De-Nazifying the “DSM”

Four nearly four decades now, the Diagnostic and Statistical Manual of the American Psychiatric Association, or DSM for short, has exercised a stranglehold of sorts over the mental health sector in the United States, and indeed around the world.

As the fifth edition of the DSM neared completion in 2012, critics railed against yet another prospective deletion from the psychiatric pantheon. When the new edition of the DSM appeared in May 2013, Asperger’s syndrome had indeed been cast on the historical scrap heap, swallowed up in the much larger, more amorphous category of autism spectrum disorders…. It is [Asperger’s] history that the Stanford historian Edith Sheffer has now uncovered in her fascinating and disturbing new book published earlier this year, Asperger’s Children: The Origins of Autism in Nazi Vienna.

Rumors have circulated for some time that Hans Asperger was a Nazi collaborator who sent autistic children to their deaths. Two recent books on autism, John Donvan and Caren Zucker’s In a Different Key (2016) and Steve Silberman’s NeuroTribes (2015), advanced radically discordant views on the subject, the former denouncing Asperger as an opportunist who was complicit in the murder of disturbed children, and the latter arguing that he was a compassionate clinician who under extraordinarily difficult and perilous conditions tried his best to save such children.

Asperger was a conservative Catholic. From the earliest stages of his career, he was associated with and sponsored by extreme right-wing elements. Franz Hamburger, for example, who appointed the 25-year-old Asperger to his first post at the University of Vienna’s Children’s Hospital, employed a strict ideological test for all appointments at the institution he ran. He purged liberal and Jewish faculty appointed before he took charge, and most of his own appointees went on to be major Nazi enthusiasts and proponents of the euthanasia of children deemed mentally ill.

Another of his other protégés, Erwin Jekelius, a close associate of Asperger’s over the years, would become the leading figure in the extermination of the mentally ill, adult and child alike. Asperger idolized Hamburger, continuing to praise him in extravagant terms as late as 1977.

Asperger had a long-standing commitment to far-right politics. As Jews were systematically purged from academic positions and from medicine, he seized opportunities to advance professionally, and after the Anschluss when violence against Jews became yet more extreme, he swore an oath to Adolf Hitler, and registered his Aryan bloodline. In the years that followed, he became a compliant and willing partner in the macabre version of psychiatry that flourished under the Nazis.

Steve Silberman, who has been one of Asperger’s primary defenders, acknowledged that Asperger had sent a single patient, Herta Schreiber, to her death in the wards of Am Spiegelgrund, the children’s wing of Steinhof, the huge mental hospital that had been constructed above Vienna in the early 20th century.…Silberman excused that action by arguing that brutal regimes like the Third Reich can compel even well-intentioned people to do monstrous things…Sheffer is able to document not one but dozens of such cases. She reminds us that in 1941, Asperger co-founded an organization that went under the Orwellian name of the Vienna Society for Curative Education (Wiener heilpaedagogischen Gesellschaft) with his one-time lieutenant, the ardent Nazi, Jekelius — a man once engaged to Hitler’s sister Paula, and by this time a notorious mass murderer, having sent 4,000 adult patients and more than a hundred children to their deaths.

In 1942, Asperger was a member of a seven-person commission for the city of Vienna that collectively examined children who had fallen into the “care” net. Sheffer cites the Austrian scholar Herwig Czech who discovered that, in a single day, these men examined the files of 210 children at the Gugging care facility, determining that nine girls and 26 boys were “incapable of educational and developmental engagement.” All were sent to Am Spiegelgrund, their files stamped “dispatched for Jekelius Action.” “Jekelius Action” was a euphemism for death. Asperger referred children to Am Spiegelgrund in his other capacities as well, and many of these referrals survive as well. Though not himself administering euthanasia, he was without any doubt “trusted in the highest echelons of the killing system” and, if not as active as some of his colleagues, “he was in the club.”

And Asperger? He was cleared of all wrongdoing, and because he had never joined the Nazi party, he benefited once again from a professional vacuum, in this case created by the mild measures of de-Nazification. Between 1946 and 1949, he served as interim director of the University of Vienna Children’s Hospital, and for decades afterward denounced the Nazis’ child euthanasia policies, which he claimed to have resisted at some considerable personal risk.

(Andrew Scull, “De-Nazifying the “DSM”: On “Asperger’s Children: The Origins of Autism in Nazi Vienna,” Los Angeles Review of Books, 12/11/18).