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弗洛伊德与 Gilles de la Tourette 氏病的诊断

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

作者信息

Kushner H I

机构信息

Department of History, San Diego State University.

出版信息

Hist Psychiatry. 1998 Mar;9(33):1-25. doi: 10.1177/0957154X9800903301.

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 1880's and 1890's, 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. 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 conculsive 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 "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.

摘要

最近,一些观察家指责弗洛伊德未能诊断出埃米·冯·N夫人(1888 - 1889年)的不由自主抽搐和发声以及丹尼尔·保罗·施雷伯(1911年)的秽语症和抽搐性抽动为妥瑞氏综合征。然而,弗洛伊德的批评者中,没有一个人将弗洛伊德对运动性和发声性抽动的理解置于历史背景中。似乎没有人意识到19世纪80年代和90年代关于抽动症状分类的争论,他们也没有认识到夏科和吉尔斯·德拉·图雷特承认运动性和发声性抽动以及秽语症也可能作为癔症症状出现的程度。到1893年(弗洛伊德首次写下埃米·冯·N夫人的病例时),吉尔斯·德拉·图雷特和夏科都通过区分应归类为“抽动症”的抽动症状和伴随癔症的抽动症状,来为自己辩护,以回应吉农关于抽搐性抽动总是癔症症状的说法。然而,夏科和吉尔斯·德拉·图雷特在1890年就已达成共识,即抽动症状可能是抽动症或癔症的结果。区分那些患有“癔症”的人的因素是特定的遗传因素以及患者的抽动和发声是否能够治愈。因此,按照夏科的观点,弗洛伊德几乎没有义务得出他那些有抽动和咒骂症状的患者应该被诊断为吉尔斯·德拉·图雷特抽动症的结论。

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