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The Trump administration’s announcement last week linking the use of acetaminophen by pregnant women to their children’s autism was (as many have by now argued) alarmist, unsupported, and irresponsible. To appreciate the depths of the harm the idea could cause, we need to understand the saga of mother blame in the story of autism. One of the most pernicious myths in this history was the mid-20th-century idea that “refrigerator mothers”—cold, intellectual, working mothers—caused their children’s autism. Historians who study this period, including me, wonder whether the refrigerator mother is now being reincarnated as the Tylenol mother.
Like many other myths, the idea of the refrigerator mother was born out of ignorance, in this case about the causes of autism. When child psychiatrist Leo Kanner first defined infantile autism as a condition in 1943, he argued that it likely had an organic origin, because newborns displayed their unique characteristics from birth. However, influenced by the widespread belief within psychiatry and psychoanalysis that mothers determined their children’s psychological development, in the late 1940s Kanner said that autistic children withdrew into autism to escape their cold, unfeeling mothers who did not display maternal warmth. For him, autistic children were kept in “refrigerators that did not defrost.” A 1948 piece in Time magazine, “Frosted Children,” announced Kanner’s change of heart. Without any evidence describing mechanisms by which mothers could make such a change in their children, the refrigerator mother was born.
Mothers were often categorized as emotionally cold simply because they had intellectual interests or wanted to work outside the home. Any mother who had aspirations beyond caring for her child was automatically suspected of being a bad mother. Although Kanner was the originator of the idea, the refrigerator mother has since become associated with the name of psychoanalyst Bruno Bettelheim. This connection was not completely undeserved. Though he never used the term, Bettelheim laid plenty of blame on the mothers of autistic children without providing any empirical or clinical support for his views.
Sadly, myths can have real consequences for real human beings, and the refrigerator mother myth deeply hurt mothers and autistic children. Just imagine: Your infant cries a lot, does not reach out to you, and does not eat well. You are sleep-deprived and worried sick. When you consult specialists, they say it is all your fault. Though you may behave and feel like a good mother, they tell you that deep down you reject your own child. This was devastating to many mothers, contributing to depression and anxiety that made it more difficult for them to take care of their autistic children. Clara Park, one mother who went to a child clinic with her autistic daughter in the early 1960s, said of the experience that she felt like she was “on trial.” She would later describe this time, which sent her into a depression, like this: “We know now in our skins that the most threatening of all attacks is the attack on the sense of personal worth, that the harshest of all deprivations is the deprivation of respect.”
The refrigerator mother theory was just as cruel for autistic children. Instead of providing support for these children, many psychiatrists and psychoanalysts recommended therapy for their mothers. Some influential ones, such as Bettelheim, also recommended that autistic children be taken away from their mothers as quickly as possible. For most autistic children, the disruption of their lives and the absence of a supportive family environment had damaging consequences. Many of them ended up in poorly run institutions that did not meet their most basic needs. And the focus on refrigerator mothers took away time and resources needed to understand autism and develop supports for autistic people. The idea also led to underdiagnosis for autistic kids from nonwhite families who weren’t middle or upper class, because doctors didn’t see their mothers as “intellectual,” as they might wealthier white women.
Parents, researchers, and autistic advocates spent several decades reaching an understanding of the condition that encompassed all of its complexity. In the United States, Bernard Rimland, psychologist and father of an autistic child, published a book arguing that autism was a biological condition in 1964. A year later, parents formed the National Society for Autistic Children. In 1967, Park challenged the scientific establishment and dared to say that a mother could have intellectual interests without damaging her children’s psyches. Intelligence and love are not natural enemies, she boldly proclaimed. Other mothers of autistic children, including Ruth Sullivan, Margaret Dewey, and Frances Eberhardy, raised their voices as well. Solid research showed that autism is a complex neurodevelopmental condition that manifests itself in different ways. Lorna Wing, British psychiatrist and mother of an autistic child, helped to get autism defined as a spectrum. Autistic advocates have since successfully fought for social supports and for ending the stigmatization of autistic people.
The idea of the “Tylenol mother” sets us back decades on all of these fronts. By oversimplifying the causes of a multifaceted condition, the focus on acetaminophen will distract from serious research on the complex ways the interaction of genetic and environmental factors leads to the different forms of autism. By presenting autism as a disaster of apocalyptic dimensions (“horrible crisis” and “one of the most alarming developments in history”), Trump negated the diversity of autism and overlooked the perspective of many autistic people who have embraced their autistic identity. That encourages the stigmatization of the condition once again. And by putting the focus on the behavior of pregnant women, his administration implies that mothers are to be blamed for their children’s conditions. Trump called on pregnant women in need of medication to “tough it out.” By implication, a gestating woman who takes acetaminophen would be “weak” and risk harming her fetus. In short, she would be a bad mother. Can you imagine the stress on a pregnant woman? We went from the emotionally cold refrigerator mother to the weak-willed Tylenol mother, perpetuating the scrutiny of pregnant women, the suspiciousness about mothers’ behaviors and feelings, and our culture’s general habit of mother blame.
Prenatal factors that can affect a fetus’ development do exist, and are very important, but we must research and discuss them in ways that don’t blame mothers, create public alarm, and contribute to new harmful myths. Mothers, in fact, are the first ones who want to avoid harming their children. In the past, we asked women to give up their careers for the sake of their children. Despite the alarmist warnings, there was no evidence that their having a job harmed children. Today, are we going to ask pregnant women to risk their physical well-being and increase their anxiety without sufficient evidence? The “Tylenol mother” idea comes at a time when mothers are also being blamed for causing ADHD by being too stressed out during their kids’ infancies—an idea unsupported by science, but so popular now as to be bandied about on Joe Rogan’s podcast.
We need to raise the bar for scientists and for politicians, and we need to stop blaming mothers. When scientists or science communicators exaggerate the significance of their findings, they undermine our trust in science. When politicians use poor studies as a basis for health policy, they undermine our trust in government. Scientific beliefs are powerful tools. Given that mother blame is still prevalent in our society, let’s be cautious when we make claims about how a mother’s behavior impacts her child’s development. As the history of autism shows, mother blame can have cruel consequences for mothers and their children.
