that psychoanalysis is a current somewhat marginal to the main stream of psychiatric thought. Nor can it be said that the present work is by a pupil of Freud's. On the contrary, Dornblüth looks upon psychoanalysis rather skeptically while appraising its therapeutic value, though it must be said that in other respects this author's disposition is, on the whole, rather favorable to the new movement. His discussion of psychoanalysis, though brief, is fair.

Psychoanalysis is a serious and momentous procedure; the author compares it to a capital operation upon the body; it is a spiritual operation of equally serious import, and, as in the case of the former, he is of the opinion that the physician who recommends this plan of treatment is under the moral obligation to warn beforehand the patient and all others concerned about the method and aims of the plan. As in the case of a major surgical operation, it is for the consultant to determine whether the plan is applicable in a given case.

It is sometimes maintained, and the present author repeats with apparent approval, that much of what is regarded as the direct result of psychoanalysis admits of a "more direct" interpretation.

We are told by this author that there are a number of things hidden which are not at all situated in the subconscious, a knowledge of which the physician may acquire without any hindrance or opposition, if he only obtain the patient's confidence. No student of psychoanalysis ever believed otherwise. But how does this invalidate a single claim of the psychoanalytical school? The real question is: Does the unearthing of consciously hidden secrets, in short, the ordinary confessional method, result in the therapeutic benefit which follows the unearthing of the pathogenic complexes out of the subconscious spheres? The man who, like Hellpach, compares the psychoanalytical course with the confessional should bear in mind that analogies are dangerous because of the tendency they create of falling into meaningless, because unreal, literalism. He who thinks that psychoanalysis means no more than the bringing of the confessional into the consulting room should rid himself of the error by learning to know what psychoanalysis really means.

Dornblüth asserts, we know not on what basis, that many cures ascribed to psychoanalysis are in reality cases of spontaneous healing. At the outset this could be granted; in a certain sense all cases heal spontaneously. The Freudians, perhaps more than any other class of investigators in the field, have striven to show that every new symptom arising in a psychopathic case represents a tendency towards cure. They interpret the whole clinical picture as an effort to readjustment.

The author believes further that the systematic use of other therapeutic means would result in cure so that the uncovering of the etiological factor in the psychoanalytical sense may be superfluous. What is required in the first place is the regulation of the patient's plan of living, especially of the patient's affectivity in such a way as to counteract the influence of the morbid complex. The increasing prevalence of psychoneuroses is looked upon by the author as the psycho-physical expression of the growing morbid affectivity incidental to modern life. A great deal can be accomplished in the case of the simpler forms of nervous instability by expert advice and systematic psychic re-education; in many cases this is all that may be needed. Even in the more difficult neuroses such a course prepares the ground for and facilitates whatever additional treatment might be advisable. The chief task is to train such patients to appreciate the role of affectivity. As it is not possible to proct patients from undue excitements and effective outbreaks, it necessary to fortify them. against such occurrences, so that they may withstand them better.

The frequent declaration of patients that their nervous trouble dates from a particular critical experience must be looked upor with suspicion. Accidents and psychic shocks like those to which patients frequently trace back their condition, may be responsible for some light or transient form of melancholia, but the more grave forms of neurasthenia and hysteria must be due to a much deeper trauma, a more or less permanent disturbance of affects requiring readjustment.

Unsatisfactory marriage relations are looked upon by the author as the most common cause of psychoneuroses. Women bear the consequence more commonly than men because man discharges his affects through his vocational activity, while woman's sphere is much more limited and affords less opportunity for sublimation.

Great stress is laid by the author upon the psychic influence for good of the family physician. He deplores the fact that as yet medical schools do not impart sufficient instruction about the more important psychoneuroses so that general practitioners must invariably turn such cases to the specialist. He sees good in and approves other methods than psychotherapy, though he is inclined to think that the success of most plans of treatment, including dietetics, is due in great part to their educative and psychic effect rather than to any inherent qualities of their own.

J. S. VAN TESLAAR.

THE JOURNAL OF

ABNORMAL

PSYCHOLOGY

AUGUST-SEPTEMBER, 1912

INTERPRETATION OF "PROFESSIONAL-CRAMPNEUROSIS" AS A TIC'

BY TOM A. WILLIAMS, M.D., M.B.C.M. (EDIN.) Corresponding Member Paris Neurological Society, Psychological Society, etc., Neurologist to Epiphany Dispensary, Washington, D. C.

Τ

HE psychological mechanism of the muscular cramps produced during the attempt to perform the acts of a very ordinary occupation is so complex that its consideration has been passed over both by Janet (2), and Meige (1), each of whom, however, has pointed out the resemblance of occupation-cramp-neuroses to true tic. To these authors they differ, however, from the tics in being. a disorder of a different normal act, whereas a tic is more in the nature of a new, acquired act, irrespective of a previously acquired automatism. The tic is, in the first place, deliberate and volitional from beginning to end. The occupation-cramp is only a modification of an act, once deliberate and volitional, which has become automatic, as far as any action under constant control of the neopallium can be so considered. But both tic and occupation-cramp may be summed up as acquired functional automatisms of pathological nature. Meige has made it a fundamental distinction that "occupation-cramp appears exclusively during the exercise of the function which it concerns, while the tics are generally aroused into activity by anything or nothing." But has one a right to postulate the origin of each tic movement from nothing? We know, on the contrary, from A portion of a communication presented in abstract to American Psychopathological Assoc., Baltimore, 1911.

the work of Brissaud and his followers, of whom Meige is not the least, and of Janet, that it is an idea which determines the cortical stimulus producing a tic; in which respect, tic does not differ from the teleological acts of everyday life. Now, this idea may be aroused in many different ways, as can the act-determining ideas of daily life. But although caused in different ways, is not the final act-determining idea always the same for the same tic in the same person? For example, the determinant of the idea which produces a tic of sucking and cheek-biting is the peripheral stimulus from the discomfort of the mucous membrane, which has become a besetment. The clonic torticollis tic is derived from the idea of seeking greater comfort by previously experienced readjustment of the position of the neck through the altered tension of its muscles. A blinking tic, again, arises from an idea, viz., that discomfort will be diminished through compression of the eyeball by the orbicularis palpebrarum.

It is true that the causal idea is not manifest in the ultimate stages of the tic's evolution; for the act has become an automatic one. In this respect, however, it does not differ from many complicated professional acts, such as piano-playing, which is undeniably a product of volition. The comparison might be carried further; and the striking of a particular note of the piano in a particular way may be compared with any selected component movement of a tic. Only a definite stimulus, and always the same for the same piano played, will cause the striking of the same note in the same way.1

The case of E. L.2 illustrates most forcibly how one' 1Of course the psychophysiological constellation which arouses the cortical activity leading to the piano-player's act may have several components, only one or more of which need be stimulated in the first place. Thus, the player may strike the note (1) upon sight of its symbol printed on the staff; (2) upon memory of its sound irrespective of symbolical representation; (3) as a consequence of the kinesthetic impressions remembered from a previous performance; and there are other possibilities. It need not be elaborated that any of these, singly or in combination, may, in accordance with the associational make-up of the player, eventuate in the same note played in exactly the same way. If the constellation, however, is not firmly associated, a different tone may be the fruit of different combinations of the stimuli causing the playing of the note.

2Studies of occupational cramps of writers and telegraphers. Jour. f. Psychol. u. Neurol. (von Brodman), Leipzig, 1912, Bd. 19, pp. 88-112.

idea produced at the same time both an occupation-cramp and a tic. It shows too that the law of Meige regarding the exclusive appearance of occupation-cramp during the function it concerns is by no means rigid, and that the anomaly of movement may occur during other acts as this disorder progresses. The case of Lit.' illustrates this in a less degree; for at times her inability to write extends to both certain kinds of sewing and the handling of heavy crockery. In the case of F. S.,' too, there is also sometimes a difficulty in sewing; and her idea of incapacity has now and then extended to many actions performed with the right arm; so that it was very difficult to convince her of the absence of disease of the muscles or joints, as also concerning her voice. Thus, it is not possible to lay down as Meige has done (pp. 72 and 192) a law separating tic and scriveners' palsy. For when the psychological mechanism is considered, and analysis is pushed deeper than has been done either by Meige or Janet, the pathogenesis is found to be essentially the same.

THE TICS. This is not the place to enter into a discussion of the various dyskineses or myoclonias. A few words, however, must be said of habitual gestures and attitudes and of the true tics. The former occur in perfectly normal individuals as well as in the insane, in whom they are called stereotypies. Examples in the normal are stroking of the mustache, wrinkling of the brow, whistling, playing with the watchchain, grimacing of the face, waving the hand, or sawing the air while speaking. So long as these are unconscious automatisms, and so long as they could be prevented without suffering by a little care on the part of the performer, they do not merit the name of habit spasm, nor can they be classed with the tics.

The latter are convulsive and intemperate in character, are accompanied by a consciousness of the act, are preceded by a desire, sometimes amounting to a passion, to perform the act, and are followed by a feeling of relief after performance of the movement. At all events the victim of tics. feels compelled to make the movements comprising the tic.

Studies of occupational cramps of writers and telegraphers. Jour. f. Psychol. u. Neurol. (von Brodman), Leipzig, 1912, Bd. 19, pp. 88–112.