Leo Kanner, ca. 1955
Chaskel Leib Kanner
June 3, 1894
|Died||April 3, 1981 (aged 86)|
|Known for||Being the "Father of Child Psychiatry"|
|Autistic Disturbances of Affective Contact|
Leo Kanner (pronounced /ˈkænər/; June 13, 1894 – April 3, 1981) was an Austrian-American psychiatrist, physician, and social activist best known for his work related to autism. Before working at the Henry Phipps Psychiatric Clinic at Johns Hopkins Hospital in Baltimore, Maryland, Kanner practiced as a physician in Germany and in South Dakota. In 1943, Kanner published his landmark paper, "Autistic Disturbances of Affective Contact," describing 11 children who were highly intelligent but displayed "a powerful desire for aloneness" and "an obsessive insistence on persistent sameness." He named their condition "early infantile autism," which is now known simply as autism. Kanner was in charge of developing the first child psychiatry clinic in the United States and later served as the Chief of Child Psychiatry at the Johns Hopkins Hospital. He is now widely considered to be one of the most influential American clinical psychiatrists of the 20th century.
Leo Kanner was born as Chaskel Leib Kanner in Klekotów, Austria-Hungary (now Klekotiv, Ukraine) on June 13, 1894 to Abraham Kanner and Clara Reisfeld Kanner. In this area, approximately 70% of the total population was of Jewish descent. Kanner despised his given names, "Chaskel," which is the Yiddish version of "Ezekiel," and "Lieb," instead choosing to go by "Leo," by which he is now known. Growing up in a traditional Jewish household, Kanner received both a religious and a secular education. Kanner spent the first years of his life in Klekotow with his family and was brought up according to Jewish tradition and custom.
In 1906, Kanner was sent to Berlin to live with his uncle. Later, the rest of his family followed. At a young age, Kanner appreciated the arts and wanted to pursue a career as a poet; unfortunately, he was not able to get his works published. In 1913, Kanner graduated from the Sophien-Gymnasium, a public state high school in Berlin, where he excelled in the sciences. He then passed the graduating Staatsexamen exam in 1919 and enrolled at the University of Berlin medical school. However, Kanner's medical education was interrupted during World War I, when he was recruited to serve in the Austro-Hungarian Army in the medical service of the 10th Infantry Regiment. After the war, Kanner went back to medical school in Berlin and officially received his medical degree in 1921. Later that year, Kanner married June Lewin, with whom he would eventually have two children: Anita (born in 1923) and Albert (born in 1931).
After graduating medical school, Kanner worked as a cardiologist at the Charité Hospital in Berlin. Kanner began doing work with normal heart sound to the relationship of the electrocardiogram. At that time, the atmosphere at the Charité clinics and institutes inspired rapid progress in science, teaching and patient care. The Charité, situated in the middle of Berlin, attracted students, physicians and scientists from all over the world, resulting in a group of outstanding personalities and renowned clinicians.
Motivated by the post-war hyperinflation and poor economic conditions of Weimar Germany, Kanner immigrated to the United States in 1924. If he had stayed in Austria his fate might have been similar to other Jewish professionals who lost their lives during the war. He stated: "Little did I know, if I had remained in Germany I would have been perished by Hitler in the Holocaust".
When he emigrated to the United States in 1924, he worked at the state hospital in Yankton, South Dakota, where he started his pediatric and psychiatric studies. Upon arrival, Kanner was appointed assistant physician at the Yankton State Hospital. It was there Kanner would learn the subtleties of pediatrics and psychiatry, two fields in which he was not experienced. To enhance his command of the English language, Kanner did the crossword puzzles in The New York Times. During his time in South Dakota, Kanner published his first works, which were on general paralysis and syphilis. Kanner also studied the effects of adrenalin on the blood pressure of patients with functional paralysis. Additionally, he published his first book, Folklore of the Teeth, an analysis of dental practices around the world in relation to customs and folklore, in 1928.
After serving four years in South Dakota, Kanner attained a fellowship position at the Henry Phipps Psychiatric Clinic at the Johns Hopkins Hospital in Baltimore, Maryland in 1928 after attracting the attention of Adolf Meyer, director of the psychiatric clinic. In 1930, with monetary support from the Macy and Rockefeller Foundations, Meyer and Edward A. Park were able to establish the Children's Psychiatry Service at the Harriet Lane Home at Johns Hopkins, which was the first child psychiatry clinic in the United States, and appointed Kanner to develop the program. Despite his inexperience in the fields of pediatric and child psychiatry, Kanner was able to teach himself pediatric psychiatry. In 1933, Meyer made Kanner an associate professor of psychiatry at the Johns Hopkins University. In 1935 the first edition of his textbook, Child Psychiatry was published. This was the first English language textbook for child psychiatry.
Beyond his revolutionary clinical research, Kanner's concern for the mentally ill through social activism was also what many people remembered him for. In the 1930s, a group of lawyers and judges arranged for 166 state-institutionalized, mentally ill residents to be released and assigned as unpaid domestic servants for affluent families around Baltimore. The release of these patients was justified through the Habeas Corpus writs and the claim to familial rights. Out of his own concern, Kanner decided to track down the 166 patients and found them plagued with a variety of dreadful outcomes such as STDs, tuberculosis, prostitution, imprisonment, institutionalization, and even death. Kanner reported that the 166 released patients had a total of 165 children, many of whom became orphans or died due to neglect. Kanner's report on these patients, "Scheme to Get Morons to Work in Homes Free Charged," made the headlines of The Baltimore Sun and The Washington Post in 1938. The publicity helped spark community action and led to the better treatment of the mentally ill. Apart from his social activism for the mentally ill, during the run-up to World War II, Kanner was instrumental in rescuing hundreds of Jewish physicians from the horrors of the Nazis by relocating them to work in the United States. He and his wife opened their home to many of these European refugees.
Beginning in 1938, Kanner observed eleven of his patients and chronicled the lives and behavioral characteristics of the children in his seminal paper, "Autistic Disturbances of Affective Contact," published in 1943. In this landmark publication, Kanner describes these children, all born in the 1930s, as living very disparate lives, but appearing to share something he labeled as "infantile autism," which is now simply known as autism. Later on, Kanner served as the Chief of Child Psychiatry at Johns Hopkins until his retirement from the position in 1959 and attaining the position of Emeritus. He was replaced by Leon Eisenberg. After retirement, Kanner continued to publish papers regarding autism until 1973. Moreover, he served as a Visiting Professor at Stanford University, the University of Wisconsin, and the University of Minnesota, and ran an active consulting practice until a few years before his passing.
Kanner expressed a great deal of concern about the usual mistreatment of mentally disabled children. He expressed concern about a society that causes the intellectual haves to look down on the intellectual have-nots, which led many to look down on the mentally deficient child as an object of adult manipulations rather than as a human being who reacts to affection and hostility, to acceptance and rejection, to approval and disapproval, to patience and irritability as any other child would. This led to his major work in 1943, "Autistic Disturbances of Affective Contact," published in 1943. In this paper, Kanner characterizes eleven cases, 3 girls and 8 boys, and would later call his observations 'autism'.
Published in the journal Nervous Child, "Autistic Disturbances of Affective Contact" was one of the most cited papers on autism in the twentieth century. In his landmark paper, Kanner took the term "autism," which Eugen Bleuler previously attributed to the inward, introspective symptoms typical in adult schizophrenia patients, and labeled the eleven children in his study as having "infantile autism." However, rather than relating his observations to the qualities and symptoms seen in schizophrenic adults, Kanner classified his description of "autism" to be independent from the psychotic disorder, explaining how autism was not a precursor to schizophrenia, and that the symptoms of the former appeared evident and present at birth. A significant work, this paper on "Kanner Syndrome" formed the basis for later research conducted by Kanner and others on what later became known as childhood autism.
From 1938, Kanner began to study a group of eleven young children (eight boys and three girls) who came to see him at his clinic at the Johns Hopkins Hospital. For each of the cases, Kanner provides a detailed account of the symptoms, health, results from diagnostic tests, familial background, and future development and progression of the children. Adding to his own observations, Kanner further contextualized the lives of his patients by including typically epistolary inputs from family members and other individuals with whom the children interacted. Generally, all of the children shared certain symptoms and came from similar socioeconomic and cultural backgrounds (all but two of the families were of Anglo-Saxon descent). The following are summaries of each of the eleven cases:
After profiling each of the patients, in the "Discussion" and "Comment" portions of the paper, Kanner stated that the common characteristics observed in the children formed a "unique syndrome" that may have been more frequent than what was reported at the time given the small sample size in the study.
Kanner indicated that the fundamental issue of this disorder is the children's inability to relate to people and objects in an ordinary way from birth. Distinguishing between the symptoms of the two disorders, Kanner explained that a person with schizophrenia steps outside his or her world and departs from already existing relationships, whereas the children he described had never established such relationships, experiencing an extreme aloneness from very early on. The notion of the innate nature of what Kanner called "extreme aloneness" was evident by recurrent reports of the failure of the children to "assume at any time an anticipatory posture" and adjust their bodies upon being picked up by their parents. The preferences the children had towards solitude manifested in complete disregard and ignorance of any external outputs that may interfere with them, such as direct physical contact, sound, or motion. Regarding the children's lack of interest towards people, Kanner stated that 'it would be best to get these interferences over with, the sooner to be able to return to the still much desired aloneness".
Kanner further noted the centrality of speech disturbances in this disorder, observing that many of the children were delayed in their speech, and that those who were verbal often used speech in peculiar ways (e.g., echolalic repetition of phrases and/or inflexible use of language as seen in the exact repetition of pronouns).
Additionally, Kanner observed that the children's behavior was governed by an anxious and obsessive desire for sameness, and that this resulted in their repetitions of actions, such as their verbal utterances, as well as limited spontaneous activity. A related cognitive attribute noted by Kanner was that many of the children had an excellent rote memory, which led their parents to "stuff" them with verse, lists of animal and botanical names, favorite songs, and random facts. Kanner indicated that four of the children had been considered deaf or hard of hearing early on. He also reported early difficulties with eating and suggested that eating may have represented the first intrusion into the children's extreme aloneness. He noted that the children had no particular health difficulties and that their EEG results were normal. He did, however, observe that f of the 11 children had relatively large heads, and a few were somewhat clumsy in their gait.
Recounting his observations of the children's families, Kanner noted the high level of intelligence characterizing parents and relatives, while at the same time asserting that there were few warm-hearted parents among the families he observed. He suggested that parenting might contribute to the development of autism, but he also balanced this suggestion with the observation that the aloneness of these children was present very early on, making it unlikely that the whole picture of the disorder was the result of parenting.
Kanner's first research publication, "General Paralysis Among The North American Indians," explored the rarity of general paralytic dementia, a neuropsychiatric disorder that occurs in late-stage syphilis, in the Native Americans he treated at the Yankton State Hospital. In his premier paper, Kanner stated that in what he considered the more "civilized" countries of Europe, there was a higher susceptibility to paralytic dementia from syphilis compared to the "less civilized" Native Americans. Although syphilis was very common amongst the Native Americans, Kanner only came across one patient, Thomas T. Robertson, who was Native American and had symptoms of the late-stage syphilis dementia. Kanner concluded that Native Americans rarely got general paralytic dementia because syphilis had been in their population for so long that it lost the power to produce general paralysis. On the other hand, Kanner argued, syphilis was relatively new to the white populations of Europe so it was more likely to produce general paralysis. However, Kanner believed that with time, the white race could also gain a similar resistance to general paralysis like that of the Native Americans.
In 1949, Kanner published another notable study, "Problems of Nosology and Psychodynamics of Early Infantile Autism*." Kanner explored the issues surrounding "early infantile autism" as it moved from having a well-defined symptomatology to being ready for a place in psychiatric nosology. Kanner focused on how early infantile autism was related and unrelated to the "intrinsic nature" of other conditions such as dementia infantilis and childhood schizophrenia. While early infantile autism and childhood schizophrenia have virtually identical symptoms, Kanner argued that they differ in onset. Prior to the onset of childhood schizophrenia, there is a period of normal mental state. However, early infantile autism manifests itself essentially right after birth. Kanner reported that the babies with early infantile autism were unusually apathetic, did not respond normally to people, did not assume proper posture to be picked up, startled at anything that disrupts their isolation, and lacked responsiveness. Kanner raised doubts about the necessity of separating infantile autism entirely from the schizophrenias because it can be considered as "the earliest possible manifestation of childhood schizophrenia." Unlike his other studies, Kanner decided to focus closely on the adult parents of the children and found something an intriguing pattern. Most of the adult parents had extremely successful careers: scientists, college professors, artists, clergymen, and business executives. In fact, Kanner had trouble finding autistic children of unsophisticated parents. This sparked Kanner's curiosity about the attitudes of the parents and the relationship dynamic between the parents and the children. He found that most of the parents had unaffectionate, mechanical relationships with their autistic children and would oftentimes dismiss them entirely. Kanner concluded that this unaffectionate dynamic potentially causes the autistic children to turn away and "seek comfort in solitude." He even argued that the children's obsessive preoccupations and remarkable memory feats represent "a plea for parental approval."
On April 3, 1981, Kanner died of heart failure in Sykesville, Maryland. In his lifetime, Kanner founded the field of child psychiatry and his research contributions laid the foundation for the fields of psychology, pediatrics, autism, and adolescent psychiatry. He is now known as the "father of child psychiatry." Kanner was the first physician in the United States to be identified as a child psychiatrist. His textbook, "Child Psychiatry" (1935) was the first English language textbook to focus on the psychiatric problems on children. In 1943, Kanner first described the syndrome of early infantile autism. His concise and cogent clinical descriptions of children with autism continues to inform, and is the standard against which current diagnostic criteria are measured. In his lifetime, Kanner published over 250 articles and eight books spanning the fields of psychiatry, psychology, pediatrics, and history of medicine.
Since Kanner's demarcation of childhood autism, research on autism continues to be an area of increasing interest. Although much progress has been made, this field is still in its infancy, and many avenues of research are just beginning to be pursued. Despite the time that has passed, the syndrome Kanner identified and his comments about the children he observed continue to have meaning today, and although some of his suggestions about the etiology and presentation of autism were grounded in the thinking of his day, many of his observations were quite prescient.
Currently, studies of autism focus on the genetic mechanisms that underlie the syndrome. There has been vast research into DNA mutations, epigenetic modifications, and rearrangements that may contribute to the onset of autism. In addition, environmental research, quantitative functional anatomy, and quantitive estimates of gene expression may help us understand "the entire cast of characters" involved in autism. These promising avenues of research heavily stem from Leo Kanner's life research.
In honor of Dr. Kanner's work, all Johns Hopkins Child and Adolescent Psychiatry Fellows are now called Kanner Fellows. The Dr. Leo Kanner Award was created by The Mind Research Foundation for those who actively serve children with autism and their families. Now there are numerous buildings, schools, and institutes that honor Leo Kanner both in the United States and abroad.