Michael and Toby: An Introduction

I first met Michael (a pseudonym), a neighbor in his early teens, in 1980. Michael periodically would blurt out what sounded like barks and often ask inappropriate questions. He informed me that these behaviors were caused by an affliction called Tourette's syndrome (TS). When Michael was about eight years old he had developed uncontrolled eye blinking; soon after he developed more pronounced facial and body tics accompanied by vocalizations that at first sounded as if he was muttering to himself. When he approached his late teens he began to curse, regularly shouting out a series of obscenities, most often “fuck you!” His cursing was accompanied by uncontrollable blurting out of inappropriate remarks, which made it diffi-cult for him to socialize with peers or with anyone unaware of the reason for his offensive behavior. At a public lecture he was apt to shout at the speaker, “Sit down, shut up!” Passing a noticeably obese woman he would blurt out, “fat pig!” Once, phoning an airline to make a reservation, he exclaimed, “There's a bomb on the plane!” The next day the FBI appeared at his door to question a suspected terrorist. When introduced to or passing by an African American, he could not stop himself from exclaiming, “Nigger!”

Like Michael, Toby (a pseudonym), a forty-something patient treated at our psychiatric clinic, developed tics and vocalizations when he was nine, and was diagnosed three years later with TS.