With these brief prefatory remarks, I shall forthwith enter into the discussion of the genesis and meaning of the tics.
I may say at once that this is not merely a theoretical and purely academic proposition which has no practical bearings in the way of prognosis and treatment. On the other hand, a real understanding of the nature, origin, and significance of the tics is of decided value in giving us proper standpoints and orientation with respect to the prevention, prognosis and cure of the condition.
I need not enter into a description of the characteristics of tics in this place. I may merely mention that tics have two aspects—a psychic and a physical. It is, in other words, a psychoneurosis. The characteristic mental state is one of doubt, of indecision, of inadequacy, of restlessness, of tension, of discomfort and of dissatisfaction, which is more or less unappeasable and irrepressible and uncontrollable until it finds vent in a rather explosive series of motor expressions which, as it were, are the safety valve for the peculiar feeling of tension and discomfort which the individual has been experiencing and which is accompanied by a sense of relief, satisfaction and a relative degree of comfort and mental rest. The mental imperfection (Charcot) of the ticquer is a polymorphic psychic defect (Brissaud, Meige and Feindel) characterized by mental infantilism; for ticquers, like other psychoneurotics, are like big children. They have the mind of children, in respect to the emotional make-up.
The mental condition of ticquers is especially characterized by the imperfection or weakness of volition, by a certain degree of mental instability and lack of inhibitory control of the desires, tendencies, activities and motor expressions of the individual, this defect laying the groundwork for the impulsions and obsessions, as also for hysterical, so-called neurasthenic, hypochondriacal, depressive and so-called dementia praecox reactions. The tic movement is the symbol of the psychic defect or degeneration or instability.
The earlier investigators were responsible for the differentiation of the tics from such other conditions as Sydenham's chorea, Huntington's chorea, the spasms, the stereotypies, the habit movements, the myoclonias, and other allied conditions. It is due to their pioneer work that tics were recognized as a definite and distinct clinical entity. The process of disintegration of these various movements and their differentiation one from the other cannot be overvalued. Among those who have contributed most to this subject may be mentioned Magnan and his pupils, especially Saury and Legrain, Gilles de la Tourette, Letulle, Guinon Noir, Pitres, Cruchet, Grasset, Trousseau, Charcot, Brissaud Meige and Feindel. Although Trousseau recognized the the ticquer was mentally abnormal, it was Charcot who first called definite attention to the psychic origin of the condition and to the fact that tic was indeed a mental disorder, a psychoneurosis, a psychomotor reaction. His lead was subsequently followed up by Brissaud, and by the latter's pupils Meige and Feindel, the latter two authors giving us a comprehensive discussion of the subject in their well-known classic. [1]More recently the Freudian school has attempted to dig down into the roots of the tree which ultimately sends forth its branches in the guise of tics.
[1] Tics and their treatment. English translation by S. A. K. Wilson. New York, 1907. This book contains an extended bibliography.
VIEWS OF THE FRENCH SCHOOL
The usual conception of tics, as laid down by Brissaud, Meige and Feindel,[1] may be stated as follows: Tic movements are physiological acts which were originally functional and purposeful in character, but which have become habits, apparently purposeless and meaningless. The motor reaction is the result of some external stimulus or idea (normal or abnormal) or both, which originally was necessary for the production of the tic movement, which latter eventually became habitual and automatic, and, owing to repetition, was executed, even in the absence of the external stimulus or idea, without apparent purpose or meaning. At first but little more than purposive habit movements, they finally became irrepressible acts which sought for expression, which were but little under the control of the will, which occurred in attacks varying in frequency, duration and severity, which decreased under distraction and generally ceased during sleep, which were increased in frequency and duration and severity by fatigue, emotional upset, mental unrest, conflict and strain, while the lack of inhibition and will power, the lack of self-control was the dominant mental state, leading to feelings of insufficiency, doubt, indecision and incapacity, and making the ground work for the psychasthenic reactions in the form of morbid impulses and obsessions, and for the hysterical, so-called neurasthenic and other morbid psychic trends.
The inherent or acquired neuropathic and psychopathic state is the basic condition which prepares the subsoil.
From a consideration of the motor symptom we may say that it is but a pathological habit, which, however, is apt to lead to the tendency toward or generation of an increasing number of such pathological habits.