Tourette's Syndrome Helped by Video Dialogue

Tourette’s syndrome is a neurological movement disorder named after Georges Gilles de la Tourette, the French physician that first described it. Gilles de la Tourette’s first interest was in the hyperstartle syndrome that was reported in some patients who would startle excessively in reaction to a surprising stimulus. If they were given a verbal command at the same time they would automatically obey the command, often repeating it simultaneously (echolalia). He did not find patients with hyperstartle but did collect a group of patients with tics and abnormal vocalizations.

He described a genetic syndrome of tics and echolalia (the repetition of words or phrases uttered by others) that began in childhood and affected males more often than females. The simple motor tics consist of movements such as eye blinking, mouth twitching, eye turning, head jerking, shoulder shrugging, hand jerking, sudden tightening of stomach muscles, and kicking movements. Many complex motor tics such as squatting, hopping backward, or spinning around while walking give the appearance of having a purpose

Some complex vocal tics seem to express a mind of their own devoted to humiliating the person. Coprolalia, the utterance of obscene or objectionable words and phrases and copropraxia, making involuntary obscene gestures, often appear to be deliberate self-abasement. Complex motor tics may appear self-abusive or self-mutilating.

The seemingly intentional behavior of complex tics may represent a variant of dissociation that is entirely due to a physical pathology. Dissociative symptoms usually express mental disorders and one such condition, dissociative identity disorder (DID), shows alterations of identity that often generate deliberate self-abasement and self-mutilation. Self-abusing behavior in DID patients can be addressed by a method of dialogue between parts of the person. These individuals often spontaneously experience inner dialogue with their parts. If this dialogue is externalized the self-abusing behavior can be discussed and negotiated toward resolution. This can be done by written dialogue with each participant taking turns and not interrupting. Video dialogue in which the messages are recorded and replayed in turn is not as easy but can be more effective.

Even though the dissociation of Tourette’s arises from a physical disorder the unwanted behavior can be discussed and subjected to negotiation between the person and the brain’s self-abusing agent. The following case example used video dialogue.

Case Example: This 28-year-old woman had suffered from symptoms of Tourette’s syndrome since early childhood but it was not diagnosed until age 24 because her tic symptoms were attributed to epilepsy. She had serious convulsions (grand mal and petit mal) that were not controlled until she was finally put on anti-convulsant medication at age 19. Her Tourette’s syndrome was manifested as compulsive blinking of her eyes, gritting of her teeth, nasal sniffing and snorting, episodes of throwing objects (dinner plates) and since age 13 or 14 episodes of explosive anger. In recent years she had symptoms of head bobbing and hitting her head with her right hand.

She denied hearing voices but she readily agreed to a video dialogue with the part of herself that could control the tics. In the video dialogue she heard a male voice. When she spoke for the voice it sounded very reasonable and benign and agreed to help her limit the tics to evening hours when she was home. She reported a 50% reduction in tics following the first video dialogue. She was unable to come to the clinic regularly due to distance and transportation problems but she came in every few weeks or months whenever her symptoms worsened for refresher dialogues.