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A Quiet Advocate for the Child : Psychology: The late Bruno Bettelheim rewrote the code of treatment for emotionally disturbed children.

TIMES HEALTH WRITER

After 50 years of study on children’s behavior, psychoanalyst Bruno Bettelheim’s last words of advice to parents were heartening: Relax and have confidence.

Bettelheim, a renowned figure in child psychotherapy, died Tuesday in a Silver Spring, Md., nursing home at 86. He apparently committed suicide.

An outspoken author and lecturer, Bettelheim deeply influenced his colleagues but was less well known to the public. In a career indelibly influenced by his years as a Nazi concentration camp prisoner, Bettelheim left his mark by rewriting the code of treatment for emotionally disturbed children and by explaining the role of fairy tales in child development.

Because Bettelheim influenced his field in a quiet manner, some say he may not receive credit for many of his ideas.

Most of his career was devoted to treating emotionally disturbed children, but his last book, written in Los Angeles and published in 1987, reached out to distressed parents with cheer. In “A Good Enough Parent,” Bettelheim suggested that most people can become satisfactory parents without relying on expert advice and how-to manuals.

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Parents are leery of such advice even as they seek it, he said. And yet he sympathized with parents: “Many people do not hesitate to accept the advice these books offer; the fear of failure is so great.”

In his forceful, if somewhat long-winded style, Bettelheim wrote that parents should not rely blindly on others’ opinions but should forge unique blueprints to shape their children.

“He says, ‘Don’t worry so much. You’re not responsible for everything that happens to your child,’ ” said Jacquelyn Sanders, director of the Sonia Shankman Orthogenic School for disturbed children in Chicago, which Bettelheim directed for almost 30 years.

While Bettelheim wrote his last book to summarize his views, much of his advice blends in so well with current child-rearing thinking that it probably will not be attributed to him, Sanders said.

“I think that his influence has been so pervasive that some of the most important ways that he has influenced the field have not been associated with his name,” she said, noting that, besides the Orthogenic School, few models of Bettelheim’s philosophy exist.

Foremost an advocate of the child, Bettelheim offered revolutionary views on how institutionalized children should be treated, ideas that now have become standard procedure, said Dr. Joseph Noshpitz, a noted Washington child psychiatrist.

“He was a man who spoke most fundamentally for the ethic of valuing children,” Noshpitz said. “Again and again, he called people’s attention to where society failed children, to where treatment needs were not met, to where parents were falling short. . . . Born in Vienna and trained in Freudian psychiatry, Bettelheim absorbed parts of others’ theories, then carved his own version of child behavior. Before it became fashionable, he advocated viewing life through a child’s eyes. His work with emotionally ill children centered on accepting the child’s actions--even aberrant behavior--as normal for that individual.

“He viewed children as doing things for a reason, and on treating children with respect,” Sanders said. “We never looked at these kids as different from us. The idea was that these kids were extremes of the normal. . . . If you wanted to understand them, you had to look into yourself first.”

At the Orthogenic Center, a residential treatment institution, Bettelheim left the doors unlocked and let children eat what they desired. He disapproved of behavior-altering drugs and encouraged children to remain at the center for as long as needed.

Bettelheim explored the events of his own life to learn about human behavior, said Rudolph Ekstein, a Los Angeles psychoanalyst and his longtime friend and colleague

In 1938, after beginning his work with disturbed children, Bettelheim was arrested by the Germans and sent to the Dachau and Buchenwald concentration camps, where “his philosophy for treating (disturbed) children was derived,” Ekstein said. “His philosophy was that there is a door to the house. From the outside, anybody who wants to can get in. But from the inside, the door is never open and the children can never run out.

“He felt free to turn that around. He was saying life is not a concentration camp. I want a safe place for children. So the environment was not imposed on children. They could always get out.”

Always seeking a window to enter children’s minds, Bettelheim--who came to the United States, partly through the intervention of Eleanor Roosevelt--clarified the role of fairy tales in child development in his hallmark 1976 book, “The Uses of Enchantment: The Meaning and Importance of Fairy Tales.”

Downplaying children’s fascination with wicked characters and violence, Bettelheim explained that fairy tales deal with themes of normal development and provide children with an escape from basic problems.

Bettelheim’s work on fairy tales influenced the field, said T. Barry Brazelton, a Boston pediatrician and popular child-rearing expert. “I thought his book on fairy tales was very good and very helpful to parents,” Brazelton said. “I thought it certainly helped us feel better about what children watch on television.”

Despite his life’s work, Bettelheim never achieved the kind of parental following that Brazelton or Benjamin Spock, the ‘60s child guru, did. Still, in his later years, Bettelheim focused on the problems of modern parenthood.

Early in his career, he was attacked by some parents’ groups for his controversial view that some children become autistic because of their environment. (Autistic children have normal intelligence but are unable to communicate and often are withdrawn and asocial.)

“That is not held today,” Noshpitz said of Bettelheim’s early autism theory. Autism’s cause now “is thought to be biological. But that was really a reflection of his basic assumption that all parents have to face in dealing with their children (is) that children are, in many ways, a product of our culture.”

Later, Bettelheim appeared to soften toward parents.

He refused to blame structural changes in society--such as divorce, step-parenting and working mothers--for parents’ problems. Instead, he shifted blame to the breakup of the extended family.

He never, however, deviated from his primary position as child advocate. In 1967, Bettelheim voiced his distaste for spanking children and encouraged parents to send misbehaving youngsters to their bedrooms for a period of time to indicate disapproval--concepts now popular with child-development experts.

He counseled parents caught in a standoff with their child to follow simple steps--to remain calm, to examine their own thinking and reactions and to consider what’s going on in their child’s mind. “It is such self-exploration which often provides the best clues for understanding and helping one’s child,” Bettelheim said.

In “A Good Enough Parent,” Bettelheim sympathized with parents, contending they have been set adrift because they both now often are forced to work and lack support from relatives. Bettelheim said parents need to give themselves a break. “From the very beginning, I consider it important to assure parents that they need not strive for perfection, because it doesn’t exist,” he said. “Besides, it’s not a characteristic of human nature.”

Bettelheim encouraged parents to shrug off their mistakes, to let their children see their human side but to try to shape them by setting good examples.

“To me, the most effective way to help others with child-rearing is not to offer how-tos--to say, ‘Follow instructions here to construct a successful child'--nor to offer ‘Right ways and wrong ways.’

“I am suggesting instead,” he said, “that parents, as well-intentioned, intelligent persons, can develop their own insights about child-rearing and find their own solutions.”


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