In November 2015, the US Center for Disease Control announced that one in 45 children aged 3 to 17 has autism. Eight years ago, one in 150 was thought to have it. But these days, autism experts are not arguing about the lack of uniformity in standards for diagnosing the disorder, how it should be treated, and similar things that tend to divide them. Their opinions are now clashing over whether or not it is right to name Asperger’s syndrome, by which we refer to high-functioning patients with autistic disorder, after Hans Asperger. Just last year, the Austrian paediatrician was being hailed as the man who protected children with special needs from the Nazis during the Second World War, but John Donvan and Caren Zucker’s recent book In a different key: the story of autism presents him in a very different light. Was Hans Asperger a Nazi?
But why are experts only now talking about this, 70 years after the end of the Second World War and 37 years after Asperger’s death? Why was his past not revisited as early as 1993, when the syndrome was named after him and included in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the bible of all psychiatrists?
Actually, they did, but at the time they found no hard evidence of Asperger’s Nazi past, and otherwise, by 1981, most English-speaking experts on autism and Asperger’s had never heard of it. It is true that he had already used the term autistic pathology publicly in 1938 and had also described the characteristics of the disorder, but he did so in German and this is understood by a limited number of people.
He only made his way into the English-speaking world when British psychiatrist Lorna Wing discovered him in 1981 and asked her husband to translate Asperger’s 1944 text from German, but he became a little better known after 1991, when Uta Frith added his biography to the translation of his text.
Frith and many who wrote about Asperger after her based their view of his life on what Asperger himself said about himself and on what Maria, one of his four daughters born to his marriage to Hannah Kalmon, reported about him. Maria has always been proud to follow in the paediatric footsteps of her father, whose birth on 18 February marked 110 years.
My mentor, a Nazi
So we learnt that Hans Asperger was the eldest of three sons of a rather strict accountant and a supposedly very warm and extremely religious mother. There was nothing she would not have done for her children, but she had to bury the youngest not long after his birth, and the middle one was killed in the Second World War.
She had no problems with Hans, even though he was a rather withdrawn child who was most at home in the world of books and writing. According to him, it was only in the Bund Neuland, an organisation similar to the Boy Scouts, that he really found himself, and it was there that he was supposedly made into the man he later became.
Three years before his death, he explained that he had decided to study medicine after having to dissect a white mouse at school. He took out a kidney and saw a white bump on it. Suddenly, a two-centimetre-long larva crawled out. Asperger was so fascinated by the fact that one living thing could live inside another that he immediately decided to study medicine.
He enrolled at the then highly prestigious Medical Faculty in Vienna, graduated in 1931 and the following year joined the University Paediatric Clinic in Vienna. This is where his story gets complicated, although until January this year it was quite simple.
The native of Vienna has always spoken admiringly of his mentors, who have had a tremendous influence on him and his career. He was particularly grateful to Franz Hamburger, director of the then highly advanced University Paediatric Clinic in Vienna, founded in 1911 by Erwin Lazar. Lazar was one of the first for whom children in need of adapted education were not “broken” or “sick”, but merely children in need of a different learning approach.
Hamburger followed his idea, and by 1938 doctors and nurses were teaching children art, drama, music, literature and science. In line with the 19th century concept of Heilpädagogik, or “therapeutic education”, children and teenagers discovered their potential here.
In 1932, Hamburger put the then 26-year-old Hans Asperger, who had been rotating for a year in other departments of the clinic, in charge of the Heilpädagogische Station, as the department was called. In 1977 Asperger could not praise his mentor enough. Fritz Hamburger had a very open personality and a remarkable gift for communicating with children and parents, he reported. His research was successful and he was fascinated by children’s mental disorders, he added. He said nothing about his Nazi orientation.
But it was not so obvious before 1938, even though Nazism was growing in Austria as much as in Germany. “The whole nation is going in one direction, fanatically, without a formed vision”, but “with enthusiasm and determination, with extraordinary discipline and control, with terrifying efficiency …”, wrote the then 28-year-old Asperger in his diary in 1934. It was the only time he ever reflected in writing on where the world was going around him.
Instead of social events, he was preoccupied with love – he married Hannah in 1935 – and work, in which he was closely involved with nurses, teachers, doctors, therapists and psychologists. Among them was the psychologist Anni Weiss.
In 1935, she described the case of a boy, Gottfried K., who showed signs that are now typical of autism. He was “obsessed” with rules and schedules. He cried as soon as his daily routine changed. He was afraid of other children, who made fun of him. He took every word literally and was hypersensitive to sounds.
Teachers described him as shy, strange and weak-witted, Weiss reported, but when she tested his intelligence herself, she was surprised to find that his thinking was so different that standard intelligence tests could not catch it. For example, when she asked him to say what a ladder and a flight of stairs had in common, he listed differences instead of similarities.
Anni Weiss was the first in the department to recognise autism, but she did not name it. But she continued her research, together with Hans Asperger and Georg Frankl. The latter would have been the most successful diagnostician in the group, but Asperger soon lost him.
In the spirit of the Third Reich
Vienna has had a strong Jewish community since the 12th century. Around 1920, some 200,000, or 10%, of the Viennese population was Jewish, but some twenty years later it had almost disappeared. When Germany annexed Austria on 13 March 1938, the non-Jewish inhabitants did not protest, and the Jewish inhabitants had no chance to protest. They either ended up in exile or in a concentration camp.
Just three weeks after Austria’s annexation to Germany, the situation changed for doctors and patients. The Medical University of Vienna began to carry out research on so-called racial progress. The driving forces behind the new approach to the “treatment” of children with special needs were Asperger’s esteemed mentor Franz Hamburger and Asperger’s former colleague Erwin Jekelius, who was the fiancé of Hitler’s sister.
The duo first cleansed the medical ranks: all those connected with medicine had to bring their birth certificates and confirm that they had no Jewish blood in their roots. Of the 5 000 doctors in Vienna at the time, only about 1 000 were of Jewish origin. All the others had lost their jobs and would have lost their lives if they had not been found to help them.
Hans Asperger was obviously not one of them, but his American colleague, Dr Leo Kanner, was. He helped dozens of Jewish doctors, nurses and researchers to get American visas and find work in America. Among those who started a new life under his tutelage was Asperger’s Jewish colleague Georg Frankl. Since Leo Kanner was dealing with patients similar to Hans Asperger, Frankl continued in America what he had been doing in Austria.
There, Hans Asperger continued his work uninterrupted. In his own words, he did his best to protect children with special needs from the Nazis. To do this, he boasted after the war, he risked his life and twice narrowly escaped arrest by the Gestapo. Although nobody knew anything about it except him, his colleagues were happy to believe him, not least because he died in 1980, or before they even became interested in him.
But the fact that he gave his first lecture on autism five months after the annexation of Austria to Germany was known to all. On 3 October 1938, he told the university hospital: “Anything that crosses borders and is ‘abnormal’ is not necessarily ‘inferior’.” For his supporters, this sentence was enough to identify him as a rebel against Nazism. In Germany, however, the “genetic health” court had already started operating four years earlier, so Hans Asperger had to take an extraordinary risk to say something publicly that condemned Nazism.
But he also said, “We are in the midst of a mighty renewal of our intellectual life, and it involves all areas of our lives, including medicine.” He pointed out that, according to the new idea of the Reich, “the whole is more important than the parts and the people more important than any individual”, warned that this idea must profoundly change their attitudes in an area that “encompasses the nation’s most precious treasure – its health”, and made it clear that everyone must defend “genetic health and prevent the transmission of disease through inheritance”. In short, in the spirit of Nazism, he celebrated eugenics.
In truth, it did not grow out of Hitler’s cabbage patch, but was perfected by the Americans. They were enthusiastic about it at the beginning of the 20th century, and by 1933 they were already completely infatuated with it. Positive eugenics, which encouraged people with “good” genes to have as many children as possible, did not interest prominent American doctors, biologists and politicians like Theodore Roosevelt. They were much more interested in negative eugenics, and in this area they were of the same mind as Hitler.
“Defective” people belong in institutions and, above all, should not reproduce, they proclaimed. To stop them spreading bad genes, they should be sterilised, the experts debated “scientifically”, and their views on who has the right to procreate and who does not were carried with credibility by scientific journals such as Science. The American journal of psychiatry even suggested mercy killings, but this was not unusual, since the American eugenics movement was funded by the US National Academy of Sciences.
“We physicians must carry out the task assigned to us in this field with the utmost responsibility”, was Hans Asperger’s reflection in 1938, although it is true that he himself never advocated either forced euthanasia or forced sterilisation. His religion forbade it, but obviously did not command him to help his neighbour.
Forced sterilisation and pestilence
When the Nazis came to power, his career flourished. The patients he was most fond of talking about later came to his ward with the Nazis. Although by the end of the war he had worked with some 200 autistic children, as he himself claimed, he spoke again and again more or less only about those who were “intellectually stronger”.
He was thus fully in line with the Nazis, for whom investing in a child with special needs made sense, up to the cost of what that child could later pay back to the state through his or her work. For Asperger, therefore, the most inspiring patients were those he described as ‘less handicapped’ and who had ‘social value’.
In 1941, he wrote that he was receiving letters from “many of our former children” who were “serving on the fronts”. These boys had fulfilled “their duties in professional life, in the army and in the Party”, and so justified the cost to the state of their education.
While it is not clear what they were doing at the front, or whether any of them survived, it is not even certain that these boys were really at the front. If they were, they were in any case among the more able, and Asperger is fond of saying that for such people, limitations are inherent in their special gifts, forming a “well-blended, harmonious personality”. He added that some autistic people have become professors, scientists and even experts in the field of heredity. He was thus demonstrating how socially useful they were, and he was risking nothing by speaking out in favour of the mentally ill.
Not then, and not afterwards, because he usually said very few words to children whose “intellectual inferiority is emphasised”. For him, their “fate was tragic”. “They wander the streets like strange specimens, grotesquely disordered, talking loudly to themselves, addressing people in an autistic posture.” When he spoke about them, he never pointed out their otherness, which could be important for society, nor did he think about how he could help them. They just felt sorry for him.
It is true that he never said or wrote that they should be sterilised or killed, but he did not resist it, even though in August 1939 Hitler issued an order requiring doctors and midwives to report to a special commission on children born with birth defects. By October 1939, the T-4 programme had already been set up, which was short for Tiergartenstrasse 4 in Berlin, where it originated.
The T-4 programme has turned hospitals and medical institutions into killing factories for people with “bad” genes and chronic health problems. Hitler backdated the decree by a month to give legal protection to doctors and nurses who started killing patients before the decree was officially published. Doctors got 250 Deutschmarks for each murder, on top of which they did not have to go to the front, and nurses got an extra 25 Deutschmarks for each one they murdered.
Medical students were taught about T-4 and the euthanasia programme. Disabled patients were called “cases unresponsive to treatment”, laws relating to euthanasia were “negative population regulations”, and killing was said to give “definitive medical care”. The clinics in which children with special needs were killed were Kinderfachabteilungen, or ‘special wards for children’.
One of the largest “special wards for children” outside Germany was the paediatric ward at Vienna’s Spiegelgrund Hospital. There, Hitler’s sister’s fiancé and former Asperger’s colleague Erwin Jekelius, who was also involved in the design of the forced euthanasia programme, had a major say.
The first child to succumb to eugenic madness was tiny Gerhard Kretschmar, diagnosed as an “idiot”, born on 20 February 1939. He was blind and made poor progress, had only one arm and part of a leg, and was often tormented by seizures. Hitler authorised his personal physician, Dr Karl Brandt, to tell the boy’s neurologist that it would be legally perfectly safe to “put the child to sleep”. The neurologist conveniently went on leave, the nurses took a coffee break and one of the trainees sorted out what needed to be sorted out.
He gave Gerhard a lethal injection, although the Spiegelgrund preferred to murder children by mixing phenobarbital into their food. If enough was mixed in, the lungs stopped working and the child died of “pneumonia”. They also left some of them out in the cold to freeze or starve them to death.
Children may have ended up at Jekelius simply because they stuttered or had rabbit lips, but most of the 789 children murdered at Spiegelgrund had autism by today’s standards.
In such an atmosphere, Hans Asperger steadily rose up the professional ladder, even though he himself later claimed that he had no contact with the Nazis and that he had protected the children from them. For years, autism expert Eric Schopler had discreetly warned that this was impossible. He also hinted at Asperger’s Nazi connections when he publicly wrote that Asperger had “long been interested in the German youth movement or Hitler’s youth”.
No one recognised the hint, but even if they had, they would probably have ignored it. Eric Schopler had to flee the Nazi pogrom during the war, so he didn’t trust anyone who had made a career under the Nazis. So he was accused of having a personal antipathy to Asperger’s and his words were not taken seriously.
The killing of Herta Schreiber
But it was much harder in 2010 to hear the now 41-year-old historian Herwig Tschech. He is not Jewish, he is the descendant of a fervently Nazi grandfather, and perhaps it is the weight of guilt that often weighs on the descendants of Nazis that has made him delve all the more deeply into the role of medicine in the Third Reich, including in Vienna.
He came across the name Hans Asperger. The documents he discovered were presented to the general public by John Donvan and Caren Zucker in their book In a different key: the story of autism.
In the archives of the Spiegelgrund, Czech found a letter handwritten and signed by Asperger in 1941. In it, he gave his expert opinion on the state of health of two-year-old Herta Schreiber. She was born healthy but suffered from encephalitis, or inflammation of the brain tissue. She spent some time recovering at home, but when she was no better, her mother took her to Hans Asperger in hospital.
The disease seemed to have left a strong impact on the brain, the report said. Her mental development had stopped, her behaviour was inappropriate and she was having seizures. Instead of one diagnosis, he suggested several possible ones, and finally added his personal opinion: “At home, this child must be an unbearable burden for a mother who has five healthy children to care for.” He advised “permanent placement in the Spiegelgrund”, which he said was “absolutely necessary”.
When Herwig Czech checked whether the Spiegelgrund had welcomed any Herta Schreiber, he found that they had. She arrived on 1 July 1941 and died there on 2 September 1941, the day after her third birthday. The death certificate said that it was due to pneumonia, and the hospital records added that her mother had agreed between tears that her daughter would be better off this way than living in a world in which she would have to face ridicule and cruelty permanently.
Asperger must have known what would happen to Hertha in the Spiegelgrund, but he sent her there anyway, so it is hard to argue that he was helping her and protecting her from the Nazis.
But Chekhov’s discoveries didn’t end there. The Austrian historian also found that in February 1942, Asperger was the representative of the city of Vienna on a seven-member commission that evaluated which mentally ill children living in hospitals were fit for education and which were not. He and his colleagues had to assess 210 children from mental hospitals in Lower Austria, i.e. in the north-east of the country.
They managed to complete the task in a single day. They looked at all 210 files and found 17 children too young to be educated, 36 too old and 122 suitable. They were left with 26 boys and 9 girls. They were not “fit to learn” and had to be transferred immediately to “Jekelius”, a pejorative term for the Spiegelgrund run by Erwin Jekelius. According to Czech, even then Asperger knew what the fate of these children would be.
When he talked about himself after the war, he always spoke of his contacts with the Nazis as if they were completely trivial and superficial. Czech found a document in the archives of the National Socialist Party in which Asperger was assessed, every time he asked for a promotion, as a man who could be trusted by the Nazi authorities. They even trusted him more every year, even though he was not a party member. The documents show that he acted in accordance with the principles of ‘racial hygiene’.
Czech also found a letter in which Asperger had signed himself Heil Hitler, although no one had asked him to do so, and a job application in his own handwriting. In it, he wrote that he was a candidate for the Nazi Doctors’ Association, which acted as a kind of medical police and had a major say in closing down the medical practices of Jews.
A document was also found in the hands of the Czech Republic, proving that Asperger had applied for a job as a medical advisor to Hitler’s youth, but there is no information on whether he was accepted or not.
Only the best are good enough
All this shed a whole new light on the paediatrician who was born in 1906 and disappeared from the world of autism after the war, even though he shone in 1944 with his second public lecture, in which he said that it was the duty of medical professionals to “stand up for these children with all the strength of their personality”.
Of course, he was talking again about the intellectually strongest children with autism. His favourites were Fritz and Harro. Fritz’s case was described in 12 pages, while Hellmuth, who came to the clinic at the age of 11, was given only one. Why? Because he was “grotesque” and “had convulsions shortly after birth … In Hellmuth’s case, there were clear indications that his autism was the result of brain damage at birth … This boy was an ‘autistic automaton’, impractical and instinctively disturbed. He terrorised the household with his meticulousness and was generally very difficult to control.”
He devoted four pages of his lecture to another boy, Ernest: “The more disturbed do much worse at school than one would expect on the basis of formal tests of their intelligence. Ernest is one of these unfortunate cases. It was clear that the boy could not make satisfactory progress at school and that transfer to a special school was inevitable.”
Ernesto’s mother “found it hard to accept that her son, who was apparently the only thing that interested her in life, was such a strange child and doing so badly at school. She was constantly trying to put him up against the school and desperately resisted being transferred to a special school for retarded children.” In the end, Asperger only convinced her that a “special school” was best for Ernest, but he did just as badly there.
According to Aperger, Ernest was one of the “more opaque” children because “his reading was very slow … He often mixed up letters and had great difficulty combining them. His comprehension of written text was perhaps noticeably better. His most obvious difficulty was writing. Like almost all autistic individuals, this motorically clumsy boy had abysmal handwriting.
The pen disobeyed him … He corrected without looking at the image and simply wrote the new letters over the old ones he had crossed out. His letters were of different sizes, but that was not the worst thing about his writing. Even when he was copying – when he was writing letter after letter with desperate effort – he made spelling mistakes. When dictating, one could hardly work out what the words were supposed to mean; he dropped letters, inserted them or put them in the wrong order, and some of them could not be recognised at all.”
The “very disturbed” Ernest probably had dyslexia, but he ended up in a “special school”. Whether this means that he and Hellmuth ended up in some kind of baby-killing hospital is unknown, but in any case Asperger spoke only of a bright future for highly intelligent autistic children, which he admitted were few and far between.
In 1952, in one of his rare post-war appearances, he confronted a former patient of his who had become an assistant professor of astronomy after finding a flaw in one of Isaac Newton’s laws. He followed this man for more than 30 years.
If this were true, the boy would have been born around 1920. Asperger’s must have been with him from birth, but he only graduated in 1931. He was employed a year later, and it was not until 1935 that Anni Weiss first spoke about autism. How, then, could Asperger’s have followed this boy prodigy for three decades, the doubters ask, and above all, how is it possible that no one in Vienna knew about it, when he had proved the mathematical error of Newton’s laws?
Useful brains
No one has ever questioned this, because Asperger’s colleagues have more or less repeated what others have said about him before them, the only difference being that some have bashed him and others have hammered him into the stars. For example, they tried to discredit Dr Leo Kanner, who is regarded in America as the pioneer of autism. For a long time, the syndrome was referred to as Kanner syndrome in many professional texts.
In 1943, he used the word “autistic” to refer to a set of characteristics he had observed in his patients. This would not have been controversial if he had not, a few years before, started working with Georg Frankl, a former Asperger’s collaborator and Jewish exile from Vienna. Did Frankl reveal to Kanner everything he had discovered with Asperger?
Kanner’s opponents are convinced that he and the American doctor “stole” Asperger’s work. However, it is not clear why Frankl has remained silent on this. Was it because he was grateful to Kanner for saving his life? But Asperger’s daughter claimed that Asperger and Frankl were in regular contact after the war. If they were, why did neither of them raise their voices against Kanner’s theft being so obvious?
Because Kanner came to his conclusions on his own? Or because Asperger didn’t want to attract attention? After the war, many who had got their hands dirty in one way or another during the war withdrew from public life. Hans Asperger, once a promising autism researcher, was just an ordinary paediatrician after the war. This was certainly not because he felt that his research was inconsistent and disorganised, as his opponents accuse him of being today. Or because he was horrified by the fallacy in which he believed that autistic syndrome was a ‘male’ condition and consequently dealt only with boys.
Leo Kanner did not make this mistake, but his first patient was a boy. Donald Triplett, the son of an educated Mississippi couple, spent a year in an institution before being transferred to the clinic in 1933. Leo Kanner observed him but did not make a diagnosis for a decade. It wasn’t until 1943 that he spoke out publicly about autistic disorder, and Donald became the first child in America to be diagnosed as autistic.
Coincidentally, since this coincided with Hans Asperger’s public activities in Nazi Austria, opponents and apologists of both have enough material to argue for years about which of them discovered autism, even though the disorder had already been observed by Grunya Efimova Sukhareva in 1926, and, after Donoven and Zucker, by Samuel Gridley Howe in 1848.
Hans Asperger studied it on an alleged 200 children. It is not known how many of them lost their lives in the T-4 and forced euthanasia programme, but it is known that more than 200,000 children and adults with disabilities were killed in the programme. Crematoria were set up right next to clinics and schools, and the bodies were conveyed to the ovens by conveyor belt. In this way, the workings of the later Holocaust were practised on a small sample.
But they did not burn intact corpses. Until 1990, research was carried out in Germany on brains taken from the skulls of adults and children with disabilities. “If you’re going to kill all these people, at least take the brains out so that the material is useful for something,” Dr Julius Hallervorden-Spatz, famous for choosing brains for research when people were still alive, reportedly whined in those days.
Nevertheless, he went down in history as the discoverer of the disease, together with Dr Franz Seitelberg, who was an SS officer. Each also gave his own criminal name. Asperger’s is thus not exactly a curiosity in medicine, but since the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders was published in May 2013, psychiatrists no longer talk about autism and Asperger’s syndrome, but only about autistic spectrum disorder.
