Tourette's syndrome and creativity.

Benjamin Simkin's article on Mozart and Gilles de la Tourette syndrome in this issue provides at least circumstantial evidence that Mozart may have had the hyperactivity, tics, sudden impulses and odd motor behaviours, echolalia, palilalia, love of nonsense words, and driven inner rhythms that so often accompany Tourette's syndrome (p 1563). ' Further evidence has been provided by Gunne.2 The case for Mozart's having Tourette's syndrome does not strike me as entirely convincing. But the case for Samuel Johnson having the syndrome, though also circumstantial, is extremely strong and, to my mind, entirely convincing. Johnson was observed to have innumerable strange rituals and compulsions, tics, gesticulations, and a great range of involuntary ejaculations and mimicries. One cannot avoid thinking that his enormous spontaneity, antics, and lightning quick wit had an organic connection with his accelerated motor impulsive state.3 If this was just a question of pathologising it would be of limited interest. The real question is whether Mozart and Johnson were singular characters, and creators, despite having Tourette's syndrome, or whether their Tourette's played a significant part in, lent a particular flavour to, their character and creativity. And what, in general, is the relation of Tourette's to personality and creativity? The matter is complicated because there are different forms of the syndrome. At one extreme is the stereotypic form with its simple motor tics, iterations, perseverations, and brief, explosive vocalisations. At the other extreme is an elaborate, innovatory, phantasmagoric form which is especially remarkable for its mimicry, antics, playfulness, extravagance, impudence, audacity, inventions, dramatisations, unexpected and sometimes surreal associations, intense and uninhibited affects, speed, "go," vivid imagery and memory, hunger for stimuli and incontinent reactivity, and constant reaching into inner and outer worlds for new material to Tourettise, to permute and transform. Stereotypic Tourette's syndrome is usually regarded as a distress, perhaps a disability, an irrelevance, and annoyance, or, in the words of one patient, "completely useless. " If one is creative one may be so despite such Tourette's, as with a Tourettic surgeon I have recently described.4 (I now know eight surgeons with Tourette's, as well as an internist, two neurologists, an obstetrician, and a psychiatrist.) But phantasmagoric Tourette's syndrome is another matter entirely, and while it can also cause much distress and disability it can hardly fail to touch, to interact with, a person's character and creativity and even to lend that person some of its own striking "character. " This was clear with my patient "Witty Ticcy Ray," who believed that there was a close analogy between his wit and his tics and spoke of his "ticcy witticisms" and his "witty ticcicisms," feeling both as expressions ofthe sudden, unexpected swerves and twists, the irruptions and interruptions, in his mental and motor stream.5 Similarly, when playing ping pong he would make "sudden, nervous, frivolous shots"-shots which, without being illegal, were so fast, so unpredictable, as to be unanswerable. (Similar, stunning "motor genius" may be seen in some patients after encephalitis.6) And with music, too: he was a weekend drummer of real virtuosity, well known for his sudden and wild improvisations. These too, while arising from a tic or a compulsive hitting of a drum, would be elaborated into entire Tourettic performances.5 In a recent autobiographical sketch by another jazz musician, David Aldridge writes of this inseparability of Tourette's and creativity: "Rhythm and Tourette Syndrome have been intertwined from the first day I found that drumming on a table could mask my jerky hand, leg and neck movements . could harness my unbounding [Tourettic] energy, directing it into an orderly flow. "7 Aldridge goes on to describe how, with jazz, the "rollercoaster ride" of Tourette's syndrome could be transformed because he was riding it, commanding it, not it him. A similar conjunction of the syndrome and creativity is responsible for the "tic dancing" so popular at the Tourette Syndrome Association's socials. Artists and writers may use their Tourette's. For one gifted Tourettic artist of my acquaintance the half convulsive excitement of Tourette's continually stimulates his perceptions and imagination, producing a ceaseless stream of extraordinary images. Some of these are trivial, some absurd, but many have a deep creative force and lend his art a range, intensity, exuberance, and surreal or dreamlike quality which one feels, he feels, it might not otherwise have. And I know of one Tourettic writer with two strikingly different modes of writing. In one he is at pains to resist his Tourette's and writes short, sober, rather formal essays and reviews; in the other he lets himself go and, at great speed, writes huge, meandering, fantastical (and often coprolalic) novels, in which he gives his Tourettic fancies full rein. Pavlov speaks of "the blind force of the subcortex": Tourette's syndrome is such a force-blind, impersonal-but one that erupts within the particularity of the individual. Luria, similarly, when speaking of the effects of a physio-