Hans Asperger is a forgotten genius whose rightful place in the history of autism was pre-empted by the wrong-headed, self-serving plagiarist, Leo Kanner. So goes the alternative narrative put forward by Steve Silberman in his fascinating account of the evolution of the condition we call Autism Spectrum Disorder. Silberman’s book, NeuroTribes: The Legacy of Autism and the Future of Neurodiversity, will delight, inform, and sometimes provoke readers familiar with the traditional story of how autism came to be . . . at least those are some of the reactions this reader experienced.
Leo Kanner, the child psychiatrist at Johns Hopkins whose 1943 paper is generally cited as the original description of the syndrome of autism, in Silberman’s account is consistently viewed in the worst possible light. He is blamed for originating and promoting the idea that parents, especially mothers, were responsible for creating autism in their children. He is charged with failing to recognize the contributions of colleagues upon whose observations he drew for his seminal work. There is a thinly-veiled accusation that he knew about Asperger’s description but deliberately ignored or even suppressed the paper to protect his own reputation. Kanner is accused of “ his moral authority to the classic narrative used to justify forced sterilization laws.” (p. 161) Silberman dredges up the story of “the one merely satisfactory grade received at the university . . . because he misinterpreted the symptoms of a patient with tabes dorsalis” (p. 145) and even mocks Kanner’s appearance – “floppy ears, puffy eyes, bad teeth, and the woebegone countenance of a sad beagle.” (p. 156)
In contrast, Silbeerman offers a picture of Hans Asperger as a warm, sympathetic clinician who was strikingly ahead of his time. Admittedly, there is good reason to celebrate Asperger’s contributions and, perhaps, to regret that he has been under-appreciated. And Silberman has clearly done his research; he offers many details about Asperger’s philosophy and practice that have been largely unknown or ignored.
The Heillpädagogik Station Children’s Clinic was a special education program founded in 1911 by a Viennese physician named Erwin Lazar. Lazar is said to have had “an uncanny knack for spotting signs of potential in every boy and girl no matter how difficult or rebellious they were alleged to be.” (p. 84) Silberman describes an approach to treating children that was strikingly progressive and introduces the reader to a staff of clinicians whose names will be mostly unfamiliar: psychologist Anni Weiss, psychiatrist Georg Frankl, psychologist Josef Feldner and Sister Viktorine Zak. Hans Asperger, a pediatrician, joined this group and absorbed Lazar’s method of diagnosis based on intensive observation; the paper for which he is best known in the English speaking world is a tribute to that method. (Asperger, 1944/1991)
An important aspect of Hans Asperger’s contribution was his commitment to recognizing that some the children he described possessed significant strengths. This recognition was seized upon and elaborated by Lorna Wing, the British psychiatrist and mother of a child with classic autism who popularized the idea of an autistic continuum, suggesting that autism extends from the relatively rare Kanner’s Syndrome into “garden-variety eccentricity. (‘All of the features that characterize Asperger’s syndrome,’ she observed, ‘can be found in varying degrees in the normal population.’)” (p. 353)
Silberman’s emphasis on Asperger’s (and Wing’s) conceptualization of the autism spectrum is in service of his primary point which finally emerges in the last 50 pages of the text, namely, that many of the characteristics associated with the autism spectrum, instead of errors of nature, are better viewed as evidence of an essential neurodiversity that is the product of years of evolution constituting a “strange gift from our deep past.” (p. 470)
Silberman maintains that the price we have paid for the field’s emphasis on a “cure” for autism has been to overlook the strengths that are represented in the continuum of “autistic” characteristics, such as the ability to focus intently on details. Celebrating those strengths and finding ways to capitalize on them is a task that is often neglected, but one that will allow people across the spectrum to be valued for their unique gifts, rather than only stigmatized for their limitations. We must be willing to listen to the voices of people with autism who have been able to use their gifts in remarkable, creative ways. Asperger’s “lost tribe” has a great deal to offer; and as an instance of neurodiversity, they represent a valuable contribution to the species and a challenge to how we generally view differences.
At the same time, there is a potential dark side to Silberman’s story. Family members of many children with autism suffer profoundly because of their disability; autism is in many instances a severely limiting condition. An exclusive focus on potential strengths runs the risk of devaluing the struggle of those families. We dare not overlook the impact of the impairment associated with a sizeable portion of the spectrum; the effort devoted to improving the lives of individuals who inhabit that portion through interventions and supports must also be recognized and celebrated.
Silberman’s book is highly readable. He has filled it with compelling descriptions of fascinating characters, dramatic stories, and a gripping (if imaginative) 50 year struggle with clearly defined heroes and villains. If the emerging picture is a little too black-and-white for some readers’ tastes, the entertainment value is enhanced considerably and that is what keeps us reading to the end.
More important, Silberman’s efforts to highlight the voices of people across the spectrum offers an important perspective. It may lead us to spend a bit more time identifying strengths in the individuals we serve and considering how those strengths can be built on to improve their lives. It may help us to better appreciate those who march to a different drum but whose lives can expand our understanding of the world and whose gifts can enrich our culture. It may lead us to value more highly the diversity of nature and the role that diversity has played in the emergence of humankind as we know it. And if we can do any of those things, this book has served its purpose.
References:
Asperger, H. (1944/1991). “Autistic psychopathy” in childhood. In U. Frith (Ed.), Autism and Asperger Syndrome (pp. 37-92). Cambridge, England: Cambridge University Press.
Silberman, S. (2015). NeuroTribes: The Legacy of Autism and the Future of Neurodiversity. New York: Avery – Penguin Random House.
