THE problem of the genesis and meaning of the
strange manifestations which we find in that peculiar
disorder which goes by the accepted name of
tics is indeed difficult of solution. The analytic
and genetic standpoint only comparatively recently assumed
in the domain of neurology and psychiatry is having an ever
wider and wider application. The problems in neurology
and psychiatry which still cry loudly for solution and rational
explanation are indeed numerous. Some of these questions
are so baffling that at times they seem almost beyond the
ken of the human mind. Nevertheless, with persistence
and the "Don't give up the ship" spirit keenly imbued
into us, and with that irrepressible spirit of investigation and
of research born of optimism and of curiosity, we may expect
to see many of these problems which now seem to us so
hopelessly unsolvable gradually rescued from the uncertain
waters of speculation and theorization and brought to the
more sound shores and land of the knowable and the known.
If our theories be but tinctured with due admixture of that
sound self-criticism that comes of prolonged and serious
reflection and deliberation, and if the results of observation
and investigation be brought forth in support of these theories,
then we need have no hesitancy in permitting freedom
in theorization and speculation. Let us also remember that
unsound theories or standpoints do not come to stay, but,
after surviving for a certain time, give way before that
which is more sound, more tangible, more near the truth,
which, to be sure, is always but approximately attained.
If, therefore, the theory which I intend to set before you for
consideration may seem on first thought far-fetched and
unsupported, I beg you to remember that in a field where
but comparatively little is known with absolute certainty,
it behooves us to take notice of all theories or conclusions
which may be propounded, since, even though they may not
contain the whole truth, they may, perhaps, contain certain
germs of truth, which may contribute, in some measure,
however slight, toward the ultimate solution of the problem
under consideration.
With these brief prefatory remarks, I shall forthwith
enter into the discussion of the genesis and meaning of the
tics.
I may say at once that this is not merely a theoretical
and purely academic proposition which has no practical
bearings in the way of prognosis and treatment. On the
other hand, a real understanding of the nature, origin, and
significance of the tics is of decided value in giving us proper
standpoints and orientation with respect to the prevention,
prognosis and cure of the condition.
I need not enter into a description of the characteristics
of tics in this place. I may merely mention that tics have
two aspects—a psychic and a physical. It is, in other words,
a psychoneurosis. The characteristic mental state is one of
doubt, of indecision, of inadequacy, of restlessness, of tension,
of discomfort and of dissatisfaction, which is more or
less unappeasable and irrepressible and uncontrollable until
it finds vent in a rather explosive series of motor expressions
which, as it were, are the safety valve for the peculiar feeling
of tension and discomfort which the individual has been
experiencing and which is accompanied by a sense of relief,
satisfaction and a relative degree of comfort and mental
rest. The mental imperfection (Charcot) of the ticquer is a
polymorphic psychic defect (Brissaud, Meige and Feindel)
characterized by mental infantilism; for ticquers, like other
psychoneurotics, are like big children. They have the
mind of children, in respect to the emotional make-up.
The mental condition of ticquers is especially characterized by
the imperfection or weakness of volition, by a certain degree of mental
instability and lack of inhibitory control of the desires, tendencies,
activities and motor expressions of the individual, this defect laying
the groundwork for the impulsions and obsessions, as also for
hysterical, so-called neurasthenic, hypochondriacal, depressive and
so-called dementia praecox reactions. The tic movement is
the symbol of the psychic defect or degeneration or instability.
The earlier investigators were responsible for the
differentiation of the tics from such other conditions as Sydenham's
chorea, Huntington's chorea, the spasms, the stereotypies, the habit
movements, the myoclonias, and other allied conditions. It is due to
their pioneer work that tics were recognized as a definite and distinct
clinical entity. The process of disintegration of these various
movements and their differentiation one from the other cannot be
over-valued. Among those who have contributed most to this subject may
be mentioned Magnan and his pupils, especially Saury and Legrain, Gilles
de la Tourette, Letulle, Guinon Noir, Pitres, Cruchet, Grasset,
Trousseau, Charcot, Brissaud Meige and Feindel. Although Trousseau
recognized the the ticquer was mentally abnormal, it was Charcot who
first called definite attention to the psychic origin of the condition
and to the fact that tic was indeed a mental disorder, a psychoneurosis,
a psychomotor reaction. His lead was subsequently followed up by
Brissaud, and by the latter's pupils Meige and Feindel, the latter two
authors giving us a comprehensive discussion of the subject in their
well-known classic. [1]More recently the
Freudian school has attempted to dig down into the roots of the tree
which ultimately sends forth its branches in the guise of tics.
