Psychiatry: The Four-Letter Men

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Just about everyone swears on occasion. But some people are cursed with a pathological need to curse—and uncontrollably shout obscenities every few minutes. Accompanied by a violent muscular tic, their singular malady is called the Gilles de la Tourette syndrome for the French neurologist who first described it in 1884. The disease is rare, but its smutty symptoms turn its victims into social pariahs, and sometimes the psychological disorder leads them to mental institutions.

Investigators strongly suspect that the tic is neurotic in origin, related to the venting of aggression. Beginning in children as muscular twitches, the La Tourette syndrome gradually progresses to grunts and finally foul shouting. Doctors have tried everything from psychotherapy to sedatives and carbon dioxide inhalation, which is akin to a form of shock therapy. Lasting cures have proved as rare as the disease, but Psychologist David F. Clark now reports in the British Journal of Psychiatry that the treatment is contained in the symptoms.

Clark describes one patient, a man of 22, who could not control "his incessant and explosive repetition of four well-known monosyllabic obscenities loud enough to disturb others in rooms 30 yards away." Not surprisingly, the patient could not hold a job, appear in public or keep girl friends. Clark cured him by getting him to exaggerate his symptoms: he was made to repeat his favorite obscenities as loud and fast as he could until exhausted. Any alternative words or flagging from a metronome-paced cursing speed of up to 200 cusses a minute was discouraged by mild electric shocks.

The purpose of Clark's punishing therapy was to build up his patient's inhibition about his own symptoms; indeed the man has since passed a driving test without swearing at the woman examiner. Two of Clark's patients have not relapsed during four years since therapy, although neither had found relief during many previous years of psychotherapy. Clark's treatment only partly helped a third patient, a 47-year-old housewife, because she was unwilling to swear on demand. Of course, restraining the symptoms may not be curing the disease; suppressed neuroses have a way of popping up in another form. But ulcers are certainly more socially acceptable than dirty words.