A Cursing Brain? The Histories of Tourette Syndrome

Howard Kushner has written a fascinating account of the evolution of the modern view of Gilles de la Tourette syndrome (now known as Tourette syndrome [TS] in the United States and much of the rest of the world), beginning with its naming by Georges Gilles de la Tourette, a young colleague of the great French physician Jean-Martin Charcot. The history of its designation as a syndrome was marked by controversy (which has persisted to the present day), partly because of the unusual nature of the symptoms. These can include cursing and obscene gestures that often seem alien to the basic personality structure of the patient, particularly in persons of refined manners who suddenly blurt out the most obscene language imaginable.

It is easy to see why one of the early controversies about the pathogenesis of this syndrome broke out between the psychoanalysts and the more organically oriented physicians—the first group believing that these behaviors represented the release of repressed sexual and aggressive material from the unconscious, and the second that the gestures were more in the nature of tics. The latter idea gained ground when it was discovered that rheumatic fever was associated with tics, even though these did not have the complex nature of the tics of Gilles de la Tourette syndrome.

As Scientific Counselor of the Tourette Syndrome Association (TSA), I was privileged to participate in the development of the early scientific efforts of the TSA. Perhaps the first real breakthrough was the trial of haloperidol, a dopamine antagonist, in patients with TS. It was quickly recognized that relief of tics involved blockade of dopamine receptors. Another important accomplishment of the TSA was the organization of an international genetic study to isolate the gene “responsible” for TS. Progress has been made in recent years, and Kushner's book will permit the reader to meet the leaders of the various scientific efforts and to appreciate the important role of the TSA in organizing the research program.

There are too many heroes in this book to describe them all, but Sue Levi-Pearl, as Medical and Scientific Liaison of the TSA, and Arthur and Elaine Shapiro, who demonstrated that TS symptoms responded to haloperidol, perhaps contributed most to the research advances thus far. Unfortunately, Arthur Shapiro died several years ago, but research into the understanding and treatment of TS has been ably continued, especially by the group at Yale under the leadership of Donald Cohen, James Leckman, and David Pauls.

Howard Kushner has spoken with many of the contemporaries he mentions, so that much of the book has a personal touch, enhanced by pictures of both historical and contemporary figures. There are extensive notes and a reference list of important articles.

All in all, this book should be useful to many, including people who would like to know more about the syndrome for personal reasons as well as those involved in research into TS and those who would like to read a well-written and interesting book on the politics that develop around a fascinating illness like Tourette syndrome.

Dr. Friedhoff is Professor in the Department of Psychiatry and Director of the Millhauser Laboratories, New York University School of Medicine, New York, NY, and Scientific Counselor of the Tourette Syndrome Association.