Autistic Spatiality and the Limits of Care

Resolution WHA67.8 was published as part of the World Health Organization’s 67th World Health Assembly in 2014, which offered a point of action for the “comprehensive and coordinated efforts for the management of autism spectrum disorders.”1 While this call for the “management” of autism spectrum disorders (ASD) is a recent phenomenon, autistic activists and disability rights groups have long called into question the present-day psychiatric context of autism pathologization. Autism advocacy is divided in two camps: the despairing parents of autistic children on the one hand, and autistic individuals and disability justice advocates on the other. We see the former in the continued dominance of the non-profit organization Autism Speaks, which prioritizes parental support over societal change, and the continued use of Applied Behavioral Analysis (ABA) in institutions for neurodivergent children. Developed in the 1980s by psychiatrist and child abuser Ivar Lovaas, ABA traditionally utilizes methods that push autistic people to “mask” autistic traits so they can complete tasks in society as a neurotypical person would. ABA is a form of curative education, in which autistic ways of being are violently repressed to fit into a hegemonic notion of the established, governed world. This particular form of so-called therapy has received vocal and widespread outcry from the autistic community as well as the queer community, as ABA has direct associations with Gay Conversion Therapy. In both, “acceptable” thoughts and behaviors in social settings are rewarded, while unacceptable ones are punished with verbal abuse, confinement, and until recently, physical abuse.

Given current knowledge about the mind, how autists survive in society, and intersections of autism with gender and race, we know that “masking” has protected a significant number of autistic women and queer people from harm, though rendering them largely invisible to written history. But with the professionalization of psychiatry as a diagnostic practice in the early twentieth century and revolutionary responses to such practices, a language has been developed for autistic people to reclaim agency and define themselves in opposition to oppressive psychiatric regimes of behavior control. The autist-run blog Neuroclastic, for instance, describes how “members of the autism civil rights movement adopt a position of neurodiversity that encompasses a kaleidoscope of identities that intersects with the LGBTQIA+ kaleidoscope by recognizing autistic traits as natural variations of cognition, motivations, and patterns of behavior within the human species.”2 Centering autistic experience, then, confronts the peripheries of communicable subjectivity in the context of modern society as such.

Autistic modes of being are so internal to the self’s relationship to the body that nothing short of total freedom—bodily, psychological, and social—is required for a full autistic liberation. The very conditions of living are of immediate concern to autistic folks, whose currents of thought run along a number of different pathways and are fundamentally resistant to generalization and typologization.3 The urgency of understanding the spatial experiences of autistic people, then, stems from the root of sociopolitical anxieties imposed by urban modernity. The trajectory of autistic spatiality in an increasingly urbanized, territorialized Europe throughout the twentieth century has had fundamental implications for how liberatory autistic spaces might be reconceived as communities that exist at—and, therefore, challenge—the societal limits of care.

Steinhof am Main, plan showing Otto Wagner’s layout design (from Auszug aus der Verwaltungstatigkeit, n.p., courtesy ONB Wien). From Topp, “Otto Wagner and the Steinhof Hospital.”

Modernity, Psychiatry, and Otto Wagner’s Steinhof am Main

German sociologist Georg Simmel’s 1903 “The Metropolis and Mental Life” accounts for the large-scale, sociopsychological shifts that come with modern urbanization. As a totalizing and ordering force, urban forms emerging at the turn of the twentieth century challenged and restructured interactions between the individual and society at large. Technologies of order and rationality in the city—divisions of labor, maintenance of a standard time, spatial arrangements of dwelling space, etc.—had produced an alienation in the individual from both the self and society. Simmel notes that “the deepest problems of modern life flow from the attempt of the individual to maintain the independence and individuality of his existence against the sovereign powers of society, against the weight of the historical heritage and the external culture and technique of life.”4 The psychological effects of such a society are structural, coming to affect the internal life of the mind. Increasingly, “metropolitan individuality is erected,” with the attendant “intensification of emotional life due to the swift and continuous shift of external and internal stimuli.”5 The metropolis as a whole is a totalizing sensory experience, imposing conditions in which one’s “emotional life” is at risk. And at the core of urban metropolitan life are its institutions, where “in the formations of social life and in the concrete institutions of the State is to be found such a tremendous richness of crystallizing, depersonalized cultural accomplishments that the personality can, so to speak, scarcely maintain itself in the face of it.”6 The silencing of one’s internal life is endemic to Simmel’s metropolis.Figure 1. As a distinctly European project, the modern metropolis is a historical construct determined by a central governing state, elite interests in industrial expansion, and a social order that is both legible and controllable. As such, the design and use of “modern” psychiatric institutions have been used to pathologize autistic spatiality. Steinhof am Main, a psychiatric facility designed by Otto Wagner outside Vienna in 1907, is key to the history of autism diagnosis. The commission for the institutional complex arose out of a broader Austrian political shift toward the conservative Christian Social Party in 1896, which vowed to reform psychiatric housing and care in order to “elevate Lower Austria’s status among civilized nations.”7 This idealized “white city,” as art critic Ludwig Hevesi described it, was an “omen of modernity,” and a microcosmic site for the enforcement of “correct” social behavior as a cure to psychological affliction of various kinds. Steinhof am Main consisted of sixty buildings, a central church, agricultural land, an enormous kitchen that distributed meals, and an electric train running throughout the complex.

With plenty of open space and opportunities for agricultural work and religious life, the design of the complex was based on an ideal model of the metropolis. As historian Leslie Topp remarks about the opening of the complex, “the doctors and civil servants who planned Steinhof embraced an overblown psychiatric optimism, with a strong emphasis on publicity, and they sought to expand the influence of the mental hospital into the lives of the wider public.” But functioning as an ideal city also requires an ideal society, which in turn requires compliance on behalf of its residents. To this point, the pews of the church were specifically designed at such a height that should an individual deviate from expected behavior, Steinhof staff could forcibly lift the patient over the pew and remove them from the service altogether. From there, the patient would be transported to a number of locations depending on the severity of the reaction. Clinics, holding rooms, and isolation cells were all included in Wagner’s original designs, as were high walls enclosing gardens, iron-caged verandas, and other methods of spatial control that gave the illusion of freedom but were in fact modes of confinement at several scales.

Plan and photograph of Steinhofkirche. From Topp, “Otto Wagner and the Steinhof Hospital.”

With the rise of Nazi rule in Vienna, Steinhof became the site of the Nazi pediatric clinic Spiegelgrund, which from 1940 to 1945 served as the location for the holding and euthanasia of “uneducable” children who could not or would not conform to Nazi Youth education. In 1940, more than 3,200 neurodivergent or disabled adults who were living in Steinhof were executed in newly constructed gas chambers in order for nine of its thirty-four pavilions to be used for the reeducation, observation, or murder of hundreds of neurodivergent or disabled children. Scales of confinement at Steinhof under Nazi administration grew ever smaller, with “problematic” autistic children being placed in cages, or threatened with them.8 At the scale of the complex, the segregation of pavilions for “observation” and killing provided a horrific form of motivation for those in the curative education pavilions. The overarching goal of Nazi psychiatry, at Spiegelgrund and beyond, was not only to further genetic hygiene, but also—and perhaps more importantly—to measure childrens’ potential to be transformed into productive laborers for the ongoing preservation of the Nazi state.

Hans Asperger, a pediatric psychologist who would become a central figure in autism research, was a practitioner in this context. He earned his medical degree in 1931 at the University Children’s Hospital in Vienna. During the rise of the Nazi state, Asperger was a participant in increasingly white supremacist political activities, eventually joining the right-wing fascist “Fatherland Front” in 1934. In 1941, Asperger consolidated the Spiegelgrund and the Vienna Children’s Hospital into a network known as the Vienna Society for Curative Education along with Max Gundel, head of Vienna’s Public Health Office and municipal director of Spiegelgrund; Erwin Jekelius, medical director of Spiegelgrund; and Franz Hamburger, director of the University of Vienna Children’s Hospital. The administrators of the Society for Curative Education (Heilpedagogik) formed a network of state institutions that aimed to “educate” neurodivergent children to be able to contribute more broadly to Nazi society. The network facilitated the removal of uneducable individuals using existing psychiatric infrastructures compatible with the project of racial, neurotypical supremacy. Heilpedagogik clinics were a crucial part in the Nazi’s highly efficient network of concentration camps. On various scales, from the Spiegelgrund interiors to the infrastructures between the Heilpedagogik psychiatric centers where initial diagnoses occurred, Asperger facilitated and maintained a network of spatial control that both activated and built upon Nazi principles of ordered society.

Children at Spiegelgrund. From Sheffer, Asperger’s Children, 2018.

Building on his experience at the Society for Curative Education, Asperger published his doctoral thesis in 1944 entitled “The ‘Autistic Psychopaths’ in Childhood,” which considered individuals with milder social and executive functioning challenges (and put the “spectrum” in “autism spectrum”). Despite Asperger’s ties to the Nazi project as a whole, after World War II Asperger continued his psychiatric scholarship and consulted at the Vienna Children’s Hospital. In 1981, British psychiatrist Lorna Wing rediscovered Asperger’s thesis and publicized the diagnosis as “Asperger’s Syndrome.”9 This diagnosis rapidly gained recognition in the global psychiatric community, and in 1994 Asperger’s Syndrome was adopted by the Diagnostic and Statistical Manual of Mental Disorders (or the DSM). It was only in 2013 that the DSM changed its criteria to combine Kanner-type (non-verbal) autism and Asperger’s Syndrome into a single diagnosis, autism spectrum disorder (ASD). Still, the pathologization of autistic people remains, with autistic folks organizing to combat systems of autistic oppression that are inherently tied to State infrastructures of psychiatric accommodation or control.

Institutional Psychotherapy and Radical Politics

Asperger was not the only one working in the field of autism research. The term “autism” was coined far earlier, in 1911, by Eugen Bleuler, a Swiss psychiatrist who described patients “who have no more contact with the outside world, live in a world of their own, they have encased themselves with their desires and wishes (which they consider fulfilled) or occupy themselves with the trials and tribulations of their persecutory ideas… this detachment from reality, together with the relative and absolute predominance of the inner life, we term autism.”10 In 1925, Jewish Ukrainian psychiatrist Grunya Sukhareva studied and described autistic children, going on to lead the department of Psychiatry in Kharkov University in 1935.11 The closest to Asperger was the Austrian-born psychiatrist Leo Kanner, who fled Weimar Germany to the United States in 1924 and published a study on “autistic” children at Johns Hopkins University in 1943. Kanner worked closely with Georg Frankl, who had worked as Asperger’s diagnostician until, facing the emergent anti-Semitic state, fled Vienna in 1937.12 Kanner’s diagnostic is slightly different from Asperger’s, and is commonly referred to as “classic” or “Kanner-type” autism characterized by social and emotional withdrawal, little to no speech, and severe cognitive impairment. These practitioners would continue to define the field of autism research globally. However, the infrastructures of psychiatry would be fundamentally challenged in post-war France, where direct responses to psychiatric institutionality formed a spatial language for more radical psychological care.13

At Saint-Alban, a clinic in the mountainous Lozère region in France, a group of leftist psychiatrists built a community with mentally ill patients that would significantly challenge existing forms of diagnosis, pathology, and treatment. Their challenges were less psychiatric than social, communal, and based in autistic spatialities. Saint-Alban was originally founded by Spanish Socialist psychiatrist Fernand Tosquelles, and saw the participation of groundbreaking thinkers such as Frantz Fanon, Félix Guattari, and Michel Foucault.14 Marxist thought was integral to these individuals, and as such was foundational to their psychopolitical spatial formations. At Saint-Alban, social divisions between doctor, patient, and nurse were blurred, contributing to the sense of an integrated community of people living together rather than a place of hierarchical treatment. The institutional psychotherapy (IP) movement was not just about societal politics, but also metropolitan/peripheral relationships.15 The success of Saint-Alban can also be credited to the lack of architectural development in and around Lozère, in the countryside of the Cèvennes mountains, which enabled non-state institutions to take root and form counter-infrastructures to established hospital functionality. Taking lessons from Saint Alban, in 1952 Guattari joined with fellow psychiatrist Jean Oury to help establish the clinic La Borde in an unused chateau in the middle of a park in Cour-Cheverny, a small commune in France’s Loire Valley. Hierarchies established in hegemonic industrial society were done away with as much as possible. At both Saint-Alban and La Borde, nurses and doctors wore the same kinds of clothing as the “patients.” They shared tasks such as cooking and cleaning, as well as facilitating care and communication between residents of all types. Patients, meanwhile, took part in directing their own care, and free communication of ideas and collective need was prioritized.

Postcard of Cour Cheverny/Clinic La Borde. Source: Public Domain.

The chateau architecture of La Borde became a site of community and “transversality.” As Guattari defines it, transversality is “the unconscious source of action in the group, going beyond the objective law as on which it is based, carrying the group’s desire.”16 Desire—and the psychoanalytic determination of it by some facilitator—was thus crucial to the group’s functioning as an alternative psychiatric community. This meant prioritizing the shared experience of space in direct opposition to bureaucratic ordering in traditional hospital psychiatry, marked by the spatial politics of diagnosis, controlled movement, and spatial segregation. As a refuge for difference, La Borde operated on three principles: democratic centralism, a rotating basis for the division of labor, and anti-bureaucracy. Patients were free to roam the grounds and actively participated—or rather, had a standing invitation to—a central governing committee. By 1966, La Borde was well established among radical psychiatrists, philosophers, and political organizers. That year, Guattari invited Fernand Deligny, an educator whose treatment of autistic children reflected similarly radical modes of communal existence, to La Borde to continue his work with his community of autistic children.

Deligny had known Guattari and others from Saint Alban from organizing with the French resistance. After the war, Deligny started collective projects with other pediatric psychiatrists to form alternatives to harsh state-run psychiatric clinics and juvenile delinquent centers.17 At Guattari’s invitation, Deligny saw an opportunity for continuing and expanding his work with mainly non-speaking autistic children at the chateau. However, he found the psychoanalytic bent at La Borde to be insufficient for his work with his community; while the mentally ill already at La Borde had methods through which to communicate their desires, Deligny’s children simply enacted their desires in a typical autistic fashion, disregarding social structure in favor of total freedom of activity. As such, Deligny initiated a project, in line with his past work, which attempted to completely exit from the harms of society in an unused house owned by Guattari in the desolate Cévennes mountains nearby.

Deligny and his volunteers acted as monitors and occasional interactees with the non-speaking children, who for the most part went about their business playing with sticks and other natural materials around them and wandering about the settlement. As the children wandered, Deligny and one of his volunteer staff, Gisèle Durand-Ruiz, instituted a daily practice of tracing each child’s movements on a site plan. The resulting archive of over 300 “maps and wander lines,” traced from 1969 to 1980, points to a counter-infrastructural practice of autistic agency, removed both from legible social structure and any semblance of physical prescription of space. Deligny wrote extensively on the revolutionary and communal potential of what he called the “Arachnean Network.” Influenced by Karl von Frische’s Animal Architecture, such a network was created entirely by the autistic “Arachnean” as a relational web in refusal of the “thought-out project,” a term he used to encompasses any planned activity from cooking to architectural production. Deligny’s dense, poetic theorization of this space compares the resulting lines as connections in an “Arachnean Network” in which modernity—that is to say, urban plans, architectural programming, and attendant modes of conduct—is profoundly avoided. To quote Deligny: “can we say that the spider’s project is to weave its web? I don’t think so. We might as well say that the web’s project is to be woven.”18 This network, based entirely in autistic creation, places immediate sociospatial demands on a community that otherwise defies easy accommodation in architectural theory and practice.

The abandoned spaces that Deligny and his community occupied were deliberately underdeveloped, offering only basic necessities and depending on the broader institutional psychotherapy community at large for material resources and connections. Deligny’s focus on living in community with the non-speaking autistic subject required immense creativity, both in spatial arrangements and interpersonal interpretation. These maps and wander lines offer a point of contact between the autistic child and the concept of the “thought-out project,” drawing a dialectical tension between inhabitation and plan that undergirds the Arachnean network.19 As Sabel Gavaldon writes, “the maps drawn by Gisèle Durand-Ruiz combined the overlapping experiences of this territory as perceived and navigated by each of the children, revealing not just a rich universe of subjectivity, but in fact a plurality of inhabited worlds… Each of those charts and drawings contained dozens of intersecting lines but no arrows, and thus no direction, no teleology … just network.”20 The spatialities of this mode of collective psychosocial innovation resists easy architectural classification and analysis. Instead, the network itself becomes the dominant form of spatial arrangement. In fact, Deligny explicitly highlights the network’s incompatibility with even the term “architecture”: “if the observer had been present, his gaze alone would have disturbed the architecture of trajectories, and should his presence have lasted or recurred, the ‘vague’ space would have become vacant. This is where architecture disappears, and if the word seems excessive let us discuss the net of our trajectories.”21

Tracings of movements of autistic children. From Fernand Deligny, Sandra Alvarez de Toledo, and Cyril Le Roy, Maps and Wander Lines (Paris: L’Arachnéen, 2013).

The Limits of Care

Confronting state territorialization and the oppressive “surfaces” of state psychiatric models, Deligny’s network of simple dwellings, non-prescribed spaces, and objects “of no use” provided a free space for autistic life outside of the prescriptive, harmful binary of pathologization and cure so central to Asperger’s psychiatry. The Arachnean Network reflects an outright exit from the political hierarchy of the nation state and a localized exit from the hegemonic psychiatric doctor-nurse-janitor-patient hierarchy. Deligny’s “primordial communist” network in the Cévennes required little architectural framework; only the bare necessities and a handful of volunteer facilitators for the program. However, the broader network shared between the Arachnean Network, La Borde, Saint-Alban, the families of those housed within the facilities, and the broader French radical community was crucial to Deligny’s success. Deligny followed his Arachneans’ trajectories with trust and acceptance, those trajectories which were incommunicable except for the fact of their completion in space. By inheriting and elaborating upon the spatial thought of his contemporaries at Saint-Alban and La Borde, and by maintaining a geographically and socially close relationship to them, Deligny’s network of Arachneans crawled (and trotted, skipped, slept, and ran) relatively happily in the ridges of the Cèvennes for almost thirty years. The Arachnean Network thus forms a more totalizing view of what a psychotherapeutic urbanism might look like. From the periphery, architectural analysis and design is made secondary to active creation, compelling us to rethink our very modes of living.

Deleuze, Guattari, other theorists, journalists, and psychiatrists would come to visit Deligny’s primordial community, offering support where and however needed. The self-organized, non-hierarchical political network of resources independent from the French state provided a foil to government-run institutions of the era. The creation of a network outside of the necropolitical psychiatric network of post-World War II Western society tells of an emergent need to confront the idealist material conditions of Western political forms of organization. In responding to Nazi psychiatry, Guattari and Deligny were additionally responding to the material conditions of global imperialist society, in which colonial frontiers and internal mental health paradigms can be described in extremely similar terms. Indeed, the presence of Frantz Fanon in Saint-Alban and the militant, revolutionary spirit of those involved in the institutional psychotherapy movement speaks not just to the evolution of anti-capitalist philosophy, but also to the instituted praxis of independent communal mental health networks.

“If I wanted to indicate one of the constants of the network,” Deligny writes, “I would note an ‘outside’ as one of the necessary components. That said, and when space becomes a concentration camp, the formation of a network creates a kind of outside that allows the human to survive.”22 The outside is beyond established communicable boundaries. It is the unknowable interiority of the autistic life of the mind, which we must protect and cultivate as dearly as we protect and cultivate our interspecies communities, our local ecologies, our planetary landscapes, our ancestors, and our children. The evolution of psychiatric ordering must center the internalities of the supposed “patient,” thus enabling the maintenance of healing, agentic, and self-organized communities, pushing the limits of established psychiatric practice.