Tics and Their Treatment

by Henry Meige; E. Feindel

These habitual words and phrases—and many more instances may be cited—are analogous to the mannerisms exhibited during concentration of the attention on the performance of certain acts. They cannot be considered tics unless reproduced at other times as well. Moreover, while the use of such terms may be overdone, it can hardly be said to be unreasonable. However irritating their effect, they indicate simply an exuberance of style and a degree of inattention, not a grave mental shortcoming.

Of a less trivial nature is a curious anomaly that consists in the complication of speech by the introduction of meaningless expressions uncontrolled by the will. This is a functional defect very much akin to the tics.

A distinguished medical colleague was in the habit of muttering the word cousisi as he talked.[128] Séglas described similar occurrences as "stereotyped acts of speech." One of the Salpêtrière patients used to close every sentence with the phrase "in all and for all." Another's opening remark was always "Araken-Doken-Zoken." It is permissible to regard many of the neologisms imagined by the insane as examples of stereotyped speech. A patient, for instance, who suffered from delusions of persecution, said he was being pursued by the Evil Eye ("reluquets"—reluquer, to leer at). With the eventual disappearance of the association linking the original idea to the neologism, the patient may no longer be capable of explaining the meaning of the phraseology he has invented, but in the case of those whose mental level is more nearly normal the coining of new words need not be more than a sort of eccentricity, which is generally accompanied, however, by other indications of instability. We may remind ourselves of O., with his "vertigos" and "para-tics."

But if, finally, words or phrases escape the subject's lips at moments of silence, with whose imperious and unexpected emission he is powerless to cope, then we are dealing with true tics of speech. Their investigation has been conducted by Guinon with great analytical skill.

At the upper end of the ladder among exclamations we meet words involuntarily and senselessly repeated, in a loud tone of voice, to the accompaniment of tics and grimaces. These expressions fall naturally into two groups that require to be rigorously differentiated.

In the first of these the words uttered may be simply anything; each patient may have his own, and so their number is absolutely limitless. Occasionally one is in a position to discover in the antecedents of the case the reason for the choice of a particular word in preference to another, as in the instance of the man whose involuntary ejaculation, "Maria!" was the echo of a passion he had conceived years before for a young girl of that name.

Such troubles are unmistakable tics. The mechanism of their production is identical, be the actual localisation brachial, facial, or laryngeal, and this applies in particular to the motor verbal hallucinations so excellently studied by Séglas. As a matter of fact, tics of speech are often nothing more than the mode of exteriorisation of these hallucinations. The same is the case with verbal impulsions.

In this rubric of tics of speech we may class various cases recorded under differing titles, among which an interesting one due to Pitres may be quoted:

Subsequently to his retirement from active business pursuits, the patient, a man fifty-nine years old, became depressed, morose, and irritable, till insomnia at length drove him in desperation to attempt suicide. By the merest chance he failed of his purpose. The development of involuntary sounds a few weeks later was followed at the end of a month by the equally involuntary ejaculation of his wife's and children's names—"Numa! Helen! Camille! Maria!" This habit persisted for as long as fourteen months, after which during three years he enjoyed excellent health. Owing to financial worries, however, a relapse occurred. Every few minutes he uttered various articulate cries in a loud, clear, and well-modulated voice, sometimes repeating the four names with great rapidity, at others calling out the same name with increasing violence. Severe convulsive twitches of arm and trunk musculature synchronised with his exclamations. The patient was incapable of either restraining or even modifying the cries; he was equally unable to replace one by another, to say Henry instead of Numa, or Jean instead of Helen.

For hours at a stretch he would repeat the names of friends who had come to visit him; on the day before a consultation on his case his one cry was the name of the new physician who was going to examine him.