A Cursing Brain?: The Histories of Tourette Syndrome

Over a century and a half ago, a French physician reported the bizarre behavior of a young aristocratic woman who would suddenly, without warning, erupt in a startling fit of obscene shouts and curses. The image of the afflicted Marquise de Dampierre echoes through the decades as the emblematic example of an illness that today represents one of the fastest-growing diagnoses in North America. Tourette syndrome is a set of behaviors, including recurrent ticcing and involuntary shouting (sometimes cursing) as well as obsessive-compulsive actions. The fascinating history of this syndrome reveals how cultural and medical assumptions have determined and radically altered its characterization and treatment from the early nineteenth century to the present. A Cursing Brain? traces the problematic classification of Tourette syndrome through three distinct but overlapping stories: that of the claims of medical knowledge, that of patients' experiences, and that of cultural expectations and assumptions. Earlier researchers asserted that the bizarre ticcing and impromptu vocalizations were psychological--resulting from sustained bad habits or lack of self-control. Today, patients exhibiting these behaviors are seen as suffering from a neurological disease and generally are treated with drug therapy. Although current clinical research indicates that Tourette's is an organic disorder, this pioneering history of the syndrome reminds us to be skeptical of medical orthodoxies so that we may stay open to fresh understandings and more effective interventions.

About the Author :
Howard I. Kushner is Nat C. Robertson Distinguished Professor of Science & Society at Emory University, where he holds a joint appointment as Professor in the Department of Behavioral Sciences and Health Education at the Rollins School of Public Health and the Graduate Institute of Liberal Arts.

Review :
The subtitle's plural is significant, since even today the definitions and treatments of Tourette syndrome vary widely. Beyond its immediate focus, Mr. Kushner's comparative study has much to say about how theories of disease in general acquire medical authority...A Cursing Brain? is a thought-provoking and balanced historical synthesis of the biological and psychoanalytic ideologies surrounding Tourette syndrome. Kushner follows the winding trail of recurrent ticcing through hysteria and hypnosis, masturbation and moral treatment, through to the still controversial suggestion that Tourette syndrome might be an auto-immune disease that follows streptococcal infection. Having told so many stories, Kushner is well aware that there may be no such unitary entity as Tourette syndrome, although there clearly are many sufferers whose symptoms can be relieved by taking haloperidol...The past, so expertly summarized in A Cursing Brain?, tells us [the latest] will not be the last theory to attempt an explanation of Tourette syndrome. Kushner's book deftly points out the extent to which cultural expectations have shaped ideas about Tourette syndrome--and, by implication, many other psychiatric disorders...[It] is particularly valuable for its well-documented message that the history of medical thought is constantly changing. In Kushner's hands, the story of Tourette's, which is richly laced with controversies, is fascinating...Kushner handles his material with such aplomb that his tale deserves to appeal not only to medical historians and the families touched by Tourette's, but to a wider readership. I highly recommend A Cursing Brain? as a brilliant and readable narrative of how, over time, we change our minds when faced with a puzzling and hard-to-treat constellation of socially maladaptive physical, behavioral, and psychological symptoms...Kushner presents superb and meticulously documented descriptions of Tourette's and of our understanding of the syndrome. Kushner combines the virtues of a detective story with those of a well-documented medical history in a fascinating narrative of the development of the knowledge about, treatments of, and medical and lay attitudes toward Tourette's Syndrome (TS) patients. The word histories in the subtitle points to a major TS reality. Many theories of TS have led into blind alleys and disputes that have not been resolved. Kushner takes us down these paths and brings to life the investigators and propagandists who sought data or pushed their own views with little to back them up. He shows us that even the name of the malady appeared and disappeared as psychological and organic causes rose and fell in favor. Many who intend merely to sample the scholarly book may wind up devouring it. As Kushner soberly explains, most diagnosed [Tourette's] sufferers don't display 'florid' symptoms, but do have involuntary physical and vocal 'tics.' This book charts the course of the disagreements over what exactly constitutes the syndrome. [A Cursing Brain?] explores the cultural and medical assumptions that have changed the classification of Tourette syndrome since the condition was first identified in the early 19th century. A well-documented, scholarly analysis of the changing ways in which practitioners have tried to explain the baffling phenomenon of motor tics and involuntary shouts, barks, and curses exhibited by those with Tourette syndrome...Kushner traces how...differing views of Tourette's causes shaped not only patients' and physicians' perception of the disorder but also its treatment: psychotherapy, lobotomies, removal of teeth or tonsils--all were tried and claims made for their effectiveness...[Kushner's] skeptical conclusion that the success and decline of the various approaches owes more to the power of a shared set of beliefs than to the rigor of scientific testing is persuasive. Kushner describes the shifting 'histories' of [Tourette] syndrome since it was first described by French neurologist Georges Gilles de la Tourette in 1885. Experts have variously attributed the Tourette complex of behaviors to moral defects, neurological damage, repressed sexual urges, and chemical imbalances. Such explanations, Kushner argues, conceal cultural assumptions that prevent physicians from fully hearing their patients' stories and thus influence medical practice in damaging ways. Kushner cautions his readers that patients themselves, unconstrained by medical orthodoxy, have much to teach. A compassionate and absorbing work of medical history. This book is a 'must' for anyone interested in the history of medicine, neurology and psychiatry as well as Tourette's syndrome. There is no doubt that this is the best exposition of the syndrome's history in the literature...Kushner's is one of the most exciting and intriguing textbooks that I have read: clinically and historically correct, extremely well written and an erudite and scholarly treatise. Does the archetype of [Tourette's] as a foul-language syndrome obscure what's really going on? And is that determined by stress, or genetically, or linked to infection? In a pleasant blend of storytelling, medicine and history, Kushner relates the history of this still-misunderstood disorder. [This book] is unreservedly excellent and ought to be read by all those interested in the history of neurology and psychiatry as well as Tourette's Syndrome. Considers the histories of Tourette's syndrome and places particular emphasis on how external influences have affected the ways in which Tourette's syndrome has been conceptualized over time...Cogently describes how patients with Tourette's syndrome have been viewed over time and provides an interesting and heuristic example of how the art and science of medicine do not occur in sterile data-informed vacuum...In short, A Cursing Brain? is a very interesting history-of-medicine book that considers how Tourette's syndrome has been understood and viewed over the past 2 centuries. Professor Kushner guides us ably through some of the first descriptions of Tourette syndrome starting with the Marquis Dampierre…This tale offers several humbling lessons; ideas about disease are often firmly rooted in the prevailing culture…this book aims to tell what happened and does not necessarily offer solutions. Above all, I left the book thinking "be humble, doubt yourself and your ideas" and imagine how history will judge us in the year 2099. A Cursing Brain? is well written and meticulously documented. It wonderfully illustrates how the historical succession of causal explanations from early in the 19th century to the mid 1990s has transformed the categorization and treatment of motor and vocal tics and allied symptoms. Kushner nicely captures the range of symptoms and the hazards associated with efforts to separate tics from obsessions and compulsions…Kushner's emphasis on the key role of the Tourette Syndrome Association and the rich legacy of Arthur and Elaine Shapiro is appropriate and timely…In several respects, I found A Cursing Brain? illuminating -- particularly in regard to the evolving French psychiatric tradition and its continued devotion to Freudian principles…Kushner's belief in the potential of auto immune mechanisms to illuminate the etiology of some fraction of tic and obsessive-compulsive disorder cases is also on target.