Leo Kanner (1943) I
Bill Long 11/30/07
The First Clinical Description of Autism
Pride of place in all the autism literature for the first description and analysis of what we today call autism is Kanner's study of 11 young people, compiled over five years and published as "Autistic Disturbances in Affective Contact." This 1943 article, from the periodical Nervous Child, has been republished several times, most accessibly in Anne E. Donnellan (ed.), Classic Readings in Autism (1985), 11-49. Interestingly enough, the foreward to the book is written by Pete Rozelle, the then-Commissioner of the National Football League. Why? Because the NFL Charities had taken an early interest in autism, and had, since 1981, set up research collections in autism in home cities of NFL teams. It made me wonder what is happening with those collections now....
The purpose of this and the next two essays is to introduce you to Kanner's article. I was immediately struck by two things as I read it. First is the freshness, vigor and clinical clarity of its observations. Kanner describes each of his 11 subjects with care and precision, quoting voluminously from statements prepared by parents or other therapists, with great attention to family-of-origin as well as manifestations of the child's condition. From all the diversity of symptoms represented by the 11 children, Kanner's contribution was to isolate what he thought was an irreducible core to what we now know as autism. He will identify this with a child's
"inability to relate themselves in the ordinary way to people and situations from the beginning of life," p. 41 (italics in original).
I will have much to say about this and other things below.
The second observation from reading Kanner is that even though he is the first to describe autism in a clinical context, he wasn't the first to use the term autism. In fact, his choice to use the term may inadvertently have contributed to the lack of clarity in autism literature until the 1970s on the subject of whether autism was primarily of biological/organic origin or was psychogenic (having a psychological as opposed to physical cause). In order for me to make this case, however, I need to show first how the term autism emerged in psychology. It came out of the work of the famous Swiss psychiatrist Eugen Bleuler.
Eugen Bleuler (1857-1939)---Quickly
Bleuler, one of whose claims to fame was to be director of the Burgholzli hospital in Zurich and to employ Carl Jung as an intern, is chiefly known today for his pioneering studies in schizophrenia. In fact, he coined three terms in 1910-1911 which are still part of the bread-and-butter of psychology: schizophrenia, ambivalence and autism. His interest in using the word autism, however, was not to describe people with autism but to come up with a rich description of schizophrenia. That is, the word autism emerged in order to help him describe something else.
Bleuler coined the term schizophrenia to describe more accurately a condition that had been known for a few decades as dementia praecox--literally "early" or "childhood" dementia. He noted that the conditions which he would later describe as schizophrenic did not just occur in childhood; indeed, the onset of it was often not until much later in life.
The German mind at the time was heavily influenced by the philosophical systems of Kant and Hegel, the practical manifestation of which was a search for "essences" of phenomena that were studied. That is, when a new word or pheonomenon such as schizophrenia was to be described, a German-educated psychiatrist would ask about what constituted the essence or defining inner core of something. For schizophrenia it was autism. But what does he mean by autism? Here is his first use of the term--note its connection with schizophrenia:
"The [...] schizophrenics who have no more contact with the outside world live in a world of their own. They have encased themselves with their desires and wishes [...]; they have cut themselves off as much as possible from any contact with the external world. This detachment from reality with the relative and absolute predominance of the inner life, we term autism," (quoted in "Schizophrenic autism: clinical phenomenology and pathogenic implications," World Psychiatry, 1(3)(Oct. 2002), 131-136. Bleuler's original study was published as "Dementia Praecox oder Gruppe der Schizophrenien," in Anschaffenburg, G., ed., Handbuch der Psychiatrie (1911)).
The "essence" of schizophrenia, or, in psychological terms, the pathognomonic (i.e., distinctively identifying feature) of the condition was the detachment from reality. Later he would characterize this detachment from reality as a "withdrawal to fantasy life." The "shorthand" for this distinctive or pathognomonic feature was called "autism." Autism, in a word for Bleuler, was a "withdrawal."
Even before Kanner began his studies, Bleuler was introduced to a French audience by Eugene Minkowski in his book La Schizphrenie (1927), which has been called the "best clinical text on schizophrenia ever written." Searching for essences himself, but influenced primarily by the regnant Bergsonian philosophy of the time, Minkowski spoke of autism not so much as a "withdrawal to fantasy" but as an expression of lack of "vital contact with reality." Minkowski went on to describe this "vital contact" as an ability to "resonate with the world" or to empathize with others. This is the "phenomenal core" that exists through all the varied symptoms of schizophrenia.
Thus, when Kanner came on the scene to do his study in the late 1930s-early 1940s, he did not come to vocabulary "fresh." The word "autism" had already been used for nearly three decades in European psychiatry. The next essay will show how Kanner interpreted the concept.