Freedom in a Tourettic World

Abstract

This chapter pursues an alternative understanding of freedom in tic disorders, which frames it as the ability to act in accordance with one’s goals and values (or ‘cares and concerns’) in the world. Drawing on the distinction between pre-reflective and reflective consciousness introduced in Chap. 3, I ask what role each plays in this alternative notion of freedom. On the one hand, I argue that being too reflectively conscious of one’s actions can get in the way of acting freely. People with tic disorders are at heightened risk of such ‘hyper-reflexivity’ since symptoms often demand their own and others’ explicit attention and interfere with everyday activities. On the other hand, reflective consciousness can serve a positive therapeutic role in behavioural and acceptance-based interventions for tics. In these approaches, consciously attending to aspects of symptoms – such as the urge to tic – can help individuals manage their symptoms and enhance their sense of agency. While the current therapeutic paradigm remains symptom-centric and focused on reducing tics, the chapter concludes by outlining alternative, strength-based strategies for treating tic disorders which transcend the deficit-model of disease.