In October 1974, TF1, France's primary television network, aired a four-part documentary on Bruno Bettelheim and his work at the Orthogenic School at the University of Chicago. Directed by Daniel Karlin, Un autre regard de la folie (Another Look at Madness) shows the American educator working closely with both parents and children in the parlor of the school as part of his treatment of autistic children. Un regard intersperses footage of students’ lives at the residential school with an extended interview between Bettelheim and Karlin detailing how the former developed his methods. Over the course of three more episodes, the documentary provides an extended view of the daily routine at the school and students’ therapeutic regimen. Due to ongoing labor issues in French broadcasting, these documentaries were the primary programming available on television that month, airing on all three national networks to an audience of over three million viewers. The documentary appeared at a time when parents were searching for a viable alternative to the existing medical regimen of institutionalization that still defined French treatment for childhood psychosis. While the acceptance of psychoanalysis as an intervention for autism was already underway thanks to the efforts of child psychologists such as Maud Mannoni, Roger Gentis, and Rosine Lefort, Bettelheim popularized the notion of the affective disorder's psychogenic (rather than biological) origins located in the disturbance of relations between children and their mothers. Bettelheim's The Empty Fortress had been translated into French in 1969, but Un regard brought wider attention to his ideas and cultivated defenders and critics of his approach among French thinkers and parents fascinated by his conclusions.

These responses to the promise of Bettelheim's methods reveal the anxieties among French parents to find new treatments for their children as well as the growing divisions between the psychological and the psychoanalytic communities (neither of which Bettelheim was associated with in France) during the 1970s. In the early 1960s, parents of autistic children began advocating for reforms to the existing system that they believed was ineffective in treating their children. Bettelheim's claims of success fostered interest in his methods, although his conclusions were not without their detractors among the French. His conclusions echoed the intellectual sentiments concerning autism in France and solidified Bettelheim's influence in French understandings of autism. While his theories were increasingly discounted within the United States, as new approaches rooted in neuroscience and behavioral psychology eclipsed psychoanalysis there, his ideas became more influential within France, where psychoanalysis became the primary treatment for childhood psychosis. Bettelheim's acceptance in France underscores the divergence between these two medical communities during the 1970s. By then, autism was increasingly recognized in anglophone countries as a social disability rather than a form of psychosis, but in France this change did not occur. Psychoanalysis gained greater currency with the French thanks to its growing significance in the intellectual milieu of the 1960s and after, which contributed to the durability of Bettelheim's ideas. Even after his death in 1990, his influence was continually disparaged by parent associations seeking to convince French authorities of the validity of behavioral treatments prevalent in the United States but ignored in France. In the rhetoric of these associations, Bettelheim represented the failings of the psychoanalytic approach not only in treating autism effectively but also by exacerbating the emotional problems the disorder created for the families of autistic children.

Equally pertinent is Bettelheim's emphasis on the role of mothers in autism, which shared existing assumptions and anxieties about motherhood that were pronounced in the postwar period in France. The blaming of mothers for a variety of social ills dovetailed with Bettelheim's conclusions about the role of mothers in their children's psychoses, making France a fertile ground for his ideas to germinate and thrive. Bettelheim believed that the behavior of parents, but especially mothers, was the source of autistic behavior. Other thinkers shared his conclusion, but Bettelheim offered a simple and direct explanation of what mothers did to cause autism that at once echoed the language of psychoanalysis and spoke in a more direct way. The broken relationship between mothers and autistic children was largely accepted as the explanation for autistic behavior, which helped solidify the relevance of Bettelheim in the autism debates of the 1980s and 1990s as an important symbolic figure in the struggle between parents and analysts concerning psychoanalysis, and underscores why his ideas persisted in France.

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The history of autism has always had an international dimension, but prior to the 1970s it followed a similar trajectory in France as it had in other Western nations in terms of definitions and treatment. Autism was not understood as a distinct disorder, but thinkers such as Jean-Marc Gaspard Itard and Éduard Séguin were pioneers in recognizing the specific experiences of enfants sauvages in the early nineteenth century, most famously in Itard's chronicling of the life of the Wild Boy of Aveyron.Footnote ¹ The asylum system that developed in France helped to establish research into the behaviors of feral children and idiot savants by concentrating populations and professionalizing psychology in the late nineteenth century. The work of Pinel, Charcot, and Janet, among others, led to new forms of mental cartography that shaped understanding of abnormal psychology through taxonomies of classification which helped to define abnormal behaviors and their origins.Footnote ² In 1911, Swiss psychologist Eugen Bleuler initially recognized autism as a specific mode of thinking, postulating it as an expression of excessive fantasy that caused children to retreat into an inner world. French psychologist Eugène Minkowski referenced the work of Bleuler (under whom he had studied) in his La schizophrénie (1927), but offered a different interpretation concerning autism. For Minkowski, autism was a deficit of interaction with the outside world based on a possible defense mechanism, which Adam Feinstein sees as an early example of the French acceptance of a psychoanalytic model.Footnote ³ The discovery of childhood schizophrenia was at the foundation of the conception of autism and was particularly resonant in the development of child psychology in the 1920s and 1930s, culminating in Leo Kanner's classification of infantile autism in 1943 and Hans Asperger's recognition of autistic pathology in 1944. However, at this point the French path remained within the orbit of other interpretations within the Western world that saw institutionalization as the sole form of treatment since much of this work developed out of an international exchange of ideas.

Histories of autism have tended to focus on the efforts of child psychologists to treat children, and were primarily written by and for the psychologists themselves.Footnote ⁴ Much of this scholarship stresses the importance of research discoveries in the anglophone world rather than the experiences of autists, although a corpus of biographic literature had developed alongside it by the end of the 1960s.Footnote ⁵ Scholars of autism have recently come to recognize the importance of social context in shaping the meaning and understanding of autism, including variations of cultural understandings of disability and the origin of concepts that defined autism within the history of eugenics and Nazism.Footnote ⁶ Current scholarship emphasizes both the social construction of autism tied to changes in government policy and child psychology and the lack of consensus within the medical community concerning its origins.Footnote ⁷ Also, a second vector of scholarship examines the growing awareness and acceptance of autism within anglophone societies, especially in light of the work of autists themselves to assert their rights, which links autism studies with other disability studies scholarship.Footnote ⁸ However, many of these changes did not take place in France despite the intellectual connections between France and the international community. Roy Richard Grinker asserts that local culture affects the definition of autism, which helps explain France's divergence from the anglophone world.Footnote ⁹ While autism was more commonly diagnosed as a developmental disorder in the latter, it remained defined as a form of infantile psychosis in the former. The importance of psychoanalysis in France is pivotal to understanding how it influenced the treatment of autism there and how Bettelheim came to signify the confluence between the two.

Bruno Bettelheim began his work on autism in the early 1950s at the Orthogenic School for Disturbed Children at the University of Chicago. His tenure remains one of continued controversy, intensifying after his death with allegations of physical abuse and doctored statistics concerning his success in “curing” autistic patients.Footnote ¹⁰ He nevertheless was a towering personality whose works demanded national attention in the United States and reached a broad readership through both his acclaimed child-rearing books and his regular contributions to popular magazines such as Ladies Home Journal, Redbook, and Good Housekeeping, not to mention his award-winning work on fairy tales.Footnote ¹¹ His work at the school reinforced his conclusions concerning the nature and treatment of autism, and the success of The Empty Fortress popularized these conclusions through his dramatic narration of three celebrated cases and his ability to reach these autistic children and cure them. Operating from a framework developed from his interpretation of Freudian psychoanalysis, Bettelheim drew upon Kanner's work that underscored the emotional distance exhibited among the mothers of autistics, crystalized in Kanner's unfortunate phrase “refrigerator mothers.”Footnote ¹² The refrigerator mother was a figure who was emotionally detached and unavailable to her children, creating an emotional disturbance that Kanner initially linked to the behavior in the autistic children he saw in his clinic. The psychological character of the refrigerator mother spoke to the assumptions concerning the fundamental nature of the mother–child relationship in postwar psychology and the impact of transgressions within the nurturing aspects of that relationship.Footnote ¹³

Bettelheim coupled this idea with his own observations based on his experiences in a concentration camp in Austria in 1938. As a Jewish socialist, Bettelheim came under political suspicion following the Anschluss and was briefly detained at camps in Dachau and Buchenwald until 1939, afterwards immigrating to the United States. He observed how his fellow inmates reacted to the situation, postulating the impact of what he termed “extreme situations” on the psychology of individuals. One of his main conclusions was that external traumas inflicted in the concentration camp caused a personality change in the inmates, leading to a regression in their behavior to a more childlike and docile state.Footnote ¹⁴

Bettelheim theorized that a similar form of psychological trauma within the family, typically centered on the breakdown of maternal relations, was the genesis of childhood schizophrenia (autism), echoing Minkowski's earlier assertion of a deliberate withdrawal. The autistic child's rejection of society was a response to the emotional brutality of her maternal (or in rarer cases paternal) relationship (either intentional or otherwise), and thus autism was a manifestation of a defensive response to perceived emotional violence within the family, which Bettelheim curtly interpreted as the parents’ wish that the child did not exist.Footnote ¹⁵ Bettelheim believed that the removal of autistics from their destructive families would begin the healing process and allow them to interact with a less threatening and fearful environment. This intervention would draw them back into engaging with the world and allow for their eventual integration into society through the emotional modeling of proper behavior and the healing power of genuine care and acceptance. He was not alone in his conclusions, as many other psychologists at that time shared a perception of autism as a psychogenic disorder of the self.Footnote ¹⁶ And yet in The Empty Fortress, Bettelheim's techniques and conclusions largely stem from the application of his personal experiences prior to the beginning of World War II in concentration camps—and his conclusions about the disintegration of the self within that environment—rather than from an engagement with the literature of the larger psychological community.

A translation, La forteresse vide: L'autisme infantile et la naissance du soi, appeared in 1969 as part of the publishing house Gallimard's collection Connaissance de l'inconscient. The collection included translations of several thinkers in psychoanalysis, including Melanie Klein and D. W. Winnicott, as well as new translations of Sigmund Freud's work for French audiences. La forteresse was Bettelheim's first French translation, but it did not at first draw the same broad interest in France as it had in the United States, where it was hailed as a definitive statement on the nature and treatment of autism.Footnote ¹⁷ In the introduction, translator Roland Humery emphasized the importance of Bettelheim's life experiences, both his time in Vienna (which was the basis of his expertise in psychoanalysis—a claim later refuted by Bettelheim's critics) and his internment at Dachau and Buchenwald before the outbreak of World War II. Humery spoke of the air of authority that Bettelheim's observations during his incarceration granted him and how his insights were integrated into his approach at the Orthogenic School. In his summation of Bettelheim's main argument, Humery emphasized the connection between autistics and the “musulmans” of the concentration camp, the validity of which was rooted in Bettelheim's experiences.Footnote ¹⁸ In The Empty Fortress, Bettelheim describes such prisoners in the camps who experience the death of all hope as exhibiting “moslem” behavior, in which all contact with the external environment is extinguished and a death wish was expressed.Footnote ¹⁹ He likened the behavior of autistic children to this population within the camp. Humery also notes the importance of removing the children from these situations as the most effective part of Bettelheim's treatment to draw these children out of their isolation, which echoed existing practices in France concerning the institutionalization of mentally disabled children.

Bettelheim claimed to organize the Orthogenic School as a type of anti-concentration camp to establish a more open and inclusive environment that would shelter troubled children from the anxieties they had experienced within the home or within institutions. This approach required that children be separated from their parents, reinforcing the notion of parental blame even as Bettelheim attempted to deflect his critics from this conclusion. Inside the school, the children (although some of his charges had reached the age of adulthood) were free to explore their interests. At the heart of his clinic's organization was Bettelheim's belief in the healing notion of segregation to treat “ego deficits.”Footnote ²⁰ Bettelheim's methods within the school weakly echoed methods developed within the practice of institutional psychotherapy, pioneered in the 1950s in France by Jean Oury at La Borde. Institutional psychotherapy developed as a method to reform the asylum system, which observers feared had become similar to concentration camps in its operation and echoed Bettelheim's language concerning the experiences of autists. Oury posited the benefits of a collective approach to therapy that emphasized openness and freedom, exemplified by his work at La Borde during the 1950s.Footnote ²¹ Other French thinkers, such as Félix Guattari (who worked with Oury at La Borde) and Michel Foucault, had already noted the similarities between the concentration camp and the asylum and advocated for more humane forms of treatment, again revealing a fertile cultural context in which Bettelheim's ideas could flourish.Footnote ²² Milieu therapy as practiced at the Orthogenic School had some collective elements in treatments that would sound familiar to French thinkers—mainly that students were grouped together to foster social interaction—but the school maintained the hierarchical structure of most health institutions of the era that distanced it from the more inclusive nature of institutional psychotherapy. Bettelheim's ideas, then, resembled treatments and concepts that had already developed in France.

Upon its publication in France, La forteresse vide generated a positive response among reviewers that focused on Bettelheim's link between extreme situations and autism, and observers also often praised his analysis and emphasized its psychoanalytic tone. In an extended review in Esprit, Gennie Luccioni noted how the validity of the psychoanalytic model had already been shown to be “extraordinarily fruitful,” observing further that Bettelheim's work provided three powerful cases to illustrate the therapeutic success of his approach.Footnote ²³ Similarly, Jean-Michel Palmer of Le Monde praised the work as historic within the history of psychoanalysis, again focusing on the case of Joey, the Machine-Boy, Bettelheim's most celebrated case, which had already appeared as an excerpt in Le nouvel observateur earlier that year.Footnote ²⁴ Reviewers placed La forteresse vide in the context of emerging psychoanalytic works of the 1960s that had found a broader audience, while at the same time noting that Bettelheim's work lacked the theoretical sophistication of thinkers such as Jacques Lacan, D. W. Winnicott, and Melanie Klein.

The tenor of Bettelheim's work connected with French audiences thanks to the growing general interest in psychoanalytic culture there after 1968. Sherry Turkle notes the transformation of the French intellectual milieu during the 1970s, characterized by the broader acceptance of psychoanalysis as a popular method of self-evaluation. Prior to the 1960s, psychoanalysis was commonly understood as a weaker formulation of other psychological theories common among French psychologists. The new popularity of psychoanalysis in France reflected the powerful influence of Jacques Lacan in reformulating Freud's ideas in a manner that was more welcome among French thinkers and audiences, despite (or perhaps because of) his rather prickly persona, in essence “making Freud French.”Footnote ²⁵ Psychoanalysis not only became more intellectually acceptable but also was seen a valuable counter to the entrenched medical community as a form of social critique. As Dagmar Herzog has observed, elements of Freudian psychoanalysis cathected with radical social theories to question existing norms as thinkers followed Lacan's lead to embrace elements of Freud while at the same time reimagining their meaning in new philosophical contexts.Footnote ²⁶ Lacan's reconceptualization of Freudian thought proved popular beyond the boundaries of the psychological community, exemplified in the popular interest in his famed lectures and the influential reach of his publications. The increased circulation of Lacan's ideas fostered a broader acceptance of psychoanalysis in France, as the number of analysts increased dramatically thanks to its newfound appeal.Footnote ²⁷

Moreover, intellectuals and analysts inspired by Lacan led a movement against institutionalization beginning in the mid-1960s, focused in particular on the treatment of children in French institutions. Institutionalization had been the primary response in the national system despite the efforts of parents advocating the merits of special education, in-home treatment, and mainstreaming. This antipsychiatry movement had begun in Italy in 1962 as a correction to the linking of the psychiatry profession and the carceral power of the state, but then developed into a questioning of the assumptions of psychiatry and notions of madness during the 1960s, often with an emphasis on ending institutionalization. As a political and medical movement, antipsychiatry found many French adherents within the growing psychoanalytic community, especially given Lacan's critical stance against the facile medicalization of psychology (a viewpoint shared by Bettelheim), especially the form of ego psychology associated with American psychoanalysis. Antipsychiatry could also be critical of psychoanalysis, but it nevertheless found inspiration in the language of Freud in its efforts to transform the social meaning of mental illness.Footnote ²⁸ Although the antipsychiatry movement pre-dated the student protests of May 1968, many adherents were energized by the students’ challenge to the political order and positioned psychoanalysis as a method of social and cultural reform, both within the discipline and in society at large.Footnote ²⁹ Within the French psychological community there had long been a reform movement calling for a new framework of treatment.Footnote ³⁰ Among French analysts, antipsychiatry became a discourse to challenge the prevailing system of asylums that housed and treated the majority of enfants inadaptées. Deinstitutionalization was one of the goals of the antipsychiatry movement, as asylums served as an example of the disciplinary power of the state and as incubators of “institutional neurosis.”Footnote ³¹ Lacanian analysts postulated a new type of clinic that would instead integrate the treatment of children with the cooperation and participation of parents (sometimes as part of the child's analysis) as a method of recognizing the personhood of these children who had otherwise been sentenced to a life solely within the institution. Bettelheim advocated much the same in The Empty Fortress. By the mid-1970s, psychoanalysis had become accepted as a viable alternative to therapeutic practice not only within the psychological community but also within the medical community at large, giving Bettelheim's conclusions the potential for greater resonance in France.Footnote ³²

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A number of Lacanian pioneers had already published books on their treatment of autistic children by the 1960s, most notably Maud Mannoni and Rosine Lefort, which established a fertile environment for many of Bettelheim's conclusions about the role of mothers in the disorder. These psychoanalysts applied many of Lacan's insights into the field of child psychology to develop therapies to treat enfants inadaptées. Reflecting on the implication of Lacan's conceptions of the mirror stage, the desire of the mother, and the law of the father in child psychology, these analysts emphasized the importance of mothers separating from their children as a critical part of the process of maturation of the self, the failure of which had led to autistic behavior. This process was basically a reconceptualization of the “refrigerator mother” thesis. In their works on the psychoanalysis of children, both Mannoni and Lefort noted how a central part of their treatment regimen was the removal of the child from the destructive nature of the home environment that was defined by the mother's desire for an “imaginary child.” Mannoni had conceptualized that the discursive potential of autistics was thwarted by their mothers’ inability to allow the child to speak. Bettelheim approached patients in a similar manner and combined elements of psychoanalytic thought with his own ideas of the need for troubled children to find their own path, allowing him to embrace a middle ground between the more rigid scientific notions of ego psychology in the United States and the emerging philosophical character of psychoanalysis in France. This middle ground contributed to his success in the United States and undoubtedly resonated among French parents looking for a possible cure for their children.Footnote ³³ Moreover, Bettelheim's work spoke to the sense of individual hope that was a central part of the antipsychiatry movement, and Bettelheim echoed that philosophical milieu in his attention to the environmental and social origins of childhood psychosis.Footnote ³⁴ Fundamentally, French psychoanalysts agreed with Bettelheim's assessments and assured parents that their autistic children had a rich internal life and that through treatment would ultimately (re)engage with the world. What Bettelheim offered in his publications was ultimately Freud without Freud, a set of ideas that vaguely spoke in the language of psychoanalysis without the real connection to Freudian theory that defined so much of the work done in the wake of Lacan that purported a high degree of success.

Bettelheim's publications had led some French child-care specialists to explore his ideas further and become his ambassadors in France. A notable example was Geneviève Jurgensen, a young speech therapist from Paris who worked at the Orthogenic School between 1970 and 1972. Jurgensen emphasized that her reading of La forteresse was instrumental in her decision to travel to Chicago in 1970 and study under Bettelheim. Her memoir of her time there, La folie des autres, recounted her experiences in Bettelheim's classes, noting how psychoanalysis had been alien to her and something that had been the object of derision in France after being introduced to it in her coursework.Footnote ³⁵ At the Orthogenic School she was responsible for the care of five young women, who exhibited various levels of behavioral challenges. Jurgensen initially felt frustration that she was more of a babysitter than a therapist, as much of her time was spent ensuring that the children completed day-to-day tasks, and had little understanding of how Bettelheim's methods were implemented.Footnote ³⁶

Bettelheim modeled much of his approach on the idea of play and encouraging children to explore through play, to develop their fantasy life, which he saw as a deficit thanks to the harmful environment of the home. Bettelheim was often unclear about a distinct method but rather emphasized the need for his young charges to find their own path to healing once they felt safe within the school. However, Jurgensen balanced her struggles in continuing to work at the Orthogenic School with her perception of his success in creating an environment in which she perceived these children were happy and allowed to be themselves rather than having to adapt to the outside world.Footnote ³⁷ Her experiences confirmed for her the efficacy of what Bettelheim had outlined in The Empty Fortress. When she informed her mentor of her impending return to France, he suggested she contact Serge Lebovici, a leading proponent of psychoanalysis whom Bettelheim knew from the Sammy case, a famous case of a French autist that first brought the two in contact in the 1960s.Footnote ³⁸

The Association au service des inadaptés ayant des troubles de la personalité (ASITP), a group of about five thousand families interested in the treatment of autism, reached out to Jurgensen on her return to France to find out more about her experiences at the Orthogenic School and their possible application in France. She provided a summary of her work as well as pointing out some further conclusions that she developed upon reflecting on her time in Chicago: “It is useful for the [autistic] child to not be endlessly confronted with the reality of his parents because the more autistic children report that this leads to the distancing between themselves and reality.”Footnote ³⁹ She directed interested parents to follow up by reading The Empty Fortress themselves to understand his interpretations more fully while at the same time contextualizing his work by comparing it with that of Françoise Dolto, a French child psychoanalyst and popular child-care expert who emphasized the importance of play as a form of treatment. Jurgensen helped connect French parents with the work of Bettelheim to introduce them to his interpretations of Freudian dynamics within the family in the instances of autism.

By the middle of the decade, French interest in Freud had reached a pinnacle in France, and psychoanalysts had propagated throughout various institutions with only minor conflict between themselves. Some, such as Lebovici, were interested in linking psychoanalysis with neuroscience in France while simultaneously recognizing the influence of Lacan.Footnote ⁴⁰ Lebovici was much closer in his interpretation of psychoanalysis to the emerging medicalized, American perspective than to the more antipsychiatry approach of the French analysts but nevertheless saw significant benefits to psychotherapy. As a leader in the French psychological community, Lebovici observed the growing influence of psychoanalysis in children's psychology and noted its worth in discussing vital childhood issues. However, solidarity among psychoanalysts was waning and ephemeral at best, and this division certainly provided an opening for Bettelheim's work, since it was not aligned with any particular faction of the community, and spoke to a philosophical version of psychoanalysis that found greater support among the French.Footnote ⁴¹ Much of this discussion about the relevance and effectiveness of psychoanalysis occurred within the smaller professional psychological community and parents’ groups until Un regard brought the issue of autism to an audience of millions.

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The documentary advocated for the validity of a clinical form of psychoanalysis as an effective treatment for mentally disabled children. Similar to Jugensen, director Daniel Karlin was drawn to Bettelheim based on his encounter with The Empty Fortress. In 1972, Karlin completed a documentary on a French primary school and became more specifically interested in the experiences of disabled children within the educational system. He found Bettelheim's work through a neurologist friend, and was mesmerized by it. Familiar with Lacan, Karlin noted how Bettelheim avoided the esoteric nature of Lacanian psychoanalysis in favor of a more direct, pragmatic approach.Footnote ⁴² About a year later, Karlin reached out to Bettelheim in the hopes of getting permission to film at the Orthogenic School, but Bettelheim had retired by this point. Nevertheless, the two engaged in a discussion that led to Karlin visiting the school in April 1974. Much like Jurgensen, he was amazed at the operation of the school and the implementation of Bettelheim's ideas there; he hoped that his documentary would lead to reform in France. Karlin's efforts to draw greater attention to Bettelheim's work amplified his influence among French audiences, especially in his understanding of autism as a form of psychosis in response to negative parenting.

The long interviews between Bettelheim and Karlin, alongside footage of life at the school (including interviews with educators and students), presented the Orthogenic School as a successful example of how to reform the existing interventions. Bettelheim began the interview with a critique of institutionalization, positing that his students who were abandoned within the American psychiatric system as incurable had found their way to mental health in the environment of his school.Footnote ⁴³ Karlin's advocacy of Bettelheim's methods was apparent in his interviews with the students; for example, in the footage with Eliane, she notes that she is happy that the documentary is being made so that “the people of France realize, realize that here or in France, those who are mentally challenged are not also nutcases.”Footnote ⁴⁴ Karlin, however, was concerned that French audiences would not understand the importance of Bettelheim's message, as he recounted anecdotal encounters with people who expressed some misunderstanding of his intentions. For Karlin, these encounters spoke to the entrenched public attitudes concerning the mentally ill despite the recent legal efforts to protect the rights of marginalized children.Footnote ⁴⁵

Following its broadcast, a number of French psychologists, analysts, and educators reacted to the ideas presented, offering support, clarification, or criticism without a clear consensus on the validity of his ideas as well as his credentials as “a great philosopher and child analyst.”Footnote ⁴⁶ The medical and psychological debate that ensued over the implications of Bettelheim's work in the context of France reveals how French medicine had to respond to his claims and how various constituencies demarcated their differences from Bettelheim. As a result, he became an intellectual flashpoint for the public discussion of autism in the 1970s. Bettelheim inserted himself into the debate with a series of trips to France to present at conferences to articulate and defend his positions and observations, and more of his books were translated into French.Footnote ⁴⁷ In their reactions to his work, parents, doctors, psychoanalysts, and proponents of special education found fault in his approaches and used the immediacy of the moment to articulate their own interpretations and the value of their ideas.

In the pages of Épanouir—the newsletter of the Union nationale des associations de parents et amis de personnes handicapées mentales (UNAPEI), an umbrella organization for numerous parents’ associations throughout France—the Bettelheim documentary drew immediate attention, especially for its role in bringing awareness of autism to the general public. While laying out some of the reactions of medical and psychiatry experts in general, Épanouir offered a detailed response from Dr Robert Lecuyer, the association's resident medical expert, who found the general tenor and presentation of the documentary favorable and optimistic but certainly lacking some clarity of method and treatment.Footnote ⁴⁸ Épanouir also included a statement from the ASITP, which emphasized how parents had been ostracized publicly due to the documentary's oversimplifications of the causes of autism. In addition, the statement questioned whether some of the children presented were actually autistic (a criticism of Bettelheim's work that arose in the United States as well). These parents engaged with his ideas and some were willing to accept that psychoanalysis was a possible method of treatment, despite the limited success they had experienced so far. However, most parents rejected the psychogenic thesis as not useful in helping autistic children, which they were already aware of through their readings of The Empty Fortress and their discussions with Jurgensen. While the parents of the ASITP recognized Bettelheim's passion for helping mentally disabled children, they feared his conclusions and their potential effects on French viewers’ understanding of how autism should be treated.Footnote ⁴⁹

While parents attempted to remain open to some of the documentary's conclusions, one of Bettelheim's most vocal French critics, the pediatrician and director of the Necker Enfants-malades de Paris hospital Pierre Debray-Ritzen, completely rejected psychoanalysis as a form of treatment. In an interview with the journal Éléments shortly after Un regard aired, Debray-Ritzer criticized French television for dedicating over four hours to the work of Bettelheim without offering any other viewpoint concerning the current state of child psychiatry in France. He repeated similar criticism in Le Figaro, calling Bettelheim fraudulent in his diagnoses of his students.Footnote ⁵⁰ When asked to explain his position, Debray-Ritzer launched into a deeper condemnation of psychoanalysis, noted it exhibited “an extraordinary naiveté … envisioning itself as having definitely established its position and refusing to debate [it] with other schools of thought. Because it is necessary to remember that Bettelheim is neither a doctor nor a psychiatrist: he is a psychoanalyst. His lack of scientific rigor is quite apparent in his book.”Footnote ⁵¹ Debray-Ritzen was an outspoken critic of the antipsychiatry movement and of what he perceived as its negative effect on the treatment of mentally disabled children, and asserted that the antiscientific nature of psychoanalysis fostered an atmosphere in France that allowed for the easy digestion of charlatan ideas such as Bettelheim's that offered easy explanations. Autism “is a very complete childhood illness that completely cuts the child off from the world. Psychiatry has acknowledged its relative ignorance [concerning it]. Bettelheim claims that this illness is the product of psycho-affective factors as do all psychoanalysts.”Footnote ⁵² Debray-Ritzen rooted his criticism in belief in the importance of experimental rigor (which he equated with the biological sciences) in developing effective methods to help children. For him, the “spirit of 1968,” which he equated with the increased fascination with psychoanalysis, fostered a criticism of science that was accompanied by its own “superstitions” of Freudianism, exemplified in Bettelheim's conclusions.Footnote ⁵³

While more vitriolic in his rhetoric, Debray-Ritzen echoes similar critiques leveled at Bettelheim within the American psychological community, especially those of Bernard Rimland, who began his research on autism during the 1960s. Rimland questioned Bettelheim's emphasis on psychogenic factors and was more interested in exploring biological rationales; in The Empty Fortress, Bettelheim makes a brief engagement with Rimland's work only to dismiss it.Footnote ⁵⁴ Rimland's view of autism's biogenic origins would eventually become widely accepted as the scientifically valid understanding of autism as a developmental disorder, counter to Bettelheim's psychogenic view. Rimland spent much of the 1960s collecting information about research on autism and sought to follow up on Bettelheim's successful cases. Bettelheim rebuffed Rimland's efforts.Footnote ⁵⁵ He in turn challenged Bettelheim's conclusions. The disagreement between Debray-Ritzen and Bettelheim fell along similar fault lines—biomedical science versus psychoanalytic theory—that have defined much of the conflict of interpretation of autism in the West.Footnote ⁵⁶ In the United States, Bettelheim's influence declined in the 1970s, thanks in large part to a chorus of dissenting voices like Rimland's.

While there was dissent in France, it was divided. In a special aired on 17 October 1974 on the French television channel TF1, five specialists (including Debray-Ritzen) gathered to react to Karlin's film, each offering their own views on autism and treatment. Debray-Ritzen reiterated his belief in a genetic basis for the disorder, while others such as psychoanalyst Maud Mannoni and child psychiatrist Roger Mises were more muted in their positions on Bettelheim's conclusions.Footnote ⁵⁷ Debray-Ritzen's emphasis on the unscientific nature of Bettelheim, however, revealed a sharp divide in the conception of psychoanalysis in the French context. Rejecting the more medicalized version of American psychoanalysis, French psychoanalysis embraced its philosophical nature following Lacan's invocation of structuralism and his rejection of the determinism of ego psychology. Nevertheless, even medical professionals found some value in Bettelheim's work. For example, Le nouvel observateur medical columnist Norbert Bensaid took a more nuanced stance in outlining Debray-Ritzen's critiques of Bettelheim. Bensaid did not fully agree with Debray-Ritzen, since, he argued, that would mean that psychosis and autism are incurable (again, reiterating the disagreement over the disease model). Nevertheless, he worried that the documentary would provide false hope for parents who could not possibly afford therapies of the type shown at the Orthogenic School.Footnote ⁵⁸ Besaid's concerns also pointed to the issues of public health and the French system's neglect in addressing the care of disabled children.

Another example of a tempered response was that of Alfred and Françoise Brauner, founders of the Externat médico-pédagogique de Saint-Mandé and advocates for disabled children and their parents. At their clinic, the Brauners practiced various forms of special education, including art therapy, to try to assist the children in their care, and found some common ground with the psychoanalysts. Years later, they recalled the impact of the documentary on parents in France and how it articulated the ideal of psychoanalysis as a cure for autism. The Brauners noted that the apparent efficacy of treatment at the Orthogenic School made Bettelheim a divisive figure concerning the nature of his work, especially as it was hard to replicate.Footnote ⁵⁹ As two groups developed, a bioscientific community and a psychoanalytic community, the middle ground that the Brauners occupied became smaller and smaller even as social awareness of autism became more prominent in France. Certainly, the broadcast of Un regard was partly responsible for the increased cultural prominence of autism, even if this was a product of the media debates that ensued which polarized the antipsychiatry movement's rejection of established medical approaches and the medical community's critique of the logic of psychoanalysis. The Brauners would later reflect on the continued power of the documentary to define the debate, even as they became more critical of Bettelheim's work by the 1980s.Footnote ⁶⁰ By that point, Bettelheim was positioned as a central figure in the understanding of autism in France and his idea about the responsibility of the parents was one of the broadly accepted interpretations of the disorder, revealing the growing strength of psychoanalysis as its primary treatment.

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The alleged role of mothers in the origins of autism was another critical connection that brought Bettelheim's work into favor in France. The belief in the psychogenic origins of autism emphasizes the gendered nature of much of the research on autism since its diagnostic recognition in 1943. At that point, Leo Kanner noted the presence of refrigerator mothers in the lives of young autists, and that their cold demeanor contributed to the asocial behavior of their children. Similarly, the central conceit of Bettelheim's work was that a disturbed relationship between the mother and child triggers autistic behavior as a defense mechanism to prevent the child from experiencing further harm. For Bettelheim, the autistic child is acutely aware that the mother is rejecting the child in some manner, and thus withdraws from the world as a form of protection. French psychoanalysts and social workers held very similar views to Bettelheim in their assessment of the origins of childhood psychosis, perhaps underscoring the continued influence of Minkowski. Beyond disability, there was a larger concern about motherhood in French society that was renewed after 1945, and cultural critics were keen to put motherhood at the center of emerging social issues, especially the perceived growing threat of juvenile delinquency and the need to rebuild French society after World War II through the development of youth. The belief that mothers profoundly affected the emotional life of disabled children echoed many of the assumptions at the heart of Bettelheim's conclusions and gave added validity to them for French audiences.

Motherhood in France had undergone changes in meaning thanks to new attitudes about family after World War II and the new political and social roles of women. Women were expected to take a more active role in society while at the same time they needed to maintain maternal roles as well, especially with the postwar “baby boom.” However, during the 1950s social critics began to observe the development of the “suffocating mother” as a sign of the failure of women to care properly for their children. As Sarah Fishman notes, the baby boom influenced the perception of parenting ideals and the new reality of multiple-child households in France, with motherhood seen as the underlying issue for the perceived increase in children's emotional disorders.Footnote ⁶¹ Childhood problems grew out of the failure of mothers to care properly for their children, especially with mothers providing greater amounts of attention to their children, which did not allow for their proper development. Organizations such as the École des parents increasingly turned to Freudian language to understand the changing expectations of mothers in the postwar period. Influential child analysts such as Maud Mannoni built on the assumptions operating in society and providing theoretical and medical scaffolding for the anxieties concerning motherhood that allowed for the broader acceptance of the “refrigerator mother” thesis in France.

Similar to the refrigerator mother, the suffocating mother was an authoritarian figure who overpowered her children with her love and her possessiveness. The suffocating mother smothered the independence of the child, creating a toxic home environment. Her love was overpowering and undermined the independence of her child, leading the child to transgressive behavior. The suffocating mother appeared in numerous juvenile case files, alongside the cold, distant mother, revealing how the public focused increased attention on the impact of maternal behavior.Footnote ⁶² Within the emerging consensus in French child psychology, the influence of Lacan helped to frame the danger of the suffocating mother in terms that dovetailed with Bettelheim's conclusions about the behavior of autists. For the Lacanians, the assumption was that there was an inherent tendency for a child to not understand independence from the mother and that Lacan's theory of the mother-as-crocodile emphasized how the mother expresses desire to metaphorically swallow the child, which birthed childhood disorders.Footnote ⁶³ Bettelheim's work echoes these conclusions, which supposed that a mother's desire had destructive consequences in the behavior of mentally disabled children.

Two of Mannoni's concepts illustrate how Bettelheim's ideas could easily integrate into the French discussion of autism. The first, parole vide (“empty speech”), emphasized the importance of emotion in defining motherhood and Mannoni's formulation of a negative maternal figure, and the second, collective discourse, stressed the power of parental discourse to affect the development of the child. The appearance of disability in the child provokes an anxiety for the loss of the imagined child, which leads to internalized issues in the mother concerning her own femininity and its failure to be fulfilled through the imaginary child, which is normal and healthy in a traditional sense. Again, this concept was similar to Bettelheim's assertion of the wish for the nonexistence of the child and focused blame on the mother for wanting a different child. For Mannoni, psychoanalysis exposed these issues as part of the treatment, with the assumption that the manifestation of these issues will allow for the reframing of the mother–child relationship without the distortions inherent in the mother's desire concerning the “feebleminded child.”Footnote ⁶⁴

Mannoni built her conclusions on her work with children with a variety of disabilities but turned most of her attention to the peculiarity of the “feebleminded,” which would now include those diagnosed as autistic, and the familial relationship that structured the environment of that child. The symptoms that Mannoni observed—children whose development was interrupted in early childhood, leading to emotional and social withdrawal and often the loss of verbal communication—are the classic symptoms detailed by Kanner when he established the diagnosis for childhood autism in 1943. While the autistic child would not communicate with the outside world, Mannoni postulated that the child had a rich internal world that he turned to to avoid the anxieties present in the family dynamic of the home environment, which shares obvious similarities with Bettelheim's conclusions. The maternal figure of Mannoni's work exhibits her own neuroses that in turn trouble her children (although not necessarily all of her children), causing them to withdraw socially and emotionally. In The Backward Child, she chronicles her treatment of French families with mothers who struggle with the special needs of their children, as the mothers displayed emotional distress or withdrawal in the presence of their disabled children. For Mannoni, this reaction signifies the symbolic nature of the disabled child and the conflicted presence of a dream child in the subconscious of the mother. “The child … has no signification other than to exist for her [the mother] and not for himself.”Footnote ⁶⁵ Therefore, within this dynamic the child fails to develop the understanding of himself as a desiring object, which explains his withdrawal. Mannoni notes that the mother is often unaware of this dilemma since psychoanalysis was not understood as a possible resource to understand the feeblemindedness of the child, again recalling the ideas at the base of Bettelheim's work.

The shared conclusions across the work of Bettelheim and Mannoni point to the important position of the mother in the formulation of autistic behavior and show how much of the anxiety concerning mothers—whether of the refrigerator or the smothering variety—provided a conduit for Bettelheim's ideas to resonate for French audiences. Jordan Jack observed that a thread that runs through Bettelheim's characterization of mothers of autists is an absence of a proper emotional attachment.Footnote ⁶⁶ Like the Lacanians, Bettelheim stressed how vital a mother's attitude was to the emotional health of her child and that any dereliction could lead to emotional trauma, which was then played out in the silent world of the autist. The durability of the French concerns about motherhood was tied to the durability of Bettelheim's scholarship there.

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Despite the perceived relationship between bad parenting and autism, parents of autistic children (and to a greater degree adults) became experts on the medical and psychological literature of autism. Chloe Silverman observed this phenomenon occurring increasingly among American parents during the 1970s, terming them “expert amateurs.” Silverman notes that these parents rejected the psychogenic model that blamed bad parenting for autism, instead seeking to participate more in the treatment of their children to help them adapt to society.Footnote ⁶⁷ The emergence of expert amateurs in France was predicated on parents learning of new approaches appearing in the United States and moving beyond the idea of a cure. This shift led to a greater emphasis on special education and the rights of their children to an education rather than psychoanalytic therapy.Footnote ⁶⁸ Many groups wished that other diagnostic models and interventions in use outside France would be considered viable treatments in lieu of psychoanalysis.

Moreover, the definition of autism was changing outside France. The conception of autism as a spectrum of behaviors rather than a form of schizophrenia, built upon British researcher Lorna Wing's rediscovery of Hans Asperger's work in the late 1970s, had gained traction in the anglophone world.Footnote ⁶⁹ Wing's work placed parents at the center of treatment for their children, and she argued that parents (and perhaps mothers specifically) were the best communicators for their children, since they often understood the autist's special language.Footnote ⁷⁰ Such a viewpoint was counter to the dominant view in France of the mother undermining the language of the autist. While parents had sometimes been included in their children's treatment, this was due to the belief that parents also needed psychoanalytic treatment to deal with their unspoken animosities toward their autistic children. An entire constellation of psychoanalysis for the family was stressed by some analysts as the key to curing their children.

The publication of the third edition of the Diagnostic Statistical Manual (DSM-III) in 1980 was instrumental in the shift away from psychotherapy as the intervention for autism in the United States, but the influence of DSM-III in France was blunted by the appearance of the Classification française des troubles mentaux de l'enfant et de l'adolescent (CFTMEA) within French psychiatry in the late 1980s. The CFTMEA continued to emphasize psychogenic disorders that required psychodynamic treatment. Jacques Hochmann observes that the radical changes in DSM-III were more influential on the international community than were previous editions, which had then conformed to accepted international standards; he also noted France as an outlier to its influence.Footnote ⁷¹ One of the growing concerns among French parents was the proper diagnosis of their children, especially given the growing divergence of conceptions of autism elsewhere. As more information about autism came from outside France, parents’ associations renewed debate about the disorder, especially in seeking to embrace more international dimensions of autism.Footnote ⁷²

Brigitte Chamak sees parents’ associations as driving the challenge to the existing psychoanalytic regime in France, noting a change in discourse defining autism as a handicap rather than a disease as part of the process of normalization. Associations also emphasized a definition of autism as a plurality of communicative disorders instead of a singular expression of childhood schizophrenia. Chamak notes how in the 1980s Bettelheim served as the prime example of the psychoanalytic model and was the main target of the parents associations’ critique of the French system.Footnote ⁷³ Certainly this was due to medical professionals referencing the documentaries and the continued defense of his ideas.Footnote ⁷⁴ However, parents’ associations were by no means in solidarity behind a single approach to public services, and schisms among groups appeared by the early 1980s, as different associations looked to a variety of methods to ameliorate their children's behaviors and help them integrate into society. Still, they more often than not shared an approach that pushed against established psychoanalytic consensus in favor of what they argued were more pragmatic efforts.

One association, Pro aid autisme, was founded in 1985 and immediately pressed for the use of new methods developed and practiced in the United States. Pro aid autisme sought specific recognition for the ideas of American researchers, especially of the work of Ivor Lovaacs on applied behavioral analysis (ABA) and that of Eric Schopler on visual learning. The parents of the association emphasized the need for new methods to help to teach their children how to communicate in the home environment, which went against the notions of milieu therapy and tried to move beyond the desire to address the psychogenic origins of autism, noting its detriment to helping autistic children and families. The advocates in Pro aid autisme were less concerned about the origins of autism than in ameliorating some of its debilitating effects to allow children to get an education and develop work skills. Still, Pro aid autisme employed much of the same rhetoric that earlier parents’ groups had, namely the importance of recognizing the need of disabled children to be treated equally within French society.Footnote ⁷⁵ Tellingly, Pro aid autisme conflated the power of psychoanalysis in French society with the work of Bettelheim, speaking out directly against his work during the 1980s and 1990s. Seeking to “break the monopoly of psychoanalysis” in the care of autism, Pro aid autisme aligned with other parents’ groups (such as Autisme France) in their advocacy of specific rights for both autistic children and their caregivers, including the right to diagnosis (based on criteria accepted by the international scientific community), the right to education, the right to information, and the right to restitution for improper treatment, all of these serving as a critique of psychoanalysis.Footnote ⁷⁶ While these ideas were developed at a national meeting of Autisme France in 1989, the Pro aid autisme leadership included them in many of their newsletters afterwards to provide a framework for the advocacy efforts of their organization. This struggle between parents and the French government continued despite the passage of the Loi 30 June 1975, which extended special protections to disabled children, primarily due to the persistent question whether autistic children were disabled or mentally ill.

In the inaugural issue of the association's bulletin, editors Emmanuel Hirsch and Pierre Toureille affirmed their support of Schopler's Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) program as an alternative to the existing regimen, noting the program's success not only in the United States but also in neighboring Belgium.Footnote ⁷⁷ Pro aid autisme sought to establish TEACCH workshops throughout France to train parents how to use the method to integrate their children into society, opening the first in 1986 in Issy-les-Moulineaux. Unlike psychotherapy, which operates on the assumption of language as a shared form of communication, TEACCH uses behavioral-therapy techniques to teach autistic children communication strategies that do not seek to change behavior, but rather provide them with a method of working independently. Psychoanalysts sought to explain and change observable autistic behaviors through removing them from their home environments, which parents argued left their children unprepared for participation in society, either through work or through schooling. Pro aid autisme asserted the importance of a pragmatic solution for autistics, noting the three defining aspects of the association's mission: helping autistics live with dignity, defending their right to social inclusion and integration, and promoting practical research for solutions to their specific social needs.Footnote ⁷⁸ More than just pragmatism, Hirsch's assertion that the quest for rights was a moral imperative to recognize the realities of autism lent the association a combative stance in favor of those who could not speak.Footnote ⁷⁹ These goals put the group at odds with the orthodoxy of psychoanalysis and the dominance of Bettelheim's interpretation of autism, which sought to remove autistic behaviors to cure children of the disorder, since TEACCH methods placed parents as central providers of therapy rather than as instigators of the disorder.

The group realized the difficulty of this challenge, and named its bulletin Le forteresse éclatée (The Broken Fortress) in honor of Theo Peeters's response to Bettelheim's famous thesis. Peeters argued in his work that Bettelheim's emphasis on psychopathology ignored the variety of behaviors associated with autism and fostered a fear of autists.Footnote ⁸⁰ A pioneer in a more inclusive understanding of the culture of autism, Peeters, a Belgian, became a critical early supporter of Pro aid autisme, which had an international board of members advocating for changes in France that had already happened elsewhere in Europe, and helped to formulate the association's critique of psychoanalysis. In an interview with France Inter from 1989, Peeters observed that elsewhere in the Western world mental professionals had long turned away from psychoanalysis as a valid form of treatment for autism and rejected its psychogenic ontology.Footnote ⁸¹ For Peeters, the persistence of psychoanalysis in France spoke to a great social injustice—the continued blaming of parents for their children's failure to develop in a typical manner—that had been corrected elsewhere. In response, he asserted that parents needed less blame and more support in their efforts to treat their children's handicaps and help them integrate into French society. Moreover, Peeters emphasized the efforts of disabled children as an important part of successful therapy, rejecting the psychoanalytic belief that their lack of communication was deliberate, which was at the heart of Bettelheim's conclusions.Footnote ⁸²

Upon Bettelheim's death in 1990, Pro aid autisme detailed the controversies surrounding his work and how they should undermine his prestige in France as much as they had in the English-speaking world. In a March 1990 editorial, Nicole Toureille noted how Bettelheim's influence in France still loomed large thanks to the continued reach of the documentaries, as well as Karlin's continued efforts to promote the curative powers of psychoanalysis through his 1981 documentary Fréderic: Une nouvelle naissance.Footnote ⁸³ In the view of the association, Bettelheim symbolized the strength of psychoanalysis to resist criticism of the psychogenic origins of autism and occupy the public's imagination concerning the disorder.Footnote ⁸⁴ Bettelheim's unwillingness to change his position at the end of his career (unlike Kanner, who later regretted the “refrigerator mothers” phrase) reinforced his negative influence on the understanding of autism.Footnote ⁸⁵ The same issue of the journal included letters remarking how the ideas promoted by Pro aid autisme were more hopeful than Bettelheim's. One mother spoke of her frustrations in dealing with the ineffectiveness of psychotherapy for her son.Footnote ⁸⁶

Pro aid autisme also turned to Bettelheim's most vocal critic in France, Debray-Ritzen, for his opinion on the continued impact of Bettelheim's work. Debray-Ritzen reiterated many of his earlier criticisms of Bettelheim's work and labeled him a fraud. He also focused on Bettelheim's equivocation between the concentration camp and autism, a central component of his theories of psychological response in extreme conditions. Debray-Ritzen noted, “Paradoxically, Bettelheim then advocated the isolation of the child, removed from the family circle to interrupt the ‘bad relations.’ Cutting to the chase, this doctrine makes the poor parents culpable, parents who already suffer from the same unfortunate situation.”Footnote ⁸⁷ The association's focus on Bettelheim underscores how parents in France continued to conflate his conclusions with the dominance of psychoanalysis there.Footnote ⁸⁸ The association disparaged his work to critique the strength of psychoanalysis in France, but the persistence of this criticism revealed Bettelheim's continued influence in the conceptualization of autism there.

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Despite the efforts of Pro aid autisme in the 1980s, psychoanalysis remained entrenched in child psychology as the predominant framework for autism. As Catherine Milicent, a child psychologist and parent of an autistic child, observed in 1991, psychoanalysis could adapt to its critics and incorporate all ideas, making it difficult to refute and move beyond, despite the efforts of alternate treatments to gain recognition in France.Footnote ⁸⁹ For the French public, Bettelheim represented the connection between psychoanalysis and autism thanks to memories of the documentaries and his famous conclusions about the role of mothers.Footnote ⁹⁰ Publications such as the Livre noir de la psychanalyse emphasized how French medicine had been colonized by psychoanalysis since the 1970s and included sections on the “damage” done by thinkers such as Bettelheim.Footnote ⁹¹ Critics attempting to reorient the debate had to convince the larger public of what they saw as the negative influence of psychoanalysis in the world of autism, thus changing their approach from working within associations to engaging with French audiences to have them advocate for new approaches through a broader, national debate. The Livre noir was the first attempt to catalog the accusations against psychoanalysis in general but again it did not change the tenor of the debate.

More recently, the relationship between psychoanalysis and autism has garnered considerable critical attention thanks to associations such as Autistes sans frontiers (ASF) and the Association de la réeducation et de l'insertion des autistes (ARIA), which advocated for similar positions as Pro aid autisme and other groups from the 1980s. Their critique was best encapsulated in a documentary by Sophie Robert, Le mur: Psychanalyse à l’éprueve de l'autisme, released in 2011. Le mur presents several stories of French families’ frustrations with the existing system and the still prominent role that psychoanalysis plays in the treatment of autistic children, showing footage of treatment that they receive to help them overcome their disability. Robert asserts in the documentary that the definition of autism as a neurological disorder has been ignored in France due to the durability of the psychoanalytic model. Robert's documentary includes numerous interviews with analysts—including prominent scholars such as Bernard Golse and Éric Laurent—in an attempt to balance her advocacy for integration and special education with the views of analysts and their justifications for the continued relevance of their work. Several analysts in the film cited Bettelheim's work as influential, noting again the durability of his narrative about refrigerator mothers.Footnote ⁹²

The short film (fifty-two minutes in total) contained numerous interviews with psychoanalytic pediatricians who tried to explain their approach to treating their autistic charges, at times revealing the continued importance of Bettelheim in their interpretation of behaviors. In the opening interview, Alexandre Stevens, a pediatric psychoanalyst associated with the École de la cause freudienne, labels autism a psychosis stemming from the response to an extreme situation, reiterating Bettelheim's famous thesis. The emphasis on discourse and language leads many of these therapists to make very direct arguments about how the problems of home life and maternal love caused autistic behaviors. In one example, Geneviève Loison equates her patient's decision to play with a toy alligator with their understanding of the dangers of their mothers, borrowing from Lacan's metaphor of the mother as crocodile as well as exhibiting the assumption of a hostile mother. In each of the interviews, the analysts emphasize many of the same points that defined Bettelheim's definition of autism (and consequently its treatment), namely that mothers’ emotional rejection of their children caused a psychotic break. Mother blaming continued in France well into the twenty-first century despite subsiding elsewhere. Robert's purpose in structuring her film in this manner was to underscore how radically different the psychoanalytic view was from the scientific consensus outside France.Footnote ⁹³

What has come to be called the “battle over autism” was one that was fought over representations as much as methods and approaches, a struggle over defining the disorder as an illness or a disease whose origins had ramification on how families were treated. While parents often focused on specific treatments, their advocacy was in response to and framed by existing cultural narratives, with one of the most powerful and influential being Bettelheim's “refrigerator mother.” Despite its rejection elsewhere, his work on autism proved durable in France due to its echoing of sentiments concerning the potential dangers of motherhood that was common among social critics in the 1960s and 1970s and the continued acceptance of psychoanalysis there. Thus Bettelheim became symbolic of the psychoanalytic order that parents and autistic people struggled against. The power of Bettelheim's work to define and shape the debate concerning the disorder stemmed largely from its potency to connect with French assumptions about the relationship among psychoanalysis, motherhood, and autism, which forced parents to continue to engage with Bettelheim's ideas even as the fortress was found empty.