For most of his career, nationally syndicated cartoonist Scott Adams has needed just two hours to produce a three-panel episode of "Dilbert," his celebrated comic strip satirizing cubicle life and misguided management. Those two hours take him from initial pencil sketch to the final inking of such beloved miscreants as Dogbert, the evil management consultant, who emerges from the pen in "one unbroken smooth line" that extends from his nose to his tail, Adams said.
But one morning last November, working in his home office in Dublin, Calif., Adams, 47, found that smooth line nearly impossible to execute.
"My pinky started moving again," he said. "Specifically, my pinky flexes. It goes stiff; it goes straight out."
That was a cue that his focal dystonia was flaring up to threaten his career once again. Adams was diagnosed with the condition -- a neurological movement disorder, marked by involuntary muscle spasms--back in 1992, around the time he launched "Dilbert." The problem affects his right hand -- the one he uses to draw.
"I would look at [my fingers] and tell them to do one thing, and they would do jagged things instead," Adams recalled. "I'd have full muscle control for everything -- except putting a pen to a piece of paper."
The first time around, he'd foiled the condition by drawing left-handed. Meantime, he was doing a conditioning exercise he devised: During the meetings that filled his old day job, he'd hold down a pen tip to paper until he felt a twinge, then pick it up quickly and rest his hand before a spasm would set in. He did this repeatedly, extending his pen-gripping time bit by bit. Eventually, he said, the problem "just went away."
But it was an arduous process he wasn't eager to repeat. "I couldn't go through another year like that," he said.
This time Adams approached the problem like the computer nerd he says he is, and found an answer online. The fact that his comics have continued uninterrupted since he began using a new drawing tool in January speaks to his success. Only his very closest followers may have noticed subtle differences in recent strips -- like Dilbert's too-skinny arm and oversized nose -- while the cartoonist was mastering the new technique.
But Adams is satisfied the approach works.
"[I figured] if I could find something that allowed me to draw that didn't have the same look and feel to my brain," he said, "my brain would not stop me from doing it."
Barbara Karp, deputy clinical director of the National Institute of Neurological Disorders and Stroke (NINDS), who has researched dystonia for 15 years, said Adams had the right idea.
The first line of treatment for dystonia, she said, is "changing techniques."
"It's just the most straightforward thing to do," she said. "It doesn't cost anything. [There are] no potential side effects. . . ."
The only problem, she said, is that often the approach doesn't work.
Focal dystonia, which can affect the hand (where it's commonly called "writer's cramp" when it affects writing), the neck (the most common site), eyelids or vocal chords, is something of a mystery. First reported in people who do fine finger work, including writers, seamstresses and musicians, it affects an estimated 29.5 individuals per 100,000 population -- or about 87,000 people nationally -- according to calculations made in a 1998 study. Though its causes are largely unknown, "we think there's a genetic component," Karp said. Often, focal hand dystonia patients are people who use the small muscles of the fingers and hands.
Whether overuse or misuse play a role in focal dystonia is debated, Karp said. The overuse theory meshes with Adams's experience, particularly since his case emerged during what the cartoonist calls his "running years" from 1989 to 1995, when he'd get up at 4 a.m. to draw "Dilbert" before heading off to his day job.
"We think the disorder is largely associated with the basal ganglia," which are deep brain structures that help regulate movement, Karp said. One theory is that repetitive movements or some other cause somehow trigger abnormal learning patterns in the brain. That makes the sources of the problem difficult to treat, Karp said. "We just treat the symptoms."
While changing manual techniques is a logical first course, often the change is not different enough, Karp said. "Sometimes the problem is more widespread in the brain and it affects multiple tasks."
Other treatments include rest, physical therapy, occupational therapy and medications. The most common drug treatment, said Karp, is injection with botulinum toxin, more commonly known by its brand name Botox, which weakens overcontracting muscles. Internationally famed concert pianist Leon Fleischer credited Botox for restoring him to two-handed piano playing last year, decades after focal dystonia in his right hand left him able to strike the keys with only his left hand.
Botulinum toxin "relaxes the muscle, and thereby releases the spasm," said Karp. But, she said, Botox treatments can cause more muscle weakness than is desirable.
There are also highly individualized tricks that some patients practice to help them cope. Some with focal dystonia affecting their mouth and jaw say holding a toothpick in their mouth appears to ease symptoms, said Karp.
"Sensory training" for focal dystonia patients is a "hot field of interest right now," she said. In some studies, patients are learning to read Braille to retrain the sensory area of the brain that may provide feedback on motor performance. If they can correct the distorted sensory processing, said Karp, they might be able to correct the motor problems.
Geeks to the rescue
Since January, Adams has been sketching and drawing "Dilbert" using an interactive display developed largely for graphic artists. Produced by Wacom Technology, based in Vancouver, Wash., the Cintiq 21UX LCD tablet allows artists to use a stylus on a pressure-sensitive computerized tablet. For Adams, this means he doesn't have to push down hard to draw. In addition, the software requires him to draw on an enlarged scale. Together, these effects keep his brain from prompting his hand to freeze up, he said.
Adams said he bought the product, which retails for about $2,500, and has no financial ties to the company. But Wacom posted Adams's photo on its Web site, along with the photos of other graphic artists who use the device. (While most cartoonists use computer technology at some point in the drawing process, Adams is one of the few who use it exclusively to produce his cartoons, said Steve Behling, managing editor of comics at United Media, the company that syndicates Adams's cartoons.)
For Adams, mastering the new tool -- which looks like the monitor of a laptop computer on a tiltable, rotatable stand -- involved a learning curve. In January it took him six hours to turn out his first Cintiq-produced "Dilbert" strips, which ran in March.
There were imperfections. "The hardest part was the body and head shapes" -- anything with a curved line, Adams said. Adjusting to the change in scale -- the software doubles Adams's usual 4-by-4-inch panel size, making Dilbert's nose about the size of a quarter -- also took time. "They definitely looked different for a few months. Suddenly, one of the characters would look too small. Things were too big or too small," said Adams. "Artistically, I just didn't have the eye" to adjust for the characters' suddenly larger size.
But soon he was getting the hang of it, and expressing relief that the method let him preserve the integrity of his work. To have somebody else draw the strip -- something some cartoonists do -- "would greatly decrease my happiness," he said.
"One of the reasons why you like to do your own drawings is, your style changes over time. And there's something about that that keeps it fresh to the viewer. This will be yet another change that I think people will enjoy without knowing why."
As of last week, it took him only an hour and a half to produce a strip, he reported.
You can't blame him for feeling he's got the upper hand again over his focal dystonia. That's better than things looked back when he first received the diagnosis. "I would sometimes sit in a crowded restaurant," he said, "and say, 'You know, I'm the only person in this restaurant who can't draw.' " ·
- American Academy of Neurology, a Minnesota-based professional organization. 800-879-1960 or 651-695-1940, http://www.aan.com/ .
- Dystonia Medical Research Foundation , a Chicago-based nonprofit advocacy group. Sponsors support groups and symposiums open to the public. 312-755-0198, http://www.dystonia-foundation.org/ .
- We Move, a New York-based nonprofit advocacy and education group. Web site provides educational information and links to support groups for patients with neurological movement disorders. http://www.wemove.org/
- National Institute of Neurological Disorders and Stroke , http://www.ninds.nih.gov/ (click on "disorders"), 800-352-9424 or 301-496-5751; TTY (for people using adaptive equipment): 301- 468-5981.
- National Spasmodic Dysphonia Association , Illinois-based advocacy group for people with spasmodic dysphonia, a form of focal dystonia affecting the voice. 800-795-NSDA (800-795-6732), http://www.dysphonia.org/ .
- National Spasmodic Torticollis Association , a California-based nonprofit advocacy group for people with spasmodic torticollis, also known as cervical dystonia, which affects the neck. 800-HURTFUL or 714-378-7837, http://www.torticollis.org/