Freud and the diagnosis of Gilles de la Tourette's illness

Abstract

A number of observers recently have taken Freud to task for failing to have diagnosed both Frau Emmy von N.'s (1888-9) involuntary ticcing and vocalizations and Daniel Paul Schreber's (1911) coprolalia and convulsive tics as Tourette's syndrome. None of Freud's critics, however, has placed Freud's understanding of motor and vocal tics in historical context. None seems aware of the contests over the classification of tic symptoms in the 1880s and 1890s, nor do they appreciate the extent to which Charcot and Gilles de la Tourette had conceded that motor and vocal tics, as well as coprolalia, could also appear as symptoms of hysteria. Freud was studying with Charcot at the Salpetriere in 1885 when Gilles de la Tourette and Charcot laid out the typology for maladie des tics de Gilles de la Tourette and had read Gilles de la Tourette's 1885 article. Freud, unlike his critics, was familiar with contemporary critiques of Gilles de la Tourette's construction of maladie des tics. Both Guinon and Brissaud had insisted, contrary to Gilles de la Tourette's claims, that many tic patients recovered from their symptoms and most never developed coprolalia. Most important, Guinon argued that his tic patients could be hypnotized. And, it was a maxim of Charcot's theory of hysteria that only true hysterics could be hypnotized. By 1893 (when Freud first wrote out his case of Frau Emmy von N.), both Gilles de la Tourette and Charcot had defended themselves against Guinon's claim that convulsive tics were always a symptom of hysteria by distinguishing those tic symptoms that should be classified as 'maladie des tics' from those that accompanied hysteria. Yet, Charcot and Gilles de la Tourette had agreed by 1890 that tic symptoms were possible outcomes of either maladie des tics or of hysteria. What separated those afflicted with 'maladie des tics' from those afflicted with 'hysteria', were particular inherited factors and whether or not the patient could be cured of tics and vocalizations. Thus, within Charcotian terms, Freud was hardly obligated to conclude that his ticcing and cursing patients should have been diagnosed with maladie des tics de Gilles de la Tourette. From this perspective, there was no reason, given even the non-psychoanalytic view of these behaviours, for Freud in 1911 to diagnose Schreber as afflicted with Gilles de Tourette's illness.