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Tics can be described as abnormal movements characterized by suddenness, inopportune occurrence, nonproductivity, and variability. They can affect the muscles of the face, neck, or shoulders, and are sometimes generalized. We distinguish between simple tics, which are often transient, multiple tics, and the chronic tics found in Gilles de la Tourette's syndrome.

In Studies on Hysteria (1895), Sigmund Freud posited that tics are a compromise between an idea and its counter-idea (countercathexis) and constitute a particular mode of expression of neurotic conflicts. In the view of Sándor Ferenczi, subjects with tics, owing to the very fact of their strong narcissism or a fixation at this stage, have an increased tendency toward discharge and a reduced capacity for psychic binding. A traumatic memory that affects the body-ego spontaneously comes to the fore each time it has the opportunity to do so: Tics are thus the hysteria of the ego. Noting that tics have a veritable muscular eroticism, Ferenczi considered them the equivalent of repressed masturbation. He also drew attention to the importance of anal-sadistic components in tics and to the connection between them and coprolalia.

According to Melanie Klein, tics are based on genital, anal-sadistic, and oral tendencies directed against the object; her uncovering of these original object relations upon which tics are based led her to consider them as a secondary narcissistic symptom. She confirmed Ferenczi's conclusion—equating tics with masturbation—but added that masturbatory fantasies are closely linked to them. Analysis of these masturbatory fantasies appears as the key to understanding the tic. Behind the homosexual content of these fantasies can be discerned the child's identification with the father, that is, the heterosexual fantasy of sexual relations with the mother. The sublimation of these fantasies in other interests leads to the disappearance of the tic.

Margaret Mahler discussed "organ neurosis." Subjects with tics experience the drives as mechanical events that are in a sense foreign to the ego. Otto Fenichel viewed tics as a pregenital conversion comparable to stuttering, which Karl Abraham had noted; for Abraham, the tic was a symptom of conversion to the anal-sadistic stage.

Serge Lebovici proposed a psychosomatic explanation: Unrepresented excitation can lead to uncontrolled psychomotor discharges. Tics have the weight of an unelaborated discharge, but on the therapeutic level, the latent meaning can be sought by means of construction. He noted the fairly close relationship between isolated or complex tics and the structured completedness of obsessional neuroses, but at the same time mentioned that they are also found with conversion hysteria or in psychotic organizations. According to Bernard Golse, obsessive traits with fixation on the aggressive tendencies of the anal-sadistic stage are discernible in the subject with a tic; but whereas with obsessional neurosis the aggressive content is not apparent because it is repressed by the visible ritual, with tics, the aggressiveness is directly externalized in motricity, without prior mental working over of the conflicts.

The etiology of tics is complex. The difficulties described occur in children who show a neurobiological predisposition, and are registered within an inter-subjective relational economy that contributes to their persistence.

CHRISTINE PAYAN

See also: Emmy von N., case of; Mahler-Schönberger, Margaret; Repetition.