Tics and Their Treatment

by Henry Meige; E. Feindel

November 20.—The head tics are still rather violent at times. A period of intellectual and bodily fatigue has supervened, but he tries his fencing again, and to his profound satisfaction he has managed to keep free of tics during the bouts. He is recommended to avoid all possible causes of cerebral and physical exhaustion.

December 3.—He continues to make satisfactory progress. His habit of supporting his chin on his cane is abandoned, though an attempt to dispense with the latter entirely, when he is out in the street, has ended disastrously. He is content to hold it in his hand and strike his leg with it from time to time.

December 13.—Whenever O. is tempted to tic again, he stands in front of a mirror and commences to sing, and while the song lasts his tics remain in abeyance. His trick of sitting crossways on a chair and rubbing his chin against the back is also discarded, with the result that the callosities have vanished. As far as his walking is concerned, he has adopted the plan of endeavouring to get from one point to another without allowing his tics to assert themselves, and his efforts have been crowned with success.

February 3.—The patient has recovered his self-confidence, and the compliments of his friends prove an additional restorative. It is true the tics still recur, but their number is less, their duration shorter, their severity considerably diminished. What O. is best able to appreciate is the disappearance of the state of mal obsédant that accompanied them.

Take another example in the person of young J.:

In his case our object was to discipline him by successive modifications of his caprices. The first important result achieved was the suppression of his precious mattress—a result not obtained without difficulty, for the mere mention of it sufficed to provoke floods of tears and ebullitions of anger. He was then sent into the country for a few days to forget his heart's desire, but the labour was lost. No sooner had he arrived than he discovered another mattress in a barn, and transferred his affections to it.

Eventually the day came when he was finally convinced of the absurdity and inconvenience of his practice, and when the tender yet firm remonstrances of his parents prevailed. The prospect of congratulations awaiting him, and his own keenness to get better, stimulated him to fresh efforts, and the reward was success.

Not long after, however, he began to complain of mental suffering from the restraint laid on him, and the distress was undoubtedly genuine. We accordingly gave him permission to stretch himself on his bed at certain fixed times and for a fixed period, which was to be reduced each day by some minutes. He entered into the spirit of the regulations so happily that in less than a month the period spent in the horizontal position had sunk from two hours and three quarters to an hour and a half daily, and at last it was dispensed with altogether.

On his "nervous movements" re-education by immobility and methodical exercises had a beneficial influence, and he acquired the faculty of controlling his variable and attitude tics. Repetition of the séances under the eye of the physician, drill in front of a looking-glass, symmetrical and synchronous exercises for the arms, as well as ordinary practice in dressing and undressing, buttoning and unbuttoning clothes, eating, drinking, etc, with the left hand—all contributed materially to his progress. Many other re-educative prescriptions were enjoined on the patient; suffice it to say that in three months he was able to dress and feed himself, to behave properly at table, and to restrain himself generally, in spite of the obstacles provided by his babyish tricks and natural weakness.

Further, the advance he has made has reacted profitably on his mental condition, and if his fickleness and vacillation persist, at the least the trend of the educative exercises has been in the direction of reinforcement of the will. Hence is it that he is now more attentive, less introspective, less capricious; he is no longer overwhelmed at the gravity of his condition; he is conscious of having taken its measure, and of his power to master it.