual disability” or “feeblemindedness.” Children who displayed significant language delays or struggled with standard cognitive assessments were often placed in this group, regardless of their underlying cognitive potential. The use of these generalized labels dictated the kind of care and institutional setting a child would receive.
Dominant Psychological Theories of Causation
The prevailing views on the origins of mental illness in the 1930s were heavily influenced by psychoanalytic frameworks. This paradigm emphasized the profound impact of early childhood experiences and the emotional environment on psychological development. Severe developmental differences were frequently attributed to emotional trauma or inadequate parenting.
This foundational idea later became known as the “refrigerator mother” theory. The theory held that a child’s psychological withdrawal was a defense mechanism—a reaction to a lack of maternal warmth or an emotionally damaging home environment. Although Leo Kanner later argued against this, the prevailing psychological climate placed the etiological focus squarely on environmental and parent-child interactions. This belief system meant that intervention often focused on separating the child from the perceived source of psychological damage, usually the parents, to allow for therapeutic intervention.
Standardized Interventions and Care Settings
Since the behaviors were largely misclassified as psychosis or severe intellectual impairment, the interventions applied were those standardized for those conditions. For children with the most pronounced difficulties, the primary form of intervention was institutionalization. State mental hospitals and asylums served as custodial settings focused on management and confinement rather than targeted developmental support.
Within institutional settings, treatments borrowed from the psychosis model were used. These included physical treatments like hydrotherapy, which involved prolonged hot or cold baths, and early shock therapies, such as insulin-induced coma, used to treat schizophrenia. Furthermore, the late 1930s saw the introduction of psychosurgery, such as the lobotomy, as a radical intervention for severe mental disorders. For families who could afford it, psychoanalytic “talk” therapy was also employed, based on the belief that the child’s withdrawal could be resolved by addressing presumed underlying emotional conflicts.