Cultural understanding of Tourette’s is still unfortunately rare, with many people treating tics as morally reflective of hidden truths about those living with the condition. Tourettes can impact people in every area of their lives, with online gaming in many cases not ready to handle the nuance required for discussions of the condition.
Let’s start at the top, what is Tourette’s?
Tourette Syndrome is a neurological and nervous system condition where a person experiences involuntary, non-conscious, motor or verbal expressions known as Tics. Typically first seen around ages 3-9, and reaching peak intensity during teenage years, these tics can vary in intensity and expression from excessive blinking, to involuntary head jerking, to repeating recently heard words, through to more complex combinations of muscle movements or actions.
Tourette’s often develops alongside conditions such as Obsessive Compulsive Disorder, and has no cure. Some therapies and medications can help to reduce tic severity or frequency for some individuals, but even with medical interventions Tics cannot be fully controlled. They are a truly involuntary firing of mental synapses, not a conscious decision made by the person.
Tourette’s isn’t always verbal and, importantly to counter common misconceptions, isn’t always vulgar in nature.
Coprolalia is a subset experience of Tourette’s, experienced by approximately 10% of those with the condition, where a person might involuntarily tic swear words, slurs, or other inappropriate words or phrases. Connected and similarly rare is Copropaxia, where a person may tic obscene gestures.
At a fundamental level, Coprolalia and Copropaxia function very similarly to other forms of Tourettes, with areas of the brain dedicated to impulse control or inhibition not functioning correctly. In the case of these rarer subsets a person with tourette’s may find that, when particularly excited or stressed or tired, they may be more likely to have tics associated with the part of the brain that handles worst case scenarios.
If you’re in an airport for example, shouting loudly and repeatedly that you’ve got a bomb hidden in your shoe would likely draw unwanted and dangerous attention to you. No person would willingly decide to do that, but a person with Coprolalia alongside Tourette’s may find themselves unable to stop themselves from doing so, explicitly because it’s the thing that they know would be the worst for them to say in that situation.
It’s the thing they most need to resist saying.
Like any other Tourette’s tic, these are not in any way a reflection of the person experiencing the condition. Like any other tic these are unconscious and involuntary, outside of a person’s control. Much like a person with OCD may not be able to help having obsessive thoughts about their loved ones dying, a person with Tourette’s may not be able to help hitting themselves in the head and shouting a phrase from a TV show in the middle of a job interview.
For a little context, I have a couple of IRL friends who experience Tourette Syndrome to varying degrees. One of them has their condition relatively under control – Their tics are pretty infrequent and tend to mostly involve minor muscle movements and echolalia style repetition of words or phrases recently heard. The other has more difficulty with their tics, and experiences Coprolalia. They have previously ticced slurs that could be aimed at myself and my identity while in my company. While initially shocking to hear, they apologised, and it wasn’t a big deal. It’s impossible to navigate life never encountering negative terminology, and Coprolalia means that sometimes their brain may simply fire off the contents of the “never say this in this scenario, it’s the worst thing you could say” folder in their brain. They fact that they ticced a slur related to my being transgender felt targeted in the initial moment, but is something that in hindsight I understand was not malicious.
A person knowing a slur, and that it would be bad for them to say (particularly to someone personally impacted or targetted), is expected. If someone has a condition where they can’t help misfiring mentally the worst thing to say in a given situation, they deserve understanding and compassion. That person knew that term, and that it would be upsetting for me to be called. Them ticcing the phrase uncontrollably was not indicative of any of their actual beliefs, they are a staunch trans ally.
With all of this background context out of the way, let’s talk about Tourette’s in the context of video games.
Many gamers with Tourette’s, particularly those with Coprolalia, find that they have to avoid open lobby voice chat in multiplayer video games. For those with Non-Coprolalia style Tourette’s, unexpected verbal tics can in some games lead to mockery by other players, and in other games can give away tactically important information, such as a player shouting out where they’re currently hiding without meaning to. In games with proximity voice chat for example, a player with uncontrollable verbal tics may unintentionally give away their presence or location, a particular detriment in hidden role games. For those with Coprolalia the possibility exists that they may unintentionally say something on voice chat that is in breach of a game’s terms of service, and then get reported by another player, and receive an in-game ban.
However, many modern online multiplayer video games are built around the assumption that players will engage in voice chat in order to plan team strategy.
For those players with Tourette’s who chose not to play these types of games using voice chat, many of the same tools designed to help Deaf or Non-Verbal players can also be useful for players with conditions such as Tourette’s. Apex Legends, for example, features a ping system which allows players to highlight locations or objects on the map from a distance, and communicate why the highlighted location is important, entirely without verbal communication, setting a solid bar for how such communication systems can function. Similarly, games like Deep Rock Galactic and Helldivers 2 allow for highlighting objects, calling for support, and being alerted to the status of other players at large distances.
Additionally, games with Emote systems can allow for a degree of quick communication of basic info with other players without using voice chat.
Text chat systems in games can also offer options for non verbal communication for players nervous about using voice chat, but this is not always a practical option in fast paced online games, or for players with motor tics which may impact their typing ability.
With the above said, some games do notably disadvantage players who are not communicating via voice chat in mixed communication lobbies. For example, if playing Among Us in a lobby with some voice chat users and some text chat users, there’s often a perceived imbalance in reliability of information. As a result, offering modes where voice chat is explicitly banned, or other communication methods such as text chat are mandatory, can help players to match up with others playing the same way as them, and even the playing field on communication types.
Beyond avoiding voice chat, many players with Tourette’s I spoke to struggled with playing video games due to their specific motor tics. For these players, it can be challenging to play games which rely on degrees of consistency in fine motor control, such as carefully aiming down scopes to try and get a headshot in a first person shooter.
For players like these, many of the accessibility features developed for players with coordination or motor control disabilities may also be useful. Aim assist, rewind functions in single player games to undo a mistake, and gameplay slow down sliders can all be useful, but additionally so can features such as VR games allowing the smoothing of unexpected sudden hand movements (as seen in Assassin’s Creed Nexus), or options to reduce the registering of accidental rapid repeat inputs (as seen as options on Windows PCs for users with tremors).
Now, beyond in-game settings and options available to the player with Tourette’s, there are accessibility accommodations that could be made by developers to help more players with Tourette’s to be able to play online multiplayer games.
Some games, for example Valorant, feature automated voice chat detection software, and will issue temporary or permanent bans to players detected to be engaging in “offensive language”. For a game like this, which doesn’t have the most robust systems for non voice chat communication, this could obviously lead to a player with Coprolalia being banned from the game if they unintentionally say a forbidden word in voice chat. Language that is “inexcusable in polite company” could result in punishments ranging from a one day comms ban to a one year full game ban.
I understand that automated systems for detecting specific language will primarily impact people deliberately spreading hate within your community. I also recognise that, for a player with Coprolalia, this essentially means they cannot risk engaging with voice chat, in case they receive a ban for something unintentional. For many with Coprolalia, the more you know that you aren’t meant to say a thing, the harder it is to avoid blurting it out unintentionally.
In cases like this, I would love to see game developers educate themselves on Tourette’s as a condition, and consider developing specific dedicated pathways for people with Coprolalia or other forms of Tourette’s to appeal infractions. Obviously there’s a lot of nuance into how you implement such a system, the line between a trust based system and one which requires evidence of disability is challenging to navigate and will vary between regions and approaches different developers take, but at its core developers need to consider if they feel that players with forms of Tourette’s like Coprolalia should be banned from voice chat, or if they are willing to make exceptions to policy for them to be able to take part in communicating with other players.
Having official policy in place, be that more leniency on when to enact bans or a full whitelisting of specific known disabled users, could do a lot to help players with Tourette’s know with confidence if they’re safe to use voice chat or not in a title.
Additionally, I would love to know what official stances streaming platforms such as Twitch and YouTube have regarding users with conditions such as Coprolalia form Tourette’s. If someone with that form of Tourette’s wants to stream themself playing a video game and they tic an offensive term, how understanding are those platform holders in their appeal process? Can these gamers stream on their platforms with a degree of protection from automated bans?
While alternatives to voice chat in games, and motor control accessibility settings, are both useful tools for gamers with Tourette’s, and already cropping up in games due to their usefulness for players with other different categories of disability, specific education for game developers around the subject of Tourette’s, and development of specific accessibility support tailored for those with the condition, are important steps for the game industry to take in the years ahead.
Far too many people either have a very narrow view of Tourette’s as a condition, or treat tics as voluntary or reflective of the “true character” of the person involved. We broadly need people to be better educated on the existence and the lived reality of the condition, but additionally we need to tackle the nuance required to make gaming more accessible for people with involuntary response conditions.