Fact sheet on controversies around causes and diagnosis of Autism Spectrum Disorders such as the refrigerator mother cause of Autism


The term refrigerator mother was coined in the 1940s as a label for mothers of autistic children, and provides an excellent example of the need for rigorous objective research into all aspects of Autism Spectrum Disorders. These mothers were often blamed for their children's atypical behaviors, which included rigid rituals, speech difficulty, and self-isolation.


The "refrigerator mother" label was based on the assumption — now discredited among a majority of, though not all, mental health professionals — that autistic behaviors stem from the emotional frigidity of the children's mothers. As a result, many mothers of autistic children suffered from blame, guilt, and self-doubt from the 1950s throughout the 1970s and beyond: when the prevailing medical belief that Autism resulted from inadequate parenting was widely assumed to be correct. Even today, there is still support for the view that Autism is a result of poor parenting.


Origins of "refrigerator mother" theory

In the absence of any biomedical explanation for what causes Autism after the telltale symptoms were first described by scientists, Bruno Bettelheim, a University of Chicago professor and child development specialist, and other leading psychoanalysts championed the notion that Autism was the product of mothers who were cold, distant and rejecting, thus depriving babies of the chance to "bond properly". The theory was embraced by the medical establishment and went largely unchallenged into the mid-1960s, but its effects have lingered into the 21st century. Many articles and books published in that era blamed Autism on a maternal lack of affection. By 1964, Bernard Rimland, a psychologist with an autistic son, published a book that signaled the emergence of a counter-explanation to the established misconceptions about the causes of Autism. His book, Infantile Autism: The Syndrome and its Implications for a Neural Theory of Behavior, attacked the "refrigerator mother" hypothesis directly.


Soon afterwards, Bettelheim wrote The Empty Fortress: Infantile Autism and the Birth of the Self, in which he compared Autism to being a prisoner in a concentration camp:

“The difference between the plight of prisoners in a concentration camp and the conditions which lead to Autism and schizophrenia in children is, of course, that the child has never had a previous chance to develop much of a personality.”


Some authority was granted to this as well because Bettelheim had himself been interned at the Dachau concentration camp during World War II. The book was immensely popular and Bettelheim became a leading public figure on Autism until his death, when it was revealed that Bettelheim plagiarized others' work and falsified his credentials. Also, three ex-patients questioned his work, characterizing him as a cruel tyrant.


As early as 1943, Leo Kanner called attention to what appeared to him as a lack of parental warmth and attachment among the mothers of autistic children. In a 1949 paper, he suggested Autism may be related to a "genuine lack of maternal warmth." In a 1960 Time magazine interview, Kanner bluntly described such mothers as "just happening to defrost enough to produce a child."

Although Kanner was instrumental in framing the “refrigerator mother” theory, it was Bettelheim who facilitated its widespread acceptance by the public and the medical establishment cognoscenti in the 1950s and 1960s.


In 1969, Kanner addressed the “refrigerator mother” issue at the first annual meeting of what is now the Autism Society of America, stating:

"From the very first publication until the last, I spoke of this condition in no uncertain terms as “innate.” But because I described some of the characteristics of the parents as persons, I was misquoted often as having said that 'it is all the parents' fault'."


This was somewhat a whitewashing of his own history. In many of his articles, Kanner does explicitly and clearly blame Autism on parental behavior. But the renunciation of the idea by the person who originated it was seen as a decisive blow in any event.


Other notable psychiatrists

For Silvano Arieti, who wrote his major works from the 1950s through the 70s, the terms autistic thought and what he called paleologic thought are apparently the same phenomenon. Paleologic thought is a characteristic in both present-day schizophrenics and primitive men: a type of thinking which has its foundations in non Aristotelian logic. An autistic child speaks of himself as “you” and not too infrequently of the mother as “I”. The “you” remains a “you” and is not transformed into “I”.


For Margaret Mahler and her colleagues, Autism is a defense of children who cannot experience the mother as the living primary-object. According to them, Autism is an attempt at dedifferentiation and deanimation (Mahler & Furer 1959). The symbiotic autistic syndrome used to be called the "Mahler syndrome" because Mahler first described it: the child is unable to differentiate from the mother.


Arieti warned that an autistic tendency is a sign of a kind of disorder in the process of socialization, and that when autistic expressions appear it should be assumed that there is a sort of difficulty between the child and his parents, especially the schizogenic mother. Children who use autistic expressions, Arieti observes, are children who cannot bond socially.


In Interpretation of Schizophrenia, Arieti maintained that for a normal process of socialization, it is necessary for the parent-child relations to be normal. Loving or non-anxiety parental attitudes favor socialization. Arieti not only maintained that the parent-child relations are the first social act and the major drive of socialization, but also a stimulus to either accept or reject society. The child’s self in this view is a reflection of the sentiments, thoughts and attitudes of the parents toward the child. Autistic children show an extreme socializing disorder and do not want any sort of relationship with people. They “eliminate” the persons from their consciousness. For Arieti the fear of the parents is extended to other adults: a tendency to cut off communication with human beings.


Persistence of the refrigerator mother theory

According to Peter Breggin’s Toxic Psychiatry, the psychogenic theory of Autism was abandoned for political pressure from parents organizations; not for scientific reasons. For example, some case reports have shown that profound institutional privation can result in quasi-autistic symptoms (Rutter, Andersen-Wood, Beckett et al 1999).


Clinician Frances Tustin devoted her life to the theory. She wrote:

“One must note that Autism is one of a number of children’s neurological disorders of psychogenic nature, i.e., caused by abusive and traumatic treatment of infants [...]. There is persistent denial by American society of the causes of damage to millions of children who are thus traumatized and brain damaged as a consequence of cruel treatment by parents who are otherwise too busy to love and care for their babies” (Tustin 1991).


Alice Miller, one of the best-known authors of the consequences of child abuse, has maintained that Autism is psychogenic, and that it is fear of the truth about child abuse the leitmotif of nearly all forms of autistic therapy known to her. When Miller visited several therapy centers for Autism in the United States, it became apparent to her that the stories of children “inspired fear in both doctors and mothers alike”:

"I spent a day observing what happened to the group. I also studied close-ups of children on video. What became clearer and clearer as the day went on was that all these children had a serious history of suffering behind them. This, however, was never referred to […]. In my conversations with the therapists and mothers, I inquired about the life stories of individual children. The facts confirmed my hunch. No one, however, was willing to take these facts seriously" (Miller 1991).


Like Arieti and Tustin, Miller believes that only empathetic parental attitudes lead to the complete blossoming of the child’s personality.


A book of Jay Joseph released in 2006 challenges the current genetic theory of Autism:

“Looking specifically at Autism, despite the near-unanimous opinion that it has an important genetic component, the evidence cited in support of this position is stunningly weak. It consists mainly of family studies, which cannot disentangle the potential influences of genes and environment, and four small methodologically flawed twin studies whose results can be explained by non-genetic factors. Not surprisingly, then, years of efforts to find ‘Autism genes’ have come up empty.” (Joseph 2006)


Despite the current genetic research on Autism and Autism-related conditions, the “refrigerator mother” theory, widely discarded in the United States, still has some support in Europe and is largely believed to be the cause of Autism in South Korea.


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The theory of the refrigerator mother was coined in the 1940s as a label for mothers of autistic children, and provides an excellent example of the need for rigorous objective research into all aspects of Autism, Asperger's and other Autism Spectrum Disorders