What Sister Viktorine Knew
Neurotribes, neuodiversity, steve sibberman, autism
In 1931, Gottfried K. was brought to the Children’s Clinic at the University Hospital in Vienna by his grandmother for an examination. He was nine and a half years old, but so physically uncoordinated that Anne Weiss, a young psychologist working at the clinic, assumed that he was “feebleminded.” His grandmother told Weiss that she too was often confused by his behavior, but Gottfried was clever and smart. Weiss listened carefully, taking notes. His grandmother had brought him to the right place. She looked forward to discussing this case with her colleagues, especially Hans Asperger, the new pediatrician who seemed to take a special interest in gifted, sensitive children.
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Hans Asperger, the eldest of three boys, was born in Austria in 1906. But his brothers died young, and he became the only child. In his early life, he joined a group of young people who called themselves the Wandering Scholars, heading off on month long hiking trips to read poetry aloud in the wilderness. He met his wife-to-be, Hanna Kalmon, on one of these trips.
After graduating from the University of Vienna, Asperger was assigned by his mentor, Franz Hamburger, to the Children’s Clinic at the University Hospital.
The University Hospital was one of the most prestigious hospitals in the city. Doctors from all over Europe came to the city to observe surgeries in vast operating theaters and consult with the leading experts in the field. Since the mid 1910s, Vienna had hosted ongoing salons where physicians and scientists mingled with artists and musicians to discuss politics, art, science, and philosophy. Much of this cultural ferment originated in Vienna’s lively Jewish community, which dated back to the 12th century. In the years after the World War I, one in five inhabitants of the city was Jews, as were many of the faculty members who taught at the university.
The Children’s Clinic was founded by a physician and social reformer named Erwin Lazar. By combining elements of medicine, psychology, and progressive pedagogy, Lazar developed an approach to helping children attain their potential based on the 19th century concept of Heilpädagogik, “therapeutic education.”
The tight-knit staff at the special-education unit, known as the Heilpädagogik Station, included Asperger, Weiss, psychiatrist Georg Frankl, psychologist Josef Feldner, and a nun named Sister Viktorine Zak. Their approach to diagnosis was based on a method of intensive observation developed by Lazar. Lazar believed a child’s true condition could only be measured by watching the child in the course of his or her daily life. Putting children through a battery of tests was not enough. No one mastered this intimate style of observation better than Georg Frankl, who had become Asperger’s chief diagnostician.
On his first day at the hospital, Gottfried did nothing but cried. But he adapted to his new life gradually. The reliable rhythms of the daily schedule seemed to comfort him. As Weiss got to know him better, she came to see the nine-year-old Gottfried was precociously smart, but he was unaware of things that most kids know instinctively. He didn’t know how to play the games around him to his own advantage. Weiss published her in-depth case study of Gottfried in the American Journal of Orthopsychiatry in 1935 after she emigrated to America in 1934.
Over the course of a decade, Asperger and his staff examined over two hundred children who displayed the same cluster of social awkwardness, precocious abilities, and fascination with rules, laws, and schedules. They also saw several teenagers and adults who fit the same profile. Asperger believed they represented a distinct syndrome that was “not at all rare” but had somehow escaped the notice of his predecessors.
In fact a Russian psychiatrist named Grunia Sukhareva had written about a similar group of young people with prodigious abilities in art and music two decades earlier in Moscow. She believed her patients had a disorder resembled schizophrenia with an essential difference. While adult schizophrenics always deteriorated, her patients often made dramatic improvements. She called this syndrome schizoid personality disorder.
Though Asperger was unaware of Sukhareva’s work, he noted his patients’ condition was similar to the condition referred to as “autistic thinking” by the Swiss psychiatrist Eugen Bleuler. In 1908, Bleuler used the term “autistic” to describe “a schizophrenic patient who had withdrawn into his own world.” Asperger used the term “autistic psychopathy” to describe their condition.
In a postgraduate thesis, Asperger describedÂ “prototypical cases” named Fritz V., Harro L., Ernst K,. And Hellmuth L. Asperger was struck by these boys’ natural aptitude for science. He recognized that his patients’ blatant disregard for authority could be developed into the skepticism indispensable to any scientist. He called this distinctive cluster of aptitudes, attitudes, skills, and abilities “autistic intelligence.” His job as the staff of the Heilpädagogik Station was to teach these kids how to put their autistic intelligence to work. He called them his “little professors.”
Asperger noted that many of these kids’ fathers and grandfathers were engineers and scientists, showing that the disorder might be genetic. But he cautioned that it would be foolish to search for a single gene responsible for such a complex range of behaviors and traits as these conditions were undoubtedly polygenetic.
When Asperger submitted his thesis to Hamburger in 1943, the Nazis had occupied Austria five years earlier. Of the 200 senior members of the medical faculty, fewer than 50 remained. Asperger’s colleagues, Anni Weiss and Georg Frankl, had fled the country, and many others were in exile, imprisoned in concentration camps, or dead of suicide.Â Asperger was speaking out for the sake of children who had not yet been murdered by a monstrous idea of eugenics imported from America.
The word eugenics (which means “well-born”) was coined in 1887 by a British named Francis Galton, the younger half cousin of Charles Darwin. Galton distinguished himself by his ability to recognize patterns. He popularized the notion of regression toward the mean in statistical analysis and the use of fingerprints in the science of forensics.
Eugenics policies were first implemented in the United States. In 1909, the state of California passed a law granting public-health officials the right to sterilize convicts and the mental patients in California. Thirty other states had passed similar laws, and a wave of sterilization swept through asylums and prisons coast to coast.
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In October 1921, the Second International Congress of Eugenics was held as a gala week long event at the American Museum of Natural History in Manhattan, New York. The event was sponsored by the nation’s most prestigious museums and promoted in journals like Science and the Scientific Monthly. In the welcome address to the congress, Henry Fairfield Osborn, the museum’s president, urged his fellow scientists to “enlighten government in the prevention of the spread and multiplication of worthless members of society, the spread of feebleemindedness, of idiocy, and of all moral and intellectual as well as physical diseases.”
As influential as they were at home, American eugenicists received an even warmer welcome in Germany. A 1913 textbook by Geza von Hoffman called Die Rassenhygiene in den Vereinigten Staaten von Nordamerika (Racial Hygiene in the United States) became the seminal guide to applied eugenics students in Germany.
Incarcerated in the Landsberg Fortress in 1924, Adolf Hitler learned about eugenics from “The Passing of the Great Race,” written by a Yale graduate named Madison Grant. Grant mentioned that Galton’s strategies for encouraging men and women of the “genius-producing classes” to mate would not stop the rising tide of idiocracy. He directed his fellow eugenicists to develop more expeditious means of eliminating the weak and the unfit. It was music to Hitler’s ears. From his prison in Landsberg, Hitler dictated Mein Kampf to his deputy Rudolf Hess saying that as a compassionate defense of the lives of children yet unborn, the future Führer put forced sterilization at the core of his vision of a new society.
As the National Socialist party rose to power in the 1930s, the body of American eugenic law became the blueprint for Nazi policies to defend “Aryan” from negative genetic influences. Unlike their American counterparts, German eugenicists did not plan to limit their efforts to asylums, prisons, and mental institutions. Instead, they aimed to carry out the implications of eugenic theory to their fullest extent. In July 1933, they enacted the “Law for the Prevention of Genetically Diseased Offspring” to sterilize any German citizen who showed signs of schizophrenia, alcoholism, bipolar disorder, Huntington’s disease, inherited blindness or deafness, or epilepsy.
In June 1934, the Nazis assassinated the Fascist Chancellor Engelbert Dolfuss and replaced him with a pro-German and anti-Semitic successor.
By 1935, a massive exodus from Austria was under way, prompted by new laws stripping Jews of property, jobs, and basic rights of citizenship. Anni Weiss was the first of Asperger’s team to leave, arriving in America in 1934. The clinic’s gifted diagnostician, Georg Frankl, left in 1937, emigrating to Maryland with the aid of a Jewish doctor who had left Austria years earlier.
On March 12, 1938, the day of the Anschluss, Austria was annexed by Nazi Germany. Gangs of civilians calling themselves Rolllkommandos looted department stores and shops in the Jewish quarter, often assisted by the police. Within weeks, the University of Vienna was transformed into the intellectual center of an academic movement to put “racial improvement” and “racial research” at the top of the medical agenda. Before the Anschluss, more than 5,000 physicians were practicing in Vienna, by the fall of 1938, less than 750 would remain. Many former professors at the university died in concentration camps. Others took their own lives. In 1938, Asperger’s mentor Franz Hamburger gave a lecture to the society titled “National Socialism and Medicine,” affirming his support of the Law for the Prevention of Genetically Diseased Offspring.
On October 3, Asperger gave the first public talk on autism in history, in a lecture hall at the University Hospital. He launched into the case histories of his patients, putting his audience on familiar turf. Then he proposed a radical way of thinking about cognitive disabilities that is opposite to the dogma of racial hygiene. He said the therapeutic goal must be to teach the person how to bear their difficulties, not to eliminate them. Unfortunately, his strategy of accentuating the positive to his Nazi superiors by basing his four prototypical cases on his chatty little professors rather than on the more profoundly impaired children he saw in the institutes, would contribute to widespread confusion in the coming decades. On the basis of the four prototypical boys in Asperger’s thesis, many clinicians assumed that he saw only “highly functioning” children in his practice, which ended up obscuring his most important discovery that autism was found in all age groups, and had a broad range of manifestations.
That night was the beginning of Yom Kippur, the most sacred day in the Jewish calendar. For the next 24 hours, storm troopers and Rollerkommandos made brutal raids in the Jewish neighborhood, stealing, burning, plundering, and killing. A month later, on Kristallnacht, the Night of Broken Glass, ninety-five synagogues in Vienna went up in flames, and Jewish homes, hospitals, schools, and shops were demolished with sledgehammers. In Berlin, more than thirty thousand Jews were dragged off to concentration camps.
Meanwhile, Asperger’s old colleague, Erwin Jekelius, was rising through the party ranks and became the director of Am Spiegelgrund (formerly known as Am Steinhof), the largest mental hospital in Vienna. He was later called “the mass murderer of Steinhof” when he helped the Nazis started their euthanasia program. In 1941, Hitler arrested him when he fell in love with Hitler’s sister, Paula Hitler. After a brief stint in jail, Jekelius was drafted into the army and sent to the Russian front, where he was captured by the Red Army soldiers. He died at the age of forty, from cancer of the urinary bladder.
On February 20, 1939, a boy named Gerhard Kretschmar was born in Leipzig. He was born blind and intellectually disabled, with one arm and only a partial leg, and he was prone to seizures. The birth of Gerhard Kretschmar provided an opportunity that Hitler had been waiting for since his days in Landsberg prison. Hitler dispatched his personal physician to examine the child and gave orders to carry out euthanasia.
In August, the Committee for the Registration of Severe Hereditary Ailments issued a decree calling for the registration of all children born with congenital abnormalities of any kind. Doctors and midwives were required to report all cases to the committee.
On September 1, Nazi Germany invaded Poland, officially starting World War II. In December, Hitler signed a secret order authorizing the creation of a program call Aktion T-4, short for Tiergartenstrasse 4, the address of the Charitable Foundation for Curative and Institutional Care in Berlin. Closed door meetings were held throughout Germany and Austria to educate medical students about child euthanasia and T-4, which primarily targeted disabled adults. These programs became fertile ground for medical research that could not have been conducted in contexts where the patient was expected to live. More than 200,000 disabled children and adults were murdered through these official programs, and thousands more were killed by doctors and nurses on their own initiative.
Asperger had never joined the Nazi party, according to his daughter, because of his loyalty to the Wandering Scholars. He refused to report his young patients to the Reich Committee, which created a dangerous situation for him. The Gestapo had showed up twice at his clinic to arrest him. Both times, Franz Hamburger had used his power as a prominent Nazi party member to intervene in his favor.
By then, the Reich needed doctors on the front lines, and Asperger was drafted into the German army to serve as surgeon in a field hospital in Croatia. In September 1944, while Asperger was still in Croatia, the Allies bombed the Children’s Clinic, reducing the Heilpädagogik Station to rubble. As the ceiling gave way, Sister Viktorine threw her arms around one of her boys to protect him. They were buried together.
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