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. Dupre[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."
[2] Soc. de Neur. de Paris, April 18, 1901, quoted by Meige and Feindel,
page 54, of the English translation (reference 1).
[3] Loc. cit., p. 62.
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.
[4] Quoted by Meige and Feindel, Loc. cit., p. 267.
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[*]
muscular movements, physiologically and not anatomically grouped,
premeditated, purposive, of abnormal intensity, apparently causeless and
inopportune.
[*] Cruchet objects to calling these tonic reactions tics.
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.