Gilles de la Tourette Syndrome [antikvár]

IntroductionI did not know at the time, and it may be hard to believe, that my interest in Gilles de la Tourette syndrome began on January 17, 1949, at 7:20 p.m., in the 8th Street Bookstore in New York City's Greenwich Village. While browsing through Horney's The Neurotic Personality of Our Time, I heard peculiar noises, which initially sounded like "shi, pi, fu," and then sounded like obscenities. At first I thought I was projecting some of my evil thoughts, and I listened more carefully. Out of the corner of of my eye, I saw a woman in her early twenties, shaking and jerking spasmodically, and erupting with "shit, piss, fuck." I dismissed the thought that it was a Greenwich Village prank as I continued to observe the young woman. She was well dressed, wore a conventional seal fur coat, and was not otherwise bizarre. She was also browsing through a book; I strained my eyes: It was the collected poetry of Keats.I do not remember thinking about this young woman again during 10 years of training and 6 years of subsequent clinical experience, nor do I recall hearing lectures or reading about tics or Tourette syndromenot until April 21,1965.A colleague in neurology referred a 24-year-old unmarried female for treatment. The diagnosis was "habit tic with hysterical personality associated with 'la belle indifference'," and the treatment recommended was "psychotherapy."Her symptoms were striking and bizarre: spasmodic jerking of the head, neck, shoulders, arms and torso; various facial grimaces; odd barking and grunting sounds; frequent throat clearing; periodic forceful protrusion of the tongue; and occasional shrill screams and coprolalia, such as "cocksucker." I instantly recalled the young woman, and I thought, "So that's what I saw in Greenwich Village 16 years ago."Over the next several months a thorough and careful clinical evaluation was conducted. It included interviews with the family, obtaining previous records, and arranging for psychological testing. The family and developmental history, psychodynamics, ego strengths and weaknesses, and defenses were carefully assessed. The most striking aspect of the illness was that the bizarre symptoms could not be explained by the patient's developmental history or psychological assessment. The symptoms suggested a malignant psychological illness. I remember seeing such bizarre symptoms in only two groups of patients. Chronic schizophrenics, usually diagnosed as hebephrenic, with bizarre, incongruous, and incomprehensible behavior, and patients with general paresis, the tertiary stage of syphilis, who tended to be older, have delusions of grandeur, and occasionally without provocation erupt with obscenities.