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Diagnostic Methods to Assess the Chronic Impairment Journal of European Psychology Students, Vol. 3, 2012 The Deconstruction of Gilles de la Tourette’s Syndrome Rowan Voirrey Sandle Contact: [email protected] Abstract The present deconstruction of Gilles de la Tourette’s Syndrome introduces this complex disorder using an existential paradigm. An analysis of the history of constructed reason and power highlights the assumptions of ‘disorder’ that infiltrate society and serves to critique predisposed thought with reference to Tourette’s. The review considers the representationalist theory of language and concepts within psychiatric discourse. A brief analysis of previous case studies shows Tourettic energy as part of the individual ‘self’ and introduces a comparison of Tourettic movement to more mutual human experience, such as music and poetry. Past research that explores preventative social interaction is introduced, which show positive advancements in treatment by challenging the conventions of internal etiology and which highlights the importance of reducing attached stigma. Keywords: Tourette’s Syndrome, Deconstructing psychiatric disorder, social stigma Introduction Echolalia, the mimicking of others vocalizations and palilalia, the repetition of Over a century since its first formal diagnoses one’s own language, have also been reported by the man whose name became the eponym in cases of Tourette’s, as well as the repetition for the condition, Gilles de la Tourette’s of gestures, known as echopraxia. Narrative syndrome remains an enigmatic phenomenon approaches have considered further composite with no consistently identifiable pathology. behaviour as Tourettic, such as a burst of Individuals with the syndrome may encounter energy when playing an instrument (Sacks, clinical misunderstanding (Turtle & 1995; Steingo, 2008). For formal diagnosis, Robertson, 2008, p. 454) as well as an two other conditions must also be met. The inherently misinformed public image. first is that the individual must present tic Tourette’s is referred to as a syndrome as it symptoms before the age of 18. Secondly, the presents itself by a cluster of symptoms. The symptoms must present themselves for over a American Psychiatric Association ( DSM-IV- year with less than three consecutive months TR , 2000) states the symptomology as of respite. Therefore, not only do tics wax and multiple motor tics with the occurrence of one wane, suggestive perhaps of some external or more phonic tics. Although it does not state influence, tics are not idiosyncratic to their appearance or form, common simple tics Tourette’s but may exist on a continuum, include blinking, twitching and coughing, experienced at a lesser extent by members of whilst complex tics may consist of more the “normal” population. elaborate movements such as twirling and phonic behaviours that involve different Tourette’s syndrome is often diagnosed with sounds, singular words or even whole phrases. co-morbid conditions. The most commonly 68 Journal of European Psychology Students, Vol. 3, 2012 reported are Attention Deficit Hyperactivity people’s perception of madness and suggests, Disorder and Obsessive-Compulsive Disorder “what the eighteenth century had first noticed (Cohen, Sade, Benarroch, Pollak & Gross- about it (madness) was not the secret Tsur, 2008, p. 299). Tourette’s however, even interrogation, but only the social effects: the when diagnosed without these associated torn clothes, the arrogance in rags” (Foucault, behavioural complexities, is still reported as a 2009, p. 190), a sentiment highlighting a social and academic disability despite regular history of how physical representation reports of IQ levels, indicating that the proceeds and dominates any real syndrome is “unrelated to intelligence” understanding of the internal condition. (Miller, 2001, p. 535). It is therefore proposed that there must be wider social implications Social Construction of Abnormal attached to the diagnosis. Hollenbeck (2003) explains that “Tourette’s differs from other Behaviour neuropsychiatric disorders in one simple way: It is largely the disease of the onlooker. When To understand how, as a society, we have I tic, I am usually not the problem. You are.” come to interpret mental syndromes such as Here Hollenbeck introduces the paradox of Tourette’s in our modern world, it is Gilles de la Tourette’s syndrome; a ‘disease’ important to understand how we arrived at that only becomes apparent in the context of assumptions of abnormality through the social and political milieu, or what we may construction of knowledge. Since the age of more commonly consider public space (Davis, the Enlightenment there have been strong Davis & Dowler, 2003). This is not to suggest distinctions between what is viewed as reason that the suffering caused by Tourette’s is and what is viewed as unreason. This is illusionary. Having Tourette’s can be a reflected in the way Tourette’s used to be distressing experience; however, what viewed as a ‘moral’ disease, a ‘weakness of will’ Hollenbeck implies is that a large part of this (Sacks, 1995) laying outside of constructed distress may not be the tic itself, but the reason. The act of separating reason from stigma it evokes from the public. Therefore, unreason is social, and society is often ruled through eradicating this stigmatization at through elite power, which inherently leads to least part of the discomfort can also be exclusion of anyone deemed different from eradicated. this power. Although we no longer live in a feudal system under the rule of sovereign In 2009, Culter, Murphy, Gilmour and power, Foucault (1991) argues that the main Heyman provided research that highlighted function of modern disciplinary power is still the damage caused by stigma. They reported “hierarchical observation” and “normalizing children diagnosed with Tourette’s Syndrome judgment” (p. 170). The key difference being as having a lower subjective quality of life and, that disciplinary power acts to subtly correct crucially, the most significant reasons those deemed different, replacing overt public effecting this quality of life were punishment conducted through the sovereign. social/emotional problems rather than Porter (1987) observed that “the history of physical symptoms. Khalifa, Dalan & Rydell madness is the history of power” and noted (2010) also reported children with Tourette’s that “labeling insanity is primarily a social act, as having lower self-perception in areas a cultural construct.” He argues “do we call including appearance, social relations and people mentally ‘confused’ because we find psychological well-being. Although unrelated them confusing?” (pp. 8-20). This to tic severity, it is questionable whether some interpretation of how we organize human co-morbid conditions reported, such as behavior is particularly relevant to the anxiety, sleep disorders and further mental Tourettic individual who has been deemed health problems (Dodel et al., 2010, p. 1060) abnormal, despite the fact that their symptoms could be related to this stigma. are often cathartic, resulting in a return for them to their internal normal state. Evans The clinical implications suggested by the (1998) explains that, apart from a minority of research points towards peer education tics that causes excess strain on certain muscle regarding the syndrome in order to challenge groups, “the noises and other tics do not people’s tendency to form opinions on disable…to be disabled infers a social context. physicality. In Madness and Civilisation , If I “have” TS (sic) and live on a desert island, Foucault notes that this is a common trait in am I disabled?” (p. 13). Here, Evans shows 69 Journal of European Psychology Students, Vol. 3, 2012 how normality is no longer a personal nearly 80 years later, the trend remains that function but a social construct. everything outside personally constructed reason is wrong and this is seen in the It may be that government and power not misunderstood attitudes towards those with only legitimise power but “make new sectors syndromes such as Tourette’s. Bilokreli (2009) of reality thinkable and practicable” (Rose, recalls that when sharing the news to other 1990 as cited in Parker, Georgaca, Harper, teacher staff that she would have a boy with McLaughlin & Stowell-Smith, 1995, p. 59). Tourette’s Syndrome in her class, “I was This construction of reality has led to perhaps most bothered and astonished when behaviours that do not fit into established the response from others was laughing” (p. 2). belief systems being punished only for these behaviours to be deemed acceptable when The potential for humour related to viewed retrospectively. What is socially Tourette’s syndrome has been exploited by constructed as abnormal in present day belief the media in comedy series such as The systems may not be viewed as abnormal in the Simpsons’ episode “Marge Gets a Job” (1992) future. An example of this is the early modern and South Park’s “Le Petit Tourette” (2007), tradition of labelling certain behaviours as with such examples focusing on an being traits of witchcraft. Szasz (1960) went exaggerated form of coprolalia, the utterance as far as to say, “Mental illness exists or is of ‘anti social’ words, which effects under 10% “real” in exactly the same sense in which of those diagnosed (Brown, 2000, p. 349), or witches existed or were “real” ” (p. 117). Jung the misguided image of associated violence. (1970) furthers this comparison; although the Perverse pleasure extracted at the expense of belief system may have changed, as a society the Tourettic individual becomes voyeuristic we still torment those seen to be different and and presents the argument that it is no longer states “We no longer subject him to the test of the individual who is problematic but it is the drinking poison; we do not burn him or put society that is acting ‘sick.’ The label screws on him; but we injure him by means of Tourette’s in turn becomes synonymous with moral verdicts pronounced with deepest these extreme and misinformed media conviction” (p. 164). This is reflected in the representations and becomes a loaded way we treat those individuals we deem discourse used for stigmatization.
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