Marga Vicedo, PhD

On April 18, 1964, Clara Park wrote a 4-page, single-spaced typed letter to the author of a recently published book that had kept her up late reading the previous night. Park was a Massachusetts homemaker and aspiring writer. The mother of 4 children, she had been struggling to find support for Jessica, her 5-year-old daughter who was autistic. Although it had been 20 years since Johns Hopkins University child psychiatrist Leo Kanner, MD, identified infantile autism as a new syndrome, there was still little understanding of the condition. Many psychoanalysts and psychiatrists still believed that intellectual, cold mothers pushed their children into 

The book that captured Park’s interest was 

Infantile Autism: The Syndrome and Its Implications for a Neural Theory of Behavior

 A psychologist working in the US Navy Personnel and Training Research Laboratory near San Diego, California, Rimland had turned to the study of autism when his 3-year-old son Mark was diagnosed as autistic in 1959. Writing in his spare time, Rimland corresponded with practically every professional in this field, starting with Kanner.

 After the publication of Rimland’s book in 1964, the first letter he received about it was Park’s.

Park presented herself as a “layman” who wanted to share her “long, detailed, and careful”

 observations of Jessica. Unaware that Rimland was also the parent of an autistic child, Park found his book not only insightful, but also “humane.”

 Rimland rejected the mother-blame theory prevalent at the time. He also solicited parents’ feedback about their experiences via a questionnaire in his book. Park’s letter inaugurated what would become an extensive exchange between them and a dialogue with other parents.

The value of letters as vehicles for gathering knowledge is well known in other scientific areas. For example, after his famous voyage to South America and the Galapagos Islands, Charles Darwin established a wide epistolary network. While composing 

 (1859) at Down House, his countryside retreat, Darwin exchanged thousands of letters, which gave him access to both lay experience and the expertise of his scientist friends regarding many issues, from pigeon breeding to the development of babies. Darwin’s extensive correspondence attests to the wisdom of building upon the practical and theoretical knowledge of diverse members of a community and epitomizes the collective nature of scientific development.

Many insights gained by psychiatrists in the early years of research about autism came through correspondence with the patients’ parents, especially the mothers.

 Kanner’s papers on infantile autism quoted extensively from parents’ observations, as relayed in detailed letters to him over the years. In fact, it was through a letter that Kanner initially heard about the child who would become his first case of infantile autism. Parents’ letters also provided clues about the development and diverse fates of the first group of children who received the diagnosis of autism, including evidence of what today we call the 

Park thought that parents’ observations and experiences could be useful to the medical community. Park was careful not to pit scientific expertise and personal experience against each other. Instead, she proposed that together they could provide a fuller comprehension of autism because, as she put it: “It is the experience—not the mere fact—of disability that is what all our work and study, parental and professional, is about.”

Park gained her insight by living with her daughter and corresponding with many other parents of children who were autistic, researchers, practitioners, and later, adults who were autistic. This network, established and nurtured through extensive private correspondence, became crucial to Park’s landmark publications about her daughter Jessica, most famously 

, which helped countless others better understand the autistic experience.

is professor of the history of science in the Institute for the History of Philosophy of Science and Technology at the University of Toronto in Canada.

2. Rimland B. Bernard Rimland to Leo Kanner. Rimland Papers. Autism Research Institute, San Diego, CA. July 30, 1959.

3. Park C. Clara Park to Bernard Rimland. Rimland Papers. Autism Research Institute, San Diego, CA. April 18, 1964.

Understanding Autism: Parents, Doctors, and the History of a Disorder

The Autism Matrix: The Social Origins of the Autism Epidemic

Understanding autism: parents and pediatricians in historical perspective

8. Park C. Review of Dorothy Johnson Beavers’ Autism: Nightmare Without End. 

The Siege: A Family’s Journey into the World of an Autistic Child

Exiting Nirvana: A Daughter’s Life with Autism

Intelligent Love: The Story of Clara Park, Her Autistic Daughter, and the Myth of the Refrigerator Mother

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How one mother of a child with autism helped countless others better understand the autistic experience.

Clara Park’s Network of Correspondence About Autism

In the 1930s and 1940s, researchers identified childhood autism as a unique condition. At the same time, many believed that children became autistic because they had cold, intellectual, emotionally withholding mothers.

But Clara Park, a woman whose daughter had autism, set out to understand autism differently and, along with other families and dedicated researchers, she upended the medical establishment’s view of her daughter’s condition.

In this Mental Health Minute, Marga Vicedo, PhD, discusses her recent book, 

. Along with telling Park’s story, the book shows how medical research can both reflect social attitudes and change them.

is professor of the history of science and medicine in the Institute for the History of Philosophy of Science and Technology at the University of Toronto. She is the author of 

Has the history of psychiatry informed your practice? 

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A mother’s quest to understand her child revolutionized our understanding of autism. 

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Looking Back to Look Forward
This MONTH in PSYCHIATRY

The First International Congress on Infantile Psychiatry took place in July 1937, in Paris, France, as part of the International Exposition of Paris. Organized by leading French psychiatrist Dr Georges Heuyer, the Congress attracted participants from more than 20 countries, including Hungary, Austria, Belgium, Germany, England, Portugal, Italy, Spain, and Switzerland as well as from places further afield, including the United States, Canada, Brazil, and Egypt.

 The international success of the meeting attested to the vibrancy of a field that was itself barely beyond its infancy.

Interestingly, the first 45 volumes of the 

(1844-1889) did not include a single article on 

by British psychiatrist Henry Maudsley, FRCP, was the first major work to include a chapter on “The insanity of early life.” Dr John Langdon Down’s 

On Some of the Mental Affections of Childhood and Youth 

of 1887 pioneered the study of children’s intellectual disabilities. In 1899, the term 

 (in French) was first used as a subtitle in Dr Marcel Manheimer’s monograph 

 Then, the early decades of the 20th century witnessed a growing interest in childhood, thanks to the child guidance movement in the US and England, the rise of therapeutic pedagogy in Germany and Austria, and various social reform initiatives directed at solving the problems of “troublesome” children in the schools and juvenile delinquency.

At first, most psychiatrists saw children’s mental difficulties as early manifestations of adult conditions. In 1911, Swiss psychiatrist Eugen Bleuler, MD, published his influential work on the schizophrenias, the conditions that Emil Kraepelin, MD, had included under 

Bleuler believed that schizophrenia was rare in childhood, but 4% of the cases he knew had an onset in children younger than 15 years.

Other conditions seemed to affect even infants. During the first decade of the 20th century, Italian psychiatrist Dr Sancte de Sanctis postulated the existence of a dementia praecocissima, which appeared in infants around two years of age. The Viennese psychologist and educator Theodor Heller, PhD, coined the term dementia infantilis for a condition that also afflicted young children.

 By the time Johns Hopkins University psychiatrist Leo Kanner, MD, published his 1935 

 textbook, the first of its kind in the English language; the volume ran more than 500 pages.

In Paris, delegates from many countries debated all sorts of children’s behavior maladjustments in 4 sections: general psychiatry, school psychiatry, forensic psychiatry, and discussions. Psychiatrists deliberated the significance of their contributions for pedagogues and for pediatricians, conscious that claiming legitimacy to treat a child’s mind required some negotiation.

 Swiss psychiatrist Jakob Lutz and French-American Louise Despert, MD, presented their work on childhood schizophrenia. Their subsequent publications listed numerous studies from colleagues in different countries about children who would later have various diagnoses ofschizophrenia or autism. This would become a lively area of research in the following decades.

The committee that organized the congress also created an international organization: the International Association for Child Psychiatry and Allied Professions. Swiss psychiatrist Moritz Tramer, MD, was elected permanent Secretary. The journal 

 that he had started in 1934 became the official publication of the organization.

 Excited about the field’s promising future, the delegates planned for the Second International Congress of Child Psychiatry to be held in Leipzig, Germany in 1941. World War II interfered, and the next congress would not take place until 1948 in London.

The war divided many of the newly self-defined child psychiatrists politically and intellectually, and it also destroyed their ability to communicate with each other. Thus, the war had tremendous consequences for the field. It also had a far-reaching impact on the mental health of many children, which became a major focus of research in the postwar period.

is is Professor of History of Science, Institute for the History and Philosophy of Science and Technology, University of Toronto. She reports no conflicts of interest concerning the subject matter of this article.

1. Premier Congrès international de psychiatrie infantile, Paris, 24 juillet au 1er août 1937; 4 volumes. Lille: S.I.L.I.C. imprimerie; 1937.

2. Kanner L. Childhood psychosis: a historical overview.

1971;15:14-19. On the start of child psychiatry in the United States, see: Schowalter JE. 

A history of child and adolescent psychiatry in the United States

On Some of the Mental Affections of Childhood and Youth. 

5. Manheimer M. Les Troubles Mentaux de L’Enfance: Précis de Psychiátrie Infantile. Paris: Société d’Éditions Scientifiques; 1899.

Taming the Troublesome Child: American Families, Child Guidance, and the Limits of Psychiatric Authority. 

Cambridge, Mass: Harvard University Press; 1999.

7. Bleuler E. Dementia praecox oder Gruppe der Schizophrenien. Leipzig: Franz Deuticke; 1911, see: Kaplan RM. The name “schizophrenia” is heard worldwide. 

8. Parry-Jones W. Annotation: the history of child and adolescent psychiatry: its present day relevance. 

9. Vicedo M, Ilerbaig J. Leo Kanner’s call for a pediatric-psychiatric alliance. 

10. Schleimer K. The history of IACAPAPA: The International Association for Childe and Adolescent Psychiatry and Allied Professions. https://iacapap.org/content/uploads/History_of_IACAPAP-75-YEARS.pdf. ❒

Solving the problems of “troublesome” children throughout the ages.