EDITOR’S NOTE: This multipart series first appeared in the March 2010 edition of the Journal of Clinical Psychology Practice and also can be found on Life’s A Twitch, a website run by Canadian psychologist Dr. B. Duncan McKinlay.
The itches come …
The best analogy for describing the premonitory urge sensations preceding most tics is that of an itch. Saying it is like a sneeze implies that tics are some unstoppable force set in motion by a tickle. Yet tics ARE at times stoppable. On the other hand, itches are slippery things — resistible, yes, but crafty. Akin to balancing a tray full of water, the slightest waver in vigilance slops a little over the side — made worse by reactive attempts to compensate.
Again, the itches come …
To call premonitory urges “sensory” sensations isn’t quite accurate either: It is not simply a matter of the tactile volume being turned too high. The impression is of a deeper more subcutaneous itch, the satiation of which is maddening in its elusiveness. It is a nagging sense of incompletion, a sort of magnified Zeigarnik effect multiplied across countless “unfinished” tasks.
Yet again, and always again, the itches come …
Like a bored and aggravating younger sibling my premonitory urges follow me, eagerly watching over my shoulder and messing with my stuff. Their omnipresence is grating; permanent, incessant and insistent. Never satisfied for long, and rubbing my nerves raw without reprieve.
At times they pulse: a localized flower of adrenaline bursting within my chest. At other times they are a vibration coursing through my body: a generalized unrest eliciting jolting paroxysms. At still other times they are a smouldering flame: biding their time, awaiting the opportunity to worm through my defences.
Tics themselves are the scratch these urges demand. As a child I was taught my itches meant I was strange so I concealed my scratching as best I could. Recurring “scream dreams,” in which I was immobilized within a straight-jacket and locked away in a padded room, plagued me. In night all who I had ever loved learned my bizarre secret and angrily renounced me; in day I did everything possible to prevent the same.
The scratch is a voluntary behaviour in the same sense that my signing a document with a gun held to my head would be a voluntary behaviour. It is chosen and purposeful and provides gratification, yes, but the deck is most certainly stacked. I am compelled. Yell at me, mortify, ridicule or punish me for ticcing and I’ll likely stop — at least for a while. But that’s only because you’ve temporarily produced a bigger gun.
Tics can certainly feel involuntary though: I couldn’t pray away the urge, my attempts to just stop failed regardless of how much I punched myself, and I felt powerless to change the misperceptions of those around me. This led to alternating feelings of anxiety, anger and suicidal depression.
Over time my automatic capitulation had created the illusion of uncontrollability, thus helplessness. I could hold off, but why? The distress seemed everlasting save one solution. To delay its execution served no purpose other than to prolong my misery. Such is the nature of negative reinforcement.