Hello, and welcome back to The Autistic Writer. In the decades since autism was first pathologised and subjected to clinical scrutiny, there have been many theories about what causes autism, what it really is, and how it should be clinically approached.
Currently, a lot of the research is focused on genetics, and this has proven controversial, to say the least. Controversy has plagued autism research from the off. Sometimes it’s due to fraud, as in the Wakefield vaccine scandal. Sometimes, it’s much worse than that.
One of the most tragic examples of the damage that has been caused by misguided autism research and clinical practice is that of the so-called refrigerator mother theory. This effectively blamed autism on bad parenting, and triggered one of the biggest scandals in autism history. Unfortunately, its effects continue to echo down the years.
My Story
I was born in the middle of the last century; 1965 to be precise. As far as I know, no one where I came from had even heard of autism back then.
By anyone’s reckoning, I came from what could charitably have been called (to use the terminology of the time) a problem family. My father was absent more than he was around, and he was pretty much a stranger to me. We rarely had any money, and life was tough. There were all kinds of problems in my family home, and from the outside I guess that when I went off the rails in my early teens, people would have seen it coming. They would have assumed I was a “bad apple”, rather than an undiagnosed autistic kid struggling to cope with the world. Considering the frequent, prolonged absence of my father, people might even have blamed bad parenting for the way it looked like I was turning out. They would have been very wrong.
Despite all the problems I had as a child and teenager, I never lacked the love, warmth, and affection of my mother. She was the polar opposite of a refrigerator mother. And yet here I am; autistic.
What is the Refrigerator Mother Theory?
Refrigerator Mother Theory is an entirely discredited and abandoned theory in psychology that attributed the cause of autism to a lack of parental warmth and affection. In particular, it was considered to be a fault of the mother. The theory is largely associated with the 1950s and Bruno Bettelheim (1903-1990), an Austrian-American psychologist. But the story started before Bettelheim became involved, and it involved another Austrian-American: the psychiatrist Leo Kanner (1894-1981).
A note on terminology
For simplicity, this article uses the term refrigerator mother theory to describe the now-discredited belief that autism was caused by emotionally cold parenting. Although the phrase is widely used today, its exact origin is uncertain, and it is not known to have been used by the principal figures associated with the theory.
Psychiatry in the Early 1900s
Before autism was clinically recognised in the English-speaking world, psychiatric practice was heavily influenced by psychoanalysis. The main thrust of psychoanalytic theory at the time was that many psychiatric conditions were caused by childhood experiences. Parent-child relationships were thought to be a dominant factor in shaping personality, and mothers were often viewed as the primary source of childhood psychological disorders.
Sigmund Freud, the founder of psychoanalysis, never proposed a theory of autism, as autism had yet to be clinically identified, but his emphasis on early childhood relationships heavily influenced later clinicians.
The Emergence of Autism
It is often thought that the identification and study of autism as a psychological condition began with Leo Kanner and the publication of his seminal paper, Autistic Disturbances of Affective Contact, in 1943. It’s not quite that straightforward, however. The infamous Hans Asperger (1906-1980), another Austrian, developed an interest in children who had characteristics we would now call autistic from the early 1930s. He published a paper in 1944, but this was largely unknown in the English-speaking world and had little influence on autism research in the UK or the United States until Lorna Wing brought his work to light in the early 1980s.
In fact, the first formal work on autism had been carried out in the early 1920s by Ukrainian-Soviet paediatric psychiatrist Grunya Sukhareva. Despite being the first known clinician to publish a detailed description of what would now be recognised as autism, Sukhareva’s work had little or no influence on the development of autism research in Western Europe, the UK and the US. Whether because of language barriers, geopolitical divisions, publication practices, or simple academic oversight, her work was largely ignored by Western psychiatry for many decades. As a result, when Leo Kanner published his landmark paper in 1943, he was widely regarded as the discoverer of autism.
Leo Kanner
Leo Kanner was an Austrian-born American psychiatrist of Jewish background, who is widely regarded as one of the founders of child psychiatry. After studying medicine in Berlin, he emigrated to the United States in 1924 and later established the first child psychiatry service at Johns Hopkins Hospital in Baltimore.
Kanner’s 1943 paper, Autistic Disturbances of Affective Contact, was the first influential English-language paper pathologising autism as a distinct developmental condition. Many of his clinical observations remain recognisable today and laid the foundation for modern autism research.
In his study, Kanner described eleven children who appeared to share a distinctive developmental pattern.
Kanner observed that these children had profound difficulties forming ordinary social relationships from an early age. They often preferred to be alone, struggled with reciprocal social interaction, and appeared indifferent to other people. Many had delayed or unusual language development, including echolalia (repeating words or phrases) and literal use of language.
He also noted an intense desire for sameness. The children often became distressed by changes in routine or environment and showed repetitive behaviours and highly focused interests. Despite these difficulties, many demonstrated excellent rote memory or unusually advanced abilities in specific areas.
Kanner opened his paper with the following statement: “Since 1938, there have come to our attention a number of children whose condition differs so markedly and uniquely from anything reported so far, that each case merits – and, I hope, will eventually receive – a detailed consideration of its fascinating peculiarities.”
It is unclear how much, if anything, Kanner knew of the work of Grunya Sukhareva almost twenty years earlier, which contained strikingly similar descriptions of children we would now call autistic. In any case, he goes on to refer to the children in his study as forming “a unique ‘syndrome’, not heretofore reported.”
One of Kanner’s observations was that the characteristics he described in these children appeared to be present “from the beginning of life.” This suggests that he believed autism was an innate developmental condition rather than something acquired later in childhood.
However, in the 1943 paper, Kanner also devoted considerable attention to describing the children’s parents. He observed that many appeared highly intelligent, academically successful and – importantly – emotionally reserved. Although he did not explicitly conclude in this paper that these allegedly emotionally cold parental characteristics caused autism, his descriptions would later contribute to the development of refrigerator mother theory, and the tragedy that followed.
Refrigerated Children
The idea of cold parenting relating to autism became embedded in the public consciousness when, in 1948 Time magazine published the article, Medicine: Frosted Children. The following is a verbatim extract from that article, describing the parents of the autistic children in Kanner’s study:
The fathers were scientists, college professors, artists, clergymen, business executives, psychologists, psychiatrists. All but five of the mothers had gone to college; all but one had been active, before or after marriage, as scientists, laboratory technicians, physicians, nurses, librarians, artists.
Cold Perfectionists. But there was something wrong with all of them. They showed a “mechanization of human relationships,” described themselves and their spouses as undemonstrative. There was, Dr. Kanner found, “no glamor of romance in premarital courtship, no impetuousness in postnuptial mating.” He saw only one mother hug her child warmly and bring her face close to his; many of the busy fathers hardly knew their children.
“Cold perfectionists” appears to be Time’s own wording, as there is no published record of Kanner using that exact term. In any case, it is a provocative phrase, providing a snapshot that public opinion could focus on.
Following the publication of Autistic Disturbances of Affective Contact, in lectures and in an important 1949 paper, Kanner doubled down on his observations of allegedly cold parenting in relation to autism.
In the 1949 paper, Problems of Nosology and Psychodynamics of Early Infantile Autism, Kanner used a hugely provocative and damaging metaphor for the parenting of the autistic children in his study. It remains one of the most infamous statements in the history of autism. He said the autistic children in his study had been, “kept neatly in a refrigerator which did not defrost.”
Kanner’s refrigerator imagery extended from the children to the parents themselves. In a 1960 interview with Time magazine, he said they had “just happened to defrost enough to produce a child.”
Bizarrely, in 1969, Kanner publicly stated that parents of autistic children had been “unfairly incriminated,” although he never formally retracted his refrigerator comments. It is difficult to pin down exactly how Kanner believed cold parenting fitted into a causal paradigm of autism, considering he originally stated that autistic traits were present “from the beginning of life,” suggesting a congenital or genetic root. This sits uncomfortably with his later focus on cold parenting, which is further confused by the “unfairly incriminated” remark.
Bruno Bettelheim
There is a common narrative that suggests Bruno Bettelheim took Kanner’s ideas and expanded upon them to create his refrigerator mother theory. The truth is not that simple.
Bruno Bettelheim was born in Vienna in 1903, to a secular Jewish family. There is some historical disagreement over the details of his education. However, it is widely believed he studied, among other subjects, philosophy and introductory psychology at the University of Vienna, in two spells.
Following the Nazi annexation of Austria in 1938, Bettelheim was imprisoned in the Dachau and Buchenwald concentration camps. His harrowing experiences from this time were a major influence on his later theories. Bettelheim was one of the prisoners released from the concentration camps early due ot a so-called political amnesty, and he arrived in the United States in 1939. With refugee assistance from the Rockefeller Foundation, Bettelheim began a career at the University of Chicago.
It was at the University of Chicago that Bettelheim formulated his theory of autism in children. Heavily influenced by Freud, Bettelheim theorised that children with behavioural disorders acquired these conditions rather than being born with them. His central idea was that autistic children withdrew because of emotional rejection by their mothers. He even, controversially, drew on his life experience to compare autistic children to inmates at concentration camps – an approach that garnered much criticism.
The “Parentectomy”
In his 1967 book The Empty Fortress: Infantile Autism and the Birth of the Self, Bettelheim argued repeatedly that autistic children should be removed from their supposedly pathogenic family environment and treated in a therapeutic residential environment such as his own school. This approach later became widely known as “parentectomy”, although it is unclear whether Bettelheim himself coined that term.
How Families Were Persuaded to Separate
Although Bruno Bettelheim believed that autism was caused by emotionally cold, rejecting parents, there is little evidence that his theories led to the widespread forced removal of autistic children by social services. Instead, the process was usually medical rather than legal. Parents who sought help from psychiatrists were often told that their child’s autism resulted from the family environment and that the best hope of recovery was to remove the child from that supposedly harmful setting.
Trusting the advice of leading experts, many parents reluctantly consented to prolonged residential treatment, believing they were acting in their child’s best interests, and blamed themselves for this outcome. For many parents, agreeing to this separation was not an act of abandonment but one of desperate hope. They were persuaded that the greatest act of love they could show their child was to step out of their life.
Many of the removed children were admitted to specialist residential institutions, most notably the Sonia Shankman Orthogenic School at the University of Chicago, which Bettelheim directed. There, contact with parents was often deliberately restricted because Bettelheim believed continued family relationships could impede recovery. Although other institutions also adopted similar psychodynamic approaches, Bettelheim’s school became the best-known example.
The exact number of children separated from their families in these circumstances is unknown.
The emotional impact of the refrigerator mother theory extended far beyond those who entered residential care. Thousands of parents were made to believe they had caused their child’s autism, often carrying overwhelming guilt for years before biological research eventually discredited the theory.
In 2002, PBS/Kartemquin Films released the documentary Refrigerator Mothers. The film contained harrowing accounts from mothers of children who were taken away. One mother said, “I spent years thinking I had actively broken my own child’s mind.”
The lasting psychological harm inflicted on these families of autistic children who were institutionalised as a result of the refrigerator mother theory is widely regarded as one of the most damaging consequences of twentieth-century autism research.
Bernard Rimland
In 1956, Mark Rimland was born to Bernard and Gloria. Bernard was a newly qualified experimental psychologist. The Rimlands and their paediatrician noticed Mark was developing atypically. None of them at that point had ever heard of autism. Mark was diagnosed as autistic at around age two.
Shortly after, Bernard Rimland discovered the parent-blaming theories permeating paediatric psychology of autism at that time. Aware that his wife Gloria was a loving mother, Rimland rejected these theories, and began work on understanding autism in a different way.
“When I started my quest, autism was no less than an obsession. I quickly read everything I could find on the subject and hungered for more. This was war.” ~Bernard Rimland
In 1964, Rimland’s landmark book, Infantile Autism: The Syndrome and Its Implications for a Neural Theory of Behavior, was published. In the book, Rimland argued that autism was fundamentally a biological condition involving brain development rather than the consequence of emotionally cold parenting.
Despite having no modern genetic evidence (that would come later), Rimland scientifically argued that the parent-blaming paradigm was inconsistent with the available clinical evidence, and that a neurological explanation was more likely.
The Research and Evidence
During the 1970s, twin and family studies began to demonstrate that autism had a strong genetic component. Researchers studying autism in twins found that if one twin was autistic, the likelihood that the other was also autistic was much higher in identical twins than non-identical twins. It was also observed that autistic traits appeared more frequently among close relatives. These findings were difficult to reconcile with the refrigerator mother theory but were entirely consistent with inherited biological influences.
Throughout the 1980s and 1990s, advances in neuroscience and developmental psychology provided further evidence that autism reflected differences in early brain development rather than the effects of parenting.
By the late 1990s and early 2000s, molecular genetic research had identified numerous genes associated with autism. This research indicated that there is no single “autism gene” but rather a complex pattern of genetic influences.
Now, the scientific consensus has shifted decisively: autism is recognised as a neurodevelopmental difference with a strong genetic basis. The refrigerator mother theory has been comprehensively discredited.
The Legacy
Despite the fact that the refrigerator mother theory has been discredited, some scholars argue that its cultural legacy continues to shape how mothers of autistic children are perceived. Rather than disappearing entirely, the expectations placed on mothers have evolved.
In her 2011 paper From Refrigerator Mothers to Warrior-Heroes, sociologist Amy C. Sousa argued that the pressure on mothers has shifted from blame to relentless advocacy. Whereas mothers were once accused of causing their child’s autism, they are now often expected to become tireless campaigners, navigating healthcare, education and support services while advocating constantly on their child’s behalf.
Autism researcher Patty Douglas argues that although psychiatry no longer blames mothers for causing autism, society continues to hold them to exceptionally high standards.
Instead of asking whether a mother’s emotional coldness caused autism, today’s questions are more likely to be whether she sought diagnosis early enough, accessed the right therapies, or fought hard enough for support. In this view, the nature of the scrutiny has changed, but the pressure remains.
Modern psychological research also shows that parents of autistic children – particularly mothers – experience higher levels of guilt, anxiety and self-blame than many other parents. Researchers generally attribute this to the pressures of caregiving, social stigma and unrealistic societal expectations rather than to the historical refrigerator mother theory alone. Nevertheless, some scholars argue that the persistence of these expectations reflects the enduring cultural legacy of an era in which mothers were blamed for their children’s autism.
Some Personal Reflections
Kanner noted that many of the parents of the children he studied were socially reserved, intensely intellectual, and deeply focused on particular interests. These could be characteristics that, today, we might identify as those of autistic people who are largely masking their autism. Modern researchers have identified something called the broader autism phenotype; people with autistic traits who do not match the criteria for a diagnosis. I think this concept deserves some critical scrutiny, and I’ll return to it in a future article.
But for now, I’m spending a moment thinking about my deceased parents. My father was a deeply troubled man who never really fit in anywhere. He struggled to hold down a job, and to maintain relationships. He had addictions, and was an avid reader of books. I look back and see an undiagnosed autistic man who was out of his depth.
My mother, an intensely kind, warm, generous, and loving person, seemed to be instantly liked by anyone who met her, and yet somehow struggled to maintain relationships of all kinds. For a woman born in the north of England in 1925, she was incredibly nerdy, and was a huge fan of Star Trek and Stargate. As a child, I used to have long conversations with her about the possibility of alien life on other planets, and whether flying saucers were really alien spacecraft. These traits, with her bubbly interaction style, I think reflect an undiagnosed autistic woman who was masking intensively.
Is it unlikely that both my parents happened to be autistic? Not at all. Autistic people have a habit of drifting together, and it is not unknown today for parents of a newly-diagnosed child to both end up having assessments themselves.
So, you could say my mother was to “blame” – if you wanted to put it that way – for my autism. Not through a lack of love – there was plenty of that – but through meeting my father, and letting genetics take it course.
Final Thoughts
Although science has rejected the refrigerator mother theory, history reminds us how easily unsupported ideas can become accepted “truth” when reinforced by authority, media and public opinion. Its legacy is not only a discredited explanation of autism, but a cautionary tale about the human cost of blaming families before the evidence is in.
Historical Note:
After Bettelheim’s death, evidence emerged that suggested some of his academic credentials had been falsified or embellished. It is unclear to what extent, if any, this had an impact on his appointment to positions at the University of Chicago.
That’s all for this time. Take care.
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