University of Virginia Library

VIEWS OF THE FRENCH SCHOOL

The usual conception of tics, as laid down by Brissaud, Meige and Feindel,[1] may be stated as follows: Tic movements are physiological acts which were originally functional and purposeful in character, but which have become habits, apparently purposeless and meaningless. The motor reaction is the result of some external stimulus or idea (normal or abnormal) or both, which originally was necessary for the production of the tic movement, which latter eventually became habitual and automatic, and, owing to repetition, was executed, even in the absence of the external stimulus or

idea, without apparent purpose or meaning. At first but little more than purposive habit movements, they finally became irrepressible acts which sought for expression, which were but little under the control of the will, which occurred in attacks varying in frequency, duration and severity, which decreased under distraction and generally ceased during sleep, which were increased in frequency and duration and severity by fatigue, emotional upset, mental unrest, conflict and strain, while the lack of inhibition and will power, the lack of self-control was the dominant mental state, leading to feelings of insufficiency, doubt, indecision and incapacity, and making the ground work for the psychasthenic reactions in the form of morbid impulses and obsessions, and for the hysterical, so-called neurasthenic and other morbid psychic trends.

The inherent or acquired neuropathic and psychopathic state is the basic condition which prepares the subsoil.

From a consideration of the motor symptom we may say that it is but a pathological habit, which, however, is apt to lead to the tendency toward or generation of an increasing number of such pathological habits.

Characteristic of tics we may mention their being conscious before and after but not during their execution, their being disordered functional acts, their impetuous, irresistible demand for execution, the antecedent desire, and the subsequent satisfaction.

The etiology of tics, as laid down by Meige and Feindel, may be summed up by stating that they occur most frequently in young subjects, less frequently in savages and animals than in the civilized, there is a psychic predisposition based on heredity (of a similar or dissimilar neuropathy or psychopathy) upon which Charcot laid great stress, imitation (especially in the young) plays a role, as also brain fatigue (emotion, mental upset and worry) and indolence, with the frequent exciting cause of an external or internal stimulus or an idea, which is the explanation of the origin, source, situation and form of the tic or tics present in any particular case.

Scattered references to emotional shock acting as a possible exciting cause of tics, as at times of obsessions, can

be found in the literature. Dupré[2] has made such reference. Meige and. Feindel[3] themselves make the statement that "Fear may elicit a movement of defense, to persist as a tic after the exciting cause has vanished." They also state that "in ticquers the impulse to seek a sensation is common and also to repeat to excess a functional act."

Bresler[4] has called attention to the fact that the movements are in the nature of defensive and protective movements of expression and mimicry and originally in reaction to some external irritant or as the result of some idea, and he proposed the name "mimische Krampfneurose" for them. This is somewhat allied to Breuer and Freud's theory of hysteria.

The object of tic is some imaginary end, the influence of the will always being present in the beginning, although later it may be absent. Tics are of cortical origin, being coordinated and synergic, clonic or at times tonic[5] muscular movements, physiologically and not anatomically grouped, premeditated, purposive, of abnormal intensity, apparently causeless and inopportune.

Insufficiency of inhibition is the cause of the beginning and of the persistence of bad habits and of tics.

Tic is a sign of degeneration, in the biological and evolutionary sense, a degenerative neuropathic and psychopathic basis, as mentioned previously, being present, although often latent.

The maladie des tics is but the extreme form.

The onset is as a rule insidious, with a tendency to spread.

Spontaneous cures may occur, while Gilles de la Tourette's disease is but the extreme form of a condition in which antagonistic gestures are frequently adopted by the patient to adapt himself and to get to a state of rest.

This, as I see the situation, is as far as the French students of this subject (including Brissaud, Meige and Feindel, and even Janet) have permitted themselves to go. And, in

my opinion, their observations and conclusions seem to be quite accurate.