“Swellness” is a monthlong series exploring the health and wellness stuff no one talks about.
“America isn’t the place for you. It wouldn’t be good for you.” The message, delivered confidently by a spiritual medium in Paris in early 2021, came more as a confirmation than as a revelation. I had moved to France in 2006 as a 21-year-old French-language student and never left.
Back then, I was still a dependent on my family’s insurance and blithely unaware of how fissured the health-care system truly was. At age 36, sitting in front of the medium, I had no illusions about the state of American health care and its inequities. Same goes for my geographical future. I could point to a whole host of reasons for keeping a distance from the U.S. — violence and political upheaval, for starters — but mostly it was France’s high quality of life and strong social foundation that became crucial in navigating my chronic neurological condition and what wellness might look like for me.
I was 8 years old when it became abundantly clear that my rapid-fire blinking, nose-scrunching, and ear-wiggling were not temporary spasms. I was diagnosed with Tourette Syndrome. TS, in shorthand, is a neurodevelopmental disorder marked by repetitive, involuntary movements and vocalizations called tics and usually presents itself in children between the ages of 3 and 9. I’ve experienced the most common— blinking, grimacing, head jerking, throat clicking, as well as a more complex series of lower-body movements that have emerged as I’ve gotten older. (Coprolalia, a possible symptom involving involuntary outbursts of obscenities or socially inappropriate remarks, which I don’t exhibit, is uncommon, despite its gross overrepresentation on big and small screens.)
Even when I was a kid, at the start of my care in the U.S., it felt like the only solution specialists seemed willing to suggest were pills, regardless of their side effects. “Isn’t there some other way?” I repeatedly asked. My hunch is that those prescriptions were seen as a guaranteed quick fix available to those doctors to alleviate the disturbance and get me on the road to blending in with other kids. This was a time before online support groups, before public figures were in the habit of making grand overtures about mental health and personal traumas, and well before schoolteachers walked on eggshells with students’ feelings. So while the diagnosis brought clarity, it also brought isolation: An out-of-control body was unsettling and distracting to others, evidently something shameful to cover up.
Throughout my life, my tics have varied in their severity, sometimes worsening over the course of a day, sometimes taking months to manifest. But their onset has always been perplexing: I’ve had tics appear overnight like new moles, stick around for many years and then vanish as curiously and suddenly as they arrived. In their place, new ones settle in. All the repeated strain on muscles and joints makes many of them physically painful and exhausting.
When I moved to France, I had already stopped TS-specific treatment — medications were either entirely ineffective or helped but generated side effects, like weight gain and cognitive sluggishness, making them unsustainable options in the long term. For many years, both as a student and as a young grad, I simply focused on keeping my anxiety in check and pretended the disorder wasn’t a constant disruption to my daily life.
That worked for a time, especially in France, where the slower pace of life and resistance to American-style productivity culture can be as effective as medication for someone with a nervous system highly sensitive to emotional and environmental stimuli. Generous leisure time (hello, five weeks’ paid vacation) meant that I could amply recharge, whether that was in a guesthouse on the Normandy coast, sprawled out in one of Marseille’s ocean inlets, or somewhere well beyond French borders — Italy, Spain, Turkey, Lebanon — but gloriously within reach.
I was, more or less, soldiering through. And in moments when I couldn’t, I focused on getting through the day and letting out the built-up tension in private. If I needed to take time off when I had a salaried job, I had the days and job security to do so. I’d head to the Palais Royal’s enclosed gardens in the city’s center, my happy place, to find calm strolling up and down its tree-lined paths and beneath its pindrop-quiet colonnaded arcades.
This struggle goes unnoticed to most people — I’m high-functioning. I have built a career abroad and published two books, and I regularly speak in public without issue. If focused on one task, I can reach an almost meditative state and my tics subside. When my environmental circumstances don’t allow for that, I do what many TS sufferers find it in themselves to do: Suppress or camouflage as many of them as possible. That abrupt upper body-twitch? I had the chills. The clicking in my throat? That was a hiccup.
I used to have a spiel for every inquiry and became so good at “passing,” even in my last corporate job in Paris, that I kept up the habit until years of suppressing them, as well as the emotional burden of not disclosing what I was going through, wore me down.
About eight years ago, it all sent me spiraling. I was depleted by each day’s end and becoming easily undone by small things. The clanging of pans as they were placed on a drying rack, extreme temperatures, the once-thrilling, closed-in feeling of being in a crowded concert venue — all made me uneasy. This sensory hypersensitivity is common in many adult TS sufferers and can exacerbate tics. Once I started drawing suspicious glances on the metro and even getting followed by security guards in my local Monoprix supermarket, I knew I needed targeted help. And because health care is treated as a right in France, I didn’t hesitate to seek it out.
I went first to my neighborhood general practitioner, the only doctor I had seen for years with any regularity. An expressionless man who typed health reports on a dust-encrusted keyboard with only his index fingers, he once questioned what I had to be anxious about in the first place. He never instilled much confidence, but he did have the good sense to direct me to a nearby center with psychiatrists who could connect me with the right specialists. It took weeks of conversations and a formal application to the leading TS experts at the neurological department of a public university hospital, pitching me as unwell enough to need their care. As painfully slow as the process felt, I rolled with it. At least I knew I wouldn’t be refused care from some insurance issue — in France, health coverage is granted under the Protection universelle maladie (Universal Health Protection Law). By extension, I knew I wouldn’t go bankrupt — the universal, government-supported program, which my taxes help fund, largely had me covered. And where it didn’t (the French sécurité sociale covers between 60 and 70 percent of costs, depending on the type of doctor and treatment required), the supplementary health insurance that costs me only 35 euros a month did. There are no deductibles, premiums, or excessive out-of-pocket costs — currently the leading source of debt in the United States.
It’s why I was able to land one of the few neurologists who could help me properly understand my condition in its current form and how to manage it. I’ve been fully reimbursed for the medications we’ve experimented with, for years’ worth of physical therapy from tic-related injuries, and for cognitive behavioral therapy — the only non-medicinal treatment for TS that has yielded conclusive results.
The French system is by no means a panacea: There’s a massive shortage of health-care workers, in both rural and urban areas, and overstretched staff in emergency rooms. The approach to medicine can also lean too conservative, both in terms of the types and generations of prescribed drugs (including medical cannabis, which is still undergoing trials through 2024) and experimental treatments that go unexplored for reasons of cost or wait-and-see caution. And as is the case everywhere, in France those who benefit most are those who feel equipped and have the time to advocate for themselves, who come to the table informed and ready to push for alternatives and second opinions.
After much trial and error with treatment, I can happily say that I have reached some form of stability — tenuous but reassuring. I have good days and painful ones, but I credit the work with my neurologist and other specialists for helping me better understand my triggers, how to handle the fiery compulsion to tic, and, most importantly, how to calm myself when it overpowers. Central to this, I see now, is stress management, rest, and boundary setting. If I know a certain outing or endeavor is liable to generate additional stress, I question whether it’s worth the expenditure of energy.
Cost and access alone can’t explain the evolution of my care — my environment and a work-life balance built into the very structure of French society clearly play a role — but they do provide a safety net that eliminates the kind of generalized anxiety that would hinder my progress. I struggle to imagine where I would be in the U.S. today, particularly as a freelancer, where care for chronic conditions tends to get more, not less, costly over time. Where the cult of overwork is literally making people sick and miserable. Where true wellness seems reserved for the affluent few. As the medium intimated, I need a place that believes I deserve to live with dignity even in my worst moments.
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