Austrian-American psychiatrist Leo Kanner (1894–1981) pioneered the field of child psychiatry, writing the first English-language textbook on the subject in 1935. Kanner became best known, however, for a 1943 article in which he described autism as a distinct disorder and suggested methods for identifying the condition. With his lengthy list of ground-breaking publications, Kanner left his mark on the field of 20th-century psychiatry.
Leo Kanner (pronounced “Connor” ) was born Chaskel Leib Kanner on June 13, 1894, in Klekotów. His hometown was part of the Austro-Hungarian empire; later, it became part of the Ukraine. Kanner grew up in an orthodox Jewish home as one of seven siblings. More than 70 percent of the citizens in Klekotów were Jewish and most locals spoke Yiddish; his given name—Chaskel—is a Yiddish form of Ezekiel. As a child, Kanner received his education at the local religious school, where he learned Hebrew and Judaism. Early on, he drifted toward writing and penned poetry as a child.
Realizing that opportunities were limited in Klekotów, his parents sent Kanner to live with an uncle in Berlin around 1906, and the Kanner family later followed. In Berlin, he attended the Sophien Gymnasium, a public, non-Jewish high school where he felt like an outsider. During this time, Kanner took an interest in science. After graduating in 1913, he began pre-med studies at the Friedrich-Wilhelms-Universität in Berlin. The outbreak of World War I forced Kanner out of the classroom. With his Austrian origin, he was called home to serve in the Austro-Hungarian army and placed in the medical infantry.
After serving in World War I, Kanner returned to Berlin and in 1919 became a naturalized Prussian citizen, which allowed him to practice medicine in Germany. At this point, cardiology captured his interest, and the following year he presented his thesis: Investigations of the Influence of Rest, Sleep and Work on the Electrocardiogram and Cardiophonogram with Special Attention to Conduction and Depolarization Time. Kanner completed his medical school studies in 1921 and began working at the Charité Hospital in Berlin.
Even though he worked in medicine, Kanner continued writing poetry and engaged with the art and culture scene in Berlin. The early 1920s were a tough time to live in Germany, however, as hyperinflation wreaked havoc on the economy. Inflation escalated so rapidly that German citizens had to spend their paychecks as soon as they were issued because the money they earned one day was worth less in buying power the next. To escape the situation, Kanner sought work in the United States through an acquaintance. He had a wife and child to support.
In 1924, the Kanners immigrated to the United States and moved to Yankton, South Dakota, where Kanner joined the staff at the Yankton State Hospital, an asylum for the insane. While he enjoyed success in his career in the United States, his family—left behind in Germany—perished during World War II. Kanner's mother was shot by Hitler's soldiers, and three of his sisters died in concentration camps. One brother committed suicide as the Nazis closed in. Of all his family, one brother and one sister survived the war.
Meanwhile, at Yankton, Kaner delved into psychiatry and was disturbed by the way some patients were treated. The higher-functioning patients were allowed to live in open cottages, while those with greater instability were locked away. Kanner became frustrated that psychiatry had not found a way to treat the patients humanely, and correcting this became his ongoing mission.
During his time at Yankton, Kanner found a way to meld his two loves—medicine and writing—by contributing articles to popular medical journals. To improve his English, he worked on New York Times crossword puzzles, and in 1926 he published his first paper in the American Journal of Psychiatry. In the article, he focused on the American Indians he treated at Yankton, noting that this population had a significantly lower rate of insanity than other races and ethnicities and exploring possible reasons for this phenomenon. The article received widespread attention.
Kanner's first landmark publication, Folklore of the Teeth, came out in 1928. This 316-page book explored dentistry through the ages by discussing remedies for dealing with tooth issues, citing practices from ancient to modern times. The book was part history, part folklore. Kanner had become interested in the topic while supervising medical students in Berlin who were writing dissertations on the topic.
In 1928, Swiss-American psychiatrist Adolf Meyer persuaded Kanner to join him at Johns Hopkins University in Baltimore, where Meyer served as psychiatrist-in-chief at the Henry Phipps Psychiatric Clinic. At Johns Hopkins, Kanner turned his attention to child psychiatry and explored childhood behavioral issues. In 1930, he opened a child psychology lab at Johns Hopkins, where he would spend the next five decades.
Kanner published his groundbreaking Child Psychiatry in 1935, producing the first English textbook to focus on children's psychiatry. The book offered a history of the specialty and then delved into an exploration of emotional and neurological disorders in children, relying on case histories to illustrate each point. In addition, the book offered guidance for corrective actions that could be taken to deal with each disorder. Kanner cited extensive research and clinical observations that reached beyond his sphere, compiling material from others working in the field. Child Psychiatry took a no-nonsense, psychobiological approach to psychiatry by examining the biological, environmental, psychological, and situational attributes that might affect a child's behavior.
In the 1930s, Kanner took up the rights of the mentally challenged after discovering that girls from the local Rose-wood State Training School were being adopted by Baltimore's wealthy elite to serve as domestic servants. He had received a tip that, for years, corrupt lawyers had filed writs of habeas corpus to get mentally disabled girls released from the asylum. The lawyers then drafted custodial agreements in which the girls were “adopted” by the wealthy and basically became indentured servants. Many of the girls were abandoned on the streets when the placement did not work out as planned.
Kanner discovered that 166 girls had been released from Rosewood, and he personally followed up on 102 to find out what had happened. He determined that 11 had died before turning 30; 17 had contracted tuberculosis or sexually transmitted diseases; 20 worked in prostitution; eight had been re-admitted to mental institutions; and six were imprisoned. Collectively, the group of 166 had given birth to 165 children. Some of those offspring had died of neglect; many were left at orphanages.
In 1937, Kanner presented a report of his findings at the American Psychological Association's annual convention, and the story made newspapers across the United States. The Washington Post exposed the scandal with a headline that read: “Record of Misery Traced in Freeing of Moronic Girls.” Afterward, Kanner gained recognition as a voice for the voiceless as he focused public attention on the need to protect the vulnerable. While he received credit for bringing the practice to light, he was also criticized for withholding the names of the lawyers and judges involved so they could be brought to justice.
In 1941, Kanner made waves with In Defense of Mothers: How to Bring up Children in Spite of the More Zealous Psychologists. In the book, he told mothers that they were the best authorities on their children and should trust their instincts. Writing in support of mothers, he argued that they had a natural instinct for parenting and only became misguided when they listened to the “experts.”
In Defense of Mothers urged moms to take a whole-child approach to child-rearing and not react to anything a child did until reviewing the context for the child's actions. He also discussed mother love and “smother love,” noting that true mother love encouraged healthy independence in a child, while smother love created lasting dependence on the mother. Kanner called smother love egotistical and selfish.
Kanner's biggest breakthrough came with the 1943 publication of “Autistic Disturbances of Affective Contact” in the medical journal Nervous Child. The article offered case studies on eight boys and three girls Kanner worked with from 1938 to 1942. The patients were all very distinct but shared common characteristics. Kanner saw how these characteristics fit together to reveal a pattern of disposition he termed “infantile autism.” These traits had been documented before and the term “autism” had been applied to describe the behavior of certain schizophrenics. Kanner's work was revolutionary, however, because he argued that this condition was a distinct, innate psychological disorder that deserved its own classification and should not fall under the umbrella of schizophrenia or mental retardation.
In “Autistic Disturbances of Affective Contact,” Kanner described each of the 11 children in detail, noting observations and results gleaned from non-verbal intelligence and ability testing. He offered a comprehensive clinical picture of the autistic child, telling colleagues what to look for in making the diagnosis. Kanner defined the traits of autistic children, arguing that they had a great capacity for rote memory but extreme difficulty relating to others. He noted their obsession with sameness and repetition and their frequent misuse of pronouns, often substituting “you” when they really meant “I.” Kanner also noted that they were concrete thinkers with no capacity for abstraction.
The condition described in “Autistic Disturbances of Affective Contact” soon became known as Kanner syndrome, but that term later fell out of favor among clinicians, who opted for the term autism. The year after Kanner published his article, Austrian pediatrician Hans Asperger described a similar syndrome and used the term autism. Asperger's disorder was widely interpreted as a mild form of autism and became known as Asperger syndrome.
Kanner's article caused some backlash, however, because he described the parents of autistic children in detail, noting that they tended to be perfectionists who were absorbed with abstractions and therefore emotionally disconnected from the people around them. This description spawned the “refrigerator mother” theory, which held that a lack of maternal affection contributed to autism. Later, it was found that Kanner was on to something, but it was a genetic connection, not a parenting issue, that accounted for the similarity in traits.
In 1969, in an address to members of the Autism Society gathered for a conference in Washington, D.C., Kanner tried to set the record straight. “I have been misquoted many times. From the very first publication until the last I spoke of this condition in no uncertain terms as ‘innate.’ But because I described some of the characteristics of some of the parents as persons, I was misquoted often as having said that ‘it is all the parents’ fault.” ’ Kanner's address was covered in Edward Dolnick's 1998 book Madness on the Couch.
Dolnick, Edward, Madness on the Couch: Blaming the Victim in the Heyday of Psychoanalysis, Simon & Schuster, 1998.
Grinker, Roy Richard, Unstrange Minds: Remapping the World of Autism, Basic Books, 2007.
Silberman, Steve, NeuroTribes: The Legacy of Autism and the Future of Neurodiversity, Avery, 2015.
History of Psychiatry, June 2003, K.-J. Neumärker, “Leo Kanner: His Years in Berlin, 1906–24,” pp. 205–218.
New York Times, April 7, 1981, David Bird, “Dr. Leo Kanner, 86, Child Psychologist.”
Yale Journal of Biology and Medicine, July 1936, E.S. Rademacher, review of Child Psychiatry, p. 664.
Johns Hopkins Medicine website, http://www.hopkinsmedicine.org/ (December 19, 2016), “Child Psychiatry Began at Hopkins.”❑