http://neurotalk.psychcentral.com/thread34000.html

This is a question that I've struggled with over the years, and still do. As someone with Tourettes--obviously we have a unique perspective to not have describe the process of a tic--we know it by feeling it! Okay--here's a sample of one of my tics:

Driving along, I see a good looking woman walking down the sidewalk. I turn to see her, then turn my head back forward and continue driving. A few seconds later--oops, wait--a thought comes into my mind "Is she still looking at me?", then I snap my head around, open my eyes wide and look at her again (she is now obviously further behind me, so I have to strain my neck to see her). At this point I know I can't even tell if she is looking at me, which was the initial reason for my turning my head--but I snap my neck anyway, two or three times, even twisting my whole body--in a sense, straining all my muscles to--to purge myself of the desire? To push that impulse out of my body? To strain to the extreme, to look harder, to try to over satisfy the urge, so it will go away? I'm just thinking out loud here--when it's happening, it's just a pure battle of my will against whatever is causing the urge.

Notice at this point that the initial cause of looking at a pretty woman, to see if she is still looking at me, has turned into a physically intense straining of my body. The idea that she is still looking at me is gone--and now I'm just dealing with the tic itself.

Perhaps this particular tic is worse if my wife is in the passenger seat. Here comes the psychology. The urges get more demanding, the more socially unacceptable they are. So obviously the wife doesn't appreciate me oggling some woman on the sidewalk. In reality she doesn't care--we can look--just can't touch! Maybe she does care little--who knows--but she does it all the time, so we have no problem with this. Regardless, the urge is more intense when she is there next to me. Now how could that increase in the urge be attributed to neurology?? It's the idea of it being socially unacceptable that is determining the neurological effect. Mind over matter, etc.

This is just one example--I could list many more.

I think that we need to look at psychological symtoms as just one aspect of the tick overall. The chemistry is another aspect. The physical nerver is yet another aspect. Psychotherapy deals with the psychological aspect, the drugs deal with the chemical aspect, etc. I think the problem comes when treatment only focuses on one aspect, sometimes even denying the other aspects even exists.

Ack--I could write for hours on this. I saw this lonely thread, and wanted to contribute--I was quite surprised to see no responses!