Listen to this episode and learn more about the topics therein at theallusionist.org/asperger.
This is the Allusionist, in which I, Helen Zaltzman, substitute language with aquafaba.
This episode is about some of the reasons why there’s a move away from using the term Asperger’s Syndrome. We’ve talked before on the show about medical eponyms, and how they can be problems because they don’t tell you anything about the condition with the name on, which can make it harder for medical practitioners to remember information about it, and it’s less understandable and more stressful for people diagnosed with it. The eponyms are sometimes not helping communication. But there’s a whole lot more going on with Asperger’s syndrome as a term, thus I must issue several content notes: Nazis, eugenics, ableism, child abuse, murder. There is some very grim stuff this episode. Take what you know about Nazis and ableism and you know it’s going to be bad.
On with the show.
HZ: How do you feel about the term ‘autism spectrum disorder’?
MORÉNIKE GIWA ONAIWU: I hate it. I hate it because I feel like it's not a disorder. It is a spectrum, yes, because it has many variations; and autism is the name we've had historically, it's not the greatest name because it means in oneself, because of the way that they perceive us and we're not, we are but we're not, you know? It's not what they think. But that's the name, I'm not going to try to come up with a new name, at this late date.
But the disorder part is bothersome to me, because my brain is not disordered. This is the way my brain works. This is the brain I was born with. This is the way that it thinks, that it processes. That's not disordered. My brother and my son are not disordered because they're left-handed instead of right-handed, even though 90% of the population is either right-handed or ambidextrous, so most people are not left-handed; but just because something is smaller in numbers doesn't mean that it's a bad thing by any means.
HZ: Unless you're buying scissors.
MORÉNIKE GIWA ONAIWU: That's true.
HZ: Morénike Giwa Onaiwu is an activist, a writer, and an academic at Rice University. She was diagnosed with autism as an adult, after her two youngest children were being diagnosed when they were toddlers and she was encouraged to be evaluated for it also.
MORÉNIKE GIWA ONAIWU: I embraced it. It was something that really helped to me explain a lot of things and make a lot of things clearer. But I found that when I would tell people, it's almost like you're telling people you had a terminal illness, like they’d look around or they say, “I’m sorry,” or, “Oh, I could never tell” or they would jump into these euphemisms that were just really, you know: “Well, my nephew is autistic and he's nothing like you, you can do this, this, this…”
And it reminded me again of how people, would say come up to me, sometimes and say, “Oh, you're so articulate!” and that means “for a Black person”, you're supposed to not know how to speak. Or how someone would come up when my daughter was younger and I'd be pushing her in the stroller and they'd be like, “What a cute baby! How long have you been her nanny?” and I’m like, “I'm her mother.” “Oh, well, she's so beautiful, she looks nothing like you,” I'm thinking, Wow. Okay. People are meaning to compliment you by insulting you.
So by someone saying, “I could never tell you were autistic,” that's an insult, because you're saying that you perceive autistic people as being something negative or something less than; or you would “never be able to tell” because I guess I'm not presenting whatever stereotypical manner you expect at this moment. "You're almost like one of us" type of mentality. I don't like that. I want to be seen as autistic.
HZ: In 1994, Asperger’s Syndrome was added to the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, the DSM-IV. But the subsequent edition, the DSM-V, published in 2013, removed Asperger’s Syndrome as a separate condition and included it under the autism spectrum. This was right around the time Morénike was diagnosed with autism.
MORÉNIKE GIWA ONAIWU: So at that time they were merging, you know, the diagnoses. So my daughter's diagnosis is under DSM-IV whereas mine was under DSM-V, despite the fact that they were very close to one another. And so for me, I was actually glad that my diagnosis did not say Asperger's syndrome, it just said autism spectrum disorder - other than fact of the disorder part - because I felt like it was more accurate, like it, I felt like it was a term that is more representative.
HZ: The World Health Organisation has also updated its International Classification of Diseases to include Asperger’s Syndrome in the autism spectrum, rather than as a separate diagnosis. Nonetheless, the way that people use language isn’t controlled by the DSM or the World Health Organisation, meaning a lot of people still use the term Asperger’s Syndrome.
MORÉNIKE GIWA ONAIWU: All the time. And I even hear it from people who I know for a fact, there's no way that that was the diagnosis that they had because it's recent, so it's under DSM-V. I think there's a couple of different reasons. I feel like one reason is because some people have had that diagnosis since childhood or it's been around forever. I don't begrudge someone, if they were given the diagnosis - I know some people who, at three years old or eight years old or whatever, they were given a diagnosis of Asperger's syndrome, that's what it said on their paper. They've never gone back to get rediagnosed, because why would you? And so, even though that diagnosis no longer exists, that's what they're accustomed to calling themselves.
But it's really arbitrary depending on who your clinician was, what diagnosis you would get. Some people were scared to give children the autistic disorder diagnosis, because their parents would freak out. So they give someone anything else, so that they could handle it. And there were people who would diagnosis-shop and go from place to place because they didn't like the diagnosis that they were given and they needed something they felt was more acceptable. It makes a parent feel better or a person feel better to say, "I have Asperger's" or "I'm high functioning". It really boils down to stigma. It is about wanting differentiation, wanting to say, “I’m not like them. I have intact cognition” or “I have the ability to speak” or “I can live independently, and I don’t have the support needs that this person has.” When in reality it’s not linear at all. People still think that disability is a dirty word. People still feel defensive about things like autism or what have you, instead of understanding that it’s a different way to be.
HZ: On top of this, there is the question about whether we should be using a term commemorating the eponymous Hans Asperger.
EDITH SHEFFER: I am Edith Sheffer. I am a historian of Central European History and a senior fellow at the University of California, Berkeley Institute of European Studies.
HZ: Edith Sheffer is also the author of the book Asperger’s Children: The Origins of Autism in Nazi Vienna.
EDITH SHEFFER: My son was diagnosed with autism when he was a year and a half old. And like any good parent, I read everything that I could about the diagnosis. I'm a historian of 20th century Germany, and I found it very fascinating, when I was reading these introductory books to autism, that there was a lot written about Leo Kanner, the American psychiatrist who came up with the diagnosis, but very little about Hans Asperger, who came up with the diagnosis in Nazi Vienna.
HZ: Leo Kanner was also originally from what was then Austria-Hungary, but had emigrated to the USA in 1924 and worked in paediatric psychiatry. Though it is unlikely that at the time he and and Hans Asperger knew about each other’s work in the field of autism research, each published very influential papers around the same time, Kanner writing in English in 1943 and Asperger in German in 1944, and both used the term ‘autism’ in a new way. ‘Autism’ had been coined by Swiss psychiatrist Eugen Bleuler in 1910 to refer to adult schizophrenia patients exhibiting what Bleuler considered extreme self-admiration, causing them to withdraw themselves from external influences. But Kanner and Asperger both were using autism about traits observed in children.
Their work did differ though, hence Kanner’s name shows up in the autism lexicon, as the eponymous Kanner’s syndrome or Kanner’s autism, often called ‘classic autism’, where the children he studied displayed repetitive and obsessive behaviours and delayed or absent linguistic development. Whereas Asperger got the so-called ‘high functioning’ label because his subjects could be academically successful if the educational system accommodated their needs, and, he noted, went on to have illustrious careers.
EDITH SHEFFER: And what I read about Hans Asperger was that he was this great guy: he was a resister to the Nazi party, and he rescued children from the euthanasia program, and that there was a thought that he even came up with the autism diagnosis as a kind of psychiatric Schindler's List, that he was designating these children as useful by calling them autistic as a way of saving them from the euthanasia program. So I thought this was a great story, and this was even on his Wikipedia page.
HZ: But then, on a visit to Vienna, Edith decided to do some research into this.
EDITH SHEFFER: And the very first file, the very first day I looked at in the archives was enough to show that, in fact, this was not a heroic story. It was really a horror story, where Asperger was implicated in the euthanasia program.
HZ: Who was Hans Asperger?
EDITH SHEFFER: He was born around the turn of the century, in a rural community outside of Vienna. He went to the medical school at the University of Vienna at age 25 and then graduated, and he fell into right wing circles, he was a member of anti-Semitic, anti modern, anti liberal institutions. And his first job for medical school was with a well-known Nazi. Then the University of Vienna Children's Hospital had a new director in 1931, Franz Hamberger, a hard right wing reactionary, who was looking to hire people with solid right wing credentials. And his mission was to purge the hospital of women and Jews and liberals. And one of his first hires was Hans Asperger, who, as I said, had these solid right wing credentials. And Asperger subsequently wrote that he was excited about this opportunity.
HZ: The psych field had been dominated by Jews in Austria for decades, right?
EDITH SHEFFER: Right. The field of psychiatry and psychoanalysis at the turn of the century and then going up through the 1930s was really in a state of flux, and it separated into psychoanalysis of Freud and then psychiatry. And although ideas were very similar and doctors were circulating throughout each other's institutions, it became really a social and political cleavage between psychiatrists, who were politically more on the right or reactionary, and then psychoanalysts who tended to be Jews and liberals.
Asperger was really quite peripheral to this world. By some, his brand of psychiatry was seen as kind of a crackpot practice that was called heilpädagogik, which translates into 'curative education'. And the idea was to integrate medicine, pedagogy, psychology, to treat the whole child. Which sounds great, but in reality was kind of gobbledegook. Famous psychoanalysts who rotated through the curative education clinic came out with very low opinions about the quality of practise that was happening there. So before the Nazi period, the curative education clinic that Asperger was running was not widely respected. But then, when the Nazis came to power and these esteemed Jewish and liberal psychoanalysts were purged and emigrated, that's when Asperger was able to come into prominence.
HZ: It seemed like his professional attitudes shifted really quickly over the late 1930s and 40s.
EDITH SHEFFER: Indeed. The practice of curative education had been meant to see the whole child and as individuals. And he, in fact, wrote as late as 1937 that it's impossible to establish rigid criteria for a diagnosis - that's a direct quote - and he published this in Vienna, that you could not diagnose children, they're individuals. And then one year later, he publishes his first definition of what he labelled ‘autistic psychopathy’, in which he called - this is I'm quoting - a well characterised group of children who fall out of the community. How did he go from 1937 saying you can't establish a diagnosis to 1938 coming out with his own diagnosis? What happened in that year? The Nazis invaded Austria and took over. And Asperger, in my opinion, saw an opportunity. And standards of Nazi psychiatry were such that labels were encouraged, it was important to diagnose children, and Asperger came up with the diagnosis.
HZ: Increasingly popular in Austria and Germany in the 1920s and 30s, particularly when the Nazis came to power, was the concept of Volksgemeinschaft, a national community, everyone united across class and political and financial divides not just to act the same way but to feel the same way, to have a common soul. As long as they were Aryan. And not autistic children whose tendencies to be socially withdrawn were not aligned with the collectivist mission.
EDITH SHEFFER: Literally year by year, his definition of autistic psychopathy changes.So, for example, in 1938, he calls these “children who fall out of the community|, in 1940, he calls them “loners”. By 1944, he says they're “no longer members of the greater organism of the people,” which is purely fascist language. "They lack this quality of gemüt", which is a key concept. I see his 1944 definition as really his last step to fully embracing Nazi ideology, because gemüt had been this concept in Nazi psychiatry of this metaphysical social connectedness that was important for children to have. And this was a word that was in wide circulation that Asperger then finally adopts in 1944.
HZ: It's technically untranslatable?
EDITH SHEFFER: It's one of Germany's famously untranslatable words. In the romantic period, it was used as a word for soul, kind of a more basic level of the soul. But then in Nazi psychiatry, it really took on the social cast and doctors began coming up with definitions of diagnoses for children who lacked gemüt.
HZ: Once you’ve been diagnosed with lacking a soul, it’s really difficult to prove that you do have a soul, and thus not be sent off for treatment for not having a soul. Well. ‘Treatment’ in inverted commas.
EDITH SHEFFER: The Nazis, and then the Holocaust too, have a very creative language of euphemism. 'Treatment' was the key word for murder. Children would be 'treated'. 'Stationary observation' was what was called evaluation for death; 'release', 'put to sleep', these were all things that were meant to ease doctors' and nurses' minds. And if you look at the post-war trial testimony of these perpetrators, they were still regurgitating this language. Language is a very powerful thing. And if you tell yourself you're putting a child to sleep and engaging in a mercy killing, it paves the way.
HZ: These killings took place in more than 30 facilities in Germany and Austria.
EDITH SHEFFER: What I think is interesting about that is these were often located inside perfectly respectable hospitals. This is not like the Holocaust, that they were building camps in secret. This was something that was fully integrated into the medical institution and the institutions of the Reich.
HZ: The Third Reich’s second largest child-killing facility was called Spiegelgrund, and this was the place to which Hans Asperger would send patients from University of Vienna’s Children’s Hospital. It was located in the Steinhof Psychiatric Hospital, a grand art nouveau campus of 34 pavilions, nine of which were given over to Spiegelgrund.
EDITH SHEFFER: And the pavilions had different roles: one was a punishment pavilion; one was an observation pavilion, Pavilion 17; and then Pavilion 15 was a death pavilion, where children who were deemed ineducable or hopeless cases were then put to death. And the method of death was very different than what we typically think of in Nazi extermination. And it was done by the doctors and nurses. It was done by people who knew these children's names, who changed their sheets, who fed them on a daily basis. This was very personal. It was not indiscriminate. These were careful decisions. It was meant to be a scientific process. These children all had carefully assembled medical files, and if they were deemed unable to become productive citizens, then they would be put to death.
HZ: The first child that was euthanized was only a few days old. So how do you even know if a baby is a productive citizen?
EDITH SHEFFER: Right, well, if they're born blind or deaf or with physical defects, that's something that automatically in the Nazi regime would disqualify someone from having a productive life. I should say: we need a better word for the euthanasia program, that's what the Nazis called it. But it's a misnomer, right? Euthanasia has connotations of kindness and mercy. And these children were not terminally ill. They were not in pain. They were not on the brink of death. They were physically healthy and they could have led full lives.
HZ: The children at Spiegelgrund were kept cold and hungry, fed emetics, punished with beatings and humiliation - and sometimes used for experimentation, doctors would intentionally infect them with tuberculosis to test vaccines, or inject air into their brains. The killings were often deliberately slow; children would be starved, or given overdoses of barbiturates.
EDITH SHEFFER: That would then lead the children to waste away and develop pneumonia, which was often listed as the cause of death. And it was meant to look like a natural cause of death. But it wasn't.
HZ: An estimated five to ten thousand children were killed in the child euthanasia program across Germany and Austria between 1939 and 1945.
EDITH SHEFFER: Several thousand children did rotate through Spiegelgrund. Seven hundred and eighty nine were killed. What's interesting is in their scientific process, children might be put under observation for death, but then released. So again, this is something that we wouldn't think about for the Holocaust, right? You wouldn't put a Jew under observation and then release; it was an automatic death sentence to be Jewish. But these children would even find themselves in the death pavilion and then be released according to whatever arbitrary value the doctors were assigning them. So I think that that's an interesting point: when we think of Nazi racial hygiene policy, we think of it entirely in terms of exterminating those deemed unworthy; but attitudes toward the disabled were bifurcated. There were children that could be remediated and pulled into the national community, and then the ones that couldn't would be put to death. But there was this what was called the positive side to Nazi eugenics, where you could reform children.
HZ: Being unreformable as a child not only included what Nazis viewed as physical or mental shortcomings, but also social ones, such as poverty or having a parent who was overstretched or had their own problems or was absent, or if the child born out of wedlock.
EDITH SHEFFER: Parents would actually request that their children be transferred to Spiegelgrund or put to death, to the point when parents got notification that their kids had been killed, some even wrote thank you letters.
The child euthanasia program really changed over time. It was meant initially for children between birth and three years old, and it was meant to be for severe defects like Down syndrome - and I use 'defects' in quotes, this is Nazi terminology - children considered to be disabled with physical, obvious differences. And then over time, the age limit was raised, to six to eight to twelve and then up to sixteen. And it was a constantly broadening category. It then started to include misbehaviour, what was called asocial behaviour, which could be juvenile delinquency, running away from home, shirking work - children deemed insufficiently socially connected to the community. So you wind up with things like at Spiegelgrund, 10 percent had no medical diagnosis at all. And then three in five had kind of diagnoses like imbecility or idiocy, very loosey goosey stuff, and only the minority had concrete medical diagnoses at all. So it did become more indiscriminate over time.
HZ: Diagnoses at Spiegelgrund went from involving at least some analysis of the child to making pretty much just a kind of cold reading diagnosis that could then typify their whole life or end it.
EDITH SHEFFER: ’Vulgar’, ‘underhanded’ - these are some of the scientific words that were used - ‘egotistical'.
HZ: It seems unrealistic to expect them to behave as if they were in a normal environment and judge them on that, when they're in an institution that abused them.
EDITH SHEFFER: Yeah, well, I think it's important to note, child psychiatry was evolving at this time and they were concerned to establish themselves as a scientific enterprise, and so it's not like there had been some grand tradition and they were deviating from it. They were really making it up as they went along. And they had a very low status, not only in the medical field, but within psychiatry is dealing with the dregs of the dregs, who wants these children? And so in some ways, getting rid of the most undesirable children and then remediating the better children was a way to gain esteem for their profession, because they were dealing with more able children, they were getting rid of the worst of the worst and then making the other ones more able.
HZ: That explains why some of them got out alive.
EDITH SHEFFER: Yeah.
HZ: Hans Asperger was not directly implicated in abusing and killing children, but he worked closely with those who did, his praise for their work is documented, and he did transfer dozens of patients to Spiegelgrund when he knew what happened to children there.
EDITH SHEFFER: Yeah, it was widely known within Vienna's community. He admitted after the war - to say "I rescued children from death" means he knew there was death happening.
HZ: Right. You can't have it both ways.
EDITH SHEFFER: People have said to me, well, what if he did try and defend children from the euthanasia program? What if he did rescue some children, as he claimed? I really don't think it matters. I think once you make a decision, a conscious decision to participate in systematic killing, that's a moral choice that can't be undone. If you rescue a dozen children, it doesn't change the fact that you transferred a dozen children. And I'm not sure I see a distinction between transferring children and working at Spiegelgrund directly. If you transfer a dozen people and they happen to survive - or they don't survive - you sent them to a potential death. And he did that consciously.
I should also say that he was very closely affiliated with top figures in Vienna's euthanasia program. So the head doctor of Spiegelgrund, Erwin Jekelius, was widely known in Vienna as the mass murderer of Steinhof. And then Franz Hamberger, Asperger's mentor for 13 years and his adviser, transferred children to Spiegelgrund and conducted these tuberculosis experiments. And Asperger co-founded an organisation with these men for curative education in Vienna and he worked very closely with them. Jekelius was so embedded in the regime that he was actually engaged to Hitler's sister, Paula Hitler. Hitler reportedly found out about the match and disapproved and had Jekelius arrested by the Gestapo and sent off to the Eastern Front, which is a convenient way to get rid of an undesirable brother in law.
HZ: Why do you think people want to exonerate Asperger in particular?
EDITH SHEFFER: Well, I think this history was not known. He, after the war, disavowed any connection to Nazism and he'd never been a member of the Nazi Party, which people took to be a sign that he was a resister. I would say seven in ten physicians in Nazi Vienna were not members of the Nazi party. So this was not unusual. And he was a member in a number of organisations that work for Nazi organisations, so he was really affiliated in everything but name.
HZ: So he benefited from Nazism and then also from not having been full Nazi.
EDITH SHEFFER: Exactly. What I think is most telling is he really moved away from his Nazi era rhetoric and his publications. And so his post-war publications tended to be about social subjects and parenting and religion and really had none of the vestiges of his Nazi era publications. He never conducted systematic research again on autism. He basically abandoned it, which is one of the reasons I think he was sort of cynically promoting it - he was trying to get a position as a tenured professorship at the time, and this was his post doctoral thesis in order to do that. And then he never wrote of it again. I should say that his post doctoral thesis was written in haste, it was basically based on four case studies of boys, and as a piece of scientific research, it would not pass muster today.
HZ: If he wasn't doing any more studies on autism for decades, how come he gets to be the person with his name on Asperger's syndrome?
EDITH SHEFFER: That is the question. He really would have been a footnote in the history of autism had it not been for British psychiatrist Lorna Wing decades later.
HZ: Lorna Wing is a major figure in the study of autism in the latter half of the twentieth century. She coined the term Asperger’s Syndrome in 1976 and it became a lot more widely used after the publication in February 1981 of her paper Asperger Syndrome: a Clinical Account.
EDITH SHEFFER: Lorna Wing was an esteemed British psychiatrist. She was working on children who did not fit Leo Kanner's rather narrow definition of autism. And her own daughter bore traits that she again was looking for a broader definition of what was happening. Asperger's article was brought to her attention and her husband translated it from the German for her to read. And it was a little known article. But as a professional courtesy, she opted to use his name when she first came out with her idea of Asperger's Syndrome.
I wonder, as a woman publishing in 1980, if using a man's name might not have been helpful to her. At that time, what would have happened if she'd come out with Wing’s syndrome? I don’t know. What she was describing in her seminal paper called Asperger's Syndrome, however, bore very little resemblance to what Asperger described. So Asperger's definition of autistic psychopathy saw malice is intrinsic to these children and sadism. And he described them in an extremely pejorative terms. And he called it a ‘psychopathy’, which in German really had connotations of criminality and dereliction. Lorna Wing really changed these features of the diagnosis and she wanted to choose what she called a neutral term, so she didn't call it a psychopathy, she called it a syndrome. And she basically took out any references to malice or sadism, and her definition of Asperger's syndrome is really what we go by today. It's really Wing's syndrome, nothing to do with anything Asperger described.
HZ: Lorna Wing is also credited with introducing the concept that autism is a spectrum. And she eventually regretted having brought Hans Asperger’s name into it.
EDITH SHEFFER: Yeah, that's remarkable. She always believed in the continuum in what she called the autism spectrum and not dividing children into the categories and she only used Asperger's syndrome is kind of a loose term to describe features of children within what she saw as a spectrum. Whereas Asperger himself - and they met in London and had a very polite disagreement over this - he saw a sharp dividing line between the children Kanner diagnosed with autism, who were severely impaired, versus what he would call Asperger's children, who had these superhuman abilities. So he really saw a bifurcation, whereas Lorna Wing did not. And one of the inadvertant results of her broadening the spectrum was bifurcating the spectrum, and she regretted that that Asperger became its own diagnosis.
But I do think it's important that Asperger's syndrome be removed as a distinct label. I don't think it's helpful medically and then ethically. Eponymous diagnoses are bestowed as an honour, to commend someone for one's life work and also to commend someone for discovering a condition. And arguably Asperger merits neither. The condition he described is not what Lorna Wing described. And diagnoses have been renamed for a lot less than child murder. There are plenty of examples of diagnoses in the Nazi regime that have been remade since.
HZ: Such as Reiter's Syndrome, which we talked about a while back in the Name That Disease episode, the term used now is reactive arthritis.
EDITH SHEFFER: Which you can see is more useful, more descriptive, aside from the ethics of using that particular eponym. So, yeah, I think the label of Asperger's syndrome is, both ethically as well as medically, not serving us. In the United States, people talk about low functioning, mid functioning, high functioning autism, which I think are pretty eugenicist labels. And people are starting to recognise the problems with with those labels.
MORÉNIKE GIWA ONAIWU: I also prefer for people to use descriptive terms, as opposed to functioning labels. Profound autism, severe autism, mild autism, high functioning, low functioning, anything that's gonna make a person feel bad. Like what's the opposite of high? It's low. Who wants to be low? I think that people should describe things in a way to where you, you know, you know, what's happening and you're not going to be made to feel any particular way elevated or, or, you know, lowered.
I know that everyone has different points of view. There's people who think autism is the worst thing in the world, and there's people who think autism is this wonderful gift. And I think it's really more in the middle. Autism just is. Some things about it are gifts, some things about it are awful; and maybe not for every person. People shouldn't have to say it's a superpower, it's a gift, because they may not feel that way. But they also shouldn't have to say it's a disorder because that's not accurate. That's a loaded term. It's not a neutral term at all. They shouldn't have to choose a side when describing it; somebody should be able to just state what it is without there being a judgment in the term on either side, positive or negative.
HZ: Morénike Giwa Onaiwu is an activist, academic, writer and editor - she recommends the collection Sincerely, Your Autistic Child: What People on the Autism Spectrum Wish Their Parents Knew About Growing Up, Acceptance, and Identity. And she’s part of the team that has just launched Dove Orchids, an organisation working to improve jobs, education and representation for autistic people. Find out more at doveorchids.com. And Edith Sheffer is a historian and educator, and the author of Asperger's Children: The origins of Autism in Nazi Vienna. I’ll link to her and Morénike at theallusionist.org/asperger.
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Your randomly selected word from the dictionary today is…
ultradian, adjective, physiology: recurring more than once a day (but less than once an hour). Compare with ‘infradian’.
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