Here is a third patient, presenting an identical muscular spasm. He
is content to apply two fingers to his chin to overcome the
otherwise irresistible bend of his head to the right. Such has been
the situation for the last five years. No line of treatment has
made any impression on this neurosis, to which two factors
contribute, though one cannot say which predominates--an
unconscious, imperious, motor impulse, and a conscious though
ill-informed volition, powerless to arrest the convulsions by
simple and normal media, and obliged to resort to a puerile
artifice, to a sickly sort of deceit. The opposition furnished by
two fingers only cannot be of any avail, yet, however feeble be the
succour, the patient's imagination is thereby appeased.
Such (adds Brissaud), fashioned in the same mould, are the
"mentals" of whom I have been speaking. Recollect the ungovernable
impulse they feel to execute a convulsive movement that their will
might thwart; remember, therefore, at the same time, their
volitional enfeeblement.
Brissaud's earliest observations were followed at no long interval by
various articles, first of all the thesis of his pupil Bompaire,[91]
then others in collaboration with ourselves. The more recent
publications of Lentz,[92] Sgobbo, Noguès and Sirol, Raymond and Janet,
Séglas, Etienne Martin, etc., may be mentioned, as well as a
contribution by Grasset,[93] notable alike for the case it contains and
for the author's interpretations.
The view that considers of prime importance the psychical phenomena of
this affection has received general confirmation. We have seen
protracted cases of "spasm of the accessorius" cured, exactly as with
the tics, by widely differing therapeutic agents. In numerous instances,
according to Oppenheim, torticollis is not consecutive to any peripheral
or central change in the nervous system, but rather indicates
irritability of nerve centres. It is probable that the kinæsthetic
centres in the cortex for the neck muscles are the seat of the lesion,
and that their congenital and hereditary imperfection fixes the form the
convulsion will take.
These and similar facts are well calculated to corroborate the opinion
that mental torticollis is nought else than a form of tic. The subjects
of the disease are satisfied of two things--that no one and no
circumstance can hinder their torticollis from asserting itself, and
that their own antagonistic gesture is the sole efficacious preventative
at their command. The attempt to put the displacement right evokes acute
pain and stimulates opposition on their part. They prefer the display of
considerable resistance to the renunciation of their satisfaction in
their tic, and follow up any momentary restraint by a riot of
inco-ordination, in recompense for the brief sacrifice they have made to
preserve immobility.
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