Jill Escher is an autism research philanthropist, president of Autism Society San Francisco Bay Area, autism housing provider, and mother of two children with nonverbal forms of autism. Several of her previous reviews of books about autism, including Immersed: Our Experience with Autism, Autism Uncensored, and NeuroTribes, have been featured on Cortical Chauvinism.

The Horrifying History of Hans Asperger
New book on the Nazi-era psychiatrist triumphs with nightmarish detail, though the subtitle misleads

Inaugural lecture of Eduard Pernkopf, the new National Socialist dean of the University of Vienna Medical School, April 26, 1938, a month after the Anschluss (from Asperger’s Children, page 78).

By Jill Escher

A new book by Bay Area scholar of German history Edith Sheffer tells a detailed, grisly story of the Nazi disability death machine and the role within it played by Hans Asperger, the Vienna clinician for whom the now defunct diagnosis of «Asperger’s Syndrome» was named. «Asperger’s Children: The Origins of Autism in Nazi Germany» is a chilling masterpiece of modern history, embroidered with layers of detail and insights that make it an invaluable resource for anyone wishing to understand how the Nazi creed of racial hygiene resulted in the unspeakable horror of the sterilization, torture, and murder of countless thousands of children and adults with physical and mental disabilities.

autistic psychopathy

(Clickable link to Amazon)

For those interested in the history of autism, however, its relevance is questionable. Indeed the book is almost an argument for why Asperger’s actual work, as opposed to the post-hoc mythologizing of it, has so little bearing on today’s understanding of autism. The “autism” of Asperger is actually his term “autistic psychopathy,” an amorphous and variable politico-psychiatric concept referring mainly to impulsive and nonconforming behavior. From Asperger’s rough description of this ill-defined trait, combined with his own admissions of irrelevance, the origins of “autism” as we know it today in 2018 can hardly be said to have a root in wartime Vienna.

In the psychiatry of the time, the word psychopathy pointed to malice, trouble-making, delinquency, and rebelliousness; it was a word imbued with the potential for criminality. And “autistic” was an adjective to describe a lack of social connectedness. Asperger never delineated much in the way of criteria for his autistic psychopathy — based on Sheffer’s account, it was at best an nebulous concept grounded in failings of “Gemüt,” a term used to describe a fascistic social spirit and the capacity for conforming to social norms.

Asperger’s descriptions of his autistic psychopaths (only four are described in his 1944 paper, one of whom had brain damage) brought to mind not our modern concepts of autism so much as what we today might label Oppositional Defiant Disorder, Attention Deficit Hyperactivity Disorder, or Conduct Disorder. Sometimes brain damage, genetic or metabolic disorders, or even Fetal Alcohol Spectrum Disorder seemed to be at play with these children. It’s too easy to get derailed by the “austis—“ in “autistic psychopathy,” and presume relevance to today’s “autism” when the intention was rather different: Asperger was concerned with a personality disorder, not a developmental disorder.

Sheffer also relates how Asperger’s concept of autistic psychopathy was politically motivated, thinly researched, poorly documented, shifted over time, and was basically a footnote in his overall career. His vague notions would not have made much of a dent in the annals of psychiatry were it not for British psychiatrist Lorna Wing’s 1981 article suggesting Asperger’s population as a variant of Kanner’s autism. This was over Asperger’s own protests—he saw a distinction between the extraordinarily capable boys (and he saw his psychopathy as exclusively male) he described and the developmentally disabled children of Kanner’s population. Even Wing later felt she had erred. “I would like to throw all labels away today,” Sheffer tells us she said before her death, and said she preferred a move towards a dimensional approach. In a recent review (https://www.jaacap.org/article/S0890-8567(16)30280-5/abstract), James Harris has also stressed that autistic psychopathy and autism as we know it apply to different clinical populations.

But surely Asperger’s work must have some relevance to the history of autism, no? I certainly have a hard time finding it and in truth, after reading this excellent and devastating book, it hardly seems important. The glory of Sheffer’s book lies not in any attempt to fulfill the promise of its subtitle, but rather in its exceptionally rich treatment of the ghastly horrors arising from the eugenics-driven Nazi mandate to purge outliers and “sick genetic material” from the Volk. For example, Chapter 8 offers a detailed account of life at Vienna’s infamous Spiegelgrund where children suffered starvation, torture, freezing conditions, sadistic discipline, horrific experiments, and open views of handcarts filled with children’s corpses. Children who by today’s standards had no or very little disability were murdered—foster children, poor children, children of single mothers, children who wet the bed or couldn’t complete test puzzles, or had delinquency. The unworthy would often die by murder instigated by barbiturate poisoning, the brutal consequence of which was thinly disguised as death by “pneumonia.” The concept of «autistic psychopathy» is but a tiny footnote to the overall parade of horrors.

What seems to be most important to Sheffer, however, is this: the Third Reich’s collapse of humanity would not have been possible without guiding principles and authorities defining how to apply them. It often fell to the psychiatrists of the Third Reich to determine which young people of post-Anschluss Austria qualified as members of the new Volk, and which, due to their disabilities or nonconforming behaviors, should be eliminated through sterilization or murder, sometimes referred to Spiegelgrund or other nightmarish facilities. Asperger’s autistic psychopathy was one of many conceptual tools for helping to rate and rank Austrian youth. At the close of the book the author prompts readers to consider the effects that labels can have on people’s concept of self, and on society’s concept of them.

Unlike medical practice of today which is grounded in the Hippocratic Oath, physicians under the Nazis aimed to promote the collective strength of the supposedly biologically superior Aryan nation rather than the health of any given individual. During the Nazi era, when Asperger, or his brethren at the University of Vienna Children’s Hospital and elsewhere, evaluated a child, it was largely in the service of the eugenic dream, not in order to promote the welfare of the patient. Those with “inferior hereditary material” were viewed as a “burden on the community” and were to “be eliminated.” As noted by Asperger’s mentor and hospital director, Franz Hamburger, «Excessive care of the inferior allows inferior genetic material to circulate.” By implying superiority or inferiority, labels in the Reich had life-or-death consequences.

Asperger described autistic psychopaths as either worthy of remediation and inclusion in the Volk, or more seriously disabled and therefore unworthy. The former were described as highly intelligent, with “astonishingly mature special interests,” and “originality of thought” capable of “outstanding achievements.” For those valuable autistic psychopaths, he sought to restore them “their place in the organism of the social community,” drawing on Nazi phraseology. However “in the majority of cases,” he wrote, “the positive aspects of autistic traits do not outweigh the negative ones.” The less desirable ones could be “nonsensical, eccentric, and useless.” Those unfortunates had an “inability to learn” and an “unfavorable social prognosis.” He likened the more intellectually impaired to automatons, and worse, “waste.” It does appear that the vast majority of the people considered to have the disorder of autism today would have been relegated by Asperger and his colleagues to the pseudo-medical death squads.

So why were some boys saved? Even the satanic Erwin Jekelius, the “overlord with the syringe,” as the Royal Air Force called him, and director of Spiegelgrund, lauded Asperger for his effort to rehabilitate those “who have been marginalized.” Why? As Sheffer noted and historian Herwig Czech emphasized in a recent paper (https://molecularautism.biomedcentral.com/articles/10.1186/s13229-018-0208-6), the Reich needed men to fill jobs, and diverting potentially useful young males to productive roles was part of Asperger’s and the hospital’s mission. Though some historical revisionists have painted Asperger as a hero for saving some young lives, both Sheffer and Czech make it clear Asperger’s participation in the murderous regime was in the service of Nazi goals, and an active choice on his part.

A memorial at Spiegelgrund.

While most of the book is in the nature of a dense academic treatise, at the close Sheffer switches gears to engage in a rambling search for a moral, a lesson that could be relevant for today’s disabled, or for her own son, who we are told in the Acknowledgements has been diagnosed with autism. For me, these lessons sprang to mind:

The name. The name Asperger had fairly neutral connotations for me until reading Zucker and Donvan’s In a Different Key, and now Sheffer’s and Czech’s work. The name now fills me with nausea, evoking a strange, complicit man who willingly, and perhaps eagerly, worked as a cog in the Nazi crusade to purify the Volk, sending innocent children to their deaths. I have little doubt it should be dispensed from the official vocabulary of mental disability and difference (and indeed it has). Whether individuals wish to continue to use “Aspie,” “Aspergian” or other terms in informal parlance should however be entirely up to them. I would even argue that “Aspie” to mean a socially challenged, science-geeky kind of kid or adult has taken on a life of its own, quite divorced from the Nazi-era psychiatrist’s work and legacy.

Labels. As mentioned above, Sheffer, who is a historian of Germany and Central Europe, a Senior Fellow at the Institute of European Studies at the UC Berkeley, is concerned about the impact of applying labels to children with developmental and cognitive challenges. Personally, I like clinical labels only to the extent they actually result in real, tangible help to patients. Labels that confer little or no meaningful benefit to suffering individuals deserve exit. I don’t find the term “autism” very useful to that end, and would agree with Lorna Wing that a dimensional approach would be better. Too much is made of the word “autism” or “autistic,” somewhat blinding us from seeing the complex genomic, neurodevelopmental, and functional realities of individuals who need our help. Incidentally, there is already a bit of movement toward the dimensional approach, which can be detected in the ICD-11’s new autism rubric structured by intellectual and communication ability.

Niemals Vergessen. Watching the rise of a nouveaux fascism here in our own country, one cannot help but shudder at the idea that the principles of Nazi psychiatry could rise again. Thankfully, Sheffer’s extraordinary work solidly echoes the clarion call engraved on a memorial at Spiegelgrund, exhorting us to “Niemals Vergessen,” or “Never Forget.”

[This review was originally published at sfautismsociety.org/blog July 9, 2018.]

Disclaimer: The opinions and assertions stated herein are those of the individual author, and may not reflect the opinions or beliefs of Autism Society San Francisco Bay Area or the Autism Society of America.