When a deaf man has Tourette’s

Yesterday, I mentioned that I’d considered calling this blog “Coprolalia,” after the term for those involuntary utterances made by some people with Tourette’s Syndrome. Coprolalia has been on my mind because I recently came across a fascinating case study. It is both straightforward and profound, equally suited to be a topic of discussion at a serious scientific conference or an impromptu cocktail party. It is, in short, just plain cool.

Communicating using American Sign Language. (These signers are not affiliated with the study in question.)

The case study, which appeared in the journal Movement Disorders in 2000, concerned a 29-year-old man who had been deaf since infancy. We’ll call him Signing Sal. Sal, as it happens, also had Tourette’s. In most people, coprolalia involves randomly blurting out obscenities. Sal, however, wasn’t shouting out obscenities—he was signing them. The researchers—led by Andrew J. Lees at the National Hospital for Neurology and Neurosurgery in London—note that Sal was particularly fond of making sexual signs when talking to women. He was also known, as part of his tic, to spell out expletives, letter by letter, in sign language.

The implications are fascinating to consider. Sal’s case illustrates that coprolalia is a lot more than some mere muscular misfire, more than some vocal cords twitching like a bad leg. The fact that Sal’s utterances were in a language that uses hands, not voiceboxes, means that coprolalia isn’t a compulsion of vocalization, per se–it’s a compulsion of expression. That suggests that the outbursts contain some legitimate, meaningful content.

So let’s look at the content. There have been many theories about why coprolalia usually involves profanity, rather than other kinds of words. Some have speculated that expletives may be commonly uttered because of some inherent phonetic quality they share. Among other things, many expletives tend to contain “fricative” sounds, produced when we push air out of a small opening, as we do when pronouncing words that begin with f or s. Perhaps something about these sounds makes them easier to access during a tic?

But, as the researchers point out in this case study, there aren’t fundamental distinctions between how obscene and non-obscene signs are made. (It’s not the case, for instance, that expletives are made extra forcefully or with a different kind of motion than other words.) And still, Sal’s tics involved expletives, not other random signs. What’s more, the authors write, “Further evidence for a semantic basis for tics is provided by … the occurrence of finger-spelled obscenities, an act equivalent to writing or spelling words out, and therefore divorced from phonologic content. This suggests that the idea underlying coprolalia is more important than the phonology of the utterance.”

The authors provide one more salient point that underscores how much content matters. When Sal was in cooking class, rather than signing expletives, he tended to display the sign for “vomit.” In some ways, in that particular context, with classmates eagerly preparing their dishes, the word vomit is even more subversive than an obscenity would be.

What the authors conclude from this accumulated evidence is that coprolalia, then, comes from some sort of urge to disrupt or disturb others. In fact, they say, coprolalia is a kind of linguistic aggression: “The utterance of obscenities is a form of aggressive behavior, and there may be failure in the control of these brief aggressive impulses in Gilles de la Tourette syndrome.” That’s an entirely different dysfunction—and, in my mind, a far more interesting one–than some twitchy vocal cords.

Reference: Morris, H. R., Thacker, A. J., Newman, P. K. and Lees, A. J. (2000), Sign language tics in a prelingually deaf man. Movement Disorders, 15: 318–320. DOI: 10.1002/1531-8257(200003)15:2<318::AID-MDS1018>3.0.CO;2-H

(Photo by David Fulmer)

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35 Responses to When a deaf man has Tourette’s

  1. Aubrey says:

    “Among other things, many expletives tend to contain “fricative” sounds, produced when we push air out of a small opening, as we do when pronouncing words that begin with f or s.”

    Are there some studies conducted on patients who speak natively semitic languages? As far as I know both Arabic and Hebrew do have fricative sounds which are more evident than other languages. Maybe could be a good testbed.

  2. Steve Silberman says:

    Fascinating, Emily! Will tweet. Thanks!

  3. Simon Dymond says:

    Sounds like attention-maintained behaviour to me. There is now substantial evidence that tic disorders such as Tourette’s can be maintained via operant reinforcement, either positive, social attention or via avoidance or escape. Behavioural treatment, such as Habit Reversal, is often highly effective:

    Himle, M.B., Woods, D.W., Piacentini, J.C., & Walkup, J. (2006). Brief review of habit reversal training for Tourette’s Syndrome. Journal of Child Neurology, 21, 719-725.

  4. PalMD says:

    Don’t forget Oliver Sacks’s “Seeing Voices”, a fascinating look at many related ideas.

    I don’t think these utterances are so simple as “aggression” and I think that this idea can be easily misused.

    In Tourette’s and other related disorders (such as OCD), the involuntary behaviors seem to reduce other sources of anxiety, rather than being some sort of uncontrolled “leak” of unacceptable behavior.

  5. Emily Anthes says:

    Thanks for your comment. I didn’t mean to suggest that there was anything “simple” about coprolalia. I just think the aggression idea is an interesting one to think about. Doesn’t mean that it’s the only explanation.

  6. Emily Anthes says:

    Yes, I would be very curious about Tourette’s in other languages. Haven’t seen much on that, though, of course, I’ve been looking through the scientific literature that’s written in English.

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  8. John Antilety says:

    I’d read an extensive article in Discover Magazine about how deaf people from other countries cannot understand each other, even though they are using International Sign Language. It’s all the same language, but each country, and even regions of that country all carry an accent.

    It drove researchers bonkers. They argued it was impossible, since ISL is the same all over. Yet people from France could not communicate with people from England. Even people from other states in the US note “Southern” or “Noo Yawk” accents in ASL. (Which means that deaf people from Boston are still unintelligible.)

    Their frustration is understandable. ISL is supposed to be a standard, much like the metric system, or Latin. It’s not supposed to change! Moreover, deaf people cannot hear spoken language, so they shouldn’t be able to develop any sort of accent, let alone one that other ISL speakers can identify, even if they cannot comprehend what is said. (“They’re signing in French, I think? They have a French accent, and I can’t understand them.”)

    Ultimately, the researchers were forced to recognize that speech is a HECK of a lot more complex than anyone ever imagined. The article went into considerable detail surrounding the pathways of the brain, cultural structure of language and more. Unfortunately, I cannot find the article, but I’m sure it was Discover, and it was a couple of years ago. If not Discover, then New Scientist.

  9. Jesse S says:

    While I do not mean to marginalize this person or study, the sample size just sounds way too small. Is he the only deaf person with Tourettes who signs in this way? Are there more (surely there must be)? How do we know that this is 100% the Tourettes, and not just someone whose behavior is, as another commenter said, “attention-maintained.”

    Either way, I always had a (completely unsupported) hypothesis that Tourette’s favoring of explicative came from the taboo, unacceptable nature of them. That the brain knows these are bad words (not to be said), and the filter that we have kind of backfires.

    I don’t know, I am not qualified in any way to discuss this stuff. Still interesting, however.

  10. Leo T. says:

    I remember seeing a programme on TV where a young girl with Tourette’s kept saying the n-word. It’s not a traditional curse like f*ck or sh*t (can I use curse words on your blog? I’d rather err on the side of caution) but still a taboo word.

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  12. I’d like to know more about that, because as far as I know, no true International Sign Language exists. Most European sign languages are derived from Old French Sign Language. American Sign Language is derived from French Sign Language and the indigenous Martha’s Vineyard Sign Language. British Sign Language, Auslan and New Zealand Sign Language are derived from Old British Sign Language, which is in turn related to (a descendent of, I think) Old French Sign Language.

    But in other parts of the world, things get interesting. In some South American sign languages, the past is depicted as ahead of the signer, and the future behind because we can see the past, but not the future. In the European sign languages, it’s the opposite, because we see ourselves as moving forward through time.

    Nicaraguan Sign Language is unrelated to any other (its development is a fascinating story, actually).

    International Sign Language is, I am almost certain, a bit like Esperanto, but less well known and less developed. It’s artificial, and it’s not a full language.

    TRiG.

  13. ASLterp says:

    If you want to be PC, I suggest changing all instances of “deaf” to “Deaf.”

  14. King Reggin says:

    People like this should be locked up, so they don’t harm our great, perfect socity!

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  17. This is a seriously challenging situation. In fact, one of the very rare occasions where you can pardon a stranger for not being able to understand or sympathize with a disability since this rare combo of disabilities can make the individual seem rather unstable…you can imagine the blend of sign language and uncontrolled gestures.

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  20. Clint.hartzell@gmail.com says:

    I don’t think there’s any reason to think that vocal tics should select for swear words based on their phonological content. Then you should get ‘coprolalia’ with English numbers, most of which contain fricatives. Or people saying “shark” , “fine” , “wish”. Looking at coprolalia in other languages would make a lot of sense, too, but as far as I can tell there is no reason to think that coprolalia has a phonological basis. This is a really interesting case, but I don’t think it shows anything we wouldn’t expect for a signer.

  21. Clint.hartzell@gmail.com says:

    I think there’s some evidence that expletives are stored or accessed differently than other words. I’m not sure what this evidence is other than their special prominence in aphasic speech, but I think there is work available on the subject. There could be an explanation for coprolalia that makes reference to the special status of swearwords without referring to their status as ‘taboo’. I don’t know which is more supported, and I have the same intuition as you!

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  24. Max says:

    A bit late, but still very appropriate. I have tourette’s, including coprolalia. I see my swearing at one end of a spectrum and yours at the other. Everybody has a need to vent out frustration by swearing or to stimulate thought by frowning, biting on a lip, or making use of stop words (e.g. “erm”). The difference between you and me, is that I “need” to do it approximately 10-15 times per second. Luckily, with a little bit of effort, I can block most of these urges.

    The nature of a tic can be understood perfectly, by examing “normal” use of expletives. Why shout an expletive when frustrated, even when nobody is around? Why shout at all? Why use an expletive? Why swear at another person?

    Answers I have found for myself are roughly:
    * Swearing has to do with releasing unwanted thoughts. An unexpected disappointment for instance. You want to shout and swear out of frustration. And it helps.
    * The relief happens when you notice your own swearing. You shout so you hear shouting. You use an expletive, so you hear it and are affected by it: swear words are taboo words, words that evoke a feeling of forbiddenness. The forbiddenness works as a bonus. There are other bonuses btw: esthetics. I prefer to tic musically, I loath tics involving clumsy use of language.
    * The relief also happens when you notice are people are affected by your actions. This effect may not be entirely obvious for someone without Tourette’s, but this explains why people swear at each other without any reasonable blame. My tics often involve an (often embarassing) way to attract attention: I feel the urge to shout when it’s quiet. When I’m with others, my mind is looking for the most embarassing / most confronting / most obnoxious / most insulting thing to do or say, given the company I’m in. The deaf guy with Tourette’s fits this picture well.

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  29. Kelly Baldwin says:

    Hello everyone I am deaf and i have tourttle symbrome too

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  32. Laura says:

    This is certainly difficult situation and it is something which anyone will generally excuse a person’s behaviour, it certainly ta of empathy and understanding of the person involved. I personally can’t see why someone with this symptom could not make gestures with their hands just as a person who speak does with their mouth, it is the same thing for them.

  33. Lily says:

    I think that people who are aware of this disability would show empathy. It is a very tough situation and many people might conceder the combination of the two disabilities as awkward.

  34. evoc says:

    Good lord. Tourette’s Syndrome is a disorder of inhibition. All the things a human has learned should not be said, expressed, or otherwise displayed usually remain in the lock up cabinet in our brains.
    But a person with T.S., having an inhibition dysfunction, will have cabinet doors that fly open and contents that fly out.
    It is not an intentional act, certainly not one of aggression. It is the brain’s very quick process of recalling what would be inappropriate in a particular situation and the damnable lack of ability to refrain from saying that thing, or displaying a ‘socially inappropriate’ gesture meant to be kept in the taboo vault.
    The researchers, and the author of this article need to do considerable more research. Spend time with Neurologists who specialize in treating people with Tourette’s Syndrome.
    All in all nice try – still miles to go.

  35. ALFdoc says:

    This is a great discussion. I hope more TS patients chime in.

    There are a group of us that treat movement disorders (including TS) with unique dental appliances (ALF). My current TS patients are children and youth. I have observed that these patients have joint laxity or dysfunction, which the body subconsciously attempts to stabilize with the musculature. This activity/effort is far greater than a normal body at ease and grace experiences, and this leads to tension and fatigue in areas that are not built for it. Ultimately, there are cyclic needs to explosively release (like cracking knuckles, but to a higher degree). There may be somewhat of a conscious aspect in the process of ‘learning’ how to get effective releases, but, as 92+% of extra-cranial input to the brain is proprioceptive, and little of that conscious, this amounts to a significant amount of feedback being processed behind the scenes, compared to a ‘normie’.

    When we provide specific craniofacial support, reducing the excess proprioception, we find a sustainable reduction in TS or other MD expression. I believe that because there is such high proprioceptive nerve density in the craniomandibular system, and because it is so tightly associated with the autonomics, we see such dramatic improvement in the whole body when we achieve the neutral stability point.

    A side effect of this excess subconscious preoccupation with posturing and managing the musculoskeletal system is a shift in the autonomic nervous system and the metabolism, further perpetuating the areas of laxity. When we support the patient with specific amino acids, and other nutrients, we also observe a sustainable reduction in symptoms.

    At this time, my experience leads me to believe that compulsivity may start as an individual predisposition that becomes activated in response to an abnormal need to consciously / semi-consciously micromanage body processes (posture, breathing, reflexes, etc.) that are being inadequately managed in the background. Over time, this management process spills into the frontal cortex, which is (clearly in the case of the youth) trying to sort out the process of life in society.

    This is just my human observation after 30+ years of being in the trenches, and yet I can see that it is such a small picture of the whole. I submit is as sort of a skeleton that needs fleshing out and some re-organization; but it is a start.

    miles to go …