The assumption of this position for his arm was at first attended
with satisfactory results, but, as might have been foreseen, its
inhibitory value decreased gradually, so he had recourse to other
means. It was then that the right hand was made to grip the left
and press it more energetically than ever against the epigastrium.
In this complex attitude both arms simultaneously participated, but
again its efficacy was purely transitory. Evidently dissatisfied
with his methods of immobilisation, and convinced that
experimentation would end in the discovery of the desired
arrangement, J. proceeded to employ the right hand in impressing
every variety of passive movement on the left hand, wrist, forearm,
and upper arm, and soon there was no checking these gymnastic
exercises. He would suddenly grasp the wrist and pull and screw it,
while the left shoulder and elbow resisted nobly; or he would bend,
or unbend, or twist his fingers, or seize the arm below the axilla
and knead it or rub it, forcing it against or away from the thorax;
he would pound the muscles and pinch the tendons, sometimes in a
brutal fashion; in short, the situation degenerated into nothing
more nor less than a pitched battle between the left arm and the
right hand, in which the latter endeavoured by a thousand tricks to
bring the former into subjection. Victory rested always with the
affected arm.
Each time that this absurd combat recommenced, the patient
experienced a sensation of relief; resignation to the imperious
motor obsession was even followed by a sense of well-being. On the
other hand, resistance was accompanied by actual anguish--he would
fidget desperately in his chair, cross and uncross his legs, sigh,
grimace, rub his eyes, bite his lips and nails, twist his mouth
about, pull at his hair or his moustache, he would look anxious or
alarmed, would become by turns red or pale, and beads of
perspiration would gather on his face. At length he would be
compelled to yield, and the bloodless battle of his upper limbs
would close more furiously than ever.
In this case the typical features of obsession are excellently
illustrated--its irresistibility, as well as the concomitant distress
and succeeding content.
Conversely, however, a tic may be said to develop into an obsession if
the exciting cause of the latter be the motor reaction.
Public-domain text, read in full here on John Shaqi.
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