In the 1950s, the understanding and treatment of autism stood in stark contrast to contemporary approaches. This post-World War II era was characterized by limited neurological knowledge, leading to theories and practices now largely discredited. Diagnostic criteria were still evolving, and interventions were often rooted in psychoanalytic thought rather than biological understanding.
Understanding Autism in the Mid-20th Century
The formal concept of autism began to take shape in the mid-20th century, notably with Leo Kanner’s work. In 1943, Kanner, an Austrian-American psychiatrist, published “Autistic Disturbances of Affective Contact,” providing the first systematic description of “early infantile autism.” He meticulously observed children exhibiting unique patterns of behavior, including extreme social withdrawal, an insistence on sameness, and peculiarities in language development, such as echolalia. Kanner’s work distinguished this condition from other developmental disorders, though he initially suggested an “innate inability to form the usual, biologically provided contact with people.”
Despite Kanner’s observations, prevailing psychiatric paradigms of the 1950s often leaned heavily on psychodynamic explanations. The term “autism” was first coined in 1911 by Eugen Bleuler to describe a symptom of severe schizophrenia. This earlier association meant autism was frequently viewed as a form of childhood schizophrenia or a profound emotional disturbance, rather than a distinct neurodevelopmental disorder. This perspective shaped subsequent theoretical frameworks.
Psychoanalytic Approaches to Treatment
The dominant theoretical framework guiding autism treatment in the 1950s was psychoanalytic, heavily influenced by the “refrigerator mother” hypothesis. This theory proposed that autism stemmed from cold, emotionally distant mothers who failed to provide adequate warmth and nurturing. Leo Kanner himself contributed to this idea in 1949, suggesting a “maternal lack of genuine warmth” and describing children as “left neatly in refrigerators which did not defrost.”
Bruno Bettelheim, a prominent psychoanalyst, popularized this theory, asserting that autism was a psychological disturbance caused by apathetic parenting. His influential work reinforced the notion that children withdrew due to perceived maternal inadequacy. This perspective placed immense blame and guilt on parents, particularly mothers. The psychoanalytic concept of “reparenting” in institutional settings emerged, advocating for the removal of children from their families to provide an emotionally corrective environment.
Clinical Practices and Institutional Care
In the 1950s, methods and settings for treating individuals diagnosed with autism were often stark and limited. Institutionalization in large psychiatric hospitals or residential facilities was a common practice, serving as the primary form of care for many children. These institutions frequently lacked specific, effective therapies for autism, as the condition was poorly understood and often conflated with other severe mental illnesses. Children were often subjected to general psychiatric interventions of the era, which could include talk therapy, even for non-verbal children, or rudimentary forms of play therapy.
Some interventions were more extreme, such as electroconvulsive therapy (ECT) or the use of heavy medication, aimed at controlling behaviors rather than addressing underlying developmental differences. Bruno Bettelheim, for instance, implemented rigid behavioral interventions at the Sonia Shankman Orthogenic School, seeking to make autistic children “normal.” The focus was largely on modifying external behaviors, with little understanding of the neurological basis of autism, leading to approaches that were often ineffective and sometimes harmful.
The Experience of Families and Individuals
The prevailing understanding and treatment of autism in the 1950s placed an immense burden on affected individuals and their families. The “refrigerator mother” theory, widely accepted at the time, fostered profound guilt and shame among parents, especially mothers, who were unjustly blamed for their child’s condition. This societal judgment and the lack of scientific clarity contributed to significant emotional distress and isolation for families.
Many autistic individuals were institutionalized, effectively removing them from their families and communities, often for life. These settings frequently offered inadequate support, leading to neglect of their actual developmental needs and potential. The long-term consequences for individuals who underwent these treatments included lifelong trauma and a failure to thrive in environments that did not recognize or address their unique challenges. During this era, advocacy or support groups for autism were virtually non-existent, leaving families to navigate these difficult circumstances largely alone.