The aftermath of the Hans Asperger exposé

Hans Asperger was celebrated worldwide. The disability he described in 1944 was named after him and appeared in mainstream diagnostic manuals. His birthday, 18 February, was designated 'International Asperger's Day' and countries across the world marked this date. For many, Asperger represented the benevolent face of psychiatry, a man whom, it was believed, saved children from the insidious peril of the Third Reich.

Surprisingly, until relatively recently, Asperger was barely known in the English-speaking world. It was only in 1981 that the renowned psychiatrist Lorna Wing introduced the term Asperger's syndrome in a journal article in Psychological Medicine. From that moment onwards, the syndrome became widely known and was finally incorporated in the DSM in 1994.

The Asperger exposé

In May 2010, Herwig Czech, an Austrian historian, strode to the front of a gathering in Vienna's ornate City Hall and addressed the assembled crowd. The audience had gathered for a two-day symposium on Asperger's life and work. Asperger's daughter and grandchildren were present. Over two days, professionals from across the world would discuss the latest developments in Asperger's syndrome and reflect on Asperger's legacy. But now they listened in startled silence as Czech explained the archival material he had unearthed that would devastate the adulatory narrative surrounding Asperger.

Perhaps the most shocking discovery Czech shared on that day was a medical note from Spiegelgrund hospital concerning a two-year-old girl named Herta Schreiber. Am Spiegelgrund was founded in the summer of 1940 on the grounds of the Steinhof Hospital in Vienna. It was led by Erwin Jekelius, a former colleague of Asperger and a leading figure of the Nazi 'euthanasia' programme. It was here that children who did not meet the Nazi criteria of 'racial purity' and 'hereditary worthiness' were sent. Almost 800 children were killed at Spiegelgrund between 1940-1945, many by poisoning or through the administration of barbiturates over a period of time; the cause of the children's death was listed as 'pneumonia' on documentation.

On 27 June 1941, Asperger assessed Herta at his clinic. In brief notes he wrote that 'At home the child must be an unbearable burden to her mother, who has to care for five healthy children.' Using the euphemistic language characteristic of German state documents of the period, Asperger wrote; 'Permanent placement at Spiegelgrund seems absolutely necessary.' A few days later, on 1 July, Herta was admitted to Spiegelgrund and on 2 September, a day after her third birthday, Herta died of 'pneumonia', the cause of death regularly induced at Spiegelgrund. Herta was not even afforded dignity in death; her brain was preserved and used for research alongside hundreds of organs of other Spiegelgrund victims. The hospital only released these for burial in 2002.

These revelations were a source of embarrassment to those who had championed Asperger. Of course, it would have been easier to doubt the veracity of these revelations. However, a subsequent article by Czech that appeared in Molecular Autism in 2018, with further grave discoveries, was so detailed, so meticulous in its painstaking collation of first-hand archival material from diverse sources, that the facts, now laid bare, were left to speak for themselves.

As Czech noted, Asperger championed the rehabilitation of those with a chance of becoming 'useful' to the German Volk. He did not, however, refer to what fate should be met by those who exhibited no chance of this. Asperger had diagnosed Herta Schreiber as 'post-encephalitic?' In 1944, he had written of working with optimism at his clinic. 'But', he noted, 'in the case of these post-encephalitic personalities, we too have to say that one in most cases has to largely capitulate.' It seemed clear that capitulation in the case of Herta Schreiber meant signing papers for her to be killed.

In the case of another five-year-old girl, Elisabeth Schreiber (unrelated to Herta), who was also transferred to Spiegelgrund, Asperger observed in his evaluative notes that she featured 'Erethic imbecility, probably on a post-encephalitic basis. Salivation, "encephalitic" affects.' In the final recommendation, Asperger wrote 'Spiegelgrund would be the best possibility.' Nurses at Spiegelgrund noted that Elisabeth was affectionate and friendly but could only say one word – 'Mama'. On 30 September 1942 she succumbed to the induced 'pneumonia' at the killing facility.

These shocking cases were paralleled by others. In December 1941, it was discovered that children based at the Gugging psychiatric hospital near Vienna were playing truant from school. A committee was ordered to convene, and it was urged that those 'non-educable' in both a 'special school' or psychiatric institution were to be handed to 'the operation of Dr. Jekelius' at the earliest opportunity. Dr Jekelius' 'operation', of course, meant death. Asperger was the only qualified clinician appointed to this panel, which by mid-February 1942 classified 35 children as uneducable and unemployable, a verdict inexorably linked to 'euthanasia'. Ultimately, 41 children were transferred from Gugging to Spiegelgrund. There were no survivors.

Contrary to the claims that Asperger consistently embellished his diagnostic reports to save children, Czech found in at least 12 patients' files that Asperger was far harsher in his assessments than even the Spiegelgrund staff. He labelled children with terms including 'unbearable burden', 'semi-imbecile' or 'psychopathic infant'. He sent one boy with 'hypochondria' symptoms to a forced labour camp as a 'cure'. He unnecessarily referred to the Jewish lineage of his patients. Following the Anschluss, the regime took measures to ensure Jewish children in non-Jewish foster families were placed in Jewish orphanages, from where they were transported to death camps. In March 1938, Asperger recommended separating a 13-year-old Jewish boy named Alfred from his non-Jewish foster mother and placing him with Jewish foster parents; a highly questionable judgment. In November 1940, Asperger wrote of a boy named Ivo; 'The only problem is that the boy is a Mischling of the first degree.' Asperger's unnecessary use of this term –which denoted individuals with one Jewish parent – was an extremely hazardous and potentially fatal piece of information.

Similarly, Asperger wrote the label 'Mischling' on the front cover of nine-year-old Marie Klein's diagnostic assessment, noting that the way she spoke contrasted 'to her quite Jewish character'. From Asperger's Heilpädagogik (therapeutic pedagogy) ward, Marie was sent to a children's home and in February 1940 was deported to the Wlodawa ghetto, from where children were taken to be gassed at Sobibor. A 12-year-old Jewish girl, Lizzy Hofbauer, was admitted to Asperger's clinic in 1939. She had displayed great fear two days before admittance and spoke of anti-Jewish persecution; something understandable in Nazi-ruled Vienna. Asperger claimed she was schizophrenic and noted 'For her age and race, conspicuously retarded sexual development'; evidence that he had internalised sexualised Nazi anti-Jewish stereotypes. Asperger also profited from the dismissal of 96 Jewish Viennese paediatricians (out of 110) and in 1935, despite not having obtained the specialist doctor paediatric degree and after only four years at the ward, Asperger took charge of the ward, in the place of more experienced Jewish doctors, including Georg Frankl.

Asperger's writings and organisational ties to Nazism

In Asperger's youth he had belonged to the right-wing faction of Bund Neuland, an anti-Jewish youth organisation. By 1940, he was a member of several rabidly anti-Semitic organisations, including the National Socialist German Physician's League, the figurehead of the Nazi Party within the medical profession. By 1938, he was signing his diagnoses with 'Heil Hitler!' In that year, referring to the 1933 Law for the Prevention of Hereditarily Diseased Offspring, which resulted in hundreds of thousands of people being forcibly sterilised, Asperger wrote; 'You know by what means one strives to prevent the transmission of diseased hereditary material' and said 'We physicians have to take on the tasks that accrue to us in this area with full responsibility.' A year later he wrote of the need 'to carry out restrictive measures' to stop 'the diseased…transmitting their diseased hereditary material' to the detriment 'of the Volk'.

He emerged unscathed from repeated vetting by the Nazi Party, which was initially concerned about Asperger's Catholicism. Vienna's deputy Gauleiter wrote in 1940 that the Nazi Party had 'no objections whatsoever' against Asperger and in 1940 the Nazi authorities deemed his political views and character 'irreproachable' and stated that Asperger conformed to 'the National Socialist racial and sterilisation laws'. A colleague warned Asperger that he went too far with pro-Nazi rhetoric and observed that a lecture of Asperger's was 'maybe just a little bit too Nazi for your reputation' and advised 'I would drop the thanks to the Führer'.

During the final two years of the war, Asperger joined the Wehrmacht in Croatia, where tens of thousands of civilians were put to death by the German forces. In 1974, Asperger declared of his service in Croatia; '…I would not like to miss any of these experiences'. He enjoyed a successful post-war career, serving the children's clinic, heading Innsbruck University's paediatric clinic and in 1962 being appointed Chair of the Vienna Paediatric Clinic. In a book published in 1952, he buttressed his claims of the importance of heredity by citing Johannes Lange, the Nazi eugenicist, and Otmar von Verschuer, who conducted 'research' by exploiting Holocaust victims' body parts sent from Auschwitz-Birkenau by his student, Josef Mengele. In 1950, Asperger wrote that child victims of sexual abuse shared a 'shamelessness' and that they 'attracted' these experiences. He denounced a 15-year-old girl abused by a 40-year-old man for showing no 'remorse' for what occurred and opined she displayed 'severe sexual depravation'. In an interview in 1974, Asperger spoke appreciatively of 'my mentor, Hamburger' in reference to the director of the Vienna Paediatric Clinic, Franz Hamburger, a committed Nazi, who by 1931 had commenced purging the clinic of its Jewish and female professionals. Writing after the war, Asperger lamented how 'feebleminded' families 'procreate in numbers clearly above the average' and declared their reliance on public welfare 'presents a very serious eugenic problem'.

Fallout and recent literature

Shortly after Czech's article appeared, a book with a similarly damning assessment of Asperger's war-time guilt was published by Edith Sheffer. Like Czech, Sheffer attacked the positive portrayal of Asperger that had been widely propagated. Sheffer's volume and Czech's article were particularly scathing in their assessment of Uta Frith's book chapter 'Asperger and his syndrome', which claimed 'Asperger clearly cared about these children, who in most people's eyes were simply obnoxious brats', and argued his innocence against claims of his Nazi involvement. In a letter to The Guardian in the aftermath of the exposé, Frith said 'none of this was known' at the time she translated Asperger's work and that she found Asperger's collusion in the euthanasia programme 'very saddening', but did not explain why her book chapter did not discuss the references to Nazi ideology in the preface to Asperger's 1944 paper.

Steve Silberman, the author of NeuroTribes, which won the 2015 Samuel Johnson prize, initially presented Asperger in a positive light as an Oskar Schindler-esque figure who tried to protect children from Nazi race hygiene measures by underscoring those children on the 'high-functioning' side of the spectrum. Czech attacked this position by illustrating how Asperger devoted a section of his 1944 paper to outlining the hereditary nature of the condition and how Asperger highlighted the severe impediments of his case studies in papers. In at least four diagnoses, Asperger referred to the heredity as 'degenerative', which increased the probability of fatal outcomes of these evaluations. Silberman's apologetic arguments in articles relating to Asperger, following the first revelations on Asperger's actions, stimulated a furious backlash from Manuel Casanova, Professor of Biomedical Sciences at the University of South Carolina. Silberman later rewrote sections of his book to reflect Asperger's disturbing history.

Following Czech's article, Dean Falk of Florida State University authored an article in an effort to defend Asperger's record. She argued that it was unlikely that Asperger knew of the murderous activities taking place at Am Spiegelgrund. However, a paper from Czech appeared shortly thereafter, positing that Falk's article misrepresented sources and failed to engage with evidence presented in Czech's paper 'by omitting everything' that did not support Falk's 'manifest agenda of defending Hans Asperger's record'. Czech argued that Falk's paper should never have passed peer review and demonstrated how Falk's arguments were severely undermined by the presence of 'basic factual errors' and mistranslations. In a rejoinder, Falk admitted she had mistranslated some key words in German but related that she still thought that as late as April 1942 Asperger did not know about the killings at Am Spiegelgrund.

However, this position seems untenable, for as Czech argues, by September 1940, long before Herta's transferal to Spiegelgrund, it was widely known across Vienna that psychiatric patients were being murdered; astoundingly, a protest was even staged outside Vienna's Steinhof psychiatric hospital. Indeed, in November 1940, public knowledge of the Nazi 'euthanasia' programme was so detailed that the official Nazi party newspaper, the Völkischer Beobachter, was forced to deny rumours that patients were receiving lethal injections or were being gassed. Moreover, to further indicate the implausibility of Falk's claim that Asperger 'didn't know' of 'euthanasia' killings, Czech cites the case of Anna Wödl, a Viennese nurse whose son, Alfred, had a mental disability. Almost a year prior to Herta Schreiber's referral, Wödl had been sufficiently alarmed by widespread rumours of 'euthanasia' killings to identify the Nazi coordinator of the T4 killing programme, Herbert Linden, and approach him directly (in an unsuccessful attempt to save Alfred, who was killed at age six at Spiegelgrund). Additionally, because Falk did not engage with all the issues Czech raised in his riposte and because Falk did not address other wide-ranging and comprehensive incriminating evidence delineated in Czech's initial paper, one is forced to conclude that the detailed historical revelations concerning Asperger stand with no credible challenge to their veracity.  

Relevance to everyday practise and use of the term Asperger's

Some may wonder how lessons from this saga are relevant to day-to-day psychological practise. With autistic people already subjected to greater levels of prejudice and stigma than the general population, it seems that we should be careful as clinicians in using terminology that can associate autistic people with infamous or brutal figures. Indeed, Simon Baron-Cohen, director of the Autism Research Centre at the University of Cambridge argues that 'The saga is relevant to everyday practise because we want autism to be free of any stigma and if we use Asperger syndrome as a term for one of the subgroups there is a risk of an association with a dark period in history. Rather than naming subgroups after specific doctors, we could just name them Type 1, Type 2, etc.'

It may be queried why it is not possible to simply divorce 'Asperger's' as a concept from Asperger as a person. When I put this question to Baron-Cohen, he noted that 'The idea that we can divorce the label from the man himself is also not straightforward. For example, some people who love Michael Jackson's music no longer play it because of his likely paedophilia.' Baron-Cohen also referred to Sibelius and Wagner as being 'composers whose music we can no longer listen to and separate from their culpability' in actively supporting anti-Semitism (Wagner's music has been under a semi-official moratorium in Israel since Kristallnacht over his rabid anti-Semitism).

It is true that the term 'Aspie' was and is used with pride by many autistic individuals who found it reflected the unique cognitive style that an Asperger's syndrome diagnosis represented. There has already been considerable research on the preferences of those within the autism community regarding what terms to use (see for example, Kenny et al., 2016), which revealed strong views on this point. Ultimately of course, it seems only correct that autistic people should be the final arbiters of how the term is used. A poll on this issue, in which 1645 autistic people took part, was conducted by the National Autistic Society (NAS). As a result, the NAS magazine, Asperger United, was changed to The Spectrum, with the editor noting that the society felt that changing the name was both 'necessary and urgent'.

Anna Kaczynski, who in 1993 founded the magazine – which is written by and for autistic people – wrote that she suggested changing the name because Asperger 'fully cooperated' with Hitler's euthanasia programme and also because 'since this information has become public knowledge some people who share our disability have even begun to receive hate mail.' When I contacted them, the Head of Research at the NAS also revealed that in response to the question posed by the NAS: 'Should the National Autistic Society reduce our use of the term Asperger syndrome immediately, except where explaining that this was a former name for a diagnosis within autism?' 53 per cent said yes and 31 per cent said no, with 16 per cent ticking 'Don't know'.

Writing in The Independent, Ryan Hendry, press officer for Autistic UK, who was diagnosed with Asperger's syndrome, wrote that 'The idea that the condition I have been diagnosed with bears the name of the individual who would have sent people like me to their deaths is something I feel extremely upset about.' He added 'after the news about Hans Asperger, I think it's time the condition was renamed.' Baron-Cohen similarly wrote that in light of the recent revelations, he is no longer comfortable using this term. He changed the acronym of the CLASS clinic that he set up in 1997 (the first diagnostic clinic in the UK for adults with suspected Asperger syndrome), from its previous meaning of Cambridge Lifespan Asperger Syndrome Service, to the Cambridge Lifespan Autistic Spectrum Service.

Our use of the term Asperger's syndrome now needs to be revised, particularly as the NAS and other evidence to date indicates that overall, the autism community prefers it not being used at all, except where explaining that this was a former name for a diagnosis within autism. This should be respected, not least because the autism community, which already has to contend with unacceptable levels of stigma, may be further stigmatised by the use of this term.

This saga is also relevant to everyday practise because it reveals uncomfortable truths about the way in which those working in our profession can easily exploit vulnerable populations whom we have a duty to both champion and protect. They deserve the basic human rights of being accorded dignity and respect. This narrative must be closely studied by clinicians and researchers so that a new generation learns from history and avoids repeating the shocking violations of human rights of the past. This dark chapter concerns the most critical ethical issues that psychiatrists and psychologists face. It is a story of careerism, breach of trust and dereliction of duty of care. These are issues that affect us all, albeit in less dramatic contexts, every day. This is a story that must be told and retold.

- Rabbi David Ariel Sher, B.Sc. (Hons) Psych, M.A. (Dist.) J.Ed, MBPsS is studying for a further postgraduate degree in psychology and education at the University of Cambridge.
He would like to thank Professor Baron-Cohen for his time in discussing various issues relating to these historical revelations.

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