I recently began reading the book “In a Different Key: The Story of Autism” by John Donvan and Caren Zucker. Given the fortuitous coincidence that Steve Silberman recently published a book (Neurotribes) on the same subject I thought that it would be worthwhile comparing both efforts. Overall I thought that Steve Silberman’s journalistic integrity was compromised by an overt bias in getting the Neurodiversity message across to his readers at the cost of massaging historical facts.
Mr. Silberman has received a lot of publicity regarding Neurotribes and his work won the prestigious Samuel Johnson Award. Among many interviews, one with The Financial Times on 11/6/15, stands out. In answering a question by a reporter Mr Silberman said, “As a writer, my worst fear is writing something that I think is good but that someone who really knows the field knows is mawkish newbie poppycock”. Mr. Silberman’s fears have come true and his own words aptly describe the value of his work and literary contribution.
As I have said before (bit.ly/20XerV3), according to Mr. Silberman, “…the history of autism is one of heroes and villains. In Neurotribes Leo Kanner is given the distinction of being dressed with the dark cloak of a villain. Indeed, Kanner is depicted as an ostentatious, if not pedantic, academician who inexcusably blamed parents for their children’s misfortune by coining the term refrigerator mothers. Silberman’s provides a glimpse into Kanner using tinted glasses. Indeed in concluding the work we must presume that Kanner was a fraudulent researcher who evidently plagiarized the work of Asperger. In all of this, Asperger remains a saint, the hero of the story, who barely survived the Nazi regimen while remaining a good Catholic man. In this role Asperger is portrayed as the embodiment of Neurodiversity ideals. All of the above assertions, the core of Mr. Silberman’s book, are incorrect or unsustainable and only reflect his personal bias.” I have already given evidence that counters Mr. Silberman’s perspective on Leo Kanner (bit.ly/20XerV3).
I realize that the title of this blog is worded in strong terms and that the same may be misconstrued by some readers. The title was meant as a play on words with “Neurotribe” and the fact that his anointed saint of the Neurodiversity movement was a Nazi sympathizer. Indeed, Asperger (aka Silberman’s mentor) rose through the Nazi ranks to occupy different positions of prestige within the government while passing the scrutiny of officials as to his personal ideologies. Despite of this Asperger’s role in the Nazi movement is absolved by Mr Silberman; “The most important lesson is not that brutal regimes like the Third Reich enable evil men to do evil, but that they are able to compel even well-intentioned people to do monstrous things” (n.pr/1NlHQ0r). In disingenuous fashion Mr. Silberman provides counter evidence to Asperger’s Nazi involvement by claiming that the Gestapo came twice to arrest him. This account was based on Asperger’s own assertions. As stated in my previous blog, and corroborated in Donvan and Zucker’s new book, this was a common way for many people in the postwar era to distance themselves from the Nazis.
Among known monstrosities, Asperger signed a letter condemning a little girl, Herta Schreiber, to the Spiegelgrund facility. Herta died after 2 months of poisoning with Phenobarbital. The drug depressed her consciousness making her choke on her own body fluids. As liquid filled her lungs little Herta slowly suffocated. Her death certificate read pneumonia as cause of death. In 1942 Asperger was the senior pediatrician in a commission that reviewed the health status of 210 children in an Austrian institution. Thirty-five of the children were deemed by Asperger as “non-educable”. The consequences of such a description was well known to members of the commission; it was their death warrant. To my knowledge the charges against Asperger were never disputed even by members of the hospital where he worked.
Contrary to Mr. Silberman I do not defend or condone these murderous actions. Mr. Silberman’s callousness is articulated in his book Neurotribes where he glorifies autism by exalting its gifts but failing to emphasize its handicaps, drawbacks or comorbidities. This fact is agreed upon by Mr. Silberman himself who in a Forbes magazine interview stated that he had left out the diaper wearers and head bangers because, “If we live long enough, we all become ‘diaper wearers’ eventually…Disability is a part of the human experience.” Again, this is NOT the case. Head banging or wearing diapers is not part of our human experience, no matter the age of the person. Mr. Silberman should stop callously minimizing some of the symptoms observed in autism spectrum disorders. As is now too common to Mr. Silberman his statements are insulting to those who are most seriously disabled and to the families who are taking care of them.
It seems that Mr. Silberman knew of the existence of documents proving Asperger’s involvement with the Nazi’s eugenics movement. Although no explanation is provided as to why this was not mentioned in his book, he now claims that future editions will clarify this fact. This new edition will have to be extensively re-written. Silberman’s attempt at character assassinating Leo Kanner has to be revised. Kanner was a compassionate clinician and an advocate for better services and accommodations for disabled individuals. The suggestion in Neurotribes that he slighted Asperger by not mentioning him for the rest of his career is false. Kanner did mention Asperger at least twice in published records. The suggestion that he stole the diagnosis of autism from Asperger is equally false. Both Kanner and Asperger believed that based on the clinical presentation of their respective patients that they had described different conditions. In the same tone, contrary to the suggestion in Neurotribes, Asperger was not keen on diversifying or broadening his diagnosis scheme. There are also the many little mistakes that make Neurotribes a difficult read to those who are aware of the literature, e.g., Asperger never used the term “Little Professors”. Maybe it is not a revised edition that needs to be written but a completely new book…Mr. Silberman should check his mailbox regularly. He may soon find a letter retracting the Samuel Johnson award.
Personally I agree wholeheartedly with the aims of Neurodiversity to provide necessary accommodations. This is something that both parents and disabled individuals have been doing together for a long time, way before Neurodiversity began. However, I also see the need for further research and treatment for those who need the same.
In the future I will provide a better criticism of the book, “In a Different Key: The Story of Autism”. At present I just wanted to offer a contrast to Steve Silberman’s Neurotribes. I exhort the reader to buy both books, read them, and come to their own conclusions.
Cortical Chauvinism 
Silberman claims that Czech, the person who provided documentation of Asperger’s involvement with the nazi’s would not give him access to the work. If this is true, it is not clear why Donvan and Zucker got a monopoly on this data.
Neurodiversity’s goal is not to help with necessary accommodations, but it is to claim there is no need to do research on autism to find better treatments, but that acceptance and accommodations will solve everything. You can check out Ari Ne’;eman’s interview on NPR where he said autistics were only disabled by society, as well as the documentation of his statements denying autism is an intrinsic disability that I have provided on autism’s gadfly over the years.
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Neurodiversity is a moving target. Once you try pinning them down on one assertion they will deny the same and move on. What I say in regards to research and treatment will be accepted by some and denied by others within the group. Hope your book is progressing along.
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Language development is the most serious handicap of autistic children. Maturation of the language areas of the cerebral cortex continues during the first 5 to 6 years of childhood, and maturation is guided by trophic neurotransmitters produced in the brainstem auditory pathway [see references 1-3 below].
The auditory pathway is fully myelinated before birth [1]. The auditory pathway also has greater blood flow and aerobic metabolism than any other area of the brain [4, 5].
Autism is often associated with complications at birth. The auditory pathway is prominently damaged by 6 to 10 minutes of asphyxia at birth, with subsequent disruption of maturation [6].
I have just read your excellent article on cell migration abnormalities, and a final common pathway of injury by autism’s many different causes [7]. In addition to the germinal matrix, the auditory pathway should be considered a possible final common pathway for injury by many of autism’s causes. Prenatal valproic acid exposure also leads to auditory pathway damage [8].
Thank you for questioning these books written by journalists, who can’t even begin to discuss brain development.
Patience (aka: Eileen Nicole Simon)
REFERENCES
[1] Yakovlev PI and Lecours A-R. The myelogenetic cycles of regional maturation of the brain. In A. Minkowski (Ed.), Regional Development of the Brain in Early Life (pp. 3-70). Oxford: Blackwell Scientific Publications, 1967.
[2] Moore JK, Linthicum FH Jr. The human auditory system: a timeline of development. Int J Audiol. 2007
[3] Friauf E, Lohmann C. Development of auditory brainstem circuitry. Activity-dependent and activity-independent processes. Cell Tissue Res. 1999.
[4] Kety SS. Regional neurochemistry and its application to brain function. Bull N Y Acad Med. 1962 Dec;38:799-812.
[5] Sokoloff L. Localization of functional activity in the central nervous system by measurement of glucose utilization with radioactive deoxyglucose. J Cereb Blood Flow Metab. 1981;1(1):7-36.
[6] Faro MD, Windle WF. Transneuronal degeneration in brains of monkeys asphyxiated at birth. Exp Neurol. 1969 May;24(1):38-53.
[7] Casanova MF. Autism as a sequence: from heterochronic germinal cell divisions to abnormalities of cell migration and cortical dysplasias. Med Hypotheses. 2014 Jul;83(1):32-8.
[8] Lukose R, et al. Malformation of the superior olivary complex in an animal model of autism. Brain Res. 2011 Jun 29;1398:102-12.
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In my previous article I commented that migratory abnormalities affected not only the cortex (periventricular germinal cells) but also the rhombic lip and therefore the brainstem/cerebellum. As an aside I must say that my own grandson is nonverbal. Soft tissue X-rays of the neck have shown a displacement of the larynx. I have seen this now in several other patients.
Thanks for the comment.
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I always wondered which could have been the reason/s that Dr. Asperger did not complete his paper in 1944 with a medical speculation describing plausible causes of his patients’ behavior. His judgment could also have been colored by the ideology of his days. Children in a Nazi regime were seen in a way that made them feel that they belonged to a superior race. And so any behavior that did not fit the «straitjacket» of preestablished ideological fabrications could readily be deemed as «abnormal.»
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…or maybe the parents believed that their children should be superior due to the ideology of the Third Reich. I have to imagine that the stigma posed by these conditions was much greater in that scenario.
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I wonder if Neurodiversity would have flourished if they knew that Asperger had associated with the Nazis.
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I think that somehow Steve Silberman will find a way of backtracking his book. In the future edition Asperger will no longer be the saint of Neurodiversity.
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Dear dr. Casanova,
Greetings from the Netherlands! I am currently working on a book about the history of autism and recently came across your blog, which is very helpful and informative.
Having read your posts, I have a couple of questions.
(1) In one of your posts on Silberman’s Neurotribes you write: ‘The suggestion in Neurotribes that [Kanner] slighted Asperger by not mentioning him for the rest of his career is false. Kanner did mention Asperger at least twice in published records’. Silberman only cites Kanner’s dismissal of Asperger in a book review which I have been unable to find: ‘The name is Asperger, and the man, at that time, could have no knowledge of Kanner’s publication; instead, he independently described what he called «autistic psychopathy,» which, if at all related to infantile autism, is at best a 42nd cousing which merits, and has received, serious attention from investigators’. Silberman then goes on to suggest that the main reason Asperger’s work remained unknown in the US was because Kanner never referred to it. Do you perhaps have a copy of this book review + of the other two articles in which Kanner refers to Asperger? I am very very curious.
(2) In another post, you cite two other articles by Kanner which I haven’t been able to find and would very much like to read:
1) Kanner L. The integrative aspects of ability. Acta Paedopsychiatrica 38(5):134-44, 1971.
2) Kanner L. Infantile autism revisited Psychiatry Digest 29(2):17-28, 1968
Do you perhaps have copies of these texts as well?
Hopefully you can help me out, that would be amazing! Speaking of the pioneers of autism research: have you ever come across Annemieke van Drenth’s work? In the Netherlands, a couple of researchers in the city of Nijmegen in the late thirties borrowed Bleuler’s term ‘autism’, and described a couple of children in practically the same way as Asperger and Kanner, without being familiar with their work. These researchers are practically unknown internationally, and even many Dutch autism experts have never heard of them. For Van Drenth’s article, see https://onlinelibrary.wiley.com/doi/abs/10.1002/jhbs.21884
Kind regards, and keep up the good work!
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Contact me through email and I will be happy to try and help as much as possible. My email is manuel.casanova@louisville.edu
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