Barrett L. Dorko, P.T.

          While a freshman at Ohio State in 1969, my roommates and I became acquainted with a student down the hall that would often perform odd, illogical rituals of movement. We'd see him stop to tap the ground with his knuckles or hear percussive sounds emanating from his room. We knew it wasn't Ina Goda Da Vida.

          Being intelligent young men from good families with a sound primary education, we recognized this behavior as obsessive and uncontrollable. We were grateful that we didn't suffer it as well. We were kind enough in our own way, and acted pretty much as if nothing was amiss when his movement blasted out of control.

          Of course, when he wasn't in the room, we referred to him as "Crazy Charlie."

          In 1885 Gilles de la Tourette described a syndrome of movement so variable and strange as to nearly defy description. The compulsions of a "Touretter" emerge as if one were possessed by another. This "other" has an odd and outlandish humor that produces twitches and tics, elaborate movements of the limbs, and facial grimaces of every sort.

          Almost thirty years after I pretended not to see Charlie thrashing about at the next sink, Paula sat before me telling me the story of her cervical pain. Her words were punctuated by a rolling of her eyes and a syncopated snapping of her head to the right. Of course, her doctor blames the Tourette's for her pain, and that certainly makes some sense to me. If she had to move her head around like this for a living we'd call it a repetitive strain injury and bill Worker's Comp.

          But I've not read anywhere that Tourette's normally produces painful movement, or that its repetitive nature injures anything. I have to assume that the obvious thing is probably not the cause of her pain. So I simply look to see if Paula is holding herself from correction as are so many of my patients. Beneath the expression of the "other" that seems bent on misleading me, I can sense the posing, posturing and sympathetic dominance I've seen so many times before. This is what I treat, and now Paula feels fine. Her Tourette's syndrome is unchanged.

          But there's more here. There's my memory of Charlie and the fun we all had at his expense. I think of how he probably wondered at his own strangeness. After all, Paula's diagnosis wasn't made until she was fifteen, despite numerous trips to doctors in several cities.

          But most of all, I think of the courage it must take for a Touretter to walk into a world that is unlikely to understand, a world so quick to judge.

          I'd like to think that it was my college education that made me look deeper and accept more, but I'm not sure it did. I was still laughing about Charlie with my friends at graduation.

          It was my life as a therapist that taught me not to assume that the surface represented the whole. It was the courage I now sense present in people like Paula that made me realize how lucky I am, and how precious is my calm and thoughtful demeanor. I cultivate that gift each day and use it as an antidote for another's pain.

          When this works, I remember Charlie, and wonder where he is today.