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Grunya Kuhavera was a Jewish Ukrainian psychologist who discovered autism almost 20 years before Leo Kanner and Hans Asperger published their work. They did not have the first accounts of autism, Dr. Sukhavera did.
Dr Sukhavera was born in Kiev to a Jewish family of Kahaim Faitelvich and Rakhil losifovna Sukhavera.
Dr. Sukhavera graduated medical school in 1915 in Kiev. Upon graduation, she joined a team of epidemiologists that traveled to areas of Ukraine affected by outbreaks of encephalitis and other infectious diseases.
When the Russian Revolution broke out two years after her graduation and medical professionals fled or died in battle, she joined Kiev’s psychiatric hospital. There was a shortage of doctors, so she helped where she was needed.
In 1921, Dr. Sukhavera relocated to the Psycho-Neurological and Pedagogical Sanatorium School of the Institute of Physical Training and Medical Pedology(Russian term for psychiatry) in Moscow. This institution was opened to help orphaned, traumatized or displaced children due to World War I. It took a more scientific approach to understanding child development than most clinics at that time.
The way this clinic was set up may have helped Sukhavera to describe autistic traits as accurately as she did. Her assessments were extremely detailed. They included the psychical health, noting hemoglobin counts, muscle tone, gastric health, skin conditions and other details. She documented small changes in behavior. These were lack of smiles, excessive movements, a nasal voice or a trigger to a meltdown. She spoke to many members of thier families when observing some behaviors that ran in families.
First Observation of Autism
In 1924, a 12 year old boy came to her clinic in Moscow for an evaluation. He was different than his peers and other people did not interest him. He preferred the company of adults to children his own age. He didn’t play with toys. He taught himself to read by the time he was 5 years old and spent days reading everything he could. He also had anxiety and frequent stomach aches.
When Dr. Efimonva (before she was married) saw him, she was carrying and attentive. She saw him as “highly intelligent” and that he loved to engage in philosophical discussions. As a diagnosis, she called him an “introverted type, with an autistic proclivity into himself.”
Autism was a Term for Describing A Mental Illness
At the time she called him autistic, it was a new term in psychiatry. 10 years before this, a Swiss psychiatrist, Eugene Bleuler, coined the term to describe social withdrawal and detachment from reality often seen in children who have schizophrenia.
Showing Autistic Children Were Different Than Schizophrenic Children
When she saw this 12 year old boy, she used the word autistic like Bleuler did. But as she saw more children who had the same trait, she decided to characterize it more fully.
Over the next year, she identified five more boys having “autistic tendencies.” All five showed a preference for their “inner world.” Each child had their own quirks and talents. One child was a very gifted violinist but struggled socially. Another child had a gifted memory for numbers but could not recognize faces. Another child had an imaginary friends who lived in the fireplace. None of these children were popular with other children. One child saw interaction with his peers useless. “They are too loud, they are hindering my thinking.”
In 1925, she published a paper describing in detail the autistic features the six boys shared. Her descriptions were simple enough for the lay person to understand but they were well written.
Setting Up Schools
Throughout the years, Dr. Sukhavera launched schools all over Russia. Her reach stopped at the boarders, hindered in part by political and language barriers. Only a small fraction of Russian research from that time was translated into other languages that wasn’t German. Even so, her 1925 paper on autism traits appeared in German the following year but the translation butchered her name and spelled it as “Ssucharewa.” This particular paper did not reach English speaking countries until 1996, 15 years after her death
Well Before Her Time
According to Irina Manouienko, a psychiatrist who runs a clinic in Stolkhom, Sweden,”Basically she desribed the criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).” Dr. Manouilenko translated Dr. Sukhavera’s work from Russian to English in 2013. She then compared them tp the diagnostic criteria described in the DSM 5. She was in awe of the similarities.
Basically, the Jewish woman doctor could have written the criteria before World War 2 that is written in the most current DSM. It took nearly a century for the DSM 5, in 2013 after years of debate. They just arrived back at the doctor’s list.
For example, where Dr. Sukhavera wrote about “flattened affective life,” “lack of facial expressiveness and expressive movements,” and “keeping apart from their peers, it is a parallel to what the DSM 5 describes as social deficits.
Another example is when the doctor descried as “talking in sterotypical ways,” the DSM portrays as stereotyped repetitive behaviors, restricted interests and sensory sensitivities.
Dr. Sukhavera is not well known in the West but is the most well known name in child psychiatry in Russia, according to Alexander Goryunov, the lead researcher in the child and adolescent psychiatry department at the Mental Health Research Center in Moscow. She saw and evaluated these children when the Society Union was still in power, so there was some isolation.
Work Reviewed in 2011
In 2011, on the 120th anniversary of her birth, the Neurology and Psychiatry Journal reviewed her wide ranging contribution to the field. She published more than 150 papers, six monographs and several textbook on topics such as intellectual disability, schizophrenia, and multiple personality disorder and other conditions. She was also a gifted teacher and mentored some doctoral students.
Why Her Work Was Lost For So Long
It is not proven but it is certainly possible that Hans Asperger , who Aspergers Syndrome was named for, read Sukhavera’s paper in German and chose not to cite it.
The first description of autism made by Asperger happened in 1938. Her description was published in 1926.
In 2018, historians Edith Shiffer and Herwig Czech independently reported that they found evidence of Asperger’s cooperation with the Nazi Party. He sent dozens of disabled children to be murdered.
It is speculated that that since Sukhavera was Jewish he may not have wanted to give her credit. Manoulienk speculates that he may not have been permitted to give her credit but no one will truly know this.
Written like a parent, Sukhavera wrote that her goal was to help the children “stay connected with real life, its tempo and movement.” She was sensitive and intuitive as a clinician, it’s unfortunate that it took so long for her work to be accessible.
Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5696677/
https://www.scientificamerican.com/article/how-history-forgot-the-woman-who-defined-autism/
https://link.springer.com/article/10.1007/s00787-021-01875-7
Fierce Autie 