Лео Каннер: пионер в изучении детского аутизма

Austrian American physician and psychiatrist

Leo Kanner ('/k//æ//n//ər/; born Chaskel Leib Kanner; June 13, 1894 – April 3, 1981) was an Austrian American psychiatrist, physician, and social activist best known for his work related to infantile autism. Before working at the Henry Phipps Psychiatric Clinic at the Johns Hopkins Hospital, Kanner practiced as a physician in Germany and South Dakota. In 1943, Kanner published his landmark paper Autistic Disturbances of Affective Contact, describing 11 children who displayed "a powerful desire for aloneness" and "an obsessive insistence on persistent sameness." He named their condition "early infantile 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 one of the co founders of The Children's Guild, a nonprofit organization serving children, families and child serving organizations throughout Maryland and Washington, D. C., and dedicated to "Transforming how America Cares for and Educates its Children and Youth." He is widely considered one of the most influential American psychiatrists of the 20th century.

Leo Kanner was born as Chaskel Leib Kanner in Klekotów, Austria Hungary (present day 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 "Leib," instead choosing to go by "Leo”. 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 Klekotów with his family and was brought up according to Jewish tradition and custom. After the war, Kanner went back to medical school in Berlin and officially received his medical degree in 1921. If he had stayed in Germany 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. 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.

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 who was the Psychiatrist in Chief and 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. 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 of schizophrenia, explaining how autism was not a precursor to schizophrenia, and that the symptoms of autism appeared evident and present at birth and early life. 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 spectrum disorder. 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. 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. 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. 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 published over 250 articles and eight books spanning the fields of psychiatry, pediatrics, psychology and history of medicine. Now there are numerous buildings, schools, and institutes that honor Leo Kanner both in the United States and abroad. (1928)
Child Psychiatry. (1935). In Defense of Mothers. How to Bring Up Children In Spite of the More Zealous Psychologists (1941)
Childhood Psychosis: Initial Studies and New Insights. (1973).