Hans Asperger: Not the Good Doctor A Review of Edith Sheffer, Asperger’s Children: The Origins of Autism in Nazi Vienna
BNote: Thank you to Jonathan Rose for permission to reprint this book review. Find the original at History News Network.
By Jonathan Rose
Edith Sheffer, Asperger’s Children: The Origins of Autism in Nazi Vienna. W. W. Norton, 317 pp., $27.95 hardcover.
Outside of a few endnotes, this book never mentions Steve Silberman’s NeuroTribes. That’s remarkable, because for all practical purposes, Asperger’s Children is a through point-by-point demolition of Silberman’s saintly portrait of Hans Asperger, based on honest research by a real historian. Edith Sheffer is a Senior Fellow at the Institute of European Studies at Berkeley. She has an autistic son, she has studied a vast array of diagnostic records and case histories in psychiatric archives, and she has produced what is by far the best early history of the autism pandemic. And while she is unfailingly polite about it, she recognizes when people are talking nonsense about autism. She says at the outset that her aim “is not to indict any particular individual” or neurodiversity as a concept. But in effect Asperger’s Children is a devastating indictment.
Sheffer recognizes that autism is something new: as her subtitle suggests, it originated less than a century ago. She does not attempt to concoct a fanciful “history” of the disorder stretching back into the mists of prehistory. Though she believes that soaring autism rates may be partly attributable to better diagnosis or changing definitions, she does not deny that there is also “an objective increase in symptoms.” (For a robust historical demonstration that autism is a very real, recent, and devastating epidemic, see Dan Olmsted and Mark Blaxill,Denial: How Refusing to Face the Facts about Our Autism Epidemic Hurts Children, Families, and Our Future . I read a draft of this book and sent comments to the authors.)
Asperger’s Children doesn’t address the causes of autism, but the scientific research clearly indicates that it is a combination of a genetic predisposition and an environmental insult. In other words, we are poisoning a subset of our children, and we can stop poisoning them if we identify and remove the environmental triggers. In that sense autism is in the same category as lead poisoning in Flint or fetal alcohol syndrome on Indian reservations.
Late in life Asperger claimed that he had worked to protect handicapped children whom the Nazis wanted to exterminate, and Silberman accepted that unquestioningly. But everything Sheffer and other researchers have found in the archives tells a very different and terrible story. Asperger was in fact a Holocaust perpetrator who signed death warrants for dozens of mentally handicapped children. Though he never actually joined the Nazi Party, he was a member of several Nazi-affiliated and ultra-right organizations, and he enthusiastically promoted Nazi eugenic policies.
Sheffer’s story begins in the 1920s, when the Nazi Party was a tiny Bavarian fringe group. Vienna was then governed by Socialists who created an impressive system of social welfare, including free clinics and school medical examinations. However, a key part of their program was eugenics, an idea embraced at the time by the Left as well as the radical Right. Julius Tandler, Vienna’s chief of public welfare, talked openly of compulsory sterilization of “the inferior” and the “extermination” of “life unworthy of life”. That was exactly the vocabulary that Asperger and the Nazis would adopt. Tandlerwas a Jewish socialist whose programs had dramatically improved the health of Vienna’s working classes, and perhaps that success blinded him to the dangers in what he was proposing. His medical services established a regime of surveillance and control over patients which the Nazis later used to carry out their own version of eugenics.
In 1930 Franz Hamburger was appointed head of the University of Vienna’s Children’s Hospital. Well before the Nazis had seized power in Germany and Austria, Hamburger was an ultra-reactionary who pushed Jews and liberals off the faculty and replaced them with doctors appointed more for their far-right politics than professional competence. He gave young Doctor Asperger his first job and swiftly promoted him: after all, someone had to replace all those blacklisted Jews, and in 1934 Asperger joined an organization dedicated to firing still more Jewish doctors. To the end of his life Asperger worshipped Hamburger, even after his mentor had been thoroughly discredited. At the Children’s Hospital Asperger worked closely with Erwin Jekelius, an outright Nazi who later supervised the killing of mentally handicapped children. (Everyone at the hospital agreed that Jekelius had a wonderful bedside manner.)
At a young age Asperger became head of the hospital’s clinic for Heilpädagogik, which translates as “Curative Education” or what we would now call “holistic psychiatry”. He had published nothing in that field: Sheffer concludes that he was “somewhat of a nonentity”. But in this brilliant department, doctors and nurses were talking about a newpsychiatric condition – autism – and they were publishing pioneering case studies. Staff physician Georg Frankl explained that autistic children “do not sense the [social] atmosphere, and so cannot adapt,” because they have a “poor understanding of the emotional content of the spoken word”. Frankl argued that this condition was not pathological, “rather just a dysfunction”, though he acknowledged that more severely affected children were “autistically locked.” Anni Weiss, a psychologist at the same clinic, described an autistic boy as awkward, bullied, and vulnerably naïve. He “cannot grasp what is happening around him with any fine shade of feeling….What others perform naturally in the social machinery—perceiving, understanding, and then acting—does not function in him as it ought to.” And she noted that some of these children had narrow but unusual talents: “calendar experts, jugglers of figures, artists of mnemonics.”
So if anyone “discovered” autism, it was Frankl and Weiss who produced very early and strikingly perceptive descriptions of the condition. We can’t explain why a mediocrity like Asperger was promoted over them, except to note that they were both Jewish, and Asperger had astutely allied himself to a powerful patron. Antisemitism forced Frankl and Weiss to emigrate to the United States, where they married. Frankl’s escape was assisted by none other than Leo Kanner, who in 1943 published his famous article “Autistic Disturbances of Affective Contact.” Steve Silberman constructed a far-fetched theory that Kanner had appropriated Asperger’s work without acknowledgement, but Sheffer shows that Kanner actually drew on Frankl and Weiss and generously cited them. Asperger also owed a great debt to Frankl, Weiss, and others in his clinic, and he never acknowledged them. Yet Sheffer notes that Asperger’s approach to autism, though highly derivative, was in one respect distinctive: his “diagnosis would be steeped in the principles of Nazi child psychiatry.”
After the German takeover of Austria in March 1938, the remaining Jews in medicine and psychiatry were forced out, opening up still more career opportunities for men like Asperger – provided they conformed to the new regime. That October Asperger delivered a notorious lecture in which he welcomed the Nazi revolution in medicine, “a massive reorganization of our mental life….The fundamental idea of the new Reich—the whole is greater than the parts, the Volk more important than the individual—must lead to profound changes in our entire attitude toward the most valuable asset of the nation, its health.” And he identified a key problem: “children who we name ‘autistic psychopaths’”, a term he had never used before. Frankl and Weiss did not regard autistic children as either geniuses or psychopaths, but Asperger now sorted them into the saved and the damned. On the one hand there were those we now call “high-functioning”, whose “astonishingly mature special interests” and “originality of thought” spurred them to “outstanding achievements”. But low-functioning children were “nonsensical, eccentric, and useless.” They were “always loners, and fall out of every children’s community.” In fact “Nobody really likes these people.”
All this was entirely in accord with the eugenic policies of the Third Reich. The Nazis never intended to eliminate all handicapped people. They honored disabled war veterans, and the Hitler Youth had special sections for the blind, the deaf, and the physically handicapped. If you could be educated and become a productive member of society, the National Socialist state offered treatment and support services. But under the T4 program (directed from a Berlin office at Tiergartenstrasse 4) the severely disabled were marked down for elimination. More than 200,000 were legally murdered, of which 5000 to 10,000 were children, including 789 at Spiegelgrund, a Vienna children’s hospital which also served as a death center. This policy literally gave physicians discretionary power over life and death. After examining patients, they could in effect check off a box: Euthanize/Don’t Euthanize. This was all part of the larger Nazi project of sorting humanity into superior and inferior breeds, nurturing the former and eradicating the latter.
There lies the terrible danger in portraying autistic people as eccentric geniuses: most of them aren’t, and those who don’t fit the narrative must somehow be eliminated. The Nazis killed them; today we merely ignore them. NeuroTribes and the mass media usually foreground high autistic acheivers, effectively marginalizing the low-functioning. Sheffer clearly rejects that kind of ableism: Asperger’s Children devotes equal attention to all of those children, regardless of their levels of ability.
Together with his colleagues, Asperger advanced the concept of Gemüt, meaning the psychological capacity to support and conform to the larger community. Gemüt was central to Nazi ideology, and it seemed to be lacking in children with autism or other behavioral problems. But in Asperger’s view, autistic Germans were still Germans, and if they were gifted with (say) exceptional mathematical abilities, they confirmed notions of racial superiority. Though they had a handicap, with treatment and support they could be molded into productive citizens of the Reich. In his clinical work, Asperger readily awarded this positive diagnosis to sons (but not daughters) of the intellectual and creative classes. He insisted that these boys were gifted with “rare maturity of taste in art”, a “special clear-sightedness…seen only in them…a special understanding of works of art which are difficult even for many adults.” Evidently they had a particular flair for “Romanesque sculpture or paintings by Rembrandt.” Sheffer skeptically notes that Asperger offered no evidence for the existence of these magical critical faculties, which girls somehow never seemed to possess. Today this idealized portrait of autism, rooted in Nazi scientific racism, is transmitted to the American viewing public in the hit television series The Good Doctor, starring an autistic surgeon blessed with Aryan good looks and positively miraculous diagnostic powers.
But to return from fantasy to reality: what did Asperger say about those autistic children who were less brilliant or more difficult, or came from troubled working-class homes? Along with delinquents, the underclass, Gypsies, and those with incurable neurological disorders, they were labelled social liabilities, and Asperger prescribed “the expulsion of the predominantly worthless and ineducable through early diagnosis.” Sheffer notes that Asperger never arrived at a clear and consistent definition of autism: “It meant, basically, not fitting in…[a] totally amorphous diagnosis. Asperger used it for some children to suggest their humanity, but he used it for others to deny their humanity.” She adds that his 1944 postdoctoral thesis was for the most part “disparaging of autistic children.” Except for the favored and treatable few, he dismissed them as “automata”, “grotesque and dilapidated”, and “unable to learn” (his emphasis).
Those words would have ghastly consequences. Sometimes Sheffer is too ready to make excuses for Asperger:
Where, if anywhere, can one draw lines of complicity for ordinary people in a criminal state? In marginal and major ways, conscious and unconscious, people became entangled in systems of slaughter. Asperger was neither a zealous supporter not an opponent of the regime. He was an exemplar of this drift into complicity….
No, Asperger did not drift into exterminating children in the passive voice. In August 1941 German Catholic bishops courageously denounced the euthanasia program, and it was officially ended. However, the killing continued covertly, carried out by (among others) Asperger and his colleagues. The following December Asperger joined forces with Erwin Jekelius and Franz Hamburger to dispatch what Asperger called “difficult cases” to Spiegelgrund for “stationary observation” and “treatment”. Sheffer fully recognizes that these were code words for euthanasia. She calculates that Asperger played a role in sending at least 44 children to Spiegelgrund, of which 37 were killed. Given that the medical records are incomplete, the actual toll was probably higher. Asperger was a Catholic who went far out of his way to violate one of the fundamental principles of his own church.
Medical personnel received cash incentives for every handicapped child they reported and eliminated, though Jekelius accepted bribes for exempting favored patients. Two commonly used methods were lethal injections or overdoses of barbiturates.Elfriede Grohmann entered Asperger’s clinic when she was thirteen. Youth services referred her because she was a habitual runaway, not surprising given that she was born to a single mother in an unstable home. Clinic reports wrote her off as isolated, insensitive to social cues, “always peculiar”, and a “very abnormal being”. But Sheffer, reading Elfriede’s medical files closely, discovers a beautiful mind. All day the girl wroteaffectionate letters to her loved ones: evidently she was highly communicative and connected. Nevertheless, the clinic pronounced her ineducable and assigned her to Spiegelgrund. Elfriede knew what happened to children in that institution. In a letter to her mother she wrote that this was “perhaps the very last mail since I do not know if we will see each other again. Because I can’t know if I won’t die in this trip.”
In fact Elfriede may have survived. Sheffer found no document confirming her death. Psychiatrists under the Nazi regime issued arbitrary and inconsistent diagnoses, and often changed their minds. But Spiegelgrund was hellish even for itssurvivors, who faced a daily regime of sadistic discipline, unheated dormitories, starvation rations, and handcarts carrying out the corpses of euthanized children. The Children’s Hospital itself carried out the kind of horrific and often fatal “medical experiments” conducted at concentration camps: for instance, deliberately infecting infants with tuberculosis in order to test the effectiveness of a vaccine.
Asperger should have been put on trial for crimes against the handicapped, but he never suffered any consequences for his actions. After the war the upward trajectory of his career resumed. He was not penalized by denazification programs, because technically he had not been a Party member. In the 1970s he claimed that he had refused to report children for euthanasia and had twice been threatened by with arrest by the Gestapo. Silberman accepted this story at face value, but it was clearly specious and self-serving. Every relevant document we have from Nazi archives suggests that the Party considered him politically reliable, a man they could work with, and as long as they ruled Austria he prospered.
Asperger’s thesis was rediscovered and promoted by psychiatrist Lorna Wing, and it was she who (after his death in 1980) created the term and diagnostic category “Asperger’s Syndrome”. Sheffer notes that we “typically research historical figures before designating eponymous diagnoses in order to avoid naming a condition after a person who has engaged in ignominiously actions,” but Asperger’s past wasn’t investigated beforehand. She adds pointedly that “numerous conditions named after Nazi-era doctors who were implicated in programs of extermination now go by alternative names.” If we rechristened it “Frankl-Weiss Syndrome” we would honor the true discoverers of autism, who described the condition more accurately and humanely than Asperger. And of course some individuals on whom we have stuck the “Asperger’s” label may prefer not to be identified with a doctor who might have had them exterminated.
Ultimately, Sheffer wonders whether we shouldn’t do away with the autism label altogether. Granted, diagnostic categories tend to pigeonhole individuals and oversimplify complex psychiatric conditions – sometimes with ghastly consequences, as in the case of Asperger and his colleagues. But realistically, it is far too late in the game to erase “autism” from the dictionary. And Scott Badesch, the head of the Autism Society, poses a sobering question: “If in the past they were called autistic and now they are not labeled anything, how will they get help?” In fact, the Centers for Disease Control are now planning to narrow the definition of autism, and a study in the Journal of Autism and Developmental Disorders estimates that this change would reduce diagnoses for PDD-NOS by 75 percent – even while demand for special education is surging throughout the developed world. There is good reason to fear that doctoring the numbers could make autistic children disappear from public consciousness, deny them the supports they need, and mask the true extent of the pandemic. Kalman Hettleman, former Maryland Secretary of Human Resources, blithely suggests that as many as 80 percent of pupils in special education classes somehow don’t belong there, a view warmly endorsed by the Washington Post.
Sheffer is entirely right to point out the dangers of unbridled medical surveillance and intervention, but neglect can be just as deadly as deliberate killing. Autism frequently leads to seizures, drowning, fatal accidents, and suicide: taken together, they can reduce life expectancy by as much as half. Unless we find some means of cure or prevention, in a few years autism-related deaths could easily exceed the toll for the T4 program.
The story told in Asperger’s Children is not entirely new: the basic outlines were previously sketched out by Austrian investigator Herwig Czech and by John Donvan and Caren Zucker in their 2016 book A Different Key. But Sheffer offers us far more background, context, and damning research. Somehow the earlier exposes of Asperger had little impact on his public image, so one hopes that Sheffer will finally make us face the reality. Everyone in the autism community should read Asperger’s Children, though they may find parts of it terribly painful, especially the sections describing the horrors inflicted at Spiegelgrund. If you are an autism parent, you will recognize your children in the institution’s inmates. If you are autistic, you will recognize yourself.
Edith Sheffer’s voice is always calm, objective, and professional, never hectoring. She lets readers draw their own conclusions, but the relevance of Asperger’s Children isimpossible to miss. This book casts a stark light on the dangers of medical dictatorship, where the rights of parents and children are disregarded, where doctors assume their own infallibility and purge dissenters from the profession, where the individual is sacrificed to “the greater good”, where “science” becomes a justification for mass murder. Asperger’s Children compels us to think about such disturbing ethical issues as Alfie Evans, the now-discredited Liverpool Care Pathway for terminal patients, the role of doctors and drug companies in creating the opioid epidemic, aborting Down’s Syndrome babies, and the young women who say they were damaged by Gardasil (should they be allowed a #MeToo moment?).
Given that Asperger’s theories were rooted in Nazi scientific racism, and given that those theories have been a source of inspiration for Silberman and many neurodiversity activists, may we conclude that they too are scientific racists? Scientific racism is the delusion, backed by pseudoscience, that some groups, defined by their common genetic inheritance, have innately superior (or inferior) intellectual powers. Silberman has claimed that “genes associated with autism are also associated with higher levels of cognitive ability.” He also endorsed Temple Grandin’s theory that “people with autism, dyslexia, and other cognitive differences could make contributions to society that so-called normal people are incapable of making” (his paraphrase). This statement is half nonsense. Yes, autistic people can make contributions, but nonautistic people can and do make the same kind of contributions: there are no limits to the powers of a fully functioning human brain. Yes, Temple Grandin can “think visually”, but so can artists, photographers, graphic designers, architects, film directors, and interior decorators. Grandin has also resorted to eugenics, speculating that autistic genes may be the source of all human creativity, going back to the cavedwellers. Those who are lucky enough to inherit these genes may be “more creative, or possibly even geniuses. If science eliminated these genes, maybe the whole world would be taken over by accountants.” And Judy Singer, who invented the term “neurodiversity”, explained that the typical brain represents “only one type of brain wiring, and, when it comes to working with hi-tech, quite possibly an inferior one”. (There she promoted the stereotype that all autistic individuals are computer whizzes: most of them aren’t.)
The latest neurodiversity hypothesis has been advanced by Barry Wright and Penny Spikins at the University of York. They argue that autism appeared in the last Ice Age: in order to survive harsh climactic conditions, cavedwellers evolved higher levels of cognition and intelligence, reflected in their cave paintings. Spikins says that artistic ability “is found very commonly in people with autism and rarely occurs in people without it,” and autism is most common among Northern Europeans (so much for Italian Renaissance painting). What’s deeply troubling here is that, if you substitute the word “Aryan” for “autistic”, you have something that reads like a Nazi racial screed. The Nazis insisted that “Nordics” had evolved into supermen because they were steeled by the rigors of the frozen north. According to this theory, Africans had it much easier in sunnier climes, and therefore developed no art. Doctor Asperger undoubtedly would have approved.
All this demonstrates that scientific racism is highly seductive, and must be resisted regardless of the form it takes. Edith Sheffer illustrates unforgettably how this ideology precipitated the Handicapped Holocaust. Sheffer and Silberman both appreciate that autistic adults can often exceed expectations and achieve remarkable things, but she is much more sensitive to the burdens that autism imposes on the autistic. Silberman, who is neither an autism parent nor autistic, tends to treat the condition as a kind of neurological trust fund. He is right to criticize some misguided psychiatric interventions, notably Bruno Bettelheim’s theory that autism was caused by “refrigerator mothers”, but he fails to recognize that the most destructive autism doctor of all was Hans Asperger.
In his 1944 thesis Asperger claimed his clinic had observed more than 200 cases of autism over a decade, though he only described four in any detail. Assuming the 200-plus figure was correct and did not include any cases outside of Austria, that would work out to an overall rate of 1 in 30,000, still extremely rare. Today the autism rate is 1 in 59 for eight-year-olds in the United States, 1 in 34 in New Jersey, and 1 in 21 among Belfast schoolchildren. Silberman, neurodiversity activists, and public health officials have consistently assured us that these soaring numbers reflect no real increase, only “better diagnosis”, and that the actual autism rate is more or less constant. That is, they ask us to believe that the rate was about 1 in 21 everywhere and at all times, in all corners of the world and throughout human history. There were untold millions of autistic people out therefor thousands of years, but until very recently no one noticed them. At that rate autistic individuals would have met face to face every day, but somehow they consistently failed torecognize each other. When the T4 program killed the mentally handicapped, medical authorities assured relatives that they had died of natural causes, but some families figured out what was happening and vocally protested, despite the grave risks of standing up to Nazi power. Of course there’s an important difference between the two cases: we don’t have to worry about the Gestapo knocking down our doors. So when are we going to react?
Jonathan Rose is William R. Kenan Professor of History at Drew University. His most recent book is Readers’ Liberation (Oxford University Press).