Introduction

(…) The syndrome we know as autism was first described on two separate occasions, by Leo Kanner [Autistic Disturbances of Affective Contact] in Baltimore in 1943 and by Hans Asperger [Die “Autistischen Psychopathen” im Kindesalter] in Vienna in 1944 (going by the publication dates of their respective papers). That is, we take those two papers to be the first clearly recognizable descriptions, the “discovery,” of what we consider autism. The origins of the word “autism,” meanwhile, lie further back in time. The coiner of the term was the great Swiss psychiatrist Eugen Bleuler, who at the time oversaw the Burghölzli mental asylum outside Zurich. Bleuler used the term in public for the first time in a 1910 paper, but made it broadly known the following year with his monograph Dementia praecox oder Gruppe der Schizophrenien (which more famously introduced the term “schizophrenia” to the world). This work presented autism as a symptom of schizophrenia and defined it as the “loss of contact with reality” that caused the schizophrenic mind to withdraw into its own world. When Kanner and Asperger published their foundational papers on modern autism, each of them knowingly adapted Bleuler’s term to the new, more specific purpose of designating this peculiar syndrome. The Kannerian and Aspergian moment at which modern autism emerges is thus the moment autism changes from a symptom of another underlying condition into a syndrome of its own.7

What, though, did Kanner and Asperger describe? This question can only begin to be answered over the whole course of this investigation. We can confirm, though, as a way of starting out, that neither of them saw himself as having seen and described the same syndrome as the other. The idea of an autism spectrum, with Kanner’s type lying more at one end and Asperger’s at the other, is an invention of the 1980s. Thanks to the spectrum model, we think of autism as ranging from low- to high-functioning individuals who also display quite varied degrees of intelligence as conventionally measured. The received view is that Kanner originally described patients mostly on the lower end of the autism spectrum, while Asperger’s cases were on the higher end in terms of intelligence and functioning in everyday life. The salient features of Asperger’s descriptions thus came to form the picture of “Asperger Syndrome,” the region of the autism spectrum that we associate with precocious intelligence, specialized interests, and social awkwardness—as opposed to the Kanner type, which we think of as having little to no language use, sometimes extreme sensitivity to stimuli, and severe, comprehensive disability. How, in the decades following Asperger and Kanner’s foundational papers, these two superficially disparate clinical pictures came to be seen as profoundly akin to each other, as just different expressions of one underlying condition, is a fascinating story in its own right, best told by Gil Eyal and his coauthors in The Autism Matrix.8

The agents behind the modern autism spectrum were a group of autism researchers and parental advocates in the United Kingdom, one of whom, Lorna Wing, wrote the 1981 paper Asperger’s Syndrome: A Clinical Account, which not only re-described the Asperger type using contemporary case material but also proposed the essential kinship of Asperger’s and Kanner’s autistic types and the idea of the spectrum. Another of these researchers, Uta Frith, published in 1991 a translation [Autistic Psychopathy In Childhood] of Asperger’s foundational autism paper (Kanner’s, having originally been published in English, has thus always been the better known of the two). And another, Simon Baron-Cohen, is the name behind the dominant theory of autism of the last thirty years: the theory that the autistic subject “lacks a theory of mind.”

That autistic people constitutively lack a theory of mind has not been convincingly proven and is put in considerable doubt by some more recent research,9 but it remains the single most powerful explanatory idea in the recent history of autism. Having a theory of mind is defined as “being able to conceive of mental states: that is, knowing that other people know, want, feel, or believe things.”10 If one lacks this ability, the reasoning goes, one will consequently display the core symptoms of autism:

Lack of theory of mind can account for both the avoidance of social contact and for an inappropriate approach: both are consequences of not understanding other people in terms of what they think or feel or want. Communication failure is an inevitable consequence of this deficiency.11

In more concrete terms, a person lacking a theory of mind will “treat people and objects alike” and “show a striking poverty of pretend play”12—refusing, say, to build a house out of blocks but instead arranging and rearranging the blocks according to an obscure serial principle.

To lack a theory of mind is, in the words of Simon Baron-Cohen, to be “mindblind.”13 Popular interpretations of the mind blindness hypothesis state that autistic people “lack empathy” or have “a literal mind” that is unable to comprehend figurative language or non-verbal means of expression.14 What underlies the theory of mind in this view is the ability to recognize that people’s knowledge, beliefs, and intentions can differ both from other people’s and from actual states of affairs: “the child has to be aware that different people can have different beliefs about a situation.”15

In this widely accepted theory of autism, the autistic person’s lack of a theory of mind is equated with a supposed inability to pretend. Pretending is even seen as a more primitive function, as the basis for all “mentalizing” or theory of mind: in the development of a normal child, there comes a point around year two at which “the ability to pretend starts to develop, and then gradually the ability to mentalize.”16 This implies that all functions of the theory of mind— all the ways of understanding other people’s mental and emotional states—are outgrowths of the primitive ability to pretend. Autistic children, however, “show little if any pretend play” and “spend much of their time in reality-oriented play”17—taking blocks as just blocks, as in the example above, not as people or houses or vehicles. So we can, without putting words in anyone’s mouth, phrase the consensus theory of modern autism as the idea that the autistic mind takes things just as they are in an objective reality devoid of other minds, and is unable to fantasize about the contents of other people’s minds. When we view things in these easily graspable terms, a peculiar relationship comes into focus between Bleuler’s autism and the autism we know: they are not just different, they are polar opposites.

If the autism we know deals exclusively in reality, in objects and their physical relations, autism as originally conceived by Bleuler is just as strongly associated with fantasy. It is the state of a mind “turned away from reality” and unable to stick to objective states of affairs. “Realism” is Bleuler’s word for the opposite of autism. For Bleuler, in other words, any kind of thinking that is independent of objective “reality,” that thinks things other than as they are, is autistic. Bleuler never intended autism to denote merely a “symptom of schizophrenia,” as it is now taken to do, and did not consider autistic thinking intrinsically pathological. Bleuler’s autism is present in ordinary beliefs, opinions, fantasies, and dreams; and in myth, art, and poetry, to name just a few of its media other than madness. So a more precise formulation of Bleuler’s concept would state that schizophrenic withdrawal from the world is one among many and various instances in which “autistic thinking” manifests itself; autism considered in itself, however, is an aspect of thought or a domain of human experience larger than any of its concrete instances.

If “fiction” seems like an adequate substitute for this notion of autism in many instances, another equally good one is “pretending” or “make-believe.” Bleuler writes: “Autistic thinking turns the boy playing soldiers into a general, the girl playing with her doll into a happy mother.”18 Meanwhile the modern autistic person is said to be incapable of make-believe play! We believe the autistic person incapable of forming representations of other people’s states of mind; but when Bleuler’s schizophrenic patients express paranoid fantasies about what other people think or want of them, they are displaying Bleuler’s autism in one of its purest forms. We could now say that they are mentalizing too much, projecting mental states and beliefs where they do not belong.

Seizing on the differences between Bleuler’s use of the term autism and our own (which we claim to derive from Kanner and Asperger), commentators have delivered a unanimous verdict: the two senses of autism have nothing in common but the name. “It is clear,” writes Frith immediately following her own quotation of Bleuler’s passage about autism as the principle of make-believe play, “that autistic thinking in Bleuler’s sense has nothing to do with autism as we know it.”19 Since it appeared, along with Frith’s translation of Asperger’s foundational paper, in 1991, this dismissal of Bleuler’s relevance to the problems of modern autism has gone unquestioned. The problem with this is that in Asperger’s view, which Frith purports to transmit to us, the total independence of his autism from Bleuler’s concept is anything but clear.

Frith’s comments are attached to a passage in Asperger’s paper in which Asperger presents a summary of Bleuler’s autism followed by his own remarks, which stubbornly resist the interpretation Frith puts on them: Autism is the paramount feature in both cases. It totally colours affect, intellect, will and action. Essential symptoms of schizophrenia and the symptoms of our children can thus be brought under a common denominator: the shutting-off of relations between self and the outside world.20 If we read Asperger’s paper in full and in the original, we find that the clear statement Asperger makes here of an essential continuity between Bleuler’s autism and the one he is about to describe is of a piece with the entire movement of his thought, and that the concept of the weakening of “relations between self and the outside world” that sustains this continuity is both richly conceived and full of implications for his description of an autistic syndrome. But from its placement in Frith’s translation and the changes she makes to the surrounding passages, most readers will fail to detect its importance. Frith’s treatment of Asperger is often an exercise in selective quotation and misleading exegesis. Frith substitutes modern clinical terms for Asperger’s much more general concepts (speaking of “goal-directed” thinking when Asperger says “von der Realität bestimmt,” for example); mixes clauses from distinct sentences of Asperger’s into new sentences of her own, thereby changing the relations between subjects, verbs, and objects; and freely rearranges the order in which Asperger presents his thoughts—here with the effect of disguising the ways in which Asperger expresses his debt to Bleuler. All this in addition to her decision to omit the entire introductory section of the paper, in which Asperger reveals the deeper intellectual sources of his concept of autism (which we explore in Chapter Three [of The Turn to The Self: A History of Autism, 1910–1944]).

Why the effort to distort the original sources, to suppress the continuity between authors in the name of a sharp break between a premodern and a modern autism? There were reasons, at the time, to underscore the specificity of the autistic syndrome—the medicalization of the condition was essential in order to obtain social services for those diagnosed with it.21 That notwithstanding, Frith’s translation of Asperger and the accounts of autism’s history put forth by Frith, Wing, and others at this time did unnecessary and regrettable damage not just to the historical record but surely to the potential richness and variety of autistic experience as mediated by historical understanding.

The fact that a word such as “autism” has one meaning at one point in time and then switches, not too long after, to an apparently opposite meaning does not show that the respective usages of the word have “nothing to do” with each other. On the contrary, the relationship of diametrical opposition—and the heavily laden terms of this opposition: notions such as reality and fantasy, logic and affect—should signal to us that they have everything to do with each other. Like the “primitive words” in which Freud discerned a double and opposite meaning— “near-far,” “old-young,” “bind-cleave,” “outer-inner”22—autism is a deceptively simple lexeme. Its root is just the Greek for “self”—autos—yet the contents ascribed to it by Bleuler, Asperger, Kanner, and others are widely differing visions of what makes up the human self in isolation from the world around. And the arc described by the movement of autism from Bleuler’s time to ours—a progression from madness to hyperrationality, from an excess of affect to its failure—is the arc of ideology in the twentieth century. This should become clearer in the chapters [of The Turn to The Self: A History of Autism, 1910–1944] that follow. For now, let us lay out the terms of the inquiry—map, as it were, the interface of autism the thing and autism the name, whose paths we then hope to trace.

The consensus view of the natural-cultural history of autism can be summarized in five points, on each of which this discursive history will propose not a mutually exclusive contestation but an additional perspective. The consensus holds (1) that modern autism was discovered by Kanner and Asperger, each of whom saw, for the first time, more or less what we now consider the autistic syndrome. As to the existence of two contemporaneous first descriptions of this phenomenon, it holds (2) that the simultaneous discovery of modern autism by Kanner and Asperger was essentially a coincidence. Furthermore, the consensus implies (3) that the term “autism” chosen by both discoverers was at the time an obscure terminological relic, which they revived under a completely new meaning. A corollary of this last point is (4) that the phenomena previously designated as “autistic,” in the premodern sense, can be clearly distinguished from the phenomenon of the modern autistic syndrome, and that all uses of autism can thus be unambiguously divided into premodern and modern. Finally, this phenomenological distinction between premodern and modern autism is underpinned by the notion (5) that it is symptoms that count in defining autism (as opposed to the ideational content of the concept of autism), so that an adequate differential diagnosis on the basis of symptoms is sufficient to demonstrate that modern autism is a distinct entity (assuming, then, that the stated symptoms of modern autism do in fact adequately perform that differentiation!). I will now expand somewhat on these points: discovery, coincidence, obscurity and revival, phenomenological dualism, and symptomatology; and sketch out how a discursive approach meets the consensus on each of them.

The first point, the question whether “discovery” is the most apt metaphor for the historical origins of modern autism, is really the sum of all the others, and cannot be fully addressed until the end. But what my approach does on this highest of levels is propose an alternate model of the emergence of modern autism from a gradual process, in which the discovery of facts is not ignored or suppressed, but in which the interpretation of what is seen or discovered plays at least an equal part.23 The model of emergence, in other words, denotes a dialogue between practice and theory. This is what we will be working toward.

Point two—the theory of dual, independent discovery—gives us the occasion here to discuss the two most important published works on the history of autism. Both are histories of modern autism; but each begins from what it takes to be the beginning, the foundational papers of Kanner and Asperger. One argues effectively that there is no reason to be surprised that autism was discovered independently on two continents at almost exactly the same time, and thus no need to posit a hidden connection between the two sites. The other then shows incontrovertibly that in spite of all this, a vital connection—hidden for decades meanwhile—did exist; Kanner’s and Asperger’s “discoveries” were not, in fact, independent.

The Autism Matrix, by the sociologist Gil Eyal and a team of secondary authors, stands out among extant publications in addressing itself not to the families or caregivers of autistic children, in order to help them understand and cope with their charges, but rather to anyone seeking a fuller understanding of how the current autism crisis arose. Its overall argument is that the “epidemic” of autism that has gathered strength since the 1980s can be explained without reference to the actual rate of incidence of autism in the population, entirely on the basis of “diagnostic substitution”: autism has come to be the preferred diagnosis for conditions that previously were lumped into other categories. The most important factor driving the shift in diagnoses was deinstitutionalization, or the emptying of American mental asylums in the 1960s. Large numbers of atypical children who would otherwise have been labeled as generically “feebleminded” and put into institutional care instead had to be dealt with in school and society. This opened up a new market for targeted therapies, and concomitantly a kind of “market” for diagnoses driven by the combined interests of therapists, researchers, teachers, and parents. This was a market on which autism performed exceptionally well. The Autism Matrix makes this argument in painstaking detail and rigorous sociological terms; and along the way it lends many insights into how the diagnosis of autism has changed since Kanner and Asperger.

Eyal and his team acknowledge what they call “the riddle of simultaneous discovery”: the question of how Asperger in Vienna and Kanner in Baltimore, their respective countries at war with one another in the early 1940s, could have apparently had the same thought—that there was a group of children, more or less the same group of children, waiting for the label “autistic” to be applied to them. Because there had never been any known channel by which they could have heard of each other’s work, this has always been thought to be a coincidence, an example of genuine dual discovery like Newton and Leibniz’s independent arrival at the calculus. But for the sociologist Eyal, very little in this picture is truly coincidental. He sets out to “dissolve” the riddle by explaining why modern autism was ripe for discovery in both Europe and the United States at this time. To this end he points out the “similar intellectual and clinical milieus” in which Asperger and Kanner—a lifelong Viennese and an Austrian by birth who emigrated to the United States, respectively—were formed, and the similar “institutional location of the two men” at the time of their autism research, “their similarly interstitial position between disciplines” (the disciplines of child psychiatry and special education). The coincidence of these two factors— intellectual milieu and institutional location—made the two of them highly likely both to come across the same kind of case material and to interpret it in the same terms.24

As successfully as Eyal’s dissolution of the riddle of simultaneous discovery is carried out, it is not strictly necessary, because the riddle also has a more conventional solution. A third doctor named Georg Frankl served as a conduit for the transmission of ideas about autism from Asperger’s clinic to Kanner’s as, in 1937, he emigrated from Vienna, where he had worked alongside Asperger, to the United States, and soon joined the clinic directed by Kanner. Only in 1938—manifestly influenced by Frankl—did Kanner even begin the work that led to his epochal publication on autism in 1943. Asperger remained ignorant of Kanner, but not the other way around.

Frankl’s story, which had been lost, was recently made public in the book Neurotribes: The Legacy of Autism and the Future of Neurodiversity, by the journalist Steve Silberman.25 In Silberman’s eyes, Frankl’s role turns Kanner into something of a fraud, eager to claim sole credit for the discovery of autism and to deny both Frankl’s and Asperger’s influence on himself. I argue in Chapter Four [of The Turn to The Self: A History of Autism, 1910–1944] that this view oversimplifies things and ignores certain other facts; for one thing, Silberman’s telling of the story assumes that the observation of autistic children was experienced by those concerned—Kanner, Frankl, Asperger—as a momentous scientific “discovery” in the first place, a prize worth trying to claim sole credit for. But at the time, before it had caught the attention of the wider world, the autistic syndrome was not likely to have registered with these authors as quite so significant in and of itself. That we should instead understand the emergence of modern autism from its precedents as a gradual process of interpretation and reinterpretation, and in fact as a process that, far from having been achieved by Kanner and Asperger, is still ongoing—this is, as already stated, one of the main arguments of this dissertation. Silberman’s diligent historical research, meanwhile, remains a valuable contribution.

So much for the question of dual discovery: it is both a perfectly explicable effect of sociological forces and a false appearance. But a highly problematic point remains: neither the sociological explanation nor the fact of Georg Frankl can explain the seemingly innocent question of why “autism,” and not some other term, was the name chosen for the new syndrome on both sides of the Atlantic.

One thing that Georg Frankl almost certainly did not suggest to Kanner is the application of the label “autistic” to any particular set of patients. Autism itself plays only a minor role in Frankl’s own work—where it never serves to designate a definite syndromal type, but rather appears in the perfectly conventional Bleulerian sense—and was first used by Asperger only in 1938, after Frankl had left Vienna. Frankl certainly communicated to Kanner the substance of the Viennese research program that had already identified close approximations of the autistic type, and he gave Kanner another concept, that of “affective contact,” that had a major impact on Kanner’s thinking and on his description of autism. But Frankl does not actually solve for us the riddle of why both Asperger and Kanner chose to call their particular groups of patients “autistic.” Neither does Eyal’s explanation suffice, for after mentioning the “similar intellectual milieus” in which Kanner and Asperger were trained in Berlin and Vienna, respectively, he goes on to elucidate these milieus in only the most general terms, and comes nowhere near the question of the concept of autism itself.

In fact, everything that The Autism Matrix—by some margin the most thorough and penetrating analysis we have of the history of modern autism—has to say about the use of the word “autism” before the modern era can be quoted here unabridged:

The Swiss psychiatrist Eugen Bleuler coined the term decades earlier to describe his schizophrenic patients. Bleuler’s patients went into states where they seemed totally detached from the outside world. Disconnecting from the world around oneself and basking in fantasy was something any person did to a certain extent, Bleuler thought. He dubbed this state of disconnection “autism” and spoke of “autistic thinking” as one modality of thought that all humans engaged in.26

This brief summation of the Bleulerian concept of autism still surpasses others in that it devotes more than a single sentence to it. Grinker’s equivalent passage reads simply: “Coming from the Greek autos, meaning ‘self,’ the term was used as an adjective by Swiss physician Eugen Bleuler in 1912 [actually 1910] to describe the behavior of some people, then diagnosed with schizophrenia, who were disengaged from everything except their internal world.”27 Chloe Silverman, whose writing centers on the history of autism therapy, autistic advocacy movements, and the contemporary sociology of autism, is content to note that “autism” was “a term [Kanner] borrowed from Swiss psychologist Eugen Bleuler, who had used it back in 1910 to describe symptoms of schizophrenia.”28 And here is Steve Silberman on the same subject: “The term autism, in the way that Eugen Bleuler originally used it, implied a gradual withdrawal into a private life of fantasy.”29

We have just read the entirety of what the best, most scholarly contemporary writers on autism have to say about the use of the concept before Asperger and Kanner. Amidst their uncertainty as to Bleuler’s profession (psychiatrist? physician? psychologist?—he was in fact a psychiatrist), none of these accounts, which all stand in marked contrast to their authors’ intellectual curiosity about other matters autism-related, adds anything to what Uta Frith wrote about Bleuler in her 1989 Autism: Explaining the Enigma.

Meanwhile, no available account provides even a clue to the question of why the name “autism” was chosen by both Asperger and Kanner. Every one of these authors, upon mentioning Bleuler, underlines how Bleuler’s old use of the term was different from the new use; none, however, has a word to say about how the two are related. This leads to a general shrug of the shoulders when it comes to the question: why, then, did Asperger and Kanner use the term at all? The authors’ helplessness on this point is a direct consequence of their belief that Bleuler’s autism and the autism we trace to those two later authors have “nothing to do” with each other: but if that is the case, there is, on those very same grounds, no possible reason for Asperger and Kanner’s uses of the term! Some accounts (including, notably, Eyal’s) state outright that “autism,” as borrowed from Bleuler, was not an appropriate description of Kanner’s or Asperger’s patients. So Eyal proceeds to suggest—and other accounts similarly imply—that both Asperger and Kanner adopted Bleuler’s term, despite feeling it inappropriate to their purposes, simply because they could not think of anything better. No careful reading of either Asperger’s (original German) or Kanner’s autism paper could support this conclusion. Both authors praise Bleuler’s coinage and give reasons for using it—Asperger calls it “eine der großartigsten sprachlichen und begrifflichen Schöpfungen medizinischer Namensgebung”30—but not a single one of these reasons makes it into modern accounts.

Even after taking full stock of Kanner and Asperger’s reception of Bleuler, however, we still have another major factor to attend to in their selection of the term “autism”: the discourse of autism that spread out from Bleuler, surrounded Asperger and Kanner, and supplied them with any number of precedents for the handling of the concept. The recent works give the impression that Bleuler’s curious invention was lying idly on the shelf when suddenly two young doctors, each for his own (quite mysterious) reasons, plucked it out of a dusty tome and applied it to a newly discovered phenomenon. This scenario, like the previous one, is as untrue as it is implausible. Kanner and Asperger would not both have chosen the same term if that term were obscure, in disuse. They chose “autism” precisely because it was easily recognized and understood; their uses of it lie in a tradition that, while stemming from Bleuler, encompasses a host of other authors and other uses of the term with which they—and their presumed readers— were so familiar that it would have been superfluous for them to go into it.

This, then, answers point three: the absence, in available histories of autism, of anything lying between Bleuler and the modern authors. “Autism” was not lying in the dustbin for Asperger and Kanner to retrieve; it was everywhere in their immediate field of child psychiatry (as well as elsewhere). They used it not on inscrutable whims, but precisely because it would be easily understood by their readers. And they used it, that means, not in a revolutionary new sense but only in a novel application. This is why both Asperger and Kanner used autism in its adjectival form in the initial designations of their syndromes: “autistic psychopathy in childhood” and “autistic disturbances of affective contact,” respectively.31 Only later did the name of the syndrome—Kanner’s syndrome, at least—change to “early infantile autism.” Initially the titles would have been read very much in the light of previous “autistic” phenomena, and even previous “autistic” personality types, in the psychiatric literature:32 an “autistic psychopathy,” for Asperger, is one of many types of psychopathy—a word that, in the German of the time, designated any kind of mild to moderate personality disturbance—this one just happening to be characterized as exhibiting autism, in precisely the received sense of the word.

Knowing that Kanner and Asperger functioned within the existing discourse of autism makes us ready to take on point four: the question of whether modern autism can be cleanly, phenomenologically differentiated from what Bleuler referred to as autism or “autistic thinking.” And here, even on the prosaic level of the clinic—that is, without going into philosophical uses of the autism concept—we can point to some complications that will arise from a fuller view of the discourse of autism between Bleuler and the early 1940s. We will take them here in order of increasing complexity.

The simplest way in which to complicate the notion of a clean break between premodern and modern autism is to note that authors were aware of the syndromes in question before Kanner and Asperger “discovered” them. This has already been done to an extent. There are compelling anticipations of Asperger and Kanner to be found in earlier authors, one of whom, Grunya Sukhareva, has received a certain amount of attention for her 1926 description of a group of children with qualities conspicuously like those found in Asperger’s autistic patients.33

Sukhareva’s description of a proto-autistic syndrome, however, was no more of an anomaly within the larger discourse of autism than Asperger’s or Kanner’s. Like both of these, Sukhareva presented a type of childhood personality disorder as a special case of a larger phenomenon. For Kanner and Asperger, this larger phenomenon was Bleuler’s autism plain and simple; Sukhareva instead names Ernst Kretschmer’s concept of the schizoid type as the larger object of her observations. Hence Sukhareva’s title Die schizoiden Psychopathien im Kindesalter with its uncanny (and perhaps not coincidental) foreshadowing of Asperger’s Die “Autistischen Psychopathen” im Kindesalter: both announce their objects to be special, namely childhood cases of the general phenomena of the schizoid or of autism. Kretschmer’s schizoid, moreover, happens to be an explicit equivalent of Bleuler’s autism: of what he himself terms the schizoid, Kretschmer casually remarks: “Autismus nennt es Bleuler.”34 Sukhareva’s paper was noticed and discussed in the literature of the time; it is highly probable that Kanner and Asperger read it.

Going back beyond Sukhareva, we can look to both Kretschmer and Bleuler themselves for highly probable, if not satisfactorily provable observations of the phenomena later discerned by Kanner and Asperger. Already in 1911, Bleuler speaks familiarly of a none-too-rare “character anomaly” found specifically in children: a “Neigung zu Zurückgezogenheit, verbunden mit einem höheren oder geringeren Grade von Reizbarkeit, so daß die Kinder schon sehr frühe auffielen, weil sie nicht mit den anderen spielten und dafür ihre besondere Wege gingen.” Bleuler’s name for these unusual behaviors?—“autistische[ ] Charakterabnormitäten.”35 (Kretschmer’s equivalent is discussed in Chapter Two [of The Turn to The Self: A History of Autism, 1910–1944].)

But is there not still a clear moment—in Sukhareva or Asperger or Kanner—when the specific and peculiar symptom-groups of modern autism make their first appearance? Here too, the facts are more ambiguous than we imagine. The clinical presentation of Asperger’s or Kanner’s autism is notable for highly distinctive characteristic behaviors—rocking or spinning, a “distant” gaze, a “singsong” voice, restlessness, patterns of “naughty” or destructive acts with particular qualities—of suddenness, of sureness contrasting with a more habitual motoric ineptitude—and particular favored objects. These had to be meticulously observed, notated, collected, and finally interpreted as signs of a specifically autistic disturbance in order for the picture of modern autism to appear. And yet, as we will see in Chapter Four [of The Turn to The Self: A History of Autism, 1910–1944], very many of these characteristic behaviors were already described, even in phrasings that are more or less copied by Asperger and Kanner, in the context of syndromes that have little to do with autism as we know it: postencephalitic Parkinsonism, say, or tuberous sclerosis. These other syndromes were even interpreted as “disturbances of affective contact” in the same manner as modern autism. If we look closely, then, we can watch as individual “pieces of description” (as I call them) migrate from one symptomatic constellation into another, making the emergence of one or more autistic syndromes seem like a more gradual and more contingent process than ever.

A third and last factor blurring the border between premodern and modern autism is of a different kind. We can characterize the distinctiveness of modern autism in at least two ways. One is to recall that it is a syndrome, where before it had been a symptom (or, in the full light of Bleuler’s thought, not so much a symptom as an ontological or anthropological category—but still not a syndrome in the modern sense). Another is to point to the qualitative distinctions between premodern and modern autism. Premodern autism is centered on fantasy while the modern kind is defined as literal; Bleuler believed autistic thinking to be driven by affect, while we take autism to consist in an affective deficit, an inability to understand emotion. In any case, the appearance in Asperger and Kanner of a new syndrome embodying the qualities now associated with autism was long preceded by a qualitative shift within the ongoing discourse of autism that prepared the ground for those appearances. In other words, even while autism was still being talked about in a thoroughly Bleulerian context, those commenting on it were gradually, almost subconsciously, but collectively shifting their accounts of it toward the modern view, even in the absence of the modern syndrome. Chapter Two describes how the association of autism with affect slowly tipped from a positive one (in Bleuler) to a negative one (as in Asperger and especially Kanner), passing through several intermediate stages on the way. Even the “symptom-to-syndrome” change was somewhat graduated. In this case the mediating instance is the idea of the type that took hold of Germanophone psychiatry (and many other branches of science as well) precisely in the years that separate Bleuler from Asperger and Kanner. Typology sought to displace the model of disease and symptom within which Bleuler had conceived of schizophrenia and autism, and to instead see the forms of the mad or merely atypical psyche as seamlessly integrated with both individual Anlage or constitution and various environmental factors such as family or race. The metaphysics of the type in this period go a long way to explain Asperger’s presentation of the autistic as a human type, which for him is something distinct from a “syndrome” in the current sense: the type is a formal-aesthetic unity that straddles or obviates the “symptom-syndrome” dichotomy. This latter is thus an anachronism when applied to the moment of modern autism’s emergence.

Our fifth and final point is about the role of symptomatology in differentiating modern autism from the phenomena collected under previous senses of that term. And here we will propose, as counterweight, a renewed attention to what is actually indicated by the concept of autism—its ideational content.

It is not a question of whether what we call autism and what Bleuler called schizophrenia are distinct conditions—obviously, they are—but of whether the element of “autism” in both constitutes a relatedness between them. But for this purpose we need to know what autism is. For us today, autism is nothing more than the syndrome that it names, the collection of symptoms it describes. If we cannot make an autism diagnosis on the basis of symptoms, we do not speak of autism. This is because we no longer believe that autism expresses a fundamental idea, or stands for an ontological condition, which might be larger than any particular syndrome, which might indeed be a very general condition of human existence that simply exhibits itself in unusual purity in the case of certain syndromes or personality types. This is evidently what Bleuler thought: for him, autism was no less than the essence of the human condition, the inescapable human propensity to “live within oneself,” to depart from reality, to try to escape or outwit the external world by constructing a world of one’s own, an autistic interior. In schizophrenia, Bleuler saw simply an instance of the autism common to us all, but in a concentrated and more pronounced form (because, to his mind, the function of logical reasoning that ordinarily keeps our autistic thinking in check had been weakened by the schizophrenic process). But not just Bleuler: in 1977, Asperger, reflecting back on his development of the modern autistic syndrome, still speaks of “autistic symptoms” first and foremost as “a complete turn away from reality” (“autistischen Symptomen, einer völligen Abwendung von der Realität”)36—following, that is, Bleuler’s formulation to the letter. He goes on to evoke the particular symptoms observed in his patients, those of the “Asperger type,” as coming “from the interior, out of the child’s self” (“aus dem Innern, dem Selbst des Kindes”),37 as expressions of “their spontaneous interests” (“ihren spontanen Interessen”).38 (All of this is a reiteration of the thoughts set out in his original 1944 paper.) And finally he reminds us that such expressions of spontaneity, cultivated apart from the social world, are not just occasionally responsible for the greatest achievements in art and in science but that, on a much more prosaic level, “to act autistically is an entirely general human possibility” (es ist ganz allgemein eine Möglichkeit des Menschen, sich autistisch zu verhalten).39 Asperger’s theory of autism is just like Bleuler’s in that it sees autism as a general aspect, if not as the core of the human, which happens to come to the fore in particular subjects or subjective states. And it is also like Bleuler’s in that it posits a weakening of some countervailing force as the factor in these particular states that allows the underlying autism—an autism present in everyone—to appear in such striking isolation. In Bleuler, the countervailing force is logic, the loosening of which lets autistic thinking break free; in Asperger, it is the social itself, the socialization that is automatic to most of us and that prompts us to respond to social cues in predetermined, socially normative ways—that suppresses, that is, our spontaneous impulses and interests, or in other words, our autistic core. For Asperger, “autism” meant much more than just one particular collection of symptoms found in a certain clinical population—the skipping and singing, repetitive movements and stereotyped language, the violent outbursts of frustration, the carefully cultivated obsessions and precocious intellectual pursuits, the impossibility of conforming to the demands of school. Even these were for Asperger expressions of the autistic essence or of the idea of autism, the idea (Idee) that in his words “throughorganizes” (durchorganisiert) the autistic personality. This is the idea contained in the very word “autism”: the idea of the self (autos).

In this light, questions of whether autism consists in an excess of fantasy or an inability to pretend; a lack of logical coherence and a flood of affects or the opposite, a dearth of affect and an overgrowth of logical structures; even whether it is present from the beginning of life (as in modern autism) or develops processually (as in schizophrenia)—these questions fall away in importance, and we begin to see that the particular qualities attributed to autism, whether in Bleuler’s era, that of Kanner and Asperger, or our own, are always those that stand opposed to the societal norm. For Bleuler, healthy thinking was logical, sober, scientific, masculine; autism, then, was a manifestation of the “other side” of thought: fantastical, emotional, artistic, feminine. When a “normal” subject of Bleuler’s era was unexpectedly confronted with his innermost, unconscious impulses, as in a dream or an episode of momentary panic, this is what he glimpsed there: his own autism. By Kanner and Asperger’s time, things had changed: “normal” subjects were understood to be emotionally attuned to others, “affective contact” was a standard of healthy development, and logical thinking had become a more specialized trait, peculiar to absentminded professors and the like, seen as potentially harmful in excess. Thus the autistic child was cast as the one whose thinking was not affective enough, was too logical, too sterile. But the sense of the autistic as the subject apart from the rest persists unchanged. And at each epochal moment we can point to at least one highly influential account—Bleuler’s, and later Asperger’s—that sees, in this isolated autistic subject, the kernel of the human, and accordingly presents autism in terms of a general theory of subjectivity or of thinking.

So perhaps the biggest reason for a discursive history of autism is to remind us of this idea itself—the idea of the interior of the self, the thinking that happens when we are alone, alone among others, alone in the world—and how powerful an idea this has been and might still be. A list of authors well known outside of psychiatry (even if some were also psychiatrists) who made notable use of autism in their writing would at a minimum include Karl Jaspers (in his pathography of Hölderlin); Hans Prinzhorn (a doctor, but just as much an art theorist, the father of our notion of “outsider art”); Jean Piaget, whose account of the normal autism of childhood is later picked up by Claude Lévi-Strauss and forms part of the basis for the latter’s “savage mind”; the literary critic and historian Herbert Cysarz (also in reference to Hölderlin); the philosopher Emil Utitz; and Hans Sedlmayr, one of the greatest art historians of the age and Asperger’s colleague at the University of Vienna, who developed ideas of an autistic style in Renaissance art that run in often uncanny parallel to Asperger’s thoughts on the autistic as a style of person. Even after Kanner and Asperger had deployed the term in their own senses, autism continued to be used in more general contexts and with philosophical resonance: by the political theorist Carl Schmitt, for example (in Politische Theologie II, 1970), and by the literary theorist Jacques Derrida (in “The Ends of Man,” included in Margins of Philosophy, 1982).

In lieu of a systematic summary of the discourse of autism, which would take up considerable space, we will let one of its representatives speak to its extent and intensity:

Autismus—zuerst eine Art Schimpf—ward daher zu einem seltsam verführerischen Wort. Die Abkapselung in eine autistische Welt büßte zwar nicht ihre Schrecken ein, aber sie umwitterte eine Ambivalenz, in der das Grauenhafte mit dem Faszinierenden sich rätselhaft mengte. Bis zu heiligen Schauern—ich erinnere an Ottos berühmte Schrift über das Heilige40—konnte diese Zerspaltenheit sich verdichten. Es ist fast selbstverständlich, daß die geistige Erkrankung—in der Autismus seine höchste Steigerung gewinnt—eben die Schizophrenie geradezu modern wurde …. Das betont Antinaturalistische des Schizophrenen, die Opferung der erfahrungsmäßigen Wirklichkeit zugunsten der Selbstherrlichkeit und Willkür des Ich, schafft bisweilen seinen Gestaltungen eine fast unheimliche Verwandtschaft mit der Kunst des Expressionismus. Wie realistische Dichtung den differenzierten Schleichwegen und schillernd abgetönten Nuancen psychopathischer Persönlichkeiten nachspürte, so wird jetzt die gefährliche Beziehung zur Schizophrenie aufgerollt. Wie in einer furchtbar drohenden Grimasse erblickt unsere Zeit ihr Zerrbild im Schizophrenen. Eine sehr intelligente Kranke … klagt immer wieder, daß sie sich heraussehne aus der unwirklichen Traumwelt in die frühere Wirklichkeit; in die Welt des Gemüts und der dampfenden Kaffeetassen, wie sie einmal sich ausdrückt. Trotzdem wertet sie ihre Phantasiewelt höher ein: “das geistige Leben ist stärker als das erlebte Leben, das Reich der Idee stärker als das wirkliche Leben.41

The year was 1927 and the author of these lines was Emil Utitz, a professor of philosophy equally noted for his contributions to psychology, characterology, and aesthetics. Having studied with the philosopher Christian von Ehrenfels, Utitz went on to edit the Jahrbuch der Charakterologie and hold chairs at the universities of Rostock and Halle and the German university in Prague. Later he was director of the official library of the Theresienstadt ghetto (and lived to see its liberation). Though writing from a perspective critical of “expressionism”— which he casts as synonymous with autism—Utitz testifies to the fact that autism, at this time, was reflexively understood to stand for arguably the highest problem of the age: the relation of the private self (or the “spiritual life”) to the public world (“real life”), a problem posed with equal urgency from the standpoints of aesthetics, spirituality, science, and politics.