The 1942 Kennedy-Kanner Debate in American Journal of Psychiatry

Kennedy-Kanner Exchange

Anti-psychiatry is a pseudoscience that denies the existence of psychiatric conditions, denies the efficacy of psychiatric medications and psychotherapy and considers psychiatrists to be evil and totalitarian monsters. Not all proponents agree on all details, but the beliefs and debating tactics is very similar to anti-GMO or anti-vaccine activists.

One common trope promoted by anti-psychiatry activists is to claim that if you support the benefits of modern medicine, you must support all aspects of medicine in history. This is, of course, nonsense, since you can accept life-saving treatments while rejecting bloodletting for infectious diseases without a contradiction. The same apply to psychiatry.

Anti-psychiatry proponents also abuse the scientific literature, trying to misrepresent it to further their own ideological goals. One such misrepresentation, in conjunction with the above tactic, occurs for the Kennedy-Kanner debate in the American Journal of Psychiatry in 1942. Despite it being 74 years ago and completely irrelevant to modern psychiatry, anti-psychiatry activists attempt to taint modern psychiatry with the beliefs expressed by the neurologist doctor Kennedy, despite the fact that the psychiatrists Kanner debunked most of the claims put forward by Kennedy.

At the time, forced sterilization was legally sanctioned in the U. S. and the debate was on the question of whether individuals with severe neuropsychiatric conditions should be forcibly ‘euthanized’ or not. Before we examine the flawed arguments by Kennedy and the refutations offered by Kanner, let us first look at how a modern scientific refutation of such a totalitarian nightmare would look.

Why involuntary ‘euthanasia’ is scientifically invalid and morally abhorrent

Involuntary ‘euthanasia’ of individuals with neuropsychiatric disabilities (or any other individuals for that matter) is considered to be a form of unjustified killing and murder by most scientific, medical and legal institutions. This is because it is not based on informed consent, violates a number of declarations of human rights and medical ethics and is based on pseudoscience. It seems bizarre that this issue is even discussed, but one of the best weapons against nonsense and bigotry that we currently have is scientific evidence and medical ethics.

It violates informed consent: informed consent is required for all medical procedures under basic medical ethics. However, informed consent is probably not possible because it requires the individual to fully comprehend all relevant aspects of the situation and because life is such a key value or instinct to humans (and indeed almost all organisms) that one can reasonably suspect that any “consent” being given to being killed is tainted and not acceptable. Or to put it more harshly, no one can consent to being involuntarily killed.

It violates human rights: the first article of the U.N. declaration of Human Rights states that “all human beings are born free and equal in dignity and rights”, the second article states that “everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind […]”, and the third article states that “everyone has the right to life, liberty and security of person.” Involuntary ‘euthanasia’ (murder of children and adults) violates these articles and many more. It is not reasonable to apply human rights selectively, because then they would by definition not be human rights. Human rights have been shown to be effective and sustainable compared with arbitrary exceptions and societies that apply the human rights perspective thoroughly are safer and better places to live in. If you open up to some arbitrary exceptions, you open the door for others.

The false positive rate is unknown: even if we, for the sake of argument, where to accept the bigoted and unscientific procedure of involuntary ‘euthanasia’, it is not at all clear how often we would be mistaken. For instance, the death penalty is conservatively estimated to have an empirical false positive rate of ~4.1% and probably higher. It is likely that involuntary ‘euthanasia’ would have comparable or higher empirical false positive rate since there are so many unknowns involved.

The reliability of decision makers is unknown: it is unknown to which degree different medical panels would agree in their decisions. If there was a marked difference in decisions by different medical panels (which we can reasonably suspect that there would be), it is a very insecure and arbitrary system.

It neglects the full range of biology: biological influences are more than genes, and so a naive view of biological impact that is restricted to the direct influence of genes is flawed.

It neglects environmental influences: proponents of forced eugenics had their golden age in a time where scientific information about the influences and causes of neuropsychiatric disabilities was not known. These proponents typically had an extreme humanitarian perspective, almost completely neglecting environmental causes. Today, we know that some neuropsychiatric disabilities are influenced by e. g. brain injuries, oxygen deprivation etc. and modern science and medicine has developed ways to reduce the risk of these events.

Neglects the complicated interaction between biology and environment: today, we know that essentially all human features are caused by a complicated interaction between biology and environment. Thus, simplistic hereditarian ideas put forward by proponents of forced eugenics are grossly out of step with modern science.

Neglects the low explanatory power of specific genetic variants: most genetic risk factors for psychiatric or neurodevelopmental conditions have a very low explanatory power. That is, the variation in particular risk factors only explains a small part of the variation in a given trait. This might be because there are a very large number of genetic risk factors involved (each with a very small influence), because of genetic interactions between genes, different genetic risk factors between different populations or the impact of copy number variation.

Neglects the possibility of gene therapy: even if there was a condition that was completely determined by genetics, it is possible to use gene therapy to replace the part of a gene that is broken with DNA that makes it functional again. For instance, gene therapy has been used to treat genetic blindness with surprising effectiveness. Gene therapy can also be used on human egg and sperm or even human embryos in the future, repairing disease-causing genetic errors before they have any effect. Even without gene therapy, sperm and eggs without genetic errors can be selected before conception.

It confuses biology with immutable: just because something has a biological or genetic influence does not mean that it is immutable or unchanging (for the reasons listed above and many others).

Assumes blind utilitarianism: proponents of forced eugenics arbitrarily assumes without evidence that utilitarianism is the correct moral theory in all instances. But there are many problems with utilitarianism that they have not addressed. For instance, there are situations where an event causes an increase in average happiness (or whatever metric you use), but all existing individuals are now less happy. The classic example is a worldwide pandemic that kills everyone besides people in a western European country. The average has gone up but everyone is less happy because they no longer have access to the intellectual, artistic and technological fruits of other countries or cultures.

It ignores the economy of scale: there is enough financial surplus being produced to give all the support needed for individuals with neuropsychiatric conditions. This is extremely obvious since so much money is being wasted on wars, alternative medicine fakery and other questionable targets. Health care and other forms of support creates jobs, benefits caretakers and society at large.

There are many other problems with forced eugenics, but this is enough to refute most core beliefs held by proponents of forced ‘euthanasia’.

Why the arguments used by Foster Kennedy do not hold up to critical scrutiny

The first part of the debate was a paper called “The problem of social control of the congenital defective: education, sterilization, euthanasia” written by Foster Kennedy. In it, he advocated murder of people at the age of five or over that were lost causes and had been evaluated by a panel of medical experts several times with a few months between evaluations. In this paper, he made several flawed claims:

Assumes impossibility of being mistaken: Kennedy literally claims that the category of people he wants to be murdered “with care and knowledge, impossible to be mistaken in either diagnosis or prognosis.” This is, of course, a completely batshit delusion. There is no way to guarantee that it is “impossible to be mistaken in either diagnosis or prognosis” and Kennedy surely did not cite any scientific references for this claim. This is the sign of a totalitarian fanatic, not a reasonable scientist or medical doctor.

Uses anecdotal evidence: Kennedy appeals to anecdotal evidence when he brings up alleged letters he had gotten from parents who supposedly want to have their children killed off. However, he cites no scientific evidence for what proportion of parents actually did want to murder their own children.

Wildly inconsistent: Kennedy refuses to accept murder of sick people because he thinks this will put dangerous weapons in the hands of “wicked men, or, worse, in the hands of the foolish”. But this is, of course, the exact same danger that will occur and has occurred historically when implementing these ideas in practice. You give the power over life and death to people who may not have your interests or the interests of society, in mind. This is very dangerous and has been very dangerous historically.

Leads to a dangerous slippery slope: Once you start murdering people based on arbitrary reasons, it is easy to expand those arbitrary reasons a bit more. This is not a fallacious argument, but a historical fact.

Assumes that human value comes from good work: throughout his paper, Kennedy assumes that the worth of a person is measured from good work, in particular intellectual achievements. But this is a very privileged position and not at all accurate as there are a lot of people who make large contributions to society in ways that are not based on intellectual achievements.

Assumes that “what is best for society” is always best: Kennedy, like many proponents of forced ‘euthanasia’, assumed that the highest virtue was that which is best for society. But it might be extremely beneficial for society to imprison the richest 1% and steal all of their money and resources and distribute them to everyone else, but Kennedy would probably refuse this (since he was likely to be in the richest 1% at the time). What is best for society is often relevant, but it is not at all the highest possible virtue.

How did Leo Kanner oppose the claims made by Kennedy?

Leo Kanner wrote the opposing case, largely defending individuals with neuropsychiatric conditions from the creeping hands of totalitarian annihilation. His paper was titled “Exoneration of the feebleminded” and was published in the same issue (although it is based on a speech delivered a year after the speech given by Kennedy). His major rebuttals were:

Some treatments might work: Kanner questioned the assertion that all individuals with neuropsychiatric conditions are resistant to treatment. In particular, Kanner rejected the narrow focus on specific treatments. He also opened up for future effective treatments and methods that prevented disability.

Broad diversity of neuropsychiatric conditions: Kanner emphasized that neuropsychiatric condition is not a categorical absolute, but that there is a broad diversity and that it is therefore not valid to treat them as a homogeneous group in the way that proponents often did.

The mental is not just the intellectual: Kanner rejected the overly heavy focus on the intellectual, and pointed out that it is invalid to judge the mind of a person purely on the basis of the intellect or more precisely the results of IQ tests.

Counterexamples: Kanner provided a counterexample to the notion that people with very low IQs are a burden to society. This might appear to be a case of anecdotal evidence, but it is valid to disprove a claim that is supposed to apply to all elements in a category by offering a counterexample. Kanner also used psychopaths and other high-functioning threats to society and the world (including Hitler) to show that we should not equate normal or high intelligence as a proxy for beneficial contributions to society. He also used historical examples such as the Galileo affair, genocides and the Inquisition to show that it was not individuals with neuropsychiatric disabilities were behind the historical offenses to science and humanity.

Highlighting the impact of culture: Kanner pointed to the fact that our view of disabilities are influenced by culture. For instance, individuals with some neuropsychiatric disabilities might be equals or even superiors in cultures that do not focus on intellectual attainment. More specifically, Kanner argues that it is society that partially forces people with some neuropsychiatric disabilities to be alleged “drags on society” and that it is, in fact, reasonable to argue that it is society that is a drag on those individuals.

People with neuropsychiatric disabilities do contribute: Kanner provided many examples of important jobs (industry, animal handling, manual labor etc.) in society that could be carried out by individuals neuropsychiatric disabilities. He also pointed out that this frees up a lot of time for others to carry out creative activities. Although this is a bit tactless with modern standards, Kanner did debunk the central claim made by Kennedy with regards to contributions to society, even thought he did not go into the details with the problem of equating good work with value.

Psychiatry should not take advice from Nazi Gestapo: being in the middle of World War II, Kanner made the following argument that should be quoted in full:

Psychiatry is, and should forever be, a science dunked in the milk of human kindness. Shall we psychiatrists take our cue from the Nazi Gestapo? Does anyone really think that the German nation is in any way improved, ennobled, made more civilized by inflicting what they cynically choose to call mercy deaths on the feebleminded?

Kanner clearly saw through the charade of “euthanasia” and call it for what it was: the murder of people who the elite thought was difficult to handle.

If you can spend billions on war, you can support people with disabilities: Kanner rightly pointed out that if a country can spend billions of dollars on wars without a shrug, they surely have the finances to support people with neuropsychiatric disabilities:

We have just recently decided with a shudder to spend 50 billion dollars in this one year to rid ourselves of a non-feebleminded menace to civilization [i.e. Hitler – Emil’s note]. This sum would be ample to maintain luxurious institutions for all those who need them and to provide proper education for all the intellectually inadequate for more than half a century. In return we should get not a world in ruins but the satisfaction of helping ourselves by helping tens of thousands of people. In return we should find that an increasing number of the intellectually inadequate would become skillfully adequate for many useful and needed jobs. We should be able to recognize them as full-fledged human beings capable of virtues and vices like the rest of us, only perhaps with less cunning and plotting, less suited for leadership but also less suited for misleadership.

Again, Kanner is not the most tactful person with modern standards, but his main argument is clear: supporting people with disabilities is hardly an economic burden on society.

However, Kanner’s paper is not without criticism. He did call sterilization “often a desirable procedure”, but argued that this should not be done based on IQ (calling that an “unfair discrimination”) and that there are many unknowns in heredity and that broad sterilization of individuals with neuropsychiatric disabilities would rob society of “people whom we desperately need for a variety of essential occupations” and that if “we decided to annihilate the intellectually inadequate today, we would experience a disaster compared to which the present world-wide holocaust would seem like a trifle.”.

Kanner is to some extent influenced by the contemporary political climate, where sterilization for eugenics was legally sanctioned in the U. S. for decades before the Nazis, but it is still unscientific and morally wrong for Kanner to accept any forms of forced sterilization.

What did the anonymous editorial claim?

An editorial from the journal accompanied the two papers. It was unsigned, so we do not know who wrote it, if more than one person wrote it, or if it had the full support of the journal. The editorial gave a superficial appearance of weighting the arguments, but ended up advocated for the position defended by Kennedy through dishonest misrepresentation of the arguments made by Kanner. The editorial falsely claimed that the only argument used by Kanner was that the parents might disagree, but as we have seen, he made many other arguments. The editorial suggested that some parents might have a pathological sentimentality for their disabled children and that this might be the focus for psychiatric attention.

In summary, the anonymous editorial was irrational and unscientific, but did admit that proponents of forced euthanasia was in the minority among psychiatrists.

A survey of this debate and the historical context is given by the paper “The 1942 ‘euthanasia’ debate in the American Journal of Psychiatry” written by Jay Joseph and published in the journal The History of Psychiatry.

The anti-psychiatry connection

So to sum up this exchange from 1942, The American Journal of Psychiatry hosted a debate about involuntary “euthanasia” (i.e. murder). Kennedy wrote a paper supporting the murder of people with severe neuropsychiatric disabilities. Kanner forcefully argued against this on several levels and largely refuted the claims made by Kennedy. Although Kanner also argued against forced sterilization of many individuals with neuropsychiatric disabilities, he could not fully uncouple himself from his culture and did not universally condemn it (instead calling it “often desirable”). An unsigned editorial was intellectually dishonest, misrepresented Kanner and took the position of Kennedy.

Modern anti-psychiatry proponents spread misinformation about this debate, falsely claiming it was a debate about whether individuals with neuropsychiatric disabilities should be forcibly sterilized or murdered (claiming that these were the only two options), but Kanner never called for universal forced sterilization. Considering the historical context, Kanner opposed a lot of his contemporaries who promoted broader approaches to forced sterilization and the large majority of psychiatrists opposed murdering people with neuropsychiatric disabilities.

Another common denialist tactic is to assert that if you defend modern medicine, you must defend all historical versions of medicine as well. Thus, if you defend modern psychiatry against pseudoscientific anti-psychiatry, you must also support all historical actions and beliefs held by psychiatrists. This is of course completely mistaken. Just because you think that modern, life-saving surgery is worth defending does not mean that you think that flawed ancient or historical attempts at surgery is categorically beneficial. That is the entire point with medical development! You reject the things that do not work, and embrace and develop the things that do work.

There is also an important difference between pseudoscientific attacks on medicine with genuine scientific improvements. One can accept the latter, but oppose the former without contradiction. Scientific skeptics do not oppose all criticisms of psychiatry, only the pseudoscientific ones.

Emil Karlsson

Debunker of pseudoscience.

2 thoughts on “The 1942 Kennedy-Kanner Debate in American Journal of Psychiatry

  • September 6, 2016 at 21:57
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    It was good to read this. In the autism community, Leo Kanner is often remembered for his blaming the condition on “refrigerator mothers” who “lacked maternal warmth.” This hypothesis of his did substantial damage to families of those on the spectrum. His rigid criteria for an autism diagnosis (contrary to that of Dr. Asperger) is also responsible for a general misunderstanding of the features and historical prevalence of the condition that persists today. Perhaps it is unfair to criticize him for how his opinions were received publicly, but he certainly was a principle contributor to several severely harmful ideas (that were and sometimes still are accepted as fact) about autism. I’ve always considered him almost a villain; I am heartened to read of his standing up for the rights and dignity of those with neuropsychiatric disabilities.

    • September 7, 2016 at 00:44
      Permalink

      Kanner partially changed his view later on, but the damaging effects of the refrigerator mother idea was already in motion.

      Kanner certainly did stand up for the rights and dignity of individuals with neuropsychiatric disabilities and stark contrast to many of his contemporaries, but he could not completely divorce himself from the political climate at the time. Although he rejected sterilization for many varieties of neuropsychiatric disabilities, he did not issue a blanket condemnation of the practice (calling it “often desirable”).

      So both Kennedy and Kanner are in some sense villains here from the perspective of modern science and medical ethics, but Kanner certainly comes out as considerably less batshit than Kennedy, for what it is worth.

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