5. In order to deceive his friends, the patient assumed a forced attitude of gaiety when really sick at heart, by inclining his head, raising his shoulders, and arching his back, and at the end of a few months a bantering remark revealed the surprising fact that he could not correct the position (Raymond and Janet[86]).
6. A woman used to pass the day sewing or knitting at her window and amusing herself from time to time by pensively looking out into the street. Not long afterwards she noticed how much more pleasant it was to allow her head to turn to the right, and how troublesome it was to keep it straight. At length she found this impossible, except with the aid of her hands (Sgobbo[87]).
7. Worried by severe occipital pains, an individual became so concerned to find they were being replaced by a feeling of great weakness, that he let his head rest by inclining it now and then to the left, an act which he is certain was the cause of his torticollis (Feindel[88]).
One further instance may be cited from Séglas,[89] where a neurasthenic lady, fifty years old, had been for three years a martyr to vague pains which finally settled in her neck, and asserted themselves on the slightest exertion. She sought to mitigate her sufferings—a veritable topoalgic obsession—by leaning her head on her shoulder, and the desire thus to procure alleviation gradually became irresistible and the movement unconscious.
Multiplication of examples is unnecessary. It is abundantly evident from the above that the repetition of a deliberate and voluntary functional act, co-ordinated and systematised, is the first step in the genesis of mental torticollis.
The mere memory of a frequently repeated movement, especially if the latter occur in the prosecution of one's avocation, may determine the type of torticollis, as in Grasset's "post-professional colporteur tic," to which reference has already been made.
In the case of one of our patients, N., the prolonged and almost exclusive use of certain muscles in the course of his business decided their involvement in the condition of practically permanent torticollis with which he was afflicted, and which was due to strong contraction of the right trapezius and sternomastoid. It appeared that for eighteen years he had been a cutter in a linen draper's, where it had been his duty, for hours at a stretch, to cut rolls of stuffs with a large and heavy pair of scissors, and in the execution of this work the right arm was extended, the hand firmly pressed on the table, the shoulder elevated, the head rotated and inclined to the left.
We cannot do better in this connection than recall the cases referred to by Brissaud[90] when directing attention for the first time to this variety of tics of the neck.
Here is a patient with energetic contraction of the muscles which depress the head on the neck. She holds her head in her hands to inhibit the movement, and succeeds. And she is quite convinced that the force requisite for rectifying the vicious attitude is not simply the power of her will acting on the muscles concerned, but the strength of her hands. She has unconsciously doubled her physical personality; her hands obey her will, her neck does not. At least, this would appear to be the key to the situation, for it can be well understood how much easier it would be to readjust the position by action of the antagonist cervical muscles than by the hands. The contraction, moreover, is entirely painless. It is a trivial act of obsessional insanity, provoked by some or other insignificant psychomotor hallucination.
Take this next man, who also must needs keep his head straight by means of his hand—obviously no irritation of the spinal accessory can be accused of originating the mischief, else would he be unable himself to replace his head. It is merely the idea that is urging him to its rotation. Try by force to prevent him from twisting his head round, or try to twist it against his will, and the difficulty of the thing will be at once comprehended. Or try to pull your own two hands apart to see which is the stronger, and you will never succeed, for the simple reason that abstraction of the will is impossible. One hand can prevail over the other only if both consent; the left cannot be in ignorance of what the right is doing. A "partial" or "local" will is inconceivable; there cannot be one for the head and another for the arm.