Harold J. Fine

Tic de Gilles de la Tourette: Survey of the literature, case study, and reinterpretation

Abstract Tic de Gilles de la Tourette, a rare but complex tic syndrome, has been recognized as such for over a century and a half. To date, neither psychological or organic explanations have been satisfactory. Psychotherapy at best has succeeded only modestly in altering symptoms, and has fared even less successfully in affecting complete recovery. Treatments combining psychotherapy and drugs have yielded promising results, but to separate the therapeutic agents from the superfluous in such ambiguous therapies is to propose a difficult procedure. Because chemotherapy with haloperidol is an almost consistently effective treatment, many researchers infer that Tic de Gilles de la Tourette is of strictly organic origin. However, other researchers with a psychiological bias do not dismiss the malignant effect that disturbed interpersonal relationships can have on the ticquer, and even go so far as to suggest that a pathological family environment may actually precipitate the tic in an individual who may have been constitutionally predisposed to the disorder. A profile describing the dynamics in a ticquers family may be drawn from available case studies. Reviews of the literature and case studies suggest that no single etiological factor can be isolated. Thus, Tic de Gilles de La Tourette appears to be among those disorders which are born of a complex interplay of psychological and physiological dysfunctions.

CONCEPT OF CHARACTER REVISITED: AN EGO-PSYCHOLOGICAL VIEW WITH SOME THOUGHTS ON THE "DEPRESSIVE" CHARACTER

The concept of character in the psychoanalytic literature is reviewed with reference to differentiation of character and its theoretical derivatives from the concept of neurotic adaptation. Developments in psychoanalytic ego psychology and cognitive psychology are incorporated into a proposed framework for viewing character structure in light of socialization processes and the role of ego functions. This formulation of character more consonant with generalized life-styles is applied to an apparent “type” of character structure and organization at post-genital levels, labeled “depressive character.” Some preliminary implications for tactical issues in the therapy process are noted.