TICS AND NEURASTHENIA
The relations between tic and neurasthenia need not detain us. Neurasthenic and tiqueur alike may suffer from aboulia, obsessions, and nosophobia, and the same depressive causes may favour the establishment of the two diseases; but this is true of any form of psycho-neurosis. To identify the one with the other is to misinterpret the physical signs of the condition as described by Beard. The term neurasthenia has been so badly abused that its fundamental symptoms have been lost sight of. Yet the polymorphic nature of these symptoms is no reason for failing to recognise the genuineness of the neurasthenic syndrome, characterised as it is by headache, rachialgia, topoalgia, gastro-intestinal atony, neuro-muscular asthenia, insomnia, and mental depression. The occurrence of any one of them in a case of tic is of no special significance; for the diagnosis of neurasthenia rests on their combination, and it is precisely this combination that is so exceptional in tic.
From time to time the co-existence or alternation of tics and headache has been remarked, but the headache bears a much closer resemblance to migraine than to the headache en casque of neurasthenia.
Whatever be the variety of tic, the remarks we have made, based as they are on clinical observation, are applicable to it. In particular, they have a direct bearing on Cruchet's psycho-mental tic. To quote that author again:
Hysteria and neurasthenia are two diseases which we meet at every turn in our study; and if we remember that, according to Raymond, fibrillary chorea of Morvan, paramyoclonus multiplex of Friedreich, electric chorea of Hénoch-Bergeron, painless facial tic of Trousseau, and disease of Gilles de la Tourette-Charcot, are all mere varieties of myoclonus, which is itself a product of neurasthenia and hysteria, we are forced to admit that it is these conditions which dominate our conception of psycho-mental convulsive tic.
Thus it comes to pass that tic is lost in a crowd of widely differing convulsive phenomena, and is threatened with the permanent loss of its distinctive characters, while hysteria itself is like to become a perfect Proteus once more. Neurasthenia too is again to sink to the level of a receptacle for all manner of ill differentiated conditions.
We, on the contrary, feel it more than ever incumbent on us to resist the tendency to class in the same section facts which clinical observation distinguishes, otherwise hysteria and neurasthenia will soon signify nothing at all. If tic is to be considered one of the polymorphic manifestations of these diseases, we shall be transported back fifty years, to the time of the famous "chaos of neuroses," out of which, in some ways at least, Charcot finally produced order.