Leo Kanner (1943) II
Bill Long 11/30/07
"Translating" the Concept of Autism
We should pause on the word autism for a moment longer before examining Kanner's 1943 work. Why? Because how we use words can tell us a great deal about confusions that might subsequently grow up around a term. In this case, the word autism grew up in a psychiatric context as a word helpful to describe the essence or pathognomonic feature of schizophrenia. But here is the problem. Since psychiatrists invented the term and defined it in the first instance as some kind of withdrawal from reality and engagement in fantasy, the first inclination of later psychiatrists who come across the word will be to import Bleuler's meaning, or the psychiatric meaning, into the term. Thus, when Kanner's 1943 study began to become recognized in the late 1940s and early 1950s, his use of the term autism is already laden with psychiatric overtones. That means that the first 'hearers' of Kanner will no doubt be people trained in the methods of psychiatry and, specifically, psychoanalysis. In fact, since Kanner "borrowed" their term, they can be excused for trying to interpret his study in the context of their prior understanding of the term.
Since their prior understanding of the term had to do with a withdrawal into fantasy life, the (mostly) Freudian-trained psychiatrists or psychologists of the 1950s would be looking for the mechanisms that prompted this withdrawal into fantasy life. Was it something that was generated by the individual himself? His family of origin? His mother? His surroundings? Even though Kanner himself cautiously speculated a more organic or what he called "biologically provided" origin to autism in his 1943 article, he had used a term that was "owned" by those who belonged to a field which tended to deny biological causation for schizophrenic conditions. We have, therefore, in Kanner's desire to use the term "autism" to describe what he is doing in 1943, the roots of the huge conflict between the "psychogenic" school of autism and the "biological/organic" approach to it. It wasn't until Bernard Rimland's 1964 book on Infantile Autism that the psychogenic explanation was put to rest in the United States, though its effects lingered well into the 1980s here and, possibly longer, in Europe.
Kanner's Decision to Use the Term "Autism"
Thus, rather than simply piling all the honors on Kanner, one ought to pause on him for a moment longer. Actually, he was aware of the potential danger of introducing the term "autism" to describe what he was doing in 1943. In his unpublished autobiography (1977), excerpts of which appear in Donnellan's 1985 Classic Readings in Autism, he says the following:
"The term autism was introduced by Eugen Bleuler who wrote: 'Naturally some withdrawal from reality is implicit in the wishful thinking of normal people...here, however, it is mainly an act of will by which they surrender themselves to a fantasy..I would not call the effects of these mechanisms 'autism' unless they are coupled with a definite withdrawal from the external world,'" (quoted in Donnellan, ed., p. 2).
I will continue the quotation in a moment, but I must stop to point out a phrase that Bleuler used. Notice how he describes autism as not simply a withdrawal into fantasy but how it is "mainly an act of will." These five words are of great importance because they suggest that the person affected by autism has somehow "willed" it. Once you go down that road, you invite consideration of how a clinician might work against the "will" of the person who "willed" his own autism. We hear "echoes" of a large debate in autism's early history even before we are getting started....
Kanner then described his work, and noted that his use of the word autism (see my next essay) isn't quite congruous with Bleuler's use of the term. He says:
"All this does not seem to fit in with Bleuler's critieria for autism. There is not withdrawal in the accepted sense of this word and a specific kind of contact with the external world is a cardinal feature of the illness. Nevertheless, in full recognition of all this, I was unable to find a concise expression that would be equally or more suitably applicable. After all, these children do start out in a state that resembles the end result of later-life withdrawal and there is a remoteness at least from the human portion of the external world. An identifying designation appeared to me to be definitely desirable because, as later events proved, there was danger of having this distinctive syndrome lumped together with a variety of general categories." Ibid.
That is, even though Kanner knew that Bleuler used the term differently than he (Kanner) did, Kanner felt that he had to use some term to give the subjects of his study a separate identity so that they wouldn't simply be lumped together with others with whom they didn't belong. So he bit the bullet and called his children "autistic." He meant by the term something fairly different, though not completely inconsistent with, Bleuler's term. Kanner emphasized in autism the lack of "affective contact" with people or the "children's inability to relate themselves in the ordinary way to people and situations from the beginning of life," p. 41.
With this rich descriptive context, then, we are ready to understand Kanner's seminal article. One further note--on Greek/Latin. The term autism was first used in the form of autismus by Bleuler in 1910. This is a "new Latin" construction (i.e., it isn't a word known in classical Latin, but was coined in the modern age) which is derived from the Greek intensive pronoun autos. Autos is the masculine intensive pronoun and is translated "he himself." Thus, the word autism, if we could divorce it from its psychiatric origin in Bleuler, is probably a good term to describe this phenomenon where the person is seemingly oblivious to or largely "blind" to others. But, by the time Kanner used the term, it was already laden with a psychiatric overlay. Let's now turn to his classic study.