When actor John Davidson, who has Tourette’s syndrome, reportedly uttered a racial slur during the British Academy of Film and Television Arts (BAFTA) ceremony, the public reaction was swift and emotionally charged. For many people, the involuntary outburst reflected true feelings or a subconscious racial bias. However, that is not the case with certain forms of Tourette’s.
Coprolalia, the involuntary expression of socially inappropriate or taboo words, is among the most misunderstood symptoms in neurology. It is a type of vocal tic associated with Tourette syndrome and related tic disorders. Contrary to popular belief, coprolalia is uncommon, occurring in approximately 10 percent of patients with Tourette syndrome. However, because of its dramatic and socially disruptive nature, it disproportionately shapes public perception of the disorder. The critical distinction is that coprolalia is involuntary.
The neurology of coprolalia
Tourette syndrome is a neurodevelopmental disorder involving dysfunction in cortico-striato-thalamo-cortical circuits. These neural pathways regulate motor output, behavioral inhibition, and impulse control. Under normal circumstances, the brain continuously filters and suppresses unwanted movements and vocalizations. In Tourette syndrome, this inhibitory system becomes impaired, allowing motor and vocal discharges, or tics, to escape voluntary control. These tics are not choices. They are neurological events.
Patients frequently describe a “premonitory urge,” an uncomfortable internal sensation that builds until the tic is released. The experience is often compared to suppressing a sneeze. Suppression is possible for short periods, but doing so increases internal tension, and the tic eventually emerges. Importantly, the release provides temporary relief from the urge, reinforcing its involuntary neurophysiological basis. Coprolalia follows this same mechanism.
Intent versus inhibition
The specific words expressed in coprolalia are typically those with the greatest emotional or social salience. This is not because the individual endorses those words or their meaning. Rather, emotionally charged language occupies privileged neural real estate within limbic and language circuits. When inhibitory control fails, these highly salient verbal fragments are more likely to emerge. In other words, the disease does not create intent. It bypasses inhibition.
This distinction is medically and ethically essential. A tic alone is not evidence of conscious or subconscious racism, bias, or belief. For speech to reflect prejudice, it must originate from intentional cognition and voluntary expression.
Patients with Tourette syndrome are typically fully aware of their tics and often experience profound embarrassment, distress, and social isolation. Many actively avoid public situations to reduce the risk of humiliation or misunderstanding. The suffering associated with Tourette syndrome is not limited to the neurological symptoms themselves but extends to the stigma and misinterpretation those symptoms provoke.
The burden of public misunderstanding
The ethical implications are significant. When involuntary neurological symptoms are misinterpreted as intentional acts, patients may face social, professional, and reputational harm for behaviors they did not choose. Public misunderstanding persists in part because Tourette syndrome occupies an uncomfortable space between neurology and behavior. The symptoms affect actions and speech, domains typically associated with personal responsibility. Yet the underlying mechanism is biological, not volitional.
The brain is an organ, and like any organ, it can malfunction. Tourette syndrome affects approximately 1 percent of the population. Most individuals with the condition lead productive, successful lives across all professions, including medicine, law, academia, and the arts. Their neurological diagnosis does not define their identity. However, misunderstanding can shape how they are perceived and treated.
High-profile incidents, such as the reported BAFTA outburst, present an opportunity for education. They remind us that neurological disorders do not disappear in public settings, nor do they conform to social expectations. The brain does not distinguish between private and public environments when inhibitory circuits fail.
Neurology teaches us a humble lesson: Sometimes, the brain produces behaviors that do not reflect the person. And when it does, our responsibility is to recognize the difference.
Jerome Lisk is a neurologist.
