6.2 The myth of ‘miracle’ cures
Over the years since Kanner's first description of autism, a number of practitioners have claimed, dramatically, that particular therapeutic procedures effectively amount to ‘cures’. To the parent or family of a person with autism, these approaches have understandable appeal, even if only on the principle of ‘try anything if it might help’. But careful scrutiny has invariably raised serious doubts about the claims, and has suggested that in some cases these approaches may be actively harmful.
The psychoanalyst Bettelheim described his approach in his book Empty fortress: infantile autism and the birth of self (Bettelheim, 1967). He maintained that cold and rejecting behaviour on the part of parents, and particularly mothers, was responsible for the ‘autistic withdrawal’ of their children. His ‘treatment’ involved separating children from their parents and caring for them in a special ‘therapeutic’ environment, designed along psychoanalytic lines. His book describes apparently dramatic improvements in the emotional adjustment, speech and behaviour of children treated in this way. However, the claims did not stand up to critical evaluation (Jordan, 1999; Rutter, 1999). Indeed, as Paradiz (2002) notes, Bettelheim probably exaggerated his credentials as an academic and psychoanalyst, and falsified his data. A visitor to the centre in the 1970s stated:
… there were locked doors everywhere – it is claimed ‘to keep the world out’ – and I caught only a brief glimpse of a pupil … For the first year the child is completely separated from his parents and after that only limited visiting is allowed – perhaps 2 or 3 times a year.
(Roth, Personal communication, 1976)
This procedure caused untold distress to parents, and the stigma and guilt that they experienced as the original ‘perpetrators’ of their children's problems lasted for many years. Several decades on it seems astonishing that involuntary separation of children from their families could be justified and implemented following one specialist's unconfirmed theoretical perspective.
Another controversial approach, introduced in the 1980s, was known as ‘holding therapy’. It was enthusiastically endorsed by the ethologist Tinbergen (Tinbergen and Tinbergen, 1983) and the clinical psychologist Richer (Richer, 1987). They believed that the origins of autism lie in profound anxiety that prevents children from establishing appropriate social bonds with parents and others. The therapy itself, pioneered by the psychiatrist Welch (1983), aimed at overcoming fear of emotional contact by close and sustained physical contact between the child and his/her mother, usually with the child sitting on the mother's lap and facing her. The role of the therapist was to help the mother initiate and maintain the hold, and to develop direct eye contact. As the child would typically find such close and prolonged contact disagreeable or frightening, considerable force was often needed to maintain it. Welch claimed some striking therapeutic successes in individual cases (Welch, 1983). But both parents and professionals have cast serious doubt on these claims and suggested that the procedure was actively harmful (Rutter, 1999). Hocking (1987) tried the technique with her son over a three year period:
After I stopped the therapy, it took me a long time before I could see the whole experience in perspective and was appalled by some of the things we had done … my son's response to our attempts to blast a way through his protective wall was to withdraw even further.
(Hocking, 1987, p. 15)
Such failures highlight the importance of establishing sound guidelines for evaluating proposed interventions.