Grunya Efimovna Sukhareva

I thought I knew a lot about autism, including the history of autism.  But then someone I follow on Instagram brought an amazing woman to my attention.  Her name is Grunya Efimovna Sukhareva.

We have been led to believe that autism was first described by American child psychiatrist of Austrian-Hungarian origin, Leo Kanner in 1943, and by Austrian paediatrician Hans Asperger in 1944.  Kanner made clinical descriptions of 11 children that later were classified as having the classical early infantile autism.  Asperger described ‘autistic psychopathy’ in four boys that later took the name ‘Asperger Syndrome’.  The actual word ‘autistic’ was first used in 1911 by Eugen Bleuler, a Swiss psychiatrist.  It was used to describe a group of symptoms (such as detachment from reality and social withdrawal) that was commonly seen in childhood schizophrenia.

Grunya Efimovna Sukhareva was a Soviet child psychiatrist.  She was born in 1891 in Kiev (which is now Ukraine but was then part of the Russian Empire).  She had a long career in child psychiatry and went on to become the most well-known name in child psychiatry in Russia.  She was very versatile, and made wide-ranging contributions to her field, publishing over 150 papers and several textbooks on intellectual disability, multiple personality disorder, schizophrenia and other conditions.

Before relocating to Moscow’s Pyscho-Neurological and Pedagogical Sanatorium School of the Institute of Physical Training and Medical Pedology, Sukhareva worked for a few years treating patients with infectious diseases as well as at Kiev’s psychiatric hospital.  It was at the Sanitorium in Moscow where Sukhareva observed six boys who she described as having ‘schizoid pyschopathy’.  She never used the word autism, but she described a syndrome that has very similar characteristics to what was later called autism.  She first published her clinical writings about these boys in 1925, in Russian, and then later in 1926, in German, in the psychiatry journal Monatsschrift für Psychiatrie und Neurologie.  This is almost two decades before Kanner and Asperger published writings.

Sukhreva’s assessments of the six boys were incredibly detailed and included the children’s physical health, including their muscle tone, gastric conditions and even their hemoglobin counts.  She documented their behaviors and took detailed family histories, noting that certain traits ran in families.  According to Sukhareva, the boys showed a “lack of facial expressiveness and expressive movements”, “a flattened affective life”, a lack of social interaction, isolation, and odd social behavior. She also described a “tendency towards automatism”, which included obsessive interests, stereotypic speech and behaviors, and a desire for things to always happen in the same way.  What is most notable is that Sukhareva noted the presence of sensory abnormalities such as heightened sense of smell and hearing, which only gained recognition in the description of ASD in the DSM-5.

No one knows if Kanner and Asperger were aware of Sukhareva’s work when they published their clinical observations in 1943/44, however we do know that Kanner sited Sukhareva in a paper published in 1949.  Why was Sukhareva’s work not more widely recognized?  I believe it was a combination of the following: the fact that she was a woman, the fact that she was Jewish, and the fact that the psychiatry journal she published in was not widely distributed. Her 1925 paper did not reach the English-speaking world until 1996, when it was stumbled upon by British child psychologist Sula Wolff.  This was 15 years after the death of Sukhareva.

I can only imagine how the journey of autism would have been different if Sukhareva’s writings were widely distributed and her findings understood.  Sukhareva was kind, compassionate, observant and understanding.  She launched schools like the sanatorium across Russia.  Thousands of children were observed, cared for, took classes in gymnastics, drawing and woodwork, and taken on outings to zoos and other public places.  This is vastly different to the experiences of the children later diagnosed as autistic, who were often locked away in mental institutions and maltreated by clinicians practicing their torturous forms of ‘behavior therapy’.  If only her findings had been discovered earlier.  It is too late to change the past, but it is not too late to recognize the amazing woman who was Grunya Efimovna Sukhareva.