In Spring 2022, I wrote an article about the sudden onset of uncontrollable tics in teens who had watched TikTok videos of people with Tourette’s syndrome. My article looked at why The Atlantic’s “The Twitching Generation” was one of the most popular posts on bioethics.com. One year later, Azeen Ghorayshi reports in The New York Times that the TikTok tics have largely disappeared. Now doctors are trying to understand why some teens were susceptible to tics in the first place. In my previous article, I discussed Trust-based Relational Intervention, or TBRI®, and asked the question, “What is the need behind the behavior?” Robert Bartholomew, who studies mass psychogenic illness, said that mass hysteria is often a social barometer. Further, Bartholomew told The Atlantic that mass psychogenic illness tends to stop when the conditions that caused it are addressed.
In this follow-up article, let’s look at the need behind the behavior and whether those needs have been addressed.
Ghorayshi reports in The New York Times of a new study by researchers at the University of Calgary that looked at 294 cases of teens from eight different countries who presented with uncontrollable tics. Their key finding was that the teens were overwhelmingly girls and, compared to the rest of the population, a disproportionate number of them were transgender or identified as nonbinary. Additionally, there was a disproportionate number that were on the autism spectrum and/or had attention deficit hyperactivity disorder. Almost all the teens had trauma in their past, and several had a history of tics. These findings correspond to initial observational studies that Helen Lewis reported on in “The Twitching Generation.”
Ghorayshi’s article notes that as teens have resumed their pre-pandemic social lives, doctors have reported fewer new cases of tics. Of those who were treated for tics, anti-psychotic medications that are typically prescribed for tics did not help, and in several cases made the tics worse. The therapy that most helped was cognitive behavior therapy that addressed the root problem rather than the symptoms. It turns out that for many of these patients, the underlying problem was intense stress, likely from a confluence of factors including anxiety from going back to school after the pandemic, re-integrating after social isolation, and coping with difficult family interactions.
The University of Calgary study reinforces the idea that these girls were manifesting a physical response to an internal struggle. Dr. Jennifer McVige, the neurologist who had treated spasms among students and teachers in a New York small town in 2011 and recently treated several teens for TikTok tics, said that these kids “all had their own little albatross that they carried.” Both the 2011 group and the current group had all experienced some kind of trauma or serious illness and were manifesting a functional disorder.
CDC Data: A Closer Look at Mental Health Issues among Adolescent Girls
Lisa Damour, a clinical psychologist and author of The Emotional Lives of Teenagers, told The Washington Post that today’s teens are one of the best-behaved generations of teenagers on record. “They drive with seat belts, they smoke less, they have less sex, they wear helmets. They do all these things that we did not do.” Yet, incidences of anxiety and depression among teens have continued to increase.
The CDC’s recent “Youth Risk Behavior Survey” looked at trends in teen mental health from 2011 to 2021. The report shows that a representative set of teen girls from both public and private schools and across all demographics are suffering from inordinate amounts of sexual violence, trauma, and persistent feelings of sadness or hopelessness. According to the survey, 14% percent had been forced to have sex, and 25% had made a suicide plan. Furthermore, school connectedness was an important factor in teen mental health, meaning that when schools were closed for the pandemic, some teens lost connections with peers. Still others were relieved to be out of school because they found a reprieve from bullying. But once school resumed, their anxieties re-ignited. According to the report,
School connectedness, defined in this report as feeling close to people at school, has a long-lasting, protective impact for adolescents well into adulthood on almost all the behaviors and experiences included in this report. In 2021, female students, students of color, LGBQ+ students, and students who had any same-sex partners were least likely to feel connected at school, indicating less protection for these groups.
The Washington Post published an article after the CDC’s report came out on the crisis in American girlhood in which they interviewed several teen girls on their experiences of trauma. The levels of sexual harassment, violence, coercion, and manipulation teen girls endure on a day-to-day basis are beyond what most of us assume goes on and certainly should not be considered normal. According to the article, the confluence of growing up in a social media culture “with impossible beauty standards, online hate, academic pressure, economic difficulties, self-doubt, and sexual violence” has put incredible pressure on young women. These pressures started before the pandemic. However, the pandemic served to worsen what was already there, which may be why many girls latched onto tics. As noted by experts in my previous article, mass psychogenic illness is often a response to extreme stress or trauma. If teen girls were already dealing with mental health issues, the added stress might have been too much.
Boys, too, are struggling, but girls seem to be doing worse on all counts. One reason, according to the article, is that girls tend to internalize depression and anxiety while boys tend to act out.
The Washington Post article is worth reading in full and with compassion for what teenage girls are truly enduring. While Christians rightly decry aspects of cultural messaging, such as gender fluidity and transgenderism, we sometimes get too caught up in the political rhetoric to recognize the need behind the behavior. When sexual attitudes are shaped by an online world saturated with pornography, is it any wonder girls hesitate on the threshold of womanhood? Girls are exposed to pornography both directly and indirectly through how they are treated by others, including expectations of how they should look and act. At least in some cases, after enduring coercion and harassment from boys and bullying from other girls in high school, some young women either reject relationships with boys altogether or reject their femininity outright. All of this while girls navigate the high-pressure, resume-building performance culture that all students must deal with.
Often functional behaviors are a desperate, and maybe subconscious, way to cope with a lack. Many of the girls interviewed by The Washington Post felt pressure to be extremely perfect or risk being bullied. They also said that they wished adults would listen to them and believe them. The tics forced parents, clinicians, and teachers to pay attention. Tics, and other kinds of pathologies, also force people to have compassion for someone for not being perfect. A diagnosis of any kind means jobs, schools, and parents are forced to accept this student’s imperfections, their human limitations, rather than demand the impossible.
Every generation responds to the social structures put in place by the prior ones. These girls are the inheritors of the sexual revolution and the well-meaning but ill-conceived overcorrections that harken to Victorian notions of sex rather than sex as part of God’s good design from the beginning. They are the inheritors of Silicon Valley techno-optimism and its eschewing of guidelines and guardrails in the name of no-holds-barred libertarian freedom. They have inherited an anthropology that reduces humans to animals (or users) and sex to instinct (or power). And they are swimming in a culture that whispers of nihilistic fatalism, the logical progenitor of postmodern fragmentation that leaves no coherence even with oneself and one’s body.
The church can offer a “counter-liturgy” writes Melissa Morgan Kelly in ByFaith magazine on the unbearable burden of making meaning. She quotes Alan Noble, author of You Are Not Your Own (Intervarsity Press, 2021) who says, “We must provide teaching and habits that counter the narrative that you make a life for yourself.” Noble describes this counter-narrative as a beautiful picture of God’s people thriving in a land that is not their home, saying it “is normal for God’s followers to live in the midst of sinful cities and to flourish inside of them,” a reference to Jeremiah 29.
Many of the girls who manifested TikTok tics had dealt with trauma, debilitating anxiety, and depression. For many of them, this was an identity that could provide meaning and relationships, and it was a way to cope with their struggles in a way that expresses a need even if they could not articulate it. But there are other ways to cope. Poetry can be a salve for when we do not have the words for emotional pain. The Psalms, in particular, can serve as both a prayer and a promise for those who feel bullied and rejected: “In God I trust; I will not be afraid. What can mere humans do to me?” (Ps 56:11, CSB). And, the Psalms can provide an anchor in the cultural morass: “Rest in God alone, my soul, for my hope comes from him. He alone is my rock and my salvation, my stronghold; I will not be shaken” (Ps 62:6).
 Azeen Ghorayshi, “How Teens Recovered From the ‘TikTok Tics,’” The New York Times, February 15, 2023, https://www.nytimes.com/2023/02/13/health/tiktok-tics-gender-tourettes.html; Davide Martino et al., “The Spectrum of Functional Tic-Like Behaviours: Data from an International Registry,” European Journal of Neurology 30, no. 2 (2023), 334–43, https://doi.org/10.1111/ene.15611.
 Helen Lewis, “The Twitching Generation,” The Atlantic, February 27, 2022, https://www.theatlantic.com/ideas/archive/2022/02/social-media-illness-teen-girls/622916/; Isobel Heyman, Holan Liang, and Tammy Hedderly, “COVID-19 Related Increase in Childhood Tics and Tic-Like Attacks,” Archives of Disease in Childhood 106, no. 5 (2021): 420–21, https://doi.org/10.1136/archdischild-2021-321748.
 Lewis, “The Twitching Generation.”
 Donna St. George, Katherine Reynolds Lewis, and Lindsey Bever, “The Crisis in American Girlhood,” The Washington Post, February 17, 2023, https://www.washingtonpost.com/education/2023/02/17/teen-girls-mental-health-crisis/.
 “Youth Risk Behavior Survey, 2011–2021: Data Summary and Report,” CDC, 2023, https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf.
 “Youth Risk Behavior Survey,” 3–4.
 St. George, Lewis, and Bever, “The Crisis in American Girlhood.”
 See my article in Salvo #47 and my interview on the Center for Parent/Youth Understanding podcast for more on the contradictory worlds of today’s teen girls. Heather Zeiger, “Do You Like Me? The Contradictory World of Today’s Teen Girls,” Salvo 47 (2018): https://salvomag.com/article/salvo47/do-you-like-me; Heather Zeiger, “Girls, Worldviews, and Contradictions,” Center for Parent/Youth Understanding, Youth Culture Matters Podcast, ep. 82, May 2, 2019, https://cpyu.org/resource/episode-82-girls-worldviews-and-contradictions-with-heather-zeiger/.
 Melissa Morgan Kelley “The Near Unbearable Burden of Making Meaning,” byFaith December 29, 2022, https://byfaithonline.com/the-near-unbearable-burden-of-making-meaning/.