Sociological and cultural aspects of Tourette syndrome

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Tourette syndrome (also Tourette's syndrome, Tourette's or TS) is an inherited neurological disorder with onset in childhood, characterized by the presence of motor and phonic tics.[1] Tourette's is a misunderstood and stigmatizing condition, often mentioned in the popular media; there are sociological and cultural aspects of living with Tourette syndrome, including legal, advocacy and health insurance issues, awareness of notable individuals with TS, and treatment of TS in the media and popular culture.

Tourette syndrome was once considered a rare and bizarre syndrome. It is no longer considered rare, but is often undetected because of the wide range of severity, with most cases classified as mild.[2] Tourette's is defined as part of a spectrum of tic disorders, which includes transient and chronic tics.[3][4] With the increased knowledge of the full range of severity of Tourette syndrome—including milder cases—it has shifted from a condition only recognized in its most severe and impairing forms, to being recognized as a condition which is often mild, and which may be associated with some advantages and disadvantages. There are many individuals with Tourette's, living and deceased, recognized in their fields, or for whom obsessive-compulsive tendencies associated with Tourette's may have helped fuel their success.

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[edit] Legal and insurance issues

There is no reason to suspect that persons with Tourette's have diminished capacity with respect to consent to treatment, participation in research, or making a will. However, support from experienced advocates can be helpful in pursuing legal rights under US federal legislation which protects some rights of individuals with TS: examples include the Individuals with Disabilities Education Act (IDEA) and the Americans with Disabilities Act (ADA).[3] Legal and other advocacy information regarding the challenges of living with TS can be found on the website of the Tourette Syndrome Association.[5]

A review of all cases tried in state and federal courts between 1985 and 2003 (civil rights, criminal, education, family, labor, and social security) found that TS was implicated in a miniscule number of cases nationwide: only about 150 cases, 21 of which were criminal, over 18 years. The authors concluded that Tourette syndrome "rarely leads to criminal behavior, but patients with TS who have behavioral comorbidities are at risk of being involved with the legal system."[6]

People diagnosed with Tourette syndrome may have difficulty obtaining new health insurance, or reimbursement for health care under their existing insurance plans,[7] in spite of overall excellent health.[8] The insurance "nightmare" that exists for thousands of people with TS[9] is a factor to be considered in the diagnostic process because a TS diagnosis can result in future denial of medical coverage. If a diagnosis is not needed for school or medication processes, some families may choose to forego a formal, written diagnosis.

[edit] Latent advantages

Samuel Johnson (1709 – 1784) circa 1772, painted by Sir Joshua Reynolds. Johnson wrote A Dictionary of the English Language in 1747, and was a prolific writer, poet, and critic.
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Samuel Johnson (1709 – 1784) circa 1772, painted by Sir Joshua Reynolds. Johnson wrote A Dictionary of the English Language in 1747, and was a prolific writer, poet, and critic.

Discussions with adults who have Tourette syndrome reveal that not everyone wants treatment or a "cure", especially if that means they may "lose" something else in the process. Some believe that there may even be latent advantages associated with the genetic vulnerability.[10] Research supports some advantages associated with Tourette syndrome.

A controlled study on a small (13) group of individuals with TS found that cognitive control may be enhanced in young people with Tourette's because the need to suppress tics results in more efficient control of inhibitions.[11] There is some evidence to support the clinical lore that children with "TS-only" (Tourette syndrome in the absence of other comorbid conditions) are unusually gifted: neuropsychological studies have identified advantages in children with TS-only. A study of full-scale intelligence quotient (IQ) testing showed that children with TS-only had higher IQ scores, relative to their parents, than predicted by statistical models.[12][13] Another neurological examination of motor function found that 76% of children with TS-only were faster than average on timed motor coordination,[14] although similar results were not found among children with TS who also had ADHD.[12]

[edit] Notable individuals

Howard Ahmanson, Jr., multi-millionaire philanthropist with Tourette syndrome.
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Howard Ahmanson, Jr., multi-millionaire philanthropist with Tourette syndrome.

Tourette syndrome has shifted from being a condition only recognized in its most severe and impairing forms, to being recognized as a condition which is often mild, and which may be associated with some advantages and disadvantages. There are many individuals with Tourette's, living and deceased, recognized in their fields, or for whom obsessive-compulsive tendencies associated with Tourette's may have helped fuel their success. An example of a person who may have used obsessive-compulsive traits to advantage is Dr Samuel Johnson, lexicographer, who had Tourette syndrome as evidenced by the writings of James Boswell.[15] Johnson wrote A Dictionary of the English Language in 1747, and was a prolific writer, poet, and critic.

Andre Malraux, the French author, adventurer and statesman, also had Tourette syndrome.[16][17] Howard Ahmanson, Jr, an American millionaire philanthropist who funds Christian causes, has Tourette's.[18] Brad Cohen is an award-winning teacher and author.[19][20]

Tim Howard, soccer goalkeeper with Tourette syndrome
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Tim Howard, soccer goalkeeper with Tourette syndrome

Recognized athletes and figures in the sports world diagnosed with Tourette syndrome include Mahmoud Abdul-Rauf (formerly Chris Jackson), a former NBA player;[21] Eric Bernotas, a three-time U.S. skeleton champion who made his Olympics debut in 2006;[22] Jim Eisenreich, a former major league baseball player;[23] Tim Howard, a goalkeeper for Manchester United Football Club (currently on loan to Everton F.C);[24] Mike Johnston, a relief pitcher formerly on the roster for the Pittsburgh Pirates;[25] Jeremy Stenberg, a motocross rider nicknamed "Twitch";[26] and NASCAR Busch Series driver Steve Wallace, son of racing legend Rusty Wallace.[27]

Recognized musicians with Tourette syndrome include Tobias Picker, a composer;[28] Nick Tatham, a singer/songwriter;[29] and Michael Wolff, a jazz musician.[30] Author and neurologist Oliver Sacks describes the case of a drummer with TS, who uses his tics to give him a certain 'flair' or 'special sound' to his drumming.[31]

Neurologist Oliver Sacks uses the pseudonym Carl Bennett to describe real-life Canadian Mort Doran, M.D., a pilot and surgeon with severe TS, whose tics remit almost completely while he is performing surgery.[32][33]

[edit] Speculation about notable individuals

Some authors have speculated that Mozart may have had Tourette syndrome. Benjamin Simkin, a medical doctor, argues in his book Medical and Musical Byways of Mozartiana that Mozart had Tourette syndrome.[34][35] Simkin is an endocrinologist[34]—not a psychiatrist or a neurologist, the medical fields which specialize in the neurological disorder. His claim was picked up by newspapers worldwide, causing an international sensation, and internet websites have fueled the speculation.[36] Letters Mozart wrote to his cousin Maria Anna Thekla ("Bäsle") between 1777 and 1781 contain scatological language; and he wrote canons titled Leck mich am Arsch ("Lick my ass") or variations thereof (including the pseudo-Latin Difficile lectu mihi mars). This alone is not indicative of Tourette syndrome, and there are alternative explanations for his use of language. While the term "Leck mich am Arsch", when literally translated, conjures up images of vulgar sexual practices, the more accurate English meaning of this phrase is simply "Kiss my ass". The fact that Mozart wrote these words and used them in the titles of canons speaks to his status as a "rock star" of his day. Used in this sense, it is an expression of flippant or playful arrogance. The additional phrase "... recht fein schön sauber", while colorful, is still only an emphasis: that is to say, "Kiss my ass real good!" [sic]. The noted neurologist and author Oliver Sacks published an editorial disputing Simkin's claim,[37] and the Tourette Syndrome Association pointed out the speculative nature of this information.[36] No Tourette's syndrome expert or organization has voiced concurrence that there is credible evidence to conclude that Mozart had Tourette's. One TS specialist stated that, "although some web sites list Mozart as an individual who had Tourette's and/or OCD, it's not clear from the descriptions of his behavior that he actually had either."[38]

Comedian Dan Aykroyd described himself (in a radio interview with Terry Gross)[39] as having mild Tourette syndrome that was successfully treated with therapy when he was a preteen, as well as mild Asperger syndrome.[40] The diagnosis of Asperger syndrome did not exist in the 1960s, when Aykroyd was a preteen. The term was coined in 1981, and became a recognized diagnosis in the 1994 DSM. Tics can be caused by other disorders, including autism spectrum disorders such as Asperger's.[41] It is unclear if Aykroyd received the diagnoses of TS or AS from a medical source, whether he was speaking in his role as a comic, or whether the diagnoses were self-made. It was an audio interview, so the audience could not see Aykroyd's facial expressions, but the interviewer indicated uncertainty about whether Aykroyd was kidding.[39]

[edit] References in the entertainment industry

Several documentaries have attempted, with varying levels of success,[42] to portray Tourette's syndrome accurately and to advocate for greater understanding of persons with Tourette's. The Emmy Award-winning[43] television documentary film I Have Tourette's But Tourette's Doesn't Have Me was produced by HBO in conjunction with the Tourette Syndrome Association, featuring children between the ages of six and 13.[44][45] John's Not Mad is a 1989 documentary about a Scottish teenager who has severe Tourette's and coprolalia.[46][42] Twitch and Shout examines a society that is quick to judge a person who strays outside the limits of conventional behavior, won numerous awards, and was nominated for an Emmy.[47]

A movie released on video, The Tic Code, stars Gregory Hines as a saxophone player with TS who befriends a 10 year old boy with TS. It was written by Polly Draper, and produced with her husband, jazz musician Michael Wolff, who has Tourette's and on whose life the script was loosely based.[48] The UK movie, Dirty Filthy Love, tells the story of Mark Furness (Michael Sheen) with Obsessive Compulsive Disorder (OCD) and Tourette's negotiating his way through divorce, matchmaking efforts, and a woman who introduces him to therapy and unconditional love.[49] A protagonist with Tourette's is presented in Jonathan Lethem's award-winning detective novel, Motherless Brooklyn.

Laura Schlessinger, a radio talk show host involved in a May 2001 incident of disinformation about coprolalia and Tourette syndrome.
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Laura Schlessinger, a radio talk show host involved in a May 2001 incident of disinformation about coprolalia and Tourette syndrome.

The entertainment industry often depicts those with TS as being social misfits whose only tic is coprolalia, which has furthered stigmatization and the general public's misunderstanding of persons with Tourette's. The symptoms of Tourette syndrome are fodder for radio and television talk shows. Some talk shows (e.g.; Oprah) have focused on accurate portrayals of people with Tourette's, while others (e.g.; Dr. Phil) have furthered stigmatization, focusing on rare and sensational aspects of the condition.[50] An incident of disinformation about coprolalia and Tourette's involved Dr. Laura Schlessinger; according to the Tourette Syndrome Association, she berated a caller inquiring whether a child with Tourette's should attend a family wedding, declaring that a majority of those with the condition exhibited coprolalia and should be excluded from many social situations, provoking an avalanche of angry calls about the misinformation.[51] Garrison Keillor, radio show host of NPR's A Prairie Home Companion, produced a segment in 2006, titled "Broadway Tourette's", about segregating people with stereotypical Tourette's from other passengers on a cruise ship, prompting a press release from the Tourette Syndrome Association.[52]

Many television shows have addressed the topic of Tourette's, but few have advanced understanding of Tourette's. A 1981 episode of the television show, Quincy, M.E., "Seldom Silent, Never Heard", was a seminal moment in the history of Tourette's. It was perhaps the first television representation of Tourette's syndrome, and its portrayal led to many undiagnosed people with tics recognizing their symptoms and getting a correct diagnosis.[53] Other television shows which helped advance accurate information about Tourette's include L.A. Law, The Practice and 7th Heaven.

In Matchstick Men, the protagonist (Nicolas Cage) is a neurotic con artist with Tourette's and OCD.
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In Matchstick Men, the protagonist (Nicolas Cage) is a neurotic con artist with Tourette's and OCD.

However, even more television and film productions are not accurate representations of persons with Tourette's, and many of them have used misconceptions about coprolalia as a plot device, or portrayed people with Tourette's as being dangerously out of control. For example, in an episode of Ally McBeal, Anne Heche portrays a woman with Tourette's who gets a sudden leg tic that causes her to run over and kill her boyfriend. An episode of Touched by an Angel, "An Angel on my Tree", was about a father who committed manslaughter in an angry "rage" reaction to an event that involved his son, both with Tourette's. In an episode of The Simpsons, Mrs. Krabappel is recounting all the diseases and illnesses Bart has claimed to have to excuse himself from a test. She says, "and that unfortunate case of Tourette's Syndrome", and Bart tries to pretend he still might have it by cursing and rambling. (Due to viewer complaints, subsequent airings omitted Bart's cursing or replaced the Tourette's mention with rabies.) The British comedic drama Shameless features Marty Fisher, a character with Tourette's syndrome who is also an arsonist.[54] Other examples are The Big White, The Boondock Saints, Deuce Bigalow: Male Gigolo, Niagara, Niagara, Not Another Teen Movie, Wedding Crashers, The Wedding Singer, The West Wing and What About Bob. In Matchstick Men, the protagonist (Nicolas Cage) is a neurotic con artist with Tourette's and OCD.[55]

Singer Pete Bennett, from Brighton, the winner of the 2006 edition of British TV reality show, Big Brother 7, has Tourette syndrome.[56][57][58] The show has been accused of exploiting Pete's Tourette's syndrome:[42] and the British Psychological Society (BPS) expressed concern and the possibility that BPS members involved in the series could face censure.[59] His condition was reported to have been aggravated by drug use.[60] Some viewers expressed concern that the show had exploited Tourette's, while others felt it was educational.[61]

[edit] References in the music industry

The UK Britpop band Manic Street Preachers recorded a song on the Gold Against The Soul album titled "Symphony Of Tourette", the lyric being sung from the perspective of a person with Tourette's. The album sleeve also contains a brief description of the condition and its symptoms following the lyrics for the song. Nirvana recorded a song on the In Utero album titled "tourette's" (uncapitalized), sung with the lyrics intensely shouted, perhaps to mimic the syndrome. After disbanding Jokke & Valentinerne, Norwegian rock-musician Joachim Nielsen played with a backing-band called The Tourettes. A musical about Tourette's, In My Life, was a flop on Broadway, opening in October, 2005, and closing quickly to poor reviews.[62][63]

[edit] See also

Topics related to Tourette syndrome
Main Causes and origins | Sociological and cultural aspects | Treatment
Terms Coprolalia | Copropraxia | Echolalia | Echopraxia | Palilalia | Sensory phenomena |Tic | Tic disorder | Tourettism
History Jean-Martin Charcot | Georges Gilles de la Tourette | Jean Marc Gaspard Itard | Arthur K. Shapiro
Organizations Tourette Syndrome Association | Tourette Syndrome Foundation of Canada
Media I Have Tourette's But Tourette's Doesn't Have Me | John's Not Mad
Notable people Mahmoud Abdul-Rauf |Howard Ahmanson, Jr | Brad Cohen | Jim Eisenreich | Tim Howard | Samuel Johnson | Andre Malraux | Tobias Picker | Michael Wolff

[edit] Notes

  1. ^ Behavenet. Tourette's disorder. Accessed 10 Mar 2005.
  2. ^ Scahill L, Williams S, Schwab-Stone M, Applegate J, Leckman JF. Disruptive behavior problems in a community sample of children with tic disorders. Adv Neurol. 2006;99:184-90. PMID 16536365
  3. ^ a b Black, KJ. Tourette Syndrome and Other Tic Disorders. eMedicine (March 22, 2006). Accessed 27 June 2006.
  4. ^ Evidente, GH. "Is it a tic or Tourette's? Clues for differentiating simple from more complex tic disorders." PostGraduate Medicine Online. October 2000 108:5. Accessed 28 October 2006.
  5. ^ Tourette Syndrome Association. Living with TS:Adult Challenges. Accessed 28 June 2006.
  6. ^ Jankovic J, Kwak C, Frankoff R. Tourette's syndrome and the law. J Neuropsychiatry Clin Neurosci. 2006 Winter;18(1):86-95. PMID 16525075
  7. ^ Tourette Syndrome Association. Health Insurance. Accessed 27 October 2006.
  8. ^ Leckman & Cohen (1999), p. 406.
  9. ^ Waltz, Mitzi. Health Insurance Issues for persons with Tourette Syndrome. Tourette Syndrome Association. Accessed 27 October 2006.
  10. ^ Leckman JF, Cohen DJ. Tourette's Syndrome—Tics, Obsessions, Compulsions: Developmental Psychopathology and Clinical Care. John Wiley & Sons, Inc., New York, 1999, p. 408.
  11. ^ Mueller SC, Jackson, GM, et al. Enhanced Cognitive Control in Young People with Tourette's Syndrome. Current Biology. 2006 Mar 21;16(6):570-3. PMID 16546080
  12. ^ a b Denckla MB. Attention deficit hyperactivity disorder: the childhood co-morbidity that most influences the disability burden in Tourette syndrome. Adv Neurol. 2006;99:17-21. PMID 16536349
  13. ^ Schuerholz LJ, Baumgardner TL, Singer HS, et al. Neuropsychological status of children with Tourette's syndrome with and without attention deficit hyperactivity disorder. Neurology. 1996 Apr;46(4):958-65. PMID 8780072
  14. ^ Schuerholz LJ, Cutting L, Mazzocco MM, et al. Neuromotor functioning in children with Tourette syndrome with and without attention deficit hyperactivity disorder. J Child Neurol. 1997 Oct;12(7):438-42. PMID 9373800
  15. ^ Tourette Syndrome Association. Samuel Johnson. Accessed 10 February 2005.
  16. ^ Tourette Syndrome Foundation of Canada. Questions and Answers. Accessed 28 October 2006.
  17. ^ Todd, Olivier. Malraux: A Life. Knopf, 2005.
  18. ^ Doward, J. Anti-gay millionaire bankrolls Caravaggio spectacular. The Observer. March 6, 2005.
  19. ^ VanderWyk & Burnham Authors. Brad Cohen. Accessed 3 June 2006.
  20. ^ Tourette Syndrome Association. Front of the Class wins independent publisher award. Accessed 3 June 2006.
  21. ^ Wall, James M. "Prayer time: Abdul-Rauf takes a stand." Christian Century. April 10, 1996. Find Articles
  22. ^ NBCOlympics.com Profiles. Eric Bernotas. Accessed 20 February 2006.
  23. ^ Jim Eisenreich Foundation. Accessed 18 February 2006.
  24. ^ Tourette Syndrome Association. Public Service Announcement for Tourette Syndrome awareness features soccer star Tim Howard. 18 January 2005.
  25. ^ Major League Baseball. Mike Johnston. Accessed 18 February 2006.
  26. ^ Brown, C.L. "Rider with Tourette's shows no fear on bike." The Courier-Journal. June 10, 2005.
  27. ^ NASCAR.com (July 26, 2006). Q&A: Kenny Wallace/Steve Wallace. Retrieved on July 31, 2006.
  28. ^ Tourette Syndrome Association of New Jersey, Inc. Mentoring program. Spring/Summer 2000.
  29. ^ CD Times. Nick Tatham. Accessed 20 February 2006.
  30. ^ Tourette Syndrome Association. Jazz musician Michael Wolff. Accessed 18 February 2006.
  31. ^ Sacks O. The Man Who Mistook His Wife for a Hat: And Other Clinical Tales. Touchstone, New York, 1998.
  32. ^ Doran, Morton L. The Tourette Syndrome Association, Inc., Connecticut Chapter 1998 Educators' Conference; 1998 Nov 6; Danbury, CT.
  33. ^ Sacks O. An Anthropologist on Mars. Knopf, New York, 1995.
  34. ^ a b Simkin, Benjamin. Medical and Musical Byways of Mozartiana. FITHIAN PRESS. Accessed 28 October 2006.
  35. ^ Simkin B. Mozart's scatological disorder. BMJ. 1992 Dec 19-26;305(6868):1563-7. PMID 1286388
  36. ^ a b Tourette Syndrome Association:Did Mozart really have TS? Accessed online 14 Aug 2002.
  37. ^ Sacks O. Tourette's syndrome and creativity. BMJ. 1992 Dec 19-26;305(6868):1515-6. PMID 1286364
  38. ^ SchoolBehavior.com. Famous People with Tourette's syndrome and/or Obsessive-Compulsive Disorder. Accessed on May 20, 2006
  39. ^ a b Fresh Air, NPR, Media Player file Accessed 20 February 2006.
  40. ^ Aykroyd, Terry Gross interview excerpt. Accessed 20 February 2006.
  41. ^ Mejia NI, Jankovic J. Secondary tics and tourettism. Rev Bras Psiquiatr. 2005;27(1):11-7. PMID 15867978
  42. ^ a b c Guldberg, Helene. Stop celebrating Tourette's. Spiked, May 26, 2006. Retrieved 2 December 2006.
  43. ^ Tourette Syndrome Association. "I Have Tourette's But Tourette's Doesn't Have Me" Wins an Emmy. Accessed August 20, 2006.
  44. ^ HBO. I Have Tourette's but Tourette's Doesn't Have Me. Accessed 9 May 2006.
  45. ^ Tourette Syndrome Association. "I Have Tourette's but Tourette's Doesn't Have Me" NOMINATED FOR TWO EMMY AWARDS. Accessed 7 July 2006.
  46. ^ DVD Times. John's Not Mad. Accessed 9 May 2006.
  47. ^ PBS.Twitch and Shout Press Release. Accessed 8 May 2006.
  48. ^ IMBb.com The Tic Code. Accessed 9 May 2006.
  49. ^ IMDb.com. Dirty Filthy Love. Accessed 9 May 2006.
  50. ^ Tourette Syndrome Association. Letter of response to Dr. Phil. Accessed 8 May 2006.
  51. ^ Tourette Syndrome Association. Oprah and Dr. Laura - Conflicting Messages on Tourette Syndrome. Oprah Educates; Dr. Laura Fosters Myth of TS as "Cursing Disorder". (May 31, 2001). Accessed 6 October 2001.
  52. ^ Tourette Syndrome Association. Letter of response to Garrison Keillor radio show. Accessed 8 May 2006.
  53. ^ TV.com. Seldom Silent, Never Heard. Accessed 8 May 2006.
  54. ^ Jamesmcacoy.com
  55. ^ IMDb.com. Matchstick Men. Accessed 9 May 2006.
  56. ^ Profile: Big Brother winner Pete Bennett. BBC News (August 18, 2006).
  57. ^ Big Brother 7. Pete Bennett. Accessed 21 May 2006.
  58. ^ U.tv. Tourette's sufferer Pete 'very brave' Accessed 22 May 2006.
  59. ^ Psychologists voice Brother worry. BBC News (August 24, 2006).
  60. ^ Parr, Charlotte. BB's Tourette lad has "fried his mind". Accessed 22 May 2006.
  61. ^ Allen, Liam. BB Pete: Exploitation or education? BBC News (August 18, 2006).
  62. ^ In My Life. Internet Broadway Database, Accessed 30 October 2006.
  63. ^ Brantley, Ben. Where an Angel Fearlessly Treads. New York Times, October 21, 2005.

[edit] External links

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