In psychoanalysis, the concept of autism is closely linked to the term autoeroticism, which was adopted by Sigmund Freud from the physician and sexologist Havelock Ellis. Autism and childhood psychosis were rediscovered in the United States during the 1950s within the framework of Freudian orthodoxy, notably through the work of Margaret Mahler. Psychoanalytic studies, particularly by Anglo-Saxon post-Kleinian analysts such as Frances Tustin, Donald Meltzer, and Donald Winnicott, followed. Bruno Bettelheim holds a distinctive place in this history. In France, influenced by the theories of Jacques Lacan, autism was notably explored by psychoanalyst Françoise Dolto.
Psychoanalytic work with autism focuses on using verbal communication (or alternative means of symbolization in more severe cases) to help the subject manage their symptoms and, where possible, reduce their impact.
The psychoanalytic approach to autism has been widely discredited and is considered to have contributed to mistreatment of autistic children. Despite this, it remains prevalent in France. According to The Guardian, France lags "50 years behind" in supporting autistic individuals, describing it as a "state scandal". The influence of psychoanalysis in autism treatment in France has been cited as a violation of the rights of autistic individuals. Nevertheless, some psychoanalysts continue to defend their practices.
The psychoanalytic framework for autism began to decline in the 1970s, particularly in the United States, but it remains prominent in two regions: France and Latin America. The application of psychoanalytic theories to autism in the 1950s and 1960s, combining child psychiatry (Kanner) and psychoanalysis (Bettelheim), led to the controversial refrigerator mother hypothesis, which blamed mothers for autism. This became a central point of contention for many French parent advocacy groups opposing psychoanalysis. Autobiographies by autistic adults such as Josef Schovanec, Hugo Horiot, and Gunilla Gerland describe suffering during psychoanalytic treatment, though some positive experiences, such as that of Donna Williams, who incorporated psychoanalytic terms or interpretations, have also been reported. Criticisms also target the psychoanalytic concept of psychosis and the ineffectiveness of psychoanalytic practices in addressing autism.
In December 2020, the University of Cambridge published an article titled "Psychoanalysis in the treatment of autism: why is France a cultural outlier?" to examine why France continues to use an approach discredited for decades due to a lack of scientific evidence and its potential to harm autistic children. The authors argue that psychoanalysis in France is shielded from criticism by political and academic networks.
1907–1944: Between sexology, psychoanalysis, and psychiatry
The concept of autism emerged through evolving perspectives in psychoanalysis and psychiatry, stemming from the notion of autoeroticism developed by Sigmund Freud, who never directly addressed autism. Freud adopted the term "autoeroticism" from physician and sexologist Havelock Ellis, but psychiatrist Eugen Bleuler rejected its sexual connotations, coining "autism" by abbreviating and contracting "autoeroticism" (removing "eroticism").
From Freudian autoeroticism to autism by Bleuler, Kanner, and Asperger The concept of autism originated at the Burghölzli Psychiatric Clinic in Zurich, directed by Eugen Bleuler, who coined the term "autism". Bleuler's rejection of the psychoanalytic emphasis on sexual drives in Freud's concept of autoeroticism, contrasted with his preference for "ipsism" in psychiatry, distinguished psychoanalytic and child psychiatric approaches. In 1943, Leo Kanner formally identified a childhood disorder as "autistic disturbances of affective contact", while Hans Asperger presented a report in 1944 on "autistic psychopathy in childhood".
Freud, Jung, Bleuler The term "autism" (from Greek autos, meaning "self") was coined by Swiss psychiatrist Eugen Bleuler and first appeared in a 13 May 1907 letter from Carl Gustav Jung to Sigmund Freud. Bleuler found Freud's autoeroticism, borrowed from Havelock Ellis, "too sexual" and created "autism" by combining "auto" and "eroticism" (replacing the latter), after considering "ipsism" from Latin. Freud retained "autoeroticism", while Jung adopted the term introversion.
Between Freud's autoeroticism and Bleuler's autism In his 1911 work Dementia praecox oder Gruppe der Schizophrenien, Eugen Bleuler defined "autism" (German: Autismus), derived from Greek autos ("self"), as a detachment from reality coupled with a predominance of inner life, noting it as roughly equivalent to Freud’s autoeroticism. According to Jacques Hochmann, Bleuler, familiar with Freud's theories, clarified that autism approximated Freud's autoeroticism but sought to distance it from Freud's broad sexual framework to avoid misinterpretations.
Jung’s conflict with Freud over dementia praecox
At Burghölzli, Carl Gustav Jung worked under Bleuler on dementia praecox (schizophrenia) and published The Psychology of Dementia Praecox in 1906. Tasked by Bleuler to engage with Sigmund Freud, Jung, initially aligned with Freud, parted ways around 1911–1913, partly due to theoretical disagreements over libido in dementia praecox. Jung argued that Freud's drive-based libido theory failed to explain dementia praecox, while Freud was developing his 1914 work Introducing Narcissism. In psychoanalysis, narcissism is defined as a necessary developmental stage transitioning from autoeroticism to object love.
Kanner: Early infantile autism
In 1943, Leo Kanner adopted the term "autism" to describe "early infantile autism", a syndrome involving impaired communication, social behavior, and cognitive functions. French child psychiatrist and psychoanalyst Didier Houzel notes that psychoanalytic research has significantly advanced the understanding of early psychic development. However, Steve Silberman argues that Kanner's initial focus on parental roles in his autism model reflected the dominance of psychoanalytic theory, which attributed disorders to parental psyche, overshadowing alternative models.
Jacques Hochmann notes that by the early 1960s, an anti-psychoanalytic movement emerged in the United States. The decline of psychoanalysis in public opinion and psychiatry was compounded by the fragility of American Freudianism, as noted by Élisabeth Roudinesco and Michel Plon. Neuropathologist Manuel F. Casanova and his team highlight that Bernard Rimland, a psychologist and father of an autistic child, collaborated with Kanner to challenge psychoanalytic dominance. In 1964, Rimland published a manifesto debunking psychoanalytic ideologies and documenting genetic causes of autism, founding the Autism Society of America in 1965.
Asperger's report and its legacy In 1944, Hans Asperger presented a report in Vienna on "autistic psychopathy in childhood" (Die Autistischen Psychopathen im Kindesalter), which remained obscure for four decades. According to Élisabeth Roudinesco and Michel Plon, Asperger described a "high-functioning autism" characterized by intact language and exceptional memory, exemplified by the character Raymond Babbitt in the 1988 film Rain Man. This claim of Asperger's own autism is disputed by Edith Sheffer. Asperger's report discussed autistic psychopathy, later termed high-functioning autism and Asperger syndrome. Rediscovered in the late 1970s by Lorna Wing, a psychiatrist and parent of an autistic child, it was translated into English by Uta Frith and published in 1981. Frith, trained in cognitive psychology, added diagnostic criteria, including the absence of theory of mind. Her student Tony Attwood refined the description, which gained widespread recognition with his 2008 book. Paul Alerini notes the emergence of a global "Asperger community" and a growing list of notable individuals identified with the condition.
From the 1950s: Anglo-Saxon psychoanalysis and autism The Anglo-Saxon approach to autism emerged shortly after Leo Kanner's 1943 description of early infantile autism and Hans Asperger's 1944 report in Vienna.
Autism and childhood psychosis were rediscovered in the United States during the 1950s within the framework of Freudian orthodoxy. Margaret Mahler's work made the psychoanalytic treatment of childhood psychosis widely accepted. According to Élisabeth Roudinesco and Michel Plon, the Annafreudian and Kleinian schools, alongside Bruno Bettelheim, most effectively studied and treated autism using psychoanalytic tools, often with success.
Investigative journalist Steve Silberman notes that psychoanalytic analyses of autistic individuals began in the 1930s, with Hermine Hug-Hellmuth, Anna Freud, and Melanie Klein interpreting their young patients' behaviors through a Freudian lens. For example, Klein interpreted a boy's fascination with door handles as symbolizing sexual penetration of his mother.
Margaret Mahler: The "normal autistic phase" of infancy
Margaret Mahler’s work on symbiotic psychosis represents the Annafreudian approach. According to Didier Houzel, Mahler positioned early infantile autism as a stage in psychic development, progressing from a "normal autistic phase" to "separation-individuation".
American pediatrician and psychoanalyst Margaret Mahler theorized the separation-individuation process in the first three years of life, drawing on Anna Freud, Heinz Hartmann, René Spitz, and, to a lesser extent, Donald Winnicott. She described the end of the "normal autistic phase" around three to four months, when separation begins. During this phase, the infant is highly focused on interoceptive and proprioceptive sensations. Mahler described this phase as a monadic system, self-sufficient in its hallucinatory satisfaction of desires. Her work highlighted the infant's competencies in perception, cognition, and social interaction.
The Kleinian school
Melanie Klein: "Childhood psychosis" According to psychiatrist and psychoanalyst Paul Alerini, Melanie Klein made childhood psychosis a viable concept by developing a dissident theory relative to Freudian orthodoxy, incorporating an early superego, a pre-Oedipal phase, and an initial schizo-paranoid position with splitting between good and bad objects within the mother's womb. Jacques Hochmann notes that in 1929, Klein presented "the case of Dick" at an international congress in Oxford, likely the first autistic child to undergo psychoanalytic treatment, though Klein labeled him "schizophrenic". Hochmann adds that as child psychoanalysis developed, Donald Meltzer and Frances Tustin focused on autistic children, enriching psychopathology semiology without attributing autism to maternal attitudes. Psychoanalyst Marilia Franco E. Silva credits Klein's concept of projective identification with significant theoretical and clinical advances in psychosis. However, post-Kleinians questioned Klein's assumption of an innate ego when addressing phenomena like echolalia and echopraxia in autistic children.
Post-Kleinians
Frances Tustin Frances Tustin, trained under Wilfred Bion (who was analyzed by Melanie Klein), distinguished several types of autism, only one corresponding to Leo Kanner’s description:
Abnormal primary autism: No differentiation between the child’s body, the mother’s, and the external world. Secondary encrusted autism (similar to Kanner’s autism): The lack of differentiation between the child’s ego and the mother is replaced by an overemphasis on difference, creating an autistic barrier as a protective shell against the external world. Secondary regressive autism or childhood schizophrenia: Development begins normally but regresses, with the child retreating into a rich, body-sensation-focused fantasy life. Élisabeth Roudinesco and Michel Plon note that Tustin viewed this as a form of schizophrenia underpinned by projective identification.