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 overvalued. 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.
[1] Tics and their treatment. English translation by S. A. K. Wilson. New
York, 1907. This book contains an extended bibliography.