Book Review

James Leckman and Donald Cohen edit this book, which is really a collective commemorative celebration of more than 25 years of clinical work and research of the extended Yale `collegiate group’ in the area of Tourette’ s Syndrome (TS) and its associated disorders. The book re ̄ ects and reviews the `Yale Child Study Centre (YCSC) approach’ , which highlights the importance of both clinical care, involvement and awareness, alongside the multidisciplinary approach to scienti ® c investigation. The major concern of the group is the acknowledged importance of `understanding and caring for individuals with TS’ . TS is a neurodevelopmental genetic disorder characterized by multiple, waxing and waning motor tics, plus one or more vocal tics lasting for longer than a year (American Psychiatric Association, 1994; W orld Health Organization, 1992). TS, moreover, is an acknowledged paradigm for childhood neuropsychiatric disorders (Cohen et al., 1982). Apart from the tics, symptoms include echolalia (imitation of sounds or words of others), echopraxia (imitation of actions or movements of others) and palilalia (the repetition of the last word or phrase of others) and, much less commonly, coprolalia (inappropriate uttering of obscene words) and copropraxia (inappropriate making of obscene gestures). Associated behaviours include obsessive ± compulsive behaviours (OCB), attention de® cit hyperactivity disorder (ADHD) and self-injurious behaviours (SIB) (Robertson, 1994). TS was at one stage considered to be very rare, but recent studies (e.g. Mason et al., 1998) suggest that this might not be the case. In the scienti ® c literature, there are now many and rigorous studies on various aspects of TS which include a substantial number of patients. There are now also a number of books devoted to TS, but none to date from one group. There is no other institution worldwide which can, on its own, produce a book of this calibre and size. It has been a privilege to review, read and share, at least in part, the editors’ and authors’ journies into the fascinating world of TS. The book is edited and authored by leading experts in the ® eld Ð YCSC clinicians and researchers and their disciples, who have moved on from the Home institution, carrying the `Yale Bible’ with them. The introductory chapter, which is beautifully written, gives a brief history of TS in the 19th century and then the history of modern day TS, predominantly in the USA, and ® nally, the intimate history of TS at the YCSC which began in the mid-1970s. For a scholarly, in-depth history of TS throughout the ages, however, the reader is referred to Kushner (1999), reviewed by Robertson (1999a). The ® rst and introductory chapter, `The self under seige’ , also includes a moving personal story of a patient, `Abe’ , who had awful SIB and, at his worst, was in non-stop movement, necessitating being tied to a bed, `begging for help’ . Leckman and Cohen, who come across as caring clinicians caring for children with TS, describe how `Abe’ seemed to be embraced by two demon bulls which attacked each other, pulling and pushing in opposite directions, with Abe in the middle; this is somewhat reminiscent of Fowler’ s (1996) personal account of TS, in which the disorder is also personi® ed as a demon, an enemy, in a constant tug of war with him. Interestingly, Shimberg (1995), also a TS sufferer, and with TS children, also refers to TS as a demon. This personal touch