My Essay On Asperger (advanced)

Posted this essay on my blog. Here is a copy. May be of interest at some point in time.

In the second part of my essay, I will discuss Schizophrenia. I will forward evidence to show that the Autistic Psychopathy of Hans Asperger and the more recent Asperger Syndrome of Lorna Wing are strongly connected to Schizophrenia. We will break this study down into very clear stages.

Let us begin by clarifying how Hans Asperger stated that the autism he described in his book Die Autistischen Psychopathen Im Kindesalter was definitely not, in his view, Schizophrenia. Here, he states:

"For the time being it's sufficient to note we did not get the impression any large percentage of our autistic children fit the criteria for Schizophrenia. More likely, from the perspective of hereditary, biological factors, (that is from the genetic point of view), autism has nothing to do with Schizophrenia. We know of only one case where we initially diagnosed autism, coupled with instinctive deficiency, but then, two years after our encountering the patient, there was a progressive personality breakdown. Therefore, at this point in time we are obliged to diagnose Heberphrenia. " (Hans Asperger)

As a point of interest, Eugen Bleuler once wrote that autism in itself could not be used to diagnose Schizophrenia:

"Аутизм как таковой не может быть использован для диагностики» (с. 243), как и аффективность, не наблюдаемая у изобретателей, политиков и т. д."
"Autism as such cannot be used to diagnose Schizophrenia and the same applies to low emotional responsiveness, noticed also in inventors and politicians et cetera."

The first observation here is that Asperger draws a distinction between autism (as perceived in his patients) and Schizophrenia. Swedish psychologist Eugene Bleuler, in actual fact, described a different kind of autism with regard to Schizophrenia. Bleuler's patients were considered to be more governed by emotion than logic and intellect. These Schizophrenia patients lived in their own reality, which was the preferred reality - subject to desire. When reality and fact tend to contradict the inner reality, any unwelcome information is rejected and filtered out. This leaves the remaining thought processes fragmented, distorted and lacking logic. Desired, subjective reality substitutes actual reality. Bleuler considered Schizophrenics suffered from defective thought processes and autism.

To this I might add there are many instances of such subjective distortion of reality in typically normal people. For example, it used to be noticed that girls tended to out-perform boys in school class-tests, which resulted in teachers deliberately marking down test papers handed in by female pupils. This allowed the boys to remain relatively superior in classwork. Therefore, we can concude that in this example, a deep-seated fear and foreboding (emotionally driven) induced teachers to deny the logic of evidence and construct a more palatable reality as a delusion. In Bleuler's schizophrenic autism, this basic rejection of reality based on desire is the same.

Asperger's interpretation of autism in his own patients was another thing altogether. The Asperger children displayed the typical symptoms of Childhood Schizophrenia but were perceived to show deficits in the sphere of emotional interaction and instinctive learning processes. The Asperger children retreated to a world of their own because they were unable to respond to the emotional demands made of them by others. They lacked mechanisms to process information through shared emotional contact and experience with human beings. They could only intellectualise and rote-learn the rules of social interaction. Their overall ability to process incoming information was poor but not on account of cognitive delay.

The second observation to make is likewise clear enough. Reality would seem to indicate the distinction between Schizophrenia and Schizoid Psychopathy often overlaps. Even if only one of the patients in Asperger's clinic was initially misdiagnosed, surely that tells us the symptoms of both conditions are extremely difficult to distinguish? Moreover, Asperger's team of specialists only altered their original diagnosis of autism after the patient had progressed to the point of disintegration of personality. This issue of "personality fragmentation" we will discuss later on.

What is strange here is the fact Asperger frequently distances his patients from any connection to Schizophrenia, despite the subtle distinctions involved. For example, Grunya Suhareva writes:

"Группа шизоидных психопатий имеет какое-то отношение к шизофрении; за это говорят: во-первых наследственно-биологические данные, большое количество шизоидных психопатов в семьях шизофренов и, во-вторых, сходство препсихотической личности шизофренов с клинической картиной шизоидных психопатий." ( Груня Сухарева)
"The Schizoid group of pathologies has a certain relationship to Schizophrenia. First and foremost, hereditary, biological data supports this. There is a larger percentage of schizoid psychopaths in families of schizophrenics and, secondly, there is a resemblance between the pre-psychotic personality of schizophrenics and that of the clinical depiction of Schizoid Psychopathy" (unquote - in childhood) (Grunya Suhareva).

Doctor Suhareva's paper, incidentally, written in 1925, quotes vast amounts of genetic and clinical research by Krechmer, Huffman, Rudin, Kahn, Medow and A. Schneider. At that time, the consensus was that Schizoid Psychopathy (more recently, Asperger Syndrome) was a neurological condition, apart from Schizophrenia but still closely related to it in family lines. Or, for the sake of simplicity, a great grandfather might have had Schizoid Disorder but his grandson might end up with Schizophrenia.

Likewise, to clarify our position so far, there were two possible diagnoses that were available to Asperger:

(1) Autistic Psychopathy (autism) as a distinct condition from Schizophrenia.
(2) Pre-psychotic autism, which appears identical to the first possibility, but later in life the patient's symptoms progress towards personality fragmentation and positive symptoms of Schizophrenia.

Schizophrenia is associated with an ongoing process which, in many cases, started off through symptoms of autism in childhood. If the autism later developed into disassociation of thought processes within an individual, with possible hallucinations or Catatonia, - all of this was thought to be a psychotic process of Schizophrenia.
"Лица, заболевшие шизофренией, часто уже в детстве обнаруживали некоторые характерные особенности. Он различает 4 типа препсихотических личностей шизофренов." Тихие, робкие, замкнутые, аутичные дети; (Груня Сухарева)
"Those suffering Schizophrenia, most frequently in childhood manifest certain characteristic features. He (Kraepelin) distinguishes 4 types of pre-psychotic, Schizophrenic personalities: Quiet, shy, withdrawn autistic chidren." (Grunya Suhareva)

So, in reality, it could be very difficult to make a clinical distinction between Childhood Schizophrenia and Asperger Disorder.

"Giese исследовал истории болезни 347 больных шизофренов. У 220 находил в детстве психопатические особенности, которые он делит на три группы." (Г. Сухарева)
"Giese researched the background of 347 patients with Schizophrenia. Of these, 220 exhibited psychopathic traits in childhood, which he divided into three groups." (G. Suhareva)

Both Asperger and Suhareva agree that Schizophrenia is not essentially the same as Schizoid Disorder or Autistic Psychopathy (or Asperger Syndrome), although Suhareva - and many European psychologists and geneticists - asserted there was still a definite genetic connection involved:

"Berze (цитировано по Kahn'y) находил у родителей шизофренов шизоидные черты характера, он их считает латентными шизофрениями." (Г. Сухарева)
"Berze (quoted by Kahn) noted schizoid character traits amongst the parents of schizophrenics and considers them to have latent Schizophrenia." (G. Suhareva)

Different disorders but both found in family medical history.
Confusing isn't it? To complicate matters further, many psychiatrists do not accept the idea of a separate condition at all but maintain what Asperger described was simply Childhood Schizophrenia.

"Более категорична Старкова с соавторами, утверждающими, что РДА по своим клиническим проявлениям не что иное как шизофрения, что при этом заболевании у детей поражаются не только эмоции, но и все стороны психической деятельности. Авторы считают что лечение таких больных (в том числе психотерапия) может желать только лучшего и вмешательство врача- психиатра ограничивается диагностикой."
"Starkova and co-authors were more specific, asserting that Autism in its clinical manifestation is nothing more than Childhood Schizophrenia and that during this illness children suffer not just emotionally but the entire psychological sphere is affected. The authors consider treatment of such patients leaves a lot to be desired and medical intervention is limited to diagnosis."

It seems strange Asperger tended to overlook the extensive research carried out by German neurologists and geneticists, which concludes families with a history of Schizoid Disorder or Psychopathy have a larger than normal proportion of schizophrenic blood relatives. The early Soviet psychiatrist Grunya Suhareva even provided her own patient history details that confirm German studies. In fact, examining a variety of published anamneses, I have found suggested hereditary links between grandparents and grandchildren.

"Дед по матери в возрасте 35 лет заболел какой-то душевной болезнью, по описанию близкой к шизофрении; умер душевнобольным; по боковой линии деда один случай самоубийства." (Груня Сухарева)
"His grandfather on the maternal side became ill at 35 with some sort of illness of the soul that, by all accounts was similar to Schizophrenia. He died as a disturbed man. On the grandfather's family line there was one case of suicide." (Grunya Suhareva)

What is clear is the fact Hans Asperger himself was convinced his young autistic patients were not suffering from a condition related in any way to Schizophrenia:

"Is personal susceptibility to Schizophrenia a basis for manifestation of the described psychopathic condition? That is, taking into account Schizophrenia is inherited through varied genes, are these patients carriers of distinct genes, through which combined susceptibility to certain illnesses triggers Schizophrenia? Or is the basis of this condition a predisposition to Schizophrenia, which under certain circumstances fails to fully materialise? Specific details of family history could clarify these questions. There would need to be schizophrenic patients amongst blood relatives of our children and these would need to be of higher than average proportion. For the time being, suffice it to say that we have had no indication of any accumulation of Schizophrenia patients in the childrens' family history."(Hans Asperger)

Here, I forward descriptions that reveal how close the Asperger children were in behavioural terms to children who had been assessed with Childhood Schizophrenia. The first quotation is taken from Asperger's paper and, in the second, a psychiatrist describes Schizophenia:

"Worked up and moody, with no inhibitions, they jump wildly around the room and lose all sense of social barriers. They act obsessively with aggression." (Asperger)
"According to the degree of emotional excitement such people start to dance, leap around, dash back and forth while engaging in other, senseless activities.".(Russian psychiatrist)

The reason Schizophrenia has always been regarded as a more severe type of autism is due to its apparent progressive nature of deterioration. This refers to the fragmentation of personality that Asperger referred to as fundamental to this condition. It is commonly thought Schizophrenia starts around 18 years of age although, as we have seen, studies by German researchers indicate these patients are often identical to Asperger children in early childhood.

In discussing his patient Fritz F, Asperger outlines his reasons why he feels the symptoms he encountered are not related to Schizophrenia:

"It goes without saying that a great deal of Fritz F's behaviour suggests a process of Schizophrenia - significantly reduced contact with the outside world, automatization and stereotypical patterns. Yet, subsequent arguments against a diagnosis of Schizophrenia are as follows: The boy's status is not progressive. There is a lack of obvious fearful symptoms that characterise the initial phase of Schizophrenia. These are severe symptoms of fear and hallucinations. In the case of Fritz F, we see no sign of any manic behaviour. There is no progressive fragmentation of personality. Much in Fritz F's personality ties in with a deviation from normality but the overall picture is constant, although this distinction depends to a large extent on the peculiarities of the father, mother and fami!y. Fritz F's personality demonstrates continual development, which in the final analysis leads to an increase in adaptation to demands of the surrounding world. Above all, the general impression - although not subject to definition - with regard to such a boy as Fritz F, and a patient with Schizophrenia, is altogether different. In tbe case of the Schizophrenia patient, we get a frightening impression of personality fragmentation, which clearly can be held in check in some way through educational support. However to get to grips with this condition is not possible, unpredictable and unfathomable as it is."

At the moment of writing, it has become quite evident the current diagnostic criteria centred around Asperger Syndrome, or autism, gradually evolved along the lines of a chain - Freud - Kraepelin - Bleuler - Kraechmer - Suhareva - Kanner - Asperger - Wing. As the chain evolved, so did the terminology. First we had Dementia Praecox and then Schizophrenia. In the 1920s, Kraechmer radically impacted upon Bleuler's Schizophrenia by introducing factors based around somatotype and racial genetics. We subsequently ended up with another definition of a disorder that was similar to Schizophrenia, but without psychosis involved and no "destructive process", referred to by Asperger.

I have found that, in actual fact, the Russian terms for Asperger Syndrome existed years prior to publication of Wing's papers. "Вялотекущая Шизофрения" "Sluggish Schizophrenia" or "Шизоидное Расстройство" Schizoid Disorder" are terms that, more or less describe what Kanner and Asperger described. Sluggish Schizophrenia indicates that the schizophrenic process of destruction of personality remains static, or greatly reduced in tempo.

To understand Asperger's papers, we really need to understand the Schizophrenic Group Of Disorders. We also need to look at the different definitions of autism.
In my next post I will describe the clinical aspects of Bleuler's Schizophrenia that applies to me.