Tourette’s campaigner John Davidson sparked fierce debate after an involuntary outburst of offensive language at the BAFTAs as a result of coprolalia, a rare, misunderstood symptom of Tourette syndrome
Many viewers have been left divided following John Davidson’s controversial BAFTA outburst on Sunday (February 22). The Tourette’s campaigner received both sympathy and criticism for shouting a racist slur while at the BAFTA Film Awards on Sunday night.
Davidson’s involuntary tic occurred while black actors Michael B. Jordan and Delroy Lindo were on stage presenting the award for Best Visual Effects. The advocate was attending as the inspiration for the BAFTA-nominated film I Swear, which dramatises his life with severe Tourette’s.
He also shouted other profanities, such as “shut the f*** up” and “boring”, during the ceremony, leaving many confused. Nevertheless, Davidson can’t control these outbursts.
The campaigner has coprolalia, which is a specific and relatively rare symptom of Tourette syndrome.
What is coprolalia?
The term “Pink Elephant Syndrome” (sometimes called the “Pink Elephant Effect”) is often used to explain the psychological roots of coprolalia, the involuntary utterance of obscene or taboo words, most commonly associated with Tourette syndrome. The phrase draws on the so-called “ironic process theory”.
If someone tells you not to think of a pink elephant, that’s precisely what pops into your mind. For people with Tourette’s, this mental quirk can have real-world consequences.
The harder they try to suppress a forbidden word or thought, especially in situations where it would be most inappropriate, the more their brain fixates on it, making an outburst more likely. This is why coprolalia can sometimes seem context-sensitive.
For example, someone might blurt out a racial slur at a public event, not because they hold those views, but because their brain is acutely aware of the worst possible thing to say in that moment. The effort to avoid saying it can create a mental loop, eventually forcing the word out.
What is the cause?
Experts believe this may be linked to a misfiring in the brain’s limbic system, which handles emotions and taboos, causing confusion between what a person most wants to say and what they least want to say, according to Tourette.org. Coprolalia is perhaps the most widely recognised, yet misunderstood, symptom of Tourette syndrome.
Nevertheless, it is widely recognised as a neurobiological “short circuit” rather than a psychological or emotional choice. Research suggests that coprolalia results from a complex interplay between specific brain regions and chemical messengers.
The leading theory centres on dysfunction in the basal ganglia, an area of the brain responsible for filtering out unwanted movements and thoughts. In people with coprolalia, this inhibitory “brake” mechanism fails, allowing unintended words to slip into speech.
Unlike motor tics, coprolalia is closely linked to the limbic system, which governs emotion and processes taboo or socially sensitive language. Some scientists even propose that these vocal outbursts may be primitive vocal fragments, similar to those used by animals for aggression or reproduction, which are inappropriately triggered in humans due to neurological dysfunction.
Brain imaging studies, such as PET and fMRI scans, have pinpointed heightened activity during coprolalic episodes in areas involved in planning speech and processing emotion, including Broca’s area, the anterior cingulate cortex, and the nucleus accumbens, according to a paper published in JAMA Psychiatry. Disruption in the connections between these regions and the limbic system appears to play a crucial role. Neurotransmitter imbalances are also implicated: excessive dopamine release is thought to drive the heightened motor and vocal activity seen in Tourette syndrome, while a reduction in GABA, the brain’s main inhibitory chemical, an contribute to the inability to suppress tics.
What are the symptoms?
As coprolalia is most often a symptom of Tourette syndrome, it usually appears alongside a variety of other physical and vocal tics. The hallmark of coprolalia itself is the involuntary outburst of socially inappropriate words or phrases, which can range from swearing to racial or sexual remarks, and even references to bodily functions.
These utterances may sometimes take the form of complete, nonsensical sentences and are often delivered with a noticeably different pitch, volume, or rhythm than the person’s usual speech. Some individuals also experience “mental coprolalia”, where the offensive words are repeated compulsively in their minds, causing significant distress even though nothing is said aloud.
In addition to coprolalia, people with Tourette’s may display a range of other vocal tics, such as repetitive grunting, sniffing, throat-clearing, barking, or coughing. More complex vocal symptoms include echolalia, the repetition of words or phrases spoken by others, and palilalia, the repetition of one’s own words.
Motor tics are also common, and can be simple, like eye blinking, facial grimacing, or shoulder shrugging, or more complex, involving coordinated movements such as hopping, jumping, touching objects, or twisting the body. Copropraxia, the motor equivalent of coprolalia, involves involuntary obscene gestures, such as making rude signs.
Most people with these symptoms describe experiencing a “premonitory urge”, a physical sensation or tension that builds up before a tic occurs, similar to the itch before a sneeze or the pressure before a hiccup. Performing the tic provides a brief sense of relief from this uncomfortable sensation, making the behaviour feel almost impossible to suppress.
Who has coprolalia ?
While coprolalia is most commonly associated with Tourette syndrome, affecting around 10–20% of those diagnosed, it can also arise from other neurological causes. These include brain injuries, particularly to the deep frontal regions, infections such as encephalitis, and, more rarely, neurodegenerative conditions like dementia or Lesch-Nyhan syndrome.
While individuals are not born with the tics themselves, there is often a genetic predisposition to Tourette’s, making it a highly heritable neurological disorder. Symptoms do not appear at birth; rather, tics typically begin in early childhood, most often between the ages of four and eight.
Coprolalia itself is rarely the first symptom to emerge. It usually develops several years after the onset of initial motor or simple vocal tics, often reaching its peak during adolescence.
What are the treatments?
Treatment for coprolalia is generally incorporated into the wider management of Tourette syndrome, as there is currently no cure. However, a range of therapies and interventions can help to reduce the frequency and severity of these involuntary outbursts.
Behavioural therapies are often recommended as the first line of treatment. Comprehensive Behavioural Intervention for Tics (CBIT) is a structured programme that helps individuals become more aware of the “premonitory urge” that precedes a tic, and teaches them to develop a competing response.
Habit Reversal Training (HRT), a key element of CBIT, focuses on specific tics and, in the case of coprolalia, might involve learning to muffle the sound, mumble the word quietly, or substitute the offensive word with a more socially acceptable alternative. Exposure and Response Prevention (ERP) is another behavioural approach, training individuals to tolerate the urge for longer periods without giving in, thereby increasing their ability to suppress the tic.
Medications may also be prescribed, particularly when tics are severe or disruptive. Antipsychotic drugs such as aripiprazole, risperidone, and pimozide are commonly used to block dopamine receptors in the brain, with aripiprazole showing particular promise for reducing coprolalia in some patients.
For severe or treatment-resistant cases, specialist interventions may be explored. Botulinum toxin (Botox) injections into the vocal cords can help by partially paralysing the muscles, reducing the volume and force of outbursts, though they do not eliminate the urge itself. Deep brain stimulation (DBS), which involves surgically implanting electrodes into specific brain regions, is reserved for the most severe and disabling cases where other treatments have failed.
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