Tourette-like mass sociogenic illness

A recent article highlighted an outbreak of a mass sociogenic illness (MSI) of Tourette-like symptoms spread solely through social media, a mass social media-induced illness (MSMI), see mass sociogenic illness brain2021 in dropbox, or orcid.org/0000-0002-7181-7419

 

Details:

--this report was from a specialized Tourette outpatient clinic in Hanover Medical School in Germany, revealing a large number of young people across different countries having a “Tourette-like” MSMI outbreak

-- a German YouTube channel, launched by 22-year-old Jan Zimmermann (who has a mild form of Tourette syndrome), depicts countless numbers of movements, vocalizations, words, phrases, and bizarre behavior that Zimmermann claims are tics

-- his YouTube channel spread rapidly on social media, reaching 1 million subscribers in less than three months, making Zimmermann the second most successful YouTube creator in Germany in 2019. Currently subscriptions are 2.23 million people and 296 videos have been released there with total views 301,440,636 times. A mobile App includes the most popular “vocal tics”

-- these tics are fundamentally different from the tics found with Tourette syndrome: these having long sentences comprised of insults, swearwords, and obscenities in a form different from what is expected in Tourette syndrome

-- an unquantified “remarkably high number” of young patients were referred to this outpatient clinic, many had been treated unsuccessfully with different drugs including antipsychotics. these patients had the following characteristics:

    -- all patients presented with nearly identical movements and vocalizations that resembled Zimmermann’s symptoms

    -- there were unexpected bizarre and complex behaviors, such as throwing pens at school and dishes at home, and crushing eggs in the kitchen

    -- many patients gave their “Tourette syndrome” a name, just as Zimmermann does (he calls his symptoms “Gisella”)

    -- patients often reported they were unable to do unpleasurable tasks because of their symptoms, but symptoms remitted when conducting favorite activities

    -- the first patients seen in their clinic were only 4 months after the launch of the YouTube channel, and all patients confirmed watching these videos before they had similar or identical symptoms as portrayed in the video

    -- in some patients, a rapid and complete remission occurred after the exclusion of the diagnosis of Tourette syndrome

-- these clinicians noted that the tics were not likely to be Tourette’s because:

    -- onset was abrupt and not slow

    -- symptoms constantly deteriorated instead of the more typical waxing and waning of tics

    -- simple movements such as eye blinking and noises such as clearing one's throat were minimal or completely absent (though these are the most common and typical symptoms in Tourette syndrome)

    -- movements were mainly complex and stereotyped, and predominately were located in the arms and body instead of eyes and face

    -- the number of different movements, noises, and words were “countless "and far beyond the typical number found in Tourette’s

    -- premonitory feelings were in atypical location, quality, and duration compared to tics with Tourette’s

--and, several of their patients appeared on the German internet and TV

 

-- so, in general the initiation of an MSI outbreak requires an index case; these clinicians feel that the index case was Jan Zimmermann as a “virtual” index case, with social media inducing “secondary virtual” index cases

-- they note that in other countries, similar channels on YouTube and TIkTok seem to have extended the network globally

 

-- most cases have been in adolescents and young adults. in Germany there is a 50/50 male/female split (at least as these clinicians noted, though they comment that there more males use social media there). 

    -- In Canada this aberrant Tourette's was promoted by Evie Meg on TikTok, a 20-year-old with the TikTok name of “thistrippyhippy”. specialists at the University of Calgary in Canada noted a female/male ratio of 9:1.

 

Commentary:

--this seems to be a pretty strong case for a mass sociogenic (also called psychogenic) illness. There have been a slew of such outbreaks over the centuries, as documented in https://en.wikipedia.org/wiki/List_of_mass_hysteria_cases , including one in Leroy,  New York of a Tourette’s epidemic in 2011-12

--it is certainly within the realm of feasibility that social media would play such a large role, given its dominance in our lives, its easy one-on-one contact with people, its widespread use by kids who access it many hours a day, and its openness to allow anything on their internet portal (including allowing huge amounts of “fake news”: witness our last election, or the current attempts by the US government to reel-in Facebook, TikTok, etc)

    --the current Covid-19 pandemic may be adding to the problem: its attendant social isolation may lead to more reliance on social media

    -- and, the target group of adolescents/young adults is a prime target for MSMI, since at this developmental age, people are much more swayable by peer pressure and make more choices from an emotional vs logical perspective (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705203/ ; the adolescent brain is being evaluated by a large, longterm ABCD study (Adolescent Brain Cognitive Development, see https://www.drugabuse.gov/drug-topics/adolescent-brain/longitudinal-study-adolescent-brain-cognitive-development-abcd-study 

--not sure it fully qualifies as a mass sociogenic illness, but we do have several conditions that may well be psychogenic, including chronic Lyme disease or PANDA syndrome, though one must always be careful in dismissing these as “functional” since it may well turn out over time that some unsuspected or unknown infectious/neurologic/psychiatric/stress-related problem may be causative.

 

Limitations:

--the big one: this was not a scientific study with quantified documentation or even a consistent metric by which to differentiate Tourette’s from what they call a Functional Movement Disorder, or an MSMI

 

So, in looking into this, I was really impressed at how frequent these MSI outbreaks are, now morphing into much more powerful and far-reaching platforms and becoming MSMI. The importance of our knowing this is that the appropriate treatment clearly varies dramatically. Antipsychotics in the above case did not work (and can be harmful), leading to many cases being labeled as “refractory Tourette syndrome” by clinicians. Perhaps the appropriate treatment for individual/groups should be more like counseling, and perhaps on a public health level figuring out how to appropriately limit social media’s pretty unregulated but profound social (and political…) impact...  

geoff

 

If you would like to be on the regular email list for upcoming blogs, please contact me at gmodest@uphams.org

 

to get access to all of the blogs (2 options):

1. go to http://gmodestmedblogs.blogspot.com/ to see them in reverse chronological order

2. click on 3 parallel lines top left, if you want to see blogs by category, then click on "labels" and choose a category​

3. or you can just click on the magnifying glass on top right, then  type in a name in the search box and get all the blogs with that name in them

 

or: go to https://www.bucommunitymedicine.org/ , a website from the Community Medicine section at Boston Medical Center.  This site does have a very searchable and accessible list of my blogs (though there have been a few that did not upload over the last year or two). but overall it is much easier to view blogs and displays more at a time.

 

 

please feel free to circulate this to others. also, if you send me their emails, i can add them to the list