Another case in point is reported by Dubois[12]:
The patient is a young woman twenty years old who has acquired the habit of beating her right elbow against her chest fifteen or twenty times a minute, until it happens to impinge with rather greater violence on a whalebone in her corset; this is accompanied by a slight guttural cry. It would appear the sole satisfaction in her tic is in the attainment of this object, since it is succeeded by temporary cessation of the movements. Their constant repetition has caused an insignificant erosion of the skin over a limited area on the elbow, and it is only when this particular spot is touched that the ejaculation is uttered and the tic arrested. If the elbow be at rest, the head is inclined from left to right several times a minute.
Evidently, then, in the subjects of tic the impulse to seek a sensation is of very common occurrence, as is also the impulse to repeat to excess a functional act. It is precisely this exaggerated and inopportune multiplication of movement that is pathological.
The mother of one of Noir's patients was always tempted to repeat any simple purposive movement that she had made a moment before, even though the reason for the act no longer existed.
The imperiousness of these impulses, and the peculiar relief attendant on submission to them, accentuate the closeness of the resemblance between tic and obsession, to which reference will be made later; but it is necessary at this early stage to indicate the bearing of these psychical phenomena on the pathogeny and diagnosis of tic.
Many of the conditions with which we are dealing are characterised in addition by an emotional element. Dupré[13] believes an emotional shook is the exciting cause of tic, as it sometimes is of obsessions.
Apropos of this view, we may quote again from the history of the young patient J.:
During his holidays he improved sufficiently to enable him to resume his classes, but another attack of influenza in the beginning of 1900 was the occasion of a relapse. He began to complain of overpowering fatigue; became depressed and morbidly anxious about his future; had attacks of hysterical sobbing; suffered great mental anguish, accompanied by flushing and profuse perspiration; in short, he fell into a veritable state of mal obsédant.
At the same time, the slightest pain or annoyance was a pretext for his tics to exhibit themselves with redoubled vigour. Even the mere idea of his tics, the fear of them, incited him further in the same direction. He seems then to have set himself to invent new movements, and forgetting forthwith that he himself was their creator, became alarmed at them as sure signs of the aggravation of his disease.
Analogous details will be found in all cases which have been studied as well from the mental as from the physical side. For our part, we consider a tic cannot be a tic unless it be associated with a certain degree of mental instability and imperfection, indubitable evidence of which is furnished by a psychical abnormality of constant occurrence in this malady—viz. anomalies of volition.