Reminiscence

Bruno Bettelheim at the Orthogenic School

Details of the life and works of Bruno Bettelheim. Selections of his work are reviewed.

By Jacqueline Sanders

I first met Bruno Bettelheim in person in the summer of 1952. I was 21 and he was 48. I had met him earlier in the pages of a textbook, Readings in Social Psychology, and had cried over his description of the horrors of the concentration camp. My admiration for him was profound: that he had maintained his sanity by observing and trying to understand what was happening to the men around him. This ability of his to speak to both emotion and intellect remained an essential part of him and his writing and, I believe, to some extent explains the strength of people's reaction to him, even today, 20 years after his death. I had also met him on the pages of Love is Not Enough, his book about the Sonia Shankman Orthogenic School of the University of Chicago. He had undertaken its directorship eight years earlier, and in the book described a new approach to severely disturbed children that we called "psychoanalytically oriented milieu therapy." This book, its subject and its author were to have a significant impact on the field of residential treatment. I was completely taken by the image of an unusually compassionate man, who, with the help of similarly compassionate staff could understand and restore hurt children.

The man that I met on that June day seemed to bear no resemblance to the one I had constructed from his writing. He was not the handsome young doctor in a white coat that I had imagined, but a homely middle-aged man with a bulbous nose, very thick glasses and a paunch. He met me at the door in his shirtsleeves and led me into his office; we couldn't use the living room because it was being redecorated. I had just arrived from Boston, having been hired to work as one of those helpers described in that wonderful book. His manner was more surprising than his appearance. He called in a young staff member and proceeded to discuss my voice. It was too soft and had holes (my hesitancies). He told me that I had to leave off my Radcliff manners—that the only good thing he could say about me was that I wasn't wearing red finger nail polish—not that he minded red fingernail polish, but it scared the adolescent boys.

But, he wasn't a different man. There was the same concern with what was best for the children: in talking about my voice and my fingernails, he was speculating about the effect I would have on those children. He was right, my voice did not convey the firmness and, thus, the security the children needed. There was the same attention to such details and their meaning, with some suggestion of that meaning being different from any that I had ever known. That he could so quickly touch on the deeply emotionally significant accounts, in part, for my early fascination with him and my willingness to return despite the aggressiveness exemplified in this encounter, an aggressiveness that had never been evident to me in his writing. The next evening at supper he apologized to me and explained that my soft voice was, of course, a reaction to my mother's shrill tone. This seemed like magic to me. I might have remembered that I had written about my mother (who had lots to be shrill about) in the autobiographical statement I had sent. But, at that time, I didn't know about reaction formation—so it was magic. I learned later, from a colleague, that Bruno had told other staff members that he was, in fact, pleased with my gentle voice and delighted to have a Radcliff graduate working with him. If I had asked him, when he apologized, why he had been so cruel at our meeting, he no doubt would have said that he wanted to test my mettle—that I would, after all, have to survive more intense assaults from the children

I came back from that interview and stayed for 13 years. I saw him every day, watched him, and interacted with him frequently. His availability for this interaction, and his support in every aspect of our work created bonds of the greatest strength and endurance. What other world famous author would come into a dormitory of wildly cavorting little boys, settle them down and then when all were asleep go over with the staff member in minute detail what had happened in order to understand and learn to deal with the antecedents of the chaos. And how many world renowned figures could be consulted about which stuffed animal would be best as a gift for a new arrival—both as to its psychological merits and its cuddliness. He was at lunch every day except Sunday, at the staff table in the kids' dining room. When he came to a meal he would first walk around the dining room—to pat a head, settle an argument, hear a complaint, or give a reprimand. He would then join the staff at their table. He led midday staff meetings as well as the Wednesday night meeting at 9:45. At these meetings he would discuss any problem a staff member brought up—and consider the psychological implications of our plans, our scheduling, our traditions or any aspect of daily life. Sometimes when no one raised a question he would walk out, in proud disgust—"if no one has any problems then there is no need for a staff meeting—you know it all." He would take phone calls during the staff meeting—both so as not to keep an anxious parent waiting—but also to demonstrate his clever repartee to the staff. And then he came around to the dormitories a bit after 3:00 when the kids came back from school—and was at dinner for a few minutes before he went home. When we had trouble in a dorm, with chaos or acute distress, we could send for him and he would come to sort out and restore order. He came back about 9:00 to say good night to the kids and then would go to his office and work or, close the door for a session with a staff member. He would emerge—sometimes to ask our help in finding the perfect word for an idea in what he was writing—and always for tea and goodies. He talked about everything: the latest movies, his favorite mysteries, the opera, politics and the children. There was no limit to our talk about the children: with him, with our psychoanalytic consultants, and with each other. It was all so very exciting. Bruno would say that it was not a job—it was a way of life. And we were entranced with this brilliant, educated man who had lived through the greatest trauma of our civilization and was leading us in our mission to understand and help the most troubled of our children in pioneering ways.

This ability to muster people to rally to the cause never left him as long as I knew him at the school. He could make a person feel as though his/her contribution was essential and the detail on which they were focusing a significant part of his therapeutic milieu. Ike Coburn, the elegant architect who designed Bruno's last project, the adolescent unit, laughed at himself when he described how Bruno had him caught up in choosing the wild variety of colors for the floors of the unit. But he didn't laugh when describing his fascination with Bruno's explanation of the psychological reason for having spaces clearly defined so that the disorganized child could know immediately the purpose of the space in which he/she found him/herself.

There was a charm and playfulness about Bettelheim that he showed, at my expense, in his conversation with the U of C counselor at that first meeting—and that I was to many times experience. He conspired with me and two other counselors to be a secret Santa Claus at Christmas time with gifts and parties to entertain the staff who were working so hard to make Christmas for the children. He would choose exquisite gifts for the staff at Christmas, their birthdays, and on his return from trips abroad. From such trips he sent postcards to every staff member and every child, carefully selected to address each person's psychology. And, no account should omit his continuing commitment that the physical environment be as beautiful for the children as one could manage to make it.

Through the years of my devotion what mattered most about Bruno was first his conviction that a person could, by examining his or her inner psyche, gain mastery of his/her fate, captaincy of his/her soul. At least as important was his deep commitment to helping others. Though I now am less certain of how often he was right about how he did it, I remain convinced that he was certain that he was helping and that was his deep desire. I think that this was so both in his work at the Orthogenic School and in the rest of his teaching and writing.

I didn't know why I was so convinced, even through the later years when I had become skeptical of much of what he did and said. Recently reviewing some of his writing, I came across the following in Surviving, and other essays (1979):

Finally, there is the group of survivors who concluded from their experience that only a better integration would permit them to live as well as they could with the aftereffects of their concentration camp experience. Their reintegration had to permit them to cope with the feeling of guilt, and the unanswerable question of "Why me?" It had to be an integration which, by including in its makeup the aftermath of the camp experience, seemed to promise to be more resistant to severe traumatization than had been the old one.

These are survivors who tried to salvage something positive from their camp experience—horrible, as it had been. This often made their lives more difficult than their old ones had been, also in some ways more complex, but possibly even more meaningful. This is the advantage they derived from restructuring their integration in a way which gave full cognizance to the most tragic experience of their lives. (p.34)

Indeed, the essays of this book intimate one person's highly idiosyncratic efforts at reintegration.

He had often told us that the two most important experiences of his life were the concentration camp and his analysis. The concentration camp taught him the power of the external environment to effect change on an individual's psyche, and his analysis taught him the power of internal forces. So—he applied this to the O.S.—the external environment of the concentration camp was designed to tear down the psychic structure—destroy autonomy, the external environment of the Orthogenic School was designed to nourish the growth of the psychic structure—build autonomy. And, every effort would be made to understand the internal forces at work in each individual so as to help the individual gain mastery.

Thus, his reintegration was what he described as optimal—since he had salvaged "something positive from…camp experience—horrible as it had been." His helping people, most especially at the Orthogenic School, was essential for his own integration.

How critical the Orthogenic School was to him was affirmed in one of his conversations with Theron Raines, his official biographer.

I said Bert Cohler saw the School as
a means to a larger end for Bettelheim,
such as research and books.

"No, not really. The Orthogenic School was the center of my life. Otherwise I
couldn't have done it. It's the other things, the things I wrote that were incidental."

So it wasn't a laboratory, a place to collect data?

"No. The university saw it as a laboratory."

And you allowed them to see it that way?

"That's right" (Raines, 2002. p.444)

It is no wonder that without the Orthogenic School maintaining that integration in the face of the existential hardships of aging became more difficult.

The idea of milieu therapy wasn't entirely his. He talked about August Aichhorn's experience described in the 1936 Wayward Youth (Aichorn)—and talked about Harry Stack Sullivan's work in the milieu with very disturbed adults. Joe Noshpitz, a Washington analyst presented a paper on this new concept—"Milieu therapy."

There were other residential treatment places for "severely disturbed" youngsters run by people with the same psychoanalytic background. The differences that I could see in those days (the 50s and 60s) were that all the others viewed the "treatment" as taking place predominantly in the session, and no other paid as much careful attention to every detail of life, considering how to arrange those details to support healthy psychic development , a consideration that was based on Bettelheim and our understanding of psychoanalytic theory, particularly that of psychoanalytic ego psychology.

We called what we did at the School "psychoanalytically oriented milieu therapy." Our efforts were to construct an environment that was as much as possible a "normal" environment and provide the kids with the necessary support to manage successfully that environment and the growth opportunities it presented. To do this required a deep understanding of each child/adolescent. That understanding came from what we learned from psychoanalytic explorations. Bruno taught that every aspect of the environment had the potential to encourage or inhibit growth. And he taught that the most important therapeutic agents were the people who spent most time with the kids, the counselors and the teachers. He required only that they be sensitive, smart and committed to helping these strangely troubled children. This staff entered an intensive learning environment wherein the stress was great but the rewards were greater—and the learning was for life.

Bettelheim wrote two books describing the Orthogenic School: Love is Not Enough, published in 1950, just six years after he came to it, and A Home for the Heart, published in 1974, a year after he left it. There has been some criticism that they are not true to the actuality of the Orthogenic School. Of course, no description can be completely true. However, the books are expressions of Bettelheim's intent and his philosophy—and are well worth reading. His was an uncanny knack of being able to imagine reasonableness in any kind of behavior so that even the most bizarre of these children could enter the realm of humanity. One parent told me that The Empty Fortress (1967) was half wonderful and half terrible: terrible because it made his wife feel guilty and wonderful because it gave him a way to see his autistic son as a human being. And Bettelheim's application of his understanding of psychoanalytic theory to these children and their treatment is always worth considering.

There are many misunderstandings of the Orthogenic School. I will address two. First, some people have the erroneous belief that we did psychoanalysis at the School. We did not. Our children did not need their unconscious impulses to be uncovered—such uncovering could easily overcome their fragile ego structures. On p.28 of Love is Not Enough (1950):

The satisfaction of a child's wants must become the means which will induce him to form a positive relation to the adults who provide for his well being. Then, to the satisfaction of the childs needs is added the unique gratifying experience that only a genuine human relationship can offer. The relation to this person eventually challenges the child to change his personality at least in part in the image of the person or persons who are now so important to him. He identifies with them, as we say, and this identification is often the starting point for the organization of his personality. Those aspects of the adult's personality with which the child identifies then form the nucleus around which he organizes his talents, his interests, his desires and his temperament, all of which have until now been chaotic and undeveloped… (Bettelheim, 1950 p.28)

This is quite different from the analysis of the transference relationship which is the recognized tool of the prevalent schools of psychotherapy…" And on p.36

In general, when applying our theory to practice, our approach is more concerned with strengthening the ego than with bringing the unconscious tendencies to light, although we must often do the latter as well. This we try to do by supporting the ego in its efforts to control instinctual desires and its strivings to master the problems of reality…These remarks are not meant to imply that strengthening the ego and making conscious the unconscious are contradictory; as a matter of fact, in supporting the ego in its battle with the id we must often bring to consciousness the nature and direction of instinctual tendencies and show the child how much damage might result if those tendencies were never to be checked. (1950)

A second misunderstanding is that the Orthogenic School was for autistic children only. In fact only a small percentage of students at any given time were autistic. From the early days of Bettelheim's tenure until recently there has been a very dramatic change in the number of children diagnosed with autism and a very dramatic increase in the amount of attention paid to them. When Bettelheim was developing the school its purpose was to treat children who had no clear organic damage, were of ordinary intelligence but could not manage in any of the three spheres of a child's life: home, school, and play. It was only later that he focused on autistic children. And, in the last years of his tenure, his focus had turned to adolescents.

From his accounts of the Orthogenic School Bettelheim omitted two practices both of which were important to the functioning of the School. Their omission leaves the account incomplete. Furthermore, their omission leaves those practices unexamined. First was that of hitting a child to stop destructive behavior and second was having sessions with staff members. Only those who have never been responsible for the overall well being of such an institution can believe that it can exist without some form of aversive discipline. Hitting is clear, quick and often for certain children very effective. It has negative side effects, but I still prefer it to restraints, isolation or the mind deadening drugs available in Bettelheim's early years. When I decided to stop the practice I worried about what would happen to the overall stability of the School and, when searching for another mode could see that all aversive measures had negative side affects. When Bettelheim was asked why he never wrote about it he would say: people would take it as license to abuse children. He preferred to concentrate on understanding what led up to the destructive behavior. What one did afterwards made little difference as long as it quickly put a stop to the behavior. But it does make a difference. I believe that the former students who, after Bettelheim's death, wrote about the hitting were more concerned with the humiliation entailed rather than the practice, and I believe that the incidents (e.g. hitting an adolescent in front of his peers) were more a reflection of Bettelheim's failing judgment than of a bad practice.

When I became director I continued the practice of having sessions with some counselors until I began to realize that it gave me an unfairly powerful hold over those with whom I was so engaged. Furthermore, there was a conflict of interest When in a session I should have had only the counselor's best interest to guide me, I could not because my major concern was the well being of the School. For example, if a valuable counselor wanted to leave I could not help him/her sort out the feelings involved because, for the good of the school, I had a vested interest in him/her staying. I never asked Bettelheim why he didn't write about this. I am certain that he thought he was doing what was best for the staff member and for the school. I think he did not see, or did not permit himself to see the conflict of interest that I felt and that led me to stop.

Though this picture of Bettelheim and of the Orthogenic School presents only one part of his life and one part of his work, I believe that for him this part was central. It was, of course, the part I knew best.

For the rest, there are now three extensive biographies of Bruno Bettelheim. The facts of his life presented in each are the same, but the "spin" is very different. The first was published in 1996, six years after his death. Its author, Nina Sutton, is a French woman who had never met him but admired him from a distance. Bettelheim was well known in France, largely because of a three-part television documentary about him and the Orthogenic School that was shown in France on prime time Saturday night. (It can never be shown in the United States because students were photographed.) Hers is a serious attempt at psychobiography based on a great deal of documentary research, interviews, letters and her own speculative analysis.

The second was published in 1997 by Richard Pollak who had met Bettelheim one time in an attempt to find out more about Pollak's younger brother, who had been a resident of the Orthogenic School. He had died after falling from a barn's second floor where he had been playing with Pollak. What appeared to me to be Bettelheim's efforts to alleviate Pollak's guilt by being very critical of his mother, seems to have backfired and made Pollak very angry with Bettelheim. Though Pollak obviously did a very substantial amount of research and interviewed a huge number of people, the book reads like an act of revenge.

The third book was published in 2002, written by Theron Raines, Bettelheim's book agent. As one might expect, it presents a very laudatory picture. The book's great asset is his interviews with Bettelheim, which are extensive.

I met with each of the three authors and my opinion about the books is very much related to how each dealt with the information from me. Nina got some of the facts of my life wrong. This, in itself, had no affect on the story of Bettelheim, but it did lead me to have less faith in her reliability. In a rather vague way she implies that I did not understand or carry on the essence of Bettelheim's work. This probably was a result of my unwillingness to agree with her interpretations of Bettelheim's behavior. I am reluctant to interpret without the presence of the person. Bettelheim often said, "I can't read other people's minds, I have a hard enough time reading my own." A particular point of our disagreement was her conviction that when Bettelheim struck a child it was a result of his loss of control. Bert Cohler and I have both been present during and after such incidents and, on the basis of our observation have concluded that it was a deliberate act. Sutton's book is full of information. She has collected more documentation (e.g. about his pre-WWII education) than one would expect possible and has extensively interviewed former staff and students and had access to important correspondence. Though I admire her effort to compose a psychobiography, I found the book seriously flawed by over-interpretation, that I thought erroneous. Most striking was her attribution of great importance to Bettelheim's mother's alleged remark at his birth, "Thank God it's a boy" with the implication that the baby was so ugly.

I spent the most time with Richard Pollak who I found to be intelligent and entertaining. I thought he would be fair. His publisher sent me a copy of the pre-publication edition with hopes that I write something for the jacket blurb. Part way through reading it I was so horrified by the relentlessly destructive presentation that I asked Pollak to remove me and his graceful thanks for my help from his list of acknowledgements lest it be interpreted as an endorsement. I was most offended by his use of what I said to convey its opposite—by using such devises as putting a direct quote from me in a paragraph in which he concludes that the Orthogenic School was "a house of fear." Worse in my mind was his misuse of what former students, staff and parents had told him. Certain of them who were very positively disposed to Bettelheim agreed to talk with Pollak in the service of presenting a full picture and so would, naturally, include the warts. Pollak would then report only the warts.

Pollak, too, did very extensive research and very extensive interviews. It is unfortunate that the strength of his bias makes it difficult to assess the value of his findings. It would have been helpful, for example, if he had used his careful investigation that found every possible instance of Bettelheim's lying, to find an explanation of why he had to do it beyond the dramatic need for a good story and beyond any benefit that would accrue to him for it.

I most enjoyed reading Theron Raines' book. In his inscription he writes to me, "I hope you find some of the Bruno you remember here." I did. Raines' volume is based on extensive interviews with Bruno and some with people who had worked closely with him. Raines so accurately presents his interviews that I could hear and even see "Dr. B." My test for their reliability stands: his report on interviews with me coincides with my memory of them. This book is flawed by an overly positive interpretation of Bettelheim. Raines believes everything that Bettelheim says. But he did have the dangerous practice of doctoring the truth. In its most benign form, he would tell stories that weren't exactly true, but made a point—and the distortions make the point more clearly. When I told a physicist friend about my concern that Bettelheim fluffed his data he said, "Mendel, too, fluffed his data, no one would have paid attention or believed him if he hadn't." So, we would forgive "Dr. B." Perhaps the most dangerous fall out from this practice is that people then distrust and disregard the very valuable and effective reports. Raines tends to give a positive interpretation to everything that Bettleheim did. But, in reading Raines' book it is not difficult to separate the accurate from the speculative so that one has reliable access to the late life thoughts of a man who is often perceived as enigmatic.

After reading all three volumes I had the sense that none of the three had captured the essence of the man and none had presented an assessment of his contribution to the field or fields that he was addressing. The more recent book by DJ Fisher, Bettelheim: Living and Dying (2008) comes closer to doing both. Fisher, a lay analyst and analysand of Bettelheim's friend Rudi Ekstein, came to know Bettelheim in his last years. His book is a series of essays about the aspects of Bettelheim that Fisher knew best. The introduction summarizes Bettelheim, his life, his work and his person in a way that is remarkably apt, particularly for such a brief summary. He clearly admires Bettelheim but says, for example "the author's utterances could be abrasive, omnipotent and intolerant." (2008, p.1). In two chapters: "A Final Conversation with Bruno Bettelheim" and "The Relationship and Debates between Bruno Bettelheim and Rudolf Ekstein" Fisher presents an intimate picture of Bettelheim that carries the weight of veracity because it is painted with Bettelheim's own words. One chapter is an interview with Bettelheim, the other is a correspondence between him and Ekstein. It is a tribute to Fisher's sensitivity that he could elicit this interview.

Three chapters are devoted to a selection of Bettelheim's published work, which Fisher summarizes and critiques. In "Psychoanalytic Cultural Criticism and Man's Soul" he reviews books and articles that are directed to the lay public and deal with issues of public interest. This calls our attention to Bettelheim's remarkable ability to speak to non-professional people about psychological issues in ways that they can understand. He, therefore, exerted a strong influence on a large portion of the educated population who turned to such public intellectuals as Bettelheim. For example, the essay, "Freud and Man's Soul" appeared first in The New Yorker. In "Toward a Psychoanalytic Understanding of Fascism and Anti-Semitism" Fisher presents Bettelheim's work in context of four other psychoanalytic writers and their contributions to this understanding. In "On Parenting and Playing" he discusses Bettelheim's work on child rearing. All of Fisher's discussions are thoughtful, respectful and critical, though I don't agree with all he says. He presents Bettelheim as a lay analyst, though he never went through a program nor did he have a training analysis. He never claimed in my presence to be a psychoanalyst and never had private patients—psychotherapeutic or psychoanalytic. He never professed that what he did with staff was psychoanalysis. This indication that Bettelheim did not have the benefit of another helping him with the examination of his unconscious, is helpful in understanding the blind spots that enabled Bettelheim to leave his hitting children unexamined and to engage in a practice with counselors that Fisher describes as exacerbating "resentments within the school, increasing competitiveness and paranoia within the hothouse atmosphere of the school, fostering both idealization and envy." (2008, p.8)

Fisher includes pieces that he himself wrote in reaction to the post-mortem attacks on Bettelheim. He appropriately complains that the nature and vehemence of these attacks "make it difficult to engage in reasonable dialogue about Bettelheim's ideas and historical significance." (2008) This volume appropriately avoids discussion of those accusations and focuses on the reasonable dialogue about his ideas.

No discussion of Bettelheim can be complete without some discussion of autism. In 1952 I took into my group a clearly autistic child. At the time the diagnosis of autism was based on a clinical judgment—a child who didn't relate in the usual way and seemed to have the characteristics described by Kanner. Published articles on autism were rare and usually consisted of debates between/among psychoanalysts not as to whether the mother was the cause, but as to in what way she was the cause. Bettelheim is the straw man for the theory of maternal culpability not because he was its originator or the only one who professed it, but because he was the most articulate of its explicators. With his "huckster" abilities, he got the most publicity: a national television play, a best selling book, a write up in the New York Times. Furthermore, he refused to stop promoting the theory even though I have good reason to believe that he thought there was an organic cause for autism.

He continued with his pronouncements long after he had stopped having any interaction with autistic children and when the entire psychological community had become convinced that it was not the mother who caused autism. Bettelheim was given a Ford foundation grant in the early 50s to study autism. The purpose was not to pursue greater understanding of autism or to find its cure. He, and the granting committee, believed he knew how to treat autistic children—using the same principles according to which we treated all our children. The point of the grant was to study ego development. The notion was that the ego in autistic children had failed to develop. Since, in our therapeutic environment, the ego would develop, we would be able to watch in slow motion how that takes place. It was the pursuit of understanding of normal development for which the money was granted.

This work led to the publication of The Empty Fortress (1967). Unfortunately, its current status is of the baby that is thrown out with the bath water. It is full of important insights. The first chapter "Where the Self begins" contains such insights. Bettelheim speculates that the self begins when an infant is able to influence the world around him. This view led us to attend very carefully to all signals that an autistic child gave, try to fathom their meaning, and respond. Whether or not the cause of autism was rejection on the part of the mother or some organic deficit, and whether the children made huge or very small advances, this approach, in my experience was powerful and effective.

Through all of his writing this thread runs clear and strong: the importance of finding a way to develop and maintain one's autonomy, control one's destiny—and his effort to teach others to do the same.

References

Aichhorn, August. (1936), Wayward Youth, New York: Putnam's Sons.

Bettelheim, Bruno. (1974), Home for the Heart, New York: Alfred A. Knopf

------. (1950), Love Is Not Enough, New York: Free Press of Glencoe

------. (1967), The Empty Fortress, New York: the Free Press

------. (1979), Surviving and Other Essays, New York: Alfred A. Knopf

Fisher, David James (2008), Bettelheim: Living and Dying, Amsterdam-New York: Rodopi

Newcomb, Theodore M & Eugene H. Hartley. (1947), Readings in Social Psychology, New York: Henry Holt & Co.

Pollak, Richard, (1997), The Creation of Dr. B, New York: Simon & Schuster

Raines, Theron. (2002), Rising to the Light: a Portrait of Bruno Bettelheim, New York: Alfred A. Knopf

Sutton, Nina. (1996), Bettelheim, a Life and a Legacy, New York: Basic Books