The Two Great Pioneers

Adam Feinstein

Chapter One

The Two Great Pioneers

“Nothing is totally original. Everyone is influenced by what’s gone before.” (Dr. Lorna Wing in conversation with Adam Feinstein) “Whatever will they think of next?” (Reported comment by the Hollywood producer, Sam Goldwyn, on being shown an ancient sundial)

The two great pioneers in the field of autism, Dr. Hans Asperger and Dr. Leo Kanner, started work in this area at roughly the same time—the 1930s. But they were very different human beings and, while their notions of the condition they first described overlapped to some extent, there are significant differences that still need exploring—and allegations of plagiarism and Nazi allegiances which also require examination.

The Scottish child psychiatrist, Dr. Fred Stone, was one of the few people who met both Asperger and Kanner. Stone told me: “There couldn’t be a bigger contrast between the two men. I met Kanner in Edinburgh in the mid-1950s. He was very spruce, carefully dressed, cautious but pleasant. I liked him.”

Stone met Hans Asperger at a conference in Vienna in the 1960s. “He was on duty `welcoming’ people—actually, he didn’t welcome anybody, he just sat there at the door of the lecture theater. I had just heard about his syndrome from the German-speaking members of my planning committee. I could not engage him. I think that those who claim that he may have been suffering from the syndrome that would later bear his name could be right.”

Most people who met Kanner reported on his warmth and charm. Physically, with his large ears and mischievous grin, he bore a resemblance to the pianist, Vladimir Horowitz. His son, Albert, a retired ophthalmologist at the University of Wisconsin School of Medicine, recalled him as a very cheerful man, enjoying puns and doing the New York Times crossword remarkably quickly. “My father was very proud of me. He always used to introduce me as `my son, Al, the eye doctor, while I am the `I doctor’!” Albert told me—an impish reference to Al’s chosen profession and Kanner’s own psychiatric research.

He had a hugely infectious sense of humor. One Baltimore journalist who interviewed Kanner in 1969 recalled that their two-hour conversation was “dotted with Latin phrases, nursery rhymes, travelogues and punstering.” His humane spirit emerged during that same interview when he said: “Every child, every adult, everybody wants what I call the three As: affection, acceptance and approval. If the child has that, regardless of his IQ or anything else, he will be all right.”

Asperger, for his part, was a courteous, old-fashioned gentleman. Lorna Wing met and talked to him (in English) in London in the late 1970s, not long before his death in 1980. She told me: “We sat in the Maudsley [Psychiatric Hospital] canteen over cups of tea and argued about whether his syndrome was a type of autism and what the relationship was between his and Kanner’s ideas. Asperger firmly believed his was a separate syndrome, unrelated to Kanner’s, although it had a lot of features in common. I argued for an autistic spectrum. We argued very happily and politely.”

For decades, it has been wrongly assumed that Kanner’s landmark 1943 paper—”Autistic disturbances of affective contact,” published in the now-defunct American journal, The Nervous Child—predated Asperger’s 1944 paper, “Die `autistischen Psychopathen’ in Kindesalter,” which appeared in the journal, Archiv für Psychiatrie und Nervenkrankheiten. However, in a lecture given five years before Kanner’s paper—at the Vienna University Hospital on October 3, 1938—Asperger was already talking about children with “autistic psychopathy” (in the technical sense of an abnormality of personality). The speech was subsequently published under the title “Das psychisch abnorme Kind” in the Vienna weekly, Wiener Klinischen Wochenzeitschrift, also in 1938.

In fact, I have discovered that Asperger was using the term “autistic” even earlier. His psychiatrist daughter, Dr. Maria Asperger Felder, told me that he had employed the word “autistic” as early as 1934 in letters to colleagues during visits to Leipzig and Potsdam in Germany. In a newly published chapter about her father, she cites a letter dated April 14, 1934, in which he discusses the difficulties of diagnostic concepts and suggests the possibility that “autistic” might be a useful term. She also refers to a diary entry from that same year in which he appears to be attacking the “fanaticism” of the German people in following a certain path, and to an unpublished article of her father’s, also from 1934, in her possession in which he makes an oblique criticism of the Nazi regime in Germany.

While Kanner described the children he had seen in consultation from 1938 onwards, Asperger had actually been treating his children from as early as 1930 in a therapeutic institution.

Professor Michael Fitzgerald, of Trinity College, Dublin, has gone so far as to suggest to me that Kanner “plagiarized” Asperger’s work. Fitzgerald is convinced that Kanner, although by then based in America, must have heard about Asperger’s writings and lectures from the many Germans and Austrians immigrating into the US in flight from Nazi persecution. He is not alone. The Swedish autism authority, Christopher Gillberg, told me: “I am pretty certain that Kanner must have been aware of Asperger’s work, because he was writing about the work of all other writers who had had anything to say about conditions with symptoms similar to his. Kanner never mentioned Asperger, but it does not make sense that he was completely unaware of someone writing in his own language, given that he was so very well aware of people writing in other languages at the same time that Asperger was working.”

It does seem very odd, especially as Van Krevelen, whom Kanner often quoted in his papers, was mentioning Asperger’s work as early as the 1950s and Bernard Rimland, in his seminal 1964 book, Infantile autism, includes a reference to “Asperger’s syndrome,” a full 17 years before Lorna Wing officially coined the term. Gillberg noted that he and his Swedish colleagues were aware of autistic pyschopathy as a concept as early as 1973.

Kanner’s supposedly pioneering 1943 paper begins: “Since 1938, there have come to our attention a number of children whose condition differs so markedly and uniquely from anything reported so far, that each case merits—and, I hope, will eventually receive—a detailed consideration of its fascinating peculiarities.” Could that 1938 reference be an allusion to Asperger’s 1938 paper, as Michael Fitzgerald believes?

Kanner’s closest colleague. Leon Eisenberg—now in his eighties but still a sharp-minded professor at Harvard Medical School—thinks not. Eisenberg told me: “That `we’ must refer to `him’ [Kanner]. That was the royal `our.’ He would not have deliberately withheld Asperger’s name if he had known about Asperger’s work at the time.” Eisenberg believes the reference to 1938 was an allusion to the date Kanner saw the first of the 11 children in his original study, Donald T.

Kanner never referred to Asperger in any of his papers, whereas Asperger makes a number of allusions to Kanner’s work—sometimes in glowing terms. (In his 1968 paper, Asperger refers to Kanner’s excellent descriptions of his children.) Nor did the two men meet when Asperger visited the United States in the 1970s. Michael Fitzgerald in Dublin believes that this might have been a sign of Kanner’s “embarrassment” at having “plagiarized” his work. Lorna Wing also said she found Kanner’s silence on Asperger “suspicious” but was careful to add: “No one is totally original…. Asperger may have read Eva Sushareva’s 1926 paper.”

If Kanner had known of Asperger’s work, could his silence on the subject be attributed to professional jealousy? One of the leading world authorities on the neurological and linguistic impairments in autism, Professor Isabelle Rapin, believes this is possible. She told me: “The field of autism is incredibly politicized here in the United States. There are the `in’ people and the `out’ people.”

Germany’s Dr. Gerhard Bosch—who, at over 90, is probably the oldest living autism pioneer on the planet (as we shall see in chapter 2, he not only began work on autism in the early 1950s but also diagnosed individuals with Asperger’s syndrome in that decade, using Hans Asperger’s term, “autistic psychopathy”)—told me that he thought Kanner had never mentioned Asperger’s cases because “he was dealing with severe cases. He had another picture and for Kanner, Asperger was describing a very different condition.” Bosch met both men but wrote a chapter on autism for a volume on twentieth-century psychology edited by Asperger.

So who were these two remarkable men, both of whom came to play such a seminal role in the understanding of the autistic condition?

Hans Asperger was born on a farm outside Vienna on February 18, 1906. A talented linguist, he had difficulty making friends and was considered “remote.” His daughter, Maria Asperger Felder, described him in similar terms in an interview with Professor Uta Frith and Professor Christopher Gillberg, prompting Gillberg to suggest that Asperger himself could have been affected by his own syndrome. When I raised this issue with Maria Asperger Felder myself, she conceded that her father “didn’t need much social contact. He was content with his own company. He loved nature. He even climbed the Matterhorn.”

In 1932, Asperger was appointed director of the play-pedagogic station at Vienna University children’s clinic. He married in 1935 and had five children, including two daughters who themselves became doctors. In the later part of the Second World War, Asperger served as a doctor in Croatia. As his daughter told me: “He saw many wounded and dead and told us about his experiences years later. He was against war. He was a nature- and people-loving person, not a soldier.”

In 1944, he became a lecturer at the University of Vienna and was appointed director of the children’s clinic in 1946. It was here that his remarkable nursing colleague, Viktorine Zak, developed the first programs for children with what we now call Asperger’s syndrome. She used pioneering music, drama, play, and speech therapy to teach the children social skills. She was killed during an allied bombing raid on Vienna and buried with the child she was clutching at the time. In 1957, Asperger became professor at the University of Innsbruck children’s clinic and from 1962 held the same position in Vienna.

Asperger’s mentor was Irwin Lazar, who had initially shown an interest in the writings of Sigmund Freud and had invited psychoanalysts to join his clinic, but later decided that psychoanalysis was not appropriate for treating children. Lazar treated the child and adolescent victims of the First World War. This interest in traumatized youth demonstrated a humanity which he may well have transmitted directly to his pupil, Asperger. Asperger adapted a method known in German as Heilpädagogik (roughly translated as curative or remedial pedagogy or the educational treatment of neuropsychopathological disorders of children). It was a term introduced in Vienna by Clemens von Pirquet. (The German school restricted the approach to individuals with mental retardation, whereas the Austrian concept was broader.) When Lazar died suddenly in 1932, he was replaced by Franz Hamburger, whose interest in a possible affective disturbance in children at a biological level of drives and instincts strongly influenced Asperger’s concept of autism. Professor Uta Frith has noted that the staff met at each other’s homes for dinner once a week and during their informal chats, she speculates, they probably discussed the characteristic features of autistic children.

Dr. Elizabeth Wurst worked closely with Hans Asperger in Vienna in the 1960s and 1970s. They first met in 1969. Sitting in the very same building in the University Clinic where they worked together, Wurst told me: “He was tall and enjoyed telling stories. He was like a grandfather, with white hair and very patient and respectful. He made you feel welcome and he was interested in what you had to say. My first impression was that I would enjoy working here with him.”

According to Wurst, one of the first questions Asperger asked the child was: “Do you know what your name means?” It was important for him to see if the child knew anything about his or her own forename. “That was the way he started every interview.”

Another of Asperger’s colleagues in the 1970s, Dr. Maria Theresia Schubert, recalled that, with the children, Asperger “appreciated the children enormously. He would give them little tasks: mathematical sums, general knowledge questions. The children respected him—but he maintained a certain distance from them.” Schubert said that Asperger liked to joke that it helped to be a little autistic if you wanted to do things well—meaning, specifically, that it helped to be focused. She told me: “My first impression was that he was very tolerant. He didn’t push people in any particular direction, giving his employees great freedom.”

Wurst told me: “Asperger had a very good memory and he had read very widely in literature—Goethe, Lessing, also Sartre and classical literature. He also loved art.” Nevertheless, he could be exceedingly harsh at times. Once, Wurst handed Asperger a manuscript she had written and he said to her: “Why have you got so much paper dirty? Why are you quoting these other people writing abut autism? My ideas are good enough.” Schubert recalled another instance of his severity. She had dressed up as Eliza Doolittle from My Fair Lady at a fancy dress event and Asperger expressed admiration for the costume: “But you have to be Eliza Doolittle.”

In a radio interview in 1974, Asperger claimed he had begun work as a clinician in 1932 under Franz Hamburger. Hamburger appears to have had strong sympathies with the Nazi Party—certainly this is suggested by a speech he gave as president of the University of Vienna in 1939, published in the Journal of the American Medical Association, in which he declared: “National Socialism means a revolution in every sphere of our civilization and culture. No phase of Western culture is unaffected by it…. Medicine has now progressed beyond its old frontiers and has broken out of its shell, thanks to the philosophy and deeds of the Führer.”

Hamburger’s clear allegiance, coupled with Asperger’s professed enthusiasm for the Jugendbewegung—a youth movement similar to the Boy Scouts—have led some critics to claim that Asperger himself had affinities with the Nazis. There seems to be no evidence of this whatsoever—indeed, the very opposite is more likely to be the case, as we shall see shortly. Nevertheless, one of the most prominent proponents of this view was Eric Schopler, the great US autism pioneer who founded the TEACCH educational program in North Carolina in the 1970s, and was himself a refugee from Nazi persecution. Dr. Lorna Wing, who first introduced Asperger’s work to the English-speaking world in 1981, told me that Schopler fervently believed that Asperger had either been a member of Hitler Youth or at least had close ties to the Nazis. I have made an extensive study of all Asperger’s lectures and I have found absolutely no sign whatsoever of praise for the Hitler Youth Movement, only of his enjoyment of the Jugendbewegung, which dated from much earlier and had nothing to do with the Nazis.

It is important to emphasize the social and political conditions under which Asperger gave his 1938 talk. The year before, the Vienna Psychiatric and Neurological Association appointed a committee to study the problem of revised insanity laws for Austria. Prominent in the legislative program sponsored by this group was the establishment of state detention institutions for psychopaths who, although not insane within the legal definition, were nevertheless a public burden. A Professor Berze pointed out in a lecture to the association that, among the psychopaths of the “borderline” type who, in the absence of any definitive mental disease, could not be declared insane were those mentally subnormal criminals who constituted a permanent social menace. The Vienna psychiatrists recommended not only the detention of dangerous psychopaths but a continuous systematic supervision of all psychopathic individuals.

Hans Asperger worked as the Director of the Department of Orthopaedagogy at the Children’s Clinic of the University of Vienna, under Franz Hamburger. Some critics have claimed that his thesis was consistent with the eugenic approach, as set out by Hamburger.

(Continues…)

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Excerpted from A History of Autism by Adam Feinstein