Leo Kanner cultivated praise and attention, but in public he feigned indifference to the plaudits that came his way. This false modesty was on display in July 1969, long after he became famous for discovering autism, when he gave a speech to a group of parents in Washington, DC.
“I didn’t go out of my way to discover this condition,” he said, after being honored for doing just that. No, he protested, to praise him on those grounds was just “a bit exaggerated.”
“A sample of serendipity,” he called it. And then he explained how that meant being in the right place at the right time.
“I wasn’t looking for anything,” he insisted.
But then Kanner took the performance a little further than he usually did.
“I did not discover autism,” he declared. “It was there before.”
IT WAS THERE BEFORE.
In that single sentence, Kanner summed up his opinion on what remains one of the lasting questions in the field of autism: Was the collection of behaviors he described as “autistic disturbance” a phenomenon new to the mid-twentieth century, or had these behaviors always been present but simply unrecognized?
This question was unanswerable for a number of reasons. One was the fact that medical notation and archiving were rudimentary before the twentieth century. Before World War I, no database was ever compiled from systematic observation of the behavioral traits of individuals in any population of a statistically meaningful size. Indeed, until the late nineteenth century, psychiatry was barely practiced at all—to say nothing of child psychiatry—in the sense of a professional discipline embracing a scientific methodology, a shared vocabulary, and an agreed-upon body of findings rooted in research and practice. In that regard, Kanner’s generation was among the pioneers. The undocumented past offered no statistical basis for asserting that autism emerged only around the time Kanner saw it in Donald.
And yet when Kanner asserted the opposite—that autism was always there—that too seemed speculative.
Kanner, however, knew that in psychiatry, the obvious often went unrecognized until someone looked at it with the right set of eyes. As he tried to explain in his speech, he had not “discovered” autism as much as found the eyes with which to see it.
KANNER’S “DISCOVERY” OF autism was not a sudden aha moment, but a slow dawning recognition, one that took nearly four years from when he first met Donald. That recognition culminated in 1943 in a groundbreaking article starring a boy he called “Donald T.”
By the time Kanner published his article in April of that year, the number of cases he was tracking had increased to eleven. Eight of his subjects were boys, and three were girls. The title of the article was the same as the name he coined for the condition: “Autistic Disturbances of Affective Contact.” He would soon replace this term with infantile autism, which merely meant, in medical terminology, that the autism was “present in earliest childhood.”
He did not originate the terms autism or autistic. Rather, they were borrowed from the symptom list of a different condition altogether: schizophrenia. This would long be a source of confusion when autism was discussed, but it made sense from where Kanner sat at the time. By 1943, schizophrenia was a widely accepted label for a mental illness that included hallucinations, disordered thinking, and other breaks with reality. Swiss psychiatrist Eugen Bleuler had also documented a tendency among some schizophrenia patients—who were overwhelmingly adolescents or adults—to detach from interaction with their environment, and to engage exclusively with an interior reality.
Around 1910, Bleuler began using the term autistic thinking to describe this behavior. He derived it from the Greek word αυτο, which means “self.” Bleuler held that a certain amount of autistic thinking happened in every person’s life. It was the essence of dreaming, as well as children’s pretend play. But with schizophrenia, autistic thinking could become pathological. That might mean a complete cessation of social interaction and a drastic flattening of the ill person’s emotional connection to the surrounding environment and the people in it. This type of autistic thinking was rarely permanent. Like hallucinations and other symptoms of schizophrenia, episodes of Bleuler’s autism came and went.
Autism, therefore, had been a part of the psychiatric vocabulary for a generation already when Kanner announced to the world that he had been seeing “a number of children whose condition differs…markedly and uniquely from anything reported so far.” This new condition was reminiscent of the autism of schizophrenic adults, but it appeared in young children, he wrote. Moreover, it appeared to him that the condition was something that “the children have come into the world with.” The condition manifested itself early in life and came with its own “fascinating peculiarities,” such as flashes of a brilliance, a distinctive use of language, and a “basic desire for aloneness and sameness.” Essentially, this was a description of Donald, but the article added copious supporting details from the cases of the other ten girls and boys as well.
The article also explored how psychiatry had viewed these eleven children before Kanner suggested viewing them through the lens of autism. Without that lens, it was easy to focus primarily on the differences among the eleven. Some of them could speak, for example, while others could not. Their particular skill sets were not identical to Donald’s—who could sing and count and who had perfect pitch—or to one another’s. These differences had produced a range of diagnoses across the group before Kanner saw them. Several were institutionalized. Two had been labeled schizophrenic. One child had been diagnosed, wrongly, as deaf. Diagnoses handed out to the others included “idiot,” “imbecile,” and “feebleminded.” As seen in Donald’s case, his evaluators at Hopkins had entertained the possibility that he had schizophrenia or Heller’s syndrome, a rare neurological condition marked by a rapid degeneration of social and motor skills. In short, nearly all the children had been judged insane or intellectually impaired.
It was Kanner who identified the two defining traits common to all of them: the extreme preference for aloneness and the extreme need for sameness. It was this pairing of extremes, he decided, that formed the heart of the syndrome he was talking about, whose presence had previously been masked by the differences among the children.
It was there before.
In retrospect, it was an assertion supported even by Kanner’s small sample, in the sense that all eleven of the boys and girls he wrote about, regardless of their diagnoses, had autism before he recognized it. So did dozens more children, whom Kanner would diagnose in the next few years, now that he knew what he was looking for. Beginning in the 1960s, scholars discovered a small scattering of clinical descriptions in the European medical literature, going back more than a century, of children reminiscent of Donald. Unknown, of course, was how many more children would also have been given the diagnosis if their parents had the sophistication and the financial means to seek consultations with the top child psychiatrist in the United States.
Even more unknowable was the number of people born decades and centuries earlier, whose traits, in retrospect, fit Kanner’s diagnosis.
But perhaps not entirely unknowable. In the decades after Kanner “found” autism, a small group of scholars investigated whether autism had a “pre-history.” While acknowledging the speculative nature of retrospective diagnosis, the researchers turned to legends and ledger books to find compelling accounts of long-gone individuals whose odd behaviors earned them, during their lifetimes, the status of outsiders, sometimes for the better, but often for the worse. Once labeled fools, idiots, or madmen, they were reevaluated through the lens of Kanner’s description of autism. Viewed this way, their stories lent intriguing support to Kanner’s assertion that autism, as one permutation of being human, was nothing new.
HALF A MILLENNIUM AGO, a Russian shoemaker named Basil, born around 1469, was spotted walking about naked in winter, spouting incomprehensible utterances, while remaining inattentive to his own needs, even for food. The populace did not see this as madness. They thought, rather, that they were witnessing extreme holiness. The Russians called this “foolishness for Christ” and regarded Basil’s self-abnegation as a courageous, difficult, and pious path, which Basil took in order to allow Christ to speak through him. Even the tsar—Ivan the Terrible—who was known to have waiters executed for serving the wrong drink at dinner, let Basil criticize him in public. He believed Basil could read his thoughts, and he took it to heart when the wandering shoemaker scolded him for letting his mind wander in church. It was said that Basil was the only man Ivan truly feared.
In 1974, a pair of Russian-speaking scholars at the University of Michigan suggested that something other than pure foolishness or holiness might have been at work in Basil, and in a few others with similar stories. Natalia Challis and Horace Dewey dove deeply into the available accounts of Basil’s life and some thirty-five other “Holy Fools” of bygone days, all recognized as saints by the Russian Orthodox Church. Challis’s and Dewey’s academic specialty was Russian history and culture, not autism. But Dewey had a son, born in the 1950s, who had been diagnosed with autism, and that gave him insights into the behaviors of the ancient wanderers. He came to believe that autism, not insanity or divinity, might explain the Holy Fools’ behavior.
This set of individuals, he and Challis wrote, was “unhampered by society’s preconceptions” and content to live in a state of social isolation. Certain of them were wedded to rituals. They noted that Basil’s tolerance of extreme cold—which let him “walk barefoot on the frozen Volga”—was reminiscent of how some people with autism appear indifferent to extremes of cold, heat, or pain. The Holy Fools were also observed to get by on limited sleep and food—again, similar to some people with autism.
While some remained mute, several were known to echo the words of others, and still others spoke in riddles. And legend has it that some blurted out whatever they were thinking into the faces of the powerful. That tendency, Challis and Dewey wrote, was a major part of what endeared the Fools to the Russian public. In a culture where few dared to question authority, their impertinence was reminiscent of the great prophets of the Old Testament.
Paradoxically, a diagnosis of autism, had it existed five hundred years ago, would have undermined the Fools’ credibility as pious citizens. Awe and respect accrued to the Fools only because it was assumed that they had deliberately chosen this harsh and isolating way of life. In later centuries, some self-appointed Fools fell under suspicion of faking their piety, adopting certain behaviors only to advance their careers as beggars and con men. The resulting mistrust helped bring an end to the phenomenon of the Holy Fool. Gradually, the worship of and tolerance for such strange behaviors abated, and those who displayed such behaviors were once more neglected, if not treated with outright cruelty.
But not always.
HUGH BLAIR OF BORGUE was fussy about wigs—an accoutrement that, as a member of the landed class in 1740s Scotland, he was expected to wear whenever he ventured out in public. He did this, but not without a great deal of bother. He was always taking his wig off, plunging it into water, and trying to wash it. There it would hang, on a tree branch outside the family manse in southwest Scotland, drying in the wind while he waited. And yet, for all that, when Hugh finally did plunk the thing on his head, often as not he put it on backward, and went out in public that way. He was either unaware of the faux pas or indifferent to it.
Hugh was in his late thirties, a loner who lived with his aged mother in the stone house his grandfather had built, where his attic bedroom was cluttered with the twigs, feathers, and scraps of cloth he picked up off the ground every day. He dressed in bizarre outfits, worn and torn and mended all over with mismatched colored patches he sewed on himself. Once a piece of clothing became his favorite, he would refuse to wear anything else. Some of these were garments he came across abandoned by the road or “found” in the closets of nearby houses. Dropping in on neighbors unexpectedly, wandering through their rooms, whether they were at home or not, he tended to carry off whatever struck his fancy. He also made a habit of attending every funeral held in the community, even when he was not particularly well acquainted with the deceased.
In the small, connected world of southwest Scotland, the neighbors were aware of his odd behaviors and apparently quite understanding of them. They knew, when he came by, that it was never for a chat. People appeared to hold no interest for him, especially not in comparison with animals. With cats, for example, he was on close terms. When he sat down for supper, they draped themselves about him to share the meal, plunging paws into his spoon even as he lifted it to his mouth. Hugh didn’t push them away. Instead, he pulled their paws to his lips and licked them clean.
This portrait of Hugh Blair of Borgue was pieced together in the 1990s by the two-person team of Rab Houston, a Scottish social historian, and Uta Frith, a London-based psychologist. It was Houston and Frith’s contention that Hugh Blair of eighteenth-century Scotland was a clear case of what Leo Kanner learned to see only after he’d met Donald in the twentieth century. Frith put it this way: “The available evidence is rich enough and unambiguous enough to demonstrate that Hugh Blair would be given an unequivocal diagnosis of autism today.”
The best evidence the eighteenth century could offer was a documented legal inquiry into Hugh’s mental competence, presided over by a judge, officially transcribed, and informed by the testimony of twenty-nine witnesses, as well as that of Hugh himself. The proceedings, which lasted over several days in 1747, arose from a family dispute over inheritance. Hugh’s father, a landowner, had died many years earlier, leaving a sizable estate to be divided between his two sons. Hugh’s half remained under his mother’s guardianship; his younger brother, John, controlled the other half. Hugh had no heirs, while John had two sons. This meant that upon Hugh’s death, the entire estate would pass back to John and his progeny. John was counting on that, since he had been running up debts and had already been forced to borrow money from his mother.
Their mother, however, had gone and arranged a marriage for her odd older son. Somehow, she had persuaded a local surgeon to give his daughter’s hand to a man who licked cats’ paws at the dinner table. The exact inducements offered to the young woman were unknown, but likely involved a transfer of money. As for the mother’s motives, she was probably worried about her son’s future. Well into her sixties, she could imagine that soon Hugh might lose his primary protector in the world, the one person who had been keeping him out of trouble for his entire life. A wife could fill this role.
The wedding that took place in 1746 immediately put younger brother John’s financial plans at risk. If Hugh and his new wife produced sons in wedlock, those boys would become the rightful heirs to Hugh’s portion of the estate, ending any claim on it by John or John’s sons. In 1747, John initiated proceedings to have the marriage annulled, on the grounds that his brother was not mentally competent enough to have entered into it in the first place.
Against this background, a hearing was called to look into Hugh’s mental competence. It helped Houston and Frith in the 1990s that the court in the 1700s was gathering the same kinds of facts about Hugh that a psychologist interested in diagnosing autism would look for today. Everything contributed by the twenty-nine witnesses—clergymen, neighbors, craftsmen, laborers, and others who had contact with Hugh—pointed to his atypical behaviors.
It all fell into place: Hugh’s various obsessions, his attachment to objects, his lack of connection to people, his indifference to social norms. There is striking evidence that Hugh exhibited echolalia, a frequently seen autistic trait in which a person only echoes what he has heard said by others.
Having considered the evidence, the Scottish court ruled that Hugh Blair was a “natural fool,” incapable of entering into a contract, including a marriage contract. John Blair had won. The marriage was annulled. The prospect of a helpless, aging Hugh Blair, alone in the world once his mother passed on, must now have seemed a near certainty.
Yet the record shows that was not what happened. Hugh’s mother must have chosen wisely, because the woman who was married to her son for a year did not leave his side once the court declared them, once again, unmarried. Hugh and his former wife remained a couple, not only living together outside the law but raising two sons as well. Hugh lived into his sixties in a family setting, where the neighbors knew who he was, and where he could collect twigs, wash out his wigs, and drop in on funerals for as long as he wished to.
FIFTY-THREE YEARS AFTER a court found Hugh Blair a “natural fool,” on the other side of the English Channel, a nearly naked boy walked out of the forest and immediately became the most famous child in France. The so-called Wild Boy of Aveyron, whose story was popularized in the Parisian press of 1800, became an object of fascination not just to newspaper readers but also to eminent scientists and philosophers of the day. The whole country puzzled over who he was and what state of the human condition he represented. A century and a half later, Leo Kanner’s description of Donald offered new insight to historians and psychologists still pondering this question: France’s Wild Boy had almost certainly been a person with autism.
He was, at best guess, a twelve-year-old, with no family, no home, no history, and no name. When he opened his mouth, all that came out was a sort of low, guttural moan or an occasional high squeal. He was small—four feet one inch tall—and bone thin. He was covered with scars, and his gait was affected by one knee that turned in hard on the other. The newspapers of the time said he had spent years in the forest, cut off from human society, naked but covered in fur, like a bear, from head to toe.
Except for the part about the fur, it was all true. He had been briefly captured by hunters around 1797 but soon escaped again. In 1800, he left the woods willingly and was taken in by a young doctor named Jean-Marc-Gaspard Itard, who gave him the name Victor. He amazed onlookers with his ability to run and climb and with his tolerance for cold and heat. Initially unwilling to wear regular clothes, he was seen rolling naked in snowdrifts. He was also known to plunge his fingers into a bed of red-hot coals to pluck out roasting potatoes, which he popped straight into his mouth before they had cooled. For a long time, this was the only food he would eat.
To the Enlightenment thinkers of the day, Victor’s mysterious arrival was viewed as an opportunity to explore the operative properties of human language. There were some who anticipated that, once he was exposed to spoken French, Victor would quickly develop a full command of the language. Some hoped this could happen within months and that it would prove the key to his full blossoming as a participant in civilization—that he would stop, for example, removing his new clothes and trying to run back into nature, or stop giving in to the impulse to defecate and urinate whenever and wherever it struck him. But when early attempts at instruction proved disappointing, interest in Victor faded. A panel of experts found him to be an “idiot,” not worthy of an education. He was shut away in an orphanage, where the other children bullied him.
Itard then arranged for Victor to be cared for by a couple whose own children were grown, while he himself patiently worked with him daily as his personal teacher. With Itard instructing him, Victor made measurable strides. He became toilet-trained. He learned to wash and dress himself, to sit for meals, and even to set the table for himself. Itard taught him these complex procedures by breaking them down into small steps that could be practiced one at a time, over and over again.
Teaching Victor to speak, however, was a frustrating exercise. Itard wrote of his excitement when, one day, Victor began repeating the phrase “Mon Dieu.” It soon became clear, however, that he was only parroting something he had heard someone else say. He did learn to manipulate a set of steel alphabet letters to spell out a few words, but his comprehension of their meaning and use was minimal. He could communicate, and often did, by pantomiming—evidence that he had something to say. These gestures always related to his immediate desires—to eat, to go outside, to play the game where he was pushed about in a wheelbarrow. But in trying to teach him to say words aloud—even just to name things—Itard got nowhere.
A key problem was Victor’s unusually selective hearing. He shut out certain sounds as though he were completely deaf to them. When Itard, as an experiment, came up behind him and fired a pistol twice into the air, Victor did not even flinch. The human voice was another sound that registered with Victor only feebly. But let someone crack a nut in the next room, and his head would jerk around in that direction.
Itard, who regarded language as the essential test of Victor’s intelligence, finally considered himself defeated. After five years, he stopped all teaching. “Seeing that my efforts were leading nowhere,” he said, “I gave up my efforts to teach Victor to speak, and I abandoned him to a state of incurable muteness.” Itard would continue to work with mentally challenged people, making contributions to the theory and methodology that became the bedrock of special education as it developed for the next 150 years.
Victor spent his last years comfortably, treated with kindness. The state paid for his upkeep under the care of the married couple, who treated him almost as a son. He died in 1828 around the age of forty, far from the wilderness, having never spoken a full sentence, and always giving the appearance, like little Donald Triplett a century later, of being happiest when left alone.
ON FEBRUARY 26, 1848, a leather-bound report was delivered to the Massachusetts statehouse by one of the most compassionate activists the state had ever seen. Samuel Gridley Howe was the founder of the New England Asylum for the Blind, the institution that almost single-handedly changed the minds of Americans about the ability of blind people to benefit from an education. In both Europe and America, blindness was treated like deafness, lameness, epilepsy, or any apparent defect in typical organic functioning. Having a disability voided all claims to opportunity. Like those who could not hear or walk, those who could not see were written off as useless and broken. Educating them was regarded as absurd, until Howe proved otherwise.
Sometime around 1845, Howe had a new inspiration. He had learned that the French were making progress teaching people of impaired intellect, and that similar progress was being seen in Prussia. Why shouldn’t he try to educate his three new students? Even though one of the boys was mute, he was able to achieve considerable success.
When he began to speak openly of the educability of this group of people generally labeled “idiots,” Howe encountered ridicule. This incensed him, as did the abuse heaped upon the mentally disabled. Writing to a powerful member of the Massachusetts legislature, Howe spoke of everyone’s shared duty “to respect humanity in every form.” When society failed at this, he argued, “the community…suffers therefore in its moral character.”
The result of Howe’s outrage was that leather-bound book, entitled Report Made to the Legislature of Massachusetts upon Idiocy. It compiled the results of an investigation he undertook in 1846 into the condition of the mentally disabled in Massachusetts. Funded by the taxpayers, Howe and two colleagues traveled on horseback to some sixty-three towns and villages across the state, examining more than five hundred people identified in each of these places as being the community’s “idiots.” The project took two years.
Packed with tables and data, Howe’s report was astonishingly comprehensive for its time. Howe told the legislature that Massachusetts was home to approximately 1,300 men, women, and children who fit the description for mental “idiocy.” This struck him as alarmingly high.
“The whole subject of idiocy is new,” Howe wrote in the text accompanying his data. “Science has not yet thrown her certain light upon its remote, or even its proximate causes.” He was right. Little effort had ever been made to understand the nature of intellectual disability. Society had never seen the purpose in doing so.
Howe himself was not prepared for one of the findings he made on his two-year tour: A good many of the people who had been pointed out to him as “idiots,” he reported, did not seem to belong in that category. Upon close examination, he found many “who have some of the intellectual faculties well-developed, and yet are called idiots.” Far from fitting the label neatly, he said, they “upset every one of these definitions.”
There was the man named Billy, whom Howe listed as Case 27, who “knows, and can sing correctly, more than two hundred tunes…and who will instantly detect a false note in any of them.” Also notable about Billy, whose age was given as fifty-nine, was that ordinary communication appeared beyond him. “If he is told to go and milk the cows, he stands and repeats over the words, ‘Billy go and milk the cows,’ for hours together, or until someone tells him something else, which he will repeat over in the same way.”
Billy was born about 140 years before Kanner began thinking about autism, but much of what Howe recorded—his talent for music, his apparently perfect pitch, and his seeming echolalia—would almost certainly have earned him a place on Kanner’s list.
Howe’s Case 360 might have made that list also: “This man has the perception of combination of numbers in an extraordinary degree of activity. Tell him your age, and ask him how many seconds it is, and he will tell you in a very few minutes. In all other respects, he is an idiot.”
And Howe’s Case 25: “This young man knows the name and sound of every letter, he can put the letters into words, the words into sentences, and read off a page with correctness; but he would read over that page a thousand times, without getting the slightest idea of the meaning.”
Howe went on to list more examples that hint at autism, though with less detail. “What they learn, they never forget,” he reported, of one particular group. Also: “There are cases, Nos. 175 and 192, idiots beyond all question, but who can count not only to 20, but to 20,000, and perform many simple arithmetical operations with a great deal more facility than ordinary persons.” There is Case 277, a girl who can “learn and know letters” but can understand nothing to which they relate.
Howe’s research took place during a period when the majority of “ordinary persons” in the United States were illiterate, with little experience of using the alphabet at all. Neither did most Americans have much exposure to math, beyond counting what was in front of their noses: farm animals, rows of crops, family members. Twenty was a number beyond which few had much occasion to go visiting in their imaginations. The “idiots” were, by comparison, intellectual voyagers, at least in this narrow respect.
Howe was ridiculed yet again when he presented his report to the legislature. For his idealism, he was compared to Don Quixote, tilting at windmills. He prevailed, however, where it counted—with the lawmakers, who came up with $2,500 to fund an experimental school for ten of the children in the survey, with Howe in charge. Three years later, each of the children, previously thought uneducable, had made progress. Howe was thrilled. His report had fulfilled his ambitions in his own time, even as it tucked away something more relevant to our own—his eyewitness accounts of what autism looked like, ninety years before it was “discovered” in a psychiatrist’s office in Baltimore.
IF KANNER WAS RIGHT, and autism had always existed, then these stories from the past hint at some unpleasant life experiences for those who, during autism’s prehistory, went through their days undiagnosed. If, in the seventeenth century, they were still burning and hanging epileptics as witches—due to their occasional fits of strange movements and sounds—that would not have boded well for a child who tonelessly parroted back whatever was said to him, or whose deep concentration on the movement of his own fingers before his eyes could not be interrupted. If mutism was confused with lunacy, then quite likely nonspeaking people with autism would have been candidates for Europe’s various institutions, which included a tower in the city wall of Hamburg, where the insane were confined to a space known as the Idiot’s Cage.
Samuel Gridley Howe saw a great deal of dehumanizing of the disabled on his tour of Massachusetts towns. He found parents mired in “gross ignorance” of their children’s capabilities. One family kept their middle-aged son in a cage in the parents’ shop. He had been there since the age of twelve. Another man, age fifty, had been chained up for twenty years.
Such outcomes were not inevitable, however. In the eighteenth century, a town of rural Scotsmen proved that through their acceptance of Hugh Blair. So, in the twentieth century, did the people of a small Mississippi town, through the way they responded to the odd child in their midst—Donald Triplett.