When the interoceptive and conceptual clash: the case of oppositional phenomenal self-modelling in Tourette Syndrome

Tourette syndrome (TS) has been associated with a rich set of symptoms that are said to be uncomfortable, unwilled, and effortful to manage. Furthermore, tics, the canonical characteristic of TS, are multifaceted and their onset and maintenance is complex. A formal account that integrates these features of TS symptomatology within a plausible theoretical framework is currently absent from the field. In this paper, we assess the explanatory power of hierarchical generative modelling in accounting for TS symptomatology from the perspective of active inference. We propose a fourfold analysis of sensory, motor, and cognitive phenomena associated with TS. In section 1, we characterise tics as a form of action aimed at sensory attenuation. In section 2, we introduce the notion of epistemic ticcing and describe such behaviour as the search for evidence that there is an agent (i.e., agentive self) at the heart of the generative hierarchy. In section 3, we characterise both epistemic (sensation-free) and non-epistemic (sensational) tics as habitual behaviour. Finally, in section 4 we propose that ticcing behaviour involves an inevitable conflict between distinguishable aspects of selfhood; namely, between the minimal phenomenal sense of self—which is putatively underwritten by interoceptive inference—and the explicit beliefs that constitute the individual’s idea of who they want to be. In sum, we aim to provide an empirically informed analysis of TS symptomatology under active inference, revealing a continuity between covert and overt features of the condition.