Evening
C.!
When individuals
like yourself make the effort to learn more about conditions like TS
the positive effects ripple throughout the population -- I thank you
for posing these questions sir.
> Please
set us straight one way or another.
Well,
C., here's the thing -- even if it wasn't utterly unethical for me to
offer a professional opinion on your client across province (where I'm
not registered) and across email (I've never met the individual in question),
I probably still wouldn't dare assume that I knew the definitive answer
you seek. I can appreciate your frustration -- not just as a colleague
but as an individual with TS myself. Not having ever been inside a "normie's"
head, I am often at a loss to know whether my behaviour (or reactions
to it, for that matter) are due to a funky neurology or due to my scapegoating
said funky neurology. Without a point of comparison it is exceedingly
difficult, if not impossible, to gauge how much effort OTHER people
have to put into inhibiting certain impulses and what ALL people experience
versus what an individual with TS experiences.
Not the
answer you wanted, I'm sure. Let me offer a few general observations
and comments, though, because fortunately I've come to learn that finding
out whether a behaviour is or is not due to TS ultimately is really
not that important.............
-first of all, the scenarios you describe are not an unrealistic presentation
of TS. While I'm not saying (and I don't know) whether or not you are
being conned or not, the patterns you described are consistent with
TS and often, appropriately or not, lead others to believe that the
behaviour is purposeful.
-The 'convenient
opportunities' you mention, for example, are all times of increased
stress for your client -- breaking rules, getting caught, being negatively
surprised (i.e. "damn they saw me"), etc. That stress increases
tic symptoms is a well-documented and well-accepted aspect of TS. As
you point out, the timing often seems chosen; this is because the very
moments where an expression of symptoms is most inappropriate/disruptive/harmful/stressful
to others are often also moments of high stress.
-The specific
swearing often throws people too: they expect out-of-context repetition
of a single swear word, or a stereotyped phrase that doesn't necessarily
match the situation. While true coprolalia (involuntary swearing) DOES
look like this, coprolalia is not very common. More often what is seen
is what you describe -- disinhibited or impulsive swearing. What he
says are all the things that someone else might THINK in that circumstance,
but doesn't actually yell out loud. While what your client is doing
isn't a tic persey, it IS still something that is related to TS neurology.
Just as people with TS have 'leaky brakes' over certainmovements and
noises, they can (and usually do) have leaky brakes over their impulses.
So the problem isn't about whether he knows the best blue streak to
yell or how to manipulate the situation. Instead, the problem lies in
HOW WELL CAN HE PUT THE BRAKES ON those thoughts and ideas and words
that pop into his head.
-that
he would yell out derogatory words that were appropriate to whoever
is present doesn't in and of itself demonstrate purposefulness either.
Tics are triggered by particular contexts, and once a person with TS
SEES, for example, a black person and various thoughts about black people,
including racial comments, pop into his/her head, (s)he will have a
hard time not blurting these comments out. In fact, the worse these
thoughts are the more difficult it will be to keep oneself from saying
them! This is because the most awful things to say will elicit the most
stress, the most mental attention ("boy I really wouldn't want
to say THAT!!") and energizes that tic the most.
-Likely
this 'leaky brake' problem is what leads to many of this fellow's rule-breaking
ways, and p;robably even landed him into his criminal activities in
the first place. He sees a temptation and acts upon it, "firing
before his aims", before considering the ramifications. He may
very well know better (and he may be very aware of this himself), but
the knowledge that would keep him out of trouble doesn't have an opportunity
to fire up before his leaky brakes get him into trouble again.
-Having said all that, C., I'm not building a case to give this fellow
a free ride. Quite the contrary, in fact. It is exceedingly important
for people with TS, and other 'leaky brakes', to be accountable for
their actions and not use the disorder(s) as an excuse. This comes back
to what I said about whether or not the actions were due to the disorder
is not that important. What IS important, ultimately, is whether the
behaviour is acceptable or not. Even assuming that your former client
is experiencing all of the neurological difficulties I mention above
and none of what he does is purposeful and manipulative, he still needs
to find a way, perhaps with the brain-storming help of others, to make
his symptoms more appropriate. In the case of swearing, perhaps he could
still achieve some satiation from saying words that rhyme with the swear
words he REALLY wants to say, or from saying them into his hand, or
only the first syllables, or writing them down, or in another language,
and so on. The idea isn't to necessarily eliminate the symptoms, which
can be extremely difficult to do and may lead to other worse symptoms.
The idea is to target certain problem symptoms and modify them, something
that can be easier to do in an atmosphere of understanding and non-judgement.
And if he doesn't try.........well, disorder or not it is not ok to
say such disrespectful things to people, and there are consequences
that do (and should) follow.
This ended
up being rather long, but I very much hope it helps you and those you
work with C. Have an excellent night sir!
Dr. Dunc.
postscript:
thank
you very much for making the time to shed insight into this. I found
your response very helpful. It illuminates the idea that care workers
need to to be less judgemental, learn and educate themselves and find
out how we can help the client problem solve. I feel sorry for the client
that has to live a life like this. The stigma of mental health is very
real NOT just percieved and I must admit that even care workers get
frustrated. You have helped reinforce some of my ideas while also providing
areas into where I need to be more effective and patient. I will print
out your response and hopefully this will shed light on our approach
--
C., AB, Canada
