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The empty fortress contains a theory of the infant-mother relationship, three long and detailed case studies, a discussion of the relevant literature on infantile autism, and a fascinating analysis of the myth of feral children. It is a landmark in the study of a subject whose significance far outweighs its rarity.
In between 1932 and 1938 Bettelheim took first one and then two autistic children to live with him in his home. Then the disorder had not been recognized, for Kanner had not yet published his first paper on the subject. Later Bettelheim was interned in a concentration camp from which he was liberated in 1944; there he witnessed many features of autism develop before his eyes amongst the inmates of the camp. It was this, he claims, that motivated him strongly to further his study.
He next worked with schizophrenic children, getting unexpectedly good results in the Orthogenic School in Chicago. His investigations led him to think that a more intensive study into the most intractable of all the psychoses of childhood would be worthwhile and, supported by the Ford Foundation, he expanded his school and studied 40 autistic children over prolonged periods—up to ten years. The length of time became significant and he makes the point that only by prolonged care could good therapeutic results be achieved.
He did not undertake treatment himself but assembled a number of skilled assistants who devoted themselves day and night to living with children who ‘subject [adults] to far-reaching isolation, and to systematic efforts at personality destruction’ (p. 8). How these children were managed can be adequately grasped only from reading the book—the demands made on the staff were enormous and one can only admire the extent of their devotion which has produced such rich dividends.
The therapeutic results are impressive compared with Eisenberg's follow-up studies of autistic children. The figures are not analysed in detail, but in relatively untreated cases under Eisenberg's