Oliver Sacks on echolalia in Tourette’s syndrome

One of the neurological case studies in Oliver Sacks’s remarkable book An Anthropologist on Mars (1995) involves Dr Carl Bennett, a surgeon in British Columbia who has Tourette’s syndrome. Sacks spends a lot of time with Bennett at home, work, and play, to learn more about the condition and how it affects his daily life.

Oliver Sacks - an anthropologist on mars - seven paradoxical tales - book coverPeople with Tourette’s are often depicted stereotypically as beset by elaborate physical twitching and involuntary swearing and the like, but this oversimplifies a very complex condition. In Bennett’s case the Tourette’s never affects his surgery, but outside of such contexts the compulsions of touching and vocalising do present to a striking degree.

Bennett’s Tourette vocalisations are not so much swears and other taboo expressions as ‘juicy’ phrases devoid of real meaning (at least in his use of them), uttered over and over again. To satisfy this urge, Bennett systematically collects odd names. One passage in the book describes how, after a calm bout of morning exercise – half an hour on an exercise bike, smoking a pipe, reading a medical book – Bennett’s echolalia returns in force:

he kept digging at his belly, which was trim, and muttering, ‘Fat, fat, fat . . . fat, fat, fat . . . fat, fat, fat,’ and then, puzzlingly, ‘Fat and a quarter tit.’ (Sometimes the ‘tit’ was left out.)

‘What does it mean?’ I asked.

‘I have no idea. Nor do I know where “Hideous” comes from – it suddenly appeared one day two years ago. It’ll disappear one day, and there will be another word instead. When I’m tired, it turns into “Gideous”. One cannot always find sense in these words; often it is just the sound that attracts me. Any odd sound, any odd name, may start repeating itself, get me going. I get hung up with a word for two or three months. Then, one morning, it’s gone, and there’s another one in its place.’ Knowing his appetite for strange words and sounds, Bennett’s sons are constantly on the lookout for ‘odd’ names – names that sound odd to an English-speaking ear, many of them foreign. They scan the papers and their books for such words, they listen to the radio and TV, and when they find a ‘juicy’ name, they add it to a list they keep. Bennett says of this list, ‘It’s about the most valuable thing in the house.’ He calls its words ‘candy for the mind’.

This list was started six years ago, after the name Oginga Odinga, with its alliterations, got Bennett going – and now it contains more than two hundred names. Of these, twenty-two are ‘current’ – apt to be regurgitated at any moment, and chewed over, repeated, and savoured internally. Of the twenty-two, the name of Slavek J. Hurka – an industrial-relations professor at the University of Saskatchewan, where Helen [his wife] studied – goes the furthest back; it started to echolale itself in 1974 and has been doing so, without significant breaks, for the last seventeen years. Most words last only a few months. Some of the names (Boris Blank, Floyd Flake, Morris Gook, Lubor J. Zink) have a short, percussive quality. Others (Yelberton A. Tittle, Babaloo Mandel) are marked by euphonious polysyllabic alliterations. Echolalia freezes sounds, arrests time, preserves stimuli as ‘foreign bodies’ or echoes in the mind, maintaining an alien existence, like implants. It is only the sound of the words, their ‘melody’, as Bennett says, that implants them in his mind; their origins and meanings and associations are irrelevant. (There is a similarity here to his ‘enshrinement’ of names as tics.)

I suspect most native English speakers will immediately see the prosodic or aesthetic appeal of the names on Bennett’s list; we might even say them aloud once or twice to savour them ourselves. So we can relate to the impulse in at least a superficial way, if not to its dominant, involuntary aspect: we get to stop when we like.

Another part of Sacks’s profile that struck me was about Bennett’s difficulty with reading. As you can imagine, his Tourette’s made medical school hugely challenging – his ‘tics and touching . . . became more elaborate with the years’. But the mechanical act of reading was also greatly hindered, by an irresistible need to repeat the text and perceive it symmetrically in various ways:

‘I’d have to read each line many times,’ he said. ‘I’d have to line up each paragraph to get all four corners symmetrically in my visual field.’ Besides this lining up of each paragraph, and sometimes of each line, he was beset by the need to ‘balance’ syllables and words, by the need to ‘symmetrize’ the punctuation in his mind, by the need to check the frequency of a given letter, and by the need to repeat words or phrases or lines to himself. All this made it impossible to read easily and fluently. Those problems are still with him, and make it difficult for him to skim quickly, to get the gist, or to enjoy fine writing or narrative or poetry. But they did force him to read painstakingly and to learn his medical texts very nearly by heart.

The inner demand for symmetry is a common feature in OCD, too, but Bennett’s is obviously a severe and particular manifestation of it. That he overcame it sufficiently to qualify as a surgeon says a lot about his patience and resolve.

Readers might also be interested in my earlier post on Alexander Luria’s The Man with a Shattered World; it includes a short video of Oliver Sacks talking about Luria’s work and its influence on Sacks himself as both scientist and storyteller.

An Anthropologist on Mars, incidentally, owes its memorable title to a phrase from Temple Grandin, as I mentioned in a recent post on the semantic scope of Martian.

9 Responses to Oliver Sacks on echolalia in Tourette’s syndrome

  1. towerwater says:

    What about the song we can’t get out of our heads? Could be much the same, just to a lower degree. Says a lot about compulsive bahaviour too.

    • Stan Carey says:

      There’s a bit about the phenomenon in Daniel Levitin’s This Is Your Brain on Music, but I don’t remember exactly what he wrote, and I don’t have the book to hand. So here’s a good article on the psychology of earworms, and there are further references in this one.

  2. Mazinbriz says:

    Your point that we can empathise in a superficial way, to the echolalia of tourettes, resonated with me. I love the narratives of Oliver Sack’s case studies, there are particular cases that strike a chord for me because I relate to their experiences, and yet I’m not yet losing or gaining functions like the title character from The Man Who Mistook His Wife For a Hat, and Dr Bennett. Thanks for the fabulous post and the prompt to get my hands on another Sacks book!

  3. Claire Stokes says:

    I have yet to delve in to Sack’s work, now am even much more fascinated. Thanks much!

  4. I wonder if Dr Bennett’s list of names included two of my own favourites, the Austrian artist Oskar Kokoschka and the Danish jazz bass player Niels-Henning Ørsted Pedersen.

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