Tourette’s Syndrome

   (TS)

   TS is an organic brain disease involving unrhythmical muscle tics, involuntary coprolalia (swearing), and obsessive-compulsive behavior, among other symptoms. In 1885, Paris psychiatrist–neurologist Georges Gilles de la Tourette (1857–1904), then an assistant of Jean-Martin Charcot at the Salpêtrière hospice, described in the Revue neurologique several cases of what he called "ticcing disease" (la maladie des tics); the patient in the article with the most characteristic symptoms was a noblewoman, the Marquise de Dampierre (1799–1884), whose disorder psychiatrist Jean-Marc-Gaspard Itard (1774–1838)—who was famous for treating "the wild boy of the Aveyron"—had already chronicled and was well-known. Gilles based his own account on the version that Itard had published in the Archives générales de la médecine in 1825. In addition to her ticcing and strange compulsions, the lady was known in Parisian circles for shouting out spontaneously such imprecations as "shit" and "fucking pig." In one of his clinical lectures in 1886, Charcot named the disorder after Gilles: "the ticcing disease of Gilles de la Tourette." Later, the grab bag of different symptoms the disorder often entails became known as Tourette’s syndrome.

   Psychoanalytic efforts to understand TS were touched off by Budapest psychoanalyst Sandor Ferenczi in 1921 (1873–1933), when he argued in the International Journal of Psychoanalysis that tics resulted from the repressed desire to masturbate and that they represented "stereotyped equivalents of masturbation." Of later psychoanalytic efforts to improve on this formulation, most influential was that of Margaret S. Mahler (1897–1985), a child psychiatrist and psychoanalyst at Columbia University, beginning in 1943 in the Psychiatric Quarterly (a paper written with psychiatrist Leo Rangell [1913–], who was training at the New York Psychoanalytic Institute). She believed that, although the illness might have an organic substrate, it occurred only in children with repressed familial conflicts. She argued that ticcers were "highly narcissistic individuals, who invest an undue amount of attention in their own bodies and who are unable to retain stimuli or irritations without immediate defensive enervation."

   In 1954, Johann Ludwig Clauss, a staff psychiatrist at a mental hospital in Berlin-Lichtenberg, and Karl Balthasar (qualified 1927), director of the neuropathology laboratory at a municipal hospital in Berlin-Lichtenberg, rather silently opened a new era by finding lesions in the basal ganglia of TS patients. They concluded on the basis of pathological anatomy that TS was an independent syndrome sui generis, not a chronic variant of Chorea minor. (Clauss had first presented some of these findings in 1943 at a meeting of the Berlin Neurological Society.) Their article, published in the Archiv für Psychiatrie und Nervenkrankheiten—and, of course, in German—was scarcely noticed in the United States.

   In 1961, Jean-Noel Seignot (graduated in medicine in 1953), a psychiatrist at the spa in Boulogne-sur-Mer, France, showed in the Annales médico-psychologiques that TS responded well to the antipsychotic drug haloperidol (introduced in France in 1960 by the Janssen Le Brun company). "The effect of R. 1625 [haloperidol] is in fact remarkable, because the daily number of tics, which was formerly around a thousand, has been reduced to a handful" (p. 579).

   With the licensing of haloperidol in the United States in 1967, New York psychiatrist Arthur K. Shapiro (1923–1995) at Montefiore Hospital and his wife, psychologist Elaine Shapiro, began a sustained drive to encourage the use of such antipsychotics as haloperidol in preference to psychoanalytic therapy for TS. Their first publication appeared in the British Journal of Psychiatry in 1968, "rejected by every major American psychiatric journal," in the words of Tourette-syndrome historian Howard Kushner. The Shapiros were instrumental in the formation of the precursor organization of the Tourette Syndrome Association later that year in New York.