N-word shouted by a guest upended BAFTAs. We explain the medical condition behind outbursts

A racial slur shouted by a guest with Tourette and broadcast during Britain’s top movie awards event has put the spotlight on coprolalia — a symptom associated with the syndrome.

The outburst included use of the N-word as two Black actors were presenting at the 79th British Academy Film Awards (BAFTA).

BAFTA and BBC both apologized Monday after the outburst by John Davidson, who inspired the nominated film I Swear. Awards show host Alan Cumming apologized to the audience for the “strong and offensive language.”

In a statement, Davidson, a Scottish campaigner for people with Tourette, acknowledged he was “deeply mortified if anyone considers my involuntary tics to be intentional or to carry any meaning” and stressed what he said did not reflect his personal beliefs.

Tourettes Action, a support and research charity in the U.K., says it works to reduce stigma and increase understanding of the syndrome.

After the BAFTAs, Tourettes Action CEO Emma McNally said: “We deeply understand that these words can cause hurt, but at the same time, it is vital that the public understands a fundamental truth about Tourette syndrome: tics are involuntary. They are not a reflection of a person’s beliefs, intentions or character.”

What is Tourette syndrome?

The genetic, neurodevelopmental disorder is primarily characterized by sudden, involuntary movements or sounds called tics that tend to wax and wane, but can worsen with excitement or anxiety, according to the U.S. National Institutes of Health (NIH). 

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Earlier this month, Lily Steinhoff and her parents attended the annual Tourette Association of America Advocacy day on Capitol Hill in Washington, D.C. The Leamington resident, who has Tourette syndrome, has been receiving training as a rising leader and advocate within the Tourette Association of America organization.

Tourette syndrome is often diagnosed during childhood, with symptoms peaking between ages eight and 12, experts say. 

According to Tourette Canada, tics are associated with a group of neurological conditions known as tic disorders. Tics can occur in as many as 1 in 5 school-aged children at some time.

Medical and behavioural treatments exist.

Some people improve during adolescence, while a quarter of those diagnosed continue to have symptoms through their lives, said Dr. Tamara Pringsheim, a neurologist and professor at the University of Calgary who treats people with Tourette syndrome and studies it.

The causes of Tourette and other tic disorders are still unknown, says Tourette Canada, which has its headquarters in Brampton, Ont. It added these conditions tend to occur in families, many studies have found genetics are involved, and researchers continue to look into the genetic angle and other underlying factors.

Many people with Tourette syndrome are also diagnosed with attention-deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD) and learning disorders.

What causes Tourette and tics?

The Tourette Association of America says about 10 to 15 per cent of people with the syndrome experience coprolalia.

The associated outbursts may appear to be purposeful but are not. The NIH’s National Institute of Neurological Disorders and Stroke’s Tourette information page says people trying to suppress them often report a buildup of tension before a tic erupts.

On CBC’s Hanomansing Tonight on Monday, Pringsheim, who is not part of Davidson’s care team, was asked whether or not Davidson might have revealed his deepest feelings.

Like other experts, Pringsheim stresses the tics are involuntary. That came into perspective the first time she met a patient with Tourette syndrome.

“This patient started yelling racial slurs and sexist remarks against me, and you know, I’m a human being — when we hear certain words, they’re going to bring up emotions,” Pringsheim said.

She said she initially felt offended and threatened.

“But it only took another moment to realize that this person had no intention to harm me or to injure me with these phrases. They were meaningless and … he didn’t believe these things about me.”

As to what causes Tourette and the tics associated with it, brain imaging studies suggest people with the syndrome have neurological differences in their brains — specifically in how they are circuited, says Tourette Canada, noting that researchers continue to explore what these differences are and whether other areas of the brain are also involved.