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Donald Triplett was autism’s “case 1” (economist.com)
74 points by jkuria on July 15, 2023 | hide | past | favorite | 62 comments


Grunya Sukhareva was studying (and published about, including in English) what we would now consider Autism in the 1920s. Perhaps it is because she was a woman, or because she was a Soviet, but histories often gives this credit to Leo Kanner or partial credit to Hans Asperger. I understand this is an obituary, but it does no one a service to indicate Donald Triplett was the first person to be treated for Autism.


"case 1" is in quotes here and it says diagnosed, not treated. It doesn't make the claim you're suggesting.


Indeed, one might even say the description on wikipedia clearly indicates he fared far better than many kids that did get treatment, even though they had much less symptoms than this guy.

https://en.wikipedia.org/wiki/Donald_Triplett


Aspie here. "treat" autism ? There is no treatment, only ways to adapt.


And accommodate.

Sometimes it's not us who should 'adapt'.

(MFW when learning that "strong sense of justice" was pathologized as a symptom of a disorder by allistics)


Beyond some point even kindness can be a pathology.


There are several treatments. CBT is one, there are some drugs that are given, and of course there is always psychoterapy.

Doesn't matter if those "treat the symptoms", they're still treatments.


Long ago there were probably (horrific) “treatments”. Lobotomy, etc.


There is a subtle but critical distinction in medicine between describing a cluster of symptoms and diagnosing a new condition. AIUI Sukhareva did the former and Kanner (also citing Sukhareva in later publications) the latter.

In particular, I don't think anyone is claiming

> the first person to be treated for Autism.

(Which depending on how you approach the question must either have been thousands of years before this, or could not happen until after Kanner proposed its existence). Rather the article is quite explicit,

> The first man diagnosed as autistic



I really appreciate that the town embraced and protected Don. May he rest in peace.


As the article mentions, Donald was featured in a documentary called "In A Different Key". I highly recommend it. Very informative about autism in general, the good, the bad, and everything in between.


Related:

Donald Grey Triplett: The first boy diagnosed as autistic - https://news.ycombinator.com/item?id=10944335 - Jan 2016 (16 comments)


Surprised he lived so long. Maybe because he was a celebrity so he received good care. Level 3s have an average lifespan of 30-40 years.


This includes things like suicide. In this case, however "he returned to his supportive hometown, where he worked for 65 years at a local bank that was partially owned by his father."


The New York Times had a nice obituary of him too, which I found heart-warming at the time: https://www.nytimes.com/2023/06/18/obituaries/donald-triplet...

http://archive.is/a0s9K


The Economist's obituary section is usually well worth the read, and this is a nice example. You can also listen to it through their free Intelligence podcast.


Ann Wroe is the editor of the obituary section. I read her book on Pontius Pilate, inspired by Ryan Holiday's recommendation, and I enjoyed it.

"This book was so overwhelmingly good that I could only read a couple pages at a time. How on earth did Wroe manage to produce such a rich and fascinating, 432-page book about a guy for which the historical record is not more than a couple artifacts and inscriptions? I don’t know–but that’s what makes it a masterwork. What so captivated me about this book is that although it is of course about the most seminal moment of the Christian world, it is happening inside the Roman world–the world of Seneca, literally. Seneca’s brother is in this book (he adjudicates a case involving St. Paul). Luciliius, who Seneca is writing his famous letters to, has the same job in a different province as Pontius. And by the way, that’s the most radical thing about this book: That you get to look at Pontius Pilate, the man who sentenced Christ to death, as a guy with a job. Did he do it well? How did it go so sideways? He said several times that he did not think Christ was guilty…he tried several times to get out of sentencing him to be crucified…yet in the end, he relented and did what he knew was wrong. What can that teach us? This was one of the most interesting and creative books I’ve read in a very long time. Wow."

https://mediadirectory.economist.com/people/ann-wroe/


"And when they span the boy would..."

This seems wrong to me. Past tense of "spin" is "spun".


Oxford English has two past tenses for spin:

    spin, v.

    (spɪn) 

    Pa. tense spun, span. 
As a commonwealth english speaker for six decades it reads fine to me.

    But he loved making things—blocks, pans, ashtrays, anything at all—spin.
    And when they span the boy would, as the psychiatrist’s report observed, jump up and down “in ecstasy”.
"And as they spun the boy would .." | "And as they span the boy would .." also parses.


I've never really had any cause to think about this before, but both past tense forms seem natural to me, and I think I use them both. I'm from the UK, if that helps.

I was trying to think of examples when I'd use each one, and it felt to me that I'd use spun if someone spun another object, and span if it was themselves that had been doing the spinning, so e.g. "I span around" (I turned around quickly) vs "I spun the crank" (I caused the crank to spin).

That said, I can also provide counter-examples: "I span the gyroscope" and "I spun around" also both sound completely natural to me, just that I think that I personally would use the other word in both cases.


“Spun” and “span” are both past tense forms of “spin”, but “span” is both archaic and singular, and so would be an odd choice in any current writing, and a disagreement in number where, as here, it is used with a plural subject.


Different past tense for singular vs plural? Are there any other words that have that besides "is"?

Wiktionary doesn't seem to mention it being singular, although I might be misunderstanding it:

> (dated, now uncommon) simple past of spin

https://en.wiktionary.org/wiki/span#English


> Different past tense for singular vs plural? Are there any other words that have that besides "is"?

Non-archaic? Quite possibly not. English has done a very good job of shedding inflections.

But “span” (as a past tense of “spin” isn’t non-archaic).

> Wiktionary doesn't seem to mention it being singular, although I might be misunderstanding it:

My sources were citing discussion in the OED, but I haven't verified them.


What do you mean singular? I span, you span, he/she/it span, we span, you span, they span. These all sound grammatical to me. I can’t think of many English verbs that inflect differently for the same person but different number. In fact off the top of my head the only one I can think of is “to be” (I am, we were)


There's nothing about it being singular in the dictionary. And I've seen both used in modern writing. Perhaps a US vs UK vs rest of the english speaking world thing?


Had to read that three times to understand the things were not spanning anything


You'd be surprised:

span (verb): Archaic or non-standard past of spin.


I'm interested in the etymology, and the detailed reasoning behind the choice of term "autism". Based on what I've read, I consider it to be an imperfect terminology, not just because of its inconsistent, broad brush and un-nuanced application, but because its a term borrowed from an earlier use, in which it was coined for an entirely different purpose.

Common information (including quotes in this article) mention the Greek roots of the word - "from Greek autos ‘self’ + -ism".

One source [0] states : "The term autism (from the Greek autos, meaning “self”) was coined in 1911 by Swiss psychiatrist Eugen Bleuler, who used it to describe withdrawal into one’s inner world, a phenomenon he observed in individuals with schizophrenia. The use of the word autism to describe the condition as it is known today originated in 1943, when Austrian-born American psychiatrist Leo Kanner [of the HN article we're currently discussing] distinguished the disorder from schizophrenia."

One might infer (correctly or not) that the etymology is principally based around a particular focus upon 'the self'. One short step from 'selfish'. Not the most flattering classification. Not one that I particularly enjoy, personally.

An opinion piece [1] alternatively states : "When I looked at the prefix and suffix of the word combined, I found that the word “autism,” in its purest form, means “a state of being oneself.”

And indeed, to interpret the term in that latter manner is reasonable, hopeful, and not inaccurate, but it isn't a targeted first-principles classification as such. All of which underlies the fact that, despite being classified as somewhere on the autism spectrum - and fully agreeing that, yes, I have some degree of minority condition or traits - if I'm ever asked outright "so, what is it, then?", I still have no concise answer. The term itself certainly holds little useful information, either for me, or the majority of people I have to interact with. We need better and more nuanced classifications to become common parlance.

Preferably (in reference to Asperger) not naming them after founding physicians, then later deciding that negative cultural associations veto the terminology.

And while I'm here shouting at clouds, I wouldn't mind if web browsers didn't consider "neurodiverse" to be a spelling error, in 2023.

/annoying rant

[0] https://www.britannica.com/science/autism

[1] https://www.jewishboston.com/read/etymology-of-the-word-auti...


The event that significantly improved my appreciation for the autism experience was viewing Temple Grandin starring Claire Danes. I could totally relate to the comfort of the "squeeze machine" and the way she figured out what was spooking the cattle. And the graphical demonstrations of how her mind worked when she was figuring something out. Here's to better-tasting steak.


For what it's worth, "autism" in Greek doesn't signify anything close to selfishness (that's "egoism"). It signifies, fairly congruously with the original definition, a withdrawal into one's self.


Fair enough. I still struggle to reconcile the root concept with the diverse reality. To the tune that I expect the classifications will look quite different in future, as understandings evolve.


Oh, for sure, my point was just that it doesn't sound negative in Greek.


Again full of prejudices this article


Was autism super rare historically? Surely there were plenty of cases over the centuries?


It would just have been labelled either 'eccentricity' or 'mental retardation' depending on the functioning level in antiquity, I imagine.


I wonder if general education had a factor in hiding some cases in the past. For example, is there much visible difference between an under-socialized / under-educated yet neurotypical person vs someone who is neurdivergent with that same education level and social/work life? And do the differences show up more when early general education is available? (Hopefully I phrased that question correctly).


> It would just have been labelled either 'eccentricity' or 'mental retardation' depending on the functioning level in antiquity, I imagine.

Or, sometimes, in 1985.


The article says the doctors weren’t familiar with what they were seeing.

It was rare enough that psychiatrists, who were very much looking for new ailments, just weren’t seeing what he had in other people.


> depending on the functioning level in antiquity, I imagine.

The classical difference between them is money. When a powerful person acted "crazy" the term used was "eccentricity".


Mostly, yes. but there were clearly common people in history that were described as 'somewhat eccentric' but still managed a normal-ish life otherwise. The chances are most of those were people who would today be labelled 'high functioning autistic' or 20 years ago would have been labelled as having aspergers.

What money/class-status afforded was the ability to be more eccentric without being pushed into an institution.


That's the meme, and it probably did go that way (crazy -> eccentric), but it's also true that someone who was just a little bit off would have been called eccentric whatever their social class.

It would not have been a very effective euphemism for a crazy rich person if it didn't also have the nicer meaning for everyone, rich or poor.


Yes. Level 1 could live their whole life not knowing about it and level 3 autists are basically chimps in human bodies and very difficult to care for if not disciplined properly. https://www.reddit.com/r/regretfulparents/comments/uhu7av/fu...


I agree with the other replier that describing autistic people as "chimps" is very inappropriate, though perhaps unintentionally so. I'm all too familiar with the coarse language some people like to use for those who are intellectually/socially disabled in some way, and I don't welcome seeing more of it here.

BUT I do think there is an important point buried in that comment.

It used to be when we spoke of autism, it was describing a very disabling condition, but increasingly we see a greater number of (for want of a better term) high-functioning cases falling under the label of 'autism'. Medical professionals even decided to get rid of the the separate diagnosis 'Asperger's' – a label that at least was something the public could understand as "like autism, but not quite".

None of this is to say that there weren't good reasons for broadening definition of 'autism'. And nor is it to say that high-functioning autistic people don't have problems they must deal with in everyday life. But I think one dangerous side effect of the conflation is that when we talk of "treating" autism, it is more obvious why one might want to do this in low-functioning cases. It's also obvious why high-functioning individuals might see this as an attempt to "erase" what makes them unique. Society can't adapt to everyone, but I absolutely think it can change to better accommodate the "high functioning".


Dehumanising people is abhorrent and has no place here.


I always wondered why there is such a huge discrepancy in people's perceptions of autism. You would think that people with autism are worse than Hitler based on what you read on the internet. The people who say the worst things (or even commit murder) also tend to be close relatives or professional caretakers, which makes it particularly shocking because this is in direct contrast with the other stereotype which is that even high functioning people with autism tend to be quiet and don't talk very much and stay out of the way of other people.

I don't know why these two things are lumped together as one thing.


To our knowledge it has been at a steady level throughout human history. Kant was mentioned in this thread, Henry Cavendish was also thought to be autistic. From Wikipedia:

> Cavendish was taciturn and solitary and regarded by many as eccentric. He communicated with his female servants only by notes. By one account, Cavendish had a back staircase added to his house to avoid encountering his housekeeper, because he was especially shy of women.

There are other threads that go back further as well, and at least in certain cultures there's a fairly broad overlap between shamanism, autism, and related neurological conditions. I've seen some studies tracking certain genetic mutations back and some at least are thought to have come about when humans started becoming human. I haven't been able to find them again but there are quite a few studies that can be found via Google Scholar on the subject.


To our knowledge? What documented knowledge are you going off of? You have a source on incident rates of autism going back 10, 20, 50, 100, 150, 200 years?


This is literally all conjecture.


If you go back far enough, autism wasn't distinguished from schizophrenia:

https://en.wikipedia.org/wiki/History_of_autism

> Eugen Bleuler was a Swiss psychiatrist who was the director of the Burghölzli mental hospital, which was associated with the University of Zurich.

> In April 1908 he gave a lecture explaining that dementia praecox was very different to other forms of dementia.[34] He proposed that it be given the unique name schizophrenia - a split mind. The term would be increasingly adopted over the next fifty years.

> What is now known as "schizophrenia" is different from what Bleuler described. He included what is today considered as autism, schizoid personality disorder and various schizophrenia spectrum disorders in his definition.

> The Neo-Latin word autismus (English translation autism) was coined by Blueuler in July 1910.[35] He first used it in print to describe a symptom of schizophrenia in the scientific paper "Zur Theorie des schizophrenen Negativismus"[36] (On the theory of schizophrenic negativism). He derived autismus from the Greek word: αὐτός, romanized: autós, lit. 'self', and used it to mean morbid self-admiration, referring to "autistic withdrawal of the patient to his fantasies, against which any influence from outside becomes an intolerable disturbance".[35][36]

> Bleuler created the term in reference to Sigmund Freud's term autoerotismus, shortening the latter term because he did not believe sexuality to be critical in the etiology of autistic symptoms.[36] He characterized the autistic patient as one who "wants to shut himself off from reality".[36] Autistic people, then, are those "most severe schizophrenics, who no longer have any intercourse at all, live in a world of their own".[37]

> Bleuler believed that the idiosyncratic behaviours of people with schizophrenia displaying autistic behaviour were due to them engaging with personal fantasy rather than with the world as it is.[1] He believed they drew on an early childhood mental state that was unable to form theory of mind.[1]

Point being, trying to track the incidence of mental and neurological disorders through history is even more difficult than most would imagine.


It's also pretty clear that, unless research totally stalls, 100 years from now we will have articles discussing how various yet to be coined disorders were all lumped under the label "autism".


I wonder about this too but there are people who definitely seem to have been autistic, e.g. Kant, so it can't have been that extremely rare.


Most of the biographical stuff I see about Kant emphasizes his stereotypical Prussian traits.

Now that I think about “Prussian virtues” and autism have some overlap.


Wow TIL! The categorical imperative is making more sense now


Because of his regular schedule?


Quoting Quora of all things here but:

> As autistic myself and student of philosophy, I’d say: probably, yes. I’ve read books that contain testimonials from Kant’s students and collegues. He showed ASD traits such as: (emotional and almost pathological) attachment to very strict routines; inability to control irritability and stress; inability to focus properly in certain situations (a famous example was given by his students: one day at a lesson he got stressed and refused to continue his speech because he felt unable to concentrate due to a missing button on a student’s jacket); he admitted to feel the inability to tell lies, even if for good purposes; in his writings he excuses many times for not being able to be clear about what he meant because he had an hard time putting himself in the reader’s shoes; he was described as socially akward and indifferent to social norms and costumes (famous was is dated and old-fashioned way of dressing), and to social relationships. We can’t of course be sure about Kant being autistic, but there is a possibility.

His "regular schedule" was more than that... It was a very detailed and strict routine which he was extremely attached to. I think his way of thinking so abstractly and also being unable to summarize himself are also things that resonate for me.


OK - I see there is a pretty strong case here.

One of the most astonishing Kant facts I've read (I've no idea how this could be verified) is that despite the sea being an hour away Königsberg, where he lived his whole life, he never felt the need to go and see the sea.


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Could easily have been about the same, only with autistic people beaten, possibly literally, into unhappy submission. As with left-handedness and homosexuality, in many cases it's probably not impossible to pass unnoticed if needs really must.


And most of the worst cases likely wouldn't have survived childhood.


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Nope, we're just learning to recognize it better, destigmatizing it so more people seek out a diagnosis in the first place, recognizing it's a spectrum and that people with a more subtle expression of autism can still be diagnosed, etc, etc, etc.

I know someone in their 50s who was diagnosed recently. They've been who they are their whole life. I know a lot of adults who have similar personality traits that haven't been diagnosed - I don't know how many would be, if they were to speak to a professional, but it's not 0. (I think there's maybe a 25% chance I could get an autism diagnosis, were I to talk to my doctor about it. People have encouraged me to, but I personally don't see how that information would be useful to me.)

These adults are the "missing" children from your statistics.


I think it’s at least relevant to note that a lot of things relating to autism was completely redefined in DSM-V. DSM-IV had many different diagnosis such as classic autism, autism spectrum disorder, aspergers and PDD-NOS (Pervasive Developmental Disorder - Not Otherwise Specified). All of those was merged into a single diagnosis titled ”Autism Spectrum Disorder”, where the criterias are communication difficulties and stereotypical behavior. My understanding is that this was mostly due to poor diagnosis stability with the prior set of diagnosis. It seems at least plausible that this general simplification of diagnosis criteria has contributed to an increase in the number of diagnosis. (It’s also worth remembering that any comparison over time has to bundle all of the previously distinct diagnosis to come up with an apples-to-apples comparison.)


Do you have any sources that back up increasing prevalism over better recognition and broader diagnostic criteria? Afaik almost everyone chalks it up to those 2.




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