Tics as Intentional Actions: A Revised Taxonomy

Abstract

AbstractWhile the complexity and heterogeneity of Tourette Syndrome are routinely acknowledged today, we still lack attempts to understand this complexity through the lens of different ‘action types’ evident across the spectrum of primary tics. In this chapter, I develop the first taxonomy of tics as intentional actions by critiquing a historical source: Culver and Gert’s influential framework of human behaviour. Although their distinction between intentional, voluntary, and free actions is useful, I highlight several conceptual problems embedded in their classification. First, the idea of ‘unintendedness’ challenges the validity of their framework and raises problems common to theories of action. I offer two new concepts – enactive spillage and normative load – to illustrate why unintended actions cannot constitute a separate action class. Instead, the distinct interrelationships between intentions, actions, and their outcomes are offered as an alternative basis for classification. Next, I critique Culver and Gert’s notion of a ‘volitional disability’ and their division between internal versus external stimuli of actions as ill-suited to capturing the complex phenomenology of tics. I propose that an affordance-based view of action as brain–body–environment interactions enables more fine-grained phenotyping of behavioural symptoms in tic disorders and beyond.KeywordsIntentional actionNonactionAction typesTic disorderTourette SyndromeAffordanceInteractionVolitionCoercionNot Just Right Experiences (NJRE)Premonitory urgeCompulsion