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Journal of Interdisciplinary History 30.4 (2000) 645-647



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Book Review

A Cursing Brain? The Histories of Tourette Syndrome


A Cursing Brain? The Histories of Tourette Syndrome. By Howard I. Kushner (Cambridge, Mass., Harvard University Press, 1999) 303 pp. $29.95.

If you think that it is easy to define an illness by sorting through the confusing tangle of symptoms and signs that exists in nature, read A Cursing Brain? to find out just how difficult it is. The history of Tourette's Disease is replete with off-key thinking that mistakes effects for causes, professional politics that substitutes for logic, the use of anecdotes to draw vast conclusions, and the power of theoretical preconceptions to alter the interpretation of data. All of these sins of science were committed for 175 years by highly intelligent, distinguished, dedicated members of the medical profession who were doing their best.

The story begins in 1825 when Jean Marc Gaspard Itard, chief physician at l'Institution Royale des Sourdsmuets in Paris, recorded the behavior of the Marquise de Dampierre, a twenty-six-year-old woman. "In the midst of a conversation that interests her extremely," he reported, "all of a sudden, without being able to prevent it, she interrupts what she is saying or what she is listening to with bizarre shouts and with words that are even more extraordinary and which make a deplorable contrast with her intellect and her distinguished manners" (10). Sixty years later, Georges Gilles de la Tourette, a young Parisian neurologist, cited this case as the first example of an illness that he called "maladie des tics." Jean-Martin Charcot, his mentor, had encouraged Tourette to [End Page 645] publish on maladie des tics, using the marquise as an example, and, in an unusually generous demonstration of mentorship, named the illness, "la maladie des tics de Gilles de la Tourette."

There followed a period of nosological confusion in which clinicians sought to clarify the relationship among the several illnesses with symptoms that included tics. For a time, Tourette's was considered a variant of Sydenham's Chorea (historically, Saint Vitus' Dance), which had recently been identified as a sequela of rheumatic fever. In this construction, the obscene vocalizations of Tourette's were considered to be evidence of "mental degeneration." Theories of infectious causes continued to live until the 1930s. The fact that the symptoms of Tourette's waxed and waned, and that some of the symptoms could be temporarily controlled by the willpower of the afflicted, or relieved by hypnosis, meant that some clinicians viewed the disorder as a kind of hysteria.

The search for etiology led clinicians down many disparate paths. The mental degeneration idea was based on a vague amalgam of environmental stresses acting on genetic inferiority. This view led directly, if imperceptibly, into a major emphasis on psychopathological factors, as psychoanalysis gained adherents and came to dominate psychiatric thinking in the first quarter of the twentieth century.

In 1921, Sandor Ferenczi published the first psychoanalytical analysis of tics, although he had never examined a patient who suffered from them. Instead, he used the description of a patient published in 1902 to assert that tics were the result of repressed masturbatory desires. His formulation was the basis for most of the psychoanalytical explanations that followed. Accounts of cures of tics by psychoanalytical treatment--usually in a single patient, with little or no follow-up--led to the conclusion that psychodynamic conflicts were to blame in all patients with tics. However, steady opposition came from neurologists and biologically oriented psychiatrists who offered organic explanations. The person with the most influence on the psychoanalytical explanation of tics was Margaret Mahler, who, between 1943 and 1949, wrote a series of papers that reintroduced the term "Gilles de la Tourette's Disease." Although she believed that there was an organic substrate to the disorder, she argued that severe, repressed familial psychological conflicts precipitated the symptoms and offered the opportunity for cure. Confusing parental worry about their severely disabled children with causal factors, Mahler and her colleagues sought to treat...

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