Free In a Different Key: The Story of Autism by John Donvan, Caren Zucker Page A

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 beendiagnosed, 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