The progressive spreading of the tic movement which so commonly occurs, as
well as the evolution of the mental aspect which develops subsequent to the
appearance of the tic movement, may be very nicely understood if we adopt,
for our present purposes the recent theories of Alfred Adler,[16] of Vienna,
concerning the makeup and development of the neurotic. This we may do
without committing ourselves, at this moment, one way or the other, with
regard to the correctness or incorrectness of Adler's views as applied in
toto to the neurotic.
[16] Ueber den Nervosen Charakter, 1912. See also Adler's Studie uber
Minderwertigkeit von Organen, 1907.
One should note that Meige and Feindel were, in a way, on the threshold of
this theory when they said that tic, like the other psychoneuroses, is due
to some congenital anomaly, an arrest or defect in the development of
cortical or subcortical association paths--unrecognized teratological
malformations.
In a very few words Adler's theory may be given as follows: Adler assumes
that there is definite somatic inferiority (based on anatomical and
physiological changes) as the basis or foundation for the neurotic soil.
The neurotic consciously comes to realize the unconscious, organic, somatic
inferiority, and the endeavor to effect a psychic compensation or to make up
for these organic deficiencies by certain definite mechanisms, frequently
results in an overreaction or over-compensation. He thus overdoes himself in
efforts to make up for his inferiority, and in these endeavors he
necessarily makes use of unusual means and devices. It is this effort which
is the great motive force which dominates the life activities of the
individual and which compels him to seek as his ultimate object or final
goal a state which is best described as one of complete masculinity, of full
manhood, of self-maximization, of the will to live, to become powerful and
to seek supremacy or "the will to power" (Nietzsche). In following this goal
he goes to extremes and employs peculiar methods and devices, most of which
have for their object the concealment of his defects, and it is these
overcompensatory efforts and these peculiar devices resorted to, which go to
form the peculiarities or traits of the neurotic. According to Adler's
theory, the conscious efforts of the individual for psychic compensation or
overcompensation (for the unconscious, organic deficiencies) leads to a
resulting feeling of insufficiency, of incompleteness, of inferiority, of
unreality, of anxiety, of inability to face reality. Thus the mental
symptoms or characteristic mental state, being but the conscious recognition
of the unconscious inferiority, become especially pronounced when there is a
failure of compensation, or, in other words, when the individual is unable
to meet with or adapt to the situation which at the moment presents itself.
In these forced efforts at defense and compensation there is a resort or
regression to older, infantile, child-like, archaic types of reaction, of a
physical or mental nature, which are thus the protective defense mechanisms
or symbols. The struggle of the neurotic consists particularly in the
conscious appreciation of his goal and of his deficiencies of makeup and in
the attempt to reach his goal of full manhood and self-maximization in spite
of his handicapping deficiencies.
Without discussing the exact status of this theory in the case of the
psychoneuroses and their related conditions in general, we may, as mentioned
previously, very conveniently use this theory in the elucidation and
understanding of the further development of the tic condition.
Let us first consider the spreading of the tic movements. We know how in the
ticquer one tic movement may disappear only to give way to another, or one
after the other an increased number of tic movements and also of definite
compensatory movements not of a tic nature but of the nature of antagonistic
gestures and stratagems may make their appearance. The latter may in certain
instances become habit movements and eventually real tic movements. One
movement after the other may be resorted to, some perfectly consciously,
others more or less unconsciously, as reactions of the personality, of the
organic makeup or psychophysical constitution. These movements are adopted
by the patient, frequently more or less unconsciously, in order to attain a
state of equilibrium and rest, and in order to hide and make up for the
defect (the tic movements) of which he is aware. In these efforts he
overdoes himself and instead of hiding the movement he exaggerates it and
even resorts to further movements in his struggles to compensate, to adapt,
to conceal, and to flee from a state of mental disarrangement to a state of
psychophysical equilibrium.
Now, most of our gross reactions are of a psychophysical nature, so that we
find that when the old types of defense or of activity are called forth (as
they are in the tics, as explained earlier in this paper, from the
evolutionary and phylogenetic standpoint), the resulting actions, now
reanimified, appear in exaggerated form, and also tend to "evoke a faint
phosphorescence of the old primordial feeling." This probably results in the
outcropping of the various psychic trends which appear in the ticquer and
which increase in degree and in number. The most common of the resurrected
psychic trends is the general tendency to dissociation or disruption of the
personality with the reanimification, in varying degrees, of certain mental
deficiencies and inferior types of reaction which are indicative of the
relative failure of the patient to measure up to and efficiently deal with
and adapt to the struggles of life as he must face and meet them. And so,
many undesirable and inferior kinds of mental trends come forth and hold
sway. The basis of their appearance is the lack of will power and of control
over these various trends which were previously more or less completely held
under control but which are now impulsively forcing their way to the surface
and being unravelled. These trends are characterized by their relative
immaturity, their infantile-like and archaic type. And so we have the states
of indecision, of doubt, of uncertainty, of inferiority, of depression, of
unrest, of self-depreciation, of self-observation, of auto and
heterosuggestion, of egocentricity, of self-criticism, of inhibition of the
expression of the personality along the broader, social lines of effort.
The groundwork for added states (hysteric, psychasthenic, and others) is
here very fertile.
The law of psychic ambivalence and ambitendency, as so nicely developed by
Bleuler,[17] here shows itself in marked degree. There is both the positive
and the negative tendency toward the performance and execution of these
activities and reactions which are necessary for the living of a life of a
high or low degree of efficiency, so that the ticquer is obsessed by the
problem of "to do or not to do." This added factor leads to an exaggeration
of all the unfavorable psychic tendencies which have made their appearance,
and the intrapsychic struggle goes on with increased vigor.
[17] The Theory of Schizophrenic Negativism. Translated by William A.
White. Nervous and Mental Disease. Monograph Series, No. II.
The entire mental picture which we find in the most extreme forms of tic
could be beautifully elaborated along these general lines. For example, the
ticquer becomes asocial, seclusive and shuns society because of the
consciousness of the condition and the exaggerated sensitiveness. This
represents compensatory, defensive methods of concealment. Absentmindedness
and the inability to concentrate the attention are conditioned by the great
degree of attention devoted to the tic. The mental dissociation or
disintegration leads to an inflating of the emotional aspect of the
patient's mental life with a resulting increased nervous irritability and
reaction and a heightened degree of susceptibility to emotional
disequilibration and fatiguability of the mental faculties. The lack of
self-assertion, of confidence in himself, and the feeling of inferiority and
insufficiency are natural consequences of the general picture. The
inhibition of even, unhampered self-expression is always observed.
In tics, it must be noted, there is regression to more inefficient and
inferior methods of response and adaptation, the types of activity being of
a somatic and psychic nature. Following the regression and owing to constant
repetition and habit formation there is a gradual fixation to certain
methods of response which become the lines of least resistance and this is
followed by progression and development of the general picture to other tics
and psychic symptoms.
In general we note that the psychophysical reaction which we come upon in
the tics leads to the unearthing of various psychophysical types of
reaction, this unearthing consisting of disintegration or regression or
dissociation, the repressed, hidden, unconscious, phylo and ontogenetic,
archaic and relatively infantile-like activities, tendencies and
possibilities coming to the fore and unfolding themselves.
It is here seen that this broad genetic standpoint is one of the greatest
contributions to psychopathology and is of infinite aid to us in the
understanding of the problems which confront us in the domain of
psychopathology and psychiatry.
Comparative and animal psychology and the study of the reactions of
children, of primitive races, and of the mentally disordered give us a
splendid opportunity for studying it and unravelling the meaning of the many
somatic and psychic manifestations which are exhibited to us in the
psychoneuroses and psychoses and in tracing out the racial history of man.
Is it not plain that an understanding of the genesis and meaning of tics
opens the gateway to the elucidation of the origin and significance of the
psychoneuroses and functional psychoses--of reaction types of various kinds?