Journey Into a Strange Affliction

book reviews

even before she made her paltry claim to Y priority in discovering fission. AR Meitner’s truest Doktorschwester, if I may Journey into a improvise on the Doktorvater of German academic tradition, proved to be a Swedish strange affliction physicist, Eva von Bahr-Bergius, who did all A Cursing Brain? The Histories of she could to help Meitner in exile. But von Tourette Syndrome COME INSTITUTE LIBR

Bahr-Bergius was as unsuccessful as Bohr, by Howard I. Kuschner WELL who did all he could in the backstage strug- Harvard University Press: 1999. 303 pp. gles of the 1940s to get Meitner the Nobel $29.95, £18.50 prize she so obviously deserved. Squalid aca- Mary Robertson demic politics overcame the factual record of 1938–39: Hahn was confused by his chemical People with Tourette syndrome can find it findings, which were brilliantly clarified by extremely difficult to obtain a diagnosis for the physics of Meitner and Frisch. their symptoms, and suffer years of misun- A deeper trouble than the ‘woman’ prob- derstanding, ostracization and pejorative lem’, or even the ‘German’ problem’, attends nicknames. The syndrome is diagnosed by Meitner’s life in physics. Is her rightful claim the presence for more than a year of multiple to the “beautiful” discovery of fission sepa- motor tics and one or more vocal tics. rable from her “great moral wrong” in stay- Coprolalia (the inappropriate uttering of ing at the bench in Berlin after 1933? Those obscenities) occurs in about 10 per cent of who urged her to leave earlier could not patients. Other symptoms include copying promise her the research opportunity that behaviour (for example, echolalia) and Gilles de la Tourette: one of the treatments for his gave meaning to her life. These particulari- obsessive compulsive behaviour. eponymous syndrome was circumcision. ties express a torment common to scientists Tourette syndrome is not uncommon. and engineers long before the Nazi regime Howard Kuschner hints at the idea that it is a that I was able to make up my own mind on and nuclear fission. When Hahn felt some spectrum disorder and highlights its genetic the possible diagnosis. qualms over his work on poison gas in the background. He introduces the recent (if We are introduced to many of the clini- First World War, Meitner gave him the stock speculative) suggestion that it is an autoim- cians, both well known and little known, who excuses: you’re only following orders; others mune disorder, and weaves the streptococccal have taken a keen interest in Tourette syn- will do it if you don’t; if our virtuous country story into the tapestry of the syndrome. It has drome over the years. He begins with the does not make this or that lethal thing, the recently been suggested that there is a sub- famous historical trio (Itard, Gilles de la evil enemy will. group of patients whose aetiology includes a Tourette and Charcot), goes on to other early Systems that keep learned servants in line group A streptococcal infection. Kuschner French physicians, and ends with today’s clin- with such excuses overwhelm the exception- takes us through the evolution of Tourette icians, including Arthur Shapiro (who died in al individuals who rebel. James Franck was syndrome from a psychoanalytic to an organ- 1995), Elaine Shapiro and Sacks — who has the only recruit to the Manhattan Project ic disorder, and shows how its classification as made Tourette syndrome a household name. who asked in advance for the right to be a mental disease has metamorphosed, so that Kuschner does not shy away from contro- involved in judging the use of the nuclear the diagnostic criteria and age at onset seem versy, joining the ‘battle’ of the psycho- bomb that would come out of it. When the to change with each revision. Through the analytic versus the organic approach to time came, and he produced the ‘Franck medium of Tourette syndrome, Kuschner Tourette syndrome that dominated the report’ recommending against the nuclear cleverly reveals the fascinating history of neu- literature for years. He also discusses hotly bombing of Japanese civilians, he and rology, psychiatry, medicine and culture. debated topics such as the phenotype for the his report were brushed aside by the men My favourite part of the book is “The Case syndrome. Views on this range from a belief in command — specialists are on tap, not of the Cursing Marquise”, in which Kuschner that there is no associated characteristic psy- on top. performs an intricate historical dissection of chopathology, to a wide variety of psychi- In many nation states, including democ- the Marquise de Dampierre, the most cited atric phenotypes and to the more parsimo- racies, scientists have been crucial agents of Tourette syndrome patient, whose story was nious view taken by thegroup at Yale Univer- the mechanized wholesale slaughter that has first reported by Jean-Marc-Gaspard Itard in sity that only obsessive compulsive behav- distinguished the twentieth century. Ein- 1825. Itard knew the afflicted Marquise well iours/disorders and some types of attention- stein noted in 1914 that “humanist” scholars and described her clinically. In fact, neither deficit hyperactivity disorder are genetically took the lead in justifying that madness, but Georges Gilles de la Tourette nor Jean-Martin related to Tourette syndrome. he later acknowledged the special contribu- Charcot ever treated her, even though it was There has been an appalling and wide tion of physical scientists. “I believe,” he de la Tourette, and not Itard, who gained variety of treatments for the syndrome — wrote in 1946, “that the terrible decline in eponymous fame for describing such cases circumcision, carbon dioxide inhalation, man’s ethical behaviour is due primarily to (including hers) in 1885. surgical removal of sinuses and tonsils, anti- the mechanization and depersonalization of Using an appealing intimacy, Kuschner inflammatory agents, speculative treatments our lives — a disastrous by-product of the describes many of the other famous and not today such as plasmaphoresis, and finally the development of the technological–scientific so famous people who may have had (now accepted) traditional medical treat- intellect. Nostra culpa!” (from Albrecht Föls- Tourette syndrome. These include historical ments such as haloperidol and clonidine. ing’s Albert Einstein, Penguin). Heroines like figures and some of today’s well-known My only reservation about the book is its Meitner demanded equal opportunity to patients, such as Sigmund Freud’s patient title. The Cursing Brain? highlights the scata- strive for beautiful discovery, and to share Frau Emmy von N and Oliver Sacks’ Witty logical nature of the syndrome, when there is that culpability. Ticcy Ray. For each patient, personal details so much more to the disorder than that. David Joravsky is in the Department of History, and arguments for a diagnosis of Tourette Kuschner does, however, justify the title by Northwestern University, Evanston, Illinois syndrome are given in such a way that I felt saying that, because today Tourette’s “has … 60208, USA. not only that I had met the patients, but also been shorn of its most well-known symptom”

(coprolalia), we are running the risk of “sani- intentions, the grandiloquently titled Pain: apart from a few trivial and serendipitous tizing” the syndrome and “ostracizing those The Science of Suffering is not that. (but useful) side effects — the pharmaceuti- who curse” — to whom the book pays tribute. Despite its extravagant promise to cal industry has, over the past 50 years, made This book is a ‘must’ for anyone interested “explore all we know about the nature and no advances in pain treatment. Yet in that in the history of medicine, neurology and causes of pain”, it is a far simpler and shorter period, for example, opiates with greater psychiatry as well as Tourette syndrome. book than that earlier one, and its intended potency but attenuated side effects, and far There is no doubt that this is the best exposi- readership is not at all obvious; to a real safer anaesthetic agents, have appeared. tion of the syndrome’s history in the litera- extent, its contents are merely a rechauffé. It Some of Wall’s criticisms of medical edu- ture. The sources for the book, which make it is, to be blunt, an old man’s pensées, and is, cation and clinical culture are telling, even if unique, include the US Tourette Syndrome for all its liberal use of sub-headings, over- the whole book shows an invalidating Anglo- Association archives and newsletters, many discursive, solipsistic and scrappily docu- centricity. He also proposes an interesting taped personal interviews, letters to the mented. I am not saying that a ‘popular’ (though not wholly convincing) concept of author, previously untranslated articles and book should be encrusted with footnotes, pain as an action-directed experience, and dissertations given to the author, as well as but it must at least provide some plausible writes, “Pain is then best seen as a needs state, personal knowledge. Such details contribute basis for its material. Wall’s new work relies like hunger and thirst, which are terminated to the very personal flavour of the book which too much for my comfort on its author’s by a consummatory act”. Can this be true? At is unique in a textbook of medicine. Kuschn- ‘introspection’, and on dogma and an appeal the risk of my sounding Platoesque, and er’s is one of the most exciting and intriguing to the reader’s respect for the author’s gravi- describing pain, not as a consequence of tis- textbooks I have read: clinically and histori- tas. The fact that there is a scattering of care- sue damage but as a quality of the psyche, cally correct, extremely well written and an less errors (such as his statement that acu- opposite to pleasure, could much the same erudite and scholarly treatise. puncture “was well known in the West in not be said of the concatenation of sensory Mary Robertson is in the Department of Elizabethan times, beginning with a text- inputs that determine our responses to music Psychiatry, University College London, book … in 1683”, or the suggestion that the or painting? Those sensations, surely, war- Wolfson Building, London W1N 8AA, UK. Latin word placebo originated with Chaucer) rant consideration as a special functional cat- erodes one’s confidence. egory, as Wall insists on exclusively for pain. Wall’s chapter on “The philosophy of So, in the end, we will all do far better to pain” is not especially lucid. Many fine minds disregard this slight book — which mostly Getting at where have, over the centuries, grappled with the reads as if it had been dictated to a machine plethora of puzzles about pain, and I am cer- — return to The Challenge of Painand look to it hurts tainly not adequate to do them justice: nor, on Wall’s accumulated papers (for all that some Pain: The Science of Suffering this evidence, is Wall — his approach being colleagues have been sceptical of their con- by Patrick D. Wall compromised by his dismissal of their efforts tent) as a more fitting testament to his Weidenfeld & Nicolson: 1999. 186 pp. as a “confused mess”. He is hostile to achievements. £12.99, mind–body dualists for reasons that are not John Carmody is in the School of Physiology and John Carmody cogently explained; he is hostile to Catholi- Pharmacology, University of New South Wales, cism, especially its tradition of valuing suffer- Sydney 2052, Australia. Scientists tend to scorn what they consider ing which, I suspect, he does not understand; ‘popular’. Yet they generally expect the popu- he tells us that he despises something for its lace to support their work gratefully or, in the triviality, yet trivializes or misrepresents ideas case of physicians, to accept their diagnoses he does not value or appear to comprehend. A provincial setting and prescriptions credulously. When a ven- He also tells us — in an otherwise inter- turesome few do write for audiences beyond esting chapter on “The placebo response” — for the oceans their cloistered laboratories and clinics, their that, in one unspecified study, “no personali- Ecological Geography of the Sea colleagues’ response is likely to be something ty type was found diagnostic of the placebo by Alan R. Longhurst akin to Samuel Johnson’s slur upon a woman’s responder”, yet only a few lines later he advis- Academic: 1998. 398 pp. £54.95, $79 preaching — “It is not done well; but you are es, “Avoid pessimists if you are looking for Yves Dandonneau surprised to find it done at all.” Still, the truth placebo reactors”. He also claims that — must be told, whatever the motives for such Oceanographers now have a global view of ventures, even if it may sound curmudgeonly. the circulation of oceanic water. This view is TMANN The field of pain research has flowered especially well depicted and explained by wonderfully in the past 30 years, in both its Matthias Tomczak and Stuart Godfrey in

clinical and scientific facets, and Patrick Wall their Introduction to Regional Oceanography, CORBIS/BET has been a highly influential figure. As co- in which the mechanisms driving the cur- founder and enduring co-editor of the jour- rents and controlling upward and downward nal Pain, and as co-originator of the so-called motions are described for non-specialists. ‘gate control’ theory of pain (which pro- Alan Longhurst frequently refers to this posed that nerve cells in the spinal cord book, and also to HaraldSverdrup’s inspired could, depending on circumstances, operate explanation of the phytoplankton spring like a gate that is either open to or closed bloom at high latitudes, which is valid over against painful input), Wall’s achievements much of the ocean. Given these current glob- are genuine and substantial. As well as speak- al views and the author’s experience and pro- ing to the profession, he has been willing to found knowledge of the oceans, I was pre- communicate with a wider public: The Chal- pared for a thoughtful and comprehensive lenge of Pain (Penguin, 1982), for example, description of biology in the oceans. The which he wrote with his Canadian friend and most interesting and original part of the colleague Ronald Melzack, remains a signifi- book is the first six chapters, which cover all cant and valuable book. Whatever Wall’s Excruciation: Bronzino’s sculpture of pain. the provinces and link the large-scale physics