James Harris Discusses the Books Neurotribes and In a Different Key

 

Recently Jim Harris wrote a critical review of two published books dealing with the history of autism (JAACAP 55[8]:729-733, 2016). One of the books reviewed was Neurotribes written by Steve Silberman and the other was In a Different Key written by John Donvan and Caren Zucker. The book review was published in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) and the issue was introduced by an editorial written by Andres Martin entitled: Leo Kanner and Hans Asperger: Setting the Historical Record Straight (JAACAP 55[8]:728). As a side note, Dr. Mark Gilbert, who is Kanner’s grandson, for purpose of the book review, gave permission to JAACAP to reproduce a portrait of Kanner that is privately owned by the family.

It is of interest to note that Jim Harris is the Director of Developmental Neuropsychiatry for the Johns Hopkins Hospital and the Kennedy Krieger Institute. He is the author of my favorite textbook in neurosciences, a 2 volume treatise on Developmental Neuropsychiatry that won the Medical Book of the Year Award for 1996. Dr. Harris has won numerous awards for his continuous work on intellectual disabilities but, most importantly, Dr. Harris knew Kanner personally and what his patients and their families thought about him.

I must say that I sensed a certain amount of what could be called justified anger on part of Drs. Martin and Harris from their written pieces. The same was directed at Steve Silberman the writer who chastised Kanner and elevated Asperger to Sainthood as the proclaimed founder of Neurodiversity. The main conclusion from Dr. Harris’ review being that Mr. Silberman fudged the interpretation of historical facts/accounts in order to benefit his own biased account of Neurodiversity and how this biased perspective stood in counter position to the more balanced historical account offered by John Donvan and Caren Zucker.

The book review starts by elucidating the role of Leo Kanner in the history of Child Psychiatry. It emphasizes his advocacy for social justice and ethical treatment for those with intellectual disabilities, his belief that treatment should be individualized to the needs of each individual, and his stance against euthanasia- the latter in clear contrast to Asperger who actively participated in the euthanasia movement. In Neurotribes, Silberman attacks Kanner’s character rather than impartially discussing the available historical facts. Through Silberman’s eyes Kanner is seen as acting in “typically [emphasis mine] grandiose fashion”, and that his “capitulation to his powerful peers was as swift as it was brutal to parents.” According to Harris, Silberman writes that Kanner was a scientist who, by blaming the parents, “made the syndrome a source of shame and stigma worldwide while sending autism research off in the wrong direction for decades.” He then spends a distressingly long time suggesting that Kanner plagiarized Asperger through Dr. Frankl (a mutual acquaintance that worked in tandem for both of them). According to Dr. Harris Silberman is wrong in all of these accounts.

Kanner always believed that autism was born of an innate proclivity, a view embraced by present day science and multiple neuropathological and genetic studies. This view is too difficult to swallow for Silberman who upon upholding Neurodiversity’s credo tries to portray autism as a result of normal variability within the human phenotype. To uphold Kanner’s view Mr. Silberman would have to agree that autism is a medical condition with grave implications for many individuals. Moreover the fact that Frankl may have helped Kanner formulate his diagnosis of autism in a way that mimicked that of Asperger lacks credence. Frankl was primarily preoccupied with non-idopathic types of autism not the classical autism formulated by Kanner. Furthermore, even Asperger recognized that Kanner’s autism was different from what he had formulated. For those interested in Frankl’s involvement in the Kanner-Asperger diagnostic saga the same is amply discussed in https://corticalchauvinism.com/2016/03/07/neurotribes-how-the-cookie-crumbles/ .

Dr. Harris offers more severe criticisms of Mr Silberman’s portrayal of Asperger with data primarily derived from John Donvan and Caren Zucker in interviews with the Austrian historian of war atrocities Mr. Herwig Czech (see https://corticalchauvinism.com/2016/06/13/the-early-nazi-history-of-autism/). According to Dr. Harris, “Donvan and Zucker present a more balanced view of Kanner’s and Asperger’s contributions but, unlike Silberman, make clear Asperger’s compliance with the National Socialist Party (Nazis) in Vienna. They challenge Silberman’s portrayal of Asperger as resisting the Nazi agenda. There is evidence (Herwig Czech, personal communication, February 28, 2016) that Asperger took an oath to Hitler and accepted his racist policies. Silberman does acknowledge that to keep his hospital position, Asperger would have been required to sign a loyalty oath to Hitler….Each time Asperger applied for a post or a promotion, he was cleared as someone who, although not a party member, abided by Nazi principles in the performance of his job. In one instance, a party official wrote that he “conforms to the principles of the policy of racial hygiene” (Herwig Czech, personal communication, February 28, 2016). Czech presented this information about Asperger’s complicity with the Nazis at an Asperger retrospective in Vienna in 2010 and published his findings in 2011 and 2014.”

For those interested in learning more about child psychiatry and Leo Kanner, Jim Harris provided a podcast that is freely available at http://www.jaacap.org/pb/assets/raw/Health%20Advance/journals/jaac/jaac_pc_55_8.mp3. Otherwise Dr. Harris book review is full of references that can be checked, including those of Herwig Czech.

ChildPsychiatrist

17 responses to “James Harris Discusses the Books Neurotribes and In a Different Key

  1. (1) “Kanner always believed that autism was born of an innate proclivity,” (and)
    “that autism is a [“medical”] condition with grave implications for many individuals.”
    “~OR~”
    (2) “autism as a result of normal variability within the human phenotype.”

    But that is a false dichotomy. For some clarification of this, I will add here some bits from my forthcoming book.

    “Two clarifications on the above. Firstly, many people have been interested in finding whether there was something different about the brain of Albert Einstein. And yet if they did find such a difference they would not then conclude that it showed Einstein had a brain “disorder”. The brains of Obama and Trump are almost certainly visibly different from one another, but it doesn’t follow that one or other of them must have a “disorder”. Secondly, all humans have a shrunken, non-functional appendix. But it doesn’t follow that they can be properly described as having “shrunken appendix disorder”. And the gaps between our fingers are created by death of the cells between those fingers. These sorts of “gone wrong” facts in no way evidence let alone prove that a “disorder” or even maladaption is involved.”
    ….
    “…..please consider the dimension of personality from extraversion to introversion, specifically in people who are a bit inclined also to above-average neuroticism. An extremely extravert person would tend to be “pathologically” impulsive and consequently doing stupid things such as reckless criminal offences or dangerous acts. And an extremely introverted person would tend to be ”pathologically” shy and averse to commonplace noise and excitement. Both these extreme persons have serious problems but they are in no way due to a “disorder” they “have”. They just are as they are, by reason of natural variation (due to genes and or environment or something in the water).
    Likewise some people have lower IQs than others. Yet there is no level of IQ which can be said with scientific justification to be a boundary between “having” or not “having” of “low IQ disorder” (“mental retardation” or whatever the latest squirm-word is nowadays).”
    ……
    “…. an outright “disorder”-like symptom can still be the result of pure “normal” variation. This is exemplified by variation in height of humans and indeed of other creatures. Above a certain height, the gravity forces on the bones become excessive such that they tend to break or have joint failures. Of course in practice that causes natural selection to disfavour people being too tall, such that such problems in practice are rare. (I can think of other examples of the same principle but they would take too much space to explain here, especially as one such suffices anyway.)”

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  2. While the Silberman book was being heavily promoted in the bookshops “best-seller” spots, I chanced to find the Different Key book in a library. Both books are severely defective in their accounts of the increase of autism, which is the most important thing in any history of autism research. Both would have their readers believe that the increase has not been real, and are very sloppy in their omission of any proper discussion of it. (Neither even have any graphs or stats!) Again this is more fully discussed in my forthcoming book but I’ll put some outlines here.

    If it were true that it’s just a change of labels or of increased recognition, then all the earlier generations of parents and professionals and teachers must have been outstandingly incompetent not to have noticed the asserted many thousands of the “lost generations”. Kanner and Asperger specifically stated they were describing a new discovery, which was quite distinguishable from mere low IQ. Indeed the antiinnatia theory states that ordinary low IQ is the exact opposite of autism in its causation. So not suprisingly the ordinary retarded are/were quite unlike autistics, being typically social rather than aloof, sheepish rather than anti-conforming, and crude-looking rather than “intelligent-looking”.

    Due to their abysmal mis-accounts of the catastrophic increase, I find neither of these books remotely recommendable unless in terms of their accounts of earlier decades. Unfortunately in a corporate-capitalist driven system, the worst (most corruption-friendly) books get the most promotion and the best get the least.

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  3. Great comment Robin. The only thing being that Silberman actually goes out of his way to indicate that there has been no real increase in the prevalence of autism. In that regard I find your comment quite complelling, “If it were true that it’s just a change of labels or of increased recognition, then all the earlier generations of parents and professionals and teachers must have been outstandingly incompetent not to have noticed the asserted many thousands of the “lost generations”.

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      • Timelord wrote: The fact that you won’t junk the vaccine myth as an example (Yes I looked you up) backs that up.

        Hmm. It’s difficult to interpret those words other than as yourself having a hallucination. I have been an active disbeliever in the “vaccine-damaged-children” concept for more than a decade, not that I was ever a believer anyway.
        I’m sorry but I don’t think I can do much more to help you. My previous comment here is just proving even more accurate. Just in case it helps I’ll repeat it:
        “Sorry Timelord, but there are some people who merely don’t know something and there are some other people who don’t even know that they don’t know something even when they’ve been told they don’t know it. Sadly you come into that latter category. Cheers….”

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    • But, Manuel, we have learned a great deal since the 40’s and also remember that psychiatry was only in it’s infancy. At the time when Freud was the norm (and has since been totally bunked) Kraepelin was junked – and both Kanner and Asperger may have been guilty of that error. More recently it has been found that in fact Kraepelin was right – and he definitely did work on what we now call Autism back in the late 1800’s. He called it “youth dementia” at the time. So the assertion of “new discovery” at the time was in fact false.

      I suspect Harris is a Kraepelin sceptic, so he shouldn’t be relied upon when it comes to criticising Steve Silberman.

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      • Good comment. I was only aware of Beluler having used autism in the context of schizophrenia; however, given the many historical accounts of autism-like cases in our past, it does not surprise me. Thanks (and glad to have you back)

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      • “I was only aware of Bleuler having used autism in the context of schizophrenia;”
        – He was using the word autism to label a feature of some schizophrenia, but it’s important to recognise that terminology and conceptology(?) don’t always coincide.
        “[Kraepelin] called it “youth dementia” at the time”.
        And also Dr Down of Down syndrome fame described something very like both early and late onset autism in 1887.
        “So the assertion of “new discovery” at the time was in fact false.”.
        Yes and (…no…). Discoveries can often be ignored for decades till someone actually “discovers” them to the sufficient extent that they become “knowledge”. . .
        psychiatry was only in its infancy.”
        Much truth there re for instance Freudism, but, hmmmmmm. It could be useful to take a look at the comprehensive historical review of the increase of “insanity” written by E Fuller Torrey, 2002, The Invisible Plague. Talking of which and of undiscovered discoveries, that author 30 years earlier had tried to publish his case that most insanity was a recent occurrence, but it had been prevented from publication, as has my own paper citing it. And how many ahem expert people have taken any notice of his 2002 book even now?

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      • Sometimes writing things can be fun. Not least the sentence in my book as follows:
        “Indeed the “thinker” Atul Gawande recently expressed alarm at the level of distrust of his “science” while successfully failing to take a hint from the fact that the more educated are the more distrustful.”

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      • Robin I hope you see this because I had to click reply on my comment instead of yours.

        I’m not familiar with the book you are referring to, but at a guess it would have been about what was missed under the generic term “mad” – which in the old days (when Kraepelin and Bleuler were doing their work) covering pretty much everything that wasn’t seen as “normal”. That would certainly make for some fine research, applying modern medicine to the days when medicine was far more primitive. Heck I don’t think there was anything that resembled psychiatry until World War 2. It was all either pills, or the asylum, or maybe an exorcism or two! It’s why many Autistics at the time didn’t survive very long, especially the low functioning. But no one will acknowledge that. A few years ago I tried to find a way to start a review of the old asylum records here in Victoria, Australia – but I ran into a privacy barrier. I’ve been meaning to follow up on that as I think its very important. That’s my take on it.

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      • I’m not familiar with the book you are referring to, but

        Some of your comments suggest it would be good to get to see a copy.

        at a guess it would have been about what was missed under the generic term “mad” – which in the old days (when Kraepelin and Bleuler were doing their work)

        K and B were not “the old days” from the pespective of Torrey’s book. It goes back several more centuries to when mental problems were very rare. Subtitle is “The rise of mental illness from 1750 to the present”.

        That would certainly make for some fine research, applying modern medicine

        Torrey’s book IS that research, it was a very major research operation.

        to the days when medicine was far more primitive.

        Gosh what a naive thought. Correction to “to the days when medicine was far less corrupted and evidence-denying”.

        Heck I don’t think there was anything that resembled psychiatry until World War 2. It was all either pills, or the asylum, or maybe an exorcism or two!

        Again your lack of familiarity with the book (and psych history generally) is evident. The obsession with pills came in AFTER the ww.

        It’s why many Autistics at the time didn’t survive very long,

        There is not the slightest evidence that there were “many” autistics at that time. On the contrary. Well, I speak only for outside of Australia. Maybe people’s sons and daughters could just die off without much fuss in Australia back then?

        But no one will acknowledge that.

        Is there any evidence that there’s any such fact that could warrant being acknowledged anyway?

        A few years ago I tried to find a way to start a review of the old asylum records here in Victoria, Australia – but I ran into a privacy barrier.

        In the modern perverted “ethics” of contemporary bureau-rats, “confidentiality” (a bogus concept worshipped by authoritarians) is infinitely more important than trivialities such as honesty and transparency and actually knowing the facts of matters. So as to protect the corrupt rather than the whistleblowers. But it doesn’t follow that all allegations and suspicions are true.

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      • K and B were not “the old days” from the pespective of Torrey’s book. It goes back several more centuries to when mental problems were very rare. Subtitle is “The rise of mental illness from 1750 to the present”.

        That’s rubbish and a good reason to show contempt for Torrey. That comment is ignorant because it assumes there was no mental illness in the human race prior to 1750. In a time when religion was the dominant “science” mental illness fulfilled the same criteria as “mad” at the time of Kraepelin and Bleuler. Such people existed and were killed or cut off from society.

        Correction to “to the days when medicine was far less corrupted and evidence-denying”.

        Corrected back to what I said previously. There is just as much corruption in medicine now as there was then – and the enemy is the same one. Science sceptics. The only difference is back then the enemy was based in religion. Now it’s coming from another direction. Medicine WAS primitive back then! We didn’t have penicillin, novocaine and a whole plethora of others things that WORK! Not to mention improvements in surgery techniques. At the time of Bleuler, who would have thought transplants of body organs would even be possible? And that’s just one example.

        You need to start your research again, and junk Torrey. From what you have said, he’s an idiot who has no idea. I can name FOUR Autistics from the 16th century or thereabouts. Wolfgang Amadeus Mozart is the biggest name. There is also Jedidiah Buxton, Gottfried Mind and the Wild Boy of Aveyron. Autistics were in the asylums. Before there were asylums there were some religions that actually cared and monasteries protected them if they weren’t killed first. It makes no sense that a genetic condition would just appear out of nowhere. Eccentricity goes back to ancient Greece – and that is a key element to the Autistic spectrum.

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      • That comment is ignorant because it assumes there was no mental illness in the human race prior to 1750.

        Well, you do seem to be an expert in (wilful) ignorance yourself! Congratulations on getting hold of a (rare) copy of Torrey and reading its 200,000 words at such an impressive pace. Until you’ve really done that I don’t think your quasi-rebuttal of what you assume to be in Torrey’s book warrants any more reply here.

        And talking of proud exhibitions of profound ignorance…..

        I can name FOUR Autistics from the 16th century or thereabouts. Wolfgang Amadeus Mozart is the biggest name.

        As the son of a mother who has conducted many concerts, and was accepted as soloist at Covent Garden Opera, I am VERY familiar with Mozart’s life and music. The notion that he was autistic is utterly bonkers. He was not even remotely autistic. His operas such as Cosi Fan Tutte, Don Giovanni, and Marriage of Figaro show a profound intuitive understanding of other minds which is the very antithesis of any autism diagnosis.

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      • Well that proves you don’t have the required understanding of Autism. When an Autistic is involved in a special interest, the intuitions are still there. I know that through personal experience. It’s outside those interests that the Autism becomes noticeable – as it was with Mozart’s social habits which were described as “bizarre”. If you REALLY knew about his life you would know that.

        Ditto knowing really about medical history. You have a poor source – that’s obvious, and I don’t need to read 200,000 words from it to know that. My research over almost 20 years would probably break a million words by now – and they say you and your source are wrong.

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      • Sorry Timelord, but there are some people who merely don’t know something and there are some other people who don’t even know that they don’t know something even when they’ve been told they don’t know it. Sadly you come into that latter category. Cheers….

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      • You just proved that you don’t respect those who are at the coal face. And if you persist in promoting such rubbish you are a threat to Autistics and the understanding of the condition both presently and historically. You described yourself in the latter part of your statement, believing poor sources that contradict common sense. The fact that you won’t junk the vaccine myth as an example (Yes I looked you up) backs that up. Autism goes back to Adam and Eve and all points in between – metaphorically speaking.

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