Tics and Their Treatment

by Henry Meige; E. Feindel

A young woman twenty years of age first began to suffer from convulsive tics five years ago. Without any warning she used to bend down as if with the intention of picking up something, but she had to touch the ground with the back of her hand, else the performance was repeated. Twenty or thirty times a day this act was gone through; in the intervals she kept turning her head to the right, looking up at the curtains in a corner of the window, and at the same time making a low clucking sound that attracted the attention of those in the room. For nine or ten years these two tics have prevailed, and have been accompanied with certain obsessions, such as the impulse to count up to three, to regard any person or object three times, etc. With the generalisation of the convulsive movements various phobias have made their appearance—viz. fear of horned animals, of earthworms, of cats, of blight, etc.

Onomatomania is another form of obsession which may be mentioned, exemplified by the dread of uttering some forbidden word, or by the impulse to intercalate some other. The term folie du pourquoi has been applied to the irresistible habit of some to unearth an explanation for the most commonplace of facts: "Why has this coat six buttons?" "Why is so-and-so blonde?" "Why is Paris on the Seine?" etc. This mode of obsession is frequent among those who tic, and is curiously reminiscent of a familiar trait in the character of children, thereby supporting our contention of the mental infantilism of all affected with tics.

Prominent among the mental anomalies of the subjects of tic are found different sorts of phobia: fear of death or of sickness, of water, knives, firearms—topophobia, agoraphobia, claustrophobia, etc.

The following most instructive case has been observed by one of us over a period of several months:

S.'s earliest attack of torticollis, of two or three days' duration merely, occurred when he was fifteen years old, and was attributed by his mother—whose mental peculiarities, in especial her fear of draughts, are no less salient than those of her son—to a chill occasioned by a flake of snow falling on his neck. S. is so blindly submissive that he accepts this pathogeny without reserve. Five years ago a second torticollis supervened, which still persists to-day, and of which his explanation is that he was obliged, when standing at a desk, to turn his head constantly to the left for two hours at a time in order to see the figures that he had to copy, and was forced, after the elapse of some months, to relinquish his work owing to pain in the occipital region and neck. From that moment dates the rotation of his head to the left.

At the present time his head is turned to the left to the maximum extent, the homolateral shoulder is elevated somewhat, and the trunk itself inclines a little in the same direction. The permanent nature of this attitude necessitates his rotating through a quarter of a circle on his own axis if he wishes to look to the right. On the latter side the sternomastoid stands out very prominently, and effectually prevents his bringing the head round; nevertheless he is greatly apprehensive of this happening, and as he walks along a pavement with houses on his right he keeps edging away from them, since he is afraid of knocking himself against them. By a curious inversion, common enough in this class of phobia, he feels himself impelled to approach, with the result that he cannons against the wall on his right as he proceeds.

Contrary to the habit some patients with mental torticollis have of endeavouring to ameliorate the vicious position by the aid of high starched collars, S. has progressively reduced the height of his until he has finished by discarding them altogether. As a matter of fact, it is the "swelling" in the neck caused by the right sternomastoid that is at the root of his nervousness, for he is convinced that it preceded the onset of the torticollis, and he has a mortal dread of aggravating it by compression.

Hence one may perhaps understand what line of erroneous reasoning has led to the establishment of the wryneck. The fear of draughts, instilled in his youthful mind by his mother, had the effect of driving him to half-strangle himself with a tightly drawn neckerchief, to hinder the inlet of air and minimise the risk of catching cold, and when he commenced to turn his head to the left at his work, the pressure of the band round his neck was felt most of all on the contracted right sternomastoid. A glance at a mirror convinced him that the unusual sensation was due to an abnormal muscular "swelling," whereat he was vastly alarmed; he hastened to change his collar, but all to no purpose. By dint of feverish examination and palpation of the muscle, he soon acquired the habit of contracting it in season and out of season, till at length an unmistakable mental torticollis supervened.

It sufficed to explain to S. the role played by the sternomastoid in head rotation, and to demonstrate the absurdity of his interpretation of the so-called "swelling": the gradual relaxation of the muscle and consequent diminution in the "tumour's" size not only satisfied him of its benign nature, but afforded such a sense of relief as was quickly made obvious by a notable improvement in his condition.

A singular tic of genuflexion occurred in a case reported by Oddo, of Marseilles: