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Gerard, M.W. (1946). The Psychogenic Tic in Ego Development. Psychoanal. St. Child, 2:133-162.
    

(1946). Psychoanalytic Study of the Child, 2:133-162

The Psychogenic Tic in Ego Development

Margaret W. Gerard, M.D.

Although there is a considerable volume of literature upon the subject of tics, only a few papers attempt to explain the production of the symptom from a psychodynamic viewpoint. Many authors describe the varieties of forms of the symptom or discuss its statistical frequency or the like. For present purposes, I shall attempt to review only those papers of import to a study of the psychodynamic factors involved in the production of the symptom and of the character formations found in tiqueurs.

Ferenczi (3) in 1921 suggested that the tic represents an equivalent of onanism, in which the libido connected with genital sensation was transformed into "muscle erotism" and displaced to other parts of the body. This displacement, he stated, resulted in decreased genital potency and an increased pleasure in muscular movement. Beyond the onanistic significance, Ferenczi believed that many tics represented a method of warding off suffering, similar to reflex withdrawal from a stimulus. However, he claimed also that some tics inflicted injury upon the self and compared this condition to the extreme self-mutilation of schizophrenics. In the same paper, he described several cases of compulsive neurosis in which the patients carried out rituals with a variety of manneristic movements. The individual elements in the ritual were compared with tic movements, and he offered this comparison as evidence that tics were often hard to differentiate from compulsive acts. In attempting to explain the dynamic cause of the symptom, he stated that it was a "narcissistic disorder of a person who is hypersensitive and unable to endure a physical stimulus without a defensive reaction." The narcissism of such a person was described as a constitutional narcissism

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1 Since the writing of this paper a series of articles on tics has appeared in The Nervous Child(13). They are interesting and rich in information concerning treatment, parent-child relationships, art expressions, and Rorschach responses of tiqueurs, and they follow the theoretical concepts of Mahler (9), (10), (11) concerning the neurodynamics and psychodynamics of the tic.

7 From the Institute of Psychoanalysis, Chicago, Illinois.

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