Scientists have known about Tourette’s Syndrome since 1885. On the most basic level, Tourette’s consists of “an excess of nervous energy,” but no two cases of Tourette’s are “ever quite the same.” Some patients learn how to get their condition under control, or even use the condition to their advantage, exploiting the “swiftness of thought” that it can create.
As Sacks alluded to in the Introduction, Tourette’s Syndrome may impair a patient’s abilities, but it may also give a patient exaggerated mental powers (or at least the feeling of exaggerated mental powers).
In the early 20th century, physicians began to ignore Tourette’s, and some even suggested that it was never a real disorder in the first place. Sacks suggests that doctors’ lack of interest in Tourette’s is indicative of the growing split in the medical community between doctors who studied the mind and those who studied the body. Tourette’s is difficult to classify—it could be considered a neurological problem, or a disease of the body—and therefore, doctors in the early 20th century often ignored it.
This passage reminds us why a diversity of conceptions of disease is important to the neurological community; without many competing paradigms of disease (abundance, deficit, etc.), some diseases will escape medical attention simply because they’re difficult to classify.
Sacks compares the reception of Tourette’s in the medical community to the reception of sleepy-sickness, the disease that he discusses in his earlier book, Awakenings. Sleepy-sickness is a disease that sometimes causes patients to fall into a coma-like condition. In the 1960s, Sacks gave sleepy-sickness patients a new drug, L-Dopa, which enabled them to “awaken,” at which point they often exhibited wild, Tourette’s-like syndromes. After he began studying sleepy-sickness, Sacks began studying tics in Tourette’s patients. He came to realize that there were many people who could be said to suffer from Tourette’s-like symptoms. Throughout the seventies, the medical community (and eventually society at large) gradually came to accept that Tourette’s, quite apart from being a rare or made-up condition, was very common. Scientists hypothesize that the causes of Tourette’s Syndrome can be found in the subcortex, the part of the brain that controls primitive responses. Tourette’s patients seem to suffer from an excess of dopamine in the brain. However, the causes of Tourette’s are so complicated that they can’t be pinned to a single chemical or part of the brain.
Sacks first rose to prominence by studying sleepy-sickness in the Bronx in the 1960s—his investigations later formed the basis for his first important book, Awakenings. Sacks treats Tourette’s Syndrome in much the same way that he treats sleepy-sickness; however, he comes to realize that Tourette’s is far more common than the medical community believes. It is because Tourette’s is such a mysterious, hard-to-diagnose disorder that neurologists in the 1960s often fail to recognize it. Furthermore, Sacks’s research into Tourette’s was instrumental in boosting awareness of the disorder and drawing both the public and the medical community’s attention.
In the early seventies, Oliver Sacks studied a patient named Ray, who suffered from Tourette’s—violent spasms prevented him from concentrating on anything for longer than a few seconds. He would also shout profanities almost constantly. Because of his condition, Ray excelled at certain games, such as table tennis. Sacks learned that he could curb Ray’s symptoms by giving him a drug called Haldol. However, Ray didn’t like Haldol, because he thought that it slowed him down. For the next three months, Sacks worked with Ray to build a life without the habits he’d acquired as a result of living from Tourette’s. Sacks then began to give Ray Haldol again, and Ray found himself tic-free, “but without significant ill-effects.” In short, Haldol performed a miracle for Ray—but only when accompanied by three months of preparation, in which Ray learned how to calibrate his new behavior.
Sacks’s treatment of Ray is emblematic of his approach to neurology in general. Although he diagnoses Ray successfully, and prescribes the “correct” dosage of the correct drug, Sacks recognizes that purely chemical treatment for Ray’s Tourette’s is insufficient. Sacks’s duty as a doctor, in other words, isn’t simply to cure Ray’s Tourette’s, but also to show Ray how to adjust his behavior to his new, post-Tourette’s life. By neglecting one-on-one patient interaction and careful training, Sacks suggests, neurologists are shirking their duties to their patients.
Ray has lived a happy life for the past nine years, thanks largely to Haldol. He has a good job and marriage, and he has many friends. But although Ray is calmer and happier, he finds himself missing some aspects of his old life—particularly, the wit and inventiveness that accompanied his Tourette’s. On weekends, Sacks says, Ray takes a break from Haldol and allows himself to “let fly.” Thus, Ray has made a happy life for himself, despite—but also because of—Tourette’s.
Ray’s life post-Tourette’s reminds us that neurological disorders aren’t always harmful, or rather, they’re not always harmful across the board. At times, Ray thinks of his Tourette’s as a gift, not a curse—that’s why he chooses to embrace his Tourette’s on weekends, balancing a normal, low-energy life with high-energy, manic Friday and Saturday nights.