Leo Kanner III
Bill Long 11/30/07
Finally, His 1943 Article
Kanner recognized, at the outset of his article, entitled "Autistic Disturbances of Affective Contact," that he had a tall task before him:
"Since 1938, there have come to our attention a number of children whose condition differs so markedly and uniquely from anything reported so far, that each case merits ...a detailed consideration of its fascinating peculiarities," p. 11.
Already we can see the vigorous style and inquisitive bent of Kanner. Rather than focusing on theory, which Germans and Austrians are wont to do, he wanted to get to the facts themselves. What confronted him was a bewildering mass of different symptoms. His significant contribution was to distill, out of the variety of symptoms presented by the 11 children in his study, some characteristic features of what we now know as autism.
His article simply recounts 11 different cases studies and then discusses them. Of special interest is Kanner's thick descriptions of the family of origin of many of his subjects. For example, "Donald T's" father "is a successful, meticulous, hard-working lawyer who has had two 'breakdowns' under strain of work. He always took every ailment seriously, taking to his bed and following doctors' orders punctiliously even for the slightest cold," (p. 13). What Kanner choses to note about the father becomes even more interesting:
"When he walks down the street, he is so absorbed in thinking that he sees nothing and nobody and cannot remember anything about the walk," Ibid.
Hm...Kanner's suggestive description already trigger issues that would make subsequent reseachers ask lots of questions-- especially about the "heritability" of autism.
Then, in the description of "Richard M" (Case 3), Kanner quotes from the mother's notes:
"I can't be sure just when he stopped the imitation of word sounds. It seems that he has gone backward mentally gradually for the last two years. We have thought it was because he did not disclose what was in his head, that it was there all right. Now that he is making so many sounds, it is disconcerting because it is now evident that he can't talk...He gave the impression of silent wisdom," Ibid., p. 21.
One of the most important issues in autism research in 2007 is the apparently "regressive" character of it in many (perhaps up to 25-30%) cases. We still don't have a good explanation for it, even though the Omnibus Autism Litigation in Washington DC is trying to convince a three-judge panel that it is more likely than not that the presence of thimerosal in childhood vaccines was responsible for some children's regressive autism. The "silent wisdom" of which the mother spoke is not to be confused with a characteristic of what Hans Asperger identified in 1944 as his "little professors." They, in contrast to Richard M. were very verbal, and even obsessively so, on minute areas of human life.
Space does not permit, nor does it require, a presentation of the characteristics of each of the 11 children (8 boys, 3 girls). Case studies are such that you simply have to read them to digest whatever you can from them. But Kanner's study concludes with an attempt to distill from the 11 diverse cases a common core or common features of what he calls these "Autistic Disturbances." His "breakthrough" sentence is this:
"These characteristics (i.e., common to the children) form a unique 'syndrome,' not heretofore reported, which seems to be rare enough, yet is probably more frequent than is indicated by the paucity of observed cases," p. 41.
What are these characteristics? Well, the "outstanding 'pathognomonic,' fundamental disoder is the children's inability to relate themselves in the ordinary way to people and situations from the beginning of life." He goes on:
"Their parents referred to them as having always been 'self-sufficient'; 'like in a shell'; 'happiest when left alone'; 'acting as if people weren't there'; 'perfectly oblivious to everything about him'," p. 41.
But there is more. There is from the start "an extreme autistic aloneness" that shuts out anything that comes to the child from the outside. Children, almost universally, reach out to touch and connect with parents as early as 4 months of age. It is therefore, in these cases,
"highly significant that almost all mothers of our patients recalled their astonishment at the children's failure to assume at any time an anticipatory posture preparatory to being picked up," Ibid.
He then noted some other features, which didn't seem to be quite as prominent. Language, though acquired by eight of the 11, isn't used "to convey meaning to others." Even though several of the students had learned to memorize nursery rhymes, lists of animals or, in one case, the first 25 questions and answers to the Presbyterian Catechism (Shorter Catechism, I presume), language consisted primarily as a "naming" and not a "meaning" tool. In addition, he noted the delayed echolalia (p. 43) of many. Then, in a feature noted in many subsequent studies, "Personal pronouns are repeated just as heard," i.e., there is no ability to differentiate the people to whom the pronouns point. When the children echo things they hear, they don't "attend" to what is being said. In fact:
"There is an all-powerful need for being left undisturbed. Everything that is brought to the child from the outside, everything that changes his external or even internal environment, represents a dreaded intrusion," p. 44.
More could be said about Kanner but, as you no doubt see, he not only is an engaging writer, but he has, as it were, come upon a vast and new phenomenon and describes it with the wonder of the discoverer as well as the discipline of the clinician. As with every first attempt or description, however, it is only a starting point in research.
His two closing paragraphs show how his research could have been taken in two completely opposite directions. First, he notices something striking:
"In the whole group, there are very few really warmhearted fathers and mothers. For the most part, the parents, grandparents, and collaterals are persons strongly preoccupied with abstractions of a scientific, literary, or artistic nature, and limited in genuine interest in people. Even some of the happiest marriages are rather cold and formal affairs," p. 50.
Can't you see this as ammunition for those psychologists and psychiatrists in the "Bleuler tradition," to try to mine the human relations dynamics of the child with autism? Do we have here the 'origin' of the 'refrigerator mother'? Then, he closes with the following:
"We must, then, assume that these children have come into the world with innate inability to form the usual, biologically provided affective contact with people, just as other children come into the world with innate physical or intellectual handicaps," Ibid.
Ah, can't you see behind this paragraph the later attempts to find biological or organic explanations (and possibly cures) for autism? We see, by a careful consideration of Leo Kanner in his historical context that some of the biggest battles that the autism would fight over the next 65 years were already presaged in his article and his choice of the word "autism." Let's see, now, how that tends to 'play out' in the following essays.