{"id":4368,"date":"2026-03-11T09:23:17","date_gmt":"2026-03-11T09:23:17","guid":{"rendered":"https:\/\/martinemussies.nl\/web\/?p=4368"},"modified":"2026-03-11T09:23:18","modified_gmt":"2026-03-11T09:23:18","slug":"grunya-sukhareva-autism-history","status":"publish","type":"post","link":"https:\/\/martinemussies.nl\/web\/grunya-sukhareva-autism-history\/","title":{"rendered":"Grunya Sukhareva and the early observation of autistic behavior"},"content":{"rendered":"\n

Published in Hektoen International Journal of Medical Humanities<\/a>.<\/em><\/p>\n\n\n\n\n\n\n\n

Grunya Efimovna Sukhareva was born and trained in Kyiv, Ukraine. By the early 1920s she had moved to Moscow, where she worked in a school for children with neurological difficulties and began keeping meticulous records of her young patients. She noted their difficulties alongside their gifts: a boy who had taught himself to read at five but was physically awkward, a gifted violinist who struggled to connect with peers, a child who could recite numbers with astonishing precision but could not recognize faces. What she observed she described with unusual care and without condemnation. Nearly a century before neurodiversity became a framework for understanding human variation, she was already practicing its essential gesture\u2014looking at children as they were, rather than as medicine wished them to be.<\/p>\n\n\n\n

This article argues that Sukhareva\u2019s papers from 1925 and 1926 demonstrate two things with equal force: that diagnostic categories are historically contingent rather than timeless discoveries, and that clinical empathy is itself a form of epistemological rigor. Her case studies preceded the landmark publications of Leo Kanner and Hans Asperger by nearly two decades,1,2<\/sup> yet her work went uncited in Western psychiatry for the better part of the twentieth century. To revisit Sukhareva\u2019s observations is to ask not only who described what first, but why certain voices carry and others do not\u2014and what knowledge is lost when they fail to reach us.<\/p>\n\n\n\n

A physician ahead of her time<\/h3>\n\n\n\n

Grunya Efimovna Sukhareva was born in Kiev in 1891 and completed her medical degree there in 1915, at a time when women in medicine faced formidable institutional barriers.3<\/sup> She worked initially at a psychiatric hospital in Kiev before relocating to Moscow, where she founded and led several therapeutic school-hospitals for children, settings that combined clinical observation with education. Her scholarly output was remarkable in its scope: over a lifetime she produced more than 150 papers, monographs, and textbooks in child psychiatry, ranging from studies of childhood psychosis and epilepsy to clinical lectures that remained standard teaching texts in Soviet psychiatry for decades.4<\/sup><\/p>\n\n\n\n

Her earliest published work already showed the orientation that would define her career. In a 1921 monograph on the analysis of children\u2019s fantasies as a method of studying emotional life, Analiz detskikh fantaziy kak metod izucheniya emotsional\u2019noy zhizni rebyonka<\/em>, she argued that children\u2019s imaginative expression offered a window into psychological states inaccessible through standard clinical questioning.5<\/sup> This commitment to looking carefully at what children actually did and said, rather than fitting them into predetermined categories, became the methodological foundation of her later work on what she would call schizoid psychopathy.<\/p>\n\n\n\n

Her most consequential work emerged from sustained observation of children at the Psychoneurological Department for Children in Moscow. Between 1923 and 1925, she closely observed six boys aged two to fourteen who had spent approximately two years in her hospital-school. The results were published in Russian in 1925 as \u201cShizoidnye psikhopatii v detskom vozraste<\/em>\u201d (\u201cSchizoid Psychopathies in Childhood\u201d) and translated into German the following year for the Monatsschrift f\u00fcr Psychiatrie und Neurologie<\/em> under the title \u201cDie schizoiden Psychopathien im Kindesalter<\/em>.\u201d6<\/sup><\/p>\n\n\n\n

Sukhareva worked within the psychiatric vocabulary of her era, drawing on Kretschmer\u2019s and Bleuler\u2019s concept of \u201cschizoid\u201d personality. Her use of the term was more descriptive than diagnostic; she used it to mean something closer to \u201ceccentric\u201d than \u201cdisordered.\u201d In a 1930 follow-up paper in the Zhurnal nevropatologii i psikhiatrii<\/em>, she refined her analysis of the structure and dynamics of these constitutional psychopathies in children, moving toward a conceptualization that she would later name \u201cautistic (pathological avoidant) psychopathy\u201d\u2014a label that would prove prescient.7<\/sup> The clinical profile she assembled, before either Kanner or Asperger had begun their work, shares remarkable phenomenological overlap with the autism spectrum as it would later be formalized.<\/p>\n\n\n\n

The children she observed<\/h3>\n\n\n\n

What distinguished Sukhareva\u2019s clinical portraits was their texture. In \u201cDie schizoiden Psychopathien im Kindesalter<\/em>,\u201d she described children who struggled to adapt to social environments, who were excluded by peers, who seemed to inhabit worlds of intense private preoccupation. She also paid equal attention to their gifts: exceptional memory, musical talent, early self-directed literacy, and philosophical thought in children far younger than expected.8<\/sup><\/p>\n\n\n\n

She documented stereotypical, repetitious behaviors and described flattened emotional affect. One child answered all questions with the same ritual refrain: \u201cDon\u2019t ask me, I won\u2019t tell you anyhow, it\u2019s my secret.\u201d9<\/sup> She noted sensory sensitivities, difficulty with transitions, and strong attachment to routines, a clinical picture that reads, a century later, with striking familiarity.<\/p>\n\n\n\n

In 1927, Sukhareva published a sequel focused on five girls, \u201cDie Besonderheiten der schizoiden Psychopathien bei den M\u00e4dchen<\/em>\u201d (\u201cThe Particularities of Schizoid Psychopathies in Girls\u201d), again in the Monatsschrift f\u00fcr Psychiatrie und Neurologie.<\/em>10<\/sup> There she identified what she called sex-related differences in presentation: girls showed a less prominent overall clinical picture, greater affect dysregulation, and less idiosyncratic interests, while sharing the core autistic disposition. This paper was not translated into English until 2020. The question of why girls with autism were historically missed or misdiagnosed is one that contemporary researchers are still working to answer; Sukhareva had already mapped part of the terrain.<\/p>\n\n\n\n

Why her work was forgotten<\/h3>\n\n\n\n

The reasons Sukhareva\u2019s work failed to circulate in Western psychiatry are multiple and interlocking. Her original 1925 paper appeared in Russian, a language with limited reach in Western academic medicine, and though the 1926 German translation brought her work into a more accessible venue, German-language psychiatry was itself disrupted by the upheavals of the 1930s and 1940s.11<\/sup> Neither Kanner nor Asperger, in their landmark papers of 1943 and 1944, cited her work or appeared to be aware of it.<\/p>\n\n\n\n

Her position within the Soviet Union compounded this invisibility. In the Stalinist years, Sukhareva faced pressure from authorities who criticized her work as insufficiently Marxist in orientation.12<\/sup> Working in an increasingly repressive academic environment, she had limited access to international scholarly networks. The isolation was not merely administrative; it reflected a geopolitical order that systematically excluded Soviet science from Western discourse, and Western scholarship from Soviet institutions.<\/p>\n\n\n\n

There is also a subtler reason for her obscurity. The clinical paradigm of the era favored categorical diagnosis over phenomenological description, pathology over observation. Sukhareva\u2019s approach\u2014attentive to talent alongside difficulty, cautious about premature judgment\u2014was at odds with a psychiatric culture oriented toward classification and containment. The very qualities that make her work admirable now may have made it seem insufficiently rigorous then. Her empathy was perhaps too visible. In this sense, her marginalization is itself diagnostic: what a field cannot accommodate tells us as much about that field as about those it excludes.<\/p>\n\n\n\n

Sukhareva within her own intellectual tradition<\/h3>\n\n\n\n

To position Sukhareva primarily as a precursor to Western diagnostic categories is to misread her on her own terms\u2014and, more broadly, to reproduce the very epistemic hierarchy that caused her work to be overlooked in the first place. She wrote from within a distinctive and intellectually generative Soviet psychiatric tradition, and her early publications coincided with the flourishing of the pedological movement<\/em>\u2014an ambitious interdisciplinary project that sought to integrate psychology, pedagogy, and medicine into a unified science of the child.<\/p>\n\n\n\n

This institutional and conceptual environment was not merely a backdrop to her work; it was constitutive of it. The pedological movement provided a framework in which careful, descriptive attention to individual children was not an idiosyncratic methodological preference but a shared scholarly commitment. When Stalin dissolved the movement by decree in 1936, denouncing it as pseudo-scientific, something more than an institutional structure collapsed: a particular way of knowing children (attentive, non-reductive, resistant to premature categorization) lost its organizational home.<\/p>\n\n\n\n

To read Sukhareva\u2019s concept of\u00a0\u0448\u0438\u0437\u043e\u0438\u0434\u043d\u0430\u044f \u043f\u0441\u0438\u0445\u043e\u043f\u0430\u0442\u0438\u044f<\/em>\u00a0(shizoidnaya psikhopatiya) as a rough equivalent of the Kretschmerian \u201cschizoid\u201d as understood in Western European psychiatry is similarly reductive. Her terminology drew on a specifically Russian clinical genealogy, shaped by the work of Bekhterev and Serbsky, that carried different theoretical commitments and different assumptions about the relationship between constitution, character, and pathology. Collapsing these distinctions in the interest of a tidy priority claim does not honor her work; it merely annexes it.<\/p>\n\n\n\n

On the concept of forgetting<\/h3>\n\n\n\n

The language of forgetting, however rhetorically convenient, is philosophically imprecise. Within the Soviet Union, Sukhareva was not forgotten; she was, by any reasonable measure, canonized. Her three-volume Clinical Lectures on Child Psychiatry<\/em> (1955\u20131965) remained a standard pedagogical text in Soviet psychiatric training for decades, and the Moscow institution where she worked for forty years now bears her name. What she was denied was not recognition but transmissibility<\/em>: the capacity of her work to cross the geopolitical and linguistic boundaries that structured mid-twentieth-century scientific exchange.<\/p>\n\n\n\n

What was at stake was not simply an oversight of Sukhareva\u2019s work, nor that she went unread in the West, but that the conditions governing whose knowledge traveled, whose languages were deemed scientifically legible, and whose institutional contexts were considered worth engaging with systematically disadvantaged Soviet scholarship and continue, in subtler forms, to shape the geography of academic knowledge today. To name this as \u201cforgetting\u201d is to aestheticize what was, in fact, a political and epistemological arrangement.<\/p>\n\n\n\n

What her observations teach us now<\/h3>\n\n\n\n

Reading Sukhareva through a neurodiversity lens is not a retrospective imposition of contemporary values onto her work. It is a response to her methodology. She described behavior, affect, perception, and talent, building her portrait from what she observed rather than from the pathological categories her era provided. It is precisely because her analysis rested on description rather than on the terminology of schizoid psychopathy that it remains legible and recognizable after a century of diagnostic revision.<\/p>\n\n\n\n

This is the approach that contemporary neurodiversity scholars argue we need more of. In my 2023 monograph Inside the Autside: A Misfit Manifesto<\/em>, I argue that autism is a natural variant within the human species, and that the neurotypical norm distorts our understanding of both autistic and neurotypical lives alike.13<\/sup> Sukhareva, writing a century earlier, had arrived at a compatible position through clinical practice: the children she described were not failed neurotypicals but people with coherent, if different, patterns of perception and engagement with the world.<\/p>\n\n\n\n

Her observations on talent are particularly striking in this context. She did not treat her patients\u2019 gifts as anomalies unrelated to their difficulties\u2014she held them together, suggesting that the same qualities that made social life challenging might also be the source of remarkable capability. This integrative vision aligns closely with contemporary strengths-based approaches to autism, which emphasize building on individual capacities rather than normalizing behavior.14<\/sup><\/p>\n\n\n\n

Her work on girls carries its own urgency. The long-standing clinical assumption that autism occurs almost exclusively in males left generations of women without diagnosis or support. Sukhareva, in 1927, had already charted a female phenotype: less socially conspicuous, differently expressed, but present and recognizable. That this had to be re-discovered decades later speaks to the cost of silencing certain voices in medicine\u2014a cost borne by patients, not by the institutions that did the silencing.<\/p>\n\n\n\n

Conclusion<\/h3>\n\n\n\n

In 2015, Moscow\u2019s Scientific and Practical Centre for Mental Health of Children and Adolescents\u2014the institution where Sukhareva worked for forty years\u2014was officially renamed in her honor. The recognition is deserved, if belated. But institutional memory is not the same as intellectual reception, and her work has yet to receive its full due in the international literature on autism history.<\/p>\n\n\n\n

What she offers, beyond historical justice, is a model of clinical attention. To observe children carefully, to record what they love alongside what they struggle with, to resist the premature closure of a label\u2014these remain as necessary as ever. Her case studies demonstrate that the capacity to see neurological differences with both precision and humanity was always available. It did not await a more enlightened era. It required only the willingness to look and the intellectual modesty to describe what was seen.<\/p>\n\n\n\n

Sukhareva saw children who were different. She wrote down what she saw. That the world took so long to hear her is worth understanding\u2014because the conditions that produced that silence have not entirely disappeared, and the people who need to be seen are still there.<\/p>\n\n\n\n

References<\/h3>\n\n\n\n
    \n
  1. Posar A, Visconti P. Tribute to Grunya Efimovna Sukhareva, the woman who first described infantile autism.\u00a0J Pediatr Neurosci.<\/em>\u00a02017;12(3):300\u2013301.<\/li>\n\n\n\n
  2. Boven F.\u00a0Solitary Persons? The Conceptualisation of Autism as a Contact Disorder by Frankl, Asperger, and Kanner.<\/em>\u00a0Dissertation, University of Groningen; 2022. https:\/\/doi.org\/10.33612\/diss.198178158.<\/li>\n\n\n\n
  3. Sher DA, Gibson JL. Pioneering, prodigious and perspicacious: Grunya Efimovna Sukhareva\u2019s life and contribution to conceptualising autism and schizophrenia.\u00a0Eur Child Adolesc Psychiatry.<\/em>\u00a02023;32:475\u2013490.<\/li>\n\n\n\n
  4. See, for example: \u0421\u0443\u0445\u0430\u0440\u0435\u0432\u0430 \u0413. \u0415.\u00a0\u041a\u043b\u0438\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u0435 \u043b\u0435\u043a\u0446\u0438\u0438 \u043f\u043e \u043f\u0441\u0438\u0445\u0438\u0430\u0442\u0440\u0438\u0438 \u0434\u0435\u0442\u0441\u043a\u043e\u0433\u043e \u0432\u043e\u0437\u0440\u0430\u0441\u0442\u0430.<\/em>\u00a0\u0422. 1. \u041c: \u041c\u0435\u0434\u0433\u0438\u0437; 1955; \u0422. II. \u041c: \u041c\u0435\u0434\u0438\u0446\u0438\u043d\u0430; 1959; \u0422. 3. \u041c: \u041c\u0435\u0434\u0438\u0446\u0438\u043d\u0430; 1965.<\/li>\n\n\n\n
  5. \u0421\u0443\u0445\u0430\u0440\u0435\u0432\u0430 \u0413. \u0415.\u00a0\u0410\u043d\u0430\u043b\u0438\u0437 \u0434\u0435\u0442\u0441\u043a\u0438\u0445 \u0444\u0430\u043d\u0442\u0430\u0437\u0438\u0439 \u043a\u0430\u043a \u043c\u0435\u0442\u043e\u0434 \u0438\u0437\u0443\u0447\u0435\u043d\u0438\u044f \u044d\u043c\u043e\u0446\u0438\u043e\u043d\u0430\u043b\u044c\u043d\u043e\u0439 \u0436\u0438\u0437\u043d\u0438 \u0440\u0435\u0431\u0451\u043d\u043a\u0430.<\/em>\u00a0\u041a\u0438\u0435\u0432; 1921.<\/li>\n\n\n\n
  6. \u0421\u0443\u0445\u0430\u0440\u0435\u0432\u0430 \u0413. \u0415. \u0428\u0438\u0437\u043e\u0438\u0434\u043d\u044b\u0435 \u043f\u0441\u0438\u0445\u043e\u043f\u0430\u0442\u0438\u0438 \u0432 \u0434\u0435\u0442\u0441\u043a\u043e\u043c \u0432\u043e\u0437\u0440\u0430\u0441\u0442\u0435. \u0412 \u043a\u043d.:\u00a0\u0412\u043e\u043f\u0440\u043e\u0441\u044b \u043f\u0435\u0434\u043e\u043b\u043e\u0433\u0438\u0438 \u0438 \u0434\u0435\u0442\u0441\u043a\u043e\u0439 \u043f\u0441\u0438\u0445\u043e\u043d\u0435\u0432\u0440\u043e\u043b\u043e\u0433\u0438\u0438,<\/em>\u00a0\u0432\u044b\u043f\u0443\u0441\u043a 2. \u041c; 1925:157\u2013187. Published in German as: Ssucharewa G. E. Die schizoiden Psychopathien im Kindesalter.\u00a0Monatsschrift f\u00fcr Psychiatrie und Neurologie.<\/em>\u00a01926;60:235\u2013261.<\/li>\n\n\n\n
  7. \u0421\u0443\u0445\u0430\u0440\u0435\u0432\u0430 \u0413. \u0415. \u041a \u043f\u0440\u043e\u0431\u043b\u0435\u043c\u0435 \u0441\u0442\u0440\u0443\u043a\u0442\u0443\u0440\u044b \u0438 \u0434\u0438\u043d\u0430\u043c\u0438\u043a\u0438 \u0434\u0435\u0442\u0441\u043a\u0438\u0445 \u043a\u043e\u043d\u0441\u0442\u0438\u0442\u0443\u0446\u0438\u043e\u043d\u043d\u044b\u0445 \u043f\u0441\u0438\u0445\u043e\u043f\u0430\u0442\u0438\u0439 (\u0448\u0438\u0437\u043e\u0438\u0434\u043d\u044b\u0435 \u0444\u043e\u0440\u043c\u044b).\u00a0\u0416\u0443\u0440\u043d\u0430\u043b \u043d\u0435\u0432\u0440\u043e\u043f\u0430\u0442\u043e\u043b\u043e\u0433\u0438\u0438 \u0438 \u043f\u0441\u0438\u0445\u0438\u0430\u0442\u0440\u0438\u0438.<\/em>\u00a01930;6.<\/li>\n\n\n\n
  8. Ssucharewa G. E. Die schizoiden Psychopathien im Kindesalter.\u00a0Monatsschrift f\u00fcr Psychiatrie und Neurologie.<\/em>\u00a01926;60:235\u2013261. See also the first English translation: Ssucharewa G. E., Wolff S. The first account of the syndrome Asperger described?\u00a0Eur Child Adolesc Psychiatry.<\/em>\u00a01996;5:119\u2013132.<\/li>\n\n\n\n
  9. Sher DA, Gibson JL. Pioneering, prodigious and perspicacious.\u00a0Eur Child Adolesc Psychiatry.<\/em>\u00a02023;32:480.<\/li>\n\n\n\n
  10. Ssucharewa G. E. Die Besonderheiten der schizoiden Psychopathien bei den M\u00e4dchen.\u00a0Monatsschrift f\u00fcr Psychiatrie und Neurologie.<\/em>\u00a01927;62:171\u2013185. First English translation: Simmonds C, Sukhareva G. E. The first account of the syndrome Asperger described? Part 2: the girls.\u00a0Eur Child Adolesc Psychiatry.<\/em>\u00a02020;29:1553\u20131557.<\/li>\n\n\n\n
  11. Posar A, Visconti P. The work of Grunya Efimovna Sukhareva in the field of autism spectrum disorder one hundred years after her original description.\u00a0J Pediatr Neurosci.<\/em>\u00a02024;19(1).<\/li>\n\n\n\n
  12. Sher DA, Gibson JL. Pioneering, prodigious and perspicacious.\u00a0Eur Child Adolesc Psychiatry.<\/em>\u00a02023;32:483.<\/li>\n\n\n\n
  13. Mussies M.\u00a0Inside the Autside: A Misfit Manifesto.<\/em>\u00a0Amazon KDP; 2023.<\/li>\n\n\n\n
  14. Halladay AK, Bishop S, Constantino JN, et al. Sex and gender differences in autism spectrum disorder: summarizing evidence and engaging the scientific community.\u00a0Autism Res.<\/em>\u00a02015;8(1):4\u201324.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Published in Hektoen International Journal of Medical Humanities.<\/p>\n","protected":false},"author":1,"featured_media":4369,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[625],"tags":[],"class_list":["post-4368","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-hektoen-international-journal-of-medical-humanities"],"aioseo_notices":[],"yoast_head":"\nGrunya Sukhareva and the early observation of autistic behavior » Martine Mussies<\/title>\n<meta name=\"description\" content=\"An essay on Ukrainian psychiatrist Grunya Sukhareva, whose 1920s observations of autistic behaviour anticipated later autism research.\" \/>\n<meta name=\"robots\" content=\"index, follow, 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