That there is a weakness of will power in the ticquer, with a lack of control or inhibition over the lower neurones normally regulated by the higher co-ordinating centres, so that certain automatic activities become dissociated and exist more or less independently, is generally acknowledged.
In fact it must be said that tics are reactions of the organism, of the organic make-up, the psychophysical personality, as a response to irritation, excitation or stimulation, sensory, nervous or psychic! It is a means of relief of tension, of organic reaction or adaptation, not necessarily conscious but frequently unconscious and automatic, as in fear. Starting in this way it may persist. In the tic we see a method by which the individual or organic personality has met a certain difficult or undesirable or disturbing situation. It is thus a constitutional, biological defense reaction, psychophysical in nature, with a reversionary tendency (when viewed from the evolutionary standpoint), and hence is indicative of degeneration, this term being used in the racial, biological, phylogenetic and ontogenetic sense.
There is not such a far cry from the simplest tic to Gilles de la Tourette's disease or maladie des tics with its more pronounced signs of psychophysical deterioration and dissociation. The tendency is a degenerative one— a prolapse to ancestral methods of reaction, a dissociation or disintegration of the personality, a lack of control over more elementary activities. We should therefore appreciate the need of early recognition and treatment of tics and fixed habit movements, especially since there is a tendency to spread, for the tics to multiply, and for mental symptoms and reactions of a hysterical and psychasthenic nature to appear, if they do not already exist or have not existed before the onset of the tic.
In brief, then, tics represent the emotional reactions and feelings of the individual—the loves and the hates, the likes and the dislikes, the wishes and the fears, the cravings and the dissatisfactions, the bodily and mental tension, unrest, excitement, discomfort and disequilibration. In other words the ticquer feels and speaks and acts by the tic. He lives by, in and for his tic. He is attempting to meet certain situations of a disturbing nature and to obtain equilibrium and equipoise by compensating for his feelings of inefficiency and unrest by the tics. It is an organic, constitutional, psychophysical, biological means of adaptation.
PROGRESSIVE EVOLUTION OF THE CONDITION
We now come to the progressive evolution of the motor manifestations and to the mental aspect of this condition.
Concerning the mental state characteristic of the ticquer it is generally agreed that there is a polymorphic psychic defect or disorder which shows itself particularly in a precocious or hyperemotional condition, in a lack of will power and of inhibitory control, leading to a state and feeling of doubt, indecision, incapacity, insufficiency and unreality, of inferiority and self-depreciation, with a tendency towards morbid self-absorption, egocentricity, self-observation, auto-and hetero-suggestion, with the consequent development in many instances of so-called neurasthenic, psychasthenic, hysteric and various psychotic reactions. I am not prepared to say definitely how frequently the mental state, in lessened degree, precedes the outbreak of the tic movements. This may be present in a certain proportion of cases, but is by no means always present and it is even questionable whether the predispositional mental condition is the ground work in the majority of patients.
Tics, it is true, are especially apt to develop in individuals with a neuropathic or psychopathic history or heredity. In other cases this history is not obtainable, the individual having been apparently perfectly normal up to the time of the outcropping of the tic. In these cases shock is apt to bring on the outbreaks and so one may say that the instability had been latent and that a severe shock was sufficient to bring it to the surface. We must remember, in all these cases, that the mental state which we see in the ticquer is but an exaggeration of that which appears in many children, and is similar to that which appears also in other psychoneurotic states, and in fact the germs of this condition may occur transiently in any of us. This psychic condition may frequently but does not always precede the appearance of the tic movement. But it is only after the appearance of the motor manifestations of tic that the mental state becomes prominent or develops where it was not noticeable if not absent before.
Be that as it may, or even granting that in most patients the characteristic mental state or the neuropathic or psychopathic make-up exists in some measure to an abnormal extent, we do know that once the tic movements have made their appearance and begin to spread, so that the individual is thrown into the struggle to perform or not to perform the movement, the development of the psychic state which we find so patent in the more pronounced forms of tic, thereafter more or less rapidly occurs, no matter what the mental condition of the ticquer may have been previously. I am also not prepared to discuss here at any length the phylogenetic or ontogenetic significance and the biological genesis and meaning of the various mental trends of the ticquer, but I may say that they too have been acquired in the course of evolution, for certain very definite reasons which need not concern us here, although it can be appreciated that the biological motive of self-preservation played a most important role in their genesis and fixation.