July 30, 2026

@michaelokun

One of the most thought-provoking ideas from Joe Jankovic's presentation in Aspen this morning was the concept that many movements do not fit neatly into the categories of either "voluntary" or "involuntary." Instead, there is a fascinating gray zone of semi-voluntary movements, where conditions such as tics, functional movement disorders, stereotypies, compulsions, perseveration, and utilization behaviors exist along a spectrum. Tics, in particular, often come with a premonitory urge that can be temporarily suppressed, but suppression comes at a cost and the movement eventually emerges. This framework resonated deeply with me because it provides a more accurate and compassionate way to think about these disorders. As we continue to educate the public, it is especially important in an era when celebrities like Billie Eilish have been unfairly accused of "faking" their tics. The science tells a much more nuanced story. Tics are neither simply voluntary nor simply involuntary; they occupy a unique space in between. Appreciating this gray zone not only advances our understanding of the neurobiology of movement disorders but also helps replace skepticism with empathy for the millions of people living with these conditions.