NOTEBOOKS OF THE ESTEVE Foundation Nº 42 The Big Bang Theory and Asperger’s Syndrome Ramon Cererols It is a mass phenomenon. Since its launch in 2007, this CBS comedy has not stopped winning fans and is now first among the most-viewed television fictions in the US, in its eighth season having nearly 20 million viewers. This sitcom starring two Caltech (California Institute of Technology) physicists, which makes constant references to physics’ most complex theories and principles, has garnered extraordinary success, thanks above all to its lead role. The character of Sheldon Cooper, who displays many of the characteristics associated with Asperger’s syndrome, has earned the actor Jim Parsons no less than four Emmy Awards In the field of scientific progress it is not unusual but is currently in the Ukraine, in 1894), their lives to find cases where two or more researchers led them on destinies far removed from each make the same discovery independently and other. At thirty years old, Kanner emigrated to the almost simultaneously, sometimes without ei- United States, and a few years later was com- ther knowing about the other’s work. Among the missioned to create the first children’s psychi- best-known cases are those of Charles Darwin atric service in the world at the Johns Hopkins and Alfred Russel Wallace (biological evolution Hospital, in Baltimore. 1Among the many children by natural selection), Isaac Newton and Gottfried he treated there, several captured his attention. Wilhelm Leibniz (infinitesimal calculus), and Elisha They displayed common symptoms differing Gray and Alexander Graham Bell (the telephone). from any other disorder identified to date, and This fact shows that any great leap in the prog- had been classed as mental or schizophrenic ress of science is due not just to a lucid mind and weaknesses. They all displayed an incapacity to great dedication, but also to the prior advances relate to people in a normal manner, a preference of many people who create a cultural environ- for objects, a language having no communica- ment that fosters the development of new ideas. tive purpose, an excellent mechanical memory, Even a figure as renowned as Newton, citing monotonous and repetitive behavior, rejection of twelfth-century French philosopher Bernardo de external intrusions or loud or sudden noises, and Chartres, recognized that “If I have seen further, it fear of change. is by standing on the shoulders of giants”. Kanner decided to call this syndrome “early One such concurrent breakthrough occurred infantile autism” because its fundamental or in the early 1940s. Its protagonists were the psy- pathognomonic characteristic is the child’s isola- chiatrist Leo Kanner and the pediatrician Hans tion in his own inner world. He borrowed the term Asperger. Though both men were born in what “autism” from Swiss psychiatrist Eugen Bleuler, was then the Austro-Hungarian Empire (Asperg- who had coined it in 1911 to define the behavior er, in Vienna in 1906, and Kanner in Klekotow, of schizophrenic adults, withdrawn and closed in now Klekotiv, a village that belonged to Poland, upon themselves. In 1943, Kanner presented his 1 Here and below, I use a male gender to refer to both boys and girls. Nevertheless, Asperger’s syndrome is around five times more common in males than in females. -35- The Big Bang Theory and Asperger’s Syndrome conclusions, along with a detailed description of tive aspects these children displayed, whom he eleven case studies, in an article called “Autistic protected in the Aktion T4 program, which aimed Disturbances of Affective Contact”, which be- to exterminate the Lebensunwertes Leben (“life came a classic of clinical psychology. unworthy of being lived”, according to the term While Kanner was treating and studying used in Nazi rhetoric). his patients in the US, Asperger was doing the Precisely because of the geopolitical circum- same in his native Vienna, at whose university he stances of the time, Kanner’s and Asperger’s gained a doctorate in medicine and specialized in articles suffered contrasting fortunes. While the pediatrics. In 1932, he took over the special edu- former’s was rapidly disseminated, Asperger’s re- cation section at the university children’s clinic, mained unknown outside of certain limited, Ger- through which hundreds of children were treated. man-speaking circles. So the name Asperger’s During the Second World War, he was a medical syndrome did not appear in English until 1970, officer and created a school that was destroyed with the translation of a book by Gerhard Bosch by shelling, in which he lost a large part of his originally written in 1962 (Infantile Autism: A Clini- earlier work. In 1944, he obtained the chair of pe- cal and Phenomenological-Anthropological In- diatrics at the University of Vienna, and two years vestigation Taking Language as the Guide). Yet later he was also named director of the children’s true international recognition would not arrive hospital at the same university, both positions he until 1981, thanks to British psychiatrist Lorna would occupy until 1977. Wing. For his qualification thesis to the chair, As- As a result of the birth in 1956 of her daughter perger focused on a syndrome he had observed Susie, who had autism, Wing focused on study- in his consulting room in the clinic, one which ing this disorder, and founded the National So- had grabbed his attention. The children who dis- ciety for Autistic Children in 1962. Her husband, played this syndrome he called “the little teach- John Wing, likewise a psychiatrist, discovered ers” since they were highly knowledgeable on a one of Hans Asperger’s studies from 1946 and particular topic, on which they could speak for translated it for his wife, who became interested hours. Despite this, their continuous, exclusive in the syndrome, considering it a subcategory of concentration on the subject of their attraction, autism. As a result of her research, in 1981, she and their lack of interest in contact with other published the article Asperger Syndrome: A Clini- people made their integration into society and cal Account, which in the words of Wing herself into the standard education system difficult. Even “opened the Pandora’s box” to the point where so, Asperger considered that “in some cases, over the next two decades 900 articles were these problems are compensated by a high de- published on this disorder which until then was gree of original thought and experience, which practically unknown. often led them to achieve exceptional successes in adult life”, and was “convinced that autistic Two different disorders? people had their place in the organization of so- cial community”. In Wing’s aforementioned article, the author Asperger presented his work in an article enti- emphasized the common characteristics of the tled Die Autistischen Psychopathen im Kindesalt- disorders described by Kanner and Asperger, to er (Autistic Psychopathy in Childhood), published the extent where she asserted one should ask in Switzerland in 1944, a year after Kanner’s ar- “whether they are varieties of the same under- ticle. The coincidence in the naming of autism lying abnormality or are separate entities”. Ten –as “infantile autism” by Kanner and as “autistic years later, in 1991, Wing came down clearly on psychopathy” by Asperger– is curious, given that the side of the former, proposing the existence of as far as we know, neither knew of the other’s a continuum from Kanner’s autism to Asperger’s studies. The characteristics described were also syndrome, as clinical cases showed, in which similar, even if Asperger emphasized the posi- “the same individual was typically autistic in his -36- NOTEBOOKS OF THE ESTEVE Foundation Nº 42 MEDICINE IN TELEVISION SERIES early years, but made progress and as a teen- tion of Asperger’s original article. This status was ager showed all characteristics of Asperger’s maintained for two decades, until in May 2013, syndrome”2. after intense polemic, a new edition of the DSM Currently it is thought that this continuum –or (DSM-5) consolidated the autism group into a spectrum– is even broader, encompassing at one single category, autism spectrum disorder, with end the most intense cases of autism, Asperger’s three levels of seriousness according to the sup- in the middle and from there a gradual evolution port required. With this decision, Asperger’s no toward normalcy –otherwise termed “neurotypi- longer has its own identity in the DSM, being sub- cal”– in which people display certain characteris- sumed into autism spectrum disorder according tics on the spectrum to such a slight degree as to to the corresponding level in each case. We must be considered simple facets of their personality. now wait and see what happens with ICD-11, In this sense, Wing considers that autistic fea- publication of which is scheduled for 2017. tures are present to a greater or lesser degree in There are five diagnostic criteria listed in all people. DSM- 5: A) persistent deficits in social commu- nication and social interaction; B) restricted, re- petitive patterns of behavior, interests, or activi- Official recognition ties; C) symptoms must be present during early The standard criteria for the diagnosis of men- childhood development; D) the symptoms cause tal disorders are established and updated in two clinically significant deficiencies in social and oc- publications: DSM (Diagnostic and Statistical cupational areas, or others that are important for Manual of Mental Disorders, published by the current functioning; and E) such alterations are American Psychiatric Association, currently in its not better explained by an intellectual disability 2013 DSM-5 edition) and the ICD (International or a retardation in overall development. However, Statistical Classification of Diseases and Related in almost all cases these symptoms are accom- Health Problems, maintained by the World Health panied by other varied manifestations that seem Organization, whose latest edition, ICD-10, came to indicate that the autism spectrum disorder is out in 1992).