09 Functionality and Pathology of Swear Words

Question 1

Taboo language - understanding

Answer 1

• swearing 0.5% of daily spoken content
• traditionally understood as inflicting harm/horror on someone by invoking aid of supernatural power
• in Western society just use of foul or taboo language
• psychoanalytic approach to its origin: intrapsychic, in conflicting experiences of unconscious desire and conscious repression of it

Question 2

What are common themes of taboo language?

Answer 2

• sex
• excrement
• related body parts

Question 3

strategic swearing

Answer 3

• can have negative, but also positive effects
• context needed to ground meaning of intended use
• e.g., embarassment, emphasis, solidarity

Question 4

Taboo language and gestures

Answer 4

• power of taboo words lies primarily in emotional force they exude
• force in close organic connection with gesture language
• self protection
• sexual obscenities as “phallic threat”, a primitive gesture of dominance involving ostentatious phallic display for the purpose of shocking an opponent (middle finger?)

Question 5

Communication of swearing

Answer 5

• image of toughness and strength, having guts to ignore formality
  evolutionary indicator of potential threat
• functional perspective: cursing can serve as deterrence
• “refers to swearing out of annoyance or frustration as a primitive act of speech, comparing to growling of animals, growling communicates emotional state, other animals will be deterred and stress level will subsequently be reduced
• development of taboo language from socio-political sensitivity (avoidance of sensitive topics in sake of social norms)
• swearing shifts from languages and cultures

Question 6

emotional aspect of swearing

Answer 6

• highest correlation with anger, frustration, humor, pain and sarcasm (can be accompanied by certain feeling of helplessness)
• pain -> activation of rage circuit: amygdala -> hypothalamus -> gray matter of midbrain (catharsis and communicates situation is deeply affecting)
  automatic swearing
• expressing negative emotions may result in tension reduction, aggressive drive reduction
• pain relief (stress-induced analgesia, ice-cold water study)
• analgesia = Schmerzunempfindlichkeit

Question 7

swearing and brain activity

Answer 7

• selective preservation of swearing in aphasic (loss of speech) patients suggests taboo words comprise unique class of words neurologically distinct from normal language use
• strategic/purposeful swearing engages left hemisphere
• spontaneous swearing is lateralized to functions of right hemisphere (involved in emotion, suggesting neural connections between swearing and emotions) (aphasia research)
• more automatic/impulsive forms of swearing result from activity in limbic system and basal ganglia (basal ganglia dysfunction disrupting inhibitory processes can lead to coprolalia (using terms of digestion)

Question 8

coprolalia

Answer 8

pathological use of swear words

Question 9

copropraxia

Answer 9

pathological use of obscene gestures
- described in chimps who had learned sign language

Question 10

swear words and vulgar gesturing as a symptom of …

Answer 10

• stroke
• epilepsy
• neurodegenerative disorders
• Kleine-Levin syndrome (sleep disorder akin to narcolepsy) (case report)
• brain damage due to CO intoxication (case report)
• encephalitis lethargica (case report)
• Gilles-de-la-Tourette syndrome (GTS)

Question 11

Gilles-de-la-Tourette syndrome - symptoms

Answer 11

• most notorious for coprolalia/copropraxia, echolalia/echopraxia (repeating someone else’s utterances/actions), and palilalia/palipraxia (repeating one’s own utterances/actions)
• these phenomena occur in probably < 10% of all GTS patients
• motor and phonic tics (distinction is disputed by some, arguing that phonic tics are just motor tics involving vocal apparatus
• GTS: several motor tics and 1 or more phonic tics for more than 1 year

Question 12

Gilles-de-la-Tourette syndrome - tics

Answer 12

• simple motor tics: 1-2 seconds, abrupt and rapid, often in repetitive bouts, affecting a single muscle group (blinking, head jerking)
• complex motor tics: coordinated sequenced movements resembling acts or gestures (touching, jumping, bending) or distorted posture for few seconds to over a minute
• simple phonic tics: sniffing, throat clearing, coughing, belching
• complex phonic tics: linguistically meaningful verbalizations and utterances (words and phrases), including echolalia and palilalia

Question 13

Gilles-de-la-Tourette syndrome - premonitory urges and tic suppression

Answer 13

• premonitory urges: feelings of tightness, tension or itching accompanied by mounting sense of discomfort or distress and relieved by tic performance
• appear by 8-10 years of age
• most individuals can suppress tics for limited time with mounting discomfort
• “Enhancing an individual’s awareness of their premonitory urges followed by a competing response (that is, the selection and subsequent implementation of a physically incompatible behavior to the emerging tic) is at the core of behavioral treatments that have proven to be the most effective
• rebound after suppression in the majority of patients
• tics sometimes perceived as involuntary, semi-voluntary, or voluntary (in response to premonitory urge)

Question 14

Gilles-de-la-Tourette syndrome - epidemiology and etiology

Answer 14

• onset 4-6 years of age, highest severity at 10-12 years of age, then decline
• prevalence seems to be around 1% (or slightly lower) of children
• 3-4 times more common in boys than in girls
• some evidence suggests geographical or ethnic disparities with low incidences in Sub-Saharan Africa and lower rates in African Americans than in Caucasian Americans
• strong heritable influence (population based heritability estimate 0.77) with 15-fold higher risk in siblings of GTS patients, but no definitive GTS associated risk gene identified so far
• pre- and perinatal factors (maternal stress during pregnancy, gestational smoking, infections) may act on genetic susceptibility to activate microglia in the embryo and alter synaptic functionality
• maternal autoimmune disease associated with 29% increase of GTS in boys
• in patients, infections can also trigger tic episodes and increase severity

Question 15

Gilles-de-la-Tourette syndrome - comorbidity and coexistent conditions

Answer 15

• > 90% don’t have “pure GTS”
  comorbid conditions
• clinical similarities or purported genetic links to GTS
• OCD (r = 0.41 shared heritability), OCB
• ADHD
• migraine in 25-26% of GTS (8-13% in non-GTS)
  coexisting conditions
• no identified genetic or other etiological overlap
• depression
• anxiety
• substance abuse
• learning disorder
• suicidality (ideation and attempt) in 9.7% of GTS (3% in non-GTS), particularly with high tic severity and comorbidities

Question 16

GTS - hypotheses on cerebral pathophysiology

Answer 16

• dysfunction of the cortico-striato-thalamo-cortical circuits that are involved in selecting contextually appropriate behavioral patterns while suppressing inappropriate ones
• several transmitter systems have been implicated, both on theoretical considerations and empirical evidence (e.g., altering tic severity by interfering with the transmitter system)
  most solid evidence for dopamine
• ventral tegmental area innervates frontal cortex and ventral striatum (“limbic circuit”)
• influences transmitter release in both glutamatergic cortical and GABAergic (direct and indirect pathway) striatal neurons
• however, mechanism of dysfunction in GTS unclear (release of transmitter vs. receptor density or function)
  other transmitters implicated are glutamate, GABA, acetylcholine, noradrenaline, histamine, and endogenous cannabinoids

Question 17

GTS - brain areas and networks involved

Answer 17

Question 18

GTS - treatment

Answer 18

• many cases with partial or full remission in later adolescence
• However: “Intriguingly, in a study in which patients were videoed when they were young and then at >20 years of age at follow up, adult patients said they were tic free, but on video, 90% of the adults still had tics. However, the tics no longer caused distress and the need for medication was much less.”
• behavioral therapy focuses on premonitory urges, training a response that is incompatible with tic performance, followed by social reinforcement (good results)
• medication: anti-psychotic drugs (dopamine antagonists) and anti-adrenergic drugs reportedly lead to tic reduction of 25-70% within 4 weeks (side effects can be severe)
• deep brain stimulation first performed in 1999 and, so far, on less than 200 individuals with a heterogeneous set of target loci (several promising reports)
• waxing-and-waning nature of GTS with tendency to improve on the long run discourages drastic interventions

Question 19

Functionality and Pathology of Swear Words - Summary

Answer 19

• swearing traditionally understood as causing harm or potential threat
• swears of sexual obscenities seen as ‘phallic threat’ to assert dominance and as a deterrence
• strategic swearing is largely lateralized to the left hemisphere while automatic/spontaneous swearing is lateralized to functions of the right hemisphere
• automatic swearing may result in both tension and aggression reduction
• vocal and gestural vulgarities occur in several brain pathologies, most prominently Gilles-de-la-Tourette syndrom, albeit here only affecting a minority of cases
• leading symptoms are motor and phonic tics, typically emerging in childhood
• genetic and environmental factors
• implication of cortico-striato-thalamo-cortical loops and associated transmitters, esp. dopamine
• treatment with behavioral therapy, medication, and experimental DBS