The following is a blog written by one of our readers, Ms. Claudia Mazzuco. In the blog Claudia reviews Steve Silberman’s recently published book “NeuroTribes: The Legacy of Autism and the Future of Neurodiversity”. Contrary to Mr. Silberman I steadfastly believe in research and medical treatment for those autistic individuals that may need the same. Although Mr. Silberman’s writings are of great interest to me, I have not read his book and will therefore forego providing an opinion of the same. In the meanwhile, I invite readers who have read the book and Claudia’s book review to provide their own comments.
Claudia Mazzucco is a writer, researcher, historian, editor and teacher of the history of golf. She was born in Santiago del Estero, Argentina, and was diagnosed with autism in the summer of 2001 in London. Claudia is an advocate of the notion that it is worth knowing the differences between the symptoms of possible autism and problem behaviors that look like autism but they are not. At the root of a spectrum that keeps getting bigger and bigger, she concluded, is the tendency in American society to categorize an increasing array for normal childhood reactions to stressful life situations as proof positive of a neurological disorder. She supports very strongly scientific research, both for curing autism and helping individuals with Asperger to find acceptance and integration.
What does Dr. Hans Asperger say about autism? The answer is: it is not schizophrenia.
“Autism” is not some isolated deviation from acceptable behavior that was found floating out there in the ether. The roots of autism are partially embedded in the highly imaginative speculation of modern psychology. It is too obvious that Dr. Asperger had become acquainted with the term “autism” which appeared in German language writings before eventually moving into English and other languages. The Swiss psychiatrist Eugen Bleuler (1857–1939) was the first to use this term in a 1908 speech. Later, Bleuler said in Dementia Praecox (1911) that “autistic schizophrenics” are “the most severe schizophrenics, who live in a world of their own.” Here the formal entrance of autism as a characteristic of schizophrenia is of uppermost concern, for it provides the proper context within which to discuss the work of Dr. Hans Asperger.
Let Asperger Be A Pediatrician
We must let Dr. Asperger say what Dr. Asperger meant. First, we can only discuss what the paper of Asperger actually contains, not what we would like it to. He sought a fundamental difference and proposed to use the label autism for, and only for, drawing a distinction between the abnormal personality structure of the children he was concerned with and the fundamental disturbance of contact that is manifest in an extreme form in schizophrenic patients. “Autism is the paramount feature in both cases,” he wrote. “Essential symptoms of schizophrenia and the symptoms of our children can thus be brought under a common denominator: the shutting-off of relations between self and the outside world. However, unlike schizophrenic patients, our children do not show a disintegration of personality. There are therefore not psychotic.”
Autism in the Time of Nazism
Second, to let Dr. Asperger say what Dr. Asperger meant, I’ve argued earlier that Dr. Asperger’s fundamental commitment to this “type” of children must be situated within the Austrian transition from perpetrators to victims, and that his conviction that autistic people have their place in society, must be seen not only as a response to the terrors of the Gestapo but, more importantly, as an effort to make good on his duties to set a boundary between normality and mental disorder. Here I would like to suggest that we should read Allen Frances’s mea culpa book Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, in a similar light. The coming of Nazism was catastrophic for Austria. During the Nazi occupation (from March 12, 1938 to 1945), children were exposed to a terrifying experience that they could not handle. Children react to war in a variety of ways. Emotional detachment and aggressiveness, indifference and disobedience, seem well justified by the circumstances. What could have gone wrong in Asperger’s children was the whole process of personal adjustment to the war and its circumstances. They found themselves isolated, betrayed, bewildered, and maybe even depressed. Their deviations from acceptable behavior could also have been due to acute post-traumatic stress disorder.
Dr. Asperger was fundamentally committed to his children in the time of National Socialism in Austria. We must not forget that many of his colleagues were part of the most extreme killing project, the most extreme human degradation in a regime of brutal racism. These children often differentiated themselves from others in the way they were capable of “dereistic thinking.” Bleuler intensified speculation concerning the nature of autistic or dereistic thinking by explaining it as guided by desires and affects and not goal directed. “Apart from schizophrenia, which it is at its most bizarre,” Dr. Asperger wrote, “autistic or dereistic thinking can also be found in people who are not psychotic, and indeed in everyday life, for example, in superstitions or pseudo-science.”
To reiterate: Dr. Asperger did not discover autism first. He explained autism only in relation to schizophrenia. Thus, he was not victimized by Leo Kanner who buried him in history – really, when you think about it, a highly improbable and infamous story – Kanner did not obscure the breadth and diversity of the spectrum because it is unlikely that Asperger experienced autism as something different from childhood psychopathy. It will always remain of cardinal significance to me that they both agreed in the essential conviction that autism was not an early form of schizophrenia. Again, Asperger’s work shows that there were no clinical signs of “progressive deterioration” and he did not expect irreparable psychotic breakdown in these children. “In essence, they remain the same throughout their life,” Asperger said, “though there is often improved adaptation, and many can achieve a reasonable degree of social integration.” Steve Silberman’s book, Neuro Tribes, while important, impressive and admirable in many ways, took creative license on these and other issues.
Third, before reading Neuro Tribes, readers owe it to themselves to read Autistic Psychopathy in Childhood, by Hans Asperger, translated and annotated by Uta Frith. Silberman affirmed that Dr. Asperger “saw autistic people as a subset of humanity that had accelerated the evolution of science and technology.” That description is nowhere to be found in his paper, because in the first place, Asperger did not put forward ideas about an “umbrella diagnosis” that covered profoundly disabled children and others who, in spite of their difficulties, come across as very bright.
Among the grounds for misreading his paper, one, particularly prominent, was that his children were not disabled. His first case was a boy called Fritz V. Fritz had an excellent apprehension of a situation and an accurate judgment of people. “He quickly learned to express himself in sentences and soon talked like an adult.” But “he shows a very severe impairment in social integration.” He felt puzzled and uncertain, as I also did, because he noticed the characteristic manifestations of autism were “not at all rare in children, especially in their milder form.” In short, Asperger’s autism (or this type of abnormally developing child) could be mitigated not through psychological treatment but by understanding, love and guidance. There was no reason for Dr. Asperger why these children could not achieve professional success, “as long as they are intellectually intact.”
Neither did Dr. Asperger expand the concept of autism to be a lifelong condition lasting “from birth to death,” as Silberman affirmed, not to be just a childhood disorder. That “they were a hidden thread in the weave of culture, and had always been here,” is unequivocally Silberman’s own train of thought, unrelated to the original work of Hans Asperger. It is highly probable that when Dr. Asperger spoke of the “persistence over time” of the autistic personality type, that was only to indicate that the condition of the child was not degenerating into schizophrenia. For, if profound social problems do not overshadow everything else, but are compensated by a high level of original thought and experience, one thing must follow: their relation with society could be dealt with in an intelligent way, but only when they could fulfil their social role within the community, especially if they find understanding, love and guidance. The self and the world need not be in conflict.
Did Dr. Asperger call these children “Little Professors”? Certainly, he did not. It is important to add that in Dr. Asperger’s account there is nothing, not a single reference to “little professors.” When Fred Volkmar, a child psychiatrist at the Yale Child Study Center, was conducting a large research project on Asperger’s syndrome in the 1990s, he distinguished children with Asperger from autism by their linguistic precocity. “Unlike the linguistically impaired autistics of the type depicted in the movie ”Rain Man,” Asperger’s children talk like little professor. They seem brilliant because they have this language,” Volkmar said to British writer and novelist Laurence Osborne. ”But in reality, it’s fact-obsessed, fact-oriented. It’s rigid and insular. It’s not a social brilliance. Usually, their social interactions are a disaster.” In his book of 2002, American Normal, Osborne called children with Asperger’s Syndrome “Little Professors,” a description all the more instructive in its introduction, no doubt sympathetic of Asperger’s sufferers.
Not that I look down on Silberman for having pursued the neuro divergent as an ideal. I am quite entertained by his efforts to make regular people look different. Most of what commonly passes for autism (or high-functioning autism) nowadays is clinically not autism at all. In my view, the concern with being different is the result of a double illusion. Neither the idea itself of the neuro tribes nor the attempt to achieve it is as Silberman supposed. But my amusement arises from the unavoidable disparity I see between what a “neuro divergent” person is imagined to be and its real character. He has taken artistic license with facts, shaping them so a coherent story will unfold with a beginning, middle, and end. What is most resonant here – and Silberman is representative – is the great distance between modern America and Dr. Hans Asperger. He said, “The more that I discovered about Asperger’s conception of autism, the more it struck me as incredibly prescient.” That is hardly the case. It does not ring true to those who have already read Dr. Asperger’s paper. I completely agree that Asperger feared that his patients were in danger of being sent to Nazi extermination camps. Yet all too often the recollection of the past is plainly created on the spot.
The very act of writing about Dr. Hans Asperger and his time is seventy years removed from the events he is recreating. This, however, did not prevent Silberman from assuming he really did know, that he really can describe them in full detail – just because the book contains such a gigantic bibliographical index – and this is how Neuro Tribes began. That is all a great, beautiful confabulation without which the story could not go on.
Hartford, September 4, 2015