How is it that these activities may come into play again? What brings them
to the surface once more?
There are many factors which come in for consideration in this connection.
In the first place the basic cause is the instinctive, organic,
psychophysical make-up of the individual. Whether and which functions
re-exist as of old and respond as means of adaptation and self-preservation,
depends on the stability and the weaknesses or defects of the nervous
mechanism or system with its various parts, systems, functions or inherent
psychophysical dispositions on the one hand, and the life-experiences and
the immediate inciting factor on the other hand.
A neuropathic or psychopathic or neuropsychopathic constitution with its
usual causes (germinal, intrauterine or extrauterine, usually of a toxic,
infectious or disturbed metabolic nature, and including particularly
alcohol, syphilis and nutritional disorders) may form the ground work. This
predisposition may be congenital--that is, present from the date of birth,
although not necessarily germinal in origin, or it may be acquired at some
period in life from physical or psychic causes. In this connection the
infantile and early childhood history are very important. Consequently the
diseases, training, example, education and opportunities in childhood and
infancy are of very great significance, the parental training and example
and the home conditions having a most intimate relationship to the
development of many of these tics. Imitation and mimicry here play a decided
role. Spoiled children, too quickly satisfied or over repressed, are apt to
develop tics. External somatic irritations may be the starting point in some
(not in all) cases. At other times an idea (normal or abnormal) may incite
the tic movements. Auto and hetero-suggestion, hypochondriacal ideas,
hysterical symptoms and obsessions may, particularly in adults, initiate
tics. Obsessions are especially apt to produce habits or tics, if they
produce any motor reaction. Tics may develop into obsessions and vice versa;
or both may co-exist simultaneously and be unrelated. The original ideas
which led to the movements vanish while the movements survive. In the insane
various sorts of delusions may be the groundwork on which a tic may later
develop. Habit movements, which represent purposive physiological acts
which have become automatic and not inhibited (hence showing weak will
power) and which seek strongly for expression, which the individual
struggles against and endeavors consciously to inhibit and overcome after
the tendency is fairly well developed, may eventually become impulsive and
irresistible with the ultimate evolution of the psychic state which is
characteristic of ticquers. Automatic habits and mannerisms or stereotyped
acts are of course not tics but the latter are but caricatures of the former
with an added characteristic mental state. Tics, as mentioned earlier in
this paper, are thus pathological habits.
Tics may also be but the symbol for a vague feeling of tension, irritation
or stimulation, which seeks relief or expression by the performance of the
tic.
Emotional stress and strain, fright, fear, excitement and mental shock can
arouse a tic. Mental conflict and unrest has not received that degree of
attention which it surely deserves. Clark and the Freudian school have
definitely called our attention to this aspect. Bresler refers to tic as a
motor reaction to original mental shock, so that it is in fact a psychic
defense reaction of expression. Dupre has stated that emotional shock may
act as a possible exciting cause of tics, as at times of obsessions. Meige
and Feindel have asserted that fear may excite a movement of defense, and
although the exciting cause has vanished, this movement may continue to
persist as a tic. They also mention that in ticquers we frequently find the
impulse to seek a sensation and to repeat to excess a functional act.
That there is a weakness of will power in the ticquer, with a lack of
control or inhibition over the lower neurones normally regulated by the
higher co-ordinating centres, so that certain automatic activities become
dissociated and exist more or less independently, is generally acknowledged.
In fact it must be said that tics are reactions of the organism, of the
organic make-up, the psychophysical personality, as a response to
irritation, excitation or stimulation, sensory, nervous or psychic! It is a
means of relief of tension, of organic reaction or adaptation, not
necessarily conscious but frequently unconscious and automatic, as in fear.
Starting in this way it may persist. In the tic we see a method by which
the individual or organic personality has met a certain difficult or
undesirable or disturbing situation. It is thus a constitutional, biological
defense reaction, psychophysical in nature, with a reversionary tendency
(when viewed from the evolutionary standpoint), and hence is indicative of
degeneration, this term being used in the racial, biological, phylogenetic
and ontogenetic sense.
There is not such a far cry from the simplest tic to Gilles de la Tourette's
disease or maladie des tics with its more pronounced signs of psychophysical
deterioration and dissociation. The tendency is a degenerative one-- a
prolapse to ancestral methods of reaction, a dissociation or disintegration
of the personality, a lack of control over more elementary activities. We
should therefore appreciate the need of early recognition and treatment of
tics and fixed habit movements, especially since there is a tendency to
spread, for the tics to multiply, and for mental symptoms and reactions of a
hysterical and psychasthenic nature to appear, if they do not already exist
or have not existed before the onset of the tic.
In brief, then, tics represent the emotional reactions and feelings of the
individual--the loves and the hates, the likes and the dislikes, the wishes
and the fears, the cravings and the dissatisfactions, the bodily and mental
tension, unrest, excitement, discomfort and disequilibration. In other words
the ticquer feels and speaks and acts by the tic. He lives by, in and for
his tic. He is attempting to meet certain situations of a disturbing nature
and to obtain equilibrium and equipoise by compensating for his feelings of
inefficiency and unrest by the tics. It is an organic, constitutional,
psychophysical, biological means of adaptation.