Chicago's "Dr. Yes"

To Psychoanalyst Bruno Bettelheim, "yes" is the most important word in the English language. Yes, he says, children suffering from the most severe forms of schizophrenia can be cured. Yes, he says, children who have been judged unalterably delinquent or diagnosed as mentally deficient can grow up into mature, functioning adults--even into Harvard professors. Bettelheim's principal prescription is almost total positivism. Whatever his patients ask, he usually says yes.

Bettelheim, who studied under Freud, is principal of Chicago University's Sonia Shankman Orthogenic* School for psychotic children. Dismissed as ultra-permissive by some psychiatrists, his approach has been impressively successful with the 190 children he has treated since he took over the school.

Statistics are unavoidably fuzzy because so much depends on the severity of the child's original handicap and on subjective judgment of what constitutes marked improvement. Bettelheim estimates the adjustment rate at 40% in the exceptionally severe psychosis known as infantile autism, a disorder whose victims refuse to recognize, listen, or in most cases even speak to the world around them. He puts the rate at 80% for other patients. Some psychiatrists think Bettelheim's figures may be optimistic, but concede that his results are vastly better than those achieved in most mental institutions.

Nude Super-mother. Bettelheim, who is also a University of Chicago professor of psychology and psychiatry, is now treating 53 disturbed children--an average-size group--at the Sonia Shankman School. There, restraints are totally absent. Doors are never locked. There are no bars on the windows and virtually no rules. Spankings and scoldings are forbidden. Bedrooms burst with toys and stuffed animals. A soda fountain and an unlocked cupboard brimming with cookies and candy await any child with a nagging thirst and a sweet tooth. Outside in the grassy courtyard, a concrete nude "supermother"--twice life-size--sprawls on the grass. "She takes a lot of abuse," says Bettelheim. "The children stomp on her, curl up in her arms, paint her breasts, endlessly scrub and sometimes kick her. They soon learn that the kicking hurts them more than the statue."

As do few other mental institutions in the U.S., the school reflects Bettelheim's belief that environment is a most important part of psychotherapy. "The children do not believe in what we say," he observes, "as much as in what we do. If they see that we have tried to make things extra nice for them, they will know we care." The concept is crystallized in the explicit instructions Bettelheim gives his staff, which includes four psychiatrists, two psychoanalysts, three psychologists, two psychiatric social workers, 18 counselors, and six teachers.

If a child runs away, he is not chased or stopped. He is accompanied and comforted until he himself decides to return.

Since attempts to impose toilet discipline often worsen emotional problems in psychotic children, Bettelheim has removed all rules about bodily elimination. Elimination any time, anywhere, is preferred to withholding or self-inflicted constipation. If a child hits, kicks or bites, he is not fought or punished but is pacified; later his therapists seek the reasons why. Argues Bettelheim: "A spanking achieves a short-range goal, but it has a price tag--degradation and anger --that I am not willing to pay. My task is to build up self-respect. And I believe people do the right thing not because they are scared to death but because their self-respect requires it."

Electric Boy. The greatest effort is made with the Orthogenic School's autistic children. Thwarted or ignored in early childhood by hostile or indifferent parents, victims of autism (from the Greek word for self) sense during infancy that their own actions cannot shape their lives. Consequently, they withdraw into a living-death fantasy existence characterized by fear and stony silence--or, at best, by unintelligible animal noises. Unwilling to admit their own existence because they fear that the outside world will destroy them, many autistics refuse to use the pronoun "I" if and when they do speak.

In his book The Empty Fortress, Bettelheim tells of Joey, a nine-year-old autistic child who believed that he was run by electrically powered machines, and therefore could not exist unless he plugged himself into imaginary sockets. At night, he could breathe only with the aid of a handmade cardboard "carburetor" hung on his bedpost. Given to maniacally destructive outbursts at first, Joey slowly quieted under Bettelheim's care. From machines, the boy switched his self-identification to eggs and chickens, which at least were living things. Literally returning to infancy during psychotherapy, he put the second fantasy to ultimate use. On the day Joey first crossed the border to the world of humans, he crawled under a blanket-covered table, cackled excitedly, flapped his "wings," then grew silent. "I laid myself an egg," he said moments later. "Then I hatched myself and gave birth to me." Joey spent six years at the Orthogenic School. Restored, he has since finished high school, and now works as a TV repairman.

Imprisoned Doctor. Born in Vienna in 1903, Bettelheim devoted himself to the arts and won a doctorate in esthetics before switching to psychology. A Jew, he was sent to Dachau, then to Buchenwald. There he observed fellow prisoners who literally died of terror or --like autistics--totally withdrew from rational life. That experience led to the monograph that was the forerunner of his series of seven renowned books. Individual and Mass Behavior in Extreme Situations was published in 1939, shortly after Bettelheim was released* and went to the U.S. This work was made required reading by General Eisenhower for all U.S. Army officers in Europe during World War II. Bettelheim's growing reputation led him to the University of Chicago and the Orthogenic School. From its. founding at the turn of the century, the school had restricted its treatment to epileptics, spastics and other brain-damaged children. Convinced that public institutions could handle such cases, Bettelheim began replacing them with young victims of extreme psychosis.

Tuition at the Orthogenic School is high--$8,000 per year. Even that fails to cover the true cost, which is $12,000 per pupil. To make up the difference and pay for the one-third of the students who receive scholarships, Bettelheim relies on foundation grants and grateful parents. Of the severely disturbed children he has treated, one is now teaching clinical psychology at Harvard. Another teaches educational psychology at Stanford. A third has gone on to become a New York stockbroker who, says Bettelheim, is "working on his second million."

Bettelheim's positivism at the Orthogenic School contrasts vividly with his tendency to say no in public. In a monthly column for the Ladies' Home Journal called "Dialogue with Mothers," he regularly naysays parents on a variety of topics. Last month he told Mom not to impose her complex political opinions about Viet Nam on young children, who perceive such issues only in simple terms of black and white, right and wrong. Bettelheim has chided U.S. schools for ignoring violence rather than facing up to this human tendency and teaching children how to deal with it. He has scoffed at the notion that U.S. women have achieved anything like the social and sexual emancipation they deserve. He also holds that the nation's racial dilemma is not unique but merely a "local variation of the universal problem" of discrimination.

Splitting hairs a bit, Bettelheim refutes those who charge that he is too permissive. "I ask these children to act rationally, to have self-respect, to take cognizance of reality. That is not permissive. That is asking an awful lot."

*Literally, straightening (ortho) development (genie). *At a time when many prisoners were released to free Gestapo guards for active war duty.

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