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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.
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. 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.
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.
I may say that in the physical aspect of tics we have a specific somatic manifestation which, if explained, should, in a way, be the gateway toward the understanding of the many somatic symptoms which we find in the psychoneuroses and psychoses. A year or more before Clark's paper appeared, I had arrived at certain general conclusions regarding the subject of tics.
Noir has called attention to the fact that the movements found in the tics correspond to the infant's spontaneous muscular play, which means the muscular play of all mankind. These authors were directing their efforts in the right direction. To appreciate this we need but remember that the mechanisms or the potentialities for the movements are inherited and have a phylogenetic significance.
English translation by S. A. K. Wilson. New York, 1907. This book contains an extended bibliography. The usual conception of tics, as laid down by Brissaud, Meige and Feindel, 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.
Perhaps I should also mention the fact that all of these symptoms or tendencies which one finds in ticquers occur in other individuals who do not present tics; and, furthermore, that all normal individuals possess these qualities or tendencies in varying degrees of intensity and in varying combinations, and that this applies to adults as well as to children, although, of course, they are seen most characteristically in children.
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.
We may thus lay down in a general sort of way a conception which I like to call the theory of psychophysical progression, fixation and regression along evolutionary and developmental lines. In the case of tics the regressive or devolutionary aspect comes in for special consideration. We may react mainly physically, or mainly psychically.
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