Tics and Their Treatment. Feindel Eugène
by any means feasible; yet nine times out of ten our efforts are abortive simply because we invent a tic to hide a tic, and so add both to the ridicule and the disease.
Alike in speaking and in writing O. betrays an advanced degree of mental instability. His conversation is a tissue of disconnected thoughts and uncompleted sentences; he interrupts himself to diverge at a tangent on a new train of ideas – a method of procedure not without its charm, as it frequently results in picturesque and amusing associations. No sooner has he expressed one idea in words than another rises in his mind, a third, a fourth, each of which must be suitably clothed; but as time fails for this purpose, the consequence is a series of obscure ellipses which are often captivating by their very unexpectedness.
His writing presents an analogous characteristic.
It has often happened that I have commenced a business letter in the usual formal way, gradually to lose sight of its object in a crowd of superfluous details. Worse still, if the matter in hand be delicate or wearisome, my impatience is not slow to assert itself by remarks and reproaches so pointed and violent that my only course on reperusal of the letter is to tear it up.
By way of precaution, therefore, O. has adopted the plan of having all his correspondence re-read by his colleague. Strangely enough, to his actual caligraphy no exception can be taken. The firmness of the characters, the accuracy of the punctuation and accentuation, the straightness of the lines, are as good as in any commercial handwriting.
With the aggravation of his head tics writing has become a serious affair. Every conceivable attitude has been essayed in turn, and at present the device he favours is to sit across a chair and rest his chin or his nose on the back; in this fashion he can write all that is required.
O.'s every act is characterised by extreme impatience. In his hurry he comes into collision with surrounding objects or breaks what he is carrying in his hand, not because of defective vision or inco-ordination of movement, but because of his eagerness to be done.
In spite of the fact that I know my recklessness to be absurd, that I see well enough the obstacles around and the danger of an encounter, I am conscious of a paradoxical impulse to do exactly what I should not do. In the same instant of time I want what I do not want. As I pass through a door I knock against the door-post without fail, for the sole reason that I would avoid it.
There is impatience in his speech. His volubility makes him out short his own phrases or break in upon the conversation of others. If an idea suggests itself, he must give it expression. Perhaps the word wedded to the idea is not at once forthcoming, yet he does not hesitate to invent a neologism, which is often amusing in spite of or because of its oddness, and if it please him he will enter it in his vocabulary and use it in preference to the other.
To wait is foreign to his nature. The least delay at table exasperates him; any order he gives must be executed instanter; no sooner has he set out than he would be at his journey's end. An obstruction or difficulty in the way is the signal for a fresh outburst; his irritation soon exceeds all bounds; his language degenerates into brutality, his gestures become increasingly violent and menacing.
It is not with any surprise, then, that we learn in O.'s case of incipient homicidal and suicidal ideas.
At times when my tics were in full force evil thoughts have often surged over me, and on two or three occasions I have picked up a revolver, but reason fortunately has come to the rescue.
As a matter of fact, the suicidal tendencies of some sufferers from tic are seldom full-blown. The will is too unstable to effect their realisation. Hence the patient's hints at doing away with himself are nothing more than empty verbiage. Similarly with the inclination to commit homicide, it vanishes as soon as it arises.
The term "vertigos" is used by O. to designate a long series of little "manias" or obsessional fears from which he suffers, among which may be enumerated dread of passing along certain streets and a consequent impulse to walk through others; dread of breaking any fragile object he holds in his hands, coupled with the temptation to let it fall; fear of heights, and at the same time a desire to throw himself into space.
I have often stood on the edge of the pavement waiting for a vehicle to pass, and at the moment of its approach darted across just under the horse's nose. On each occasion I have been conscious equally of the absurdity and yet of the irresistibility of the idea; each time the attempt to withstand it has been labour lost.
O. is a great nosophobe. At one time he was immoderately apprehensive of contracting hydrophobia, and used to flee from the first dog he saw. To his sincere regret he had several of his pet dogs killed, because of his conviction that they would become infected, although he felt such harsh measures to be quite unjustifiable. At a subsequent stage he turned syphilophobe for no adequate reason. He was alarmed lest a minute pimple on his chin should develop into a chancre. Recently his chief misgiving has been that he may become ataxic or demented.
Among his various afflictions mention must be made of an umbilical hernia, supposed to have originated in the chafing of his umbilicus by a belt he was wearing during a long spell in a canoe. As a matter of fact, the hernia is purely imaginary – at any rate, there is no trace of it to-day. Yet at the first it bulked very largely in his mind, and he is still fully persuaded of its reality, though no longer of its gravity.
O. further complains of all sorts of noises in his ears, but these are simply the ordinary sounds that one can produce in the middle ear by clenching the jaws together. He will not accept so obvious an explanation, however, preferring to regard them as indubitable evidence of the "lesion" with which he is preoccupied. The tinnitus, therefore, is rather of the nature of an illusion than of a hallucination.
He is distinctly emotional, and lives at the mercy of his emotions, but from their very bitterness he contrives to derive some pleasure. His passion for horse-racing is not due to the fascination of the sport, but to a bitter-sweet sensation which the excitement of the scene calls into being. He is indifferent to arrest or aggravation of his tics; all that he seeks is the association of a certain sense of anguish with certain "tremolos in the limbs," wherewith he is greatly delighted.
In the domain of his affections there does not appear to be any abnormality. O. is an excellent paterfamilias, adoring his children, but spoiling them badly at the same time. In this part of our examination we did not press for details, but as far as we have gathered he is capable of sympathies keenly felt though rarely sustained.
Thus, whatever be the circumstances, changeableness, versatility, want of balance, are manifested clearly in all his mental operations; and when he remarks himself on the youthfulness of his disposition, he is simply stating a truism as far as those who tic are concerned, for, in spite of the advance of years, their mental condition is one of infantilism.
Under our direction O. has devoted several months to the eradication of his tics, and he has not been slow to appreciate the aim of the method or to acquire its technique. One of the first results was the repudiation of various procedures more harmful than otherwise, and the successful endeavour to maintain absolute immobility for an increasing space of time. The outcome of it all has been a gradual diminution of the tics in number, frequency, and violence, and a corresponding physical and mental amelioration.
We do not intend in this place to enlarge on the details of our treatment: suffice it to say that it consisted in a combination of Brissaud's "movements of immobilisation" and "immobilisation of movements" with Pitres's respiratory exercises and the mirror drill advocated by one of us. To-day the utility of these measures is an accepted fact; but at the same time we rely on an inseparable adjunct in the shape of mental therapeusis, seeking to make the patient understand the rationale of the discipline imposed.
Our task has been lightened to an unusual degree through O.'s intimate acquaintance with the beginnings of his tics and his striking faculty of assimilation. On many occasions he has anticipated our intentions and of his own accord outlined a programme in harmony with the indications we were about to give him. Thanks to this happy combination of circumstances, the improvement effected by our treatment has been quickly manifested.
I am conscious of very material gain. I do not tic so often or with such force. I know how to keep still. Above all, I have learned the secret of inhibition. Absurd gestures that I once thought irrepressible