Tag: AS: Asperger Syndrome

Introduction

Johann Friedrich Karl Asperger (18 February 1906 to 21 October 1980) was an Austrian physician.

Noted for his early studies on atypical neurology, specifically in children, he is the namesake of the autism spectrum disorder Asperger syndrome. He wrote over 300 publications on psychological disorders that posthumously acquired international renown in the 1980s. His diagnosis of autism, which he termed “autistic psychopathy”, has also garnished controversy. Further controversy arose during the late 2010s over allegations that Asperger referred children to a Nazi German clinic responsible for murdering disabled patients, although his knowledge and involvement remains unknown.

Personal Life

Hans Asperger was born in Hausbrunn, Austria, and raised on a farm not far from the city. The eldest of three sons, Asperger had difficulty finding friends and was considered a lonely, remote child. He was talented in language; in particular, he was interested in the Austrian poet Franz Grillparzer, whose poetry he would frequently quote to his uninterested classmates. He also liked to quote himself and often referred to himself from a third-person perspective.

As a youth, he joined the Wandering Scholars of the Bund Neuland, a conservative Catholic organisation within the German Youth Movement. He considered this a formative experience, later stating: “I was molded by the spirit of the German youth movement, which was one of the noblest blossoms of the German spirit.”

Asperger studied medicine at the University of Vienna under Franz Hamburger and practiced at the University Children’s Hospital in Vienna. He earned his medical degree in 1931 and became director of the special education section at the university children’s clinic in Vienna in 1932. He joined the Austrofascist Fatherland Front on 10 May 1934, nine days after Chancellor Engelbert Dollfuss passed a new constitution making himself dictator. Asperger married in 1935 and had five children.

Career

During World War II, he was a medical officer, serving in the Axis occupation of Yugoslavia; his younger brother died at Stalingrad. Near the end of the war, Asperger opened a school for children with Sister Viktorine Zak. The school was bombed and destroyed, Viktorine was killed, and much of Asperger’s early work was lost.

Georg Frankl was Asperger’s chief diagnostician until he moved from Austria to America and was hired by Leo Kanner in 1937.

Asperger published a definition of autistic psychopathy in 1944 that resembled the definition published earlier by a Russian neurologist named Grunya Sukhareva in 1926. Asperger identified in four boys a pattern of behaviour and abilities that included “a lack of empathy, little ability to form friendships, one-sided conversations, intense absorption in a special interest, and clumsy movements”. Asperger noticed that some of the children he identified as being autistic used their special talents in adulthood and had successful careers. One of them became a professor of astronomy and solved an error in Newton’s work he had originally noticed as a student.  Another one of Asperger’s patients was the Austrian writer and Nobel Prize in Literature laureate, Elfriede Jelinek.

In 1944, after the publication of his landmark paper describing autistic symptoms, Hans Asperger found a permanent tenured post at the University of Vienna. Shortly after the war ended, he became director of a children’s clinic in the city. It was there that he was appointed chair of pediatrics at the University of Vienna, a post he held for twenty years. He later held a post at Innsbruck. Beginning in 1964, he headed the SOS-Kinderdorf in Hinterbrühl. He became professor emeritus in 1977, and died three years later. AS was named after Hans Asperger and officially recognised in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1994; it was removed from DSM-5 in 2013.

Posthumous Developments

Asperger Syndrome Diagnosis

Asperger died before his identification of this pattern of behaviour became widely recognised. This was in part due to his work being exclusively in German and as such it was little-translated; medical academics, then as now, also disregarded Asperger’s work based on its merits or lack thereof. English researcher Lorna Wing proposed the condition Asperger’s syndrome in a 1981 paper, Asperger’s syndrome: a clinical account, that challenged the previously accepted model of autism presented by Leo Kanner in 1943. It was not until 1991 that an authoritative translation of Asperger’s work was made by Uta Frith; before this AS had still been “virtually unknown”. Frith said that fundamental questions regarding the diagnosis had not been answered, and the necessary scientific data to address this did not exist. Unlike Kanner, who overshadowed Asperger, the latter’s findings were ignored and disregarded in the English-speaking world in his lifetime.

In the early 1990s, Asperger’s work gained some notice due to Wing’s research on the subject and Frith’s recent translation, leading to the inclusion of the eponymous condition in the International Statistical Classification of Diseases and Related Health Problems 10th revision (ICD-10) in 1993, and the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders 4th revision (DSM-IV) in 1994, some half a century after Asperger’s original research.

Despite this brief resurgence of interest in his work in the 1990s, AS remains a controversial and contentious diagnosis due to its unclear relationship to the autism spectrum. In 2010 there was a majority consensus to subsume AS into the diagnosis “Autistic Spectrum Disorder” in the 2013 DSM-5 diagnostic manual. The World Health Organisation’s ICD-10 Version 2015 describes AS as “a disorder of uncertain nosological validity”.

In his 1944 paper, as Uta Frith translated from the German in 1991, Asperger wrote, “We are convinced, then, that autistic people have their place in the organism of the social community. They fulfil their role well, perhaps better than anyone else could, and we are talking of people who as children had the greatest difficulties and caused untold worries to their care-givers.” Based on Frith’s translation, however, Asperger initially stated: “Unfortunately, in the majority of cases the positive aspects of autism do not outweigh the negative ones.” Psychologist Eric Schopler wrote in 1998:

Asperger’s own publications did not inspire research, replication, or scientific interest prior to 1980. Instead, he laid the fertile groundwork for the diagnostic confusion that has grown since 1980.

Since 2009, Asperger’s birthday, 18 February, has been declared International Asperger’s Day by various governments.

Nazi Involvement

Edith Sheffer, a modern European history scholar, wrote in 2018 that Asperger cooperated with the Nazi regime, including sending children to the Spiegelgrund clinic which participated in the euthanasia programme. Sheffer wrote a book further elaborating on her research called Asperger’s Children: The Origins of Autism in Nazi Vienna (2018).

Another scholar and historian from the Medical University of Vienna, Herwig Czech concluded in a 2017 article in the journal Molecular Autism, which was published in April 2018:

Asperger managed to accommodate himself to the Nazi regime and was rewarded for his affirmations of loyalty with career opportunities. He joined several organisations affiliated with the NSDAP (although not the Nazi party itself), publicly legitimised ‘race hygiene’ policies including forced sterilisations and, on several occasions, actively cooperated with the child ‘euthanasia’ programme.

Dean Falk, American anthropologist from Florida State University, questioned Herwig Czech’s and Edith Sheffer’s allegations against Hans Asperger in a paper in Journal of Autism and Developmental Disorders. Czech’s reply was published in the same journal. Falk defended her paper against Czech’s reply in a second paper.

In May 2019, Ketil Slagstad, a Norwegian doctor and historical scholar, added his interpretation of both Sheffer’s and Czech’s work, in his article “Asperger, the Nazis and the children – the history of the birth of a diagnosis”, in which he describes the nuances of the situation. He offers an alternative explanation of Asperger’s involvement: citing the challenges of war, a desire to protect his career, and protection of the children for whom he was caring. Slagstad concludes:

The story of Hans Asperger, Nazism, murdered children, post-war oblivion, the birth of the diagnosis in the 1980s, the gradual expansion of the diagnostic criteria and the huge recent interest in autism spectrum disorders exemplify the historical and volatile nature of diagnoses: they are historic constructs that reflect the times and societies where they exert their effect.

Critically, Slagstad noted “Historical research has now shown that he [Asperger] was…a well-adapted cog in the machine of a deadly regime. He deliberately referred disabled children to the clinic Am Spiegelgrund, where he knew that they were at risk of being killed. The eponym Asperger’s syndrome ought to be used with awareness of its historical origin.”