The Frontal Cortex

The Advantages of Tourette’s

I was a stuttering child. Whenever I got the slightest bit nervous, I had an annoying tendency to run out of air on vowel sounds, so that beginning a phrase with “A” or “eee” or “I” was all but impossible. I would choke and sputter, my eyes blinking in mad frustration. This minor affliction led me to become extremely self-aware of my speech. Before I said anything out loud, I would consider the breathy weight of the words, and mentally rehearse all those linguistic speed bumps and stop signs. If the phonetics seemed too dangerous, the sentence would be rewritten in my head, edited down to the consonant essentials. While my stuttering has certainly improved – thank you, years of speech therapy! – I think the childhood affliction has left me with an enduring interest in language. And I still hate sentences that begin with the intake of air.

John Updike, in Self-Consciousness, describes his own childhood of stuttering. (“When I stutter,” he wrote, “I am trying, with the machete of my face, to hack my way through a jungle of other minds’ thrusting vines and tendrils.”) Here is Updike describing how this difficulty hurt him into writing:

Stuttering is kind of — I suppose it shows basic fright. Like in the comic strips, when people begin to stutter it’s because they’re afraid. And also, a feeling that — my father thought that I had too many words to get out all at once. So, I didn’t speak very pleasingly, but I never stopped speaking or trying to communicate this way, and I think the stuttering has gotten better over the years. I have found having a microphone is a great help, because you don’t have to force your voice out of your throat, just a little noise will work. But, it was real enough, and one of the things — you know, you write because you don’t talk very well, and maybe one of the reasons that I was determined to write was that I wasn’t an orator, unlike my mother and my grandfather, who both spoke beautifully and spoke all the time. Maybe I grew up with too many voices around me, as a matter of fact.

For me, the lesson of stuttering is that obstacles can also be advantages, that who we become is deeply influenced by what we cannot do. (Or, to quote the sage words of Kanye, “Everything I’m not/made me everything I am.”) The secret is to struggle through, because the very act of raging against a disadvantage generates its own set of skills.

That, at least, is the message of this new paper on Tourette’s Syndrome and cognitive control. Tourette’s is a developmental disorder defined by a set of involuntary motor and verbal tics. The most common tics are eye blinking and throat clearing, although some people with Tourette’s can also suffer from the “spontaneous utterance of taboo words or phrases”. The constant attempt to suppress these tics relies on the activation of the dorsolateral prefrontal cortex, a brain area closely associated with self-control, working memory and motor regulation. Interestingly, this chronic struggle leads to enhanced cognitive control, at least on certain tasks. Consider a 2006 study led researchers at the University of Nottingham. The experiment involved a challenging eye-movement task, in which subjects were forced to actively inhibit automatic eye movements. Here’s where the results get strange: individuals with Tourette’s made significantly fewer error responses than their “neurologically normal” peers, without a decrease in speed. The scientists speculate that this result “likely reflects a compensatory change in Tourette individuals whereby the chronic suppression of tics results in a generalized suppression of reflexive behavior in favor of increased cognitive control.” In other words, the struggle makes us stronger.

That’s also the message of a brand new paper which shows an increase in “timing control” in people with Tourette’s. Here’s the BPS Research Digest:

Carmelo Vicario and colleagues tested nine children with Tourette’s (average age 11 years) and 10 controls (average age 12) on timing perception and timing production. The former involved the children judging whether two circles were on screen for the same length of time or not. The latter task involved the children noting the time that a circle appeared on-screen and then pressing the space key on a key board for the same duration. Half the trials involved intervals in the sub-second range (from 310ms to 500ms), the other half were longer than a second, up to 1900ms.

There was no difference between the groups on timing perception or sub-second timing production. However, the children with Tourette’s were more accurate at the longer ‘supra-second’ version of the timing production task.

On a related note, it’s interesting to think about these timing control advantages in light of the fact that Tim Howard, the goalie on the U.S. World Cup squad, has Tourette’s. Here’s Hampton Sides in the New Yorker:

He [Howard] refuses to take medication for [Tourette’s] for fear it will make him “zombielike” and impair his motor skills. “I’m very adrenaline-filled, and I wouldn’t want to suppress that,” Howard said. “I like the way I am. If I woke up tomorrow without Tourette’s, I wouldn’t know what to do with myself.

Comments

  1. #1 barney
    June 24, 2010

    not entirely on topic, but on the stuttering side, have you seen David Mitchell’s fictional take in Black Swan Green? 13-year old protagonist spends a lot of time weighing his words to avoid trigger sounds.

  2. #2 oli h
    June 24, 2010

    Oliver Sacks goes into depth about his deft surgeon friend with Tourettes in British Columbia in “Anthropologist on Mars”. I think one of the most interesting aspects of that particular piece was how those around him adapted to the tics.

    This once again reveals how disadvantages breed advantages in many people.

  3. #3 Madison Guy
    June 24, 2010

    Jonathan Lethem’s memorable novel Motherless Brooklyn features an unforgettable youthful detective with Tourettes. Some cognitive compensation going on there as well, though Lethem is more interested in using the protagonist’s point of view to reflect on the poetry and mysteries of language.

  4. #4 OftenWrongTed
    June 24, 2010

    Your enduring interest in language, which has contributed to your being a writer, is similar to what Dylan Thomas relates in his essay, “Notes on the Art of Poetry”.

  5. #5 Jenny.X
    June 25, 2010

    Social psychologist Keith Payne has a blog entry a couple of months go on Psychology Today on how individuals with Williams Syndrome seem to display significantly less racial prejudice than individuals without Williams. This is most likely due to the lack of social fear as one of the characteristics of Williams.

    Of course, this is a little removed from what you talked about in your entry here. Dr. Keith Payne mostly discussed this finding in relation to his own research on racial bias using the weapon identification task-which essentially taps into the component of social fear that potentially manifests into biased or prejudiced behaviors. However, reading your entry reminded me of Dr. Payne’s entry, especially what you said about how sometimes obstacles in one way could become advantages in another. I still remember my former mentor (who studied extensively with children with Williams) telling us about how incredibly friendly and naive those children are even to complete strangers:)

  6. #6 George Couros
    June 25, 2010

    I just wrote a post about this with one of our students that we were very proud of. I think it is very applicable to this post. Here it is: http://georgecouros.ca/blog/?p=778

  7. #7 Shelley
    June 25, 2010

    Since one of my characters is deaf, I have thought a little about communication difficulties, and I notice that I can never hear a stutter without a visceral reaction that in its own way the stutter is a perfect metaphor for any kind of hesitant attempt to communicate: which is to say, all genuine attempts.

  8. #8 OftenWrongTed
    June 25, 2010

    Here is a quote from the writer David Foster Wallace on perceived disabilities:

    “What I mean is that a lot of stuff that I thought were weaknesses of mine turned out to be strengths”.

    From A Road Trip with David Foster Wallace, by David Lipsky. ISBN: 9780307592439

  9. #9 Debrah
    June 25, 2010

    “Social psychologist Keith Payne has a blog entry a couple of months go on Psychology Today on how individuals with Williams Syndrome seem to display significantly less racial prejudice than individuals without Williams. This is most likely due to the lack of social fear as one of the characteristics of Williams.”
    *****************************************************

    I find this a gratuitous venture into society’s culture wars, at best.

    Inane to-the-max, at worst.

  10. #10 Chelsea Smith
    June 25, 2010

    I was in California for the Phi Theta Kappa Honors Inst. and was actually in the small group where we had the small question and answer session and I was very impressed with your composure. In other words I did notice the stutter but I LOVED the fact that you did not feel the need to explain it or apologize for it, which many people may have in that position. I have to admit in a weird way it also made you seem more approachable…easier to talk to (ironic?) than the other speakers ….and by the way I totally would have eaten the marshmellow.

  11. #11 Michele
    June 25, 2010

    Alan Rabinowitz, who is Director of the Science and Exploration Division, Wildlife Conservation Society, Bronx Zoo, told an absolutely hypnotic story about stuttering and its aftermath at The Moth one night. You cannot imagine how moving it is. You can listen to it here – the fifth podcast down. http://www.themoth.org/listen

  12. #12 Eli B
    June 27, 2010

    I have two friends who are awe inspiring jazz musicians with Turrette’s Syndrome. One of these guys has it very severe and has had challenges working with black and/or female musicians because of the uncontrolled utterances. But once the horn is at his lips, he is totally focussed and uninhibited by his tics.he will not take his meds because he says he can’t improvise with them. Improvising music is so similar to talking from my experience in the way that ideas are formulated and almost instantly produced though motor skills. If my friend were a jazz vocalist, I wonder if he’d have the same problems. I imagine it would. Ive seen him give lectures, and that certainly doesn’t supress it any. So, then how would putting a horn to your mouth change things?

  13. #13 Alexandra Carmichael
    June 27, 2010

    Thank you, Jonah, for posting this! I have a chronic tic disorder (like Tourette’s without the vocal bit), and definite self-control issues. I completely agree that this has made me stronger, because I’ve had to overcome challenges that I wouldn’t have had otherwise.

    For example, I have a great sensitivity to my thought patterns now, and can tell when I’m needing self-care as destructive hyper-cycling thoughts start to emerge (has anyone investigated thought tics in addition to physical and motor tics for Tourette’s?)

    Another advantage: channeling the tic tendency into work is a positive outlet that makes me incredibly productive and lets me juggle more projects in my head than people I’ve asked about this can comprehend.

    I’ve definitely worked hard to compensate for whatever poorly defined neurological condition I have, but I have come to be somewhat grateful for it. The struggle has brought me many gifts, including new connections to people going through similar challenges.

    Your article also reminds me of David Dobbs’ piece on orchid children – especially the idea that an obstacle, given the right set of conditions, can become an advantage. http://www.theatlantic.com/magazine/archive/2009/12/the-science-of-success/7761/

    Thanks again – I feel somewhat more normal, or at least self-accepting, after reading your words. :)

    Alexandra Carmichael
    Co-Founder, CureTogether
    Director, Quantified Self
    Research Affiliate, Institute for the Future

  14. #14 David Dobbs
    June 28, 2010

    Hey Jonah. Splendid stuff. I wanted to respond to Alexandra Carmichael’s note of an echo between the upside/downside dynamic you look at here and the sort of upside/downside dynamic I looked at in my article on the orchid hypothesis. A post at my blog (http://scienceblogs.com/neuronculture/2010/06/tourettes_goalie_timing_and_do.php) goes into this a bit more, but the gist of it, extracted here from that post, is this:

    Is the apparently increased cognitive control a necessary part of whatever creates Tourette’s — another expression of it — or do people develop this control as a compensatory mechanism? I think — and I say this not knowing much about Tourette’s — that the latter is perhaps more likely. If that’s so, then this isn’t really an example of the orchid/sensitivity dynamic: It’s not the upside of a trait that can in other cases create a downside; rather it’s an upside created in compensation of a downside.

    This makes it no less wonderful. We have few assets more valualbe than our ability to compensate and correct for deficits. If I’m short-tempered, I can learn to be quick to apologize. If I’m tall so I have trouble getting low for backhands, I can train and practice and learn to get lower. If I write slowly, I can compensate by trying to write more deeply. (Or does the deep make me slow? Hm. That one’s complicated.) But these aren’t the same as a sensitivity that can take one either down or up.

    So what about Howard’s aversion to medication? He doesn’t want it because he doesn’t want to be less “adrenaline-filled.” I suspect that the suppressing effect of Tourette’s medication, however, doesn’t mean that his high-octane style is part of his Tourette’s. Then again, as I note, I don’t know Tourette’s so well, so perhaps there’s something there.

    Anyone?

  15. #15 Gopherus Agassizii
    June 28, 2010

    I honestly do not mean to be difficult, but this study and the discussion reminds me a good deal of the limited research and reactions to dyslexia back in the ’80s and ’90s.

    There was some research supporting and plenty of individuals claiming that individuals with dyslexia were actually more intelligent on average than their peers. This research was explained to me by students with dyslexia who also liked to point out that Leonardo da Vinci and Albert Einstein had dyslexia too.

    The problem was that the research often had huge problems with sample selection or was driven by profit motivated institutes. Individuals who did not come from well-connected middle-class families were ignored in the research and the discussions.

    I think something like that is happening here.

    I’m sure many individuals do overcome their disabilities and leverage their difficulties into strengths in one way or another, but I also suspect that many more people do not deal with their situations so well.

    I teach adults in a basic skills program in a semi-rural area and work with students who are frequently perfectly intelligent but have layers of emotional and intellectual baggage that prevents them from learning or accomplishing much. These strategies of avoiding confronting their situation are probably easier to develop and incorporate into one’s personality than those Johan, Howard and Updike have fostered over their years.

    I don’t think that Johan or others deny that negative reactions to psychological disabilities are common, but there should be an awareness that turning a disability into a strength is not as common as most people want to believe.

  16. #16 MarkW
    June 28, 2010

    Jonah, are you familiar with basketballer Mahmoud Abdul Rauf (born Chris Jackson)? He was featured in a documentary years ago about Tourette’s, and it was clear that when he got his “game face” on, not only did his tics disappear, but his athletic skills peaked.

    Just one data point, but it fits quite well with your story about Tim Howard.

  17. #17 AP
    June 28, 2010

    Jonah, thanks for sharing this. For me Howard’s comment at the end echoes a statement the Brit actor/writer Stephen Fry made in his gripping documentary on bipolarity, namely, that he would never wish the ailment completely away. In Fry’s case, the same condition that manifested itself in torturous mood swings, and drove him very near the edge, has also given him the fuel to compose and perform brilliantly over a three-decades plus career. I guess in his particular case it was the ailment itself, more so than his struggle against it, that became an asset. Fascinating info, thanks again.

  18. #18 Lord Ahmad Nazir
    June 29, 2010

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  19. #19 Lord Ahmad Nazir
    June 29, 2010

    That which does not kill me makes me stronger.

    Nietzsche

  20. #20 Dave Ross
    July 1, 2010

    David Dobbs, my only experience with Tourette’s medication was a low dose of Haldol provided to “take the edge off” at business meetings. I felt like a different person. Not only was the urge to tic lessened, so was pretty much everything else: daydreams, laughing, pride, love. I never finished that first bottle, and it hasn’t hampered my career one bit. My understanding is that comments like Tim Howard’s aren’t unusual. A person with Tourette’s is constantly in motion. For me, “relaxation” isn’t about laying motionless on the beach, it means letting my guard down and being able to tic. I believe the book “Twitch and Shout” goes into this aspect of Tourette’s from the perspective of a drummer with Tourette’s who thanks his condition for the passion and energy that drive him. you might want to find a copy to get a better explanation than I can type in this text box. Plus, it’s a good book and a quick read.

  21. #21 Elizabeth Austin
    July 7, 2010

    Thanks to all for your posts and thoughtful recommendations. My 11 yr. old son was recently (finally) diagnosed with TS. One of the questions he has had is if he will be excluded from any occupation because of his condition, specifically that of surgeon. So I will be looking up the Oliver Sacks book and the “Twitch and Shout.” When I recently told him that the USA soccer goalie Tim Howard has TS, he thought for a moment about it and then said, “That’s probably why he is so good.”

  22. #22 debbie lloyd
    July 8, 2010

    I’ve just been reading all the posts and have found them very interesting. My son is 12 and has Tourettes Syndrome, he’s on medication which helps with his tics but his main problem is the lack of self control. Does anyone know whether bad behaviour is common in children with TS. At home he is a lovely, funny, well behaved child, however has had numerous incidents at school where he has gotten into fights and flown off the handle too easily. The other kids know what makes him upset and annoyed and when they provoke he falls everytime. He’s now excluded and i’m trying to home school but he misses the interaction with the other kids, surprisingly. Any advice?

  23. #23 Karen Miller
    August 3, 2010

    My 13 year old son has Tourette Syndrome and I run a very active TS Support Grp (60 families) here in the town we live in. I wanted to comment on the musician and basketball player with TS who stop ticcing when the play their instrument or play in a bball game. The majority of kids in our group stop ticcing when they hyper focus. This could be anything from singing, playing football, to taking a test. My son in particular plays football and basketball. Once the play is called by the coach there is not one sign of his TS.
    I just wish there was more research on how/why this occurs.

    In regards to Tim Howard, the US goalie. Tim says he doesn’t want to loose that “adrenline -filled feeling” that he lives with by taking meds. ADHD is a comorbid condition that you typically find with TS. This high octane feeling that many TS patients live with is often an ADHD component. I saw a quote that stated, “People with ADHD drive a Ferrari through life”. That is clearly my TS son.

    In regards to TS medication dulling this high octane feeling. The older TS meds did do this a great deal. Now many in our support group are taking Abilify for their TS. It is being used off label at this time, but has proven to be a miracle drug in many cases. It has not dulled that high energy in my son in the least has completely changed his life. 95% of his ticcing is gone.

    Lastly, I wanted to touch on the comment regarding the the looping of the same thought over and over. Another comorbid condition with TS is OCD. Although the line b/w TS and OCD is often grey this looping is more of the OCD component.

    To close I am in hopes that in the near future, as are many in our support group, that there will be research done to closely look at what is actually taking place in the brain when these TS patients stop ticcing due to hyper focusing. The info in the above study is not new to me. I see these results every single day in my son as do the other parents in our group. I believe a study such as what I mentioned could lead to the next generation of TS drugs. I should note one would think ADHD drugs would help since they help ADHD focus more. No, these stimulants make TS patients tic more.

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    “What I mean is that a lot of stuff that I thought were weaknesses of mine turned out to be strengths”.

    From A Road Trip with David Foster Wallace, by David Lipsky. ISBN: 9780307592439

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