TikTok Tourette's
The rise of “mass social media-induced illness”
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“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:
I can confirm that none (!) of our patients seen [at the Hannover Medical School in Germany] "faked" their symptoms. So it was not voluntary and not malingering, but a functional neurological disorder (FND).
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:
However, I assume that some of the influencers on YouTube and TikTok who state that they have developed "Tourette overnight" indeed may “fake” symptoms (perhaps in order to increase visibility, influence, income etc).
At least for those patients with a clear overlap with Jan Zimmermann’s symptoms seen here in our center, it is an outbreak of mass sociogenic illness, because patients present with more or less identical symptoms that have never been seen before. Stress (due to COVID-19, anxiety, depression, triggering factors, bullying etc etc) predisposed these patients.
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:
[The] current outbreak of [mass social media-induced illness] represents not only the “modern” form of [mass sociogenic illness] motor variant, but can also be viewed as the 21st century expression of a “culture-bound stress reaction” of our post-modern society emphasizing the uniqueness of individuals and valuing their alleged exceptionality, thus promoting attention-seeking behaviors, and aggravating the permanent identity crisis of modern man. It can be assumed this is triggered by eco-anxiety, COVID-19 pandemic, and further challenges in post-modern society.
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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The best social media control for me has been deleting it from my phone. I can still access it on my iPad or computer, but I don't find myself scrolling without making the conscious choice to get on anymore, and I don't stay on nearly as long on my less portable devices. My time on social media has dropped drastically and most other aspects of my mental and emotional health involving patience and focus have improved quite a bit.
THere exists a phenomenon which we can legitimately call in organisms with brains, "cognitive", which refers to the basic evolutionary nature of brains: retention of sensory events and associating these with interoceptive, proprioceptive, and subsequent sensory events.
The concept of "learning" , then, doesn't really difer from "TikTok Tourette's."
Limiting ourselves to the modularity of animals here, we are biased toward both sensory and motor activity to seek (or create, in the sense of inserting ourselves to discover likely useful resources) ANY possible social & therefore resource Niche.
The proliferation of novel information occurring on the internet (a rather complex issue, as we can both access real resources as well as the illusion of new social affiliations - which can also become, with pursuit real individual and group affiliations!) opens , more than previous recent fictions like "dungeons & dragons", and other games played through communications links, delusory worlds.
Whether via Zoom or in less mutual delusory presences, one is NOT in actual sensory contact. The brain cannot register or evaluate ALL the normal component signaling occurring via screens.
Molecular sensing, of hormones/pheromones (see the copious literature on sweaty t-shirt evaluation of attractiveness as a single example), or brain registration of environmental cues (heat, and so many cues involving relative time, exteroceptive & the interoception of the various cutaneous neural signals are just a few. Interaction options are limited in these false settings: there's no real option for mutual self-modulation through, for example, deciding to eat together, an action that fosters synced change into parasympathetic states).
Our brain searches for essential , vital cues, in order to predict better , more likely subsequent and more distant probabilities.
So, this medium is bound to lead to evaluations less connected with reality.
Yet, as humans, we have a limited universe of responses. . In comment I can't really d more than sketch any of the factors. But anxiety is a motivator of our evolved desire (or Necessity) to resolve arousal.
Living in large dense groups, as Robin Dunbar looked at for decades now, promotes anxiety. Due to our brains limitation on evaluation of more than a limited number of others, failure to resolve, to learn and interpret accurate signaling of other individuals, does lead to assessing others in a sterotypical, heuristic fashion.
brains are always attempting to reduce experiences to simpler heuristics, and largely conservatively correct those heuristic distillations.
Whether dancing in a small group to assuage distress/anxiety through establishing soothing social entrainment, or imitating to achieve the same end (and REMEMBER, imitation is how we learn from infancy, to establish relationships likely to promote survival and the protection that social ingrouping endows).
This is the ancient goal of niche-seeking, with only its human social aspect sketched here.