Over the next few years, Swedo and her colleagues treated a number of children with Sydenham’s chorea and OCD. Was it possible that this autoimmune disease, an illness of the body, was triggering illness in the brain? If you could cure one, would the other disappear? And when she looked at the case reports of patients with Sydenham’s chorea, she discovered that many had developed compulsive thoughts and obsessive behaviors weeks before their tics began. Rapoport had found that children with OCD showed increased activity in the basal ganglia. The worst damage occurs in the basal ganglia, the part of the brain that controls habits and movement. Unable to differentiate friend from foe, the antibodies attack both. The antibodies try to grab hold of the distinctive sugar-protein clumps on the exterior of the bacteria-but, in a stroke of evolutionary bad luck, some brain cells wear similar clumps. They are believed to secrete toxins that open up the blood-brain barrier, allowing antibodies in. But some Streptococcus seem to carry a secret key.
Scientists have yet to work out exactly how one progresses to the other, but the theory goes something like this: Pathogens and antibodies in the bloodstream generally have a tough time getting past the tight-knit barrier of cells and blood vessels that protect the brain. Sydenham’s chorea, it turned out, is the neurological manifestation of acute rheumatic fever. Left untreated, the pathogen can cause acute rheumatic fever, a serious autoimmune disease of the heart, joints, and skin. Not until the 1930s did scientists discover that children suffering Saint Vitus’ dance, now known as Sydenham’s chorea, had something else in common: Their blood contained antibodies for Streptococcus. He attributed the cause to “some humor falling on the nerves.” Thomas Sydenham, the 17th-century English physician who first described the condition, called it Saint Vitus’ dance, after the dancing manias that emerged in continental Europe during the Black Death, when large groups of people, sometimes thousands at a time, would cavort in the streets until they collapsed from exhaustion. Patients jerk their limbs in a strange and uncontrollable dance their tongues flicker their fingers seem to hammer the keys of an invisible piano. They concerned a childhood illness that causes tics in the face, hands, and feet.
Her mentor there, Judith Rapoport, was challenging the prevailing theories and seeking a medical explanation for OCD.Ī few old papers in the literature had piqued Rapoport’s interest. (Mothers were also blamed for a number of other conditions, including autism.) So when a pediatrician named Susan Swedo joined the National Institute of Mental Health in 1986, she was delighted to be part of a new vanguard. If a child developed tics or obsessive-compulsive disorder, the thinking went, it must be because her parents were emotionally frigid or had punished her during toilet training. Up until the 1980s, psychiatry in the United States was still a quasi-Freudian undertaking.
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