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Wednesday, January 27, 2016

Was Dr. Asperger a Nazi? The Question Still Haunts Autism

From NPR's Health Blog "Shots"

By Steve Silberman
January 20, 2016

"The most important lesson is not that brutal regimes like the Third Reich enable evil men to do evil, but that they are able to compel even well-intentioned people to do monstrous things."

Dr. Hans Asperger with a young boy at the Children's Clinic at the
University of Vienna in the 1930s. Courtesy of Maria Asperger Felder

The publication of a new history of autism called In a Different Key, by John Donvan and Caren Zucker, has reopened an unsettling question about the pioneering Viennese pediatrician Hans Asperger: Was he a Nazi sympathizer, or a man who paid lip service to his bosses' murderous ideology in order to save the lives of as many of his young patients as possible?

The implications of this question are far-reaching, because Asperger's work on autism at the University of Vienna in the 1930s was ignored for decades after the war. That had a catastrophic impact on autistic people and their families, and on the course of autism research.

The controversy also gets to the heart of the difficulty of accurately judging the behavior of people living under brutal regimes, particularly decades after the fact.

In Donvan and Zucker's view, Asperger was an ambitious opportunist who uncritically spouted Nazi ideology in his first public lecture on autism in 1938, and enthusiastically signed letters "Heil Hitler!"

Most devastatingly, he signed a letter of referral effectively condemning a little girl with encephalitis named Herta Schreiber to death in a Vienna rehab facility that had been converted into a killing center by Asperger's former colleague, Erwin Jekelius.


Donvan and Zucker base their conclusions on documents allegedly uncovered by a Holocaust scholar in Vienna named Herwig Czech, whose grandfather was a Nazi. Czech has made a career of documenting the horrific crimes of the medical establishment under the Third Reich, while "outing" secret Nazis like neurologist Walther Birkmayer, who pioneered the use of a drug called L-dopa to treat Parkinson's disease but was a member of the dreaded SS.

While researching my own history of autism, NeuroTribes, published in 2015, I ultimately came to take a more nuanced view of Asperger as a compassionate clinician and educator working under the most difficult possible circumstances as Hitler and his henchmen rose to power.

My book explores the historical background of the Nazis' attempt to wipe disabled people off the face of the earth, including the fact that the Third Reich's genocidal policies were inspired by eugenics research originally conducted in America under the auspices of mainstream scientific organizations like the Rockefeller Foundation and the Carnegie Institute.

Asperger, in the bottom row, far right, with other staff members at the
Children's Clinic, realized in the 1930s that autism was a spectrum of
disorders that conferred both disability and ability.
Courtesy of Maria Asperger Felder

I also made clear that once the Nazis marched into Austria to annex the country for the fatherland in 1938, nearly all of Asperger's colleagues became fervent members of the Nazi party, while his Jewish colleagues were purged from the faculty at the University of Vienna and forced to flee the country or face death in a concentration camp. Many chose to commit suicide instead.

I focused primarily on the years leading up to World War II and on the crucial work that Asperger and his colleagues did at the Children's Clinic at the university, before the Nazis took over and transformed the once hallowed institution of learning into a center for the study of "racial hygiene" staffed by bumbling fanatics.

What I found led me to conclude that Asperger was the true discoverer of what we now call the autism spectrum — a lifelong condition with a broad and strikingly heterogeneous range of clinical presentations.

To come to that conclusion, I drew on the first case history of autism, written at the Children's Clinic in 1935 by Asperger's colleague psychologist Anni Weiss, which had been overlooked for 80 years. Weiss evaluated a boy named Gottfried who exhibited many traits now considered classic manifestations of autism — including difficulty in relating to his peers, which made him a frequent target of bullying, heightened sensitivity to sound, and a rigidly logical cast of mind.

After having Gottfried take an intelligence test, one that he undertook with great difficulty, Weiss came to an astonishingly prescient conclusion. Instead of presuming that the shy, awkward boy was feebleminded, as many of his teachers had done, Weiss noticed that Gottfried was acutely anxious about violating the rules of the test, which hampered his performance. She concluded that in fact he was highly intelligent, but in a way that couldn't be captured by the usual standardized tests.

I discovered another forgotten paper written by an American psychiatrist named Joseph Michaels, who visited Asperger's clinic before the war. At first skeptical about the lack of psychoanalytical frameworks guiding the staff, Michaels was eventually converted by what he called the clinic's "highly personal" approach, which viewed eccentric behavior as problematic only if it created problems for the child.

"Fundamentally there appears to be no special interest in the differences between normal and abnormal," Michaels wrote, "as it is felt that theoretically this is unclear, and practically it is of no great importance ... great value is placed on intuition gained ... while working, or better, while living with the children."

Asperger and his colleagues would eventually examine more than 200 children with autism at all levels of ability — from nonspeaking children who would always require assistance in their daily lives to a young man who became an assistant professor of astronomy after detecting an error in one of Isaac Newton's proofs.

Asperger noted the prevalence of autistic traits among "distinguished scientists," and went so far as to say, "It seems that for success in science and art, a dash of autism is essential ... the necessary ingredient may be an ability to turn away from the everyday world, from the simply practical, an ability to rethink a subject with originality so as to create in new untrodden ways."

In his first talk on autism in 1938, which Donvan and Zucker put forth as evidence of Nazi sympathies, Asperger may well have emphasized his "most promising cases" to his Nazi bosses in part because newly passed eugenics laws in Austria targeted more impaired children for extermination. This tactic inadvertently led to one of the most pernicious myths about Asperger's legacy: that he only saw high-functioning children, when he made clear in his published work that he saw children from all points on the spectrum.

Donvan and Zucker's account of that lecture omits any reference to the most radical statement Asperger made that day: his observation that his patients' impairments were inextricable from their special gifts, forming "natural, necessary, interconnected aspects of one well-knit, harmonious personality."

Later, he would make the prescient suggestion that the enhanced pattern-recognition abilities of his autistic patients would make them valuable code-breakers for the Reich. This view was completely at odds with the eugenicists' core belief that humanity could only thrive by shedding the "burden" of providing disabled people with the support they need, while they make contributions that only they can.

In this belief, Asperger anticipated the development of the modern neurodiversity movement, which views conditions like autism, dyslexia and ADHD as profound disabilities that can also convey striking gifts in the presence of adequate accommodations and educational resources.

As a clinician who worked with children with many types of hereditary disabilities, Asperger was in an acutely perilous position — particularly because the man who originally assigned him to work in the Children's Clinic, an infectious disease specialist named Franz Hamburger, became one of the most prominent Nazis in Austria. Hamburger portrayed the Fuehrer as a grand physician, opening up "new avenues of health for the 80 million folk of Germany."

Under the influence of fanatics like Hamburger, the distinction between normal and abnormal behavior became a litmus test that meant the difference between life and death. The Nazis embarked on a series of euthanasia campaigns to murder disabled children and adults in large numbers, which effectively became practice runs for the Holocaust.

Doctors were required to report disabled children in their care, medical students were trained to administer lethal injections while filling out fictitious death certificates, and clinics and hospitals became factories of death — including the former rehab facility in Vienna called Am Spiegelgrund that became the primary killing center for all of Austria under the supervision of Erwin Jekelius.

Dissent in the ranks was punished harshly. A prominent bishop who objected to the mass murder of disabled children on religious grounds was quickly dispatched to a camp. Medical students at the University of Munich who opposed euthanasia were arrested, convicted of treason by a people's court and publicly beheaded.

Asperger found himself in what he later described as a "truly dangerous situation." According to Adam Feinstein, author of A History of Autism, the Gestapo came to the clinic twice to arrest Asperger — and both times, Hamburger was able to send them away.

In order to retain his position at the university, the soft-spoken Asperger would have been required at the very least to take a loyalty oath to Hitler. After giving another talk in 1940, Asperger was chided by his colleague Josef Feldner for paying lip service to the Fuehrer, which, Feldner advised him, was "a bit too Nazistic for your reputation." Though nearly all of Asperger's colleagues eventually joined the Nazi party, Asperger never did.

Understanding the terrible historical forces that Asperger was up against makes sense of the oddly strident note he struck in his best-known paper, filed to Hamburger in 1943. "The example of autism shows particularly well how even abnormal personalities can be capable of development and adjustment," Asperger wrote. "This knowledge ... gives us the right and the duty to speak out for these children with the whole force of our personality."

Ultimately, Asperger's insights would inspire the British psychiatrist Lorna Wing to conceive of autism as a broad and inclusive spectrum instead of a rare, narrowly defined form of childhood psychosis — allegedly caused by unloving "refrigerator" parents — that was described by Leo Kanner, the child psychiatrist at Johns Hopkins Hospital who took sole credit for discovering the condition in 1943.

The real story was much more complicated than that. In fact, it was Kanner who rescued Georg Frankl and dozens of other Jewish clinicians from the gathering storm leading up to the Holocaust, reaping the benefits of Frankl's expertise by having him evaluate Kanner's first autistic patients. Kanner would go on to become the world's leading authority on autism, while mentioning Asperger's work only once in print, dismissively, much later in his career.

Rumors that Asperger was more compliant with his Nazi bosses than he himself suggested after the war have circulated for decades. As Donvan and Zucker point out, Eric Schopler, the founder of TEACCH — a pioneering autism education and research program in North Carolina — objected to Lorna Wing's coinage of the term "Asperger Syndrome" for this reason, preferring the term "high-functioning autism."

But In a Different Key raises the speculation about Asperger's character to a new level. Again citing Czech's research, the authors claim that Asperger served on a committee that decided which children should live and which should die, though they do not explore the possibility that Asperger could have used that position to save as many children as possible.

Czech has never made his information available to me, despite numerous requests of increasing urgency over the years, even after his allegations appeared in a review of my book in The Spectator by autism researcher Simon Baron-Cohen.

But I was able to find support for his claim that Asperger signed the letter of referral sending Herta Schreiber to Am Spiegelgrund in the work of another scholar named Waltraud Hauepl, whose sister also perished there. I have amended the text of future editions of my book to reflect this darkest episode in Asperger's career.

It would be unfortunate if Donvan and Zucker's revelations are used to discredit the work of Asperger and his colleagues Georg Frankl and Anni Weiss. As filmmaker Saskia Baron points out in her review of In a Different Key in The Guardian, "Whether Asperger was a saint or a sinner should not dominate the discourse around autism." (She probed the ethical dimensions of the Third Reich's medical crimes in her documentary Science and the Swastika: Hitler's Biological Soldiers.)

What matters is focusing on the availability of services and support for autistic people and their families — a population that has been drastically underestimated in history, primarily because Asperger's work was not made widely available in English until 1991.

Without her serendipitous discovery of Asperger's work when it was still being overlooked, the British psychiatrist Lorna Wing would never have been inspired to broaden the diagnostic criteria for autism into a spectrum that included what she called Asperger's syndrome, making support services available to a wide range of people — including teenagers and adults — who had been excluded from a diagnosis before.

The reframing of autism as a spectrum in the 1990s also made possible marvelous things that Asperger himself could never have predicted, such as the emergence of a vibrant autistic culture (embodied in books like The Real Experts: Readings for Parents of Autistic Children), and the proliferation of autistic-run organizations like the Autistic Self-Advocacy Network, which are demanding a place at the table when public policy that impacts autistic people and their families is formulated.

Asperger's daughter, Maria Asperger Felder, a pediatrician and psychiatrist in Vienna, told me recently that she is carrying on her father's work to this day, seeing autistic patients from age 5 to age 60. She also says that after the war, Georg Frankl immediately re-established contact with her father, and the two men maintained a lively correspondence about the progress of their patients, as they had done in the years before darkness fell in Austria. They also visited one another cordially in their respective home countries, which one wouldn't expect if Frankl believed that Asperger was a Nazi monster who had enthusiastically sent his young patients to their deaths.

I look forward to Herwig Czech finally making his research available to other scholars. But if Donvan and Zucker's allegations turn out to be true, the most important lesson of this tragic chapter in history is not that Asperger's work should be ignored, as it was in most of the world until developmental psychologist Uta Frith finally made it available in English.

The most important lesson is not that brutal regimes like the Third Reich enable evil men to do evil, but that they are able to compel even well-intentioned people to do monstrous things.


Steve Silberman is author of NeuroTribes, a New York Times best-selling history of autism and the neurodiversity movement.

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