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Updated: May 7, 2025
The law of psychic ambivalence and ambitendency, as so nicely developed by Bleuler, here shows itself in marked degree. There is both the positive and the negative tendency toward the performance and execution of these activities and reactions which are necessary for the living of a life of a high or low degree of efficiency, so that the ticquer is obsessed by the problem of "to do or not to do."
The habits range from the queer desire to bite one's nails to the quick that is so common in children and which persists in the psychasthenic adult, to the odd grimaces and facial contortions, blinking eyes and cracking joints of the inveterate ticquer.
The entire mental picture which we find in the most extreme forms of tic could be beautifully elaborated along these general lines. For example, the ticquer becomes asocial, seclusive and shuns society because of the consciousness of the condition and the exaggerated sensitiveness. This represents compensatory, defensive methods of concealment.
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.
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.
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.
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.
This probably results in the outcropping of the various psychic trends which appear in the ticquer and which increase in degree and in number.
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.
Although not denying the basic neurotic constitution present in ticquers, Clark sums up by giving the following definite and fully developed theory: "The ticquer has a strong sexual attachment; this is so strong that the love instinct ineffectually sublimates the hate instinct and in the warring conflict doubt and physical and psychic inadequacy arise.
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