By Claudia Mazzucco
In 1942, the world was a hellish place when Austrian pediatrician Dr. Hans Asperger submitted to Vienna University his postdoctoral thesis (published two years later). Adolf Hitler had outlined – in 1924 – a political philosophy for a new Aryan state based on a combination of blood, soil and National Socialism. The party platform was filled with passion, pomposity, paranoia, and anthropological ideas that purported to uphold the superiority of the Aryan race over others, in particular the Jewish race. Nazi propaganda filtered into Austria and anti-Semitism was gaining a foothold throughout the country. It was a time of racism to an insane degree, laws of sterilization, eugenics and euthanasia policies, and seriously misguided notions of intelligence and human heredity. The truth of the matter, Edith Sheffer (ref 1) said, was that:
“The Third Reich was a diagnosis regime, obsessed with sorting the population into categories, cataloging people by race, religion, politics, sexuality, criminality and purported biological, mental and behavioral defects. Nazi officials created massive population indexes that compiled individuals’ medical, financial, educational, criminal and welfare records — even sports club files. By 1942, Reich Health Leader Leonardo Conti estimated that ten million Reich citizens had been indexed — 12% of the total population. These files, then, established the grounds for sterilization, deportation and extermination.”
Hitler did spark a world war with fifty million dead, massacred six millions Jews, set up the Gestapo, and so forth. No subject within the Reich was free from politicization. Neurobiology and psychology had been under ideological attack for years. The National Socialist party established its pedagogic goals and demanded that it be the only valid one.
In 1938 – on the eve of World War II – Dr. Asperger wrote an article (The Mentally Abnormal Child) that presents two boys. The first boy was “intelligent far beyond his age” but suffered from mental and physical “over-sensitivities” – no link to autism. The second represented the first case of an “autistic psychopath” in medical literature, as Herwig Czech reports in Hans Asperger, National Socialism, and “Race Hygiene” in Nazi-Era Vienna. He suffered from a “profound disorder of the personality,” although he exhibited – like the first boy – “a contrast between pathological and in some ways valuable traits.”
Dr. Asperger had spent pivotal years of his career in Nazi Vienna. He managed to become a member of the Bund Neuland, a Catholic youth organization focused on outdoor activities, with roots in the German Youth Movement. He was someone the party could count on, and that is how it turned out at the Vienna University Children’s Clinic. But he was not a Nazi; he was a man who performed his duty honestly and without shirking. The world needs to reorganize itself both intellectually and spiritually, he said. Not least in medicine. This simple sentence is sufficiently vague to contain the universal anxiety about such reorganization, mixed with the universal hope that it will actually happen. It is not National Socialism he embraced, but its anti-individualistic and totalitarian approach to medicine and health. Change has seized all areas of this life. “The central idea of the New Reich,” Asperger said, “that the whole is more than its parts, and that the Volk is more important than the individual, had to bring about fundamental changes in our whole attitude, since this regards the nation’s most precious asset, its health.” And yet, he sees the problem not from the standpoint of the Volk as a totality but from the standpoint of the abnormal children.
It is true that Dr. Asperger recommended permanent placement at Spiegelgrund of Herta Schereiber, a little girl – two months shy of her 3rd birthday – who he examined at his clinic on June 27, 1941, but she died of pneumonia two months and six days later (on Sept 2). We rebel at this conclusion but also demur on grounds that, in the direst of circumstances, there was a paucity of medical supplies, no antibiotics, and no treatment that could help her survive. Herta showed signs of “severe motoric retardation and personality disorder, an excessive degree of idiocy and seizures.” A few months before, she had fallen ill with encephalitis. Spiegelgrund was a psychiatric hospital in Vienna, which during the war became a collecting point for children who did not conform to the regime’s criteria of hereditary worthiness and racial purity. Her mother asked to be notified if the condition of her child should get worse. She could see for herself that the child was mentally not well. If she could not be helped, it would be better if she died. She would not have anything in this world, she would only be ridiculed by others.
There was an acute fear of ridicule in a society permeated by contempt for the unworthy life and the social stigma of mental disability. Similar stories were found in the Soviet Union even after the death of Stalin in 1953. “One arrested physician,” William Taubman said, “the well-known pathologist Yakov Rappoport, later recalled the mother of a child with pneumonia, who refused to administer the penicillin prescribed by a doctor: “Let him die from illness, but not from poison that I gave him with my own hands(ref 2).”
As a pediatrician, Dr. Asperger was an advocate for his children’s interests. However, his prognoses for the “autistic psychopaths” were far from universally optimistic. He did not highlight their potential but rather contrasted them unfavorably with other, less impaired patients. He emphasized that the condition varied greatly in terms of “social prognosis” and “worthiness.” While he deemed some of the “autistic psychopaths” capable of “great intellectual achievements,” in other cases, “autistic originality” was deemed “bizarre, eccentric, and useless,” with “fluid transitions towards schizophrenia” whose “main characteristic is also autism, the loss of any contact with the surroundings.” He treated troubled children with the utmost dedication to help them overcome their challenges. He advocated on their behalf, defending their value as human beings, and calling for loving care for each of them.
But there is a limit. Dr. Asperger was intensely absorbed on the questions ‘concerning the inheritance of mental traits and mental abnormalities,’ leading the way “in the practical tasks of eugenics, especially with regards to the problems relating to the Law for the Prevention of Hereditarily Diseased Offspring.” He studied the influence of optimal environmental conditions on ‘hereditarily burdened individuals,’ as he put it. He sought to attribute mental troubles to constitution rather than environmental factors. Genetic makeup determined primarily an individual’s possibilities of mental development. However, he did appreciate the importance of education “in spite of inheritance,” concluding that it is worth the trouble with individuals outside the norm. The most important question for him was: How much can we accomplish for these children?
In a Spectrum that is more about strong emotion that solid evidence, is it not time for researchers to put a fresh set of eyes on the very definition of autism to be sure that we are talking about the same thing? For example, it was not a “small miracle,” as Uta Frith (ref 3) said, that a young doctor was captivated by these difficult children; there was an urgency to Dr. Asperger’s work that left little room for scientific curiosity or idle – purely speculative – theories of autism. It was a matter of state and of the utmost importance: the worthiness of human beings. He felt so strongly for his patients with autism that he explored every possible path of recovery. “We think that such individuals have their own place in the organism of the social community, which they fully occupy, some of them maybe in ways nobody else could. […] Such individuals show more than others what capacities for development and adaptation even abnormal personalities dispose of. Often, in the course of development, possibilities for social integration arise which one would not have expected before. […] This fact determines our attitude and our value judgment towards difficult individuals of this and other kinds and gives us the right and the obligation to stand up for them with the whole force of our personality.”
As Dr. Asperger thought it, I would have to admit that his clinical insights about autism are surely akin to those of my own pediatrician, Dr. Nazario. What matters most about Dr. Asperger is not that he discovered autism before Kanner did, but that he speculated that there is inherent resiliency in the constitution of the brain. He was indeed dropping the barriers of determinism. “To our own amazement, we have seen that autistic individuals,” Dr. Asperger said, “as long as they are intellectually intact, can almost always achieve professional success, usually in highly specialized academic professions, often in very high positions, with a preference for abstract content (ref 4).”
A simple and righteous man, Dr. Nazario was also enough of an armchair psychologist to understand that not being the most sociable child in the neighborhood was not a big deal. Dr. Asperger had established as the essential feature of the condition that autism was a disturbance of adaptation to the social environment. “They are strangely impenetrable and difficult to fathom,” Dr. Asperger said, “Their emotional life remains a closed book.” Dr. Nazario could not refute it openly because my grandma confirmed that I was oblivious to my surroundings. It began to seem plausible to him that I might have autism but “psychopathy” (or clinical idiocy) was also the applicable word to denote autism as a disparity from normal functioning. For my pediatrician, that was absurd and destructive. Not knowing what the condition really was, he said to my grandma, “You think this, you think that, but let’s try to educate these children. Whatever is wrong with them might be fixable.” She then started believing that autism would be manageable. I was seven years old already, and very receptive to education.
Although Dr. Asperger felt empathy for abnormal children, he understood autism as a childhood psychopathy; specifically, he designated a group of children with distinct psychological characteristics as “autistic psychopaths.” The modern description of Asperger’s Syndrome is essentially social clumsiness. The one has nothing to do with the other. How can one reconcile Kanner’s description of autism as an innate inability to form the usual, biologically provided contact with people with Asperger’s syndrome that recognized autistic traits in verbally fluent individuals who demonstrate superior intelligence and creativity? It is also hard to understand how such verbally fluent individuals could demonstrate superior intelligence and creativity without establishing some sort of contact with the world and its people. To accomplish verbal fluency does require us using language to record the ongoing discovery of the world, and thus develop our intellect and originality.
Lorna Wing got it all wrong. The problem is not chiefly the fact she tried to keep Dr. Asperger utterly separated from the Nazi Regime but that she had obviously not studied his postdoctoral thesis deeply enough. As a result, the bridge between her insights and research and those of Dr. Asperger is weak. According to Simon Baron-Cohen and Francesca Happe, “her epidemiological work at the Medical Research Council Social Psychiatry Unit at the Institute of Psychiatry in London demonstrated the clustering of social and communication impairments with lack of pretend play (replaced by repetitive behavior and interests) that marked autism as a syndrome.” Dr. Asperger’s narrative makes no reference whatsoever to lack of pretend play, and the neurocognitive deficit in theory of mind.
Sometimes the best way to reject those who contradict us is by converting the other to our views. Did Wing realize that she made a lousy adaptation of Dr. Asperger’s paper? How could Wing support creating an Autism Spectrum Disorder that would include individuals who obviously did not show the traits of “autistic psychopathy” described by Asperger’s account? No wonder, modern diagnosis in ASD has resulted in “There is something wrong with this kid. Look in the DSM to find out what is it. Don’t trace the signs to any real experience from the outside.” Ultimately, what the diagnosis could take away from him is the truth about himself. For when an 8-year-old does not present developmental issues, the reason that makes him “troublesome” or mentally imbalanced is not to be found in his genes or in a brain built wrong, which certainly is the main characteristic of Kanner’s autism.
1 Edith Shefferis a Senior Fellow at the Institute of European Studies at the University of California, Berkeley. She is author of the forthcoming book Asperger’s Children: The Origins of Autism in Nazi Vienna.
2 William Taubman in Gorbachev: His Life and Times, W.W. Norton & Company, New York/London, 2017, p. 45.
3 See Autism and Asperger Syndrome, Cambridge University Press, 1994, p. 7.
4 From Autistic Psychopathy in Childhood, Cambridge University Press, 1994, p. 87.