“Etude sur une affection nerveuse caracterisée par de l’incoordination motrice accompagnée d’echolalie et de copralalie”
“Gilles de la Tourette on Tourette Syndrome”
Postencephalitic Respiratory Disorders
Psychopathology of Forced Movements and the Oculogyric Crises of Lethargic Encephalitis
Tics and Related Disorders
“Psychoanalytic Evaluation of Tic in Psychopathology of Children”
Tics and Their Treatment
“Limbic Innervation of the Striatum”
“Acquired Tourettism in Adult Life”
“Witty Ticcy Ray”
“A Case of Gilles de la Tourette’s Disease After 10 Years’ Treatment with Haloperidol (R.1625)”
I want to edge into my subject indirectly and personally, by recalling my own education as a neurologist, and how this served—or failed to serve—me in later years, when I encountered the realities of various syndromes and afflictions, in particular encephalitis lethargica and Tourette’s syndrome, a syndrome of multiple convulsive tics. As a resident in neurology, I “rotated” through psychiatry, just as psychiatric residents “rotated” through neurology. These short rotations did nothing for us in terms of bringing about any unity of the two. One gained a little extraneous psychiatric knowledge, or a little extraneous neurological knowledge, but no real sense that the two were, or could be, related. I even think it encouraged, rather than prevented, some dissociation between neurological and psychiatric orientations, between body and mind, a dissociation which common experience, life itself, contradicts at every point.
When I emerged from residency to encounter the full reality of patients, I often found I had to be as much a psychiatrist as a neurologist. I felt this strongly when seeing patients with migraine, whose moods and feelings, attitudes and perceptions, could alter pari passu with their neurophysiologies: these patients showed me the absolute continuity of body and mind. But it was another affliction that was my real education, my education, that is, as a neuropsychiatrist. This was the lethargic encephalitis, the great sleeping sickness that affected nearly 5 million between 1918 and 1927. The moment of truth, or revelation, or “conversion” for me was when I encountered some eighty-odd postencephalitic patients at a hospital in New York. These patients had a myriad of disorders both “neurologic” and “psychiatric”: Parkinsonism, myoclonus, chorea, tics, strange compulsions, phobias, obsessions, gusts of passion. A “pure” neurologist or a “pure” psychiatrist with such patients would be utterly lost. The neurological, the psychiatric, had to be conjoined. One had to be as observant and knowledgeable about the psychological, the psychodynamic, as about the physiological, the neurodynamic.
What I found for myself here was no more than a repetition of what had been found in the 1920s, when the epidemic encephalitis burst upon the world. And of all the pioneer observers of that time, I found Smith Ely Jelliffe and his writings the most penetrating and the most faithful to experience. Jelliffe was both a neurologist and an analyst, equally “Sherringtonian” and “Freudian” in outlook, as indeed one has to be if one is to observe such patients, for they are equally Sherringtonian and Freudian. Thus Jelliffe felt impelled to write in 1927:
In the monumental strides made by neuropsychiatry in the past ten years, no single advance has approached in importance that made through the study of epidemic encephalitis…. An entirely new orientation has been made imperative.
This “new orientation” of which Jelliffe spoke, and of which he himself was a notable exemplar, did not involve merely combining neurological and psychiatric knowledge (as every neurologist and psychiatrist does to some extent), but conjoining them, seeing them as inseparable, seeing how …