What is Tourette's Syndrome?

With regards to the genetic dimension of TS, the phenotype observation determines the etiology. Since there is no agreement on the phenotype, there is no agreement on definition, prevalence or intervention. In order to understand the phenotype differences, it is essential to begin with the most basic definition. A phenotype is linked by definition to a genotype. A genotype can be defined as the genetic constitution of an individual or group, or as a class or group of individuals sharing a specific genetic makeup. In this light, a phenotype is the visible properties of an organism that are produced by the interaction of the genotype and the environment. More importantly, it is a group of organisms sharing a particular phenotype. The phenotype standard for the studies examined in this work use the diagnostic criteria from the Diagnostic and Statistical Manual 3rd Edition-Revised (DSM III R) as its base. It is essential for this discussion to outline the DSM III R as it will continuously come under fire as the efforts to develop a standard are undertaken. The DSM III R definition is outlined below:
307.23 Tourette's Disorder
A. Both multiple motor and one or more vocal tics and have been present at some time during the illness, although not necessarily concurrently.
B. The tics occur many times a day (usually in bouts), nearly every day or intermittently throughout a period of more than one year.
C. The anatomic location, number, frequency, complexity, and severity of the tics change over time.
D. Onset before age 21.
E. Occurrence not exclusively during Psychoactive Substance Intoxication or known central nervous system disease, such as Huntington's chorea and postviral encephalitis.

Tourette's Syndrome: An examination of dominant discourses and power relations in the the genetic controversy (HTML)
Tourette's Syndrome: An examination of dominant discourses and power relations in the the genetic controversy

	Tourette Syndrome and Human Behavior by David Comings: In the tradition of the 19th century classification debate surrounding Tourette's Syndrome (TS), history is repeating itself in the controversy surrounding the unorthodox genetic theories of Dr. David Comings. Drawing from his years of treating patients, Comings has come to theorize that TS is more than a tic disorder. Much like his predecessor Guinon, Comings also asserts that his colleagues have too narrowly defined their disorder. Comings' genetic studies have led him to conclude that TS is a polygenic disorder, caused by the convergence from both parents of several genes which affect the levels of dopamine, serotonin and other brain chemicals. Because Comings believes that TS is genetic, he speculates that a gene, which is semi-dominant and semi-recessive, is involved in TS. Moreover, he has defined TS as a spectrum disorder, which includes a host of other behavioral disorders such as alcoholism, drug abuse and compulsive eating disorders. He feels that by defining TS as an autosomal dominant condition, his colleagues' efforts are doomed to fail. This theory has dramatic implications regarding the causes of certain behaviors that mental health professionals have traditionally attributed to psychological problems, poor parenting or learning behaviors. Comings represents the most thorough and persistent view of the genetic component of TS. In this light, Comings' views are worth understanding and must be taken seriously. However, he is not without opposition and his findings have undergone extreme scrutiny and criticism. Ranging from the absurd to the technical, Comings has been accused of conjuring up the ghosts of Eugenics to merely being guilty of an ascertainment error. His perspective and the objections of his detractors are the subject of this work. In the end, whether Comings is ultimately vindicated is moot. What is important is, as we inch closer to a full explanation of the etiology of TS, a possible explanation has not been ignored by the reductionist tendency of specialization.
	A Cursing Brain? The Histories of Tourette Syndrome by Howard I. Kushner: 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.
	Framing Disease: Studies in Cultural History (Health and Medicine in American Society) by Charles E. Rosenberg, Janet Golden: Looking at disease as a function of dominant discourses should be viewed as a positive thing. "Framing Disease" opens up a new space of analysis to physicians. Up to now, we were reacting to traditional research and conclusion unaware of our role in this interplay. This book takes us an important step back to examine how we do things and to take another step back from there. It is one thing to be self aware and even better to be aware of such awareness. As much as traditional research methods have been helpful, they are inherently limited and are holding us back. This book does not discredit what has gone on before but rather that the answers we have come up with are not the only answers. Perhaps we can move forward, acting on this new awareness that we are human and subject to human frailties. We should be grateful for Rosenberg and Golden and re-ask the question, What is a disease?
	The Coming Plague: Newly Emerging Diseases in a World Out of Balance by Laurie Garrett: "While the human race battles itself... the advantage moves to the microbes' court. They are our predators and they will be victorious if we, Homo sapiens, do not learn how to live in a rational global village that affords the microbes few opportunities." I find myself astounded at how many educated people insist we are in a war against microbes. Anyone with a lucid view of the state of nature can see that organisms, not genes, do what comes naturally - survive. Why? Well that is a question for Philosophers and Theologians. Laurie Garrett, in this myth-destroying book, is no different from Rachel Carson when she brings to light what might otherwise be clear to make attentive news reader. Garrett puts things in perspective and that is the power of the book. The only real enemy we are fighting is ignorance so I think the quote above is a wake up call to shock us into realization. Essentially, we are fighting against ourselves. The range of this book is amazing. The "sexier" more "exciting" stories revolve around Hemorraghic Fever and Ebola. However, what folks fear most is actually the least of their problems: Ebola. Ebola kills its host within a span of 24 to 72 hours. If blood is not transferred via improperly sterilized needles or contact, the disease can very easily contained. Toxic shock syndrome can be prevented by education, and more extensive clinical trials. Now, something like AIDS and Legionella proves that differing public regarding how a disease is perceived and acted upon can have a very different consequences. Foucault would be proud of Garrett as she outlines public policy relating to the "other" - those considered "fringe" - Haitians, IV Drug Users, Homosexuals, etc. (those categorized as "high risk" are treated differently. Garrett does her research and has prompted me to more. I had to read this book about 2 years ago for a medical history class and wish everyone would read it.