In the late 1960’s, while a student in Ortaokul (middle school) at the English High School for Boys of Istanbul I developed a tic. It was a peculiar contortion of my upper lip, raised high up, and draping the underside of my nostrils. By necessity my entire lower face distorted during the act, and my mouth took on a strange, puckered, rounded appearance. In the decades to come I was to study neurology and learn the precise definition of a tic: a sudden, repetitive, non-rhythmic, stereotyped motor movement. Classified as a variant under the heading of “movement disorders” (such conditions as Parkinson’s disease), tics differ in that they are, as neurologists say, semi-voluntary, i.e. the owner of the tic can partially control it. At the onset of my tic, aged around 13, I was still far away from such formal definitions which might have sanitized my act as some sort of medical condition. In the Istanbul of the 1960’s however, no-one, my own parents included, viewed this mysterious contortion of my face as justifiable. It was repugnant to all and insulting to some.

I have since encountered grown ups with more revolting, “semi-voluntary” habits. When I was a medical student at the University of Chicago, doing my Junior Year Obstetrics & Gynecology clerkships, my small team of students was assigned to a rather disheveled female Chief Resident, who was pleasant enough to work with and, unlike many others of her rank, did not give us much hard time. She would have been quickly forgettable were it not for her peculiar habit of picking her nose while she was reading medical records, and then licking the products on her finger as though they were ice cream – the crunchy kind – and chewing down her own buggers. This she did in full view of anyone she happened to be near, and without any inkling that it might be disgusting to those who witnessed it. In fact she was usually so absorbed in her reading that I was certain her actions were semi-conscious, a behavior she probably acquired in early childhood, and retained into potential embarrassment now as an adult, a doctor nonetheless. As medical students we were at the very bottom of the hierarchal packing order and thus dared not say anything to this woman about her habit. I am sure others did, but I never witnessed them.

A yet higher-up person, also from my medical school days was a German general surgeon by the name of Dr. Schraut. He was a young attending physician, a protégé of Dr. George Block, one of the most illustrious senior Professors on the staff, specializing in bowel fistulas (for those who don’t know what this is, I recommend that you not research it; suffice it to say that it involves bowel contents creeping to body parts where they don’t belong). A short, rather handsome dark haired man with a thick German accent, Dr. Schraut had the physique and agility of a striker in a German soccer team. His rather gross habit was that whenever he conducted a rectal examination, and this he did multiple times a day, he brought out his gloved finger that had just probed the cavity and smelled it. It was a brief smell, not much to it, but noticeable nonetheless. None of us students had been educated in the diagnostic potential of smelling our stool contaminated fingers, and indeed, to our knowledge, no one else practiced this art. We made fun of him behind his back, speaking in a fake German accent, imagining what he thought as his finger approached his nostrils, “hhmmm, shtool; smells gut!”

These rather more disgusting habits that were to make my rolling upper lip look flowery by comparison were no consolation for me in my teenage years as my tic took over my life and promised to make it more miserable than my early teen angst that was already doing a pretty good job.

I remember when this habit first started. It was my uncle Albert, married to my mother’s sister Victoria (yeah, no kidding, I had a Victoria & Albert in my family; decades later my first wife’s parents in Salinas, California were to acquire two dogs named Charles & Diana, but that’s another story) who once asked me if I could curl my lip up like that. I tried, I did, and I never again stopped. In fact a more satisfying form of the tic, a “super-charged” version if you will, was when I lathered my upper lip with a good, thick layer of saliva from my tongue, and then curled the wet mass onto my nostrils, deeply inhaling the satisfactory smell of my own oral secretions, Dr. Schraut be damned. Thus, I had a dry version of the act and a wet one.

“Tics may increase as a result of stress, fatigue, boredom, or high-energy emotions, which can include negative emotions, such as anxiety.” (Wikipedia) Now you tell me! Yes…All of the above was probably at play as my daily repetitions of the act became more prominent in Ortaokul. “Immediately preceding the tic onset, most individuals are aware of an urge that is similar to the need to yawn, sneeze, blink or scratch an itch”, continues the definition. A tension builds up, and it has to be released, as if the possessor of the tic “had to do it”. That’s exactly the way it was. But why did those grown ups not understand this at the time?

My parents, who correctly identified my behavior as a tic, and labeled it as such, were horrified that their beloved son, the one who was going to that most prestigious school and of whom they were therefore so proud, could engage in such a repulsive contortion of his face multiple times a day. Aside from making numerous negative remarks about it, and imploring me to quit, they did nothing else. I suppose nowadays, in the U.S. the same act would have precipitated an excursion through numerous doctors and specialists in search of a remedy, and possibly administration of some psychiatric drug. In the Turkey of the ‘60’s no one went to a doctor unless they were dead ill, and there was a strong stigma associated with seeking psychiatric help, especially for one’s children. Every adult in my world, the Europeanized, secular, affluent Istanbullus, lived vicariously through the accomplishments of their children, and openly seeking such remedy, in other words, admitting there was something nutty-the-matter with your kid was near social suicide. Eventually my parents got tired of repeated admonishments and learned to live with my tic.

This is about when my teachers at the English High School began noticing me. In those days we all sat behind old fashioned personal desks, lined in three or four rows. I never sat in the front of the class where one was an easy target for such acts as oral quizzes frequently flung on us by the teachers . Nor did I sit in the very back, usually reserved for the slackers and clowns, “shamatacilar” as they were labeled in Turkish. I preferred the safety of an obscure middle desk, preferably with plenty of mates blocking the teacher’s line of sight. I was thus able to conceal my emerging tic for quite a while, in a way I could not do at home. Eventually the inevitable happened. It was first noticed by several female teachers, some Turkish, some English. The females were at a disadvantage in our school, and I suppose in our society, because, by virtue of their gender, they automatically commanded less respect. This they knew well, and they were very sensitive to any sign of disrespect. Unlike my unsophisticated parents, who despite their lack of education, correctly diagnosed my condition, these female teachers took personal offense at my curling lip and protruding mouth. They thought I was sending them some kind of personal message with my mouth. Nowadays, as an adult, I can just imagine what they must have imagined. These women did not react to me in open class. Instead they called my parents and complained that I was making faces at them, multiple times a day during every class, and that they were outraged and insulted. My disrespectful behavior had to stop, immediately.

Each such complaint resulted in a new eruption at home from my parents who, exhausted and disappointed as they were, puzzled too, had no recourse other than talk me out of what was now an impossibly entrenched tic. All this did was embarrass me further, hopeless as I was, and try to invent excuses for why I felt the compulsion to smell my upper lip. My most common excuse was, “but, it smells good!”. This threw them into more frenzy. No amount of complaining or lecturing could stop my now compulsive act. And so I went through years of Ortaokul and then Lycee curling my lip and experiencing the consequences, embarrassed, and unable to stop it no matter how hard I tried.

My embarrassment reached its peak with a male teacher who eventually noticed it. His name was Mehmet Ali Akyol, and he taught us history. He was a stocky man with a dark complexion and pencil-thin moustache who carried himself with the high dignity of a mid level Ottoman bureaucrat who demanded more respect than his rank deserved. We found him intimidating, as we did with most male teachers. He had a natural aura about him that induced discipline in what was otherwise a group of teenagers prone to anarchy. He also had a special gift for sarcasm, of the Turkish kind, which he freely unleashed on us students, especially in ubiquitous oral exam sessions when single hapless kids stood in front of the whole class and fielded questions from him about the subject of the day. Those who were ignorant, and particularly those who attempted to bullshit their way out of their obvious cluelessness, received the most humiliating sarcastic humor at their own expense in front of their peers, a fate worse than physical punishment which was also quite common . A slap on one’s body, or even the strike of a wood blackboard pointer used as a whip hurt for a few minutes. The tongue lashing unleashed by Mehmet Ali Bey, and the resultant humiliation, could last for days, indeed for some, a lifetime.

And so it was that Mehmet Ali Bey eventually came to notice my curling upper lip, as I attempted to conceal it behind my classmates in those middle row seats. Since he taught us history for several years, it was eventually bound to happen sooner or later. Unlike his female colleagues he did not take the cowardly route of confronting my parents. In his usual direct, unabashed style, he took me on in front of the whole class. He interrupted his history talk, looked directly at me and told me, much to the amusement of my classmates and their loud laughter, that what I was doing made my face resemble a horse’s ass right before it was about to defecate. In those days horse driven carriages were still quite common in Istanbul, especially in the Princess Islands where motor vehicles were not allowed, and the main transportation was a “payton”, a rickety carriage. If one rode next to the driver, and we as kids loved doing that, one inevitably encountered horses that shit copiously as they trotted along, pulling the heavy carriage. There was not one kid in our class who had not witnessed a horse raising its tail and puckering its anus as it got ready to do the act. Often the hay like yellow balls that fell out of the puckered ass were preceded by a fart or two. Thus Mehmet Ali Bey’s imagery struck a funny bone in every member of the class. Needless to say, my face being likened to a horse’s ass ready to take a shit was extremely embarrassing. It would have been humiliating at any age, but it especially stung in those sensitive, angst ridden teenage years.

Somehow my parents discovered about Mehmet Ali Bey’s comment, and they found it even more amusing than my classmates. Having been frustrated by the non-ending tic for much longer than anyone in the school, they could not have put it to words any better than my self-important history teacher. They repeated the “horses ass” image to me for many years to come, well into my adulthood as my tic persisted. In the meanwhile I kept curling my upper lip, and puckering my mouth helplessly, because I needed to, regardless of how anyone reacted. I learned to develop a thick skin and deflect derisive mockery at my expense from everyone, including my closest family, not that it did not hurt. It was to serve me well in years to come as I went through a surgical residency where public humiliation and dressing-down by superiors was an integral part of the order, a military-like experience. To this, I suppose, I have my tic to thank for.

I still pucker my lip to this day, but no one notices any more. Maybe I do it less frequently, or maybe I have learned to better conceal it. No one has commented on my residual tic, nor has anyone taken offense in many years. I no longer ride horse driven carriages. But on those rare occasions, usually on vacation somewhere, where I encounter a shitting horse, I can’t help but think of Mehmet Ali Bey. In a strange way the imagery that he attacked me with has now come to be associated with his own visage. It is his well groomed, serious face I see as the horse lifts its tail in that special, determined way that presages the coming of farts and feces. There in the smelly droppings of the beast lies an almost holographic image of this influential man from my past, silently glaring at me as the shit falls to the ground.