Tourette is often described as causing ‘involuntary‘ motor and vocal tics.
But are tics really involuntary? It depends on who you ask.
Let’s look at the definition and why opinions may differ from person to person.
Many medical definitions describe them as ‘involuntary’
The NHS in the UK describes them as involuntary.
Tourette’s syndrome is a condition that causes a person to make involuntary sounds and movements called tics.nhs.uk
The CDC states that sufferers cannot prevent tics:
Tics are sudden twitches, movements, or sounds that people do repeatedly. People who have tics cannot stop their body from doing these things. For example, a person might keep blinking over and over. Or, a person might make a grunting sound unwillingly.cdc.gov
It seems that the many medical definitions are in agreement that tics are involuntary.
Involuntary may not be the best description
Imagine a bank robber holding up a bank.
The robber goes in and demands money from the bank teller.
The bank teller, clearly under huge pressure to give money, voluntarily hands the money over to the robber.
Although the worker voluntarily handed the money over, they were left with very little choice.
It would be unfair to say the employee voluntarily handed money over, although they did. This is why the employee’s job would probably be safe during an investigation.
Although the money was given voluntarily, there was incredible pressure to do so.
For some (but not all) of tic sufferers, this is an accurate way of describing the feeling of having to do a tic.
Voluntary, with a lot of pressure to do so.
The urge before the tic is involuntary, the tic itself can be voluntary
Another way to describe tics would be like scratching an itch.
We can all agree that the sensation of an itch is both unwanted and involuntary. It just happens from time to time.
Scratching that itch however, that is voluntary.
This is the most accurate way I can describe the pre-sensory urge and resulting tic.
We can choose not to act on the itch, but it stays and gets increasingly more difficult to ignore.
Eventually we give in, and scratch that itch.
Some ‘scratching’ can be subconscious however
We can sometimes scratch without knowing. It happens when we are lost in a movie or deep in conversation.
Interestingly, I found this passage over at the National Eczema Association (I will get back to tics, I promise!) on the topic of if scratching is voluntary:
Then who is in charge here? Neither your conscious mind nor your unconscious mind. You don’t direct the scratching, but you’re not aware of it either. Your scratch control center is directly linked to the healing part of the mind.nationaleczema.org
So here, the scratching is the grey area between conscious and unconscious.
I would say that many tics I experience fall into this grey area also.
Severe Tourette may make tics feel involuntary
Someone with severe Tourette may have an urge so strong the resulting tic feels automatic. The gap between an urge and the tic is practically non-existent.
I have talked to sufferers that don’t feel the pre-sensory urge, they just do the tic.
For them, the tic feels very much involuntary and not at all a choice.
It makes sense as to why medical professionals may describe tics as involuntary.
Professionals most likely assess patients with a more severe form of Tourette or tic disorder, severe enough to seek medical assistance.
The more severe cases may increase the likelihood that tics feel involuntary.
Are tics voluntary or involuntary? Conclusion
It is certainly a grey area, with no definitive answer.
My tics feel voluntary. An undesired but conscious reaction to an unwanted urge. However there are times my tics do feel subconscious.
Some people feel their tics are involuntary, with no pre-sensory urges before the tic comes out.
This leads me to believe not all tics are involuntary, but some certainly are.