This afternoon I had another session of Habit Reversal Therapy (HRT). I’ve found the last couple of weeks of this difficult, not because of anything I’m being asked to do physically, but because of how it challenges the way I think about my tics.

I felt particularly confused after a session last week during which we’d been exploring the way thoughts and emotions influence my tics. While I know that both have a noticeable effect, I’ve always felt strongly that they’re not the root cause.

While we were talking, the therapist said he’d not seen any evidence that Tourettes was neurological. I pointed out that there’s also no evidence that it’s anything other than neurological, and that there’s a frustrating lack of research into Tourettes generally.

It’s taken a long time for me to get to a point where I accept my tics and don’t blame myself for having them. But after I left the appointment last week I felt like this had been undermined, and each time I ticced I felt disgusted with myself.

I know that this was not the therapist’s intention and that he wasn’t suggesting I could just stop ticcing. But perhaps because I often look like a stereotypical ‘mad woman’ I’m very sensitive about theories that suggest tics are caused by psychological factors.

The fact is I don’t live with Tourettes as a theory. I live with the relentless movement, noise and unusual experiences it brings. To maintain my sanity and self-confidence I hang on to the fact that I do have control over my thoughts and feelings, even if I can’t control my body or speech.

When I got home after last week’s session I talked to Fat Sister about how it had made me feel. She said she thinks Tourettes is multi-factorial, meaning there’s a mix of different issues involved – neurological as well as emotional and behavioural. This makes a lot of sense to me.

For a long time I was part of a team that supported children with autism. It’s generally accepted that autism is purely neurological, even though there’s little hard evidence to support this. It’s also clear that behavioural techniques can play a major part in the treatment of people with autism. But this obviously doesn’t make it a psychological condition. It’s just what seems to work best.

I’ve been thinking about the psychological aspect of my tics all week and it’s upset and confused me. We talked about it again at my appointment today, and afterwards, on my way home, I realised it doesn’t matter to me at all what causes my tics.

Different theories about what makes me tic aren’t that important. What does matter is that I keep an open mind about all the possible methods of dealing with Tourettes, and if I try them, I do so wholeheartedly.