But did Kanner steal the idea? That's the question raised in a provocative paper by Nick Chown: ‘History and First Descriptions’ of Autism: A response to Michael Fitzgerald. The piece stems from a debate between Chown and Irish autism expert Michael Fitzgerald, who first made the accusation in a book chapter.
On the evidence presented, I don't think there's good reason to believe that Kanner did "steal" autism, and Chown doesn't seem convinced either. But there's an interesting story here anyway.
Fitzgerald says that in 1938, Hans Asperger - of Asperger's Syndrome fame - gave a series of lectures in Vienna. These were published in a Vienna journal called Wiener Klinischen Wochenzeitschrift as an article called "Das psychisch abnorme kind" ("The mentally abnormal child").
In this article, Asperger put forward the concept of autism. The term was coined by Eugen Bleuler in 1911 in reference to symptoms seen in 'schizophrenia' (he came up with that word too), but that was nothing to do with children.
In 1943, Kanner published his landmark paper, in which he did not mention Asperger. Asperger published his first major description of 'autistic psychopathy' in 1944. The big question, then, is - had Kanner read or heard of Asperger's ideas before 1943?
Asperger was working in Austria while Kanner, although Austrian-born, was in the USA. WW2 would have made it impossible for them to have communicated directly - however, word of Asperger's ideas could have reached Kanner via one of the many European doctors who fled to America, over that period.
There is however no direct evidence that this happened. Fitzgerald makes much of the fact that Kanner opened his 1943 paper by saying "Since 1938, there have come to our attention a number of children..." This could be a reference to Asperger's 1938 work - but Kanner said it referred to his first "diagnosis" of autism, Donald T.
This leaves us with a fluke: two Austrian-born psychiatrists independently discovered the syndrome we now call childhood autism, decided to borrow Bleuler's term "autism" for it, made their first observations in 1938 and first published properly in 1943-1944.
Personally, I think that while that is a remarkable coincidence, such things are not uncommon in science. I see no reason to think that Kanner plagiarized Asperger, although it remains possible. If someone were to discover a copy of Asperger's 1938 article tucked away in one of Kanner's old notebooks, then I'd change my mind, but not before...
Chown, N. (2012). ‘History and First Descriptions’ of Autism: A response to Michael Fitzgerald Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-012-1529-5
29 comments:
I'd check their coats of arms if I were slightly more paranoid than you:
http://www.houseofnames.com/kanner-coat-of-arms
http://www.houseofnames.com/Asperger-coat-of-arms
Tell me they're not working together?
I don't see how it was a 'fluke'. For many years Kanner's autism was still referred to as childhood schizophrenia because 'autism' was one of the symptoms of schizophrenia.
Child psychiatry was a relatively new area of interest, so it's quite likely that two practitioners would identify a similar syndrome for the first time at around the same time - and that they would use an established term to describe it.
More importantly, who made it into the diagnostic nightmare it is today? The tendency to just add people with autistic symptoms to a 'spectrum' doesn't make for a better perspective. It only makes it murky.
I propose to return to the basics. Autism is only autism when accompanied with certain distinctly patterned shared white matter variations. All the rest are not autism, but autism symptoms. World of difference
The evil doer here is the 'test'. The 'scale'. A mobius strip of self confirming behavorial observations larded with observer prejudice and a bad understanding of the neurological underpinnings of autism.
Micael Fitzgerald has created a profitable cottage industry with numerous articles and books claiming to have 'retrospectivly' diagnosed historical figures past and present with 'Asperger Syndrome'. The list is very long and includes Isaac Newton, Albert Einsten, Bill Gates and Adolph Hitler.
Last year on the 200th anniversary of the birth of Charles Darwinhe made the claim that he had 'retrospectivly' diagnosed Charles Darwin with Asperger Syndrome.
His claims about Kanner stealing Asperger's work is, as Faulkner would have stated, 'full of sound and fury signifying nothing'
@petrossa. If white matter is formed in neural pathways used very frequently, don't white matter distribution patterns reflect frequency of use?
If autistic characteristics have a heterogeneous aetiology, then you'd expect different white matter patterns in different people, surely.
@ Raj. Would second sound and fury comment :-)
Oh yeah. It's that Michael Fitzgerald. I know him... I just didn't put two and two together.
I read his paper on Wittgenstein having Asperger's a while back; he might actually be right about that one. But Darwin, I don't think so...
And as I said I don't think Kanner stole autism, but it is a nice coincidence.
@logicalincrementalism
Very very succinctly:
First you have genetically driven white matter variation. Then you have grey matter variation in the fetal brain due to a another reinforcement pattern, then you have after birth environmental reinforcement.
Goes for not only autism but pd, schizo etc.
Thanks petrossa. I know white matter patterns are different to the normal range in people with autistic characteristics, but are there distinctive patterns?
@whatisautismanyway
not beinf formally educated on the subject I don't speak the jargon very well, i just have an asperger obsession with the mammalian brain since the 80's. So i'll refrain of making a fool of myself to start on that. For jargon i refer to online resources, for example:
http://scholar.google.com/scholar?q=white+matter+asperger&hl=en&btnG=Search
Also Pubcrawler gives scores of hits with the same search criteria.
Neuroskeptic,
Michelle Dawson - an autistic person who desserves to become a full professor even if she never went to university as a student -urged us to read Kanner at the 2012 NAS professional conference this year and rightly so : this 1943 paper is amazing in its clarity and insights. To my mind The author discovered that some retardated and autisitc children were not schizophrenic loosing connection with the world but were born with a disturbance of affective contact. The sensory difficulties were discribed.
As Dr Lorna Wing -which I also greatly admire put it- to oppose Kanner and Asperger is a fault since both of them made an important contribution to medical science on the autisms and a complementary one at that.
The retarded but not stupid autistic Kanner's clients were different from the "little professors " as Pr Aspergers called his autistic young clients.
I was taught that for some of the laters Pr Asperger had to rely on a trusted nurse for the diagnostic (they stimmed in the waiting room) because they could behave normal during their interview with the professor.
Thanks for giving to many people the opportunity to read an important paper.
NB: The "Inborn" in Leo Kanner 1943 article's title - "Inborn Autistic Disturbances Of Affective Contact" - is missing in your post and it is not triffle (if I am not wrong with my memory of the title) since many of the French psychoanalysts are still accusing the mothers lack of love of the child (or incest according to others )of causing autism.
RAJ,
Thanks.
I heard Pr Simon Baron-Cohen telling Pr F at a meeting after a Pr F lecture that he wasn't convinced of the feasability of a "post-mortem" diagnosis of Asperger.
It is something that Pr F has in common with many homeopaths who love to classify historical figures according to the homeopathy remedies personalities.
I can't stand many homeopaths and do not go anymore to their meetings but it can be said for them that they do not harm the planet by using meetings breaks to put paper publicities for their "history work" on every available chair.
@ Ivana Fulli
The 'inborn' isn't in the title of Kanner's paper. He *concludes* in the paper that the children's autistic disturbance is inborn but is clearly not entirely convinced about this as some of his later work shows.
The disturbance of affective contact theory makes sense only if you believe that typically developing children have a social instinct - an assumption made by psychodynamic theorists almost a century prior to neuroscientists figuring out that social and communicative skills are higher-level functions of the brain. That is, they are not basic instincts but are reliant on lower-level input from other areas of the brain.
As for the affective lower layer link to the cognitive layer
http://www.ncbi.nlm.nih.gov/pubmed?term=21777159
http://www.ncbi.nlm.nih.gov/pubmed?term=21784971
http://aut.sagepub.com/content/early/2011/02/25/1362361310386506.abstract
Whatisautismanyway,
I am sorry that "Inborn" was not in the title but nobody is perfect in choosing a title.
By the way, does anyone know if the APA is contribuiting to Pr F's "cottage printing business"?
A potential conflict of interest lies there since Pr F accusations implies that classical autism and Asperger syndrome are the same thing.
When that DSM5 proposal of suppressing Asperger from the DSMs for the time being is opposed by very serious and comptetent persons like Pr Volkmar from Yale University and the New England Asperger whose petition on it is to be closed next Friday-if I am not wrong:
http://www.change.org/petitions/american-psychiatric-association-dsm-5-task-force-and-work-group-improve-dsm-5-diagnostic-criteria-for-autism.
PS: In France if you dare to accuse the memory of Jacques Lacan or Françoise Dolto (our French Bruno Bettelheim) their heirs suit you in court since hiring the most expensive lawyers.
Whatisautismanyway,
///He *concludes* in the paper that the children's autistic disturbance is inborn but is clearly not entirely convinced about this as some of his later work shows.///
Actually, for a simple soul like I, it is lucky for the great Kanner's legacy that he didn't take for granted that what he suggested was proven when it was not.
///The disturbance of affective contact theory makes sense only if you believe that typically developing children have a social instinct ///
The disturbance of affective contact theory kanner's way makes sense in differenciating the autisms from schizophrenia- hudge progress in knowledge and very useful for a psychiatrist:Autistic persons are more likely to be wrongly diagnosed as schizophrenic if psychiatrists and psychologists do not know that the autisms do exist .
NB: That doesn't mean at all that an autistic person cannot suffer from schizophrenia-whatever that is. I am yet to meet one but I do not know so many aspies.
The absence of delusions and other schizo symptoms usually helps a lot ;)
Still to my mind they are all an offspring of the same branch. The confusion stems from the decades of behavioral study based diagnosis.
That made for a mess of diverse conditions which only exist by the grace of badly understood working of the nervous system. DSM should be scrapped and rewritten from ground up, with a distinction between 'hardware' problems and 'software' problems.
PSTD can be seen as a software malfunction, however autism is a pure hardware malfunction.
One needs to start to seriously divide along these lines, autism is one of the best (worst) examples where behavioral based diagnosis goes completely wrong.
From a simple clear cut neurological disorder it became the huge minefield of ASD it is now. Al you need to to pass a test and bingo you have ASD. Spectrum. What a ridiculous concept.
The idea in itself is proof it doesn't work. If you need a diffuse spectrum to explain a 'condition' it's concept is necessarily wrong.
That way you just name the human mind a spectrum and anything that goes wrong or different then the norm is just part of the human spectrum. Why stop at autism?
That's why discussions about ASD are inherently fruitless. ASD doesn't exist other then in a book so why bother discussing it? Discuss philosophy, that also is fruitless since it's about ephemeral stuff but at least doesn't harm people.
petrossa,
Not to speak about conducting research in neurosciences- or more modestly in clinical medical science-without a diagnostic of the studied groups, many persons with autisms-or some parents- want help from their health care providers and the education system , want special needs to be met on the work place and special lodging accomodation etc...
You need a diagnostic to obtain that unless you are very rich.
Disclosure is another question but many aspies are also relieved to get diagnosed.
Thank for the information you provide petrossa (I remember that you disagree about disclosure at the work place).
I see that many here are commenting without having read either Kanner or Asperger. I find that really sad and pretty pointless. Why comment if you hsven't got a clue what you're talking about?
For me, both pioneers make relevant and fairly parallel statements, from different cultures/historicity and different jobs.
Kanner was a child psychologist/psychiatrist the first ever in the Western world, working at Johns Hopkins. Asperger was a general doctor, but his role was as head of a hospital school in Vienna, during WW2. He was essentially a teacher of disturbed children, almost exclusively boys. His work was a kind of PhD, whereas Kanner's work was case notes. Both were strongly influenced by Bleuler, whose work both of them knew really well. I believe that Asperger used the word 'autism' before Kanner, but it doesn't matter, as neither of them originated the term.
What we really need to look at is why, on earth, current 'thinking' is so wrong about what Kanner actually wrote. Of his original 11, only one was mute.He regarded none as 'retarded', in fact he made a point that all of them, boys and girls, had an apparently genuine high cognitive ability, if a little different from the norm. Many showed exceptional skills. He was convinced that what 'dulled' these children was being institutionalised.
Finally, he looked back at a large group of his child patients, in adulthood. 15% of them, without any intervention whatsoever, were leading fairly 'successful' lives. This is better than any RCT results from Lovaas type EIBI.
Asperger looked at only 4 boys (unlike Kanner who also looked at girls) who were sent to him because they were disruptive at school. Only 2 of those had what we may now call 'Asperger's Syndrome'. One other was intellectually impaired and the other suffered a brain trauma at birth and showed behaviours which were similar to 'autism' but weren't identical.
Anyone and everyone attempting to discuss autism should start from basics - Kanner and Asperger. There is no excuse for not reading Kanner's 1973 book, "Childhood Psychosis: Initial Studies and New Insights", an amazing book. I've read it cover to cover 10 times.
There is no excuse for not reading Asperger's 'PhD', translated into English by Uta Frith.
Both of these pioneers use narrative - case studies. Their writing is detailed and exceptional.
Are the two accounts different? Yes. Each has his own insights. But is what they describe the same?Yes. Do either of them point to intellectual impairment as being a core characteristic of autism? No. So either of them make an issue of mutism? No - but Eisenberg did.
Essential reading. Autism 101. Find out how far we've drifted.
My excuses for not reading Kanner's 1973 book?
a) Although I have a great deal of respect for Kanner, I don't agree with him. His hypothesis was, by his admission, waiting for biological evidence to support it. When that biological evidence came along, it didn't offer support either to his hypothesis nor to psychodynamic theory - the analytical framework he was using.
b) It's out of print and expensive. Interlibrary loans are are slow and (now) also expensive in the UK. (But I might take the risk after such a glowing recommendation.)
However, I have read Kanner's 1943 paper from cover to cover at least 10 times and I've tabulated the characteristics he recorded from the case studies. In my view his conclusions aren't supported by his data.
http://whatisautismanyway.wordpress.com/2012/04/04/a-critical-look-at-kanners-autism/
Barbara,
///Why comment if you hsven't got a clue what you're talking about?(...)Kanner was a child psychologist/psychiatrist the first ever in the Western world,(...)Asperger was a general doctor///
Grunya. E. Ssucharewa in 1926: Die schizoiden Psychopathien im Kindesalter. Monatsschrift für Psychiatrie und Neurologie 60:235-261.is considered by some to be the real first paper on autism in children.
I am not aware that Kanner ever was a psychologist as you wrote. He got an MD from Berlin university and to my knowledge none of his autistic client had a great carreer like "our petrossa" and Pr Asperger 's subjects of study (one become an astronomer another a famous writer).
Pr Hans Asperger, MD from Vienna university was a pediatrician who interested himself in psychiatry like many USA child psychiatrists.
Many of his "aspies" had great carreers as adults.
Reasonable people are waiting for neuroscientists to give much needed answers in the autisms.
But barbara, you live in a free country and you are free to study a 1973 Kanner book like other people study the bible, the Thora, Freud's lies, Samuel Hahnemann organon (some homeopaths) as the true sources of knowledge.
For modest I: It was a great step to describe to the world that every "aloneness" in a child was not schizophrenia -whatever schizophrenia is.
But now we are at the autisms with a sand autistic persons as well as researcher like Dr Olga Bogashina have told the world the importance of sensory perceptual problems in autism.
As petrossa put it for us on NS blog on the 25 April 2012 06:51 (commenting a NS post on antidepressant in OCD in autism):
"sensory overstimulation, the root cause of autistic behavioral problems.
Imagine you are a classical music lover and suddenly you find yourself next to a speakersetup of a heavy metal and with the laser show projected on your face and a stampede of people is trying to flatten you.That's how it feels for most autistics when they are in social situations.(...)"
Ivana Fulli said
"I am not aware that Kanner ever was a psychologist as you wrote."
Kanner was appointed by Adolf Meyer to develop the child psychiatry service at Johns Hopkins Hospital and founded the first child psychiatric department at Johns Hopkins University. He might only have been a humble MD but he had an influential post at a prestigious institution.
Whatis...
I wrote that Kanner was an MD and not a psychologist to Barbara who wrote that he was a psychologist as well.
Barbara decided also that Hans Asperger was a modest general doctor and I corrected her: he was an academic and pediatrician turned child psychiatrist.
I can't see where you found the need to explain to me that Kanner was not a simple doctor!
My apologies. Thought you were implying that Kanner wasn't as well qualified as Barbara was suggesting.
Since I don't give sht I will comment. Kanner was Jewish need I say more.
Whoever wrote for Whatisautismanyway,
Thanks for your kind apologies.
By the way I would put a s in autisms in you very informative collective effort site.
and I am not accusing you of being a spam mind you.
Your site is very honorable and seems informative enough
What I cannot stand are the non autistic persons lobbying for their trade or a facilitation of their trade -ABA and psychoanalysis often for the former and DSM5 proposals on the autisms for the later-
They shout nonsenses loudly like "barbara" and often won in public opinion since psychiatry is in a mess ( premature dogmas, overpublication of badly thought and done research papers, overdiagnosis and overmedication).
My hope lies in the autistic persons activism in politics and involvment in research like Michelle Dawson.
Thank you Ivana.
Ivana, Olga is one of the group I set up, 'Autistic Intelligence'. She is a very good and close friend of mine.
Michelle Dawson is the finest researcher into autism as it is lived.
Hans Asperger was a practitioner of Heilpaedagogik.
Ssuchawera's work was continued in the UK by Sula Wolff, who in turn influenced others in the concept of schizoid/schizotypal personality disorder, and particularly influenced Szatmari in his own diagnostic criteria.
Kanner's subjects included rather more modest achievements than Asperger's. But tell me how Asperger 'followed' as he says, a client from 1927?
I have no time for psychodynamism in autism, nor for ABA, both of which I hate,and would appreciate your not rushing to judgement or sitting in it.
Dr Barbara
barbara,
How unfortunate that war bombs have destroyed Pr Hans Asperger's archives.
Anyway, I do not know who your Olga is but for sure
the 1926 paper considered the first description by a child neuro psychiatrist of Autism in the modern use of the term in psychiatry was published in the western world in German unless the western world stop at the USA Est coast:
Grunya. E. Ssucharewa in 1926: Die schizoiden Psychopathien im Kindesalter. Monatsschrift für Psychiatrie und Neurologie 60:235-261
NB: Being anonymous for me you could be anybody but it doesn't give you the right to decide that Asperger syndrome do not exist by the authority of an anonymous and stating that Pr Hans Asperger was a general doctor.
NB:I have a close friend who is a german academic in psychiatry who knows Pr Asperger's daughter.
I bet that beat your Olga as a scientific proof!
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