John Davidson, who suffers from a neurodevelopmental disorder called Tourette Syndrome — a condition that causes involuntary outbursts and motor responses — and whose life story inspired the film I Swear, stirred up a row at the Bafta awards ceremony. He used racial slur words while Black actors Michael B. Jordan and Delroy Lindo were presenting an award, something which was violative of social decorum but something he didn’t seem to have control over.
Experts say Tourette Syndrome patients may use cuss words involuntarily due to a symptom called Coprolalia, which is an uncontrolled swearing or utterance of obscene words. The words are not deliberate, considered or even a reflection of the person’s actual beliefs or deeper emotions. Rather, it is a neurological release. High-stress situations, anxiety, or intense excitement can trigger such a bout. In such situations, the taboo nature of the word itself can sometimes increase the likelihood of it being used. “However, this uncontrolled use of obscene words occurs in only about 10-15% of cases and is often exaggerated in the media. Most people with Tourette Syndrome experience simpler vocal tics (sudden, brief, repetitive sounds that a person makes involuntarily),” says Dr Shefali Gulati, professor of neurology at the All-India Institute of Medical Sciences (AIIMS), Delhi.
In fact, the Tourette Syndrome Association of America also issued a statement to clarify the BAFTA row over Davidson’s outburst. “When Tourette Syndrome involves racial slurs, it is deeply traumatic for those who hear them and that hurt cannot be minimized. It is also traumatic for those who utter them… Importantly, these vocal tics are not reflective of the beliefs or values of the person experiencing them. The public discourse surrounding this moment underscores the continued need for greater awareness and understanding of Tourette Syndrome. We encourage the public to approach this moment with empathy and a commitment to learning, understanding, and inclusion,” it said.
What is Tourette Syndrome?
Tourette syndrome, says Dr Gulati, is a neurological disorder characterised by repetitive, involuntary movements or sounds called tics, typically starting in childhood. It affects the brain’s ability to regulate these actions smoothly.
What are the manifestations of this disorder?
Tics are the primary signs, divided into motor (physical) and vocal types. “Simple motor tics include eye blinking, head jerking, or shoulder shrugging; complex ones involve touching objects, hopping, or twisting. Vocal tics range from throat clearing and sniffing to repeating words or rare barking sounds,” says Dr Gulati.
What are the triggers for tics?
These cannot be pinpointed but can happen because of genetic, neurological and environmental factors. “Stress, excitement, fatigue, or anxiety often worsen tics, though the exact causes are unclear and may involve genetics or brain chemistry imbalances. Certain situations like focused attention can temporarily suppress them,” suggests Dr Gulati.
Are tics permanent?
Tics are not always lifelong; they often peak in early teens and improve or fade by early adulthood in many cases. “However, they can persist variably for some,” adds Dr Gulati.
What about managing tics?
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“People can sometimes suppress tics briefly through willpower, but this is tiring and often leads to a rebound of stronger tics later. Behavioural strategies help more reliably than full suppression,” she says.
What are co-occurring conditions?
Common ones include attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety and learning difficulties, which can impact daily functioning more than tics alone.
What is the prevalence of Tourette Syndrome in India?
Global rates are quite variable but usually range around about 1 in 160 children. “However, specific Indian data is limited; studies suggest similar prevalence, potentially affecting hundreds of thousands, though underdiagnosis is common due to stigma,” says Dr Gulati.
What about diagnosis?
This involves a long-time vigilance of repetitive behaviour. “It is usually diagnosed clinically by observing multiple motor and at least one vocal tic lasting over a year, starting before age 18, after ruling out other causes like medications or substances. No single test exists,” says Dr Gulati.
Is there a cure for Tourette Syndrome?
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No cure exists but early interventions help in managing the condition life-long. “Behavioural therapies like Comprehensive Behavioural Intervention for Tics (CBIT) train habit reversal to manage tics effectively. Medications such as antipsychotics or alpha-2 agonists target severe cases alongside stress reduction techniques,” says Dr Gulati.
Can a person with Tourette Syndrome live a long life?
Dr Gulati has seen most patients lead normal, productive lives with minimal impact as tics lessen over time. “Challenges arise mainly from co-occurring conditions affecting school, work, or social life, but proper support mitigates this. With management, people with Tourette Syndrome often thrive in careers, relationships and activities. Many successful professionals have it, emphasising acceptance over limitations,” adds Dr Gulati.
What about new research?
Recent research shows that neurostimulation through wearable devices stimulates the median nerve to manage tics. Researchers are testing deep brain stimulation (DBS) for severe, treatment-resistant cases and for better and safer pharmacotherapy options.
