It’s not Me, It’s You – Social Repercussions of Tic Disorders

This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare two 1,000ish word posts on a particular class of mental disorders.

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It’s not Me, It’s You – Social Repercussions of Tic Disorders by Melody Reynalds

We are often told that we are unique and distinct individuals, unlike any other. We embrace this idea while simultaneously presenting ourselves to fit in with the rest of society. We are normal. We are unique and we are normal. How does this make sense and what is normal anyway? Who of us have not altered some aspect of ourselves when we did not feel normal, so as to camouflage our abnormality in the midst of a judgmental culture? As it turns out, the camouflage itself is perfectly normal. In other words, it is normal to feel abnormal. So who decides what normal is? As it turns out, you and I do.

Social norms are unwritten rules about how to behave. These norms direct us in how to display our behavior in particular social groups or cultural situations. We feel pressure to conform to social roles, conforming to the expectations of others and responding to their approval when we play our roles well. When we do not play our roles well, though, we are subjected to disapproval. It is instinctive for us to play the societal chameleon, and we have learned to adapt to various settings based on what is expected of us. The labels that we carry may assist us in fitting in, helping us to form relationships if our label has been deemed acceptable. On the other hand, if our label is not acceptable, this will hinder our social status and ability to form relationships. But where do the labels come from? You may be surprised to understand that a large part of our own labels come from within us.

Self-Perception Theory explains how we draw inferences about who we are based on observations of our own behavior. The theory further explains how we sometimes jump to conclusions, believing truths about ourselves that are perhaps not true at all. For example, I have observed myself indulging in very greasy and fatty Mexican food. This behavior triggers an idea that I am gluttonous and unhealthy. I begin to feel badly about myself because of this new truth that I have discovered based on my indulgent behavior. In reality, I very rarely eat any type of greasy or fatty food and I make a habit of exercising five times per week. I have labeled myself incorrectly and may begin to play the part of my new role, though reality may not be consistent with my new belief of myself. This example may seem obviously contradictory, yet you would be surprised at how often we believe faulty impressions about ourselves.

We also label others based on their behaviors. People are very good at making quick judgments based on minimal information. We base our impressions on social norms and expectations, mentally categorizing people into different groups based on common characteristics. Our perception of people, based on those characteristics, create their societal label. Likewise, their perception of us contributes to our label. We treat others and ourselves according to the assumed label that has been assigned. As we have discussed, our perceptions can often be faulty. If we cannot even perceive ourselves accurately, then we would certainly be less accurate in perceiving who others are based only on the characteristics that we are aware of.

Making quick assumptions can be useful in the interest of saving time. However, it can also be detrimental to certain individuals who are incorrectly labeled time after time. Those who endure the signs and symptoms associated with a mental health diagnosis experience first-hand how a behavior deemed as socially unacceptable can shape a societal label. Culture may tell us that someone with a mental illness is “not like everyone else” or that a person with mental illness is less worthy than someone without an illness. These ideas are based on perceptions which can be changed. Ideally, these perceptions should be changed since they are largely incongruent with reality. In fact, the entire notion of mental illness is based on a social construct. Rather, mental illness is a label that deviates from what has been determined as “normal”. This does not mean that mental illness is not real. It certainly is to the extent that it interferes with cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. This definition comes from the most recently revised version of the Diagnostic and Statistical Manual of Mental Disorders, although it is not without controversy.

The behaviors associated with tic disorders are perhaps more scrutinized than other abnormal behaviors because of their obvious outward display (seen below).

Tics are characterized by sudden twitches, movements, or sounds that people do repeatedly. Tourette’s syndrome is a commonly recognized type of tic disorder that is associated with repetitive motor and vocal tics. Simple tics may go largely unnoticed, while complex tics are usually more apparent. Tourette’s syndrome is distinguished by multiple motor tics as well as at least one vocal tic that has lasted for at least 12 months.

Tics are certainly behaviors that are susceptible to the judgment of society. As the pressures of maintaining normalcy can be devastating for those of us who do not display overt signs of a mental illness (though we all possess some degree of abnormality, displayed or not), imagine the judgment that you might endure while walking down the street, blurting out random words and flailing your limbs. While adaptation into society often involves changing our role to fit specific settings or perhaps suppressing an abnormality, this chameleon-type modification is not an option for people who experience a tic disorder. Motor tics can have damaging effects on social relationships and may contribute to increased risk for a poor quality of life outcome.

Although it may be difficult to form relationships with a tic disorder, it is not the presence of tics that is most disabling, but rather the presence of co-occurring anxiety that is often present in individuals who happen to have a tic disorder. You would be anxious as well if your daily life consisted of the less –than-empathetic-glances that someone with a tic disorder often has to face, not to mention the fear of offending a bystander unintentionally. As it turns out, tics are rarely incapacitating at all and it is more often social attitudes about physical and vocal tics that cause problems in typical social settings, such as the work place.

Let us re-think the way we perceive and treat others who stray from our mental categories. In reality, people do not fit neatly into specific classifications. We are unique and distinct individuals who all deviate from the social norm to some extent. Our perceptions deceive us when they are inconsistent with what is real. You may not have noticed, but we all possess traits of abnormality, and that’s perfectly normal.