The comparison of this case with the one immediately preceding raises a very interesting question. Why is this patient apparently completely cured and the other one not? Several reasons may be noted. The patient is much younger. He had never been through anything like the same mental strains. His trouble was of short duration. But above all as he was successful in his business he was successful in his sublimation. Here is a sine qua non of a successful psychoanalysis: the capacity and the opportunity for successful sublimation. If these are present the prognosis is good.
It is interesting also to compare this case in its results with the contentions of Clark and of Stekel. It is hard to see any signs of a definite criminal tendency. Inasmuch as the temptation to go back to his early love is a sign of a tendency towards regression and erotism generally the patient shows what Clark has spoken of as a desire to return to the mother-body. This case is not very important, however, to the views of either Clark or Stekel as the analysis is relatively superficial, and there is no knowing what a more thorough analysis might reveal. From the point of view of superficiality, however, the case is important as it emphasizes Taylor's view of the value of a modified analysis. The patient was seen only five times.
On the basis of these, and a number of other similar cases, I should like to suggest, from a descriptive point of view, that the epileptiform seizure is of the nature of an orgasm. An orgasm is a sudden, explosive, discharge of nervous energy, raised to the breaking point of nervous tension. I should like to generalize the idea of orgasm. Ordinarily, of course, it is confined to the sexual sphere. In the last case I reported it seems to me fairly clear that the explosive actions, convulsive-like impulses, were closely associated in the mind of the patient with sexual ideas. That they were substitutes for the normal relief of sexual tension, seems to me also clear. This idea is perhaps more convincing if I add the fact, as stated by the patient, that his last attack started when he saw an attractive girl sitting at a nearby table in the Thorndike Hotel, and who started him dreaming about Anna, because she looked so much like her.
The second case I reported seems also easily brought under this conception. Here we know more about the earliest childhood of the patient and we can easily imagine that there was an especial predisposition for the form the symptoms took. This, however, does not militate against the descriptive value of the above conception. That the epileptiform attacks did not take place until after actual sexual orgasms had been experienced, lends weight to the conception I am presenting here. The first case is not so clear. This is partly due to the fact that it was impossible to make anything like a complete analysis. But it shows nothing contradictory to the conception, and indeed has some slight value as added evidence in favor of the conception, in as much as the original trauma consisted of a kick in the genitals, by her father.
This conception does not contradict either Stekel's or Clark's ideas, but rather supplements them. The essence of the criminal act lies in its unrestrained aggressive character. From this point of view anything getting in the way of the libido discharge has to take the consequences. This also agrees with Clark, only his idea seems to me perhaps a little too passive to describe fully the dynamic quality of the attack.
Here, as in Hysteria, the therapeutic effect of an analysis depends on the possibility of sublimation. The three cases I have given in some detail may easily be arranged in order. The last case having the best chances for sublimation shows the best results.
ON THE GENESIS AND THE MEANING OF TICS
BY MEYER SOLOMON, M. D.
Associate in Neurology, Maimonides Hospital, Chicago
THE problem of the genesis and meaning of the strange manifestations which we find in that peculiar disorder which goes by the accepted name of tics is indeed difficult of solution. The analytic and genetic standpoint only comparatively recently assumed in the domain of neurology and psychiatry is having an ever wider and wider application. The problems in neurology and psychiatry which still cry loudly for solution and rational explanation are indeed numerous. Some of these questions are so baffling that at times they seem almost beyond the ken of the human mind. Nevertheless, with persistence and the "Don't give up the ship" spirit keenly imbued into us, and with that irrepressible spirit of investigation and of research born of optimism and of curiosity, we may expect to see many of these problems which now seem to us so hopelessly unsolvable gradually rescued from the uncertain waters of speculation and theorization and brought to the more sound shores and land of the knowable and the known. If our theories be but tinctured with due admixture of that sound self-criticism that comes of prolonged and serious reflection and deliberation, and if the results of observation and investigation be brought forth in support of these theories, then we need have no hesitancy in permitting freedom in theorization and speculation. Let us also remember that unsound theories or standpoints do not come to stay, but, after surviving for a certain time, give way before that which is more sound, more tangible, more near the truth, which, to be sure, is always but approximately attained. If, therefore, the theory which I intend to set before you for consideration may seem on first thought far-fetched and unsupported, I beg you to remember that in a field where but comparatively little is known with absolute certainty, it behooves us to take notice of all theories or conclusions which may be propounded, since, even though they may not contain the whole truth, they may, perhaps, contain certain germs of truth, which may contribute, in some measure, however slight, toward the ultimate solution of the problem under consideration.