by John Donvan
Grant argued for the forced sterilization of people deemed not worthy of procreating. So powerful was the enthusiasm for eugenics that seventeen states legalized forced sterilization in the 1920s. These measures found support all over the political spectrum. In 1926, Margaret Sanger, the founder of Planned Parenthood and a defender of the disadvantaged, said to a Vassar College audience: “The American public is taxed, heavily taxed, to maintain an increasing race of morons, which threatens the very foundations of our civilization.”
The state of Mississippi’s sterilization law was written to cover hereditary “insanity, feeblemindedness, idiocy, and epilepsy.” In fact, Mississippi was less aggressive in sterilizing its disabled than some other states. By 1933, the year Donald was born, twelve people had been forced to undergo the procedure, versus 1,333 in Virginia and 8,504 in California. In 1939, Mississippi’s laxity seemed to bother an editorial writer for the Delta Democrat Times in Greenville. Envying Virginia’s record, and “the money the state was set to save by practicing preventive eugenics”—which reduced the financial burden of caring for “defectives”—the writer suggested hopefully that “Mississippi might profit by Virginia’s example.” Donald was five years old when that editorial appeared.
Of course, Hitler, once in power, took things a great deal further. He started World War II eight months after that Delta Democrat Times editorial, and under his rule, following his “bible,” the number of disabled Germans murdered to purify the racial stock of the Third Reich reached into the tens of thousands.
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REMARKABLY, CONSIDERING that the United States was by then at war with the Nazis, a soberly worded endorsement of “mercy killing” for mentally disabled children appeared in the July 1942 issue of the American Journal of Psychiatry, published by the American Psychiatric Association. It was written by Robert Foster Kennedy, an Irish-born American neurologist.
“Nature’s mistakes,” Kennedy argued, deserved relief from the burden of a life “that at no time can produce anything good at all.” He called for painless methods of killing and spelled out a careful selection process. First, the parents of such a child would need to request the death. Then, three examinations should be conducted, over time, but only after “a defective…has reached the age of five or more.” Should it then be found “that the defective has no future nor hope of one,” he wrote, “then I believe it is a merciful and kindly thing to relieve that defective—often tortured and convulsed, grotesque and absurd, useless and foolish, and entirely undesirable—of the agony of living.”
Not everyone took Kennedy’s side. In the very same issue of the Journal of Psychiatry, there appeared a six-page clarion call for the “humanization” of the mentally disabled, a recognition that each disabled person has a place in society. The author used the language of the era—defectives, feebleminded, imbeciles—but his compassion for the disabled and his respect for their dignity and right to exist was palpable. Indeed, he wrote, it was time that psychiatrists ceased “to treat the term mental deficiency as a swear word,” and to recognize that when a society diminishes the standing of its weakest, the whole society is diminished as well. “By exonerating the feeble,” he concluded, “we thus exonerate ourselves.”
And so a rare gauntlet was thrown down on behalf of mentally disabled children, by a child psychiatrist from Johns Hopkins named Leo Kanner. Kanner was, at that time, less than a year away from publishing a far more important article, one that would be quoted around the world and into the next century. It began with a description of a boy who had been brought to Kanner’s Baltimore office by his parents six years earlier. The boy was from Mississippi, and his name was Donald Triplett.
3
CASE 1
The Preventorium had been a premature surrender. True, life was more serene now at the Triplett house. The new baby was so different from Donald. Oliver looked at them when he smiled, and he curved his body into their arms when they held him. Even so, either Mary or Beamon, or both of them, eventually reached the conclusion that the Preventorium was the wrong solution for Donald, and that it was far too soon to give up trying to find the right one. They had already traveled all over Mississippi, and as far north as Minnesota, in search of answers. This time, they would travel even farther, to Baltimore, to meet with a doctor by the name of Leo Kanner.
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IN THE 1930S, Leo Kanner ranked as the top child psychiatrist in the United States, perhaps even the world. It had only been thirty years or so since psychiatry had discovered childhood as a subspecialty; it took the profession quite some time to cease thinking of children merely as miniature adults. Kanner’s 1935 book, Child Psychiatry, was for many years the standard, and only, textbook on the topic. He was the first head of the department of child psychiatry at Johns Hopkins University in Baltimore, which was, in turn, the first such academic department of its kind in the United States. To American eyes, Kanner certainly looked the part. Slight and stooped, with oversized ears and a basset hound face, he spoke English in a high, reedy voice, with an accent so heavy that at times he was incomprehensible. Like Sigmund Freud, he was both Austrian and Jewish.
Kanner’s move to the United States, in 1924, happened on a whim. That was something of a pattern with him. He was once hit by a train when, on a lark, he took a stroll out onto a railroad bridge where it crossed over water. Having never learned to swim, he was lucky to be saved from drowning by a member of the train crew. He had tried, also on impulse, to join the German army as a young man to fight in World War I. Rejected due to his small stature and two missing front teeth, he headed for the recruiting office of the Austrian army, where he was accepted.
Kanner was sent to the front as a medical corpsman but, with his hands stained with the blood of men far too young to die, he quickly realized that war was not for him. He performed his hospital duties fully and well, then worked just as diligently at arranging a series of transfers for assignments farther and farther from the front. He won an honorable discharge one year into his service, granted on the premise that he would be more valuable to the Fatherland as a fully trained physician. He committed to return to Germany to start medical school.
By late 1923, Kanner, now a husband and father, had been in general practice in Berlin for three years, and his patient list was growing. It might have gone on this way had he not befriended a young American physician, Dr. Louis Holtz, who had come to Berlin to take a few medical courses. Kanner liked Holtz enormously and began bringing him home for dinners. Holtz, who had recently become a widower, took comfort in the Kanners’ company and appreciated the friendship extended him in a foreign land. Over dinner, he would regale Kanner and his wife, June, with stories of the wonders of life in America. Having resolved to repay the Kanners’ kindness, Holtz talked Kanner into applying for a visa to the United States—just in case he ever wanted it—and then turned up bearing a written offer of a position as a physician at the South Dakota State Hospital for the Insane, in Yankton, South Dakota. Within four weeks, Kanner had arranged for a one-year leave of absence from work and shipped the family’s two featherbeds to America.
Kanner was thirty years old and fluent in seven languages when he arrived in Yankton. Unfortunately, English wasn’t one of them. He worked at changing that, just as he worked hard to adopt American ways. He bought a Chevrolet, tried to take an interest in golf, and joined a weekly poker game. Soon enough, he was publishing medical articles in English. He learned to live with the fact that Americans were always either misspelling or mispronouncing his last name, which rhymed with “honor.” (When they did pronounce it right, they often assumed they were talking to “Dr. Lee O’Connor.”) Eventually, he became known around Yankton as “the German doctor,” not a bad credential when German medicine was seen as the best in the world.
In the United States, most psychiatrists started out as garden-variety MDs who learned the specialty by going to work in mental institutions—just as Kanner was doing. The discipline of psychiatry was stil
l young enough that doctors largely taught themselves, sorting out what worked and what didn’t patient by patient, by trial and error, gradually formulating their own guiding principles for how to treat mental illness. It was at Yankton that Kanner noticed, and rejected, an institutional penchant for pigeonholing patients by syndrome. He hated this. Too much emphasis was put on figuring out what label to stick on each patient, he concluded, and not enough time was spent listening to the patients themselves. Kanner developed his own style of writing up an individual’s medical history. Instead of the usual dry compendium of dates and previous illnesses, he presented his patients’ histories in full sentences, with well-developed paragraphs and telling details taken from his personal observations. This would become a hallmark of his work: to appreciate the actual stories of his patients, and to use that understanding as the key to diagnosing and treating them.
More controversially, Kanner became increasingly impatient with medical procedures that seemed to have no rationale other than habit. One Christmas Eve, Kanner ordered that most of the restrained patients be released from their straitjackets for the evening. The floor supervisor objected strenuously and took the matter to the hospital director, but Kanner prevailed—by volunteering to spend Christmas in the ward personally. It worked out—there were no incidents—except that his wife had to spend the day without him. By the time the holiday was over, it was clear that the straitjackets were unnecessary. The patients remained unrestrained from then on.
In 1928, Kanner, ever ambitious, met and impressed Adolf Meyer, the head of psychiatry at Johns Hopkins, which led to Kanner’s landing a fellowship there. Two years after arriving in Baltimore, Kanner was tasked with establishing the university’s first clinical department of child psychiatry.
In short order, he became the field’s most prominent figure. This was not least due to Kanner’s penchant for seeking the spotlight. He wrote often for the popular press, where he positioned himself as a demystifier of the art and science of childrearing and as a defender of the weak and vulnerable—clearly relishing, and even cultivating, the recognition that came with that role. He also worked for years on an autobiography in which he related, in minute detail, his striver’s story of a small-town boy who wanted to be a poet, making good instead as a man of medicine on the world stage. While he looked in vain for a publisher, the manuscript went through several rewrites. But it remained a portrait of a progressive doctor fighting with skill, wit, and humility against entrenched forces that sought to crush the human spirit.
In fact, his self-portrait was not entirely unjustified. When Jewish psychiatrists and other medical professionals were fleeing the Nazis in Germany and Austria, he personally intervened in scores of cases to ensure that the refugees were granted permission to enter the United States, and then he helped them find jobs so they could support themselves and start over again. Taking into account the families of those he aided, Kanner can be credited with saving hundreds of lives.
More publicly, Kanner blew the whistle in 1937 on a racket run out of the Baltimore Home for the Feebleminded. While working on a study of outcomes for released patients, he and a social worker named Mabel Kraus learned that ten to twenty years earlier, close to a hundred teenage girls had ended up in what he described as slavery. The scheme was engineered by a corrupt judge and a lawyer working on behalf of dozens of wealthy Baltimore families. For a fee—which the two men split—the judge authorized the release of the girls to specific families who claimed to be giving the girls homes. Instead, they put them to work as servants, scrubbing their toilets and in some cases, Kanner hinted, sexually servicing males in the family. Many of the young women ended up on the street, in prostitution. By the time Kanner found out about this, the judge enabling this abuse had long since retired. But Kanner went public with the details anyway, in a speech to the American Psychiatric Association. After that he told the story to newspaper reporters.
The man who had released mental patients from their straitjackets also held relatively progressive views—for his day—on race. In 1938, he told a young doctor who wrote asking for “a comparison of the Negro child’s mental abilities with that of the white race” that no difference existed. “The fact that a child comes into the world as a Negro does in no way serve as a barometer for his intellectual potentialities,” Kanner wrote back. At the time virtually all mental hospitals were still segregated by race.
Yet for all his manifest high-mindedness, Kanner was no radical. Having worked so hard to reach the upper ranks of American society, he never took a stance that truly ruffled feathers or risked alienation from that society. Instead, he hedged. While exposing the scandal of the servant girls, for example, he rued the fact that the women were having children, who were likewise mentally disabled, and he refused to name the wrongdoers publicly. And his letter to the doctor about racial differences was private. In public, he never questioned the racial segregation that prevailed in the wards of Johns Hopkins into the 1950s. Similarly, although he spoke out against euthanasia for the disabled, and opposed the forced sterilization of those with low IQs, he described sterilization as “a desirable procedure” when parents were too intellectually impaired to care for their children safely, in which case the obligation for care would fall to society. Thus, Kanner, who clearly aspired to land on the right side of history, was still in many ways captive to the views of his day.
This then was the man Beamon and Mary turned to in 1938 to get help for their son. But before meeting the boy, the doctor who liked stories asked to know a bit more about him. So in the late summer of 1938, Beamon set out to write for America’s greatest child psychiatrist the complete story of Donald.
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BEAMON TRIPLETT didn’t type. For that, he needed Katherine Robertson, who commanded the outer room of his one-man law practice. Hardly a word went out above Beamon’s signature that did not go through Katherine. Beamon would dictate in his mild Mississippi drawl while she filled her notepad with shorthand. Then, she typed.
Kanner would later remark on the sheer amount of detail Beamon packed into the letter, which struck him, frankly, as the output of an obsessive man. Perhaps so, for Beamon did come with a few personality wrinkles of his own. There was his tendency to tune out the world when he went for walks, to the point where he couldn’t remember afterward where he’d been or whom he’d seen along the way. While at Yale Law School, he had cracked under the pressure and taken to his bed with what he regarded as a nervous breakdown. A doctor he consulted diagnosed an irrational fear of teachers.
But that had been years ago. Beamon was successful now, a sharp lawyer, a man with first-rate observational skills who had every reason to want to get this letter absolutely right. And he was determined to compose a full biography of this four-year-old child trapped in the Preventorium, a place that made no sense for him. In time, Beamon’s words would travel far and wide. They would be quoted in scholarly research; discussed in university classrooms; translated into multiple languages; excavated, late at night, by frantic parents scouring the Internet. But that humid day in Forest, it was just one father speaking, and it was Katherine Robertson alone who heard this story, for the first time, and got it down.
“He never seems glad,” Beamon dictated, “to see father or mother. He seems almost to draw into his shell, and live within himself.” In minute detail, he described Donald’s eating habits, his verbal patterns, the clarity of his enunciation, the ages at which he learned to walk and count and hum and sing. And so it poured forth, what would become the seminal account of a child with autism, a term and diagnosis that did not yet exist.
The Donald that Beamon described was unreachable by any of the usual ways parents connect to their children: “He seldom comes when called but has to be picked up and carried or led wherever he ought to go.” Yet, at the same time, the toddler Donald tantalized his parents with hints of a sharp intelligence. His focus on the activities that captivated him could not have been more intense. “He seems always to be
thinking,” Beamon observed, “thinking and thinking.”
Beamon listed the things Donald had committed to memory at the age of two: the words of many songs and the melodies that went with them; the names of all of the presidents of the United States; and “most of the pictures of his ancestors and kinfolk on both sides of the house.” Yet Donald could do little with these facts beyond reciting them. Conversation was impossible, Beamon said, as “he was not learning to ask questions or to answer questions.”
He appeared indifferent to the company of other children, and in one episode Beamon recounted, he positively shunned them. One day, in what was meant as a pleasant surprise, a playground slide was delivered to the Triplett backyard. Donald seemed not to grasp its function, but a small crowd of neighborhood children did. As they clambered all over it, Donald held back, resisting furiously when his father picked him up and sat him at the top to show him how it worked. “When we put him up to slide down, he seemed horror-struck,” he recounted.
It was different, though, when no one else was there. The next morning, he walked out, climbed the ladder, and slid down. He knew, after all, exactly how it worked. Beamon reported that Donald continued to slide on it frequently, but only when no other children were present.