Eisenberg/Kanner's 1956 "Update"
Bill Long 12/10/07
The "Refrigeration" Thesis Articulated
Thirteen years had passed since Kanner's pathbreaking 1943 study of 11 children with autism. Along with Dr. Leon Eisenberg, also at the Children's Psychiatric Service at Johns Hopkins Hospital in Baltimore, Kanner now wrote a brief and clear statement of the research he had been conducting on the phenomenon he called "infantile autism" in a 1944 article. The influence of this new article far exceeded its length (11 pages). Though first published in a journal in 1956, it was quickly taken up as the first article (pp. 3-14) in the leading text on abnormal psychology of the day: Psychopathology: A Sourcebook (ed. Charles Reed, et al.; Harvard UP 1958), and it also appeared as the first article in the 1963 revision. This article, entitled "Early Infantile Autism, 1943-55," became what you might call the "state of the question" or the "authoritative" article on autism studies, then, in the early 1960s. It is remarkable on a number of fronts: (A) its clarity in restating and refining the conclusions of Kanner's 1943 study; (B) its emphasis on parental coldness as a major contributing factor to the origin of autism; and (C) its recognition that unspecified innate or biological factors also played a role in the genesis of autism. This essay lays out these three points; the next essay looks at Eisenberg's essay on "autism in adolescents," originally published in 1956.
I. Reiterating/Refining the 1943 Conclusions
E & K begin by reiterating the five conclusions of the 1943 study: (1) the pathognomonic [i.e., basic characteristic of the] disorder was "the children's inability to relate themselves in the ordinary way to people and to situations from the beginning of life." Then, (2) there was the failure to use language for the purpose of communcation; (3) "an anxiously obsessive desire for the maintenance of 'sameness,'"; (4) in contrast to the lack of concern about people in (1) above--autistic children had a "fascination for objects which were handled with skill in fine motor movements"; and (5) "good cognitive potentialities." I want to emphasize the last one because somewhere scholarship seemed to go down incorrect paths in emphasizing the, in general, mental deficiencies of children with autism. Kanner's work doesn't support that thesis.
But after studying autism for 13 more years, with a "tenfold increase in clinical material" (p. 5), E & K decided that there really were two pathognomonic features to autism, both of which must be present in order for a diagnosis of autism to be correct: (a) "extreme self-isolation"; and (b) "the obsessive insistence on the preservation of sameness" (p. 5). Even though language deficiencies and peculiarities are often the most striking thing first noticed about a child with autism, these may be seen "as derivates of the basic disturbance in human relatedness." They say it again but in different words:
"the presence of elaborately conceived rituals together with the characteristic aloneness serves to differentiate the autistic patient" [from severely retarded children], p. 5.
Thus, Eisenberg & Kanner will conclude that autism is neither schizophrenia nor oligophrenia (a common word then, though rare now, for mental retardation), but is a distinct condition. That, more than anything else, probably freed the field to hasten the separation of "infantile autism" from "childhood schizophrenia," which it could still be called in the mid-to-late 1960s.
One more point should be mentioned. E & K highlighted the "amazing lack of awareness of the feelings of others" among autistic children. Even the child with autism from the 1943 study who had progressed the farthest (next essay will tell about him) by the time of the 1956 essay, showed this lack of awareness of other people. For example, he was called upon to speak at a football "pep rally" at his college. Rather than "revving up" the crowd, he told them that he thought the team probably was going to lose. It turned out that he was right. He couldn't understand the obloquoy and booing from the supposed friendly crowd, especially when he had told them the truth.
II. The Role of the Parents
You can tell that parents are going to take it on the chin when you read the following statement:
"Physical examination failed to reveal any consistent organic abnormality that could be related to the clinical picture. Family background was striking in universal presence of high intelligence, marked obsessiveness, and coldness, " p. 4 (my italics).
Again, lest we missed it:
"One of the striking features of the clinical histories remains the unusually high percentage of these children who stem from highly intelligent, obsessive, and emotionally frigid backgrounds," p. 8.
They do admit, however that 10% of the parents don't fit this stereotype and many who do fit it have raised "other normal, or in any event, nonpsychotic children," Ibid. This probably should have warned them not to make their bold conclusions about parents, but they plowed on, giving a case of extreme parental coldness towards a son and then saying:
"this case, an extreme instance chosen for emphasis, can serve as a paradigm of the 'emotional refrigeration' that has been the common lot of autistic children," p. 9.
Once more, lest we were deaf:
"The emotional frigidity in the typical autistic family suggests a dynamic experiential factor in the genesis of the disorder in the child," p. 8..."It is difficult to escape the conclusion that this emotional configuration in the home plays a dynamic role in the genesis of autism," p. 11, my italics.
Striking also, however, is E & K's conclusion that therapy doesn't seem to be effective with children with autism. They say:
"It should be stressed that, insofar as our data permit evaluation, psychotherapy seems in general to be of little avail, with few apparent exceptions. If one factor is signficantly useful, it is a sympathetic and tolerant reception by the school," p. 7.
III. Innate Factors--and Conclusion
With all this emphasis on the frigidity of the parents, you would think that E & K would be totally in the "psychogenic" camp--that autism had a completely psychological etiology. But they ended with a sort of "balance" by stressing the importance of heredity or in-utero existence.
"There appears to be some way in which the children are different from the beginning of the extrauterine existence....There is little likelihood that a single etiologic agent is solely responsible for the pathology in behavior," p. 11.
Hereditary and environment are not antithetical but rather "interpenetrating" concepts, Ibid. I suppose that this is rather cold comfort for parents who felt that they had been trashed in the rest of the article.
I think we have good reason now to understand the power of the negative stereotype of parents of children with autism that was circulating in the 1950s and 1960s. Words like "frigid," "cold," "refrigeration," and "barely able to defrost," were used by the leading clinicians in the field. What were parents to do? Most accepted the conclusions of the leading Germanically-educated doctors. Except one person, whom I shall tell about below.