Bruno Bettelheim's 1967 book The empty fortress: Infantile autism and the birth of the self has a bad reputation in autism circles; it is said to blame autism on the mother, while nowadays one believes the causes of autism to be biological rather than to lie in early childhood experiences. This blaming of the mother is seen as unjust and as having caused unneeded feelings of guilt. A close reading of the book has been undertaken to verify the correctness of this view.
Bettellheim is a highly intelligent and skilful author with an excellent mastery of the English language and an intriguing vocabulary, all of which has no doubt contributed to the impact of this book. His concept of autism is rooted in Freudian psychoanalysis; that is, he believes that frustrations early in life cause autism, in particular during the "oral phase" (breast feeding) and "anal phase" (toilet training). The child senses parental rejection, for instance when the mother pulls back the breast when the child reaches for it, and this causes the child to assume "the autistic position". It is this rejection, and the parents' deep desire that the child not be there, that are the cause of autism. Bettelheim says that in so many words.
The author's devotion to the psychoanalytic paradigm becomes obvious in the case histories, when he mentions episodes of severe psychiatric illness from which parents of his patients have suffered, but conspicuously fails to notice the possibility of a hereditary connection between the disorder of the parent and the autistic condition of the child. Hans Asperger and Leo Kanner, decades before Bettelheim, did see that connection. Bettelheim though theorizes from a paradigm that disallows any hereditary influence on human behaviour and personality; he was well aware of the views of others who suspected a hereditary component in autism.
According to Bettelheim, autistic persons have an incomplete, undeveloped personality, and are lacking a self. They are not complete humans. He says that the self develops through the experience that one can influence the world around one through one's actions. When this experience is absent or frustrated in certain critical periods, like the oral or anal phase, some infants turn away from the world and "assume the autistic position". Bettelheim also writes about autism in terms of it being a psychosis and a severe form of childhood schizophrenia; this view may not have been entirely uncommon among psychiatrists in the 1960s.
Regarding the development of a self, Bettelheim says it is in the anal phase (learning to defecate by one's own decision in a socially acceptable form) that autonomy and the self develop, that one learns the distinction between self and non-self by the act of purposely pushing out the faeces, thus turning something into non-self that was hitherto self.
As an example, he mentions a nine-year-old autistic boy who had always referred to himself in the second person ("you"), and only began to use "I" for himself when he started using the toilet by his own decision. Also noteworthy is this remark by Bettelheim:
True, it was psychoanalysis that made us aware of how personality can depend on what the individual experiences around toilet training — whether he will, for example, become a compulsive miser or a spender.
Bettelheim believes that autism can in many cases be healed. He describes the progress made by children at his Orthogenic School, and relates the dramatic relapse of a girl who was taken from the Orthogenic School by her parents and ended up in a state institution. He visited her one last time there, and found the girl in a completely autistic state again like when she first came to his school. When she saw him she appeared to come back to life a bit, and hopefully put her hand on his knee. Then he told her that she would not be able to return to the school (where she had made such good progress), and the girl withdrew again and remained silent and unresponsive.
Bettelheim believes the cause of autism lies in early childhood experiences, in particular in frustrations during breast feeding and toilet training; essentially it is the parents' rejection of the child, sensed by the child, that causes autism.
Hans Asperger thinks autism is a hereditary condition, in some cases combined with (worsened by) non-hereditary factors like early brain damage or hormonal disorders.
Bettellheim sees autistic persons as not having developed a "self", and considers the condition a psychosis and an extreme form of childhood schizophrenia.
Asperger regards autistic persons as having personalities of their own, and uses the term psychopathisch for them, a word that then referred to less serious disorders of the kind one nowadays calls "personality disorder", as opposed to psychotisch (which was used for serious disorders). Asperger also notes that autistics can not understand the world "from the heart", but necessarily approach it through the intellect.
Bettelheim believes that autism can in many cases be healed through intensive loving care as provided in his Orthogenic School, where children were to some extent left free to pursue their idiosyncratic activities and behaviours.
Asperger says that some autistic persons can achieve independence and success later in life by finding a niche where they can pursue their special interests and talents.
Of interest is a section of the book that deals with "wolf children"; that is, children allegedly raised by wild animals. Bettelheim observes that the behaviour of these children is similar to that of some of the patients of his Orthogenic School. He believes that the supposed wolf children have not really been raised by wild animals, but are autistic or otherwise disordered children who have been abandoned by their parents because of their deviance. This may be his most sound conclusion in the book. He describes a few cases, such as those found or studied by someone in India named Singh.
Remarkably, while reading this section a documentary on wolf children was broadcast on The Learning Channel. It was filmed in India too, and also involved a person named Singh as the discoverer or researcher of the children. The son or grandson of Bettelheim's Singh perhaps? Clearly, the wolf child industry is still going strong in India, and they are keeping it in the family! The documentary appeared less enlightened than Bettelheim, and took the claim of the children's having been raised by animals serious.
The Empty Fortress should be seen against the background of a number of cultural, philosophical, political, and pseudoscientific movements that evolved over the twentieth century and became dominant in Western societies around 1970. Common to these movements is the rejection of hereditary, genetic, or otherwise biological influences on human behaviour and personality; the belief that human personality is formed exclusively by social-environmental factors, and that inborn differences in potential are non-existent. While incompatible with the findings of contemporary science, these viewpoints de facto continue to be the only acceptable ones in public and political discourse.
Examples of such movements are egalitarianism, multiculturalism, political correctness, feminism, the extreme variant of behaviourism, psychoanalysis, and the "race does not exist / is a social construct" school of anthropology. These, together with various other ideologies and movements, became the building blocks of what is in broader terms called "neo-Marxism", "cultural Marxism", or simply "leftism". Bettelheim, coming from Freudian psychoanalysis, fits this picture, and The Empty Fortress (1967) was published in the revolutionary years of the late 1960s when such ideologies were at their peak popularity and people were ready and eager for ideas as set forth in the book.
The negative reputation of The Empty Fortress is largely deserved because, most likely, the book eloquently and convincingly misleads the reader regarding the causes of autism and the possibility of curing it. While the psychoanalytical ideas presented by Bettelheim may seem attractive and many would like them to be true, they are not supported by proof or evidence, and are not the result of rational and empirical scientific work but belong in the realms of belief, ideology, and politics. Moreover, there exists now a fair amount of evidence in favour of theories that propose biological causes of autism, although it is still too soon to consider those proven beyond doubt.
Having said that, it would also be mistaken or premature to conclude that circumstances as claimed by Bettelheim to cause autism never contribute to the condition at all. And, improvement is a goal that should always be striven for, even if it does not lead to a complete recovery from autism. The biological nature of a condition should not lead one to assume a fatalistic position with regard to it.