The Close Link Between OCD and TS Disabilities

Disability, through the scope of today's societal conventions, is rarely recognized as anything more than an impediment in the functioning of a human being. Most often disability is defined by its medical function, or malfunction, rather than its social implications and self-identifying concepts. In exploring these concepts of disability, the notion of disability as not only an identity, but as a catalyst for positive achievement in areas such as creativity and artistic expression must not be ignored, due to overwhelming social and scientific evidence that such links do exist. Today, the romanticized ideal of the troubled artist has a valid basis in reality, as the world of science discovers more and more about the brain and genetics. Where it was once simply hypothesized that many writers and other creative thinkers were manic-depressive, it can now be proven that certain intellectual characteristics are genetically linked to manic-depression. Such is the case for Tourette Syndrome (TS) and Obsessive Compulsive Disorder (OCD). As scientists uncover the genetic causes of TS and OCD and the specific areas of the brain that are affected by these disorders, they are continually discovering a fuller range of symptoms that accompany TS and OCD.

TS is a "neurobiological disorder characterized by tics - involuntary, rapid, sudden movements and/or vocal outburst that occur repeatedly"(Handler 207). Motor tics can range from the constant jerk of an arm or the roll of the neck to excessive jumping up and down or kicking of walls. Lowell Handler, a writer with TS, described, "feeling the need to jump in the air and kick the back of [his] thighs" as a teenager (Handler 2). Vocal tics are tics involving audible yelps, grunts, words, and phrases. The specific term for the uncontrolled outbursts of vulgarities and swear words is corprolalia. Handler writes that the urge to do a certain tic, "is like a build up or pressure, which must be relieved by an action" (Handler 92). Obsessive Compulsive Disorder is a mental anxiety disorder. Like TS, the exact causes of OCD are unknown. Experts strongly suspect that a biochemical imbalance is involved(Mental Health Web Page). It is believed that alterations in one or more brain chemical systems that regulate repetitive behaviors may be related to the cause of OCD (Mental Health Web Page). With OCD the words "obsessive" and "compulsive" need to be defined in order to understand the nature of the disorder.

Obsessions are "intrusive thoughts that force themselves into your mind"(Baer 9). They are "repetitive, difficult to control, annoying, and sometimes even frightening thoughts" (Handler 36). Compulsions on the other hand refer to actions one feels compelled to carry out. They are performed in response to an obsession (Baer 9). The actions that people with TS and OCD often do in response to their unbearable urges elicit both negative and positive responses from others who do not have these disorders. Some are thought of as "crazy", while others, especially those with TS, are seen as entertaining and popular; as Handler writes, "Tourette is often accompanied by a quick wit and agile intelligence that provide a coping mechanism through different social situations" (89). It is necessary to make the distinction between mentally ill persons, and persons with OCD and TS. Besides the tics and overwhelming obsessions and compulsions, people with OCD and TS remain in touch with reality and are in fact sane. (Baer 8).

TS and OCD are very closely related. In most cases patients with TS also experience obsessive-compulsive behavior and patients with OCD exhibit tics (Chase 83). One such hypothesis is that there exists "a genetic linkage between TS and OCD"(33). The difference between tics and compulsions is that "motor tics, although they can be complex and may dispel an 'urge' or a build-up of tension, are not instigated by a thought and not typically accompanied by anxiety"(83). One important similarity is that both tics and compulsions give temporary relief to the TS/OCD patient. In regards to a TS and OCD personality it is best to think of them as on a spectrum - where one ends and the other begins is very muddled.

Now that the basic science and symptoms behind TS and OCD have been reviewed, one is able to begin the process of linking these disorders with the creative process. Although many environmental factors may contribute to creative thought, it is conjectured that certain personality traits make a person more susceptible to creative endeavors. First, TS/OCD is strongly connected to creativity in a physiological manner. The distinguishing characteristic of TS is ticcing. Although the ticking of TS is a motor function, it is not completely confined to the motor domain (Chase 213). It is believed that "the neuroanatomical substrate underlying symptoms in TS is assumed to include Limbic as well as motor mechanisms"(Chase 213). The Limbic System is a very integral part of the emotional center to the brain. It holds "many secrets related to the chemistry of consciousness and emotion"(Groch 277). It performs important physiological functions by which the body expresses emotion. Emotions are an integral part of the creative process, as those with a creative mind have an "openness to all their feelings and reactions [that distinguishes] them - according to psychologists who have studied them - from others less able to confront their emotions"(John-Steiner 67).

Because ticking. has an emotional source, TS patients may be drawn to creative activities that delve into their emotions. They may even feel less of a need to tic when immersed in a creative act. Creative exploits dealing with emotions give TS patients a feeling of "satisfaction" that they normally feel when completing a tic. Lowell Handler describes his love for photography: "When a photograph communicates emotionally it transcends the act and becomes an art. After I complete a day's assignment, I feel satisfied, as if I have really accomplished something" (Handler 65). Another TS patient, that calls himself Witty Ticky Ray, states that he "could scarcely have survived - emotionally or economically - had he not been a weekend jazz drummer of real virtuosity". Because a creative activity engages the brain for a long uninterrupted amount of time, that feeling of "satisfaction" may even last longer than the feeling after the completion of a tic, providing a strong incentive to partake in these actions.

The basal ganglia seems to also play an important role in TS. The basal ganglia "serve as way stations for a variety of sensory inputs" (Treffert 181). Because of the relationship between the basal ganglia and TS, many tics are sensory related. An example of this is a Touretter's need to touch objects repeatedly. Because of these tactile urges, TS patients feel that they sometimes develop a "heightened sensitivity to things that most others would not be at all attentive towards"(Saslow). Individuals with TS have such a heightened sensitivity that they can tell which way the elastic in their socks is directed without even looking. The way any person perceives the world is through his/her senses. Because TS patients have senses that are heightened and altered they are given a unique outlook on their surroundings. They see and feel things in the world that others will never notice. Part of the creative process is portraying the world with a unique perspective. This is not to say that people without TS/OCD are not afforded a unique perspective or outlook on life; however the symptoms of TS/OCD only strengthen the minds perception and sensitivity to the aspects of life that procure exceptional creative work.
The psychology of creativity runs parallel to the psychology of TS/OCD. Both creative thinkers and TS/OCD patients tend to live on the fringes of society. Creative thought "involves the rejection of the established order [thus] the creative person is likely to appear rebellious, eccentric, even 'crazy'"(Groch 224). When people depend on the "rules of society to give order to their consciousness [they] become anxious", and with this anxiousness comes the inability to create on one's own terms (Csikszentmihalyi 86). This leads one to ask the question, who then is truly disabled? TS/OCD patients cannot rely on the rules of society because no matter how hard they try it is impossible for them to abide to them. Their odd behavior usually scares people away from them and they are in turn misunderstood. Many famous people in history who were deemed crazy or eccentric actually suffered from OCD (Baer 5). Lowell Handler realized during his many travels across the United States that he was "an outcast even among outcasts"(Handler 19). The TS/OCD sufferer, much like the artist, is exiled to the "periphery of society" (Groch 224).

Much of what pushes creative minds to the periphery of society is their unique way of thinking. Although this type of thinking can be alienating it can also have its rewards. One benefit is that creative minds have more of a potential to experience the pinnacle of creative thought - "flow." The "flow" state is "an altered awareness found in people performing at their peak"(Goleman 22). It is when the artist falls in love with the simple act of creating. A painter who most savors "the joy of painting itself, valuing process more than product" is more likely to stay with painting even if he does not find financial success(Goleman 22). Flow is when creative and "psychic energy flows effortlessly" (Csikszentmihalyi 39). There exists an unpredictable pattern that varies from artist to artist. Finding and mastering this pattern is part of surrendering to flow. That is what the creative process consists of - discovering this pattern within oneself. By being "totally faithful to one's own individuality, we are actually following a very intricate design"(Nachmanovitch 26). The final creation is the culmination of an artist laying his/her soul bare. Each piece of art one creates "… reflects our own mind back at us, complete with all its imperfections, exactly as it is"(Nachmanovitch 25).

The internal pattern of TS/OCD is a unique and amazing one. When a TS patient learns more about himself and his infliction he begins to discover that "there is an order to it, a dance of symptomatology"(Monaghan 12). Every tic that seems so strange to those without TS is a tic that is deeply imbedded within the psyche. Lowell Handler explains his TS as "a rhythm of energy, movement, sound, discovery, touch, smell, taste, feel, and sight"(Monaghan 12). Because TS/OCD patients have such a unique internal rhythm, they have the ability to find their flow and create in this systematic rhythm.

Many different cognitive skills bring on flow. One of these skills is exploration and play. Playing is exploring just for the fun of it. In fact "creativity has much in common with play"(Boden 46)51. Uninhibited play leads to many surprising discoveries that a more orthodox approach may never find. By playing, a person frees himself "from arbitrary restrictions and expands [his] field of action"(Nachmanovitch 43), and those who are more susceptible to flow are revealed as " people who seem to enjoy situations that ordinary persons would find unbearable" or uninteresting (Csikszentmihalyi 90).

Obsessive exploring of the environment is a very common symptom of TS/OCD persons. The following account illustrates a particular Touretter's incessant exploration of his environment:
"The young man's exploratory behavior was extreme and was certainly drawing attention. Everything on the street attracted him, a tree, an iron grid work, a trash bin. He examined the objects compulsively and with all his senses. He looked, listened, touched. He smelled them by bringing his face very close to the objects, and tasted them by licking them with his tongue"(Goldberg xvi).

By exploring their environment with all their senses, creative minds and TS/OCD patients alike are actually exploring the playing field of their mind as well. Each touch, each smell, and each observation causes electrical explosions and reactions in the brain of a TS/OCD patient. Each explosion and reaction leads to ideas, connections and revelations that can be acted upon.
Because of their impulsive nature, TS/OCD patients often lack inhibitions that cause ordinary people to feel uncomfortable just "fooling around." This lack of inhibitions "can lead to a greater sense of playfulness, a greater sense of creativity...and a liveliness"(Saslow). A common characteristic TS patients have is their obsession with playing with words. They often become "lost in the amusement park of the mind where they can spend hours turning over the vocal and mental variations in form, inflection, pitch, and even the meaning of a word or phrase"(Handler 37), thereby analyzing and using language in a way English major's only dream about.

Culturally, the representations of TS/OCD present in today's society seem to support the claim of intensified creative thought in people with TS/OCD. In Motherless Brooklyn, the very fact that the protagonist has TS forces him to mull over small details that would otherwise go unnoticed by his coworkers, which in turn leads him to be an excellent investigator. Although his ticcing and corprolalia often make him a subject of entertainment for his coworkers, they also allow him to deconstruct the details of cases and in turn creatively construct the investigations. Likewise, in As Good as it Gets, Jack Nicholson's character is a talented writer who also has a severe case of OCD. His obsessions and neuroses alienate him from society and from himself, yet his mind works as a pathway to free his self from the constraints physical and mental constraints of OCD. Just like the protagonist in Motherless Brooklyn, Jack Nicholson's character's behavior is used to entertain and amuse the viewer. His actions seem outrageous; yet they are recognized as part of his being and as a strong influence in his writing. These cultural constructions of TS/OCD fit the romanticized ideal of the "troubled artist" and contribute to the societal conceptions of the "freak show"; being awed and amused by the amazing talents and feats of the handicapped and disabled.

Although this paper links TS/OCD with creativity, there can be no absolutes to this argument. Just because one has TS or OCD does not necessarily mean that they will definitely be exceptionally creative. And just because someone does not have TS/OCD does not mean that they are incapable of creative thinking. Making claims like these would be similar to saying that just because one may have a genetic predisposition to alcoholism they will definitely become an alcoholic. There are a multitude of factors that contribute to both creativity and alcoholism: social and cultural environment, upbringing, genetics, etc. TS/OCD provide just another link, albeit a strong one, to the creative process for those people who experience their symptoms, enhancing the likelihood of personal creativity.

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