Jeffrey P. Baker, MD, PhD,a​ Birgit Lang, PhDb Eugenics and the Origins of Autism

Autism has become a deeply moment when the latter had contested diagnosis. Whereas become the target of a powerful family advocacy organizations “eugenics movement.” have long characterized the condition as a disorder in Eugenics is a slippery term need of effective treatments, a to define, but in the context of growing number of adults who the early 20th century, it can be think of themselves as having thought of as a social movement high-functioning autism (or dedicated to improving the quality of the human race through the Asperger syndrome) insist that – autism is an identity deserving science of heredity. From roughly “ ” the time of the Great War (1914 of acceptance. The latter use the – 1919) through the Second World term neurodiversity to contend a War (1939 1945), it attracted a Trent Center for Bioethics, Humanities, and History of Medicine, that autism should be regarded School of Medicine, Duke University, Durham, North Carolina; and as a profoundly interwoven wide following in many countries, bSchool of Languages and Linguistics, University of Melbourne, combination of intellectual gifts including the United States, Great Melbourne, Australia and social differences. Some Britain, and (most2 notoriously) Dr Baker contributed significantly to the conceptualization, even question the motivations Nazi Germany. Its appeal was background research, drafting, and revision related to this fed by widespread anxiety article, and he brings his own perspective as an historian underlying basic scientific “ ” and researcher who has lectured and written about the role research, arguing that genetic regarding what was often called the menace of the feebleminded,​ played by Dr Leo Kanner in the first descriptions of autism in markers will be used in prenatal the United States; and Dr Lang also contributed significantly diagnosis to eliminate rather than the fear that the intellectually to the conceptualization, background research, drafting, and inferior classes were reproducing revision related to this article, and her perspective draws improve1 the lives of people with autism. at a far higher rate than that of from extensive historical research on the work of Dr Hans their more socially responsible Asperger and Dr Leo Kanner. The debate over whether to superiors. The number of DOI: https://​doi.​org/​10.​1542/​peds.​2017-​1419 consider autism a disability or children consigned to residential Accepted for publication May 22, 2017 identity is surely complicated institutions soared in this period. by its expansion into a spectrum Address correspondence to Jeffrey P. Baker, MD, PhD, Cognitively impaired children Pediatrics, Trent Center for Bioethics, Humanities, and History that encompasses a wide range of could be institutionalized with of Medicine, Duke University School of Medicine, PO Box 3040, individuals and functioning. But only minimal formal evaluation, Durham, NC 27710. E-mail: [email protected] this controversy is also rooted and it is highly plausible that many PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098- in a fundamental tension within would be diagnosed today as 4275). the core definitions of autism as 3 having autism. The economic and Copyright © 2017 by the American Academy of Pediatrics formulated in the 1940s by the social burden associated with the FINANCIAL DISCLOSURE: The authors have indicated they 2 physicians credited for first rise of institutionalization led to have no financial relationships relevant to this article to describing the syndrome. Drs cries for more definitive solutions disclose. Leo Kanner and Hans Asperger in the form of sterilization in the FUNDING: No external funding. “ both highlighted the presence of United States, and ultimately, the ” POTENTIAL CONFLICT OF INTEREST: The authors have intellectual gifts in many of their systematic elimination of lives indicated they have no potential conflicts of interest to patients, alongside social deficits not worth living in wartime disclose. and characteristic behaviors. This Nazi Germany through forcible To cite: Baker JP and Lang B. Eugenics and the Origins of emphasis is best understood as euthanasia.NeuroTribes a strategy to draw a sharp line Autism. Pediatrics. 2017;140(2):e20171419 dividing autism from mental In his book4 , Steve retardation, reacting to a historical Silberman has portrayed Downloaded from www.aappublications.org/news by guest on September 25, 2021 PEDIATRICS Volume 140, number 2, August 2017:e20171419 MONTHLY FEATURE ’ ä “ Hans Asperger as a pioneer of capacities for memorization and In Asperger s case, the Heilp dagogik ” neurodiversity who resisted eugenic complex interaction with objects. His Station where he had studied his little ideology by promoting a positive first patient, Donald T., could recite professors stayed in operation only and benign view of autism. The 25 questions and answers of the to be destroyed in a bombing by Allied “ 5 Austrian pediatrician gave his Presbyterian catechism. ’ forces at the end of the war. Nor is ” ’ first public lecture on autistic Just as striking was Kanner s there any evidence that, if Asperger “ psychopathy in October 1938, just characterization of his patients did anticipate an autism spectrum, this ” months after the incorporation of parents: They all come of recognition led him to protect patients Austria into the Third Reich. That highly intelligent families. Most functioning at lower cognitive levels. lecture (later to become the basis of the fathers had advanced After the annexation of Austria into of his more widely cited 1944 professional degrees, and all but 3 Nazi Germany, this potentially meant thesis) described 4 patients whose of their extended families were well euthanasia. Documents unearthed striking combination of intellectual American Men of Science by Austrian historian Herwig Czech “ represented in compendia5 such as gifts and social interaction deficits . The autism (recently publicized in the English- ” “ Asperger likened to that of little pedigree was effectively the opposite speaking world by journalists John ” professors. All had been seen in of the counterpart for feeble- Donvan and Caren Zucker) have ä ’ an innovative special education mindedness so vividly summarized indicated that, in common with unit, the Heilp dagogik Station, by Justice Oliver Wendell Holmes many of his peers under the Nazi characterized by an optimistic famous opinion in the ruling regime, Asperger referred children Buck v. Bell “ therapeutic philosophy contrasted justifying eugenic sterilization in with severe mental retardation to ” with the fatalism so often associated , Three generations of hospitals9 that were known euthanasia with institutions. Interestingly, 6 centers. Historians have already “ imbeciles is enough. “‍ Asperger commented that he had shown that physicians cooperated ” ” specifically chosen not too severe The focus on special intellectual with the Nazi regime for a variety of and thus more promising cases,​ abilities,​ so prominent in the reasons, including personal gain and “ ” 10 suggesting to Silberman that he was thinking of both Kanner and professional survival. The revelation aware that they represented part of Asperger, can be best understood as that St Asperger was among them a broader continuum of autism. He a strategy to distance their patients remains poignant, a reminder of the thus emphasized the continuity of from the stigma of mental retardation moral vulnerability of even the most the syndrome with intellectuality in the eugenics era. Neither was sympathetic and forward-thinking “ rather than mental retardation. simply describing what they saw; physicians of the time. ’ ” Who among us does not recognize both were aware of children with “ Nonetheless, Kanner and Asperger s the autistic scientist,​ Asperger autistic symptoms who had no such evidence of precocious intelligence. construction of autism as an entity asked, whose clumsiness and lack “ ” combining both special abilities and of instincts have made him a familiar As already noted, Asperger presented social deficits has left an important caricature, but who is capable of only his more promising cases. ” legacy. Although autism has formally extraordinary accomplishments in a Kanner appears to have disqualified 4 been defined in terms of deficits highly specialized field? ‍ patients with congenital syndromes associated with intellectual disability and pathologies,Rain theMan public image of autism, particularly since the It has been less noticed that Asperger (such as tuberous7 sclerosis) from an 1988 movie , has often was not the only pioneer of early autism diagnosis. “ ” emphasized the theme of giftedness. autism who sought to distinguish The practical consequences of this ’ autism from the unfit. Kanner, the distinction between autism and For some, this dimension of ’ Johns Hopkins psychiatrist whose mental retardation for Kanner s and autism is framed as a hidden self, ’ 1943 article is widely regarded as the Asperger s patients is debatable. awaiting discovery and liberation first American description of autism, Most of Kanner s original 11 patients through curative treatment. For ’ made a rather similar diagnostic were placed in state institutions neurodiversity advocates, such special move. Kanner s vivid case series of and eventually lost their8 earlier abilities are part of the core identity 11 patients described many of the intellectual abilities. The main of the person with autism. But either classic behaviors that continue to exceptions, in fact, were the 3 who way, we need to understand the define autism today, but it differed evaded residential placement, most often highly charged debate over the in one important respect. None of notably his index case, Donald T., meaning of autism in the context of the children, he asserted, had mental whose intellectual gifts became the legacies of the eugenics movement deficiency. He based his belief on the something of a sensation in9 his home and the long history of stigmatization presence in his patients of striking town of Forest, Mississippi. of mental disability. Downloaded from www.aappublications.org/news by guest on September 25, 2021 2 Baker and Lang References 1.  Solomon A. Far From the Tree: 4. Silberman S. NeuroTribes: The 7. Frankl G. Language and affective Parents, Children, and the Search Legacy of Autism and the Future of contact. Nerv Child. 1943;2(3):251–262 for Identity. New York, NY: Scribner; Neurodiversity. New York, NY: Avery; 8. Kanner L. Follow-up study of eleven 2012:221–294 2015:82–139 autistic children originally reported 2. Kevles DJ. In the Name of Eugenics: 5. Kanner L. Autistic disturbances in 1943. J Autism Child Schizophr. Genetics and the Uses of Human of affective contact. Nerv Child. 1971;1(2):119–145 Heredity. Cambridge, MA: Harvard 1943;2(3):217–250 9. Donvan J, Zucker C. In a Different Key: University Press; 1985 6. Lombardo P. Three Generations, No The Story of Autism. New York, NY: 3. Eyal G, Hart B, Onculer E, Oren N, Imbeciles: Eugenics, the Supreme Crown; 2016:25–80, 338–341 Rossi N. The Autism Matrix: The Social Court, and Buck v. Bell. Baltimore, MD: 10. Proctor RN. Racial Hygiene: Medicine Origins of the Autism Epidemic. Johns Hopkins University Press; Under the Nazis. Cambridge, MA: Cambridge, UK: Polity; 2010 2008: 169 Harvard University Press; 1988

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Updated Information & including high resolution figures, can be found at: Services http://pediatrics.aappublications.org/content/140/2/e20171419 References This article cites 3 articles, 0 of which you can access for free at: http://pediatrics.aappublications.org/content/140/2/e20171419#BIBL Subspecialty Collections This article, along with others on similar topics, appears in the following collection(s): Developmental/Behavioral Pediatrics http://www.aappublications.org/cgi/collection/development:behavior al_issues_sub Autism/ASD http://www.aappublications.org/cgi/collection/autism:asd_sub Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: http://www.aappublications.org/site/misc/Permissions.xhtml Reprints Information about ordering reprints can be found online: http://www.aappublications.org/site/misc/reprints.xhtml

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