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.