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From a psychological point of view, spasmodic torticollis, like camptocormia, with its pain, spasm, rigidity and muscular fixation, is a symptom which is related to the conversion hysteria type of phenomena in the same manner that tics are related to obsessive compulsive syndromes. The behavior of the muscles of the neck in either case expresses the pathological conflict solution, i.e., the spasmodically-fixed neck muscles of the patient with torticollis protect him from repressed and unconscious affects and memories of a painful nature. The intermittent nature of the tic expresses the ambivalence, rebellion and continual struggle of the ego for control that is characteristic of the compulsive obsessional individual. Just as cases of conversion hysteria are frequently combined or associated with compulsive obsessional traits so are cases of torticollis frequently either associated with tics or become tic-like in nature. Such shifts in a patient's ego defenses may occur with or without therapeutic intervention.
While some authors (14, 22) feel that the etiology of spasmodic torticollis is mainly “organic” in origin, the data on which they have based their claims are inconclusive; i.e., only 48 percent of 83 patients they studied showed any neurological signs and of this 48 percent many of the so-called neurological signs might have been considered the manifestations of a neurosis, i.e., tremor of hands, hyperesthesias, etc. Many writers on this subject (29, 30, 9, 19, 15, 8, 18) differentiate a “psychogenic” form of spasmodic torticollis, yet from the literature it would seem that such attempts are also inconclusive and that the symptom of spasmodic torticollis contains both elements.
No method of treatment has been uniformly successful. As a rule elimination of focal infection, immobilization, traction, novocain infiltration, sedation, etc., have produced only temporary relief (4, 21), and surgical procedures have been partially effective in only 60 percent of cases e