A patient who has quite severe facial tics forced me to consider the connection between tics and ghosts. I have been seeing this patient for several years, and as long as I have known him he has displayed a compulsive eye-blinking tic and a head-jerking tic, both of which fluctuate in their frequency and intensity. His tics appear most often when he is experiencing some kind of stressor in his real life, or in the therapy, and early on in the work I formulated that his tics were the result of severe trauma and abuse he experienced in his childhood.
It is one of the theories of the meaning of tics (and the syndrome of tics called “Tourette Syndrome”) that they are the body’s automatic and learned response of extreme fright. Often, I have speculated that in the moments before a tic appears, my patient is having a feeling or thought that is too frightening to be fully aware of and experience, and that the tic interrupts the awareness of the thought or feeling and “manages” it.In this way the tic is experienced as affectively self-regulating and self-cohering: one still feels ok and not overwhelmed with fear since the tic did its job and the dreaded thought or feeling was kept unconscious and at bay. Tics perform a self-protective, homeostatic function, perhaps similar to how the physiological response of shivering is biologically designed to defend the body against cold.
Additionally, my patient’s tics are of a particular kind – they strongly suggest the turning away or avoidance of contact with another person. Compulsive head-turning, eye blinking, and so on, suggest a turning away from the object, which is precisely what we observe in infants who turn away from people who over-stimulate or frighten them. In other words, my patient’s tics are his way of regulating his fear that is somehow elicited through his contact with people, who (I speculate) conjure up his memories, either somatic or actually remembered, of being abused.
Recently, my patient was ticking very severely, and I know this patient well enough now so that I could say, in a playful way, “Oh, I see you’re jerking again – it’s ok – no need to be afraid of me . . .” He responded by laughing in recognition of his tics and perhaps of my reassurance of his safety (tics which he is well aware of but says he cannot control). He began to tic a little less, before talking about ghosts, which he had never talked about before. He understood ghosts as the trace of someone that is left after they had died, and I found it interesting that he talked of ghosts right after I mentioned his tics and his fear.
This got me thinking about a possible connection between tics and ghosts, and how the tic can be understood as a defense against someone’s past ghosts, or abusers, whom they continue to feel haunted by. Victims of abuse frequently appear to fear the return of their abuser, or experience their abuser as a ghostly or shadowy figure who might return and retaliate for the patient’s disclosure of their abuse. The psychologist Selma Fraiberg conceptualized ghosts in a slightly different way, when she observed how parents could experience their children in a way that was similar to how they experienced their own parents. If a parent was afraid of their own parent, they could likewise experience fear in relation to their child – in this way their child was a kind of “ghost” or facsimile of a past, traumatizing figure. What I am suggesting about my patient, is that he is fundamentally confused about “who was who” – was I his good therapist or his scary abuser? Could he count on me staying the way I was or would I suddenly change and become terrifying? In this way, my patient could experience me as a kind of ghost from his past, requiring a fast antidote in the form of a protective tic.
To summarize, the patient comes into contact with people whom he fears, due to his expectation of being traumatized by them in the way he previously was by his abusers (a transference of fear and dread). This fear may lead to a mostly unconscious body/mental memory of abuse or the abuser, and a tic is displayed to defend against this ghostly fear of the abuser, which the patient senses is somehow alive and present in the moment. From this perspective, the tic defends the patient against the ghost – it is a protector and “ghost-buster.” Indeed, my experience of the tic in the moment is that it is being used to “bust experience up,” or interrupt what was a seamless continuity of experiencing. Communication goes through many tiny fractures as the patient searches for a way to make me safe again.
This is a theory, but like all theories it should be taken lightly, since the mystery remains about how best to treat severe trauma and tics. In a calm period my patient can go weeks without showing a tic – in these phases the patient seems more soothed with me and less afraid. But then, without warning, the tics are back full-force, and they persist despite my talking tentatively to the patient about the transference of dread, his past trauma and his present ghosts. Active interpretation of his fear and reassurance of his safety, and my being casual, friendly, playful and humorous all help to put him at ease and reduce tics. But the tics continue . . . In the last two years my patient has improved in many different ways and he continues to make progress in his therapy overall, but his tics, perhaps like defensive armor, are still needed by him and cannot be given up yet. The atmosphere of danger has improved, the ghosts have become less persecuting, but perhaps he needs more seamless, benevolent, warm, playful, and safety-evoking interactions with me before the ghosts can leave him completely. He needs more time: time to get to know me, to trust me, and to see that I am really me and not a ghost.
