14: The Possessed

Summary 1

Imagine a world where at the push of a button you could shift your consciousness to a more vivacious self; Picture an image of you that is more verbally acute, musically inclined, and more timing adept on the weekends and a more calm, subtle, and clear self on the weekdays. This is the universe that “Witty Ticcy” Ray lives in, for he like many suffer from an affliction known as Tourette’s syndrome.

Tourette’s syndrome as characterized “excess of nervous energy, and a great production and extravagance of strange motions and notions”. Ray has suffered from sporadic and violent movements or tics throughout his life. He was stigmatized for this growing up despite exhibiting high intelligence. It became second nature for Ray to take advantage of his Tourette’s. When it came to exemplary reflexes in ping pong and timing related sports he excelled. His drumming would take wild and remarkable improvisations when he would get the tic. Ray’s personality had valor, he had an odd sense of humor and he had even adopted the name “Witty Ticcy”.

These perks came at cost however. When it came to employment Ray was would immediately be disqualified for many positions on account of his Tourette’s. It also often took a toll on his marriage and left him feeling “confined”. He thought of his sickness as both a blessing and sickness.

The disturbance from Tourette’s seems to be localized in the thalamus, hypothalamus, limbic system, and amygdala. It is characterized by the excess of dopamine receptors in the brain. Haldol is a dopamine antagonist that can lower dopamine effect. Ray was prescribed this medication in an effort to reduce his ticks and sustain a relatively “normal” life.

Initially Ray did not respond well to the introduction of Haldol. His tics seemed to now be slowed and prolonged. His thoughts and processes had dimmed. He once mistimed his step leaving a revolving door and injured his face in the process. Ray was not ready for this drastic change. After months of counseling and deep self-reflective thought, He was once again placed on Haldol and it worked. His tics disappeared, his marriage became “stable”, he was loved by his friends and family, and he had mental clarity and sobriety.

Although Ray maintained his medication for three years, he began feeling that there was something missing from his life. He felt that his senses were too “dulled” and was missing a major component. Ray eventually decided to stay on his medication for the weekdays when he had to work, and go off Haldol on the weekends. He was able to maintain his job and control his ticks during the work days, and on the weekend he was the galvanized Witty Ticcy Ray.

Summary 2

In the 14^th chapter, "The possessed", the author presents to us a case of severe and rare form of Tourette's Syndrome (TS). Tourette's Syndrome is a neurological disorder and its clinical manifestations are primarily motor and vocal tics, that can be accompanied by cognitive disorder, such as attention-deficit and hyperactivity disorder (ADHD) and obsessive compulsive disorder (OCD). Sometimes, the syndrome can manifest in an aggressive and violent form, that makes the patient seem possessed, and it is called "Super Tourette".

The cause of Tourette's Syndrome remains unknown, but recent research suggest that abnormalities in basal ganglia, which alters the normal dosage of dopamine and serotonin neurotransmitters, can be the responsible for the occurrence of the syndrome. In extreme cases, Super Tourette can affect motor control, resulting in compulsive tics and frenetic movements as well as behavioral and personality disorders.

This chapter highlights how doctor's offices don't allow their patients to express their chaotic minds and ambiguous personalities and how most of the details that would be essential to the diagnoses are lost or cannot be totally understood. Thus, there is no better place to watch a person than under natural conditions, in the real world.

To illustrate, Dr. Sacks tells us the story when he was once walking in the streets of New York City and came across with an old lady exaggeratedly imitating people that were passing by the street. Her movements were distorted, involuntary and intense. She clearly lost the normal sense and barriers of inhibition. Undoubtedly, she lost her individuality and acquired everyone's personality. "This woman, who, becoming everybody, lost her own self, became nobody. This woman with a thousand faces, maskes, personae - how must it be for her in this whirlwind of identities?" Describes Dr. Sacks.

The importance of observing patients within social context and keeping their integral interactions with people hasn't been something new in neuroscience, others authors and research had already discuss about "Street Neuroscience", as it is known. For instance, James Parkinson had first described Parkinson disease after noticing different people in the streets attentively.

Since the unexpected meeting with that disturbed woman in the street, Dr. Sacks devoted his time to study and observe Super-Touretters and concluded that observing others while they are in contact with people is a necessary procedure in the diagnoses. It's not only about the patient, but its relationship with people around and how they perceive the world.

Figure 1. The syndrome was named after Georges Gilles de la Tourette, a French neurologist, who first describe the symptoms of nine patients, in 1885.

Figure 2. Development of Tourette's Syndrome is connected to harm and irregularity in the basal ganglia of the brain, which is involved in voluntary control movement, cognition and behavior.

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Richards, C. A., & Black, K. J. (2015). Tourette Syndrome research highlights 2014. F1000Research, 4, 69