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The clinical characteristics of 20 golfers suffering from golfers' cramp or the "yips" are described. The typical description is that of a middle-aged golfer who has played competitive golf since his teens and develops the problem during a tournament in the form of a jerk, spasm, or freezing of movement while putting or chipping, with the rest of the game being relatively unaffected. The problem generally takes a chronic fluctuating course, and a number of 'trick' strategies are partially or fully successful. In this study, the subjects were compared with a matched group of 20 unaffected golfers on a number of indices of psychopathology; no significant differences emerged. The more severely affected golfers also did not differ significantly from the mildly affected ones, except on the subjective report of anxiety. These data support the argument that golfers' cramp is not an anxiety disorder or a neurosis. The important role of anxiety and arousal in its manifestation is, nevertheless, recognized and its pathophysiology speculated upon.

In recent publications writer's cramp is mostly seen as a "focal dystonia", which denotes a group of organic-degenerative disorders of the basal ganglia. In opposite to this view psychoanalysts have pointed out since many years the psychogenesis of the syndrome. Our investigation starts with the descriptive analysis of three own cases. It will be shown how clinical facts present a complex situation, which allows the hypothesis, that somatic and psychogenetic factors coincide in the pathogenesis of occupational cramps. Finally a proposition is made how empirical evaluation of the hypothesis is possible.

In the history of medicine new diseases have appeared recurrently, frequently in epidemic form. "New" medical and surgical treatments become fashionable and "diagnosis" becomes a reinterpretation of ambiguous phenomena in accordance with prevailing concerns, often promoted by vested interests. Such an epidemic can be understood in its social context against its background of shared beliefs, social stresses and group demands. False rumours and other exacerbating factors can be identified and eliminated, and measures taken to control them. The management of such epidemics is a public health problem which demands community and institutional support as well as cooperation by the media.

We have examined 29 subjects with writers' cramp (and 4 with typists' and one with pianists' cramp) and have noted two major groupings, simple and dystonic. We have observed spread from one to the other. We have seen repeatedly, in patients with isolated simple writers' cramp certain subtle physical signs which are found also in other basal ganglia diseases. We have noted also the frequent association of other features of segmental and generalized dystonia in patients with dystonic writers' cramp. We have demonstrated that patients with isolated writers' cramp have no higher an incidence of psychiatric disturbance, as judged by formal Present State Examination, than the normal population. We conclude that isolated writers' cramp is a physical illness rather than a psychological disturbance, and that it is a focal dystonia.

Problems involving the coordination of movements of the hand analogous to the "writers cramp" have been seen in musicians and other professions. They occur in individuals with muscular imbalance, who assume abnormal body postures affecting not only the involved limb but also the spine and pelvis. These patients also often have a particular psychological make up. Treatment is based on the re-training of their muscular actions and on teaching the patients to avoid assuming abnormal stances or postures.