Teenage Tics

(right through the night)

I heard something interesting from my teenage daughter the other day, a story about some of her friends who have suddenly picked up a tic - a type of involuntary physical movement. I'd heard about this before, a couple of years ago, so I went looking online for any articles to confirm what I'd remembered from before; the idea that this is a mass psychogenic illness.

I quickly found a great article from The Atlantic from February this year, and I was filled with confidence about the article when I saw that the writer had consulted with Robert Bartholomew. Robert is an academic at the University of Auckland who specialises in “medical sociology” including mass psychogenic illnesses (MPIs). He's written on some fascinating topics in the past, such as Havana Syndrome (the US embassy workers who have been suffering from a range of symptoms while working overseas), and the case of a chemical leak in Parnell in Auckland, where over 100 people reported feeling ill even though it's likely the type of chemical and the amount which leaked was unlikely to have caused the symptoms that were seen. In both of these cases, Robert argues that the symptoms originate from inside people's heads, and that this idea of being sick can be passed to others who end up with similar symptoms. This is not to say that people aren't suffering from something real, it's just a very different kind of illness to what people think it is.

The Atlantic article about these teenage tics documents the history of this particular condition - with the current incarnation starting a few years ago, just before the pandemic. Back then psychiatrists, and especially Tourette's researchers, started noticing an increase in the number of teens, mostly girls, who were presenting with physical tics (sudden jerking movements of their limbs like jumping, hitting themselves and others, etc), and uncontrolled outbursts of rude words (which I learned is called coprolalia - presumably related to glossolalia, the usually Christian “speaking in tongues”). However, unlike Tourette's sufferers, these teens seemed different - firstly, it was unusual that such a specific new demographic would be suddenly affected - Tourette's usually first presents in kids between 5 and 8 years old, and mostly in boys. And secondly, Tourette's sufferers usually fight to try to minimise their outbursts, whereas these new patients weren't doing that.

At a conference in October last year, researchers and clinicians from around the world compared notes and found that a lot of the manifestations of these tics in their patients were the same, including the same physical movements and the same words being used. These include throwing food, hitting their chests, shouting the word “beans” and, for German sufferers, saying “you are ugly” and “flying sharks”.

What's interesting here is that these tics seem to originate from people with Tourette's syndrome who are social media celebrities. The German Jan Zimmermann, who runs the YouTube channel “Thunderstorm in the Head”, has worked out how to make money from his condition - selling shirts, hoodies and mugs with some of his most frequent phrases, and these include his catchphrase “you are ugly”. And Evie Meg Field from England has a particular tic where she says the word beans, and she often films herself preparing or eating food, which leads to a lot of throwing of her food. Here's a video of Evie talking to the BBC about her Tourette's:

Robert Bartholomew and other professionals interviewed for the article all agree that this new spate of young sufferers do not have Tourette's syndrome. Instead, this appears to be more of a mental health issue that is exacerbated by social media and peer groups, and is being called “Tic-Like Behaviour”, or sometimes Functional Tics (a type of Functional Neurological Disorder (FND), if there's a mild underlying condition). The genesis of these tics can often be stress or anxiety, which I guess teens are very familiar with, and apparently this has become more prevalent recently due to stresses from COVID - uncertainty, lockdowns, disrupted routines, etc. So these particular manifestations of tics that psychiatrists are seeing have been learned from others, and the internet has turned what used to be a much more local issue, that of viral psychogenic conditions, into something that can and has spread globally.

It's not like the social media stars with Tourette's are doing anything wrong here. In fact shining a light on Tourette's and raising awareness seems to be a positive thing, and even making money from selling merchandise seems like a perfectly acceptable idea, given how hard it's likely to be to hold down a job with such a debilitating condition. But this unintended consequence of viral TikTok videos (videos tagged with #tourettes have been viewed over 5 billion times on TikTok) seems to have inflamed a problem, and opened the way for this issue to become much larger than it otherwise would have been.

The good news is that, unlike Tourette's, which is a lifelong condition that is treated with drugs such as antidepressants, antipsychotics or ADHD medication which can have serious side effects, these psychogenic tics often go away fairly rapidly, and can be treated with therapies like Cognitive Behavioural Therapy (CBT) or even just an awareness in the sufferer that the tics are psychogenic and usually don't last more than a few days.