Sheffer started this book intending to praise the Austrian doctor celebrated for pioneering our understanding of autism. Hans Asperger saw autism as a lifelong impairment existing on a continuum, and developed creative forms of education that influenced modern practice.
The term Asperger syndrome first became popular in the late 1980s. It was adopted as a positive identity by a new movement of autistic activists, and as a means of challenging widespread discrimination and stereotypes about the condition. In 1994, it became an official diagnostic term for a “high-functioning” form of autism.
However, the facts Sheffer unearthed, following separate research which made virtually identical findings, are a stark and shocking contrast to our view of Asperger that has until now been universally accepted.
Her book explodes key myths, such as the belief that Asperger tried to protect children under his care by embellishing their diagnoses, and that he was an opponent of the Nazis. Instead, she shows that Asperger actively participated in their Aktion T-4 euthanasia programme.
After becoming director of the children’s hospital at the University of Vienna in 1930, fascist Franz Hamburger began sacking the hospital’s Jewish staff and replacing them with his own supporters. Among the latter was Asperger, one of Hamburger’s own postdoctoral students.
Despite his later claims that refusing to join the Nazi Party had damaged his career, the records show that Asperger benefited from these purges, becoming an associate professor at the age of just 37. He was active in several far right organisations years before the Nazi takeover of Austria in 1938. Sheffer also shows that, after diagnosing dozens of child patients as “unable to learn,” Asperger sent them to the Spiegelgrund clinic, the Third Reich’s second-largest euthanasia killing centre.
Nazi policies dictated the extermination of all Jews. The Aktion T-4 programme, however, provided only vague guidelines, enabling doctors to make largely autonomous decisions as to which adults and children were “unworthy of life.” The regime therefore depended on people who, in Sheffer’s phrase, were “neither committed killers nor even directly involved in the moment of death”, to decide and facilitate mass murder.
In 1937, Asperger cautioned against any diagnosis of autism, but by 1944 had fully consolidated his definition of autistic psychopathy. Central to this was the concept of Gemüt, a term co-opted by Nazi thinkers to mean the capacity to form deep bonds with other people. Asperger described autistic children as “sadistic”, attributing what he called their “malice and cruelty” to “a poverty of Gemüt.” In his view, autistic people formed a hierarchy, from “the highly original genius, through the weird eccentric who lives in his own world and achieves very little, down to the most severe contact-disturbed, automaton-like mentally retarded individual.” As Sheffer puts it, “Asperger’s eugenicist focus on the ‘favourable cases’ in his thesis obscured the extent to which he was a eugenicist.”
Asperger’s 1944 article was rescued from obscurity when British psychiatrist Lorna Wing published it in 1981. Wing replaced his hierarchy with the concept of a “spectrum” and in place of psychopathy substituted the more neutral term syndrome.
Ten years later, Uta Frith’s new translation of the 1944 thesis replaced “autistic psychopathy” with the term “autism” — which Asperger had never used. Frith also excluded his preface, which expressed his diagnosis within the intellectual framework of Nazi psychiatry. In this way, Asperger’s work was stripped of its political and historical context as it became popularised and made more mainstream.
While Asperger syndrome became on the one hand particularly popular in middle class families, on the other it was increasingly criticised as divisive. The American Psychiatric Association eventually abolished the term in favour of an umbrella diagnosis of “autism spectrum disorder” in the 2013 edition of its handbook.
Sheffer describes how multiple factors have shaped current services and policies on autism. However, she omits the important role played by autistic activists in shaping current laws and attitudes. Their new concept of neurodiversity stressed that variation in our brains is both natural and normal. Many of them also championed Asperger syndrome as a positive identity.
Asperger’s legacy is therefore highly contradictory. His post-war articles presented autistic children as more benevolent and with special abilities. While his positive relationship-based approach to his “little professors” remains influential today, his dismissal of other autistic children he judged “ineducable” — with the fatal consequences this often entailed — has until now been mainly ignored.
Sheffer argues that our understanding of autism is still coloured by these historical roots. Despite her damning research, however, the way Asperger syndrome has taken on an identity relatively independent of the man himself suggests that the debates over Asperger syndrome — as a diagnosis or identity — are not yet over.