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REGRESSION

As I have stated in a previous paper,[18] the pathogenesis of tics and allied conditions can best be appreciated by viewing the subject from an evolutionary standpoint. In our reactions and adaptations to the varying experiences with which we meet we respond by one or more of several methods of motor reaction. These motor expressions are of increasing complexity as we ascend the scale of evolution and development. One of the simplest kinds of adaptation is by simple, reflex muscular action, the response being anatomical and not physiological in its extent. Then come our simple physiological reactions. A more complex reaction is by those physiologically co-ordinated motor reactions or movements which go to comprise our pantomimic movements. This is seen most characteristically in our facial

expressions, gestures, mimicry and dancing. Still higher up in the scale we find our conduct and feelings as exemplified in our speech. And finally, highest of all, we must place our conduct as shown in written or printed language. This is a brief outline of our evolutionary and developmental ascent and of the increasing complexity and refinement of our social conduct.

In our motor adaptations we respond in one or more of these ways. When for some reason or another one outlet us denied us, we find avenues of expression through one or more of the other paths. Now, the manner and degree of our response is dependent on our stage in evolution and development, on the development of our senses, on our instincts, feelings and emotions, on our intellect and experiences. Unable to find expression by means of writing or speech, we instinctively fall back upon and seek expression by a less refined method, one earlier acquired and thus lower in the scale of evolution. This has a more or less general application throughout the scale of human (individual and social) conduct. It is an application of the universal law of adaptation to existing conditions in the best manner possible under the circumstances. We may thus lay down in a general sort of way a conception which I like to call the theory of psychophysical progression, fixation and regression along evolutionary and developmental lines. In the case of tics the regressive or devolutionary aspect comes in for special consideration. We may react mainly physically, or mainly psychically. But as a rule we react by both physical and psychic means, the manner and degree of our conduct being determined, as above mentioned, by our stage in evolution and development.

How does all this preliminary and general discussion apply to the problem of the tics? The relation seems to me to be most intimate and most important. The tics are methods of response or reaction to certain external irritations or ideas, this response being the manner of adaptation. The response may be mainly motor or mainly psychic, most frequently psychomotor. When the source of irritation and the cause for action is known, our conduct is more specific and is apt to be less diffuse, less inadequate, less indefinite.

In our reactive adaptations, which, as explained above, are greatly dependent upon our psychophysical make-up or constitution, we protect ourselves consciously or more or less unconsciously against disagreeable, inimicable, unpleasant or irritating environmental factors, physical or psychical, by bringing into activity certain psychical or physical or psychophysical reactions or processes. The special defense reactions brought into the foreground are those which follow the line of least resistance, due to hereditary or environmental construction, or are those which were most intensely stimulated or irritated and the most biologically useful and adaptive at the particular moment or under the special circumstances. The young child's reactions are preponderately motor, or at any rate psychomotor and not purely psychic. When there are sources of irritation or bodily or mental discomfort, there is a more or less general bodily reaction, psychophysical in nature. When the irritation is definite and clearly recognized by the child, the local motor response is also apt to be definite. When, on the other hand, the irritation is but vaguely perceived and not clearly appreciated or localized, we find that the child may show a general diffuse reaction, or even, in some cases, a reaction limited to certain regions as determined by the reaction taking place along the line of least resistance. This is plainly seen in the conduct of the physically sick child. Every pediatrician will find ample proof in support of this statement in his observations of the defensive reactions of the ill child.

When this irritation along a certain nerve path is oft repeated or quite constant, we have a consequent repetition of the defensive reaction, whatever it may be. This performance may be so frequently repeated that the idea of irritation or mental conflict or the anticipation or the expectation of a repetition of same may be quite sufficient in itself to arouse this reaction. It may become so habitual that, even though no such idea be in the mind, there may be a repetition of the movement whenever the individual is nervously excited or upset, whenever there is any mental stress, strain or discomfort. And we may go even further and say that as a result of some unusual mental struggle,

some excessive mental strain, defense or adaptation is brought about by regression or resort to a tic, this being conditioned by the fact that for the particular individual under discussion this is the easiest, most convenient or most immediate form of reactive response. The discharge is, as is seen, along the line of least resistance. This line of least resistance is determined by the organic nervous constitution and by certain life-experiences or habit-formation factors. In some cases the movement, once initiated, may be continued long after the disappearance or cessation of the external irritation, because of the sense of relief or satisfaction or pleasure[19] which is obtained by the performance of the tic. In many instances the habit has become rather fixed, and, as a relief from the struggle to do or not to do the movement, and because of fatigue in the effort to inhibit or control the movement, the individual adopts the path of least resistance, best for immediate relief from mental struggle; and as a psychobiological effort at self-preservation and self-gratification, as immediately as possible and at any cost to be paid in the future, he gives vent, as it were, to the movement.

The psychic symptoms may come on at a later date than the motor symptoms or simultaneously, although, of course, the early life history, in childhood and puberty, for example, if we are dealing with an adult, may show, at least in a certain proportion of cases, that the individual was of a psychopathic type, perhaps somewhat shut-in or asocial. If the appearance of the psychical symptoms be simultaneous with that of the physical symptoms, we can understand at once how, like the motor symptoms, they may be repeated time and again. In many instances, at least, the psychic symptoms arise later, being added to the motor symptoms. These later psychic symptoms may be a direct reaction to the source of irritation, or may be occasioned by the dissatisfaction at being unable to control the movement in question.

The degree of reaction, its duration and severity, depend upon the hereditary and developmental make-up of the individual and the severity, frequency and duration of the

irritation, physical or psychical. The psychic element is particularly apt to vary. The more neuropathic and psychopathic the make-up the greater is the reaction.

Where mental enfeeblement or mental disorder exist, the severity and chronicity are apt to be still greater.

There is thus a fixation, or rather a regression or reversion, oft repeated, to a type of reaction of a very infantile, primitive sort, farther down in the scale of evolution and development.

This picture may be further complicated by so-called neurasthenic, psychasthenic, hysterical or other reactions. Naturally one would expect to find these conditions, especially the more aggravated forms, in individuals of a neuropathic and psychopathic family strain, and who themselves are neuropathic or psychopathic or both.

It may be mentioned here, as is clearly appreciated from what has been said before, that there is an inter-relationship between the tics on the one hand and the symptoms which we discover in the psychoneuroses, psychoses and the mentally unstable on the other.

In all of these conditions we find a cortical origin for the disturbance, there is a lack of will power, of inhibition and of control of the lower centres, there is a nervous and mental instability with a tendency toward regression or dissociation, and the assumption of more or less independent, almost automatic activity, this activity being characterized by its almost (relatively) infantile, primitive, archaic makeup.

Were I to take up any one of the tics as an illustration, this general idea could be applied very nicely. But I shall not present any illustrative cases in this paper. I shall leave it to the reader, however, to explain the genesis and evolution of, for example, facial tics (which are so common) from this standpoint.

In passing I may say that the tic movements may have a special, individual, psychological significance. But this is by no means necessarily so. Frequently, I am inclined to believe usually, these movements result rather merely because there has been effected a psychobiological reaction, following the theory of psychophysical-progression, fixation

and regression with involvement of the nervous paths most seriously affected or most easily disturbed.

In the case of the tics, therefore, it is as if the various tic movements are being used in reaction to or in adaptation to sources of internal or external, physical or mental irritation, for the protection, defense or self-preservation of this or that particular part of the nervous system—as if the movements which we find in the tics and which are the expressions of certain engrams, neurograms, mnemes or organic memories, are existing in and for themselves, except that, in the tics, they are reacting with and for the psychophysical organism, the organic make-up or personality.

The individual, as a biological unit, is reacting to the particular situation which presents itself by the tic mechanism.

By granting the phylogenetic, racial significance we also give the basic, psychophysical meaning of tics in all ticquers.