WittyTiccy_Possessed - 10 Witty T iccy Bay In 1885 Gilles...

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Unformatted text preview: 10 Witty T iccy Bay In 1885 Gilles de la Tourette, a pupil ofCharcot, described the astonishing syndrome which now bears his name. ‘Tourette’s syndrome’, as it was immediately dubbed, is characterised by an excess of nervous energy, and a great production and extravagance of strange motions and notions: tics, jerks, mannerisms, grimaces, noises, curses, involuntary imitations and compulsions of all sorts, with an odd elfin humour and a tendency to antic and outlandish kinds of play. In its ‘highest’ forms, Tourette’s syndrome involves every aspect of the affective, the instinctual and the imaginative life; in its ‘lower’, and perhaps commoner, forms, there may be little more than abnormal movements and impulsivity, though even here there is an element of strangeness. It was well recognised and extensively reported in the closing years of the last century, for these were years of a spacious neurology which did not hesitate to conjoin the organic and the psychic. It was clear to Tourette, and his peers, that this syndrome was a sort of possession by primitive impulses and urges: but also that it was a possession with an organic base — a very definite (if undiscovered) neurological disorder. In the years that immediately followed the publication of Tourette’s original papers many hundreds of cases of this syndrome were described —- no two cases ever being quite the same. It became clear that there were forms which were mild and benign, and others of quite terrible grotesqueness and violence. Equally, it was clear that some people could ‘take’ Tourette’s, and accommodate it within a commodious personality, even gaining advantage from the swiftness of thought and association and invention which went with it, while others might indeed be ‘possessed’ and scarcely able to 87 8 8 Part Two: E xcesses achieve real identity amid the tremendous pressure and chaos of Tourettic impulses. There was always, as Luria remarked of his mnemonist, a fight between an ‘It’ and an ‘I’. Charcot and his pupils, who included Freud and Babinski as well as Tourette, were among the last of their profession with a combined vision of body and soul, ‘It’, and ‘I’, neurology and psychiatry. By the turn of the century, a Split had occurred, into a soulless neurology and a bodiless psychology, and with this any understanding of Tourette’s disappeared. In fact, Tourette’s syndrome itself seemed to have disappeared, and was scarcely at all reported in the first half of this century. Some physicians, indeed, regarded it as ‘mythical’, a product of Tourette’s colourful imagination; most had never heard of it. It was as forgotten as the great sleepy-sickness epidemic of the 19205. The forgetting of sleepy-sickness (encephalitis lethargica) and the forgetting of Tourette’s have much in common. Both disorders were extraordinary, and strange beyond belief — at least, the beliefs of a contracted medicine. They could not be accommodated in the conventional frameworks of medicine, and therefore they were forgotten and mysteriously ‘dis- appeared’. But there is a much more intimate connection, which was hinted at in the 19205, in the hyperkinetic or frenzied forms which the sleepy-sickness sometimes took: these patients tended, at the beginning of their illness, to show a mounting excitement of mind and body, violent movements, tics, compul- sions of all kinds. Some time afterwards, they were overtaken by an opposite fate, an all-enveloping trance-like ‘sleep’ — in which I found them forty years later. In 1969, I gave these sleepy—sickness or post-encephalitic patients L—Dopa, a precursor of the transmitter dopamine, which was greatly lowered in their brains. They were trans- formed by it. First they were ‘awakened’ from stupor to health: then they were driven towards the other pole — of tics and frenzy. This was my first experience of Tourettedike syndromes: wild excitements, violent impulses, often combined with a weird, antic humour. I started to speak of ‘Tourettism’, although I had never seen a patient with Tourette’s. Early in 1971, the Washington Post, which had taken an interest in the ‘awakening’ of my post-encephalitic patients, asked me how they were getting on. I replied, ‘They are ticcing’, which 10 Witty Titty Ray 89 prompted them to publish an article on ‘Tics’. After the publication of this article, I received countless letters, the majority of which I passed on to my colleagues. But there was one patient I did consent to see - Ray. The day after seeing Ray, it seemed to me that I noticed three Touretters in the street in downtown New York. I was confounded, for Tourette’s syndrome was said to be excessively rare. It had an incidence, I had read, of one in a million, yet I had apparently seen three examples in an hour. I was thrown into a turmoil of bewilderment and wonder: was it possible that I had been overlooking this all the time, either not seeing such patients or vaguely dismissing them as ‘nervous’, ‘cracked’, ‘twitchy’? Was it possible that everyone had been overlooking them? Was it possible that Tourette’s was not a rarity, but rather common — a thousand times more common, say, than previously supposed? The next day, without specially looking, I saw another two in the street. At this point I conceived a whimsical fantasy or private joke: suppose (I said to myself) that Tourette’s is very common but fails to be recognised but once recognised is easily and constantly seen.* Suppose one such Touretter recognises another, and these two a third, and these three a fourth, until, by incrementing recognition, a whole band of them is found: brothers and sisters in pathology, a new species in our midst, joined together by mutual recognition and concern? Could there not come together, by such spontaneous aggregation, a whole association of New Yorkers with Tourette’s .3 Three years later, in 1974, I found that my fantasy had become a reality: that there had indeed come into being a Tourette’s Syndrome Association. It had fifty members then: now, seven years later, it has a few thousand. This astounding increase must be ascribed to the efforts of the TSA itself, even though it consists only of patients, their relatives and “‘ A very similar situation happened with muscular dystrophy, which was never seen until Duchenne described it in the 18505. By 1860, after his original description, many hundreds of cases had been recognised and described, so much so that Charcot said: ‘How come that a disease so common, so widespread, and so recognisable at a glance -— a disease which has doubtless always existed — how come that it is only recognised now? Why did we need M. Duchenne to open our eyes 9’ 90 Part Two: Excesses physicians. The association has been endlessly resourceful in its attempts to make known (or, in the best sense, ‘publicise’) the Touretter’s plight. It has aroused responsible interest and concern in place of the repugnance, or dismissal, which had so often been the Touretter’s lot, and it has encouraged research of all kinds, from the physiological to the sociological: research into the biochemistry of the Tourettic brain; on genetic and other factors which may co—determine Tourette’s; on the abnormally rapid and indiscriminate associations and reactions which characterise it. Instinctual and behavioural structures, of a developmentally and even phylogenetically primitive kind, have been revealed. There has been research on the body-language and grammar and linguistic structure of tics; there have been unexpected insights into the nature of cursing and joking (which are also characteristic of some other neurological disorders); and, not least, there have been studies of the interaction of Touretters with their family and others, and of the strange mishaps which may attend these relationships. The TSA’s remarkably successful endeavours are an integral part of the history of Tourette’s, and, as such, unprecedented: never before have patients led the way to understanding, become the active and enterprising agents of their own comprehension and cure. What has emerged in these last ten years - largely under the aegis and stimulus of the TSA —- is a clear confirmation of Gilles de la Tourette’s intuition that this syndrome indeed has an organic neurological basis. The ‘It’ in Tourette’s, like the ‘It’ in Parkinsonism and chorea, reflects what Pavlov called ‘the blind force of the subcortex’, a disturbance of those primitive parts of the brain which govern ‘go’ and ‘drive’. In Parkinsonism, which affects motion but not action as such, the disturbance lies in the midbrain and its connections. In chorea - which is a chaos of fragmentary quasi-actions - the disorder lies in higher levels of the basal ganglia. In Tourette’s, where there is excitement of the emotions and the passions, a disorder of the primal, instinctual bases of behaviour, the disturbance seems to lie in the very highest parts of the ‘old brain’: the thalamus, hypothalamus, limbic system and amygdala, where the basic affective and instinctual determinants of personality are lodged. Thus Tourette’s — pathologically no less than clinically 10 Witty Titty Ray 91 — constitutes a sort of ‘missing link’ between body and mind, and lies, so to speak, between chorea and mania. As in the rare, hyperkinetic forms of encephalitis lethargica, and in all post- encephalitic patients over-excited by L-Dopa, patients with Tourette’s syndrome, or ‘Tourettism’ from any other cause (strokes, cerebral tumours, intoxications or infections), seem to have an excess of excitor transmitters in the brain, especially the transmitter dopamine. And as lethargic Parkinsonian patients need more dopamine to arouse them, as my post-encephalitic patients were ‘awakened’ by the dopamine—precursor L-Dopa, so frenetic and Tourettic patients must have had their dopamine lowered by a dopamine antagonist, such as the drug haloperidol (‘haldol’). On the other hand, there is notjust a surleit odepamine in the Touretter’s brain, as there is notjust a deficiency ofit in the Parkinsonian brain. There are also much subtler and more widespread changes, as one would expect in a disorder which may alter personality: there are countless subtle paths ofabnor— mality which differ from patient to patient, and from day to day in any one patient. Haldol can be an answer to Tourette’s, but neither it nor any other drug can be the answer, any more than L-Dopa is the answer to Parkinsonism. Complementary to any purely medicinal, or medical, approach there must also be an ‘existential’ approach: in particular, a sensitive understanding of action, art and play as being in essence healthy and free, and thus antagonistic to crude drives and impulsions, to ‘the blind force of the subcortex’ from which these patients suffer. The motionless Parkinsonian can sing and dance, and when he does so is completely free from his Parkinsonism; and when the galvanised Touretter sings, plays or acts, he in turn is completely liberated from his Tourette’s. Here the ‘I’ vanquishes and reigns over the ‘It’. Between 1973 and his death in 197 7, I enjoyed the privilege of corresponding with the great neuropsychologist A.R. Luria, and often sent him observations, and tapes, on Tourette’s. In one of his last letters, he wrote to me: ‘This is truly of a tremendous importance. Any understanding of such a syn— drome must vastly broaden our understanding of human nature in general I know of no other syndrome of comparable interest.’ 9 2 Part Two: E accesses When I first saw Ray he was 24 years old, and almost incapacitated by multiple tics of extreme violence coming in volleys every few seconds. He had been subject to these since the age of four and severely stigmatised by the attention they aroused, though his high intelligence, his wit, his strength of character and sense of reality, enabled him to pass successfully through school and college, and to be valued and loved by a few friends and his wife. Since leaving college, however, he had been fired from a dozen jobs - always because of tics, never for incompetence — was continually in crises of one sort and another, usually caused by his impatience, his pugnacity, and his coarse, brilliant ‘chutzpah’, and had found his marriage threatened by involuntary cries of ‘Fuck!’ ‘Shitl’, and so on, which would burst from him at times of sexual excitement. He was (like many Touretters) remarkably musical, and could scarcely have survived - emotionally or economically — had he not been a weekend jazz drummer of real virtuosity, famous for his sudden and wild extemporisations, which would arise from a tic or a compulsive hitting of a drum and would instantly be made the nucleus of a wild and wonderful improvisation, so that the ‘sudden intruder’ would be turned to brilliant advantage. His Tourette’s was also of advantage in various games, especially ping-pong, at which he excelled, partly in consequence of his abnormal quickness of reflex and reaction, but especially, again, because of ‘improvisations’, ‘very sudden, nervous, frivolous shots’ (in his own words), which were so unexpected and startling as to be virtually unanswerable. The only time he was free from tics was in post-coital quiescence or in sleep; or when he swam or sang or worked, evenly and rhythmically, and found ‘a kinetic melody’, a play, which was tension-free, tic-free and free. Under an ebullient, eruptive, clownish surface, he was a deeply serious man — and a man in despair. He had never heard of the TSA (which, indeed, scarcely existed at the time), nor had he heard of haldol. He had diagnosed himself as having Tourette’s after reading the article on ‘Tics’ in the Washington Post. When I confirmed the diagnosis, and spoke of using haldol, he was excited but cautious. I made a test of haldol by injection, and he proved extraordinarily sensitive to it, becoming virtually tic-free for a period of two hours after I 10 Witty Titty Ray 93 had administered no more than one-eighth of a milligram. After this auspicious trial, I started him on haldol, prescribing a dose of a quarter of a milligram three times a day. He came back, the following week, with a black eye and a broken nose and said: ‘So much for your fucking haldol.’ Even this minute dose, he said, had thrown him off balance, interfered with his speed, his timing, his preternaturally quick reflexes. Like many Touretters, he was attracted to spinning things, and to revolving doors in particular, which he would dodge in and out of like lightning: he had lost this knack on the haldol, had mistimed his movements, and had been bashed on the nose. Further, many of his tics, far from disappearing, had simply become slow, and enormously extended: he might get ‘transfixed in mid—tic’, as he put it, and find himself in almost catatonic postures (Ferenczi once called catatonia the opposite of tics — and suggested these be called ‘cataclonia’). He presented a picture, even on this minute dose, of marked Parkinsonism, dystonia, catatonia and psychomotor ‘block’: in reaction which seemed inauspicious in the extreme, suggesting, not insensitivity, but such over-sensitivity, such pathological sensitivity, that perhaps he could only be thrown from one extreme to another — from acceleration and Tourettism to catatonia and Parkinsonism, with no possibility of any happy medium. He was understandably discouraged by this experience — and this thought — and also by an0ther thought which he now expressed. ‘Suppose you could take away the tics,’ he said. ‘What would be left? I consist oftics —— there’d be nothing left.’ He seemed, at leastjokingly, to have little sense of his identity except as a ticqueur: he called himself ‘the ticcer of President’s Broadway’, and spoke of himself, in the third person, as ‘witty ticcy Ray’, adding that he was so prone to ‘ticcy witticisms and witty ticcicisms’ that he scarcely knew whether it was a gift or a curse. He said he could not imagine life without Tourette’s, nor was he sure he would care for it. I was strongly reminded, at this point, of what I had encountered in some of my post-encephalitic patients, who were inordinately sensitive to L-Dopa. I had nevertheless observed in their case that such extreme physiological sensitivities and instabilities might be transcended if it were 94 Part Two: Excesses possible for the patient to lead a rich and full life: that the ‘existential’ balance, or poise, of such a life might overcome a severe physiological imbalance. Feeling that Ray also had such possibilities in him, that, despite his own words, he was not incorrigibly centred on his own disease, in an exhibitionistic or narcissistic way, I suggested that we meet weekly for a period of three months. During this time we would try to imagine life without Tourette’s; we would explore (if only in thought and feeling) how much life could offer, could offer him, without the perverse attractions and attentions of Tourette’s; we would examine the role and economic importance of Tourette’s to him, and how he might get on without these. We would explore all this for three months - and then make another trial ofhaldol. There followed three months of deep and patient explor- ation, in which (often against much resistance and spite and lack of faith in self and life) all sorts of healthy and human potentials came to light: potentials which had somehow survived twenty years of severe Tourette’s and ‘Touretty’ life, hidden in the deepest and strongest core of the personality. This deep ex- ploration was exciting and encouraging in itself and gave us, at least, a limited hope. What in fact happened exceeded all our expectations and showed itself to be no mere flash in the pan, but an enduring and permanent transformation of reactivity. For when I again tried Ray on haldol, in the same minute dose as before, he now found himself tic-free, but without significant ill-effects — and he has remained this way for the past nine years. The effects of haldol, here, were ‘miraculous’ — but only became so when a miracle was allowed. Its initial effects were close to catastrophic: partly, no doubt, on a physiological basis; but also because any ‘cure’, or relinquishing of Tourette’s, at this time would have been premature and economically impos- sible. Having had Tourette’s since the age of four, Ray had no experience of any normal life: he was heavily dependent on his exotic disease and, not unnaturally, employed and exploited it in various ways. He had not been ready to give up his Tourette’s and (I cannot help thinking) might never have been ready without those three months of intense preparation, of tre- mendously hard and concentrated deep analysis and thought. The past nine years, on the whole, have been happy ones for Ray — a liberation beyond any possible expectation. After twenty 10 Witty Ticcy Ray 95 years of being confined by Tourette’s, and compelled to this and that by its crude physiology, he enjoys a spaciousness and freedom he would never have thought possible (or, at most, during our analysis, only theoretically possible). His marriage is tender and stable — and he is now a father as well; he has many good friends, who love and value him as a person —- and not simply as an accomplished Tourettic clown; he plays an important part in his local community; and he holds a responsible position at work. Yet problems remain: problems perhaps inseparable from having Tourette’s — and haldol. During his working hours, and working week, Ray remains ‘sober, solid, square’ on haldol - this is how he describes his ‘haldol self. He is slow and deliberate in his movements and judgments, with none of the impatience, the impetuosity, he showed before haldol, but equally, none of the wild improvisations and inspirations. Even his dreams are different in quality: ‘straight wish-fulfilment,’ he says, ‘with none of the elaborations, the extravaganzas, of Tourette’s’. He is less sharp, less quick in repartee, no longer bubbling with witty tics or ticcy wit. He no longer enjoys or‘excels at ping-pong or other games; he no longer feels ‘that urgent killer instinCt, the instinct to win, to beat the other man’; he is less competitive, then, and also less playful; and he has lost the impulse, or the knack, of sudden ‘frivolous’ moves which take everyone by surprise. He has lost his Obscenities, his coarse Chutzpah, his spunk. He has come to feel, increasingly, that something is missing. Most important, and disabling, because this was vital for him — as a means both of support and self-expression — he found that on haldol he was musically ‘dull’, average, competent, but lacking energy, enthusiasm, extravagance and joy. He no longer had tics or compulsive hitting of the drums — but he no longer had wild and creative surges. As this pattern became clear to him, and after discussing it with me, Ray made a momentous decision: he would take haldol ‘dutifully’ throughout the working week, but would take himself off it, and ‘let fly’, at weekends. This he has done for the past three years. So now, there are two Rays — on and off haldol. There is the sober citizen, the calm deliberator, from Monday to Friday; and there is ‘witty ticcy Ray’, 96 Part Two : Excesses frivolous, frenetic, inspired, at weekends. It is a strange situation, as Ray is the first to admit: Having Tourette’s is wild, like being drunk all the while. Being on haldol is dull, makes one square and sober, and neither state is really free You ‘normals’, who have the right transmitters in the right places at the right times in your brains, have all feelings, all styles, available all the time — gravity, levity, whatever is appropriate. We Touretters don’t: we are forced into levity by our Tourette’s and forced into gravity when we take haldol. You are free, you have a natural balance: we must make the best of an artificial balance. Ray does make the best of it, and has a full life, despite Tourette’s, despite haldol, despite the ‘unfreedom’ and the ‘artifice’, despite being deprived of that birthright of natural freedom which most of us enjoy. But he has been taught by his sickness and, in a way, he has transcended it. He would say, with Nietzsche: ‘I have traversed many kinds of health, and keep traversing them And as for sickness: are we not almost tempted to ask whether we could get along without it? Only great pain is the ultimate liberator of the spirit.’ Paradoxically, Ray — deprived of natural, animal physiological health — has found a new health, a new freedom, through the vicissitudes he is subject to. He has achieved what Nietzsche liked to call ‘The Great Health’ — rare humour, valour, and resilience of spirit: despite being, or because he is, afflicted with Tourette’s. 14 The Possessed In Witty Ticcy Ray (Chapter Ten), I described a relatively mild form of Tourette’s syndrome, but hinted that there were severer forms ‘of quite terrible grotesqueness and violence’. I suggested that some people could accommodate Tourette‘s within a commodious personality, while others ‘might indeed be “possessed”, and scarcely able to achieve real identity amid the tremendous pressure and chaos ofTourettic impulses’. Tourette himself, and many of the older clinicians, used to recognise a malignant form of Tourette’s, which might disintegrate the personality, and lead to a bizarre, phantas- magoric, pantomimic and often impersonatory form of ‘psychosis’ or frenzy. This form of Tourette’s —— ‘super- Tourette’s — is quite rare, perhaps fifty times rarer than ordinary Tourette’s syndrome, and it may be qualitatively different, as well as far more intense than any of the ordinary forms of the disorder. This ‘Tourette psychosis’, this singular identity—frenzy, is quite different from ordinary psychosis, because of its underlying, and unique, physiology and phenomenology. None the less, it has affinities, on the one hand, to the frenzied motor psychoses sometimes induced by L-Dopa and, on the other, to the confabulatory frenzies of Korsakov’s psychosis (see above, Chapter Twelve). And like these it can almost overwhelm the person. The day after I saw Ray, my first Touretter, my eyes and mind opened, as I mentioned earlier, when, in the streets of New York, I saw no less than three Touretters — all as characteristic as Ray, though more florid. It was a day of visions for the neurological eye. In swift vignettes I witnessed what it might mean to have Tourette’s syndrome of ultimate severity, not only tics and convulsions of movement, but tics and 115 116 Part Two: Excesses convulsions of perception, imagination, the passions — of the entire personality. Ray himself had shown what might happen in the street. But it is not enough to be told. You must see for yourself. And a doctor’s clinic or ward is not always the best place for observing disease — at least, not for observing a disorder which, if organic in origin, is expressed in impulse, imitation, impersonation, reaction, interaction, raised to an extreme and almost incredib- le degree. The clinic, the laboratory, the ward are all designed to restrain and focus behaviour, if not indeed to exclude it alto- gether. They are for a systematic and scientific neurology, reduced to fixed tests and tasks, not for an open, naturalistic neurology. For this one must see the patient unselfconscious, unobserved, in the real world, wholly given over to the spur and play of every impulse, and one must oneself, the observer, be unobserved. What could be better, for this purpose, than a street in New York -— an anonymous public street in a vast city — where the subject of extravagant, impulsive disorders can enjoy and exhibit to the full the monstrous liberty, or slavery, of their condition. ‘Street-neurology’, indeed, has respectable antecedentsjam- es Parkinson, as inveterate a walker of the streets of London as Charles Dickens was to be, forty years later, delineated the disease that bears his name, not in his office, but in the teeming streets of London. Parkinsonism, indeed, cannot be fully seen, comprehended, in the clinic; it requires an open, complexly interactional space for the full revelation of its peculiar char- acter, its primitive impulsions, contortions, transfixions, and perversions. Parkinsonism has to be seen, to be fully com- prehended, in the world, and if this is true of Parkinsonism, how much truer must it be of Tourette’s. Indeed an extraordinary description from within of an imitative and antic ticqueur in the streets of Paris is given in ‘Les confidences d’un ticqueur’ which prefaces Meige and Feindel’s great book Tics (1901), and a vignette of a manneristic ticqueur, also in the streets of Paris, is provided, by the poet Rilke, The Notebook of M alte Lauride Brigge. Thus it was not just seeing Ray in my office but what I saw the next day that was such a revelation to me. And one scene, in particular, was so singular that it remains in my memory today as vivid as it was the day I saw it. 1 4 The Possessed l l 7 My eye was caught by a grey-haired woman in her sixties, who was apparently the centre of a most amazing disturbance, though what was happening, what was so disturbing, was not at first clear to me. Was she having a fit? What on earth was convulsing her — and, by a sort of sympathy or contagion — also convulsing everyone whom she gnashingly, ticcily passed ? As I drew closer I saw what was happening. She was imitating the passers-by —- if ‘imitation’ is not too pallid, too passive, a word. Should we say, rather, that she was caricaturing everyone she passed 9 Within a second, a split~second, she ‘had’ them all. I have seen countless mimes and mimics, clowns and antics, but nothing touched the horrible wonder I now beheld: this virtually instantaneous, automatic and convulsive mirroring of every face and figure. But it was not just an imitation, extraordinary as this would have been in itself. The woman not only took on, and took in, the features of countless people, she took them off. Every mirroring was also a parody, a mocking, an exaggeration of salient gestures and expressions, but an exaggeration in itself no less convulsive than intentional — a consequence of the violent acceleration and distortion of all her motions. Thus a slow smile, monstrously accelerated, would become a Violent, milliseconds-long grimace; an ample geSture, accelerated, would become a farcical convulsive movement. In the course of a short city-block this frantic old woman frenetically caricatured the features of forty or fifty passers-by, .in a quick-fire sequence of kaleidoscopic imitations, each lasting a second or two, sometimes less, and the whole dizzying sequence scarcely more than two minutes. And there were ludicrous imitations of the second and third order; for the people in the street, startled, outraged, bewildered by her imitations, took on these expressions in reaction to her; and those expressions in turn, were re—reflected, re-directed, re-distorted, by the Touretter, causing a still greater degree of outrage and shock. This grotesque, involuntary resonance, or mutuality, by which everyone was drawn into an absurdly amplifying interaction, was the source of the disturbance I had seen from a distance. This woman who, becoming everybody, lost her own self, 118 Part Two: 'Excesses became nobody. This woman with a thousand faces, masks, personae — how must it be for her in this whirlwind of identities ? The answer came soon -— and not a second too late; for the build-up of pressures, both hers and others’, was fast approach— ing the point of explosion. Suddenly, desperately, the old woman turned aside, into an alley-way which led off the main street. And there, with all the appearances of a woman violently sick, she expelled, tremendously accelerated and abbreviated, all the gestures, the postures, the expressions, the demeanours, the entire behavioural repertoires, of the past forty or fifty people she had passed. She delivered one vast, pantomimic egurgitation, in which the engorged identities of the last fifty people who had possessed her were spewed out. And if the taking-in had lasted two minutes, the throwing-out was a single exhalation — fifty people in ten seconds, a fifth of a second or less for the time-foreshortened repertoire of each person. I was later to spend hundreds of hours, talking to, observing, taping, learning from, Tourette patients. Yet nothing, I think, taught me as much, as swiftly, as penetratingly, as overwhelm- ingly as that phantasmagoric two minutes in a New York street. It came to me in this moment that such ‘super-Touretters’ must be placed, by an organic quirk, through no fault of their own, in a most extraordinary, indeed unique, existential posi— tion, which has some analogies to that of raging ‘super- Korsakov’s’, but, of course, has a quite different genesis — and aim. Both can be driven to incoherence, to identity-delirium. The Korsakovian, perhaps mercifully, never knows it, but the Touretter perceives his plight with excruciating, and perhaps finally ironic, acuity, though he may be unable, or unwilling, to do much about it. For where the Korsakovian is driven by amnesia, absence, the Touretter is driven by extravagant impulse — impulse of which he is both the creator and the victim, impulse he may repudiate, but cannot disown. Thus he is impelled, as the Korsakovian is not, into an ambiguous relation with his disorder: vanquishing it, being vanquished by it, playing with it — there is every variety ofconflict and collusion. Lacking the normal, protective barriers of inhibition, the normal, organically determined boundaries of self, the Touret- ter’s ego is subject to a lifelong bombardment. He is beguiled, 1 4 The Possessed l 19 assailed, by impulses from within and without, impulses which are organic and convulsive, but also personal (or rather pseudo-personal) and seductive. How will, how can, the ego stand this bombardment? Will identity survive? Can it develop, in face of such a shattering, such pressures —- or will it be overwhelmed, to produce a ‘Tourettized soul’ (in the poignant words of a patient I was later to see)? There is a physiological, an existential, almost a theological pressure upon the soul of the Touretter — whether it can be held whole and sovereign, or whether it will be taken over, possessed and dispossessed, by every immediacy and impulse. Hume, as we have noted, wrote: I venture to affirm that [we] are nothing but a bundle or collection of different sensations, succeeding one another with inconceivable rapidity, and in a perpetual flux and movement. Thus, for Hume, personal identity is a fiction — we do not exist, we are but a consecution of sensations, or perceptions. This is clearly not the case with a normal human being, because he owns his own perceptions. They are not a mere flux, but his own, united by an abiding individuality or self. But what Hume describes may be precisely the case for a being as unstable as a super-Touretter, whose life is, to some extent, a consecution of random or convulsive perceptions and motions, a phantasmagoric fluttering with no centre or sense. To this extent he is a ‘Humean’ rather than a human, being. This is the philosophical, almost theological, fate which lies in wait, if the ratio of impulse to self is too overwhelming. It has affinities to a ‘Freudian’ fate, which is also to be overwhelmed by impulse - but the Freudian fate has sense (albeit tragic), whereas a ‘Humean’ fate is meaningless and absurd. The super-Touretter, then, is compelled to fight, as no one else is, simply to survive — to become an individual, and survive as one, in face of constant impulse. He may be faced, from earliest childhood, with extraordinary barriers to individu- ation, to becoming a real person. The miracle is that, in most cases, he succeeds — for the powers of survival, of the will to survive, and to survive as a unique inalienable individual are, 120 Part Two: Excesses absolutely, the strongest in our being: stronger than any impulses, stronger than disease. Health, health militant, is usually the victor. ...
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WittyTiccy_Possessed - 10 Witty T iccy Bay In 1885 Gilles...

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