When Did Tic Disorder Become an Illness? – Diagnosis, Medication, and What We Missed

1. From Unnoticed Movements to Illness

Many children nowadays frequently blink their eyes or sniff their noses. When asked, "Is it a habit?", doctors now respond, "It could be a tic disorder." In some cases, dopamine modulators, including antipsychotic drugs, are prescribed. But was this situation always diagnosed to this extent in the past? While the concept of tics has existed for a very long time, classifying it as a disease, establishing diagnostic criteria, and intervening with medication is a more recent development than one might think.

2. The Origin of Tourette Syndrome – Georges Gilles de la Tourette

The first person to describe tics as a disease category was Georges Gilles de la Tourette, a 19th-century French neurologist. In 1885, he observed several patients exhibiting complex muscle movements and vocal tics and published a paper on them. This paper became the origin of 'Gilles de la Tourette Syndrome'. However, at that time, the diagnostic concept of 'tic disorder' was not as prevalent as it is today, and these symptoms were generally classified as neurosis, hysteria, or one of various bizarre symptom groups. In short, they were rare, peculiar, and special cases.

3. The Diagnostic System Created by DSM – Expansion of Pathology

The period when diagnoses exploded was effectively after DSM-III in 1980. From then on, tic disorder and Tourette's disorder began to be explicitly codified. Previously, symptoms that were grouped under schizophrenia, neurasthenia, or some childhood behavioral disorders were now coded as 'standalone diseases'. The DSM's diagnostic system is fundamentally a statistical classification system. It doesn't deal with causes but diagnoses based on repeatedly observed symptoms. And importantly, the basis of this system is 'interference with social adaptation'. So, the same eye blink is just a habit when alone, but pathology when presenting at school. This structure tends to look at the behavior itself rather than the context.

4. Diagnosis Has Exploded. It May Not Mean More Illnesses.

The prevalence of tic disorder was estimated to be less than 0.05% until the 1980s. However, now, including motor tics, 5-10% of all children are candidates for diagnosis. This is not simply a matter of 'increase'. It means the concept of disease has expanded, and 'our perspective' on it has changed. Sociologists call this phenomenon "medicalization" or "diagnostic expansion." It's a structure where the boundary between normal and abnormal is constantly widening. And this expansion is intertwined with the demands of the treatment market, the pharmaceutical industry, school systems, and evaluation systems across society.

5. The Shadow of the Dopamine Theory – Was Suppression the Answer?

The most commonly used treatment for tic disorder to date involves dopamine D2 receptor antagonists. Representative examples include risperidone, haloperidol, and aripiprazole. However, this treatment is based on the assumption that 'tics = dopamine overactivity'. But surprisingly, this hypothesis solidified without direct scientific evidence, rather by reasoning that "it must be so because there's a response."

Furthermore, many children experience psychological side effects or functional impairments such as reduced concentration, weight gain, and emotional flattening when taking these medications. While tics may decrease, the child's overall life may become more restricted.

6. The Sensory-Motor Loop: How Tics Are Formed

Recently, another hypothesis explaining the pathology of tics has gained attention: the concept of the sensory-motor loop. Many children say: "My eyes itched, so I squinted." "My throat felt stuffy, so I sniffed." Tics can be interpreted not merely as 'involuntary movements' but as reactions to alleviate uncomfortable sensations. In other words, sensation → reaction → temporary relief → repetition → automatized tic. Suppressing tics doesn't break that sensory-reaction loop; it can sometimes serve to cement tension more strongly.

7. Korean Medicine Sees It Differently – A Perspective of Flow and Balance

Korean medicine approaches these movements with a completely different lens from Western medicine. Eye blinking can be expressed as Liver Wind Stirring Internally (간풍내동), sniffing as Lung Heat Ascending (폐열상역), and shoulder shrugging as Liver Qi Stagnation (간기울결) or External Wind Invasion (풍사 내중). That is, it doesn't suppress the movement itself but seeks to interpret the body's flow and context that necessitated the movement. And indeed, children with tics commonly exhibit sleep imbalances, appetite fluctuations, digestive dysfunction, emotional sensitivity, and sensory hypersensitivity. This implies that it's not merely a 'brain issue' but connected to systemic autonomic nervous system and sensory regulation failure.

8. To Suppress or To Understand?

Ultimately, we stand at a crossroads. Will we suppress the movement known as a tic, or will we understand the context in which that movement was created? A tic is not merely a neurological disease. It is a 'reflex-response system' in which how a child perceives a sensation, how their body reacts to that sensation, and how society accepts that reaction are all intertwined. And I believe the perspective of Korean medicine is much broader, deeper, and gentler in this regard.

Tics sometimes seem strange, but they might be the body's way of speaking when emotions cannot be expressed verbally. Do we need to view this only as a disease? Can't we reframe the question slightly?

'Why did this movement appear?' 'What is this child feeling right now?' These questions might be the beginning of treatment that we should ask, even before medication, before diagnosis.