Notes on a Case of Maladie Des Tics

In her short paper on reaction to motor restraint, Dorothy Burlingham1 reminds us that in spite of the 'close tie between aggression and motility, it seems plausible that also on the libidinal side an essential, though less spectacular, flow of discharge takes place constantly by way of muscular movement, creating a similarly close link between libidinal tensions and motility'.

A case of maladie des tics will illustrate how involuntary, diffuse muscular activity can serve not only for discharge of aggression but equally as a libidinal indulgence—as an expression, in other words, of erotic pleasure which the patient has been reluctant to give up.

The patient was a boy, fifteen years of age, who was analyzed from the age of ten to twelve years and returned to treatment two years later. He was a clever, resourceful child who, upon casual observation, seemed likable and aroused sympathy; but those who knew him intimately and were constantly with him described him as 'insidious', although he was not belligerent or destructive and never lost his temper. His symptom involved his whole voluntary neuromuscular system. Throughout his waking hours he twitched and yelped. The twitches were generalized tics, mainly of the muscles of the trunk and upper extremities, sometimes of the head and neck and legs, or of combinations of some or all these muscles. As is typical of the tic syndrome, never an isolated muscle but groups of muscles were involved. The yelping consisted of meaningless sounds, often but not invariably accompanying the twitches. I was never