Shameful tale of an ugly duckling

Psychoanalysis tells us that behind every idealisation lurks a covert denigration: we create gods and then find their feet of clay in order to contain our envy. Psychoanalysis has had its fair share of debunking recently, fuelled no doubt by the personal and cultural discomfort that this protean subject evokes. Bruno Bettelheim's death in 1990 unleashed a spate of claims depicting him as a plagiarist, a liar and a sadistic terroriser of autistic children and their families, rather than the liberator he purported to be. Spurning journalistic half-truths, this well-researched biography manages to present a balanced picture of Bettleheim's complex and at times contradictory character. It spans his life from its origins in the Jewish middle classes of Vienna in 1903 to his lonely death by suicide in a Washington "retirement residence".

Although he occasionally denied this, Bettelheim was not formally trained in psychoanalysis or child psychiatry. But growing up in the Vienna of Freud and Mahler and Schnitzler it was impossible not to be influenced by psychoanalytic ideas: "everyone" was in analysis, many of them with Freud himself. Bettelheim and his first wife, Gina, to whom he was unhappily married during the 1930s, successfully fostered a disturbed American girl while Bettelheim was running the family lumber business; he had a year of analysis with Richard Sterba in 1937; and, encouraged by Trude, who was to become his second wife after they had emigrated to America, he took a PhD in the psychology of aesthetics. These were the qualifications of the man who was to become a world expert in psychoanalysis and child care.

Perhaps the greatest irony of Bettelheim's life was the impact of his year in Dachau and Buchenwald in 1938. He had always considered himself weak and physically inadequate; in the camps he discovered a strength of mind and imagination that enabled him to survive. He forced himself to view his incarceration as a grotesque psychological experiment that he had to observe and learn from. In this way his spirit remained intact. When he was released, thanks partly to some high-level intervention from America involving Eleanor Roosevelt, his compelling account of the experience, later expanded into the classic The Informed Heart was, on Eisenhower's orders, distributed to troops entering the camps.

The camp experience was the turning point in his life. He moved to America, happily married Trude, and through his work in the "Orthogenic School" discovered his charisma and intellectual power in a country hungry for European ideas and wisdom. He was determined to use his experience in the camps as a model for the origins and treatment of autism. The Empty Fortress portrays the family of the autistic child as cold and anti-life; Bettelheim's simple answer was the combination of loving concern based on making the child feel special and encouragement to express the rage and hatred he felt lay at the heart of these children's inability to relate to others. Here, too, we find contradictions. Bettelheim advocated almost impossible standards for his counsellors who were required always to put the children first and never to criticise or retaliate; yet he himself ran the school in a thoroughly autocratic manner, was often irascible and even on occasions struck the children. More significantly, so determined was he to insist that autism is psychogenic in origin (that is, the result of faulty emotional upbringing), and that its treatment should be psychotherapeutic, that he turned a blind eye to the scientific rules of evidence that would have argued that his good "results" were highly selective, and to the mounting body of opinion suggesting that autism is organic in its origins, even if its manifestations are psychological and interpersonal.

Unlike Freud, who despite his cultural breadth never wavered in his espousal of science, Bettelheim, like Jung, belongs to the hermeneutic, romantic wing of psychology.

Bettelheim's central message was the need to find meaning in experience, however painful or inhuman it appears to be. He believed it was this that enabled him to survive the camps, and what could liberate the troubled children of the Orthogenic School. The Uses of Enchantment, his delightful account of the importance and underlying psychological significance of fairy tales, shows how stories give shape and significance to the developmental tasks of childhood: separation from parents, overcoming envy and jealousy, the excitement and threat of sexuality: signposts through the troubled pathways of infancy and adolescence. When Bettelheim's hard-won meanings collapsed at the end of his life - physically ill, deprived of the support of the ever-loyal Trude whom he had always expected would outlive him - despite continuing accolades and invitations to speak around the world, he became a strong advocate of euthanasia, and eventually decided to take his own life.

Nina Sutton, despite never having met Bettelheim and being a journalist rather than a psychotherapist, speculates interestingly about her subject. She sees him as suffering from what she calls "shame", a narcissistic wound present from birth when he was perceived by his mother as ugly and handed over to a wet nurse - he never lost the sense of his ugliness. This feeling of shame was compounded when he discovered that his father suffered from syphilis, compelling Bettelheim to take over the family business rather than follow his preferred academic career, and leading to inhibition of his own sexuality and difficulties in his first marriage. Fascism and political persecution reinforced his sense of being a shameful outsider. Bettelheim's survival, his happy second marriage, and his success as a therapist fostered the healthy self-love that had eluded him as a child, but this once more collapsed at the end of his life, leading to despair and self-destruction.

The book is full of fascinating detail, especially about Bettelheim's early years and the end of his life, but it cannot be considered the definitive account. Like so many contemporary biographies, it is overlong and too discursive. It veers between being a "life" and a series of extended rather personal essays about Sutton's views on Bettelheim's Jewishness, his attitude towards Israel, his alleged plagiarism, whether he was really sadistic towards the Orthogenic children, among other topics.

The book is generally readable and passably translated from the French but at times descends into a psychoromantic style. For example: "In matters psychological - for that indeed is what is at stake here - there are no bad marks to be handed out. Just feelings to be recovered." But the main disappointment is that no real attempt is made to evaluate Bettelheim's writings and theories in a critical way or to demonstrate the exceptional clarity and persuasiveness of his thought. One ends up wanting less Sutton and more Bettelheim - but that, I suppose, could be a good outcome for a biography.

Jeremy Holmes is consultant psychiatrist/psychotherapist, North Devon District Hospital, Barnstaple.