Howard, who on Tuesday solidified his position as the greatest goalkeeper in national history, has Tourette’s syndrome. Though the United States lost its game against Belgium 2-1, the ending tally would have been much, much worse if not for Howard. He had 16 saves, three more than the previous World Cup record of 13.

“Between now and four years ago, I’ve played a couple hundred games for my club and country,” Howard said after the game. “Just more experienced. I don’t really get too high or too low. I think when you have a big tournament, that’s the important thing, managing emotion.”

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It has always been that way for Howard. He always has had to think about managing emotion. The bigger the game, the bigger the moment, the more his tics and symptoms flare. “I’ve never counted [how many tics I have in a game],” he said in a 2013 interview with Spiegel Online. “It happens all the time, without any warning, and it increases the nearer an important game draws,” he said. “It always occurs more when I am particularly nervous.”

When the ball is far away, he says he indulges his twitches. “I don’t suppress it,” he told the German publication. But when an opposing striker approaches and readies an attack — which happened over and again on Tuesday — his muscles miraculously calm. “I have no idea how I do it,” he said. “Not even my doctors can explain it to me. It’s probably because at that moment my concentration on the game is stronger than the Tourette’s syndrome.”

The standard stereotype of Tourette’s, a neurological disorder characterized by repetitive, involuntary sounds and movements that may afflict between 1 and 3 percent of people, is an image of a person cursing uncontrollably. But only 10 percent of Tourette’s patients exhibit that symptom, and Howard isn’t one of them. “I’ve never had a curse word simply slip out,” he said.

What does slip out: tics and twitches. They’ve been with him his entire life. At 10, Howard’s facial tics started when he was growing up in New Jersey. Unfamiliar situations made him anxious and he developed obsessive-compulsive behaviors. Things could never be straight enough. Ordered enough. Counted enough. He compulsively touched cracks in the floor or bricks in the wall. “A certain pattern had to be followed, an exact routine,” mother Esther Howard told the New Yorker. “He had to put his clothes on the same way every day.”

The tics would come in waves. “From the age of 9 to 15, it was just this chaos of different tics, and they were pretty strong,” Howard explained to Neurology Now. “I would just begin to figure out how a tic worked with my body, and, bam, six months or a year later, a new tic would come.”

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But early on, he found an outlet: soccer. His abilities made sense to his mother.

“I believe there’s a certain yin and yang to things,” she told the New Yorker. “If you have a disorder like this, then you also have a gift that you’ve been given and you just try to learn what it is. Soccer was his gift. It provided an escape from Tourette’s — it absorbed that energy.”

He got a hot hand in the U.S. youth soccer leagues, began traveling around the country and, when he was only 18, went pro with the MetroStars in New York. It was there that he drew the attention of Manchester United, which in 2003 would bring him to the United Kingdom. There, he began to build his reputation as one of the world’s best — but his sickness took on greater importance.

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The British press, never known for its magnanimity, was particularly cruel. “We swear it’s true: Tourette’s sufferer is target for United,” taunted London’s Mirror. “United want American with brain disorder,” the Guardian snickered. “Manchester United trying to sign disabled goalkeeper,” the Independent offered. One Dutch newspaper called him “handicapped,” and another reportedly called him “retarded.”

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The fans were even worse. Whenever he made a save, Manchester fans would serenade him — “Tim-timminy, tim-timminy, tim-tim, te-roo, We’ve got Tim Howard and he says, ‘F— you!'”

During his second season with the team, he made some major blunders, one of which eliminated Manchester from the Champions League tournament in the 90th minute of the game. The press said he was “under scrutiny” and “way off the standard” and wondered whether his Tourette’s had worsened. “It was brutal,” he told the New Yorker. “It seemed like they wanted my downfall.”

He eventually rekindled his career elsewhere — and has since come to define the U.S. soccer team in a way few other players have, starting a record eight times in the World Cup as goalie for the team.

On Tuesday, however, it was unclear whether there would be any more World Cups for Howard. He is 35. The World Cup is a tournament pervaded by 20-somethings — and by the time the next one comes around he’ll be nearly 40.

But he says he’s not going anywhere. He’s most proud that he didn’t “allow myself to be restricted by Tourette’s syndrome.”

And today, “one of the biggest things I can do [for Tourette’s awareness] is be in the public eye,” he told Neurology Now. “I’m on television, ticcing and twitching. I think that’s kind of cool.”