Tic Docs
February 27, 2022 4:10 AM   Subscribe

Bartholomew thinks that the current spate of sudden tic-like-disorder patients will eventually abate, when the conditions that created them change. “It’s a sign of the times,” he told me. “It’s a social barometer.” The tics are allowing teenagers to express something about the unbearable alienation and intimacy of modern life, which is lived so much through screens. Mass-psychogenic-illness outbreaks tend to stop when it becomes obvious that there is no chemical leak or secret biological weapon involved—which is why Bartholomew believes that recognizing them as social contagions is important, even if it offends people. from The Twitching Girls [The Atlantic; Archive ]
posted by chavenet (19 comments total)

This post was deleted for the following reason: I appreciate some of the thoughtful comments in here but I am gonna break to the side of the feeling that that's not a good enough reason to bother keeping this piece, and this author, on the front page. -- cortex



 
Did I read this correctly, that the specialists in Le Roy used the word "hysterical" to describe the girls there? Is that a clinical term?
posted by Zumbador at 5:32 AM on February 27, 2022 [3 favorites]


Fyi, the author of this piece is a terf, which makes me suspicious about her motivations for writing about “social media contagion.” The exact same argument is frequently used to dismiss the identities of trans teenagers.
posted by theodolite at 6:00 AM on February 27, 2022 [46 favorites]


I can't speak to what these kids are going through, but I can say that I understand the psychogenic (or, rather, as they currently call it, "functional") disorder thing, because I had a functional disorder episode a couple of years ago.

I was extremely stressed for multiple reasons, and additionally got very ill (with just a regular winter illness), but something flipped a switch in my mind and I started physically flailing in a couple of specific tic-like ways. It felt a little Tourettes-like, at least how Tourettes has been described to me- that there was a building urge that got released with the tic. It was severe enough that I went to see a neurologist.

In the same way that the pull quote here suggests, recognizing it as the entirely psychological phenomenon that it was, and not caused by a neurological illness or other physical cause, was extremely useful in helping me defuse it and get back to normal. Well, mostly normal. I do still have some tic-like stuff that happens when I get wound up, but it's not as impairing to my life as what I had during that episode.

I think it's something that could happen to anyone when the world gets to be too much. And the world is getting to be too much for a lot of people these days. Kids, parents, everyone.
posted by notoriety public at 6:03 AM on February 27, 2022 [23 favorites]


Is that a clinical term?

Standard usage in the scientific community.
posted by flabdablet at 6:24 AM on February 27, 2022 [1 favorite]


Is that a clinical term?

It was a hundred years ago. I wouldn't trust anyone using a term like "hysteria" farther than I could throw them. (Or on seeing flabdablet's link, zap 'em with proton energy streams.)

That said, functional disorders are quite common and have been around since probably the dawn of time; the Atlantic article references Le Roy (2012) and Salem (1690s), but there's nothing specific to teen girls about functional disorders, except that the stressors of teen girls are usually dismissed as frivolous by society at large. (And then when they do manifest, they get called "attention-seeking" which makes me want to scream; it's no more attention-seeking than diagnosis of cancer.)

I specialize in movement disorders; since the pandemic started, there has been a noticeable uptick in functional movement disorders, particularly what are referred to as TikTok tics, as mentioned in the Atlantic article, but I have seen a LOT of functional dystonia, functional tremor, and functional speech changes.

As notoriety public says, the treatment for these is psychological rather than neurological, but at the end of the day, it takes a careful history and physical, both to rule out an alternative diagnosis and crucially to look for positive features of FND. The #1 thing I try to impart to my residents and students is that FND is not a "diagnosis of exclusion" and definitely does not mean the same thing as malingering (aka faking). There is too much of that already in the medical community.
posted by basalganglia at 7:03 AM on February 27, 2022 [36 favorites]


Not to abuse the edit window: while I don't know Dr. Lichter (in Buffalo NY) or Dr. Wessley (who is in London??), I know plenty of pediatric neurologists who cared for the girls in Le Roy, and terms like "hysterical" or even "conversion disorder" are definitely not part of their vocabulary. It's also ludicrous to characterize FND as "not any known movement disorder in science" when it is, like, the second most common movement disorder worldwide!
posted by basalganglia at 7:08 AM on February 27, 2022 [29 favorites]


Fyi, the author of this piece is a terf,

Fuck. Why do these people continue to be given a platform on mainstream media?
posted by splitpeasoup at 7:16 AM on February 27, 2022 [9 favorites]


Thank you, basalganglia, for bringing your professional expertise to the thread. Metafilter can be amazing like that, sometimes. I would like to chime in further, from the patient side, that the doctors I saw did indeed treat my issue as genuine. It wasn’t rooted in anything physical, but that didn’t mean it wasn’t real, and it was treatable. Acknowledging both the reality and treatability are key things.
posted by notoriety public at 7:38 AM on February 27, 2022 [18 favorites]


The article refers to Gulf War illness as a mass psychogenic event, but research over the past 30 years has indicated that exposures to burn pits, oil well fires, depleted uranium, etc., may be to blame. A lot remains to be understood, but describing it as strictly a matter of mass psychogenic illness feels pretty off.
posted by evidenceofabsence at 8:32 AM on February 27, 2022 [6 favorites]


I really appreciate theodolite's and basalganglia's comments because when I read this post earlier, the quote upset me so much that I wasn't up to reading the article. (I have done so now, however.) I knew I'd disagree with it and I'd be upset.

I've tended to be skeptical about "Havanna Syndrome" and I call that to mind to challenge myself with regard to how I feel about this. One thing that immediately comes to mind is that one group are adult diplomats and the other group are teenage girls. And why am I utterly certain that the former group have been collectively taken seriously from the beginning while the latter group is almost never taken seriously? That's a clue.

This issue is very much related to how medicine is still patriarchal and frequently dismisses women's concerns and patronizes them. I think any analysis that doesn't begin with this at the forefront is suspect and, wow, is this especially disturbing if it's coming from a self-identified feminist. In fact, it's exceptionally strange and is quite revealing coming from this specific writer — a feminist well aware of how medicine is patriarchal. Another clue is that this author included that quote including the term "hysterical", surely knowing its history and implications.

Given this, I think it's obvious that this article is stealth propoganda attempting to legitimize the TERF transphobic moral panic and its argument of "social media contagion".

The article mentions the Le Roy, New York incident. There are, and always have been, many such incidents. There are, and always have been, people with what are best termed “functional disorders”. I believe that a number of self-diagnosed illnesses are functional disorders.

However, what the history of medicine teaches is that a bias toward dismissing someone's symptoms as "psychosomatic" does much more harm than good. Often, many illnesses are eventually shown to be physiological. But even when they're not, and even when there's very strong evidence that it's not physiological, adopting a dismissive or minimizing stance causes more harm than it helps — a point to consider, given the Hippocratic Oath.

Another and related phenomenon comes to mind: satanic ritual abuse. I was in my 20s during the period thirty years ago when this was a moral panic. More to the point, I worked as a rape crisis advocate and our center (at the time, one of the largest in the US) got special training on it. As it happens, even though we did hear a lot of the credulous claims from people who made their livings as anti-SRA activists, we also were presented with a lot of more reality-based information. And after a great deal of discussion among the center's professional staff, management, and the board of directors, it was decided that because the calls to the hotline concerning RSA trauma were frequently extraordinarily detailed and explicit, such calls were too traumatic for the phone advocates and would be, as a matter of policy, turned over to staff prepared for it, if they were available.

I mention this because while I very much believed then and still believe now that RSA was a moral panic and did not, in fact, actually occur, I also felt that it was a rape crisis center's responsibility to advocate for survivors and not to arbitrate, in any event, the truth of the sexual violence survivors describe as experiencing. It may be someone's job to do so — but our job was to be a safe space for survivors of sexual violence in a society which all-too-often dismissed such accounts and, instead, compounds the injuries of the survivor.

In the case of medical professionals, including mental health specialists, these distinctions are quite a bit more blurred: treatment often requires a correct diagnosis of an underlying trauma and being credulous, though perhaps well-intentioned, is often not an option and less than optimal.

But there is a reason that basalganglia, as a professional, approaches these tics discussed in TFA and in their comment the way they do — and why their comment is quite a contrast to TFA's. They are neither credulous of these patients' self-diagnosis nor are they in any respect minimizing or dismissive of these patients' experiences.

And it's because the things we're discussing: the harm that comes from minimizing or dismissing someone's symptoms or trauma. It's especially important in the case of women in general and teen girls in particular because there is a long history of institutionized misogyny in medicine and mental health.

I think it's worth pointing out, for those who aren't already aware of it, how TERFs view transgender men and boys. With regard to men, they pretty much ignore them as if they don't exist (which is revealing). But with transgender boys, there's another side of the moral panic they're fomenting: the idea of the threat to teen girls.

With this in mind, it becomes explicable how a self-described feminist would write an article concerning functional disorder amongst teen girls that (seemingly) inexplicably includes the term hysterical and completely elides the extremely relevant history of patriarchal medicine's dismissal of women's and teen girls' experience of their own bodies and health. A responsible feminist would have placed the conundrum of both not perpetuating this institutionalized misogyny while nevertheless searching for the best way to treat these patients. Instead, very suspiciously, the writer hitches their wagon to the — justified — concerns about social networking's ill-effects on teen girls.

So what is both missing from this piece and what is emphasized reveal a bias that can only be explained by examining the author's history of transphobia. This article is a trojan horse. And it really pisses me off because it's a betrayal of the feminist values the author claims to hold: not only is it a trojan horse for transphobia, it also throws teen girls under the bus by inviting her audience to minimize or dismiss these tics as yet another example of the ills of social media. I feel this piece is exceptionally insidious and, at best — if it's unwitting and unintentional — then the writer is a fool. If it's deliberate, it's simply malevolent.

“A lot remains to be understood, but describing it [Gulf War Illness] as strictly a matter of mass psychogenic illness feels pretty off.”

Confirmation bias, right? Where otherwise you might expect this author in this publication to be skeptical of the bias against the legitimacy of Gulf War Illness, here she marshalls it alongside every other example at hand which seems to bolster her argument.

† The "ritual satanic", part. I believe that in many or most cases — or all — some kind of sexual violence was, nevertheless, committed against these survivors.
posted by Ivan Fyodorovich at 9:14 AM on February 27, 2022 [19 favorites]


Simon Wessely is well known to the myalgic encephalomyelitis community as a psychologizer who attributes the disease to "faulty illness beliefs" and therefore a mortal enemy. He has consistently advocated for graded exercise therapy and cognitive behavioral therapy for ME, the former of which is well-known by patients to be harmful because the cardinal symptom of ME is post-exertional malaise/post-exertional neuroimmune exhaustion. Many, many patients have suffered permanent harm from exceeding their exertional limits. After decades of patient advocacy, those ideas were finally removed from the UK's NICE guidelines last fall, but Wessely and his associates are still pushing them.
posted by jocelmeow at 9:24 AM on February 27, 2022 [13 favorites]


These are the same people trying to get us to think Covid too is nothing more than a mass hysteria. No thanks.
posted by bleep at 9:37 AM on February 27, 2022 [5 favorites]


Are they talking about the same thing as How Teens Around the World are "Catching" Tourettes (Rebecca Watson)?
posted by kschang at 9:41 AM on February 27, 2022 [1 favorite]


The article refers to Gulf War illness as a mass psychogenic event, but research over the past 30 years has indicated that exposures to burn pits, oil well fires, depleted uranium, etc., may be to blame

I was wondering about that too! To not even mention that part of the context worries me.
posted by Zumbador at 9:48 AM on February 27, 2022 [5 favorites]


I think it is irresponsible of The Atlantic to publish this garbage.
posted by Catblack at 11:40 AM on February 27, 2022 [6 favorites]


The book is called "The Sleeping Beauties: And Other Stories of Mystery Illness" by Suzanne O'Sullivan, a neurologist. This paragraph is from a Guardian review:

Throughout her travels, O’Sullivan acts with humility about the limits of western medicine. Many doctors are so specialised, she argues, that they can only understand illness as it manifests in a single organ rather than as a result of living a particular life in a particular environment. At times, she clearly feels conflicted about her role and what is expected of her. In Nicaragua she notes that the MPI, known locally as grisi siknis, “looked very much like the dissociative (psychosomatic) seizures I see every day of my working life”, but acknowledges that here, benzodiazepines and epilepsy drugs don’t work, “while shamanism is largely successful”. In westernised society, on the other hand, we drive people who are suffering psychologically “to get a disease label that will earn them the help and respect they are asking for”.

O'Sullivan explains to communities and doctors that FNDs (functional neurological disorders) are “real” – “a result of physiological mechanisms” in the brain “that go awry to produce genuine physical symptoms and disability” and FNDs (functional neurological disorders) are NOT attention-seeking, sexually frustrated and crazy behaviors. She visits communities all over the world--the book's title refers to an MPI (multiple psychogenic illness) where young girls have been lying in bed with closed eyes, not moving, for YEARS. ( I do rather wish the title didn't echo an awful fairytale).

In Nicaragua, O'Sullivan asks a local what he thinks is going on. He says he doesn't know, but he thinks maybe the girls were weak, and grisi siknis makes them strong.

"By making social problems visible on the body, O’Sullivan believes, these conditions allow voiceless people to tell their stories and to make themselves heard. Perhaps this eloquent and convincing book will be the start of making people in authority listen, make change and help." (Guardian)

I can't recommend this book enough.
posted by mygraycatbongo at 11:42 AM on February 27, 2022 [3 favorites]


Previously, "resignation syndrome", a form of catatonia that spread among refugee children in Sweden, sounds rather similar to this.
posted by heatherlogan at 11:47 AM on February 27, 2022 [1 favorite]


That's what it's called, yes. That was the hardest chapter to read for me.
posted by mygraycatbongo at 12:13 PM on February 27, 2022 [1 favorite]


Fuck. Why do these people continue to be given a platform on mainstream media?

Maybe because self-proclaimed allies of trans people have no memory of which journalists write anti-trans hit pieces or which mainstream news sources publish them? Because these publications are those allies' first port of call for information about major news, are left intact on their news feeds, are shared virally when they publish hot takes about literary fiction, and rake in monthly subscriptions? Because there are no consequences for publishing the daily entries in this years-long escalating hate campaign against us?

But perhaps if people did care they would have trouble finding an article they're comfortable sharing with analysis of Trump's latest inane rant, and that would be inconvenient.
posted by polytope subirb enby-of-piano-dice at 12:48 PM on February 27, 2022 [6 favorites]


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