Cotton first noticed something was wrong when he was about 14. It started with uncontrollable twitches in his arms and neck. The twitches were relatively minor and infrequent, though, and didn't seem like much cause for concern.
"When his arms twitched he would sort of play it off, like he was adjusting his cuffs or moving to scratch his head," said Catherine McMillan, Blake's mom. "It really wasn't that noticeable."
By the time Blake started his junior year at Gaston Christian School, however, the twitching had become more frequent and pronounced. Even more troubling was that Blake began to blurt involuntary and sometimes obscene verbal outbursts. A battery of physical and neurological tests followed. A few weeks after his 16th birthday in 1998, Blake was diagnosed with Tourette's Syndrome (TS).
"I had no idea what it was," Blake said, who is now 20 and a sophomore at Mars Hill College near Asheville.
Blake and his mom searched in books and on the Internet to find out more about this baffling disorder that, for someone like Blake who was already shy and introverted, made most social situations nearly unbearable.
What Blake and his mom discovered is that Tourette's Syndrome (often also called Tourette Syndrome) is an inherited neurological disorder that produces repeated involuntary utterances and body movements. The symptoms of TS generally appear before the age of 18, usually between 7 and 10 years of age. Typically, symptoms begin with motor tics (brief, repetitive, purposeless movements of muscles), including eyebrow raising, nose flaring, mouth opening, throat clearing, head shaking, teeth gnashing and stamping and kicking. Patients also make uncontrollable sounds, called vocal tics. These include grunting, barking, belching, speaking unintelligibly, and involuntary verbalizing of vulgar words. Tics usually occur multiple times each day, and the location and type of tics may vary considerably over time.
Tourette's Syndrome affects people of all ethnic groups, although males are affected three to four times more often than females. It's estimated that 100,000 Americans have full-blown TS, and perhaps as many as one in 200 show a partial expression of the disorder.
As is often the case in people with TS, Blake also suffers from other disorders. He was diagnosed with a learning disability when he was in second grade, and later with obsessive compulsive disorder (OCD), a severe form of anxiety. Over time, Blake's different disorders became intermingled, feeding off each other and making his daily existence a real struggle. In person, Blake is shy and almost childlike, with remnants of adolescent acne on his broad features. But at 5' 9" and 230 pounds, he's no kid, and says that in high school he often used his size to his advantage.
"I was always about twice the size of the people I associated with, so most of them didn't tease me about my Tourette's," he said. "I'm actually a fairly nice guy. But I can intimidate people. I'm real good at it."
"He has this scowl, so people won't make fun of him, and he likes that idea," Catherine said. "It's a defense mechanism."
Blake, comforted by the presence of his mom, opens up during our conversation to display a clever sense of humor, particularly about his struggles with TS.
"If you can't laugh about it you'll go nuts," he said. "If you've got a disorder, Tourette's is one of the most amusing you can have."
Surprisingly, both Blake and his mom seem to enjoy relating stories about his Tourette's, and say that in many ways, because Blake must often explain to classmates and friends what TS is, the disorder has brought him out of his shell a little bit. Blake said that his verbal and physical tics are often influenced by the power of suggestion, or sub-conscious thoughts. Both doctors and TS sufferers have compared the physical and vocal tics to a hiccup, in that seconds before a tic occurs, there is usually an anticipatory sensation. Most report that with medication and practice, they can suppress the tics, but it's physically and mentally draining, and over time the tics build up to a point at which they have to be released, usually in a single, rapid-fire episode.
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