Remarks on the etiology of Gilles de la Tourette's syndrome.

Utilizing a case of Tourette's syndrome as an illustration, this paper seeks to refine the problem of causality in medical illness. In contrast to numerous examples reported in the literature, the patient presented in this communication, a 26-year-old man afflicted with tics, convulsive movements, intractable vomiting, and coprolalia, failed to respond favorably to medication, although he showed marked improvement in the course of psychotherapy. Despite rather transparent psychodynamic connections between his life history on the one hand and the nature and vicissitudes of his symptomatology on the other, it cannot be concluded that the psychological factors alone can account for the clinical picture; at best they may be regarded as contributory, as opposed to necessary or sufficient causes, a distinction that may be applied to other conditions as well. This report includes a review of some of the literature on Tourette's syndrome, with special emphasis on the case of Dr. Samuel Johnson, who in retrospect appears to have been a likely victim of that unfortunate malady.