H-Diplo Roundtable XXI-14
Edith Sheffer, Asperger’s Children: The Origins of Autism in Nazi Vienna. New York: W.W. Norton, 2018. ISBN: 9780393609646.
15 November 2019 | https://hdiplo.org/to/RT21-14
Roundtable Editors: Daniel Steinmetz-Jenkins and Diane Labrosse | Production Editor: George Fujii
- Introduction by Benjamin P. Hein, Brown University, Samuel Clowes Huneke, George Mason University, and Michelle Lynn Kahn, University of Richmond.. 2
- Review by Kathryn Brackney, Vienna Wiesenthal Institute for Holocaust Studies. 5
- Review by David Freis, University of Münster. 8
- Review by Dagmar Herzog, Graduate Center, City University of New York. 11
- Response by Edith Sheffer, University of California, Berkeley.. 14
Introduction by Benjamin P. Hein, Brown University, Samuel Clowes Huneke, George Mason University, and Michelle Lynn Kahn, University of Richmond
On 1 July 1941, Hans Asperger (1906-1980), then a not-yet-famous doctor at Vienna’s Children’s Hospital, transferred two-and-a-half-year-old Herta Schreiber to Spiegelgrund, a children’s medical center that was actually the heart of Nazi child euthanasia efforts in Austria. Asperger had sent Herta there, noting that her disabilities “must present an unbearable burden to the mother” (145). Two months later, Herta was dead, pneumonia the cause listed on her death certificate. Asperger, on the other hand, would go on to enjoy a long and celebrated career as the creator of the autism diagnosis.
In her new book Asperger’s Children: The Origins of Autism in Nazi Vienna, Edith Sheffer delivers a compelling portrait of Nazi murder, its entanglements with the Viennese psychiatric profession, and its ramifications for how we think of autism today. Through careful analysis of the career of Asperger, whose eponymous diagnosis has made him a household name in recent decades, Sheffer makes the entire fascist eugenic program, which exterminated those who lived a so-called “life unworthy of life,” her subject (31).
Asperger, a staunch Catholic and member of Vienna’s psychiatric profession, described himself in the wake of the Second World War as a resistor, someone who had fought to protect innocent children from fascist brutality. And for years, that story stuck. As Sheffer writes, “Asperger also has a reputation for defending disabled children from Nazi persecution” (16). But when Sheffer went to the archives of the Vienna Children’s Hospital, she discovered a very different man. There she found evidence that Asperger had sent children from his clinic to the infamous Spiegelgrund center, knowing full well that they would be murdered. Far from being a kind-hearted savior of disabled children, Asperger was in fact complicit in the Nazis’ crimes against the most vulnerable members of society.
But Asperger’s Children is not simply a biography of a man. Through Sheffer’s account of Asperger’s life and career, readers are introduced to the killing apparatus that was Nazi Vienna: its professional networks, its intellectual universe, its institutions, and its victims. Much as in her previous monograph, Burned Bridge: How East and West Germans Made the Iron Curtain, Sheffer excels at bringing her subjects to life through depictions of everyday interactions. In Asperger’s Children, those interactions are largely between victims of the Nazi euthanasia program and the doctors and nurses who murdered them. Through close readings of medical records, Sheffer brings the murdered children, whose voices and stories are absent from the historical record, back to life. In so doing, she intertwines intellectual history and the history of everyday life in the service of understanding Nazism as both ideology and practice.
Perhaps the most chilling insight of Sheffer’s research regards the functioning of dictatorships. This book reminds us that much like the decision to enact a ‘final solution’ regarding the Jewish population of Europe, the decision to murder helpless children at Spiegelgrund required little coercion or explicit instruction from above. Instead, the idea to overdose children with barbiturates until they died of pneumonia emerged among a group of careerist physicians competing with one another over who could most effectively meet vague and ill-defined policy goals. It was no wonder that Asperger’s autism diagnosis, much like his definition of a human being’s inner spirit—what the Germans call Gemüt—for decades remained frustratingly broad and imprecise. In the world of Nazi child psychiatry, ambiguity was no accident. It was the midwife of state crimes and the enemy of the rule of law.
Although written for a general audience, Asperger’s Children makes a number of historiographical interventions. By disentangling the social, intellectual, and professional networks of individuals active in the child euthanasia program, Sheffer not only contributes to the field of the Nazi history of science but also joins a growing number of historians who have turned to unexpected places to understand how Nazism worked. Much like scholars’ efforts in the 1990s to demonstrate the complicity of organizations such as the Wehrmacht, which had emerged largely unscathed from trials and denazification efforts, Sheffer reveals psychiatrists as complicit in murderous fascist programs. Her work also resembles more recent historiography, such as Wendy Lower’s Hitler’s Furies: German Women in the Nazi Killing Fields and Catherine Epstein’s Model Nazi: Arthur Greiser and the Occupation of Western Poland for its focus on less-known figures, places, and crimes.
Likewise, Sheffer’s geographic focus on Vienna offers a fresh perspective on the Holocaust. Asperger’s Children reveals the renowned metropolis of Sigmund Freud and his cohort of liberal Jewish psychoanalysts simultaneously as the hotbed of racial ideologies and the actual ground on which the killings took place. Focusing on the peripheral spaces of Vienna and Austria helps decenter both Germany and Eastern Europe as the singular sites of Nazi extermination, providing further fodder to complicate Austria’s postwar ‘first victim’ myth.
Sheffer’s chief contribution to Holocaust historiography is her characterization of the Third Reich as a “diagnosis regime,” in which “the state became obsessed with sorting the population into categories, cataloguing people by race, politics, religion, sexuality, criminality, heredity, and biological defects” (18). It is a compelling lens through which to understand fascism’s need to ‘other,’ to categorize individuals in terms of the herd. But, more provocatively, it also places Nazi Germany in an intellectual genealogy with other Western countries. During the nineteenth century and into the twentieth, Western science—and not just medicine—had become ever more interested in such sorting. New sociological and medical categories arose to describe supposedly aberrant behaviors. By naming Nazi Germany a “diagnosis regime,” Sheffer suggests Nazi Germany was not so much an outlier of Western modernity as its logical conclusion.
The reviewers in this roundtable all appreciate the book’s accessibility and readability, celebrating Sheffer’s finesse at approaching the subject from both a scholarly and a moral standpoint. They all emphasize the usefulness of the concept of the “diagnosis regime,” but point out that it may have limitations. They use the book as a starting point for broader reflections on how and why the history of psychology, medicine, and diagnosis should be written. Finally, they all grapple with the question of what role history can and should play in our current discussions of autism: in other words, should Sheffer’s dark genealogy of the term ‘autism,’ with which many individuals self-identify, challenge our willingness to use the label?
Kathryn Brackney highlights Sheffer’s argument about the gendered nature of the autism diagnosis, which paralleled the hysteria diagnosis for female patients. She questions, however, the extent to which autism can be attributed to Asperger versus the other doctors who further researched and popularized the diagnosis after his death. David Freis argues that the concept of a “diagnosis regime” may not be so unique to the Third Reich given that Europe was booming with new medical diagnoses throughout the nineteenth and early twentieth centuries but finds value in Sheffer’s characterization of autism as the opposite of fascism. Dagmar Herzog praises the care with which Sheffer gives voice to the victims and captures the everyday complicity of the perpetrators, but casts doubt on whether individuals diagnosed as autistic, many of whom identify with the label, will support changing it.
Edith Sheffer is a historian of German central Europe and Senior Fellow at the Institute of European Studies at the University of California, Berkeley. She is the author of Burned Bridge: How East and West Germans Made the Iron Curtain (Oxford University Press, 2011) and Asperger’s Children: The Origins of Autism in Nazi Vienna (W.W. Norton, 2018).
Benjamin P. Hein is an assistant professor of modern European history at Brown University. Interested in the histories of migration, work, the family, and capitalism in the nineteenth-century Atlantic World, Hein is currently preparing a book manuscript tentatively titled The Migrant’s Spirit. Germany’s Rise to Economic Power in an Age of Transatlantic Migration.
Samuel Clowes Huneke is an assistant professor in the Department of History and Art History at George Mason University. His work focuses on the history of sexuality in modern Germany and has appeared in venues including New German Critique and The Journal of Contemporary History.
Michelle Lynn Kahn is an assistant professor of modern European history at the University of Richmond, where she works on the histories of migration, race, gender, and sexuality. She is currently revising a book manuscript on the transnational history of Turkish migration to postwar Germany and researching a new project on Neo-Nazis in Germany and the U.S.
Kathryn Brackney is a Junior Research Fellow at the Vienna Wiesenthal Institute for Holocaust Studies. She holds a Ph.D. from Yale University. Her article, “Remembering ‘Planet Auschwitz’ During the Cold War,” appears in the Fall 2018 issue of Representations.
David Freis is a medical historian at the Institute for the Ethics, History, and Theory of Medicine of the University of Münster. He received his Ph.D. in History and Civilization from the European University Institute in Florence in 2015 for a thesis about the psycho-political programs of German, Austrian, and Swiss psychiatrists in the inter-war period. Currently, he is preparing his thesis for publication and is researching the past futures of medicine in cold-war Germany.
Dagmar Herzog is Distinguished Professor of History and Daniel Rose Faculty Scholar at the Graduate Center, City University of New York, where she works on the histories of religion and secularization, Holocaust and aftermath studies, and the histories of sexuality and gender. Her publications include: Sex after Fascism: Memory and Morality in Twentieth-Century Germany (2005); Sexuality in Europe: A Twentieth-Century History (2011); Cold War Freud: Psychoanalysis in an Age of Catastrophes (2017); and Unlearning Eugenics: Sexuality, Reproduction, and Disability in Post-Nazi Europe (2018). She is currently writing on the histories of disability, theology, and ethics in the Christian and Jewish traditions.
Review by Kathryn Brackney, Vienna Wiesenthal Institute for Holocaust Studies
In her provocative and assiduously researched biography of Dr. Hans Asperger, Edith Sheffer contextualizes the development of the autism diagnosis within the broader context of Nazi psychiatry, eugenics, and medicalized murder under the Third Reich. Sheffer assesses the impact of fascist institutions and ideology on Asperger’s work—but the aim of her book is also broader. Through the figure of Asperger, Sheffer traces out the diffuse nature of complicity in what she calls a “diagnosis regime,” (18) which relied on an extensive bureaucratic apparatus to determine who was eligible for biosocial belonging in the Reich.
The book’s subtitle, “The Origins of Autism in Nazi Vienna,” belies Sheffer’s more complex periodization: Autism was first described by Asperger’s colleagues during the interwar period, when municipal interventions in the welfare of children significantly expanded under the celebrated ‘Vienna system.’ Sheffer tracks the development of Heilpedagogik, or curative education in Vienna, which focused on the potential of children with special needs to transform through therapeutic intervention. This approach had “both liberal and authoritarian elements” (37), she explains, and can be understood as part of a broader bureaucratic colonization of childhood. Early in his career, Asperger became the director Vienna’s Curative Education Clinic and developed his descriptions of autism in this research setting.
Under Austrofascism and particularly after the Nazi annexation of Austria, eugenic ideological elements in Vienna’s welfare programs became radicalized. The Third Reich charged medical professionals with the duty not just to cure the body politic but to purge it of “life unworthy of life.” The regime pushed to the fore specialists ready to act on radical fantasies about shaping the biosocial Volk, and in 1939, medical professionals were required to report all children under three who appeared to have mental or physical disabilities. Vienna’s infamous Spiegelgrund clinic became a major center in the Nazis’ child euthanasia program. Specialists in curative education, while relatively peripheral in the field of psychiatry, played a disproportionate role in determining which children might benefit from intervention and which children would be subject to sterilization and even murder.
Asperger did not work at Spiegelgrund, but Sheffer shows that his clinic recommended the transfer of nine children to the facility, two of whom died. In his broader role in the “polycracy” (133) of the Third Reich, Asperger also appears to have approved the transfer of 35 other children who died at the facility. By focusing on a doctor at one degree of remove from Nazi crimes, Sheffer provides us with a nuanced portrait of complicity. Arguing along similar lines to scholars of genocide like Jennie Burnet, who has revised the categories of rescuer, perpetrator, and bystander in her research on the Rwanda, Sheffer writes that “one might conform, resist, and even commit harm all in the same afternoon” (234) under the Nazi regime. Asperger never joined the party, a decision which would have put him at some professional risk—but he proactively joined organizations and municipal institutions that promoted racial hygiene and were linked to state murder. While Asperger was working at the University of Vienna’s Children’s Hospital, his mentor there, Dr. Franz Hamburger, was supervising unspeakable experiments on children considered unworthy of life, and Sheffer shows that Asperger maintained close professional ties with leading figures in the euthanasia program.
After Asperger’s research on autism was reintroduced to the psychiatric world by British doctor Lorna Wing in 1981, Asperger was celebrated as a champion of neurodiversity because of his assertion that not all abnormal traits should be considered inferior. Asperger has since been remembered as a resister against the Third Reich. After the war, he stated that he had refused to report children with cerebral injuries for extermination because of his Catholic faith, and that this principled stance had twice put him at risk of arrest by the Gestapo. This heroic reputation was one of Sheffer’s initial motivations for studying the doctor. In her research however, she could not find evidence for these threatened arrests. What she did find in Asperger’s district party file were reports that his Catholicism did not compromise his loyalty to the regime, even though he had access to “materials for exposure” at Children’s Hospital.
In a compelling close read of Asperger’s published work, Sheffer tracks how the doctor’s research on autism became increasingly critical under the Nazi regime, with his postdoctoral thesis finally defining the “autist” in 1944 as “only himself (autos)” and “not an active member of the greater organism” (214). In the preface to his thesis—which was not translated when his work was introduced to the English-speaking world—Asperger framed his analysis of autism as a pathological lack of Gemüt, a complex, quasimetaphysical German term referring to a feeling of “cosmic empathy” (71) in the broader community. Sheffer argues that the capacity to feel community spirit was of utmost ideological importance to National Socialists, who aimed to fashion citizens of the Reich from childhood to adulthood through belonging in a variety of youth and professional groups. Sheffer tracks Asperger’s medicalized concept of a “deficit of Gemüt” (219) back to Hans Heinze, a leading figure in the euthanasia program, whose article “On the Phenomenology of Gemüt” (1932) had a lasting impact on Nazi psychiatry. Sheffer speculates that autism, which derives from the Greek term for self, may have become legible as a “psychopathy” to Asperger as the inverse of fascism—from the Latin root meaning bundle, or group. Using the framework of Gemüt, Asperger finally deemed autism to be not just a typology, or distinct set of behaviors, but instead a pathology.
Asperger did celebrate the potential gifts of children who appeared to be socially withdrawn—but Sheffer shows that he also condemned those with “crackpot interests” of no “practical use” to society (178). While his work tended to focus on the most favorable cases, he maintained that among the majority of children with his diagnosis of “autistic psychopathy” negative traits outweighed the positive (178). In the broader context of Nazi psychiatry, the potential to be of service of the community resulted in a differential distribution of compassion and could constitute the line between life and death. Sheffer reads Asperger’s case files against the grain to reveal both the arbitrary ground of his diagnoses and how race, class, and gender prejudices inflected his medical observations. The doctor believed high-functioning autism to be an “extreme variant” of “male intelligence” (171), with the boys who bore its traits exhibiting an “almost aristocratic appearance” (158). Girls who exhibited similar behaviors were, by contrast, not diagnosed with “extreme intelligence,” nor were they given the same educational interventions. Asperger claimed that he had never seen a girl with full-fledged autistic psychopathy and diagnosed some girls instead as acting out in response to onset of menstruation. In a lucid and thought-proving parallel, Sheffer suggests that the hysteric, overly emotional female can be understood as the stigmatized inverse of the male autistic genius. The implication here is that both categories—hysteria and autism—are too broad and historically prejudiced to be of medical value.
The specific Nazi contours of the autism diagnosis become blurrier when we consider that the most influential doctor to describe infantile autism during the 1940s was not Asperger but Leo Kanner, a psychiatrist of Jewish origin at Johns Hopkins who originated the ‘refrigerator mother’ theory. Kanner was born in the Habsburg empire and ultimately helped many medical professionals in Austria to emigrate—including some of Asperger’s Jewish colleagues. Sheffer includes a fascinating comparison of Kanner, Asperger, and émigrés from the Curative Education Clinic. The major difference between Kanner and the Viennese doctors—including both Asperger and his purged colleagues—was that doctors from the Clinic included far less disabled children in their work on autism and emphasized their gifts as well as their disabilities. Sheffer’s argument about the specific Nazi contours of the autism spectrum would be even more compelling if this trans-Atlantic intellectual comparison could be expanded.
The determinative impact of the Nazi connection also appears questionable when Sheffer explains that the most significant research on Asperger Syndrome came out long after the war. Dr. Wing, who named the syndrome after discovering Asperger’s postdoctoral thesis, ended up doing much more thorough and influential work than Asperger himself—research that was motivated in part by a desire to understand the psychology of her own daughter.
What should this history mean, then, for the increasing number of children today who have been identified as on the spectrum? Regardless of where readers fall on the weight of the evidence that Sheffer presents to connect autism with Nazism, we must reckon with her conclusion that the diagnosis still reflects anxiety over the possibility of an individual’s integration into the community. Asperger Syndrome was recently dropped from the DSM, but Asperger’s fundamental distinction between high-functioning autism and more profound disabilities remains. His clinic’s emphasis on the potential for transformation through intensive education and socialization has also shaped therapeutic approaches to autism today, which should force us to ask a critical question: When children on the spectrum are treated, is therapy aimed at the wellbeing of the child or the expectations of the community? For many people who identify as autistic, receiving the diagnosis can bring a sense of relief and therapeutic direction; however, recent research shows that for others receiving care for a variety of psychiatric and neurological disorders, the stigma that comes with labeling can be a stumbling block. Today some mental health professionals are moving away from a model of diagnosis and toward more personalized treatment and support; Sheffer’s work lends historical support to this broader trend in psychiatry, even if she refrains herself from rendering a verdict on the ultimate value of the autism diagnosis.
Sheffer places her acknowledgements at the end of the book in order to give the last word her teenaged son, who was diagnosed with autism when he was just over a year old, and who now asserts that the label only deepens his experience of social alienation. Many historians pursue research that speaks to their own personal backgrounds—connections which can be difficult to acknowledge. When Sheffer includes her son’s voice, she conveys, in the deepest sense, the lasting stakes of these categories.
Review by David Freis, University of Münster
It does not happen every day that a study about the history of medicine in mid-twentieth-century Austria makes it onto the book review pages of leading international journals and newspaper—especially so when the protagonist is not the inventor of psychoanalysis, but a pediatrician who even at the time played a fairly limited role in the development of his discipline and of medicine in general. There are at least two reasons for the exceptional success of Edith Sheffer’s Asperger’s Children. The first is that it is a good read, well-written and well-structured, informative, and accessible to a broader audience. Sheffer tells her story clearly, with judgement and compassion, and with a sense for poignant single-sentence summaries. The second reason is that, while even most medical historians know little about Dr. Hans Asperger himself, he is nevertheless a household name. The term ‘Asperger syndrome’ was popularized in the early 1980s to describe a disorder on the autism spectrum and has since been included in the tenth revision of the International Classification of Diseases (ICD-10) and the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Although the eponym was struck from the fifth edition of the DSM in 2013, the diagnosis is still prevalent in child psychiatry, and has become a common cliché in popular culture. A book tracing the origins of ‘Asperger’s’ back to the Nazi era certainly had good chances of arousing considerable public interest.
The person behind the eponym has so far received little attention. Asperger was a child psychiatrist in Vienna and conducted his research at a time when the city was part of Nazi Germany, publishing his study on ‘autistic psychopathy’ in 1944. Yet, unlike many of his close colleagues, some of whom had been directly involved in the mistreatment and murder of children who were considered to be biologically ‘inferior,’ he was long considered innocent. In the post-war period, Asperger even fashioned himself as a Catholic opponent of Nazism, who took personal risks to protect the children in his care from the horrors of Nazi ‘euthanasia.’ This story has not withstood historians’ scrutiny. Two 2018 publications—an extensive article by the Austrian historian Herwig Czech and Sheffer’s book—have used previously unexamined archival documents to deliver a devastating double blow to this narrative of heroic opposition. Both authors come to very similar conclusions: The right-wing Catholic Asperger accommodated himself to the Nazi regime, legitimized ‘racial hygiene’ policies, and even actively cooperated with the child ‘euthanasia’ program. While he was not among the main perpetrators of Nazi medical crimes, Hans Asperger was at best a morally compromised opportunist with barely enough distance between himself and the Nazi doctors to pass as untainted in his post-war career.
However, although he is the book’s protagonist, this is not a biography of Hans Asperger in any traditional sense. Like other authors who follow the recent trend of writing the biographies of illnesses instead of those of their discoverers, Sheffer is interested less in Asperger himself than in the diagnosis that later brought him to eponymic fame. Her aim is to uncover the historical conditions in which the concept of ‘autistic psychopathy’ emerged. Hence, her argument is not about indicting Asperger for his collaboration with Nazi medicine—Sheffer repeatedly distances herself from any simplistic and moralizing finger-pointing—but about showing how the diagnosis itself was a product of Nazi child psychiatry. Evidently, this is a far greater challenge to our present understanding of autism, as it calls into question the underlying normative assumptions of the diagnosis rather than just the name given to one specific subtype. Apart from obvious differences in genre and style, this is also where Czech’s article and Sheffer’s book most clearly diverge. Czech focuses on Asperger’s political views and actions, and his personal culpability, but shies away from linking his contributions to autism research to Nazi ideology. Sheffer, by contrast, unambiguously states that “Asperger’s diagnosis of autistic psychopathy emerged from the values and institutions of the Third Reich” (13).
In ten chapters, Sheffer explores the ideology and practice of Nazi child psychiatry in Vienna, from the creation of a sophisticated system of social welfare institutions by the city’s socialist governments in the interwar years to the murder of biologically ‘inferior’ children in the art nouveau pavilions of the Spiegelgrund clinic in the first half of the 1940s. Hans Asperger and his Curative Education Clinic played only a minor role in the network of institutions that screened, diagnosed, and transferred children to their deaths. In some chapters Asperger is only a marginal figure, or—as in chapter 8, which recounts the experiences of surviving Spiegelgrund patients—entirely absent. Nevertheless, the narrative always returns to Asperger as the book unveils the local institutions and ideological and medical debates that made up the historical context in which he practiced and wrote, and shows the deadly consequences that his diagnoses and decisions could have for his patients.
Sheffer boldly situates Asperger and his concept of ‘autistic psychopathy’ at the center of a history of Nazi medicine. As she claims, Asperger conceptualized “autism and Nazism as inverse states of being”. Pathologically unable to create and maintain social bonds, ‘autistic psychopaths’ were directly at odds with the Nazi ideal of an organic national community. After all, Sheffer points out, “‘fascism’ comes from fascio, Latin for ‘bundle,’ and ‘autism’ from autos, Greek for ‘self’” (220). For Asperger’s patients, this distinction was a question of life and death. As social connectedness became a central political norm of the Nazi Volksgemeinschaft, those mentally unable to conform found themselves outside the community. While Nazi medicine was willing to use its resources on those it considered redeemable, it was also ready to expunge those it deemed untreatable. This dialectic of “annihilation and cure” has been a common theme of much of the historiography on Nazi medicine in the last two decades, and it was also at work in the practice of Asperger and his colleagues, who were supportive of some patients but had no qualms about sending others to their likely deaths.
The pivotal concept linking child psychiatry and racial politics was Gemüt. Even in German, this is a complicated notion with very different uses, ranging from everyday language to metaphysics, and Sheffer stresses its ambiguity and centrality by consistently leaving it untranslated – a striking exception in a book where everything else, including the proper names of institutions and newspapers, is rendered in English. This is one of those cases were the distance created by the transposition of the historical sources into another language provides an additional layer of analysis. The exact meaning of Gemüt as a kind of social feeling is nuanced and contextual. As Sheffer shows, in his 1944 habilitation treatise Asperger used a specific definition that was directly adopted from some of the main scholars in Nazi child psychiatry, for whom Gemüt was a necessary property of any member of the German Volk. Asperger’s understanding of ‘autistic psychopathy’ as a lack or defect of Gemüt excluded his patients from the national community.
The juxtaposition of autism and social connectedness allows Sheffer to develop a broader argument about the relation between self, society, and politics in Nazi Germany. As she suggests, Asperger’s creation of a diagnosis was paradigmatic for the way in which the Nazi state operated: “The state became obsessed with sorting the population into categories, cataloguing people by race, politics, sexuality, criminality, heredity, and biological defects. These labels, then, became the basis of individuals’ persecution and extermination” (18). From this perspective, Sheffer claims, child psychiatry in Vienna, with its construction of new diagnostic categories and their deadly consequences, was emblematic of the Third Reich as a “diagnosis regime.” The categories and the practices of this regime were neither rigid nor universally applied. As the case of Asperger illustrates, individual actors in the system had considerable leeway in deciding their patients’ fates. Decisions that led to the mistreatment, forced sterilization, or death of juvenile patients were often haphazard and arbitrary. And while it is obvious that racial categories played a central role in Nazi medicine, the book provides many examples of how the different family backgrounds, class, and gender of the children influenced Asperger and his colleagues’ judgement.
Conceptualizing the Third Reich as a “diagnosis regime” may provide a compelling way of putting the history of Nazi medicine at the center of the broader history of Nazi Germany. Yet, while it would certainly be interesting to further explore the analytic potential of this perspective, it remains essentially underdeveloped in Sheffer’s book. The key problem is that Hans Asperger was, after all, only a marginal and hardly a representative figure in Nazi medicine. Sheffer and Czech’s research leaves no doubt that Asperger willingly collaborated with child ‘euthanasia’ in Vienna, but he was not involved in the medical and political decision-making that created the system. Even as Sheffer elegantly balances biography and context, there is an inherent limit to how much a story centered on Asperger can tell about the workings of Nazi medicine and the Nazi state. Moreover, the concept of a “diagnosis regime” raises questions that the book does not directly address. How specific was the Nazis’ obsession with categories, labels, and diagnoses? Medicine—and psychiatry in particular—had been creating a plethora of new diagnoses throughout the nineteenth century. The proliferation of diagnostic categories was neither limited to Nazi Germany, nor did it cease in the second half of the twentieth century. As a “diagnosis regime,” Nazi Germany was one part of a broader trend of medicalized bio-politics that was a feature of many projects of modernism. What set the Nazi state apart was not its attempt to define “model kinds of personality” (19), but the murderous brutality it used against those that it categorized as threats to the national community. In Sheffer’s book, the limitations of this perspective become apparent in the continuity that she claims between the social and medical reforms of ‘Red Vienna’ on the one hand, and the horrors of Spiegelgrund on the other. Singling out the Nazi state as a “diagnosis regime” runs the risk of overlooking other approaches to public health and welfare in which improving the lives of some did not mean killing others.
This caveat notwithstanding, the praise that Asperger’s Children has received is well deserved. It certainly is among the best and most important recent publications about the history of medicine in Nazi Germany. Sheffer tells a complex story in a way that is emotionally captivating, morally nuanced, and highly topical. What is today diagnosed as ‘Asperger syndrome’ is only indirectly related to Hans Asperger’s research on ‘autistic psychopathy’ conducted in Nazi Vienna. Nevertheless, Sheffer uses the story of the Austrian child psychiatrist to develop a detailed account of the workings of Nazi medicine and the suffering of its victims. This research has implications for how we discuss and diagnose autism today, and it may well be that the eponym ‘Asperger’s’ will soon vanish from the medical manuals.
Review by Dagmar Herzog, Graduate Center, City University of New York
This is a brave and brilliant book—and an urgently needed one. It has been nearly a quarter-century since Michael Burleigh, in Death and Deliverance (1994), Götz Aly et al., in Cleansing the Fatherland (translated 1994), and Henry Friedlander, in The Origins of the Nazi Genocide (1995) provided English-language readers with important histories of the Nazi programs of eugenic sterilizations, euthanasia murders, and (both pre-and postmortem) experimentation on humans. And although since the turn of the millennium, and increasingly in the last dozen or so years, there has been a remarkable outpouring of outstanding German-language scholarship on these matters (including recursive attention to the eventually unfolding—though often also deliberately stalled—postwar recovery of the facts of what actually happened during the Third Reich), very few of the newest findings have been brought to the attention of Anglophone readers. Yet Sheffer’s innovative and distinctive work charts ambitious directions all its own. Exhaustively researched and scrupulously argued, and at the same time accessible to a very broad readership, Asperger’s Children achieves multiple aims at once.
At its most straightforward level—and in this task it is joined by the breakthrough essay published near-simultaneously by the Austrian historian of medicine Herwig Czech in the journal Molecular Autism—Sheffer’s book unmasks Asperger himself. Far from matching the untainted, near-saintly image he crafted for himself in the postwar decades, Asperger turns out to have been a deft careerist who adapted to the Nazi regime’s killing operations and personally assisted in sending “dozens” (16, 141, 230, 237) of children he deemed “‘incapable of education’” (142) or “‘an unbearable burden’” (145) to their certain deaths in Vienna’s notorious Spiegelgrund murder facility. Sheffer judiciously takes into consideration a variety of possible interpretations of Asperger’s motives as well as his actions. Nonetheless, she accumulates a wealth of substantive, concrete evidence: that Asperger was fully aware of the murder program, as indeed was a substantial portion of the Viennese population; that his Nazi superiors attested to his reliability; that he saw the victims of his colleagues’ brutal experiments in his daily labors (involving such techniques as exposure to extreme temperatures, deliberate infection with tuberculosis bacillus, or the months-long deprivation of fats and vitamin A to babies to cause blindness as well as to study affected infants’ livers postmortem); that he nurtured close professional ties with the killers and the experimenters both; that he directly ordered transfers to the murder facility, joined in an evaluation panel that ordered such transfers, and encouraged his colleagues and subordinates in ordering such transfers; and, whether in strategic opportunism or in sincere conviction it is impossible to say, repeatedly published his evolving ideas about socially, emotionally, and/or mentally atypical children in language that more and more incorporated explicitly derogatory, pathologizing, and Nazi psychiatry-inflected terminology.
A further overt goal of the book is to challenge the reflex of medical and social categorization and diagnosis. Aware that numerous individuals affected by the umbrella condition now officially labeled “autism spectrum disorder” also actually identify with the label—as do many individuals who love them—Sheffer nevertheless wants to promote greater hesitancy and skepticism. Sheffer pursues this goal via several tactics. One entails her (intriguing and productive) coinage and elaboration of the concept of the Third Reich as a “diagnosis regime” (13, 18-19, 96, 99, 236). Another involves her insistent point that the symptoms and qualities now associated with the diagnosis of autism took shape, quite specifically, in the grotesque and lethal contexts of Nazi psychiatry and pediatrics, especially their Austrian subdivisions, and she identifies clear echoes between the turns of phrase developed in Third Reich Vienna and the language formalized in the United States’ Diagnostic and Statistical Manual of Mental Diseases to this day. And yet a further means Sheffer employs to destabilize too-easy confidence about the reality and boundaries of what was then and is today bundled under the rubric of autism is the rich documentation of the perspectives of individuals so labeled. Sheffer has set her sights on taking readers into “the nightmarish contexts of autism’s creation” (13) and understands her book expressly as “a cautionary tale in service of neurodiversity” (16).
These two main projects, distinct as they are from each other, are compellingly presented—and even as the latter will surely be the tougher sell, at least Sheffer will have prompted extensive thoughtful reflection. Arguably, however, some of the book’s greatest strengths lie elsewhere, as additional subplots are no less significant to the overall contribution it makes. I see at least five further particularly impressive features, all of which involve narrative and interpretive choices that are at once methodological and ethical.
First, as noted, the book recurrently provides extensive documentation of the voices and the viewpoints of the children themselves. The importance of this cannot be underestimated. Some of the evidence comes from postwar testimonies of child survivors, but much also is drawn from Sheffer’s close, against-the-grain readings of nurses’ and doctors’ evaluations. In Sheffer’s presentation, the children—including, crucially, also the non- or barely verbal and more profoundly disabled ones—emerge as personalities, as precious, unique individuals. The chapter on “The Daily Life of Death” (an especially powerful—and, I can testify, teachable—excerpt) additionally includes extensive evidence on the torture of children within Spiegelgrund. The torture included beatings, continual pitting of children against each other, days of tight wrapping in wet sheets, injections of apomorphine that caused hours of vomiting and dry heaving, compulsory eating of vomit, injections of sulfur that caused weeks of muscle pain, hours of forced marching around the courtyard, or punishments for bedwetting such as “‘running in circles… push-ups’” or “‘kneeling, standing for hours on one leg, and the punishment got harsher if you cried’” (189). This is a catalogue of horrors that is by no means gratuitous but rather facilitates reader empathy with the children, and clarifies as well both the intimacy of their tormentors’ interactions with them and the extended duration of their suffering.
Another strength of the book is the way it models for students and other readers how one can clear away obfuscatory murk and learn effectively to decode the euphemistic, innocuous-sounding language of Nazi psychiatry and pediatrics by careful periodization, contextualization, charting of subtle but telling shifts in phrasing, and explication of the significance of cross-referencing of now-unknown but then-prominent authors. A key example is Sheffer’s extended discussion of the in hindsight truly stunning ubiquity of talk among Nazi-identified professionals about a concept they named Gemüt, a racialized and nebulous—but therefore all the more capriciously and malevolently usable—quasi-spiritual term meant to indicate soulfulness, character, or capacity to bond with other human beings. Adaptable in a plethora of compound variations ([G]emütstiefe (70, 218) or Gemütsreichtum (219)—depth or wealth of Gemüt, versus gemütsarm (73, 112), Gemütslosigkeit (112), Gemütsmangel (218)—poverty, lack, or deficit of Gemüt), the term allowed doctors—including, increasingly, Asperger—to place individuals on a continuum of capacity for empathy and soulful connection to others and to the community of the Volk as a whole, and contrast these with those who tended, as Asperger said autistic children did, toward “‘wickedness and cruelty’” (219). Asperger cited with special appreciation the work of Hans Heinze, a leading figure in the euthanasia program who supervised the murder of thousands of children and trained other doctor-killers, for his thoughts on Gemüt. Heinze had written on the problem of children who evinced “Agapemangel” (216)—i.e. a deficit of agape, the Greek and Christian term for selfless love—a searing instance of the more general Nazi habit of accusing one’s victims of the evils of which one was oneself guilty. Sheffer does not need to spell out for readers that if anyone had a manifest deficit of agape, it was the Nazis; the memorable point is made by understatement.
A further thread of discussion that is particularly well handled by Sheffer involves the understudied, but signally important phenomenon of intellectually underwhelming, mediocre gentiles, especially right-leaning ones, making rapid career rises not least because the more adept and better qualified Jewish and/or politically more progressive professionals had been driven into exile or removed from their positions and an enormous professional-social vacuum had been created. Asperger, Sheffer details, again with quiet understatement, was hardly the genius of insight into children’s characters that he claimed to be; more creative, intellectually rigorous, and child-sensitive experts had fled to American shores.
Similarly useful is Sheffer’s nuanced discussion of the often studied, but still inadequately understood subject of complicity under an openly murderous regime. Sheffer not only provides helpful accounts of the breathtaking speed of cultural transformation once the power balance shifted rightwards, along with the many pressures and incentives to conform—as well as the proactive, conscious choices made by individuals like Asperger. She explicates also how postwar defenders of Asperger could have been so misled about his involvements. In part, this has to do with his own retrospective mendaciousness. But it has to do, too, with the very particular “double-sided character” (19) of the National Socialist treatment of atypical children—the “linkage of help and harm” (22), i.e. the “double-pronged mission to help children deemed redeemable, and to purge those who were not” (199). And it has to do as well with a wider phenomenon by which individuals like Asperger, “neither a zealous supporter nor an opponent of the regime,” ended up “entangled in systems of slaughter…drift[ing] into complicity, part of the muddled majority of the populace who alternately conformed, concurred, feared, normalized, minimized, repressed, and reconciled themselves to Nazi rule” (21). Or as Sheffer eloquently sums up the point: “Caught in the swirl of life, one might conform, resist, and even commit harm all in the same afternoon” (234).
Finally, Sheffer addresses the heartbreaking fact of postwar continuities, including ongoing violence toward surviving children in (utterly insufficiently reformed) institutions, and the profound traumas they often sustained—all contrasted with the majority of the perpetrators’ bright postwar careers. It is imperative that English-language readers learn just how shockingly late any efforts at recognition and reparation of harms committed came to Germany and Austria alike. It is really only since the turn of the millennium that disability rights of all kinds, carried by impassioned and inventive activists, including self-advocates, have risen to prominence on the international agenda. The most recent gains are wonderful, but they remain exceedingly fragile—and they have been extended more readily to those with fewer disabilities and hence less need for intensive care. The renewed aggressive rightward surge in many nations, accompanied as it often is by a deliberate dismantling of social services and welfare state provisions, makes Asperger’s Children an even more essential read.
Response by Edith Sheffer, University of California, Berkeley
I would like to thank all of the participants in this roundtable for their gracious and nuanced engagement with Asperger’s Children. These robust reviews function as essays in their own right. They range far beyond the immediate contents of the book to reflect on the nature of perpetration in the Third Reich, the place of eugenics and euthanasia in Nazi extermination, and the practice of history. It is an honor and a pleasure to be a part of this discussion. I am grateful to Kathryn Brackney, David Freis, and Dagmar Herzog for their analysis and insights, and to Benjamin P. Hein, Samuel Clowes Huneke, and Michelle Lynn Kahn for their generous introduction
While I cannot do justice to the many threads of conversation in the space of these comments, I will focus on a question all of the participants raise at the end of their reviews: the implications of this research for today. Each of the authors, in different ways, suggest that this macabre story of Nazi medicine and its diagnosis regime might bring us to rethink current practices of labeling and the classification of autism. I agree.
In the epilogue to the book, I had raised questions about psychiatry today – but I had not wanted to put forth a programmatic argument about the present in a work of history. It is an interesting question—the extent to which a historian can or even should reveal his or her influences. I debated how explicitly I should share my (strong) point of view on autism as well as my son’s own autism diagnosis. In the end, I opted for what I thought was an honest, yet minimal approach in the epilogue and acknowledgements, hoping not to distract from the import of the historical research.
The near simultaneous publication of Asperger’s Children and Herwig Czech’s article in Molecular Autism in the spring of 2018, however, immediately sparked a lively discussion about where we go with the autism diagnosis and the Asperger’s eponym today. I confess I was surprised by how receptive readers were to the claims that Asperger’s definition of autistic psychopathy is suffused with Nazi ideology, and that he was complicit in a system of systematic killing. Some colleagues had warned me that people might minimize Asperger’s actions, and that the book would be controversial. I am so pleased it was not. The overwhelming response has been an open reckoning with Asperger’s life and work.
I have also been pleased to see that many readers and leaders in the autism community are calling for us to stop using the Asperger label. While I did not weigh in on this question in the book itself, I have since spoken and published about the imperative to discontinue the eponym. Asperger Disorder is no longer an official medical diagnosis in the United States – it was reclassified as “autism spectrum disorder” by the American Psychiatric Association in 2013 – yet it persists as a social label applied to millions. As medical eponyms are meant to credit and honor a researcher for defining a diagnosis, I believe Asperger merits neither credit nor honor. His 1944 description of “autistic psychopaths” as full of “wickedness,” “cruelty,” and “malice” is at odds with understandings of autism today (219, 159, 157, 85, 156, 217). And his participation in Nazi killings is at odds with current medical ethics. Many observers and voices in the autism community now share this view. Some Asperger societies have already renamed themselves, and many individuals who previously self-identified as ‘Aspergers’ no longer choose to do so.
The problem is, we still don’t have an adequate vocabulary yet to describe autism. As research hopefully advances to break out subtypes, I think moving beyond the Asperger’s label is an important step. One thing I have learned in the writing of this book and its publication is that psychiatry is fluid. Since labels, medications, and treatment so define us, and our children, it is vital to choose our language with care.
I’ll end on a positive note about the practice of history. It feels like we are living in a moment that is open to questioning the labels around us – labels of identity as well as our landscapes, of streets, statues, and schools. I wonder if this research on Asperger would have met with the same reception five or ten years ago. It would seem that readers are eager not only for the stories, but the ethics of our work, and that histories of the past can have unforeseen effects on our present.
 Edith Sheffer, Burned Bridge: How East and West Germans Made the Iron Curtain (New York: Oxford University Press, 2011).
 For example, Herwig Czech, “Hans Asperger, National Socialism, and “race hygiene” in Nazi-era Vienna,” Molecular Autism 9:29 (2018); Ute Deichmann, Biologists Under Hitler (Cambridge: Harvard University Press, 1996); Robert N. Proctor, Racial Hygiene: Medicine Under the Nazis (Cambridge: Harvard University Press, 1988); Sanford L. Segal, Mathematicians Under the Nazis (Princeton: Princeton University Press, 2003).
 Christian Hartmann, Johannes Hürter, and Ulrike Jureit, Verbrechen der Wehrmacht. Bilanz einer Debatte (Munich: C.H. Beck, 2005).
 Wendy Lower, Hitler’s Furies: German Women in the Nazi Killing Fields (Boston: Houghton Mifflin Harcourt, 2013); Catherine Epstein, Model Nazi: Arthur Greiser and the Occupation of Western Poland (Oxford: Oxford University Press, 2010).
 Jennie E. Burnet, “Accountability for Mass Death, Acts of Rescue, and Silence in Rwanda,” in Antonius C.G.M. Robben, ed., A Companion to the Anthropology of Death (Hoboken: Wiley Blackwell, 2018), 205-221.
 Czech, 32.
 Angelika Ebbinghaus and Klaus Dörner (eds.), Vernichten und Heilen: Der Nürnberger Ärzteprozess und seine Folgen (Berlin: Aufbau, 2001); see also Maike Rotzoll et al. (eds.), Die nationalsozialistische “Euthanasie”-Aktion T4 und ihre Opfer: Geschichte und ethische Konsequenzen für die Gegenwart (Paderborn: Schöningh, 2010); Robert Jütte et al. (eds.), Medizin und Nationalsozialismus: Bilanz und Perspektiven der Forschung (Göttingen: Wallstein, 2011).
 Hans Asperger, “Die ‘Autistischen Psychopathen’ im Kindesalter,” Archiv für Psychiatrie und Nervenkrankheiten 117:1 (1944): 76-136.
 Michael Burleigh, Death and Deliverance (New York: Cambridge University Press, 1994); Götz Aly, et al., Cleansing the Fatherland: Nazi Medicine and Racial Hygiene (Baltimore: Johns Hopkins University Press, 1994); Henry Friedlander, The Origins of the Nazi Genocide: From Euthanasia to the Final Solution (Chapel Hill: University of North Carolina Press, 1995).
 Maike Rotzoll et al., eds., Die nationalsozialistischen “Euthanasie”-Aktion “T4” und ihre Opfer: Geschichte und ethische Konsequenzen für die Gegenwart (Paderborn: Schöningh, 2010); Svea Luise Hermann and Kathrin Braun, “Das Gesetz, das nicht aufhebbar ist: Vom Umgang mit den Opfern der NS-Zwangssterilisation in der Bundesrepublik,” Kritische Justiz 43:3 (2010): 338-352; Stefanie Westermann et al., eds., NS-“Euthanasie” und Erinnerung: Vergangenheitsaufarbeitung—Gedenkformen—Betroffenenperspektiven (Münster: LIT, 2011); Sara Berger, Experten der Vernichtung: Das T4-Reinhardt-Netzwerk in den Lagern Belzec, Sobibor und Treblinka (Hamburg: Hamburger Edition, 2013); Götz Aly, Die Belasteten: “Euthanasie” 1939-1945—Eine Gesellschaftsgeschichte (Frankfurt am Main: Fischer, 2013); Sascha Topp, Geschichte als Argument in der Nachkriegsmedizin: Formen der Vergegenwärtigung der nationalsozialistischen Euthanasie zwischen Politisierung und Historiographie (Göttingen: Vandenhoeck & Ruprecht, 2013); Ralf Forsbach, “Die öffentliche Diskussion der NS-Medizinverbrechen,” in Stephan Braese et al., eds., NS-Medizin und Öffentlichkeit: Formen der Aufarbeitung nach 1945 (Frankfurt am Main: Campus, 2016). Still indispensable: Ernst Klee, “Euthanasie” im NS-Staat: Die “Vernichtung lebensunwerten Lebens” (Frankfurt am Main: Fischer, 1983).
 Herwig Czech, “Hans Asperger, National Socialism, and ‘Race Hygiene’ in Nazi-era Vienna,” Molecular Autism 9:29 (2018): 1-43, DOI: https://molecularautism.biomedcentral.com/articles/10.1186/s13229-018-0208-6. See also Herwig Czech, “Nazi Medical Crimes, Eugenics, and the Limits of the Racial State Paradigm,” in Devin Pendas et al., Beyond the Racial State: Rethinking Nazi Germany (New York: Cambridge University Press, 2017).
 Asperger’s high self-regard, clever circumlocutions, and outright misrepresentations can be heard in a 1974 ORF radio interview, https://www.mediathek.at/atom/01782B10-0D9-00CD5-00000BEC-01772EE2.
 A vital example of activism is the work of the Arbeitsgemeinschaft Bund der “Euthanasie”-Geschädigten und Zwangssterilisierten, founded in Detmold in 1987. See https://www.euthanasiegeschaedigte-zwangssterilisierte.de/.
 Dagmar Herzog, Unlearning Eugenics: Sexuality, Reproduction, and Disability in Post-Nazi Europe (Madison: University of Wisconsin Press, 2018).
 Herwig Czech, “Hans Asperger, National Socialism, and “Race Hygiene” in Nazi-Era Vienna,” Molecular Autism 9:1 (2018): 29.