Lost Children

The Empty Fortress

by Bruno Bettelheim
Free Press, 484 pp., $9.95

Professor Bettelheim is an authority on the capacity to survive extreme situations. His earlier book, The Informed Heart, which was mainly based on his personal experiences and observations while a prisoner in Dachau and Buchenwald, was largely an analysis of what decided whether a person lived or died in a concentration camp. In it he was concerned not so much with the physical capacity to survive brutality and torture as with the psychological factors determining whether a person will be able to resist demoralization in a setting in which he has ceased to be in any way a free agent—a setting, moreover, which is designed to reduce him to a nonentity and, indeed, has no wish that he should go on living.

This same preoccupation with the response of human beings to extreme situations which sap the will to live also pervades The Empty Fortress, an account of his therapeutic work with autistic children at the Chicago Orthogenic School. It is Professor Bettelheim’s thesis that these children have been brought up in families in which they have never been allowed to become themselves, and in which they knew, or rather sensed, perhaps from the very beginning of life, that their parents wished they did not exist. The empty fortress of the title is the psyche of such children, which he likens to a fortress designed to preserve the possibility of a self emerging in an environment that is felt to threaten its existence. Before considering Professor Bettelheim’s reasons for taking this view of the nature and origin of an illness which many psychiatrists believe to be organic, I should perhaps give a brief account of childhood psychosis and of infantile autism in particular.

Although childhood psychosis is a rarity compared to neurosis, its devastating effects both on the child himself and on his family, the therapeutic challenge it presents, and the possibility that it may provide fundamental evidence about emotional and intellectual development, combine to give it an importance out of all proportion to the number of children affected. Descriptive psychiatry recognizes four kinds of childhood psychosis: schizophrenia and manic-depressive psychosis, both of which replicate the adult diseases; the symbiotic psychosis first described by Mahler, in which the child remains in emotional contact with his mother but with her only; and infantile autism, in which the child makes contact with no one. Bettelheim himself would also include among the childhood psychoses infantile marasmus, the wasting away unto death which afflicts emotionally deprived children in institutions. These he likens to the “moslems” of the concentration camps, who resigned themselves fatalistically to the inevitability of death, and faded away.

AUTISTIC CHILDREN are often at first suspected of being deaf or mentally defective, but they do not look stupid nor does their ability to handle things support the idea of an inherent intellectual defect. Their most striking features are their “extreme autistic aloneness,” their self-sufficiency and their obsessive need to control the inanimate objects in their environment. They also display …

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