Autism Spectrum Disorder and Louis XVI

Sometimes researching the life of a major historical figure can teach as much about the present as it does about the past.  Often it illustrates how far we have progressed since the days of superstition and intolerance—but sometimes it instead points out how ingrained are prejudice and narrow-mindedness.  This, I have found, is especially true when it comes to psychological disorders, as demonstrated by the scornful reaction of Caroline Weber writing in The New York Times Book Review, to the idea that Louis XVI, the French king who famously lost his head during the Revolution, had been born with Autism Spectrum Disorder. 

I know it is difficult to understand how it is possible to diagnose a disorder like autism without a personal examination by a qualified physician.  But historians are used to gathering data and probing testimony to piece together an accurate portrayal of a subject.  Lack of a personal examination has not stopped scholars from concluding that Charles VI, who ruled France in the fifteenth century, and who spent several months every year for three decades babbling incoherently, refusing to bathe or change his clothes, and rolling in his own excrement, suffered from schizophrenia.  Or that George III of England, whose medical condition was popularized in the 1994 film “The Madness of King George,” was a victim of bipolar disorder (as defined in 2015 by the DSM IV, the official diagnostic manual of the American Psychiatric Association), possibly augmented by arsenic poisoning. No one says, “The madness of King George is a lie because no one today examined him personally!”

Louis XVI’s symptoms, while not perhaps as dramatic as those associated with psychosis, were nonetheless as obvious and telling.  As a young child, he did not speak or look at anyone in his presence.  He did not display emotion.  He had problems with coordination and walked clumsily.  He did not play with his brothers but instead ran around chasing cats on the roof of the palace.  As an adult, he continued to shun people and retreated as often as could to his own rooms, or outside to go hunting.  He uttered shrill sounds and cried when he was upset. Although highly intelligent, he had great difficulty in beginning or engaging in a conversation.  He was obsessed with clocks and by the time he became king at age nineteen kept to a strict routine.  “The king went to bed every night at eleven precisely; he was very methodical, and nothing was allowed to interfere with his rules,” observed Marie Antoinette’s lady-in-waiting more than once in her memoirs.  At the age of twenty-two, he did not understand how to consummate his marriage. 

These are classic symptoms of Autism Spectrum Disorder as defined by DSM 5, the current manual.  In 2020, the CDC reported that 1 in 54 children had been diagnosed with ASD and that boys were four times as likely as girls to be identified as having the disorder.

After reviewing the Mayo Clinic’s description of ASD (the layman’s version of the DSM 5) and researching the disorder extensively, I consulted a developmental pediatrician with thirty years’ experience in this area at a major university hospital, who was accustomed to dealing with these behaviors.  She was exactly the sort of specialist that Louis XVI’s parents would have taken him to if he had lived today.  I did not tell the doctor who the historical subject was but merely listed his symptoms.  She noted that, even though she could not examine him personally as would have been optimal, he displayed every symptom specified in the DSM 5. 

On this basis, I concluded that, had Louis XVI been born in this century, he would most certainly have been diagnosed with ASD.  I did so believing that at least here in the U.S. the condition was understood and that there was no longer a stigma associated with it.  In Louis’s time, of course, it was different.  Although he was dauphin of France and later king, he was regularly bullied and ridiculed by his brothers, and treated contemptuously by other courtiers, merely for being different.

Millions of parents and children have had to deal with this sort of heartless behavior every day.  They have been fighting for decades to make the public understand that ASD is not some made-up diagnosis.  Consequently, when I wrote that Louis XVI had struggled with the same issues over two hundred years ago, I expected it to resonate.  I believed it would help sceptics see that ASD is not a new disorder but rather an old one.  I confess I am stunned that the massive difficulties the king faced, and his almost heroic attempt to do what was expected of him, has not evoked more sympathy. 

In my book, Louis XVI is a figure of dignity and pathos, as people with ASD deserve.  He was never a tyrant, as the Revolution sought to portray him; he simply perceived the world differently—and was executed for it.  They behaved cruelly but at least had the excuse of not understanding his behavior. 

What is ours?