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BY Jonathan Lethem

April 6, 1999 | Led by its flagship symptom, compulsive cursing, Tourette's syndrome has recently entered the popular imagination as joke, metaphor and disease of the week. The colorful syndrome has been the subject of reflections by Oliver Sacks in the New Yorker and gist for popular memoirs and fiction. What’s still little known is the complex history behind the seemingly obvious-as-the-crazy-expression-on-your-face diagnosis -- a history that continues in the persistent disagreement between French and American clinicians. Tourette's, with its garish array of twitches, shrieks and mutterings, has for more than a century been a football in the struggle between psychological and neurological views of human behavior -- and between psychoanalytic and pharmacological approaches to treatment.

Fascinatingly, the current American consensus for a neurological view was galvanized, in the '60s and '70s, by parents of Tourettic children who were furious about psychoanalytic interpretations of the disease -- interpretations that, implicitly or explicitly, blamed inadequate parenting. This grassroots rejection of Freudianism, so American in its activist pragmatism, transformed the medical establishment's approach to the symptoms of Tourette's. The French, on the other hand, remain in the grip of the more literary and existential Lacanian psychoanalytic tradition. For them, Tourette's remains an outward clue to deep psychological trauma and a beautiful metaphor for stifled masturbation, eroticized parental love and resistance to societal pressure to conform.

Does this battle between Freud and pharmaceuticals remind you of Peter Kramer’s "Listening To Prozac"? It should. But alas, Howard Kushner, professor of the History of Medicine at San Diego State University, is not only no Oliver Sacks, he’s not even a Peter Kramer. His "A Cursing Brain" might best be described as dogged in its exploration of the fascinating evolution of the definition of French physician Gille de la Tourette’s maladie des tics. Ever the scholar, Kushner is scrupulous, thorough and professional in his approach -- so much so that he dampens, almost before it can arise, any metaphorical or literary resonance in his provocative subject. He seems hidebound in his objectivity, and though he eventually comes down squarely in favor of a neurological interpretation, he cloaks his preference in an evenhandedness that is exasperatingly dull. He declines to dramatize his subject, let alone take any pleasure in the surrealist implications of a neurological disease that manifests itself in a social dimension -- or in a leading researcher's being named Dr. Abuzzahab (which would make an excellent tic, don’t you think?).

Kushner’s prose is dense, not like cake but like wood. His book is as crucial a contribution to the small shelf of serious scholarship on the subject of Tourette’s syndrome as it is impossible to recommend to the general reader.

AAbuzzahab!
salon.com | April 6, 1999

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