[Psychopathological study on Gilles de la Tourette's Syndrome]

Ten cases of Gilles de la Tourette's Syndrome (GTS) are reported. Average age of onset of the syndrome was 6.3 years old. Many of them were eldest children. 40% of them were caused by hereditary factor, and 40% of them had some abnormalities at their birth, for verbal tics including coprolalia. The GTS were classified into two types, Type I and Type II, from psychopathological point of view. Type I is "sadistic self-conversion type" and Type II is "masochistic personality type." Type I have an experience of attacks from others first, and, then, the desire of sadism aroused by the others converts to themselves after the others are abandoned from their mind, but it remains the stage of self-injurious. Principal mechanisms of Type I are "turning round the desire upon oneself" and "identification of oneself to the aggression." Type II have basically masochistic personality. They desire to be loved by others, but frustration that they feel they are not loved by others arouse the tic symptoms that violate the prohibition. With the tic symptoms, they can gain "punishment" and "pleasure" at the same time. Their symptoms of tics have the meaning of "masochistic provocation." They have the mechanism of "avoidance of anxiety by demanding to be loved by others." Both types have a common psychopathology, that is, they can not grasp objects (self or others) as a whole. It is suggested that patients with the GTS stopped their growth at pre-sexual stage. There exists a phase of self-injurious tics and that of other-injurious (provocately) tics during the progress of the symptoms of complex motor tics and verbal tics (coprolalia). The phase when both tics turn over each other was also observed. Echo-phenomena were seen only for patients of Type I. It is suggested that the degree of organic dysfunction of the brain and spectrum of masochism are almost coincident.