Bruno Bettelheim: The Empty Fortress: Infantile Autism and the Birth of the Self.  The Free Press, New York., 1967. $9.95. (£4 in England).

This is an important book, if only because out of the recent spate of books on infantile autism, this is the first one which stresses the psychogenic aetiology of autism and the value of psychotherapy. The results from the type of psychotherapy given at the Orthogenic School are encouraging, and challenge the somewhat gloomy reports of other writers concerning the value of psychotherapy in the treatment of autistic children. The writer of this review has encountered similar encouraging results from psychotherapy both in her own work and in the work of colleagues with whom she is closely associated. Encouraging results from psychotherapy do not necessarily imply a purely psychogenic causation and more work needs to be done before we can write with certainty concerning this. But, whether we go along with experienced workers like Dr. Mildred Creak who thinks that it is a mistake to adopt an either/or hypothesis and thinks that the presence of organic factors increases the psychological experience of frustration, or the operant conditioners like Rimland who tend to favour organic causation, we shall read with respect the work of Bettelheim who from long experience with psychotic children presents a case for a psychogenic aetiology of this puzzling and acutely distressing syndrome. Of his deep human compassion, this book as his others, leaves the reader in no doubt whatsoever. The three case histories presented in the book show the infinite patience and skill with which the understanding of these children proceeded and the courage with which the therapists under Bettelheim's guidance entered the bizarre world of the autistic child. He draws widely in his attempt to understand these children, on his bitter experiences in Nazi concentration camps, on his study of the Israeli Kibbutz, on his long experience at the Orthogenic School in Chicago, and on his reading, both in psychology and ethology.

His hypothesis concerning aetiology which draws on recent work concerning “criti