Recently I had the opportunity to read an article by John Elder Robison. The same was titled, “Kanner, Asperger, and Frankl: A Third Man at the Genesis of the Autism Diagnosis”. The article was printed by the English publishing house Sage in their journal Autism and can be downloaded from http://bit.ly/2cApEZh. It is a lengthy 10-page original article that bears on the historical coincidence of 2 Austrians, Kanner and Asperger, coming to describe different tail ends of the severity spectrum of autism while using the same terminology borrowed from Bleuler. In this regard Robison points to the possible influence of Georg Frankl acting as a middle man between both Kanner and Asperger.
I was very impressed with the quality of John’s article. It marks a transition for John Elder Robison the bestselling author of different autobiographical accounts into a serious investigative journalist. The main point of the article, that Georg Frankl went from working with Asperger to working with Kanner, was brought to public attention by Steve Silberman in his book Neurotribes. However, John Robison expands on the story and gives a detailed documentation of this transition based on work he did at the Johns Hopkins archives, genealogical databases, Ellis island immigration documents, and a large number of articles in the medical literature.
At least in terms of Kanner, the queries as to how he came about diagnosing autism, bear in part on how he recruited his original series of patients. I must say that even though a lot of credit has been given to Silberman, Donvan and Zucker for bringing to light the medical record of Donald Triplett (patient 1 for Kanner) from Johns Hopkins very little praise has been bestowed on the person who originally discovered and published the same. This was the work of Dan Olmsted who published a series of articles on the subject in 2005. His main discovery was how Donald was given gold salts to treat a crippling disabling juvenile arthritis. The treatment was not recorded by Kanner, but according to Donald’s brother, the treatment cured his arthritis and some of the affective symptoms associated with his autism. In 2011 Olmsted published in a book the story of Donald along with all other participants from Kanner’s original series. This was several years before Silberman, Donvan or Zucker published their efforts.
What I like about Robison’s story is the ideas by which he ties Frankl’s love affair with Ami Weiss and brings it to play in the diagnostic controversy involving Kanner and Asperger. In doing so Robison talks about the Nazi prosecution of the 1930’s, Kanner’s generous nature as a sponsor of many refugees, Frankl’s contributions to the medical literature, and how the dreams and jobs of all of these important people became entangled at a particular chronological singularity.
Personally I like many of the insights offered by John Robison. One of them was the possibility that Asperger saw higher functioning individuals because, at the time, the Third Reich would have involved lower functioning ones in their euthanasia movement and killed them (this is something I have spoken about in previous blogs). Robison is also careful to point out the importance of many Jewish physicians in the early history of autism as well as in clearly defining some of the controversy involving the use of translated terms and their etymology. Lastly, I would like to point out that many of the clinical observations provided by John Robison are as astute as they are relevant. John is a very insightful individual.
Personally I disagree with the importance given to Frankl in the history of autism and have enjoyed a congenial email exchange with John on this matter . For those interested in reading a counter point to John’s arguments see http://bit.ly/1RI9asz . However, I must praise John’s effort in giving a balanced appraisal on the subject. The story he pieced together reflects several years of investigative efforts. This is a must read for anybody interested in the history of autism. They will find that 10 pages are too short and and that you are left wanting more. I wish this was the beginning of a book with a historical account from John’s own viewpoint.
Cortical Chauvinism 
I never really thought that the use of the word autism by both Kanner and Asperger’s was necessarily a bizarre coincidence since it had already been used by Bleuleur and he was such an influential individual at the time. Though Frankl may have worked with Asperger before Kanner, it is unclear how much influence he had in Kanner’s supposed stealing of the word autism and plagarizing Asperger’s work as Silberman implies in his book. So I don’t think even if Frankl had never been in the picture that there’s a good chance Kanner would have come up with the term autism on his own, even if he had never heard of Asperger’s work just because of Bleuleur’s use of the word to describe symptoms of schizophrenia.
I agree John Robison’s article was interesting, well-written, and provided a much greater balance than did Silberman’s work, though most of what Robison wrote was not really anything novel and I’m not sure how much the love affair between Georg Frankl and Anni Weiss contributed to the history of autism, but is more of an irrelevant side story.
I suspect John Robison will use this subject matter for his next book, so I think you’ll get your wish.
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Manuel, how about the following possibility. A major characteristic of autism (broadly defined) is lack of learning to behave in accordance with social normals.
In Austria under the Nazis, any child who didn’t quickly learn the correct way and timing of how to do the salute and so on, would stand out and be classed as problematic and in need of diagnosis and therapy.
Meanwhile the US in the 30s was culturally a free-living era of jazz and diversity. Any child who didn’t start reciting the Stars and Stripes or who smiled at a «n…..r» would be considered to be just exercising his right to liberty in the Land of the Free.
Hence mild cases would be much more picked up in Nazi-controlled lands. And as said above, the more severe cases would likely be euthanised there anyway.
It follows that while there remains the theoretical possibility that autism was manifesting differently in different countries, a sufficiently credible interpretation would be that it was merely a difference of recognition.
Meanwhile have you made any more progress with my book? I note above your reference to «a lengthy 10-page article» which I guess implies that a 360+-page entity would be outside the range of available adjectives?
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You are correct in all of your comments. I did read the 10 page article at John’s request, even though I was on my anniversary vacation, RIght now I am working on a chapter for a book I am co-editing and afterwards in my agenda will be still another chapter for a book Estate Sokhadze is editing. Baby steps, trying to overcome hurdles, one step at a time.
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Meanwhile the JADD journal started off titled «Journal of Autism and Childhood Schizophrenia». Hopefully we can blame the Nazis for that too, notwithstanding the 26-year gap.
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Maybe it would be worthy of still another blog on the subject. I think back then nobody, including Kanner, wanted to step on Lauretta Bender shoes.
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Hi Manny,
It certainly wasn’t my intent to dismiss Dan Olmsted’s tracking down Donald Triplett. I don’t know if that is relevant to the story I published in AUTISM, though. My inspiration came from reading NEUROTRIBES and DIFFERENT KEY, and being inspired to «dig deeper» for some of the answers to questions those books raised in my mind.
Funny you should mention those gold salts. My dad (also autistic) got those for years for arthritis in his knees. Was there a bad side effect associated with them? My dad died 10 years ago.
I know that you have a hard time seeing Frankl have as prominent a role in the transfer of knowledge as me, but I stand by what I found for evidence and of course you and I may interpret that evidence differently. That fact is, Kanner saw several cases in the mid 1930s that were later recognized as autistic on re-evaluation by Frankl That alone strongly suggests he brought significant new insight. Frankl first recognized impaired affective contact as the central observed issue in autism, and that too was very important.
You base a lot of your argument on the idea that «the people at Hopkins were really good.» But Manny, the University of Vienna Med School hospital was arguably the top such institution in Europe in the day. Kanner saw them as peers – he said so in many contemporaneous writings. That was why he wanted Frankl. To suggest otherwise is to me a slight on another very great institution.
Thanks for your thoughtful review of my paper, and your kind words. And best of luck with your vacation!
Woof
John
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Thanks you for the comments. I think the gold salts had serious side effects accounting for which they are not used so much anymore. The side effects were primarily seen on the skin and mucosa but I think kidney and liver damage/failure were also reported.
I think Frankl was another addition to Hopkins but his academic contribution came to almost nothing. I differ in the interpretation of his few articles. I have to believe that he had an associate faculty appointment and could never get tenure track, -but this is a question Jim Harris could probably answer. Otherwise, Kanner came on his own with the word autism as a diagnosis long after Frankl had left and mentioned so in a letter to Donald’s mother. Also from Frankl’s writings, he seemed interested in syndromic or non-idioathic cases rather than classic autism as espoused by Kanner. It was Kanner who upheld the neurobiologic basis of autism and who clearly tried to differentiate it in the literature from childhood schizophrenia. Kanner’s work and reputation grew not only because of one publication but because of many. He did the heavy lifting in clearing the hurdles to get autism recognized within the medical community.
I am editing this after the fact, but readers should be aware (and it comes across in your article) that Kanner probably saved Frankl’s life. Kanner gave Frankl a job at Hopkins and even though he could not make headway academically, he got him another job at another institution- not academically oriented. They were close friends until Frankl died.
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Hi John, you mentioning gold tablets that your father took for arthritis reminds me of my father in law who had rheumatoid arthritis and passed away age 75 some 15 years ago now. He was given regular gold injections http://www.arthritisresearchuk.org/arthritis-information/drugs/gold-injections/possible-side-effects.aspx
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John Robison states that there were several cases that Kanner saw in the 1930’s that Frankl saw and reevaluated as autism. This is another one of JER’s factual inaccuracies. Kanner saw one of his cases Alfred in 1935 who later came back to the clinic after Donald was evaluated who was Kanner’s first case and subsequently Alfred was given the diagnosis later. Frankl never evaluated Alfred. He only evaluated two of Kanner’s 11 patients, Donald and Fredrick. Again, though no one can possibly know all the facts, it’s unlikely that Frankl had anything to do with Kanner using the word «autistic» or that he stole it from Asperger with the help of Frankl as Steve Silberman suggests, but rather he was influenced by Bleuler’s work and his use of the word to describe symptoms of schizophrenia.
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Jonathan, Can I borrow the time machine you used to nip back to the 1930s? I want to use it to check (a) whether the CDC et al will ever admit there really was an increase of autism and (b) whether some other people will ever agree that vaccines weren’t the main cause of that increase. (Plus some other checks I’d best not list here.)
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Robin, even if you had a time machine, i don’t see how it would help in that endeavor. I did not need to use a time machine, just read Kanner’s original 1943 article which John Robison appears not to have read very carefully.
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Did you also read the reports from 1939 that Poland invaded Germany back then? They were written by local people at the time so presumably true!
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