From the Analysis of a Patient with Cramp of the Spinal Accessory

At the beginning of June 1920 a baker's assistant aged forty-three came to me for treatment on account of a torticollis tic from which he had been suffering for about three years. It had at first caused him but little inconvenience, but had become very much worse in consequence of several emotional experiences. The man now displayed an almost continual tonic cramp in the muscles innervated by the spinal accessory nerve, which only occasionally ceased for a moment. Only during sleep was he undisturbed. At the same time he suffered from a number of other tics in his hands: he smelt at his thumbs, held his hand before his eyes, lifted up the lapels of his coat, etc. He had at first intended these tics as para-tics (in the sense of a patient of Meige's): if he merely raised his hand to his face he could overcome the torticollis. But now they continued in a compulsive way without his being able to exercise the slightest influence on them. He had been forced to give up his work, which was to take round bread in a baker's cart, because he could no longer push the cart. He could not look straight up the road because his head was absolutely askew, and as he continually held one hand up to his face he had to push the cart along with the other hand alone which was only possible for a short time. During the treatment it soon became evident that there were a number of other symptoms. For more than a year he had been psychically impotent;