I came across this on Twitter this morning and found it pretty interesting. Four psychiatrists from Hannover Medical School (here’s background on the lead author, Dr. Kirsten R. Müller-Vahl) published a paper this week which describes a new “mass sociogenic illness” (MSI). What’s unique about this MSI is that it appears to be spreading mostly online.

Psychiatrists report an outbreak of a new mass sociogenic illness spread by social media. Affected adolescents exhibit Tourette's-like behaviour which they "caught" from a popular YouTube creator. https://t.co/2ivFmU5Pav pic.twitter.com/MchXI5uwJz

— Steve Stewart-Williams (@SteveStuWill) August 24, 2021

Adolescents are suddenly reporting Tourette’s-like symptoms and in many cases are being diagnosed and medicated as if they have Tourette’s. But the Hannover psychiatrists, who are experts in real Tourette’s cases and behavior, say the whole thing is actually just adolescents imitating a very popular YouTuber in Germany who has a channel devoted to living with Tourette’s. The psychiatrists believe the young man who started the channel does have Tourette’s but that he is essentially exaggerating his symptoms in ways that make for very watchable YouTube videos:

On February 21st 2019 – only shortly before the first patient with MSMI presented in our clinic in June 2019 – the German YouTube channel “Gewitter im Kopf” (English: “Thunderstorm in the Brain”) was launched by a 22-year-old man called Jan Zimmermann. Judging from the videos, he indeed suffers from a mild form of Tourette syndrome. On this YouTube channel, however, he shows a countless number of movements, vocalizations, words, phrases, and bizarre behaviours that he claims are tics, but are clearly functional in nature. Tourette experts can easily tell the difference6,7, since the majority of supposed “tics” is complex and stereotyped and mimics those symptoms that lay people typically associate with Tourette syndrome: coprolalia, copropraxia, and non-obscene socially inappropriate behaviours (NOSI). For the majority of the shown symptoms, there are obviously strong situational contexts with exclamations of long sentences with insults, swear words, and obscenities that are in this form unknown in Tourette syndrome. Furthermore, the number of symptoms and in particular the number of different swear words and insults presented is countless and thus far beyond that of tics in Tourette syndrome. Finally, presented symptoms quickly change nearly on a weekly basis in parallel to newly released videos, while “most popular” symptoms are repeated several times.

It may not sound like the kind of thing you’d want to spend your free time watching but in Germany the channel is a huge success with about 1/3 of a billion views in just two years.

Soon after it was started, the YouTube channel “Gewitter im Kopf” was rapidly spread on social media and reached 1 million subscribers in less than 3 months making Jan Zimmermann the top YouTube breakout creator in Germany in 2019. He earned further attention from the YouTube and Internet community by participating in other popular YouTube channels and TV shows, through posts of these shows on YouTube and reaction videos from the highest-earning influencers in Germany Unge and MontanaBlack, and by receiving special TubeAwards. Today, Jan Zimmermann is the second most successful YouTube creator in Germany and enjoys enormous popularity among teenagers (status on July 19th, 2021): “Gewitter im Kopf” is subscribed by 2.23 million people and 296 videos have been released that were in total viewed 301,440,636 times. Meanwhile, the channel is accompanied by a merchandising campaign and most popular exclamations are reproduced on products such as shirts and caps.

You can find all of the Gewitter im Kopf videos on YouTube. Just to give you a sense, here’s one where Jan Zimmermann goes through a series of drive-thrus and places orders while interjecting his vocal tics. For instance, “I would like to have a BOMB. I would like a salad dressing.” (And if you think the screengrab I picked for this post is meant to mock him, please notice the image he picked to promote his own video.)

Maybe this isn’t your idea of fun but it’s not hard to imagine how 15-year-olds would find this sort of clip captivating. And the result has been a bunch of adolescents being referred to specialists for sudden onset of nearly identical Tourette’s symptoms. In fact, many of these new cases are kids who spontaneously interject the exact same words and phrases into conversations that Zimmerman is now selling on t-shirts.

Over the last two years, a remarkably high number of young patients has been referred to our specialised Tourette outpatient clinic presenting with symptoms closely resembling the ones Jan Zimmermann shows in his videos. All these patients had been pre-diagnosed with Tourette syndrome, partly even as treatment-resistant Tourette syndrome after having received pharmacotherapy with different drugs including antipsychotics. Remarkably, in none of these cases, neither the correct diagnosis of functional (“Tourette-like”) movement disorder (FMD) had been made, nor the interrelation with and influence by social media had been recognised. Although a detailed description of clinical characteristics is beyond the scope of this paper and is currently in preparation for publication elsewhere, here we want to briefly summarize, how in this group of patients diagnoses of “Tourette-like” FMD were confirmed. Firstly, all patients presented with nearly identical movements and vocalizations that not only resemble Jan Zimmermann’s symptoms, but partly are exactly the same such as shouting the German words “Pommes” (English: fries), “Bombe” (English: bomb), “Heil Hitler”, “Du bist häßlich” (English: you are ugly), and “Fliegende Haie” (English: flying sharks) as well as bizarre and complex behaviours such as throwing pens at school and dishes at home, and crushing eggs in the kitchen. Even more, similar to Jan Zimmermann, words and phrases are pronounced with changed voice in low pitch so that family members are able to differentiate normal conversation from supposedly “vocal tics” solely based on the tone of voice. Secondly, a substantial number of patients gave their supposed “Tourette syndrome” a name just as Jan Zimmermann does, who calls his symptoms “Gisela”. Thirdly, patients often reported to be unable to perform unpleasable tasks because of their symptoms resulting in release from obligations at school and home, while symptoms temporarily completely remit while conducting favourite activities. Fourthly, in some patients, a rapid and complete remission occurred after exclusion of the
diagnosis of Tourette syndrome.

Although some patients indeed suffered in addition from mild Tourette syndrome, for all newly emerged symptoms, it could be clearly ruled out that they were tics for several reasons: (i) onset was abrupt instead of slow, (ii) symptoms constantly deteriorated instead of typical waxing and waning of tics, (iii) “simple” movements (e.g. eye blinking) and noises (e.g. clearing one’s throat) were clearly in the background or completely absent, although being the most common and typical symptoms in Tourette syndrome, (iv) movements were mainly complex and stereotyped and predominantly located at arms and body, instead of at eyes and face, (v) overall, the number of different movements, noises, and words was “countless” and far beyond the typical number of tics in Tourette syndrome, and (vi) premonitory feelings were reported with atypical location, quality, and duration compared to tics in Tourette syndrome.

In short, most of these kids don’t have Tourette’s at all. Even for the few that have a mild case, the symptoms they are displaying aren’t actual Tourette’s symptoms but an imitation of things they’ve seen on YouTube. And, not coincidentally, their symptoms prevent them from doing things they don’t want to do but abate when they get to do something they do want to do. Some of the kids even snap out of it when they are told they don’t have Tourette’s.

The psychiatrists noted that about half of the new patients in Germany were male but among similar cases in Canada, most of the cases were adolescent women. Why the difference? The authors suggest that’s because a different influencer is making videos with similar behaviors in Canada and she happens to be a young woman.

Based on the already initiated exchange among international Tourette experts, it seems that patients identified in Germany exhibit some differences compared to cases seen in other countries such as Canada (personal communication). While it appears that age at onset is very similar in different countries with a preponderance of adolescents and young adults, gender distribution seems to be different: while half of our patients are male, the group of Davide Martino and Tamara Pringsheim at the University of Calgary in Canada reports a female to male ratio of about 9:1. This difference might be related to the different gender of most influential “virtual” index cases in Germany compared to Canada. While we were able to clearly identify the German speaking man Jan Zimmermann as a “virtual” index case, in contrast, in Canada, tic-like symptoms in young patients seem to be mainly triggered by the presentation of such behaviours by the English speaking 20-year-old female Evie Meg or better known under her TikTok name “thistrippyhippie”.

Here’s a YouTube clip from ThisTrippyHippie:

The paper doesn’t suggest that this YouTuber is exaggerating her symptoms and I’m not suggesting that either. The point is that this sort of thing has become interesting content and adolescent viewers are imitating the behavior convinced that they also have Tourette’s when in fact they do not.

The paper does say this is the first time where someone has described this kind of mass sociogenic illness happening primarily online. However, Tourette’s apparently isn’t the only sort of behavior which is becoming a form of influential online content. I noticed these responses to the tweet above:

Some claim to have a ‘system’ of 100s and 1000s of identities, of which they switch between on camera online for likes and comments. Weirdly enough, it’s not only young teenagers doing it but adults in their 20s too

— Lily (@TigerLilyKitty_) August 25, 2021

I’m not on TikTok yet so I can’t really verify this is a thing happening there but in theory you could see how it would a) be interesting content and b) be something some kids might imitate.

The study concludes by suggesting this sort of MSI behavior, which has been recorded as far back as 1374, may be the result of anxiety related to climate change and/or the coronavirus pandemic among young people. They see it as a cultural stress reaction expressed in terms of attention-seeking behavior.

…current outbreak of MSMI represents not only the “modern” form of MSI motor variant, but can also be viewed as the 21th century expression of a “culture-bound stress reaction” of our
post-modern society emphasizing the uniqueness of individuals and valuing their alleged exceptionality, thus promoting attention-seeking behaviors, and aggravating the permanent
identity crisis of modern man.

Finally, I can’t help but notice the behavior described in this paper seems to have something in common with the very controversial claim that the sudden uptick of gender dysphoria cases among adolescents is also partly sociological. If people can exhibit moderately convincing Tourette’s behavior (good enough to fool doctors who aren’t aware of the context of popular influencers on YouTube), couldn’t something similar be happening with gender dysphoria?

To be very clear, I’m not saying there aren’t real people with real gender dysphoria any more than I would claim there aren’t real people with Tourette’s. Both things clearly exist. But perhaps we’ve underestimated the degree to which an unusual condition presented as a struggle in daily life might appeal to impressionable adolescents looking for an identity to adopt. If you’d asked me yesterday if anyone who doesn’t have Tourette’s could become convinced they have it, to the point where they’d be medicated and seeing doctors, I would have said no. But it seems that’s not the case. Once Tourette’s becomes popular online and a mark of personal identity which attracts attention from peers, it turns out some kids will become convinced they have it too.