Mozart at play: the limitations of attributing the etiology of genius to tourette syndrome and mental illness.

There has been a persistent attempt to explain Mozart's talent as connected to physical and mental illness. While Mozart's musical compositions and performances were often acclaimed for their "taste," the composer's personal behavior sometimes astonished those who witnessed "blödeln" or wild horseplay, practical joking, and scatological humor. Most recently, Mozart's eccentric behavior has been attributed to Gilles de la Tourette syndrome. This chapter investigates the evidence for these retrospective diagnoses and reassesses this evidence by paying particular attention to the milieu in which Mozart lived. We argue that Mozart's putative pathological behavior was a manifestation of his resilience in face of multiple adversities and was deeply rooted in his sense of play. Our hypothesis is that play, rather than neuropsychiatric disease, was essential to the operation of his genius.

Norman Geschwind and the use of history in the (re)birth of behavioral neurology.

When Norman Geschwind (1926-1984) attended medical school in the 1940s, his psychiatry professors taught as if behavior were unrelated to neuropathology. The focus of neurology remained the diagnosis and treatment of aphasias and epilepsies, while cognitive impairments and developmental disorders were classified as functional (psychological) disorders. Geschwind was troubled by the fact that many of the patients he saw with neurological deficits also presented with behavioral (developmental) disorders. Geschwind's generation also had been taught that aphasias resulted from global rather than localized or focal neurological lesions. These holists, including the prepsychoanalytic Sigmund Freud, targeted the work of aphasiologist Carl Wernicke as an exemplar of the flaws of the localizationist hypothesis. Reading Wernicke in the original, Geschwind discovered a complex and multilayered explanation for aphasias that implicated lesions located in association pathways that, when extensive, resulted in behavioral disorders. Geschwind also reread the works of the holists, discovering that, while their rhetoric rejected Wernicke, their explanations of aphasias actually reinforced Wernicke's hypothesis. Building on his reading of these historical documents and his clinical experiences, Geschwind urged the resurrection of Wernicke's disconnection syndromes that Geschwind labeled as Behavioral Neurology.

A tale of Congress, continuing medical education, and the history of medicine.

Well-intentioned attempts by the Senate Finance Committee to improve the content and quality of continuing medical education (CME) offerings had the unanticipated consequence of decimating academically oriented history of medicine conferences. New guidelines intended to keep CME courses free of commercial bias from the pharmaceutical industry were worded in a fashion that caused CME officials at academic institutions to be reluctant to offer CME credit for history of medicine gatherings. At the 2013 annual conference of the American Association for the History of Medicine, we offered a novel solution for determining CME credit in line with current guidelines. We asked attendees to provide narrative critiques for each presentation for which they desired CME credit. In this essay, we evaluate the efficacy of this approach.

Autism, lateralisation, and handedness: a review of the literature and meta-analysis.

A number of recent investigators have hypothesised a link between autism, left-handedness, and brain laterality. Their findings have varied widely, in part because these studies have relied on different methodologies and definitions. We conducted a systematic review and meta-analysis to assess the literature, with the hypothesis that there would be an association between autism and laterality that would be moderated by handedness, sex, age, brain region studied, and level of autism. From a broad search resulting in 259 papers, 54 were identified for inclusion in the literature review. This list was narrowed further to include only studies reporting results in the inferior frontal gyrus for meta-analysis, resulting in four papers. The meta-analysis found a moderate but non-significant effect size of group on lateralisation, suggesting a decrease in strength of lateralisation in the autistic group, a trend supported by the literature review. A subgroup analysis of sex and a meta-regression of handedness showed that these moderating variables did not have a significant effect on this relationship. Although the results are not conclusive, there appears to be a trend towards a relationship between autism and lateralisation. However, more rigorous studies with better controls and clearer reporting of definitions and results are needed.

Why are there (almost) no left-handers in China?

Surveys of Chinese students since the 1980s report that less than 1% are left-handed. This is an extraordinarily low number given the generally accepted view that between 10 and 12% of humans are left-handed. Are there actually very few left-handers in China and, if so, why? A number of sometimes overlapping reasons have shaped Chinese attitudes toward left-handedness. Some of these reflect the transcendent human reactions to biological laterality. Others have been shaped by Chinese historical and cultural experience. What is true in China can be identified in other societies: attitudes and practices toward left-handers have been and continue to be shaped by over-determined forces, which at the same time transcend specific cultures, while they respond to historical and cultural pressures. Like the Chinese, many North and East African peoples attempt to 'cure' left-handedness by a combination of restraints and severe punishments. Religion has often reinforced these practices. In China, we can see how a combination of traditional values and practical considerations seems to have merged to reduce both the actual and reported prevalence of left-handedness. When we add in the population of India, and much of the remaining Islamic world, we can conclude that for two-thirds of the world's population, being born left-handed exposes one to discrimination and stigma.

Deficit or creativity: Cesare Lombroso, Robert Hertz, and the meanings of left-handedness.

In the first decade of the twentieth century two influential researchers attempted to explain the origin and impact of left-handedness in human history. The first, the Turin physician Cesare Lombroso, often referred to as the father of modern criminology, was nearing the end of his long distinguished career. Lombroso tied left-handedness to criminality, insanity, and feeble mindedness. According to Lombroso, these groups shared biological regressions to primitive mentalities that could not be reversed by education or training. The second, French sociologist Robert Hertz, was at the beginning of a career cut short by his death in combat during the First World War. Hertz challenged Lombroso's claims, insisting that the predominance of right-handedness, whatever its biological substrate, was ultimately a cultural artefact driven by a primitive human urge to make sense of the world by dividing it into binary oppositions in which the right was viewed as sacred and the left as profane. Ending discrimination against left-handedness would, according to Hertz, unleash access to both hands and thus both hemispheres. The results, he insisted, would allow repressed talents and creativity to flourish. The conflicting views of Lombroso and Hertz have informed investigations of the causes and consequences of left-handedness until today. While the language of the debate has been reframed in current scientific discourses, left-handedness continues to be portrayed in the contradictory ways first elaborated by Lombroso and Hertz more than a century ago as either the cause of a variety of learning disabilities or as the key that can unlock creativity and talent. The debate also exposed the extent to which other cultural concerns, particularly anti-Semitism, informed theories of handedness.

Retraining left-handers and the aetiology of stuttering: the rise and fall of an intriguing theory.

Many twentieth-century British and American educators, psychologists, and psychiatrists advocated forcing left-handed children to write with their right hands. These experts asserted that a child's decision to rely on his or her left hand was a reflection of a defiant personality that could best be corrected by forcible switching. The methods used to retrain left-handers were often tortuous, including restraining a resistant child's left hand. In contrast, those who saw left-handedness as inherited, but natural, not only disapproved of forced switching, but also often warned of its putative negative consequences, especially stuttering. These claims were given credence in the 1930s by influential University of Iowa researchers, including psychiatrist S. T. Orton, psychologist L. E. Travis, and their students. From the late 1920s until the 1950s, the Iowa researchers published articles and books connecting the etiology of stuttering to forcing natural left-handers to write and perform other tasks with their right hand. Based on their clinical studies these practitioners concluded that stutterers displayed weak laterality. The Iowa group also published detailed case studies of patients whose stuttering was putatively cured by the restoration of their left-handedness. By the late-1940s, the connection between stuttering and retraining evaporated, due in large part to the growing dominance of psychoanalytic psychiatry. Despite robust statistical and clinical evidence, the connection between forced hand switching and stuttering has largely been forgotten. Recent imaging studies of stutterers, however, have suggested that stuttering is tied to disturbed signal transmission between the hemispheres. Similar to the Iowa researchers of the 1930s, current investigators have found connections between stuttering and weak laterality.

Suicide, social integration, and masculinity in the U.S. military.

Reports indicate that suicide in the U.S. military has increased significantly in recent years. This increase has been attributed to a number of factors, including more frequent deployments, more relaxed screening of recruits, combat trauma, economic difficulty amongst soldiers, and the breakdown of interpersonal relationships. In this article, we add an element that we believe is crucial to an understanding of military suicide: the socio-cultural environment of the military itself. In particular, we examine the role that the masculine ideologies governing military life play in the internalization of individual frustrations and in suicidal behavior. Suicide investigators often have ignored the role of masculine ideologies in military suicide because of the assumption that suicide results from social disintegration. In contrast, we argue that military suicide is driven largely by excessive social integration. From this perspective, current explanations of military suicide are constrained by gender and etiological assumptions. Finally, this paper suggests the implications of these findings for designing more effective prevention programs for military suicide.

Sports participation and problem alcohol use: a multi-wave national sample of adolescents.

BACKGROUND: Sports participation, though offering numerous developmental benefits for youths, has been associated with adolescent alcohol use. Differences also exist between men/boys and women/girls in both sports participation and patterns of alcohol-related behaviors, but there are few longitudinal investigations of this relationship. PURPOSE: This study investigated the relationship between school-based sports participation and alcohol-related behaviors using data from a multiwave national study of adolescent men/boys and women/girls. METHODS: Nationally representative data from the National Longitudinal Study of Adolescent Health, collected between 1994 and 2001, were analyzed in 2009 (n=8271). Latent growth modeling, accommodating the complex sampling design, was applied to examine whether participation in school-based sports was associated with initial levels and change in problem alcohol use over three waves of data collection. RESULTS: After taking into account time-invariant covariates including demographics and other predictors of alcohol use, greater involvement in sports during adolescence was associated with faster average acceleration in problem alcohol use over time among youths who took part in only sports. The findings suggest, however, that the relationship between sports participation and problem alcohol use depends on participation in sports in combination with other activities, but it does not differ between men/boys and women/girls. CONCLUSIONS: Sports may represent an important and efficient context for selective interventions to prevent problem alcohol use and negative consequences of alcohol use among adolescents.

An old autopsy report sheds light on a "new" disease: infantile polyarteritis nodosa and kawasaki disease.

Although Kawasaki disease (KD) was first discovered and identified in Japan by Kawasaki in the 1960s, fatal KD cases resulting from coronary artery aneurysms had been identified retrospectively in the West as early as 1871. Kawasaki initially postulated that this disease was a new, as yet unidentified, self-limiting illness with no fatal coronary sequelae. The connection between fatal cases, then diagnosed as infantile polyarteritis nodosa, was not made until the late 1970s. Kawasaki's thoughts were reinforced by an apparent absence of nonfatal cases in the West before 1967. Close examination of a 1948 autopsy report suggests that nonfatal cases of KD did indeed exist, at least in the United States, before its emergence in Japan in the early 1950s. These nonfatal cases of KD were misdiagnosed as Stevens-Johnson syndrome. The autopsy report reviewed in this article reinforces the likelihood that KD did occur in the United States before it was identified as Kawasaki disease in Japan.

Sports-specific factors, perceived peer drinking, and alcohol-related behaviors among adolescents participating in school-based sports in Southwest Georgia.

This study investigated the relationships among sports-specific factors, perceived peer drinking, and alcohol-related behaviors among adolescents, examining sex differences in the relationship between perceived peer drinking and alcohol-related behaviors. A questionnaire assessing demographics, sports-specific factors, perceived peer drinking, and alcohol-related behaviors was administered among 378 adolescents who were mostly male (76.3%) and non-Hispanic black (70.0%). Varsity sports participants reported higher levels of perceived peer drinking compared to those who participated in sports at other levels (B 0.64, 95% CI 0.28, 0.99, p<0.001). Participants in both sports offering team- and individual-level competition reported greater perceived peer drinking (B 0.71, 95% CI 0.05, 1.38, p=0.04), compared to those who only participated in individual sports. Perceived peer drinking was associated with alcohol-related behaviors (B 0.39, 95% CI 0.31, 0.47, p<0.001) and there were no significant differences between males and females in this relationship. Suggestions for future research include examining factors contributing to the low prevalence of drinking behaviors, and investigating factors related to sports that impact perceived peer drinking and alcohol-related behaviors.

Kawasaki disease in India: increasing awareness or increased incidence?

Reports of Kawasaki disease (KD) throughout India are increasing. This article addresses the question of whether the increased diagnosis of KD in India represents the emerging recognition of an illness that had been previously obscured by misdiagnosis, or whether KD is new to India and is increasing in incidence.Whichever answer turns out to be correct, the burden of KD is likely to pose a significant challenge to the health-care system in India in the coming years, due to the high cost of treatment and the potential for lifelong cardiovascular sequelae.Moreover, elucidating the factors that have contributed to the increased recognition of KD in India may provide useful insights for the continuing search for the etiology of KD worldwide.

The two emergencies of Kawasaki syndrome and the implications for the developing world.

Kawasaki syndrome (KS) is the most common cause of acquired pediatric heart disease in the developed world. There have been 2 distinctive patterns for the emergence of KS that are likely related to several factors including exposure to the causative agent(s) and host genetics. In Europe and North America where we presume the genetic susceptibility seems to be low, KS has existed in the pediatric population for more than a century and is associated with relatively low incidence. In Japan where genetic susceptibility is presumed to be high, KS seems not to have existed before the early 1950s. This relatively recent exposure has resulted in 3 nationwide epidemics and a high current endemic rate of 200 per 100,000 in children less than 5 years. If our history of alternative patterns of the emergence of KS is valid, it may prove useful as a predictive tool for countries including India, where clusters of KS cases have been recently reported. This article examines the historical evidence in support of a 2-tiered emergence of KS in Euro-America and Japan and then returns briefly to discuss its implications for the pediatric populations of India and the health care delivery systems in the developing world.

Taking biology seriously: the next task for historians of addiction?

Despite more than a century of attempts to control the use of addictive substances, prevalence rates continue to grow for most of them. Exceptions are tobacco and alcohol use, which, nevertheless, remain major public health concerns. Why have these attempts at drug control had little success? This question is addressed in the histories of substance use that are examined in this essay. While these studies show that there are multiple histories, definitions, and frames of addiction that have shifted over time, some broad themes emerge. Foremost is the argument that the classification of a substance as licit or illicit has had more to do with cultural values than with the substance itself. Historians, skeptical of essentialist categories, have questioned whether addictions are diseases and the wisdom of selectively criminalizing drug use. They argue that the socioeconomic status of users has influenced attitudes toward addicts and the legal classifications of substances.