@KaseiJin,
One fairly common myth, so it seems, amongst those who basically know of TS, is that those with the disorder go around blurtting out obscenities, or curse words (coprolalia). While of course some patients do let foul language come spilling out of their mouths, at the most of embarressing times even, or make obscene gestures (copropraxia), it is not true that all do; in fact, studies estimate that only from 10~15% of TS patients do so.
However a person with TS will most usually have tics, for example, they may make clicking noises, or grunts, or blurt out words or sentences over and over (more so in stressful situations). These do tend to wane and wax, and are of two types--simple and complex. One case study took note of how one patient would call his mother a slut, or tell her to f~ off, while shopping with her. At times the sexual vocalizations seem to be slightly environmentally casued--as when in a situation where there are girls around (in this case); also repeating portions of what has been said
(1)).
Motor tics might be in head jerking, arm waving, scratching, touching, hitting, or pointing, amoung other things. One famous Canadian surgeon (who last I heard was still giving winter semester lectures at the U of Arizona), Mort Doran, would slouch in awkward, distorted positions, tapping colleagues on on their shoulders with his toes while discussing, for example, an up-coming operation. There are also cases of those who spit, such as John Davidson (Galashiels, Scotland) who would always do so during family meals...trying to hit everyone's plates. (but they put up 'shields' [only the father totally refused to eat with the family]).
It has been reported that there is a greater tendency (again, urban myth) that these things are totally voluntary; they can be controlled to a great degree for some period of time, but these activities (tics) are in no way voluntary (
in the normal sense of the word). When professor Hollenbeck (Neurobologist at Purdue University [as of 2004]) taught his classes, the up and down movements of one arm, the twists of his head, and the barely audible sounds, all but disappear. He is quoted by Science (Vol 305, 3 Sept. '04; pp 1390-92) as saying that by the time the lectures were finished, the desire to tic was unbearable, and he'd rush back to his office to "tic, tic, tic" until that pressing urge had subsided--although tics were still there, but just that the urge that built up in stimulation had been released. When Dr. Doran goes in to do surgery, his tics are totally under control.
While it is a great incapacitation in many situations or cases, that is not always the case. Just as certain neurological abnormalities can give rise to greater function and capacity in other areas of brain build, TS does evidence a possible tendency to bring out an ability to concentrate (likely learned as a side task to conditioned suppression efforts) as seen in the areas of sports or music. John (above) was a very good basketball player, and his symptoms are at a lower level in game. Also, more famous sports people like Jim Eiesenreich (former Major League Baseball), Tim Howard (goal keeper for Manchester United), and Mike Johnston (relief pitcher for Pittsburgh Pirates), and Mahmoud Abdul-Rauf (former NBA player), as well as muscians like Michel Wolff, and another jazz drummer who says that TS really helps him focus in the rhythym, have TS. It is very possible that author Samuel Johnson may have had TS, and perhaps less sure, but possible, according to circumstantial evidence, that Wolfgang Mozart had had TS as well.
The 'urge' that comes up for the tics, and the OBC-like activity, is evidently the same that normal brain can, and has been shown to produce--a conscious (newer sense) brain thing, but not a matter of consciousness . . . not a voluntary execution of a command through a state of awareness and intent. (as has been demonstrated in open brain surgery). The fault most evidently strongly falls in inhibition loss in the systems that rely on, and make up, the basal ganglia.
The act itself, the tics and the persistent rituals are recognized and acknowledged by the state of consciousness having been activated, of course, and even the urge--the feeling that you just have to do it [perhaps like scratch that mesquito bite]--is cognized and recognized by the state of consciousness, but that sensation is brain working in an abnormal way which lies in the level of conscious brain which is below the threshold we call consciousness. (for this reason, the urge can not be surpressed, and builds up tension through spiking activity)
It has been contend that it is thinkable that the troubled girl who had formed the basis for the book (then movie) The Exorcist had had TS, and it had been misinterpreted by some observers as having had demonic possession. What appears (on the surface at least) to be contradictory in nature here, is that while brain is in control, the brain is not. That is because the element of cognizant volition in the realm of consciousness that is mind, is not able to execute inhibition of that part of the motor system that it otherwise can control through inhibition.
There are additional elements worth embedding, in the area of other sensory areas effects on M1, PMA, and SMA, before moving on with the outline, but a quick run-through of those systems might best be done firstly. I'm sure I'll be having a little more time to do so from the end of this week.
1. Often worded as repetitive sterotyped movements;
that is, echolalia, and echopraxia.