The following paragraphs were written for an editorial published by the Siberian Journal of Special Education in the early part of 2016. I asked the editor of the journal, Elena Chereneva, permission to reproduce the same in my blog. For those who want to read the original article, the same can be found at Researchgate (https://www.researchgate.net/publication/298424495_Leo_Kanner_the_Anti-Psychiatry_Movement_and_Neurodiversity). In part, my intent in writing the editorial was to give a broader perspective on the history of Neurodiversity than the one often cited in the literature (see for example the account offered by Silberman in his well-publicized account in Neurotribes). In addition, I found that Silberman’s view on Leo Kanner was extremely biased and I was hoping to correct the reader’s perception of this great man. Given the length of the editorial I have divided its content into 2 blogs. The first part was published a couple of weeks ago (https://corticalchauvinism.com/2017/07/26/the-historical-underpinnings-of-neurodiversity-part-i/).
The editorial was entitled: Leo Kanner, the Anti-Psychiatry Movement and Neurodiversity
The 1960’s were characterized by the emergence of the “New Left” in psychoanalysis when its implementation was seen as an uprising against the traditional ideas of society (Zarestsky, 2012). At that point in time psychoanalysis reigned over the way of thinking of medical professionals and Freudian verbiage became a fad within lay society. Causality was readily ascribed to parents, and they themselves were ready to accept blame if it could help establish a possible treatment and cure to their troubled children. Kanner was the first person to talk about refrigerator mothers for autistic individuals when mentioning how many of the parents in his series were strongly preoccupied with abstractions of a scientific, literary, or artistic nature. This opened the doors to medical charlatans like Bruno Bettelheim to dominate the lay literature with disturbing and false proclamations. In his book, The Empty Fortress (1967), Bettelheim provided a psychoanalytical study of different cases that made him suggest that autism resulted when mothers withheld their affection and failed to bond to their children. In this regard, he considered the worldview of autistic individuals as similar to what would have been attained in a concentration camp. The end result of these psychoanalytical ruminations made autistic individuals bear the brunt of ill-advised interventions leading to their isolation from loved ones and falling target to harsh interventions.
It really did not help that the psychoanalytical approach was followed by another movement heading in the opposite direction. This crude reaction turned away from the psyche in order to instigate the use of operant conditioning and thereby establish desired or targeted behaviors. The new approach, named behaviorism, was able to make accurate predictions and could be tested by rigorous scientific experiments. The major exponent of the method was Ivar Lovaas who used the principles of applied behavioral analysis (ABA) to train individuals in the comportment that he, or other therapists, considered normal. This early history into ABA was marred by the use of aversives and ultimately the dehumanization of the individual taught or trained by this method. Lovaas was keen on using physical methods to attract the attention of his patients, e.g., slapping the thigh, pulling the hair, or using an electric shock device known to some in the scientific community as the “mini-cattle prod”. He dissuaded doubts from his trainees as to the usefulness of these interventions by assuring them that they were punishing the behaviors, not the patients?! Fortunately, the use of aversives has been frowned upon during the last few decades and its present-day use is circumscribed to dangerous self-injurious behaviors like head banging. The use of licensure procedures for ABA therapists now allows families to raise disputes to regulatory agencies in an effort to prevent any abuse.
The flawed scientific thinking of some mental health professionals during the 1960’s lent the proper scenario for a valiant figure to stand up from the crowd in defense of both parents and autistic individuals. Bernard (Bernie) Rimland was the flag-bearer of a revolutionary movement advocating the existence of irrefutable medical evidence for an organic basis for ASD. Rimland was the father of an autistic individual and himself a psychologist with a penchant for research. Rimland aligned himself with Kanner and together tried to put an end to the reign of terror brought about by psychoanalysis.
In 1964 Rimland published a manifesto based on a large review of the literature where he debunked psychoanalytical ideologies thus helping parents assuage their grief. Rimland clearly pointed out evidence from twin studies indicating the hereditability of the condition, i.e., patients were born with the condition regardless of postnatal rearing. During his life Rimland was clearly the most ardent advocate for proper accommodations for autistic individuals, a fact that until recently was not acknowledged by members of the Neurodiversity movement. This willful neglect probably stems from Dr. Rimland’s writings where he acknowledged the disabling aspects of the condition, its comorbidities, and the need for more research and treatment interventions.
Rimland’s efforts brought him into a close alliance with Kanner, both exchanging adulatory remarks as to their individual efforts. In effect, both individuals opposed the psychoanalytical ruminations of their day with Kanner openly mocking Bettelheim’s efforts (Kanner, 1968). For patients requiring medical assistance Kanner valued an integrative approach tailored to the individual, not psychoanalysis, institutionalization or the application of operant conditioning. Kanner’s plea to help affected children and provide them with adequate accommodations was extremely humane and characteristic of him using his own journal (as an editor) to call into action all of those involved in the care of children to become their advocates, acknowledging that intervention at the earliest ages would help those children with difficulties stay out of mental hospitals and prisons.
Kanner, recognized the historical existence of individuals who fell into the spectrum. He lauded their gifts and called for parents and educators to help pave their creative potential while publicizing the dire downward spiral for those who did not receive proper support. Indeed, Kanner promoted the civil rights of the individuals to be themselves (a right to their identity regardless of medical appellations). In a certain sense Kanner can be considered the father of the civil rights movement for disabled individuals which is now attributed to the Neurodiversity movement:
“This is the place to retell the story of Willy. Willy was the scion of a noted scientist father and a college graduate mother. He was in good physical health; socio-economic conditions were satisfactory; his I.Q. was phenomenally high. He absorbed erudition like a sponge. Already in pre-adolescence he achieved national fame as a wondrous child prodigy. At 12 years, he delivered a much-admired lecture before a distinguished audience of university notables. No one seemed to notice that Willy had no companions, that he was bewildered, lonely, and miserable in a world in which the everyday pleasures of childhood were denied him. Oversaturated, Willy threw all his learning to the winds, rented a room in a large metropolis, and spent the rest of his life as an obscure office clerk. When he died at 48 years of age, all that he left behind was an album of transportation tokens, the collection and mounting of which had become his interest”(Kanner, 1971).
“In the last few millennia our species has had its gifted and productive thinkers and poets and artists and scientists and explorers. Many of them have advanced our civilization by upsetting deep-seated archaic notions guarded zealously and at times cruelly by mighty autocracies of one kind or another. We are now in a position to spot potential talents at an early age and have the laudable desire to see to it that as many as possible reach their optimum. We can do this only if, as they mature, we as parents, educators, and human engineers can pave their way toward the developments of unhampered automaticity. It is up to us, then, to attenuate the hampering agents, be they organic, emotional, or social, and to encourage rather than crush, spontaneity and self-organization”(Kanner, 1971).
“I wish I could say that the Willys, the Stevens, and the Jacks are exceedingly rare exceptions. But they are not. They are some of the casualties of the neglect of their right to their right identity, being given no opportunity to think and to plan for themselves, painfully reacting to the kind of upbringing which does not differ too much from computerization and carrying with them the unmitigated results of the disharmony of the integrants of personality”(Kanner, 1971).
A schism exists among those critical of present day efforts at treatment and cures in favor of accommodations. This movement had a historical precedent in the medical nihilism of the anti-psychiatry movement and the humanistic work of Leo Kanner. In effect, both sides of the argument were held by prominent psychiatrists whose efforts helped steer psychiatry into a more focused biomedical field. In the ensuing decades, the anti-Psychiatry movement did not become an anachronism but rather evolved into a call for a transfer of power from the medical profession to those who had socio-political power (Micale and Porter, 1994). In the end, Psychiatry did not need to be deconstructed but rather improved by the feedback of patients.
References
- Bettelheim B. The Empty Fortress: Infantile Autism and the Birth of the Self. Free Press, new edition, 1972.
- Kanner L. Infantile autism revisited. Psychiatry Digest 29(2):17-28, 1968.
- Kanner L. The integrative aspects of ability. Acta Paedopsychiatrica 38(5):134–44, 1971.
- Micale MS, Porter R. Discovering the History of Psychiatry. Oxford University Press; Oxford, 1994.
- Rimland B. Infantile Autism: The Syndrome and its Implications for a Neural Theory of Behaviors. Jessica Kingsley Pub, 2 edition, 2014.
- Szasz TS. The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. Harper Perennial, Anv edition, 2010.
- Zaretsky E. Psychoanalysis, authoritarianism, and the 1960s. In Damousi J and Plotkin B (eds) Psychoanalysis and Politics, Histories Under Conditions of Restricted Political Freedom. Oxford University Press:Oxford, 2012.