History of TS

Mental tics

The existence of Mental tics has only recently been recognized by the Tourette Society and other medical institutions. Not much is known about them, however, and very little is publicised in literature or on the web. Most of what I know of mental tics is from my own observations and from chatting to other Touretters.

Ive had to make up some of my own terminology.

Mental tics are not quite the same as physical tics and cannot be defined as an involuntary, rapid, sudden anything. They ARE involuntary, but seem to only come in complex form.

Mental tics are any conscious thought process or pattern that one feels a compulsion to perform.

The use of the word compulsion in that sentence was not accidental. Since the time of my diagnosis with Tourettes I have also been told I have Obsessive Compulsive Disorder. This is no big surprise; it happens in a fair percentage of cases. However, everything I knew about OCD suggested to me that part of what I was experiencing wasnt OCD. As far as I can understand; OCD obsessions are repetitive thoughts about danger. Examples may be: Ive left the gas on, were all going to suffocate. or the less logical If I dont tap this doorway three times every time I walk through it, my wife will die in a car crash. This thought then stays prominent in the mind until the corresponding compulsion is performed.

Mental tics are obsessions, but not in an OCD way. They are any conscious thought sequence or pattern that must be completed correctly (in the same way a motor or vocal tic must).
Distraction tends to be the best way of dealing with mental tics.

Probably the best way of demonstrating mental tics is to give examples:

Echomerimnia: The mental form of echolalia. Those affected will hear the last few words spoken by another echoed in their minds. Echomerimnia also happens with music or any other sound heard. As far as I can tell, echomerimnia is a very common mental tic.
Copromerimnia: The mental form of coprolalia. Copromerimnia is immeasurably less disruptive than coprolalia. The thinking of socially unacceptable phrases is mildly frustrating (worse when combined with palimerimnia), but often sparks worries of a progression to coprolalia. Im not sure how close the link between the two is; but the more I read, the closer they become. Sometimes copromerimnia can only be controlled by a motor tic of the mouth. I have even read some articles where copromerimnia is classed as part of coprolalia.
Palimerimnia: The mental form of Palilalia. The repetition of ones own conscious thoughts or spoken words. Palimerimnia can make reasoning and coherent conscious thought difficult. It can grab hold of a phrase or single word and repeat it hundreds of times before you can move on to complete the sentence, then take you back to the beginning and make you rephrase the sentence using different stresses.
Counting, listing, or reciting: Ever had a tune stuck in your head and you cant get it out? In this mental tic the tune will be stuck good, but you know there is one way to get it out. If you mentally sing the song all the way through, with rests, major accompaniment and everything, it will stop playing. But you have to get it exactly correct, one small mistake and your brain takes you right back to the start. A lot of people get tunes stuck in their head, but this is an obsessional need to take it all the way through. This tic also happens for poems, or lists such as numbers. A person may need to count, in twos, to 200 putting exactly the same emphasis on each number and mentally saying each number the same distance apart.
Mental manipulations: These are very difficult to explain.
All tics have a sensory stimulus that triggers the need to tic, like an itch. In mental manipulations the stimulus is in a discreet area (like a ball) but is not on a part of the body, it is floating through the air. The mind has control (within certain limitations) over the movement of this ball of itchiness. Sometimes the need is to guide the ball through a specific pattern. Other times the ball is already moving, say in a circle or swinging like a pendulum, and the object is to stop the movement. Its not as easy as it sounds; its like trying to stop a grandfather clocks pendulum by tilting the clock from side to side.
Another tic is when you need to push the ball away from the body in a straight line. This is the most annoying one for me because, once the ball gets about twenty centimetres away from the centre of my head its path curves back on itself, as if gravity was pulling it into orbit. This makes this tic unsolvable for me and the only way to rid myself of the urge is to distract myself from it.

I have received a wonderful email from Mr. LW, which says:
"...in your description of "mental manipulation" tics, I was blown away by your description of something I've done for years: 'In mental manipulations the stimulus is in a discreet area (like a ball) but is not on a part of the body, it is floating through the air. The mind has control (within certain limitations) over the movement of this "ball of itchiness". Sometimes the need is to guide the "ball" through a specific pattern...' Maybe it was silly of me never to have associated this strangeness with my Tourette's, but I've never thought much more about it than maybe I'm just a little nuts. Thanks for giving me a name for this "thing." Let me describe to you how it manifests itself in my life, and maybe you can expand your description...
I usually get this "mental manipulation" going while I'm riding down the highway. My imaginary object is more like a curved string or a wire, and I imaging it tunnelling (sic) underground and twirling in space as I pass the roadside scenery. It usually has some objective that I try to guide it through, but like a grocery cart with a wobbly wheel, it tends to stray off its ideal path through space, making me reel it in and try again. Sometimes it needs to jump between or around the dashes in a multilane highway, or between "soft" patches in the curb (concrete, trees, or cars are "bad," while grass or dirt is "good"). This tic, or whatever I should call it, often comes to play when my windshield wipers are running. As you say in your own case, the only way to get rid of it is to distract myself and think about something else."

Breathing tics

Breathing tics are any sudden, rapid, recurrent, stereotyped control of breath.

Ive left out non rhythmic in that description because they can be VERY rhythmic. They are often classed as vocal tics (for many years the only vocal tics I had were breathing tics, yet I was still diagnosed with TS), but only involve the lungs. Dr Comings classed them as diaphragm motor tics. Perhaps the definition of a vocal tic should be expanded to include tics of the lungs. The most notable thing about breathing tics is that they can be terrifying!

Examples of breathing tics are:

Pacing breaths: When the person hears someone else breathing loudly, or there is a strong rhythmic sound (e.g. the bass in pop music) their lungs get confused and they must consciously match the beat with their own breathing in order to breathe comfortably.
Holding of breath with another tic: A person will hold his breath while performing a complex motor tic. Until the motor tic is completed properly, the breath cannot be released. This probably starts as a way of concentrating on correctly performing the motor tic, but becomes ingrained as part of the tic.
Independent breath holding: The person will only realize he is holding his breath when he begins to choke. He must then remind himself to breathe, usually in a desperate gasp for oxygen.
This can be scary.
The autonomic nervous system is supposed to keep you breathing even when youre unconscious, which is why you cant commit suicide by holding your breath. But some people worry that because the tic will occasionally stop them from breathing, and some tic in their sleep, they may suffocate themselves. Dont worry, it cant happen, the autonomic nervous system is incredibly strong. The worst youre likely to get is sore lungs and dizzinessand woken up.