Autism Spectrum Disorder: Two Sides of the Street

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COMMENTARY

For those of us who grew up in Chicago, as I did, it was virtually impossible to ignore University of Chicago’s Orthogenic School. The school ostensibly treated youths with autism spectrum disorder (ASD). At the time, autism was blamed on “refrigerator mothers,” a term coined by Bruno Bettelheim, PhD, a psychology professor and an administrator at the school. Related psychoanalytically inspired theories also loomed large in the 1950s and 1960s, which were the heydays of psychoanalysis.

A European emigree who escaped the Reich, Bettelheim was a larger-than-life figure, even though his credentials later came under fire. In contrast, his book about the psychological underpinnings of fairy tales, The Uses of Enchantment (1973), retains its cache to this day.

Much like the “disappeared” from Argentina’s “Dirty War,” or like fictional serial killers’ victims on Netflix, it sometimes seemed as if everyone had a friend of a friend or knew of a neighbor’s family member who had been carted off to this once prestigious but subsequently disgraced school. The school’s staff—and Bettelheim himself—would later stand accused of physically mistreating those youthful charges, not to mention psychologically damaging their maligned mothers. Even the diagnoses of ASD that supposedly “qualified” students for admission to the school would be called into question. Bettelheim eventually died by suicide.¹

Bettelheim did indeed have a PhD in aesthetics, which probably contributed to the quality of his well-received book about fairy tales. But he represented himself as a psychologist, even though his European diploma could not be found. He claimed that it was misplaced during the war years. In contrast, it was confirmed that he trained as a psychoanalyst in Europe, where prior training in psychiatry, neurology, or psychology was not required, as it once was in the US.

There is much to be said about Bettelheim that is beyond our scope here but suffice it to say that what he lacked in credentials, he compensated for with chutzpah. He was lauded for his 3 weeks’ worth of “research” (conducted without experimental design) on children reared by Israeli collectives or kibbutzim.² That study became Children of the Dream (1967).

Previously, Bettelheim chronicled his own concentration camp experiences in a widely cited 1943 paper on “Individual and Mass Behavior in Extreme Situations.” That study made him a de facto spokesperson about the stresses of concentration camps—yet it was later learned that he himself had never been incarcerated in a camp, as he had claimed.

Most importantly, Bettelheim promoted since-debunked and much-maligned—yet highly persuasive—theories about “refrigerator mothers” who allegedly caused their children’s autism. His best-selling book, The Empty Fortress: Infantile Autism and the Birth of the Self (1967), established him as an expert in the field and attracted the not-always-favorable attention of well—respected reviewers, such as Stella Chess, MD, in JAMA,³ and elsewhere. Many medical journals subsequently denounced his studies on autism.⁴ Scientific research has since linked up to 80% of ASD cases to genetic factors (with some inherited from parents, but probably more from accidental chromosomal breakage or spontaneous mutations). Some 200 to 1000 genes contribute to ASD risks.

Moving forward to the present day: knowing about this background—and remembering my “disappeared” neighbor—I would come to feel especially saddened whenever I encountered parents of children on the spectrum who could not shake the lingering shadows left by these unfounded accusations made decades earlier.

As recompense, I could console them with current scientific data that contradicts Bettelheim’s theory, or I could direct them to high quality informational programs on ASD, like the ones hosted by Mount Sinai’s Seaver Center, which is affiliated the same medical school where I serve as voluntary faculty. . . or I could take an entirely different approach and alert them to the success of IDF’s Unit 9900. This unique unit is comprised of young adults who are on the spectrum and who are recruited because they can hyperfocus for hours on end and can attend to details that escape the attention of neurotypical soldiers. These volunteer recruits are noncombatants who work on computer screens and take part in an aptly named program, Spectrum of Talent.

My goal was not to goad anyone to enlist their children in Israel’s IDF, not by a longshot, given that we in psychiatry are mandated to maintain strict boundaries about separating our own political or philosophical or religious persuasions from our patients’ belief systems. Rather, my intent was to reassure distressed families that their children with ASD could possess untapped abilities that are deemed valuable enough to merit a special program.

More about Unit 9900, which is referred to as “Roim Rachok” (translated as “we see far”) and which was the progenitor of related and expanded programs in IDF, and which has been written about extensively in Times of Israel articles,^5-8 as well as by American business publications.⁹ Articles on the topic appear in men’s magazines such as Esquire or in The Atlantic, a more generic literary monthly.¹⁰ Hadassah Magazine, published by a Jewish women’s organization, also weighs in on “An IDF Program for Teens on the Autism Spectrum.”¹¹

The mere fact that this unique unit was the brainchild of 2 unrelated parents of adolescents with ASD is especially compelling, for it confirms that families can advocate for their children, to help them achieve more than had previously been expected of them and to help these young adults integrate into society at large and shed their outsider status. Even though persons with ASD can be exempted from Israel’s military obligations, the participants in this pilot program volunteer on their own accord. Many elect to remain after completing their terms of service.

Qualified volunteers are routed to professional training programs that tap into their innate skills, skills which confer a comparative advantage over neurotypical individuals. By their own admission, these young adults with autism focus on details for extended periods of time and relish repetitive tasks rather than resenting them. Many like lists of tasks.

The first graduates learned to analyze aerial and satellite photographs. The expanded program trains participants for software quality assurance, information sorting, electro-optics, and electronics. A key 9900 task is to screen vast numbers of photos of the same subject matter in order to detect small variations between them. Sometimes they scour social media for emerging trends. Apart from their technological know-how, many participants possess specialized knowledge on topics ranging from archaeology, languages, or music. When enlisted, these special soldiers are accompanied by therapists and psychologists who help them navigate potentially stress-inducing social barriers that they face. About 90% finish their program, prepared for future careers in technological fields should they decide to leave the IDF.

As testimony to the success of this pilot program, military divisions in the UK, US, and Singapore expressed interest in developing the model on their own shores.¹² How uplifting this information can be, especially for families of children who might have been marginalized and undermined.²

Dr Packer is an assistant clinical professor of psychiatry and behavioral sciences at Icahn School of Medicine at Mount Sinai in New York, New York.

References

1. Sutton N. Bettelheim: A Life and a Legacy. Basic Books; 1996.

2. Packer S. Book Review: Bettelheim: A Life and a Legacy by Nina Sutton. Jewish Book Review. 1996.

3. Chess S. Book Review: The Empty Fortress: Infantile Autism and the Birth of the Self. JAMA. 1967;199(12):949.

4. Packer S. How the Holocaust/Shoah helped shape 20th century american psychiatry. In: Moffic HS, Peteet JR, Hankir A, Seeman MV, eds. Anti-Semitism and Psychiatry. Springer Nature; 2020:83-97.

5. Sales B. Soldiers with autism take on key roles in IDF. The Times of Israel. December 9, 2015. Accessed October 16, 2024. https://www.timesofisrael.com/soldiers-with-autism-take-on-key-roles-in-idf/

6. Ginsburg M. Soldiers with autism give army rare view into intel, and disorder. The Times of Israel. March 8, 2015.Accessed October 16, 2024. https://www.timesofisrael.com/soldiers-with-autism-give-army-rare-view-into-intel-and-disorder/

7. Kushner D. Serving on the spectrum: the Israeli army's Roim Rachok program is bigger than the military. Esquire. April 2, 2019. Accessed October 16, 2024. https://www.esquire.com/news-politics/a26454556/roim-rachok-israeli-army-autism-program/

8. Goldenberg T. For autistic soldiers, army service opens door to integration. The Times of Israel.February 20, 2016. Accessed October 16, 2024. https://www.timesofisrael.com/for-autistic-soldiers-army-service-opens-door-to-integration/

9. Nelken-Zitser J. Most armies ignore autistic people. Israel is calling them up. Business Insider. January 12, 2023. Accessed October 16, 2024. https://www.businessinsider.com/army-autistic-people-israel-idf-calling-up-military-conscription-2023-1

10. Rubin S. The Israeli Army unit that recruits teens with autism. The Atlantic. January 6, 2016.Accessed October 16, 2024. https://www.theatlantic.com/health/archive/2016/01/israeli-army-autism/422850/

11. Frucht LE. An IDF program for teens on the autism spectrum. Hadassah Magazine. September 2017. Accessed October 16, 2024. https://www.hadassahmagazine.org/2017/09/28/idf-program-teens-autism-spectrum/

12. Luttwak EN, Shamir E. The Art of Military Innovation: Lessons from the Israel Defense Forces. Harvard University Press; 2023.