NeuroTribes, by Steve Silberman, takes the reader on a historical journey of autism since the 18th century. I stumbled on this book after watching both of Hannah Gadsby’s Netflix Comedy specials (Douglas and Nanette). In both of them, she discusses her Autism diagnosis and how it affects her life. This wasn’t the first thing I watched about autism that I related to. Last year I stumbled upon Temple Grandin and her presentations on autism. Autism is widely known to be prevelant in the software industry, so whether I have it or not, I am likely to be exposed to it. I believe it is important to learn about so that I can better understand others and myself.
Autism as a Spectrum
We didn’t always consider autism as a spectrum. You are likely familiar with the term “aspergers”, which if you are the average person, you might define as “similar to autism but not as bad”. I thought this was the extent of the confusion, but there was also pervasive developmental disorder-not otherwise specified (PDD-NOS) and childhood disintegrative disorder (CDD). What started out as child schizophrenia eventually evolved in to what we now know as the autism spectrum disorder.
Brief History of the DSM
The “Diagnostic and Statistical Manual of Mental Disorders” (DSM) is the manual used in the United States that lays this all out. It was preceded by the American Psychiatric Assiciation Manual (1917) which was laid out in response to national census data that started being collecting in 1840.
The U.S. population at the time was around 17 million (2.5 million were slaves). The census asked for “number of insane and idiotic in public or private charge, by race”. Nearly all slaves were marked as mentally ill and pro-slavery advocates used this as evidence of the consequences of emancipation. A more logical conclusion was provided by John Quincy Adams that the census demonstrated “a multitide of gross and important errors”.
Despite performing his research at the same time as Leo Kanner (1940s), Aspberger’s Syndrome didn’t find it’s way in to the DSM until DSM-IV, thanks to Lorna Wing resurfacing Aspberger’s work. It wasn’t until the most recent DSM V that the four categories of autism mentioned above were consolidated into an umbrella diagnosis of autism spectrum disorder. Although Silberman covers the main names behind autism in great detail: Leo Kanner, Hans Asperger, and Lorna Wing, I found the timeline difficult to follow. I will attempt to condense a very long story below.
Quantum Mechanics: An Idea in Two Places at the Same Time
I always struggle to keep dates straight when there are too many of them. Below lays out the the timeline of Kanner and Asperger’s research.
|1911||Physician, schoolteacher, and social reformer Erwin Lazar opens Children’s Clinic where Asperger eventually works|
|1924||Leo Kanner moves to US from Berlin after graduating from medical degree (cardiology)|
|1927||Georg Frankl starts working in the Children’s Clinic|
|1930||Leo Kanner helps establish the Children’s Psychiatry Service at the Harriet Lane Home at Johns Hopkins|
|1931||Asperger earns medical degree from University of Vienna|
|1935||Kanner publishes Child Psychiatry. This was the first English language textbook for child psychiatry.|
|1937||Kanner hired Georg Frankl, Aspberger’s chief diagnostician|
|1938||Kanner starts observing 11 patients in preparation for “Autistic Disturbances of Affective Contact”|
|1938||Aspberger gives first public talk on autism in history|
|1939||World War II Starts|
|1943||Kanner publishes landmark paper “Autistic Disturbances of Affective Contact”|
|1944||Asperger publishes landmark paper describing autistic symptoms|
|1945||World War II Ends|
|1994||Asperger’s Syndrome added to DSM-IV|
One interesting part of this story, is that Kanner denies having any knowledge of Asperger’s work. Silberman frequently alludes to this, but refrains from boldy declaring that Kanner was avoiding mentioning Aspberger so he could take all the credit. The hiring of Georg Frankl is presented as evidence that there is no way Kanner wasn’t aware of Aspberger’s existence.
Another important piece of the puzzle is framing the discovery of autism in the context of World War II. Kanner and Asperger were just starting to get down to business when the world erupted in to war. Asperger served as a medical officer in the Axis occupation of Yugoslavia. Near the end of the war, a school Aspberger opened to help the children he was seeing was bombed, destroying it and much of Aspberger’s early work. In Maryland, Kanner was busy rescuing hundreds of Jewish physicians by helping them relocate to the United States and housing them.
This is the first part of three based on the book NeuroTribes. The next part will focus more on the topic of eugenics and how it intertwines with the history of autism.