In the last couple of years, the autism world has witnessed a very intense debate regarding the historical origins of the neurotype we study.  Traditionally, Hans Asperger – one of the first people if not the first to use the term autism in its modern diagnostic sense,¹ and the man after whom “Asperger syndrome” was named – was thought to be an essentially benevolent figure within the murderous Nazi state, which had embarked on a policy aimed at slaughtering disabled individuals who were thought to have no social utility to the German people.  In this traditional narrative, Asperger worked to protect children under his care and convince others of their worth, despite the threat of persecution by the Gestapo.

This view is contested by Edith Sheffer and Herwig Czech in the former’s book and the latter’s article in Molecular Autism.  Drawing on a great deal of new source material, these authors paint a complex picture of Asperger as someone who was not as steeped in Nazism as many of his wartime colleagues, but who was nevertheless still influenced by the prevailing ideas of his time (gender stereotypes, class-based discrimination, the merits of institutionalization over living with family, etc.) and who was not entirely innocent of involvement in the killing of children with disabilities.  However, Dean Falk rejects these authors’ conclusions, suggesting that Asperger was working and lobbying for the protection of children with disabilities to the maximum extent that he could given the climate in which he found himself.  Czech criticized Falk’s work in very strong terms, but Falk maintains her position.

I have no intention of addressing that debate here.  Apart from the handful of relevant articles and quotes that have been translated into English, I’m entirely unfamiliar with the source materials, which hardly puts me in a good position to weigh in.  Besides, there are bigger issues here besides Asperger’s personal role in genocide, or lack thereof.  Personally, I agree with the argument that autistic people should feel free to continue identifying with Asperger syndrome if they like that term, or they can choose not to identify as Aspies if they don’t want to; they shouldn’t have to allow Asperger’s actions and views – be they good or bad – to define their identities.

However, I do think that the vivid and disturbing picture of the Nazi psychiatric establishment painted by Sheffer and Czech may have implications for how we view autism and disability today, and that’s what I’ll be focusing on for the remainder of this post.  This is something I’m embarking on with some hesitation.  I want to bridge gaps between different communities and stakeholder groups, as I think we have much we can learn from one another, and in the internet, we know that bringing up the Nazis invariably doesn’t contribute to intelligent and rational debate.  The last thing I want to do here is give the impression I think people who disagree with my personal opinions on autism and neurodiversity are like Nazis.  Please don’t misquote me by suggesting otherwise!

The reason I’m proceeding to discuss this anyway, despite the risk of wading into controversial waters, is that I don’t feel it would be appropriate to ignore the Nazi psychiatric establishment and any implications it might have for us today just because Nazism is a heavy topic.  On the contrary, the horrific crimes perpetrated by the Nazis and other totalitarian, personality cult-based dictatorships are the exact reason why so many of us have passionately and appropriately anti-Nazi views, and those very crimes seem to me like excellent reasons why we shouldn’t be ignoring the Nazi era and its relevance to our society today.

The Power and Biases of Professionals

In the West, much of the twentieth century was an age of “institutional psychiatry,” to use a term employed by Thomas Szasz.  Psychiatrists gathered for themselves vast and extraordinary powers – most notably, the power to forcibly detain individuals without due process, even if they have done nothing wrong, for the alleged good of themselves and/or the society from which they were removed.  (This could be readily abused for political purposes, as in the former USSR where political dissidents might face psychiatric institutionalization, though of course the vast majority of the victims of institutional psychiatry were people with disabilities themselves.)  Furthermore, the treatment of these psychiatric detainees was often far harsher than the treatment of convicted criminals – one only needs to look at, for example, Geraldo Rivera’s documentary footage of the chilling reality of the Willowbrook institution to see how atrocious these conditions could become.

Sadly, while one would like to think that the era of institutional psychiatry is over, at least in the advanced Western economies, the reality is far more complicated.  For one thing, there are still patients in institutions today who were never moved out in the deinstitutionalization era.  For another, the danger of going back to the institutional psychiatry era is real – for example, I was recently alarmed to see that the mayor of a city not far from the one I grew up in is advocating for involuntary institutionalization as a solution to the problem of homelessness among the neurodivergent and mentally ill.  While homelessness is surely a complex problem, I am concerned about the slippery slope of moving back towards the old extrajudicial imprisonment system of institutional psychiatry.²

In any case, under the Nazi state, psychiatry accumulated for itself even greater powers than those it wielded throughout the rest of the era of institutional psychiatry.  In the short period of what might be called genocidal psychiatry in Nazi Germany, psychiatrists’ decisions were not only the difference between freedom and institutionalization in atrocious facilities or even concentration camps, but often the difference between life and death.  This expansion of psychiatric powers was meant to serve the interests of the German people as a whole.  Nazi ideology defined people with disabilities as “useless eaters” who could not be of service to their romanticist, counter-Enlightenment, ethno-nationalist notion of a Germanic “Aryan” nation-state community.

The Nazi psychiatric system – and, for that matter, the institutional psychiatric system prevailing in the rest of the world at the time – was horrific.  I see little need to go into detail about the appalling manner in which people were abused, maltreated, and in many cases killed.  Suffice to say that, far from behaving like enlightened humanists pursuing the best interests of society and individuals, many people working in the psychiatric and special education systems in the Nazi era showed themselves to be indifferent to the children in their care, or even to be outright sadistic.  I suppose it reflects the basic findings of the infamous Stanford prison experiments: when individuals are placed into a system of power inequality, with themselves in charge, and encouraged to be violent and abusive, they can be violent and abusive.

Now, obviously things today are much improved.  I would also add that I do believe the vast majority of researchers and professionals in disability fields are genuinely motivated by a desire to support people with disabilities.  However, certain inequalities of power remain, and there are many ways in which researchers and professionals may not always consider the negative impacts of their actions on disabled populations: not out of malice, but a failure to take the perspective of those less powerful than themselves.  As evidence of this, I think we need look no farther than the language we use to describe these disabilities: disorders, deficits, and the like.  In my view, we are far too comfortable with explicit judgements that people with disabilities are less than neurotypicals.³  Researchers and professionals come from a particular vantage point that is not the same as the vantage point of neurodivergent individuals themselves, who I think do not have enough power to influence our current system.

Ableism

Another intriguing aspect of the Nazi psychiatric system discussed by Czech and Sheffer was its division of people with disabilities into two groups: those who could be of use to the German people and those who could not.  They imply that Asperger was chiefly interested in the welfare of the former group.  Whether or not this was the case, Sheffer and Czech also argue that this division was fairly typical of Nazi psychiatrists – in Nazi eyes, some individuals could be educated and made part of the national community, but others were useless and therefore unworthy of further life.

This is clearly a debate with contemporary relevance, as one of the major political conflicts in the autism world revolves around the question of whether all autistic people should be treated alike, or whether separate groups of so-called “high-functioning” and “low-functioning” individuals should be treated differently.⁴  (Of course, the debate has changed in some very fundamental ways – the Nazis were envisioning that relatively able individuals should be cured and those less able killed, whereas today someone might envision that relatively able individuals should be accepted and those less able cured.)

The dominant opinion in the neurodiversity movement today appears to be that the neurodiversity approach should be applied across the whole constellation of autism itself.⁵ However, there is nothing that necessarily forced mainstream neurodiversity advocates to adopt this position.  Indeed, there are a number of individuals – some of whom I know – who have expressed a much different opinion – namely, that “high-functioning” individuals, particularly those with “Asperger syndrome,” are not less able than neurotypical individuals in any fundamental sense, and that many of their difficulties are constructed by a society that is inaccessible and that discriminates against them, and that therefore society should reform, make itself accessible, and treat them – but not other autistics – as equal members of the community.  I think it is likely true that many autistics can contribute as much or more “productive labour” as a neurotypical individual, if their abilities are accepted and valued, though this isn’t what I would like the neurodiversity approach to be about.⁶

When Judy Singer first introduced the neurodiversity idea, it suggested that a diversity of brain types might prove valuable to society.  Since then, advocates have been free to interpret Singer’s idea of neurodiversity as they see fit.  In many ways, it would have been natural for more verbally-fluent advocates with higher IQ scores to take this idea and argue narrowly that they – and not other autistics – should be accepted because they are not less able than a neurotypical in any fundamental sense.  They could still contribute to society, if they are allowed to.  As noted earlier, this has indeed been an opinion expressed by some advocates, but my sense is that it is not the dominant view.

This is particularly surprising given the strategies adopted by other historical movements for the rights of marginalized or disenfranchised groups.  For example, women and various ethnic groups have historically been portrayed as and treated as biologically inferior and disabled: hysterical and irrational, primitive and stupid.  A major part of the movement to promote equality between these groups and men from dominant ethnic groups has the rejection of these ideas of biological inferiority, and recognition that the marginalization of these groups reflects societal discrimination.  Similarly, LGBTQIA people have historically been portrayed as deviant and pathological.  Finally, though Deaf people have likewise traditionally been seen as inferior and disabled, the Deaf community has argued that Deafness is not in fact a disability: from this point of view, the fact that most hearing people do not know sign languages is what really prevents the social inclusion of the Deaf.

These examples suggest that an argument for acceptance and full inclusion of only a narrower group of autistic people with higher IQ scores could work.  Perhaps it would be less controversial, and therefore more successful.  But to me, the more ambitious goal of accepting people even when they are less able to contribute “productive labour” to society, seems like a better goal.  Why should someone’s ability or their labour define their worth?  Should we not always strive to do what is best for people’s well-being, regardless of the monetary value of their labour?

This is, I think, an excellent reason to argue that the neurodiversity paradigm should include people with more obvious disabilities.  I don’t see any reason to believe that we should accept some people and not others because we think some people are more useful.  On the contrary, I think we should accept people when it is helpful to them and enhances their well-being to do so.

I’ve argued elsewhere that some of the people with more obvious disabilities – low IQ scores, lack of expressive language, and so forth – might actually benefit most from a neurodiversity approach, insofar as many of the most important supports for these people – like augmentative and alternative communication, or community living and residential supports – are fundamentally based on modifying the environment around the individual to suit their needs, not on curing the individual.  Whether or not the people providing the supports realize it, these supports reflect an interactionist or even social model of disability, not a medical model.

Also, it’s important to remember that many neurodiversity advocates – probably most – think that disability is caused by a mixture of the environment and the individual’s own characteristics, not the environment alone.  Thus, we’re not usually opposed to teaching people useful adaptive skills.

Fascism, Conformity, and Autism

Finally, one last thing that struck me reading Sheffer’s book was the focus on Gemüt, meaning soul or disposition.  According to Sheffer, the Nazis placed great emphasis on this concept because of the nature of Nazism as a fascist ideology.⁷ Fascism is about a strong collective identity: the subordination of the individual to the nation, as well as a cultish, faith-based devotion to a supreme dictator.  In Nazi psychiatry, an individual lacking Gemüt might be unable to form these collective bonds, which could be a threat to the Nazi agenda.

This reminded me of an observation by Damian Milton: Milton suggests that autism is “nature’s answer to over-conformity.”  The idea that autistic people may be less interested in social conformity is supported by research studies, such as Chevallier et al. (2014) or Large et al. (2019).  People with more autistic traits also show less bias to favour ingroup members and discriminate against outgroup members (Bertschy et al., 2019), and while most people seem inclined to ignore rule-breaking by one’s own country in sports, autistic individuals show no such favouritism to the nation (Paz et al., 2019).  In short, autistic individuals may be in some sense resistant to fascist and totalitarian suppression of individuality, to subordination of individuals to collectives, and to discrimination by ingroups against outgroups.  To me, these would appear to be invaluable qualities in many circumstances, although the authors of some of these studies seem to disagree and view them as deficits.  To be fair, perhaps the authors are right and they do reflect deficits in “empathy” or social categorization,⁸ but this to me suggests a couple of things: firstly, that “empathy” must severely over-rated when it comes to morality if it actually makes you act immorally by favouring your group above others, and secondly, that perhaps recognition of ways in which these traits can reflect weaknesses should not drown out their positive aspects.  We don’t have to ignore the negative side, but we shouldn’t focus exclusively on it.  A solely negative focus might just reflect the biases and power inequalities we discussed before.

1. Of course, there are earlier descriptions of what seem to be autistic individuals that don’t use the same terminology.
2. I want to be clear that I’m not criticizing contemporary efforts to offer some kind of institutional setting as a voluntary living option for individuals with disabilities, rather than one imposed on people without their consent or the consent of their family.  I suppose there may be an ethical danger involved in giving families the power to simply hand minor children or individuals under guardianship to institutions – in the institutional era, some families voluntarily sent their children to atrocious psychiatric hospitals, and in the Nazi period, some families seem to have voluntarily accepted the murder of their children (e.g., see Sheffer, 2018, pp. 201-206).  However, I understand and am not unsympathetic to arguments supporting institutional “intermediate care facilities” made by groups like the controversial National Council on Severe Autism, as I do realize that different individuals have different needs, and for all I know it may indeed be true that an institutional setting is necessary for some individuals.  I’m also aware that smaller group homes don’t necessarily always work better than big institutions – for example, see this story.  Obviously I’d be more comfortable if individuals could make a supported decision to choose their own residential placement, but if they don’t have the capacity to communicate such a preference, then I suppose we would just need a very robust system to ensure that individuals in these settings are well supported and not subjected to abuse and neglect.
3. This is not, of course, to deny the reality of disability and that many people do face very genuine barriers that in some cases may be rooted quite deeply within their own neurology. But there are also ways that neurotypical behaviour and actions can contribute to disability, making the notion of internal deficit problematic. I’ve written more extensively about these complex issues in posts like this and this, and I don’t have time to repeat myself here.
4. Of course, these functioning terms are widely viewed as offensive and unhelpful by many, including myself – I’m just noting the argument that has been made here.
5. Though not necessarily to co-occurring conditions, which leaves some considerable scope for the medical model.
6. Of course, I don’t mean to suggest that autistic people with intellectual disabilities, or non-speaking or minimally-verbal autistic people, are incapable of contributing to society!  On the contrary, I strongly believe in the importance of opening up community employment to people with intellectual disabilities without any appalling, discriminatory subminimum wage laws.  I also know minimally-verbal individuals who have jobs.  And there are other social contributions besides productive labour, of course. All that being said, somebody who embraces the ableist idea that ability should be a basis of value probably could still argue that those with higher IQs and less obvious disabilities are in some sense more able, relatively speaking, than those with lower measured IQs and more obvious disabilities. And there are, of course, some autistic people whose disabilities are so great that they are genuinely unlikely to ever “contribute” to society in the sense we are talking about here. Just because some minimally-verbal individuals can have jobs does not mean all can; there is considerable diversity here.
7. Czech criticizes Sheffer a little here, suggesting she inappropriately exaggerated the importance of these ideas of Gemüt and collective feeling as though they were the dominant concern of Nazi psychiatry, when Czech suggests they were just one of the various personality traits studied by Nazi psychiatrists.  But both seem to agree that Gemüt had some relevance.
8. Another idea mentioned is a lack of social motivation.  I find this idea more problematic, given the extent to which many autistic people want social interaction – ironically, what may be stopping them from getting it is a lack of motivation from neurotypicals to engage socially with autistics.  The social motivation account is particularly unconvincing when it is thought of as a core theory of what autism is, since it does nothing to explain non-social features of autism like sensory differences.  Of course it is true that autistic people often attend less to social information than neurotypicals in early development, but it seems to me that this is could reflect a general difference in attentional processing rather than a specifically social mechanism, and even if it is primarily a difference in social orienting there’s a big gap between this and social motivation.  I also think it’s problematic to study social motivation in adolescents or other older individuals as their lack of social enthusiasm might partly reflect negative social experiences and the development of social anxieties, rather than a fundamental lack of social interest per se.