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PROGRESSIVE EVOLUTION OF THE CONDITION

We now come to the progressive evolution of the motor manifestations and to the mental aspect of this condition.

Concerning the mental state characteristic of the ticquer it is generally agreed that there is a polymorphic psychic defect or disorder which shows itself particularly in a precocious or hyperemotional condition, in a lack of will power and of inhibitory control, leading to a state and feeling of doubt, indecision, incapacity, insufficiency and unreality, of inferiority and self-depreciation, with a tendency towards morbid self-absorption, egocentricity, self-observation, auto-and hetero-suggestion, with the consequent development in many instances of so-called neurasthenic, psychasthenic, hysteric and various psychotic reactions. I am not prepared to say definitely how frequently the mental state, in lessened degree, precedes the outbreak of the tic movements. This may be present in a certain proportion of cases, but is by no means always present and it is even questionable whether the predispositional mental condition is the ground work in the majority of patients.

Tics, it is true, are especially apt to develop in individuals with a neuropathic or psychopathic history or heredity. In other cases this history is not obtainable, the individual having been apparently perfectly normal up to the time of the outcropping of the tic. In these cases shock is apt to

bring on the outbreaks and so one may say that the instability had been latent and that a severe shock was sufficient to bring it to the surface. We must remember, in all these cases, that the mental state which we see in the ticquer is but an exaggeration of that which appears in many children, and is similar to that which appears also in other psychoneurotic states, and in fact the germs of this condition may occur transiently in any of us. This psychic condition may frequently but does not always precede the appearance of the tic movement. But it is only after the appearance of the motor manifestations of tic that the mental state becomes prominent or develops where it was not noticeable if not absent before.

Be that as it may, or even granting that in most patients the characteristic mental state or the neuropathic or psychopathic make-up exists in some measure to an abnormal extent, we do know that once the tic movements have made their appearance and begin to spread, so that the individual is thrown into the struggle to perform or not to perform the movement, the development of the psychic state which we find so patent in the more pronounced forms of tic, thereafter more or less rapidly occurs, no matter what the mental condition of the ticquer may have been previously. I am also not prepared to discuss here at any length the phylogenetic or ontogenetic significance and the biological genesis and meaning of the various mental trends of the ticquer, but I may say that they too have been acquired in the course of evolution, for certain very definite reasons which need not concern us here, although it can be appreciated that the biological motive of self-preservation played a most important role in their genesis and fixation.