By the time Sigmund Freud died in 1939, psychoanalysis, the method he developed for the interpretation and therapeutic treatment of psychological disorders, had come to dominate the field of psychology and had far-reaching influence in the medical community at large. Psychoanalysis is based on the concept of the unconscious mind, and it focuses on emotional disturbance — usually the result of some early childhood experience of trauma — as the cause of psychological disorders, rather than organic factors in the brain or nervous system. Freud's work put particular emphasis on the first few years of life because he theorized that early childhood experiences were the root of unhealthy developments in the human mind. The legacy of psychoanalysis can be clearly traced in the early history of autism diagnosis and particularly the phenomenon of mother blame. Armed with their understanding of psychoanalytic theory, medical experts in the late 1940s to 1970s searched for emotional causes for autistic symptoms and identified the root of these symptoms to be the figure most dominant in children's early lives; their mothers.
In 1943, Leo Kanner, a Johns Hopkins University psychiatrist, identified autism as a distinct neurological condition. He named the syndrome Early Infantile Autism because it usually appeared sometime during the first three years of life. Before the 1940s, children who would now be called autistic were labeled emotionally disturbed, schizophrenic or psychotic. Kanner created the diagnostic criteria for autism under particular circumstances that help explain the origin of the "refrigerator mother" theory. Kanner had observed a small sampling of children from educated families typically from the academic community. Because of the limited size and selectiveness of his study, Kanner made an incorrect assumption that autistic children were more likely to be born to highly intellectual parents who were white and middle or upper class. Though Kanner thought the children's inability to relate to others was probably innate, he also stressed what he observed to be the cold, intellectual nature of their parents, especially their mothers. He is attributed with coining the term "refrigerator mother" to describe the mothering of autistic children as if from a refrigerator that didn't defrost. Coming from an early expert on autism, Kanner's focus on the dysfunctional mother-child relationship helped successive psychiatrists embrace a psychological cause for the disorder, and the "refrigerator mother" theory became the reigning psychiatric orthodox.
At the same time as Leo Kanner was developing his theories, Hans Asperger, an Austrian psychiatrist, was working to identify a similar disorder and to attribute a genetic cause for it. The symptoms Asperger identified in 1944 were closely related, but not identical, to Kanner's Early Infantile Autism. Asperger syndrome sufferers experienced the same difficulty with social interactions as autistic children, but had greater facility with language (often including remarkably large and highly-developed vocabularies) and an unusual grasp of highly technical knowledge. Asperger's work went virtually unrecognized until the 1970s, and Asperger syndrome was only recently recognized in the Diagnostic and Statistical Manual of Mental Disorders in 1994. Researchers today are still undecided on the relationship between Asperger syndrome and autism. Asperger himself believed that the two were distinct disorders, but many today emphasize the similarity between Asperger syndrome and high-functioning autism and consider them both to be autism spectrum disorders.
Bruno Bettelheim was a renowned University of Chicago professor and child-development specialist. From the late 1940s to the early 1970s he served as director of the Sonia Shankman Orthogenic School at the University, a residential treatment facility for children with behavioral disorders. Through his work at the Orthogenic School, Bettelheim built a reputation as a highly regarded specialist in the treatment of autistic children and an influential figure in promoting the "refrigerator mother" theory. Building upon Kanner's earlier work, Bettelheim declared that autism was an emotional disorder that developed in some children because of psychological harm brought upon them by their mothers. Substantiated by his own questionable case studies, Bettelheim's theories likened the lives of autistic children to the experience of prisoners in Nazi concentration camps, where he himself had spent ten months during WWII. He compared the parents, particularly mothers, of autistic children to Nazi guards. One of the factors that made the "refrigerator mother" theory particularly pernicious was the extent to which the theory was hyped through mainstream media, largely due to Bettleheim's charisma and public status. His books, among them The Empty Fortress: Infantile Autism and the Birth of the Self, were widely read by general readers who were attracted by his plain-spoken approach. He further popularized his theories on national prime-time television shows and in popular magazines.
Bernard Rimland, a parent of an autistic child and a research psychologist, was the first person to challenge the psychiatric orthodoxy about the cause of autism. Through his own methodical research Rimland came to believe that the "refrigerator mother" theory was founded on nothing more than circumstantial and anecdotal evidence. In his book Infantile Autism: The Syndrome and Its Implications for a Neural Theory of Behavior, published in 1964, Rimland questioned the theory that autism was the result of unloving parent-child relationships and presented the first solid argument that autism is a biological condition. Despite the publication of his book, Rimland didn't have the kind of media access and celebrity enjoyed by Bruno Bettelheim, so his work and theories went largely unnoticed by the general public. However, a growing number of parents of autistic children — many of whom had suffered under the mother-blame myth for years — began to hear about Rimland's work. In 1969, along with a small group of parents, Rimland founded the National Society for Autistic Children, now the Autism Society of America (ASA). Originally run out of the homes of volunteer parents, NSAC broke ground as a public voice for parents of autistic children who rejected the "refrigerator mother" myth. Rimland is also founder and director of the Autism Research Institute in San Diego, which serves as a data-collection center and information resource for parents of autistic children worldwide.
Richard Pollak is a journalist and author who grew up under the shadow of autism and mother blame in his own family. His younger brother Stephen attended Bettelheim's Orthogenic School in the late 1940s until he died in a freak accident. Year later, after a personal encounter with Bettelheim, Pollak discovered the damage that the "refrigerator mother" theory had caused in his own family, and he was motivated to learn more about Bettelheim. Pollak spent years painstakingly researching the life of Bruno Bettelheim and ultimately published the biography The Creation of Dr. B. in 1997. In the book, Pollak investigates Bettelheim's public persona, turning up evidence that Bettelheim had misconstrued his own life story, exaggerated and even invented his credentials and expertise on autism, abused the children under his care, terrorized parents, and popularized the destructive "refrigerator mother" theory without adequate proof.