Guessfrog!—a big Polish guy—Barnamum Pierogi!
cribbed from an interview but: it's cool how he seems always to have characters with pathology/conditions in his books, and they're not clowns or their condition is not the end-all-be-all of them. the other example is the blind guys in As She Climbed Across the Table. I guess they were a bit a comic relief in their weirdness, but they did serve a purpose and did sit with the main guy for a few conversations iirc. and, what is crucial, and something that Doerr in "All the light we cannot see" did as well is not elevate or put on a pedestal these people for "overcoming their tragic condition". they just are blind, and that's all there is to it.
Here with lionel, not only is he not a clown, it's not particularly funny or sad when he outburst, it just IS PART OF HIM, and Lethem explicitly describes lots of the indifference of other characters (usually by saying "it was not interesting to [whoever was sitting nearby]". i remember this distinctly at least twice)
he also is the main character, or at least the most prominent out of the 4 main guys (just because it's first person doesn't mean they have to be The Main)
so. knowledgeable representation is key. Lethem said he researched watchign docus and reading Oliver Sacks, and while he intentionally tried to "get it right", he did not model it after anyone he knew, nor—and this is important—is he trying to appease anyone. He was surprised that an important Tourette's association reached out to him with their appreciation, and he was surprised because he didn't write this -in order to- give representation , or signal his awareness about the condition.