These reserves made, it is clear that removal of the patient from his
environment has its advantages, but it is better to maintain only a
degree of isolation, and to allow him to come into his own circle from
time to time, under a wise supervision. The ideal measure would be to
consign him to the care of an attentive and devoted teacher, whose
superintendence would be permanent. In this respect, unfortunately, all
that we can do at present is to indicate what we think a desideratum,
for while well-to-do families may have their tutor, we do not know of
any one who has held a corresponding office as an instructor of children
with tic. The realisation of this novel proceeding might present genuine
difficulties in practice, but we may hope that once parents, patients,
and physicians are acquainted with the nature of tics and the efficacy
of the re-education method, many prejudices against that fruitful
therapeutic contrivance will vanish.
PSYCHOTHERAPY
Immobilisation and regulation of exercise and occupation do not
constitute the whole of the treatment; they form merely its objective
side. Psychotherapy is another factor, of capital importance.
In the words of Brissaud, psychotherapy is an _ensemble_ of
agencies calculated to demonstrate to the patient where his will is
at fault, and how to exercise to the best advantage what of it is
left. To come to particulars, his defect lies in his inability to
check a cortical caprice. These are not rhetorical unrealities, nor
is there anything mysterious about the method; it demands no
special competence beyond the gentle and encouraging firmness of
the ideal teacher. The physician can constitute himself instructor
without having to borrow from the more or less occult practices of
hypnotic suggestion. In fact, we must make it clear to the patient
that the co-operation of the latter is indispensable, and that it
is his will which is to come into action. The personal influence of
the teacher will be exerted in sustaining his pupil's efforts, in
making him take note of the progress effected, in keeping him to
the allotted times for exercise and drill.
Thus, and thus only, is psychotherapy to be applied to tic. Lucid and
sincere explanations and kindly counsels are wanted, not ceremonies and
mysterious paraphernalia. Resoluteness, patience, clemency, and good
sense are the weapons in the physician's armamentarium; docility, faith,
and perseverance, on the patient's part, will enable him to emerge
victorious. As soon as the compact is made, the battle against bad
habits, where there is neither truce nor quarter, commences in earnest.
The victim to tic will speedily unlearn the habit of perpetuating bad
habits; he will, in addition, learn the habit of not contracting bad
habits. In this way a double benefit--physical as well as moral--will
accrue.
Public-domain text, read in full here on John Shaqi.
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