Bodily, psychological and historic wounds
Life in Am Spiegelgrund was harsh. The children were physically punished, for example by being forced to do push-ups for not having cut their nails or made their bed properly. The nurses could withhold meals. Survivors have reported that they were constantly hungry, and if they vomited, they were forced to eat their vomit. The children were set against each other, so there was no real solidarity between them. For example, bedwetters were lined up in front of the entire dormitory. For those who survived, their stay left them highly traumatised.
Many parents wrote letters in despair (and in vain) to the doctors, pleading to have their children returned to them. However, some wrote thank-you letters to the doctors after the death of their children. Some parents knew what was going on. Herta Schreiber's patient records note that the mother had tearfully said that 'if she [Herta] cannot be helped, it would be better if she died. She would not have anything in this world, she would only be ridiculed by others. As the mother of so many other children she would not want that for her, so it would be better if she died.' (2). The statement testifies to the widespread acceptance of racial hygiene and eugenics in the population, in addition to the lack of institutional places and help for children such as Herta under the Nazi regime (2). Parents of children with functional impairments were not unaffected by the culture and society of which they were part. Herta's mother was afraid that her daughter would fail to fit into a society where deviations from the norm were unwanted. It reminds us that it is our shared responsibility – as a society – to defend a concept of normality that encompasses the entire spectrum of human nature.
The doctors in the child euthanasia programme claimed to be driven by compassion: 'With the cases that we had by the dozens in the institution, putting an end to this human wretchedness was an automatic thought', said Marianne Türk, who was a doctor at Am Spiegelgrund ((1), p. 201). During the court proceedings she admitted to having given children lethal injections, but could not recall how many. She was sentenced to ten years in prison and lost her right to practice medicine. In 1957, a committee of professors at the University of Vienna decided to restore her doctoral title to her.
After the war Asperger returned to the Vienna university clinic. He was allowed to keep the academic merit he had earned during the Nazi years, and in 1962 he was appointed chief medical officer at the children's clinic in Vienna (2). Senior medical officer Heinrich Gross kept the brains of more than 400 children in jars in the basement and used them for research purposes well into the 1980s.
In historiography, the historian will invariably have to choose what kind of source material to highlight, how to weigh the sources against each other, and what kind of narrative will finally emerge. Scheffer's and Czech's studies are both extremely thorough, but differ in fundamental respects. Scheffer's book has a momentum that makes it hard to put down. Despite certain repetitions, it is well written. I nevertheless feel that there is an underlying current of anger in her writing, and I occasionally feel that the picture she draws of Asperger is somewhat monotonous. The fact that Scheffer herself is the mother of a child who has suffered because of the categorising effect of diagnoses is an item of information that I would have liked to see in the preface, not in the final acknowledgements. This does not diminish the credibility of the book, although it makes her engagement more understandable. I feel, though, that Czech presents a story which is more nuanced and more honest regarding what we can or cannot tell based on the sources. Although he concludes that Asperger obviously knew that children were put to death, and that he could have prevented many of them from being sent to Am Spiegelgrund, Czech also makes it clear that Asperger also helped save a number of children. Space is provided for a more complex picture of the Austrian doctor.
Scheffer argues that the story of Asperger, Nazism and the children indicates that we ought to be critical of the diagnosis of autism spectrum disorder. The new knowledge of Asperger's relationship with Nazism should be added to the curriculum for medical and psychology degrees, and the eponym should be used with awareness of its historical origin. The relevance of Asperger's relationship to the Nazi regime when it comes to understanding today's discussions on autism spectrum disorders, which include questions of human normality, neurodiversity, the reliability of diagnostic criteria and the stigmatising effect of diagnoses, is an altogether different matter.
Another point is that Leo Kanner's study of 11 children from 1943, in which he claimed to have identified 'a unique "syndrome", not heretofore reported', characterised by an 'extreme autistic aloneness', gained a far greater importance in English-language medicine than Asperger's study (8). In 1981, Asperger's research gained a new lease of life through an article by Lorna Wing, who proposed the term Asperger's syndrome (9). However, Wing's description of the syndrome, which differs considerably from Asperger's, was the start of the syndrome's expansion as a diagnosis. Asperger's syndrome first appeared in the diagnostic manuals in 1992 (ICD-10) and 1994 (DSM-IV), but in the DSM-V the diagnosis has been removed and collapsed into the far broader diagnosis of autism spectrum disorder. ICD-11, which is currently out on a consultation round, follows the same pattern.
The prevalence of autism spectrum disorders has increased considerably over many decades. Today, one in every 40 American children has been diagnosed with an autism spectrum disorder (10). In parallel, there has been an explosive increase in references to them in popular-science books and the media (an n-gram in Google Books and the National Library, i.e. showing how often a word occurs in publications in these databases, shows an exponential growth for the terms 'Asperger's syndrome' and 'autism spectrum' through the 1990s and 2000s).
The story of Hans Asperger, Nazism, murdered children, post-war oblivion, the birth of the diagnosis in the 1980s, the gradual expansion of the diagnostic criteria and the huge recent interest in autism spectrum disorders exemplify the historical and volatile nature of diagnoses: they are historic constructs that reflect the times and societies where they exert their effect (11). The story of Asperger and Nazism reminds us that the psychiatric notion of illness ought to be kept narrow and defended against medicalisation of ever more areas of human life. This is an endeavour that German academic psychiatry has addressed with the utmost seriousness (12), in awareness of the lessons that history has taught us of how porous the distinction is between medicine and politics, not least in authoritarian regimes.