TikTok Tourette's

“Development of new approaches in mass communication, most recently the Internet, increase the ability to enhance outbreaks through communication.”

That ominous prophecy is from a 1997 paper, and the CDC-scientist author is addressing the phenomenon of “epidemic hysteria.” That is: mass outbreak of disease symptoms with no natural cause, and spread among people “who share beliefs related to those symptoms.”

I came across the paper after reading about the surprising recent emergence of clusters of Tourette syndrome — which involves involuntary physical or verbal tics — particularly among young girls spending time on TikTok. Rather than actual Tourette's, the outbreaks seem to be what is sometimes called “mass hysteria.”

The 1997 paper, which reviews a century of research on mass hysteria, points out that outbreaks fall into two symptom categories: the “anxiety variant” and the “motor variant.”

The anxiety variant involves symptoms like stomach pain, nausea, vomiting, headache, fatigue, and dizziness. A classic example: in 1988, a local water supply in Camelford, England was contaminated with aluminum phosphate. As the water company fumbled in its response, public outrage grew, and hundreds of people reported illness. A subsequent investigation determined that those people were suffering, but that their symptoms were the result of the viral spread of anxiety in the community — with one person’s symptoms making their acquaintances more likely to show symptoms— not of any chemical exposure.

The motor variant of epidemic hysteria is characterized by apparently uncontrollable physical movements, and it has a long, bizarre lineage. Historians have documented a number of “dancing plagues” in the Middle Ages, in which groups of people gyrated, convulsed, or danced wildly in public for days (or longer), as if in a trance, to the point of injury — or perhaps even death. The outbreaks would start small, but spread like a contagion.

Among the common factors of mass hysteria in both anxiety and motor variant outbreaks were strong cultural cohesion among the affected people — schools, factories, or small towns were often ground zero — and very high levels of stress. Medieval dancing plagues, for example, were preceded by events that shattered close-knit communities, like devastating floods or bitter famine.

According to the 1997 review paper, the motor variant of epidemic hysteria was thought — at least in modern Western society — to have been entirely replaced by the anxiety variant. And yet, the paper notes, the motor variant still pops up from time to time, and could become more common if cultural contagion can spread on the Internet. Which brings me to the news…

“Mass Social Media-Induced Illness”

About those recent headlines: Tourette's is not a contagious disease, so the sudden emergence of clusters all over the world doesn’t make a ton of sense.

Needless to say, there isn’t some new, Tourette's-causing chemical in the water. Rather, as predicted by the 1997 paper — which, perhaps not coincidentally, was published the same year as the creation of the first social media site — the Internet has proven a source of innovation for social contagion.

A fascinating new paper by a group of German psychiatrists traced one of the recent outbreaks to its source, and proposed a new medical term: “mass social media-induced illness,” or MSMI.

The psychiatrists focus on an early-20s German man named Jan Zimmermann, who on February 21st, 2019, launched a YouTube channel titled “Gewitter im Kopf” — translation: “Thunderstorm in the Brain.” Based on the videos, the psychiatrists write that Zimmermann probably legitimately suffers from a mild form of Tourette syndrome. On his channel, however, he displays a large number of different physical movements and blurts words and phrases that he portrays as symptoms of Tourette’s, but that apparently are not.

“Tourette experts can easily tell the difference,” the psychiatrists write. Unlike real Tourette's tics, many of Zimmermann’s behaviors are not random, but appear connected to the context in the video, like “exclamations of long sentences with insults, swear words, and obscenities that are in this form unknown in Tourette syndrome.”

Furthermore, according to the psychiatrists, Zimmermann employs a vastly larger repertoire of obscenities and insults than occur as legitimate Tourette's tics. And if that’s not convincing enough: his symptoms change “nearly on a weekly basis” as new videos are released, but the “most popular” symptoms tend to get repeated. And now I shall coin a new medical term: YouTube algorithmically induced Tourette-like syndrome. In other words, the psychiatrists contend that Zimmermann is curating his tics according to viewership.

Seems like it's working. Zimmermann’s channel spread like grassfire; within three months, he had a million subscribers. By the summer of 2019, there was a mobile app with his most popular verbal outbursts, and his videos had been viewed 300 million times. Business was booming. Meanwhile, Tourette's advocacy groups in Germany distanced themselves from Zimmermann’s channel because of “obvious misrepresentations and disrespect to people with Tourette syndrome.”

Then the patients started showing up.

The German Outbreak

In June 2019, a Tourette syndrome outpatient clinic — where the psychiatrists who wrote the new paper work — got its first unusual case. Dozens of teenagers soon followed. By the time they were referred to the clinic, some had already been put on drugs — to no avail.

Very conspicuously, all of the patients presented with similar tics; they shouted phrases like “Heil Hitler!” (a German classic), “and “fliegende haie” — “flying sharks” (not a German classic that I’m aware of). Some were throwing pens in school or dishes at home, and crushing eggs in the kitchen. They also shared the unusual practice of naming their affliction. (Zimmermann calls his “Gisela.”) Eventually, the psychiatrists learned that all of their new patients had been watching and sharing Zimmermann’s videos.

As news stations picked up on the epidemic, some of the clinic’s patients appeared on TV. Those clips were then shared on social media, exacerbating the social contagion of symptoms.

Fortunately — for some patients — their symptoms vanished once they were convinced that they couldn’t possibly have Tourette syndrome. But not for all of them; some needed sustained therapy.

Anxiety Triggers

One of the questions I was left with after reading the psychiatrists’ paper: If some patients could be cured simply by being told they didn't have Tourette's, does that mean they all were faking it?

I wrote to professor Kirsten Müller-Vahl, lead author of the new paper, asking how to think about these symptoms. Here is Müller-Vahl's reply:

A functional neurological disorder means that there "is a problem with the functioning of the nervous system and how the brain and body sends and/or receives signals, rather than a structural disease process" like Tourette's, or multiple sclerosis. Back to Müller-Vahl:

So in this case, it seems, a signal processing problem occurs in individuals who are already vulnerable and exposed to a suggestive trigger — like the videos they're binging.

And here is the weighty, zoomed-out description Müller-Vahl and colleagues provide toward the end of their paper:

That's more than I can quickly digest. But just like those medieval dancing plagues — in which cohesive social groups under extreme stress displayed bizarre movement patterns — the psychiatrists are arguing that the pandemic and pervasive climate change anxiety have laid the groundwork for a mass stress response to spread among young people who are worrying about the same things, watching the same things, and connected on social media.

The good news is that the sudden rise in Tourette's-like symptoms is not a reflection of underlying neurological disease. But as with more common responses to stress, like talking too fast (✋), the fact that it has a psychological component doesn’t mean that it’s instantly fixable. The foreboding news is that similar outbreaks have now been reported in at least six countries; and, ya know, social media — and TikTok in particular — isn’t getting less popular.

The psychiatrists conclude that the modern versions of medieval dancing plagues are no longer contained to local communities, and — unless we do something to curb them — we should expect mass social media-induced illness to represent a growing burden on the healthcare system.

What to Do

Among the remedies that the psychiatrists suggest is that the media share the opinions of Tourette's experts far and wide so that these sorts of outbreaks will be recognized by doctors and families for what they are, and hopefully contained.

So I just tried to do my part to spread the word. But another aspect of Müller-Vahl's comment that struck me — and that stood out in the paper and in accounts of medieval dancing plagues — is that afflicted people were already vulnerable. Perhaps, as a society, we should be better prepared.

Maybe we should think about stress management, and skills for coping with anxiety, as part of a basic education. Maybe healthier social media habits should be in there too.

Most of us will never have to worry about developing tics, but I doubt there's a single person on social media who doesn't suffer some ill effects — alongside the benefits. I have two tactics that have helped make my social media experience less stressful: 1) I don't argue on Twitter 2) When I catch myself doomscrolling, instead of continuing mindlessly, I find a specific question to investigate; then I'm in control as opposed to the feed being in control.

If you have any habits that improve your experience of social media, let me know in the comments. I'm eager to share (and to steal) some good ideas.

David's Digressions

I only have one this week, and it’s weird. The last time I remember thinking about mass hysteria was in an elevator with Tony Robbins at CNN in 2012. (Good tease, right??)

Back when I was at Sports Illustrated, I used to go on CNN now and then. (In 2012, it was usually about Lance Armstrong.) On one such occasion, Tony Robbins and his retinue of several young people stepped into an elevator after me, all of us headed to studios.

My first thought was to laugh, because I was reminded of the ridiculous scene in Shallow Hal when Robbins is stuck in an elevator with Jack Black, and alters Black’s consciousness so that he’ll be attracted to people based on their inner beauty. My time in an elevator with Robbins was comparatively brief, and I was the one who stepped up with an assist.

Robbins’s helpers had these binders they were flipping through to prep him for his appearance, but they weren’t finding what he wanted. He kept asking if they could remind him about a particular recent story that sounded like a case of social contagion. I knew what he was talking about — it had just been a big story in the New York Times: “What Happened to the Girls in Le Roy?” So after a short period of futile binder flipping, I decided to pull it up on my phone and show it to them. Robbins was excited, and e-mailed himself the article from my phone. When he gave it back, he said something like: “Now you have my email, so don’t start stalking me!”

I’m sure he was kidding, but “thanks” would’ve been less awkward. In any case, all these years later, I think it’s fair to say that I’m absolved of stalking-Tony-Robbins suspicions.

On that exculpatory note: Thank you for reading. See you next week, when Range Widely will get less weird...I think. It has to, right??

David

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