[.ca] A Cursing Brain?: The Histories of Tourette Syndrome (ISBN 0674003861)

organic or psychogenic:
CENTURY OLD DEBATE ABOUT WHETHER THE ETIOLOGY OF TOURETTE SYNDROME IS ORGANIC OR PSYCHOGENIC Tourette Syndromes an often misdiagnosed, misunderstood, complicated and visually compelling disorder. In A Cursing Brain? The Histories of Tourette Syndrome, Howard I. Kushner undertakes a compelling deconstruction of the labyrinth that is the discourse surrounding Tourette Syndrome. Throughout a major portion of the book, Kushner it seems leans towards multifactorial analysis of the syndrome. A collection of manifestations, Tourettes is sometimes not diagnosed as such unless accompanied by a co-morbid condition such as ADHD or OCD. Moreover, complications arising from a differences in perspective and classification make diagnosing and treating the syndrome more difficult. The split that divides runs between an infection/genetic camp and a purist camp whose assertions lie in a solely genetic argument. Lastly, along with such disorders as Syndenhams Chorea and similar manifestations of neurological disorders, it is "in your face" making it such a visually compelling disorder that it should move people to action. The aim of this book is to examine several perspectives and to explain them well. In an anti-reductionisin mind set Kushner attempts to zero in on the infectious and genetic perspectives. Kushner digs deep, analyzing in a Foucualdian way, the tradition as began by of Jean Marc Gaspard Itard, Jean Martin Charcot, Georges Gilles de la Tourette and George Guinon. In his involvement with Tourette Syndrome, Kushner seems to lean towards a more organic rather than a psychogenic origin. However, he is clear to point out that despite the success of Dr. Arthur Shapiro using Haloperidol to treat his patients, the side effects seem to be harder to live with than the cure. Kushner briefly introduces the groundbreaking work of both Dr. Louise Kiessling as well as the work of Dr. David Comings - who represents the most thorough and persistent view of the genetic component as alternative perspectives. Dr. Comings theory has broad implications about certain behaviors that most mental health workers have historically attributed to psychological problems. Genetic studies have led Dr. Comings to conclude that Tourette Syndrome is a polygenic disorder, caused by the coming together from both parents of a number of genes affecting dopamine, serotonin and other brain chemicals. After undertaking this long study, Kushner gives us a broader understanding of the syndrome and leads us to a conclusion relating to the plausibility and viability of each examination, treatment and perspective. WHERE THE GENETIC AND INFECTIOUS ETIOLOGIES DIVERGE AND CONVERGE Tourette Syndrome as a behavioral disorder often misdiagnosed and misunderstood. Kushner sought to gain a better understanding of its cause through two etiological models, the genetic and the immunological. Although the two models diverge in their essential constructs, he speculates that a key juncture where they converge is in the role of neurotransmitters. Whether TS underlying pathology is ultimately genetic or infectious both models point to the chemical interaction of dopamine, serotonin and norepinephrine as a key mechanism of the disorder. The Cursing Brain? The Histories of Tourette Syndrome examines a large cross section of perspective from the clinical to the historical and with a multinational flavor. As for the models themselves, Kushner found that researchers are far from a definitive understanding of the genetic model because of its extremely complex nature. In my opinion, it seems like researchers of Tourette Syndrome seem to feel that they can calibrate the effects of serotonin, dopamine and norepinephrine if they can find the genes that are responsible for regulating these neurotransmitters. To complicate things further, the immunological theory proposes that TS can be caused by GABHS, which triggers cross-reaction between GABHS antibodies and the cells of the basal ganglia. Kushner's hope is to inspire the move to a more cooperative effort in a more systematic attempt at a joint formal standardization of the TS phenotype. The immunological faction concludes that a prior streptococcal infection could be the cause of tics and ticcing behavior in some TS children. However, the fact that not all children who are infected with GABHS develop into Tourette Syndrome implicates genetic and epigenetic factors. In the end, in the words of a highly esteemed expert in the field of TS, "theory takes you only so far-and often nowhere helpful." It should not, however, stop us from acting or, more specifically, from trying to relieve the distress of illness. As we all take steps to fully understand the complex nature of TS, we have to understand that the definitions may be a product of the dominant discourse of the day. However Tourette - the illness, is real. We treat the symptoms even if we don't fully understand the underlying cause. And as science inches closer to a complete explanation of the etiology of TS, we are increasingly hopeful that someday we can confidently say that we've found a cure. Miguel Llora

Fascinating but a bit thick:
This is a fascinating and well-researched book, both in terms of TS itself and the history of medicine and psychology in Europe and the US. Some of the stories are just heart rending. The writing is sometimes a bit overly academic, however, and readers without graduate degrees or lots of other practice reading turgid prose may get a bit worn out while plowing through some of the paragraphs.