This harrowing book describes the context in which Hans Asperger developed his theories on autism during the Third Reich in Vienna. After the war, he gained a reputation for ‘defending those with disabilities’, but this book sheds new light on these assertions. Sheffer has studied his work from this period, and describes how he actively colluded with the regime by supporting the racial hygiene and ‘euthanasia’ programmes. This book was published a month after similar evidence was published in Molecular Autism (April 2018) by Czech, drawing on the same archival material.

Hans Asperger (1906–1980) was appointed to his first post by the new director of the Children's Hospital in Vienna, Dr Hamburger. Hamburger was a Nazi who promoted a ‘eugenicist vision of women as breeders and children as physical specimens’, and presided over the purging of all Jewish and liberal-leaning staff at the Children's Hospital. Asperger hailed Hamburger as his mentor. Asperger, a Catholic, did not join the Nazi party but belonged to several antiliberal, antisocialist and anti-Semitic groups.

In 1938, Asperger lectured on ‘autistic psychopathy’ and endorsed Nazi views on racial hygiene and the use of sterilisation laws to stop undesirable people from breeding. In 1940, he obtained a job as a medical expert in Vienna's Public Health Office, which screened people for hereditary diseases and then promoted the forced sterilisation programme in the interests of promoting positive eugenics.

Asperger described features of ‘autistic psychopathy’ as a ‘failure of the instinct functions, an interference of understanding the situations, and disruption of relationships with other people’. However, Asperger also emphasised that autistic children had ‘malice’ and ‘recalcitrance’. He developed these ideas in his 1944 thesis in which he stated that this ‘abnormal group of children’ lack ‘Gemüt’, the ability to take an interest in others. A poverty of Gemüt was a justification for euthanasia in the Nazi era. Asperger did protect some autistic children whom he believed could be educated, but was dismissive of those who were more disabled. Asperger sent at least 37 of his patients to Spiegelgrund, a children's clinic in Vienna, on the grounds that they lacked Gemüt or were ineducable. Sheffer describes conditions at Spiegelgrund where children were abused and experimented on, often dying from starvation or lethal injections.

Lorna Wing brought Asperger's clinical observations to the attention of English speakers, coining the term ‘Asperger's syndrome’ in Psychological Medicine (1981). Wing suggested that Asperger and Kanner were describing different aspects of the same condition, their work fitting together into an autism spectrum.

Having read this book, I am persuaded not to use the term ‘Asperger's syndrome’ as it raises the spectre of this barbaric time where medical values were distorted to support the Nazi ideology. This book is topical at a time when Müller (Lancet Psychiatry) has highlighted the belated apology to psychiatric victims by the German Psychiatric Association for the behaviour of German psychiatrists during the Reich.