Millions of people are identified with Asperger’s syndrome, as a diagnosis, an identity and even an adjective. Asperger’s name has permeated our culture—yet I believe we should no longer invoke it.
Naming medical diagnoses after individuals is an honor, meant to recognize those who discover conditions and to commend their work. While there is a move toward descriptive diagnostic labels in medicine, certain eponyms have entered our everyday language and will likely endure. Alzheimer’s and Parkinson’s diseases, for example.
Hans Asperger, however, neither described Asperger syndrome as we understand it today nor merits commendation. I have spent seven years researching his past in Nazi Vienna, uncovering his complicity in the Nazi regime and its “euthanasia” program that murdered children considered to be disabled. Contrary to Asperger’s reputation as a resister in the Third Reich, he approved the transfer of dozens of children to Vienna's killing center, Spiegelgrund, where they perished. He publicly spoke—and published—about the need to send the most “difficult cases” to Spiegelgrund. He was also close colleagues with top euthanasia figures in Vienna, including Erwin Jekelius, the director of Spiegelgrund, who was engaged to Hitler’s sister.
Nazi ideology shaped Asperger’s research. Children in the Third Reich were to display community spirit, being enthusiastic participants in collective activities such as the Hitler youth. In Germany in the 1930s, Nazi psychiatrists identified children whom they believed lacked social feeling, unable to join the national community. Asperger, in his early 30s, warned against classifying children, arguing that they should be regarded as individuals. But right after the Third Reich annexed Austria in 1938—and the purge of his Jewish and liberal associates from the University of Vienna—Asperger followed his senior colleagues in Nazi child psychiatry and introduced his own diagnosis of social detachment: “autistic psychopathy.”
The term psychopathy carried criminal connotations in Nazi child psychiatry, and indeed Asperger attributed “sadistic” traits to autistic children. His definition of the diagnosis grew harsher year after year, as he sought promotion to associate professor under his ardent Nazi mentor, Franz Hamburger. By 1944, while lauding the “highly original genius” of children on the “favorable” end of his autistic “range,” he said those on the “unfavorable end” would grow up to “roam the streets as ‘originals,’ grotesque and dilapidated.” He also embraced the fascist rhetoric of Nazi psychiatry, maintaining that autistic children did not fit into “the organism of the social community.” In this view, autism was the psychological opposite of Nazism.
In the postwar period, Asperger distanced himself from his Nazi-era work on autistic psychopathy. His work remained little known outside Austria until leading British psychiatrist Lorna Wing discovered Asperger’s 1944 thesis and publicized the diagnosis in 1981 as “Asperger’s syndrome.” The idea took off. In 1992, the World Health Organization included it as a distinct diagnosis in its International Classification of Diseases, Tenth Revision (ICD-10), and in 1994, the American Psychiatric Association added Asperger’s disorder to its Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Neither body, it would seem, thoroughly vetted Asperger’s life during the Third Reich before giving the diagnosis his name.
The new idea of an autism “spectrum” encompassed many different types of children. Navigating the diagnosis became complicated. In the United States, the broad category of pervasive developmental disorder (PDD) included autism, Asperger’s disorder and pervasive developmental disorder not otherwise specified (PDD-NOS). In reality, the lines between the diagnostic criteria were fuzzy. My son, for instance, was diagnosed with all three conditions by three different clinics. There was endless analysis; PDD-NOS was applied as “autism-lite,” while Asperger disorder hinged upon whether his speech was sufficiently typical.
While the diagnostic subdivisions of the autism spectrum seemed subjective, the labels had profound real-world consequences. A child diagnosed with autism typically received far more public services and school support than a child diagnosed with Asperger disorder or PDD-NOS. Children with the latter diagnoses often went without the help they needed.
Because of indistinct diagnostic criteria, the American Psychiatric Association reclassified Asperger disorder and PDD-NOS as autism spectrum disorder in 2013. Now, the World Health Organization is poised to do the same in the International Classification of Diseases. Losing the Asperger’s diagnosis has been controversial, since many identify with Asperger’s more than they do autism, or fear that the spectrum is being narrowed—that some people with needs might not meet the changed criteria for autism and thus go without support.
Personally, I agree with the reclassification of the Asperger’s diagnosis. For a psychiatric diagnosis, the subdivisions never made sense for my son, and got in the way of his care. For an eponymous diagnosis, Asperger merits neither the credit nor the the honor—and in fact, other conditions named after physicians found to have participated in Nazi extermination now go by other terms, such as Reiter Syndrome (reactive arthritis).
The fact is, autism spectrum disorder remains a vexing, heterogeneous diagnosis. Our psychiatric organizations have left us without a good vocabulary for articulating distinctions among people. In shorthand, professionals and parents may slot people as having “low-functioning,” “mid-functioning,” or “high-functioning” autism, language that can be problematic. Hopefully, as research progresses, we will develop a more appropriate vocabulary. In the meantime, we can effect a positive change by no longer invoking Asperger’s name.