‘Street-neurology’, indeed, has respectable antecedents. James Parkinson, as inveterate a walker of the streets of London as Charles Dickens was to be, forty years later, delineated the disease that bears his name, not in his office, but in the teeming streets of London. Parkinsonism, indeed, cannot be fully seen, comprehended, in the clinic; it requires an open, complexly interactional space for the full revelation of its peculiar character (beautifully shown in Jonathan Miller’s film Ivan). Parkinsonism has to be seen, to be fully comprehended, in the world, and if this is true of Parkinsonism, how much truer must it be of Tourette’s. Indeed an extraordinary description from within of an imitative and antic ticqueur in the streets of Paris is given in ‘Les confidences d’un ticqueur’ which prefaces Meige and Feindel’s great book Tics (1901), and a vignette of a manneristic ticqueur, also in the streets of Paris, is provided by the poet Rilke in The Notebook of Malte Laurids Brigge. Thus it was not just seeing Ray in my office but what I saw the next day that was such a revelation to me. And one scene, in particular, was so singular that it remains in my memory today as vivid as it was the day I saw it.
My eye was caught by a grey-haired woman in her sixties, who was apparently the centre of a most amazing disturbance, though what was happening, what was so disturbing, was not at first clear to me. Was she having a fit? What on earth was convulsing her— and, by a sort of sympathy or contagion, also convulsing everyone whom she gnashingly, ticcily passed?
As I drew closer I saw what was happening. She was imitating the passers-by—if ‘imitation’ is not too pallid, too passive, a word. Should we say, rather, that she was caricaturing everyone she passed? Within a second, a split-second, she ‘had’ them all.
I have seen countless mimes and mimics, clowns and antics, but nothing touched the horrible wonder I now beheld: this virtually instantaneous, automatic and convulsive mirroring of every face and figure. But it was not just an imitation, extraordinary as this would have been in itself. The woman not only took on, and took in, the features of countless people, she took them off. Every mirroring was also a parody, a mocking, an exaggeration of salient gestures and expressions, but an exaggeration in itself no less convulsive than intentional—a consequence of the violent acceleration and distortion of all her motions. Thus a slow smile, monstrously accelerated, would become a violent, milliseconds-long grimace; an ample gesture, accelerated, would become a farcical convulsive movement.
In the course of a short city-block this frantic old woman frenetically caricatured the features of forty or fifty passers-by, in a quick-fire sequence of kaleidoscopic imitations, each lasting a second or two, sometimes less, and the whole dizzying sequence scarcely more than two minutes.
And there were ludicrous imitations of the second and third order; for the people in the street, startled, outraged, bewildered by her imitations, took on these expressions in reaction to her; and those expressions, in turn, were re-reflected, re-directed, re-distorted, by the Touretter, causing a still greater degree of outrage and shock. This grotesque, involuntary resonance, or mutuality, by which everyone was drawn into an absurdly amplifying interaction, was the source of the disturbance I had seen from a distance. This woman who, becoming everybody, lost her own self, became nobody. This woman with a thousand faces, masks, personae—how must it be for her in this whirlwind of identities? The answer came soon—and not a second too late; for the build-up of pressures, both hers and others’, was fast approaching the point of explosion. Suddenly, desperately, the old woman turned aside, into an alley-way which led off the main street. And there, with all the appearances of a woman violently sick, she expelled, tremendously accelerated and abbreviated, all the gestures, the postures, the expressions, the demeanours, the entire behavioural repertoires, of the past forty or fifty people she had passed. She delivered one vast, pantomimic egurgitation, in which the engorged identities of the last fifty people who had possessed her were spewed out. And if the taking-in had lasted two minutes, the throwing-out was a single exhalation—fifty people in ten seconds, a fifth of a second or less for the time-foreshortened repertoire of each person.
I was later to spend hundreds of hours, talking to, observing, taping, learning from, Tourette patients. Yet nothing, I think, taught me as much, as swiftly, as penetratingly, as overwhelmingly as that phantasmagoric two minutes in a New York street.
It came to me in this moment that such ‘super-Touretters’ must be placed, by an organic quirk, through no fault of their own, in a most extraordinary, indeed unique, existential position, which has some analogies to that of raging ‘super-Korsakov’s’, but, of course, has a quite different genesis—and aim. Both can be driven to incoherence, to identity-delirium. The Korsakovian, perhaps mercifully, never knows it, but the Touretter perceives his plight with excruciating, and perhaps finally ironic, acuity, though he may be unable, or unwilling, to do much about it.
For where the Korsakovian is driven by amnesia, absence, the Touretter is driven by extravagant impulse—impulse of which he is both the creator and the victim, impulse he may repudiate, but cannot disown. Thus he is impelled, as the Korsakovian is not, into an ambiguous relation with his disorder: vanquishing it, being vanquished by it, playing with it—there is every variety of conflict and collusion.
Lacking the normal, protective barriers of inhibition, the normal, organically determined boundaries of self, the Touretter’s ego is subject to a lifelong bombardment. He is beguiled, assailed, by impulses from within and without, impulses which are organic and convulsive, but also personal (or rather pseudo-personal) and seductive. How will, how can, the ego stand this bombardment? Will identity survive? Can it develop, in face of such a shattering, such pressures—or will it be overwhelmed, to produce a Tourettized soul (in the poignant words of a patient I was later to see)? There is a physiological, an existential, almost a theological pressure upon the soul of the Touretter—whether it can be held whole and sovereign, or whether it will be taken over, possessed and dispossessed, by every immediacy and impulse.
Hume, as we have noted, wrote:
I venture to affirm . . . that [we] are nothing but a bundle or collection of different sensations, succeeding one another with inconceivable rapidity, and in a perpetual flux and movement.
Thus, for Hume, personal identity is a fiction—we do not exist, we are but a consecution of sensations, or perceptions.
This is clearly not the case with a normal human being, because he owns his own perceptions. They are not a mere flux, but his own, united by an abiding individuality or self. But what Hume describes may be precisely the case for a being as unstable as a super-Touretter, whose life is, to some extent, a consecution of random or convulsive perceptions and motions, a phantasmagoric fluttering with no centre or sense. To this extent he is a ‘Humean’ rather than a human being. This is the philosophical, almost theological, fate which lies in wait, if the ratio of impulse to self is too overwhelming. It has affinities to a ‘Freudian’ fate, which is also to be overwhelmed by impulse— but the Freudian fate has sense (albeit tragic), whereas a ‘Humean’ fate is meaningless and absurd.