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Uncontrollable Laughing and Crying

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Uncontrollable laughing and crying are effects of brain injury. There is even a professional name for it: Pseudobulbar Affect. Referred to as PBA its cause is unknown, like so many other brain injury effects. An article in the Summer 2010 issue of The Challenge, published by the Brain Injury Association of America, states, "The first step to treating PBA is to receive an accurate diagnosis from a physician and ask what treatment option is best. Currently, there is no FDA-approved treatment for PBA."

So Much for the First Step, huh?

You could almost have guessed there was no treatment by reading that the medical community doesn't know what causes it. In fact, Charles Darwin wrote about various brain diseases that tended to induce weeping — back in 1872. Uncontrollable laughing and crying are not new effects.

More troubling, however, is the work of Kinnier Wilson in 1924. In describing the core features of this syndrome he said they were out of proportion to the stimuli and inappropriate to the social context in which they occurred. Oh, yes, it’s inappropriate behavior. Other terms came into use: pathological laughing and crying, emotional lability, emotional incontinence, pathologic emotionality.

Is it any wonder that some physicians attempt treating PBA with antidepressants? First, you depress the patient by saying their actions are inappropriate and display pathologic problems involving incontinence. Then, you treat them for the depression you caused.

The BIAA article quoted a mother of a TBI patient, "We would never know when [the outbursts] were going to occur. They embarrassed the family." I am the husband of a person who suffered a brain injury. My wife and I have been living with the effects of brain injury for over 20 years, and we've learned a few things about living successfully following such an injury.

Brain injury is a physical injury. A broken arm is a physical injury. A cut on your hand is a physical injury. A bruise on your body is a physical injury. If that broken arm prevents you from throwing a ball, are you embarrassed by it? If that cut on your hand prevents you from being able to sign your name legibly, are you embarrassed by it. No, you usually say something like, "this [injury] is causing me a little problem."

If you or a loved one has a brain injury, it is causing more than a few "little problems" each and every day. Disinhibition is a term used to describe uncontrollable actions. Think of it this way. Let’s say that deep inside your brain is a box that contains your emotions. There are wires from that box to your eyes, mouth and other parts of your body that show expression. The emotions travel down the wires, pass through a filter (frontal lobe of the brain) and then are expressed by your body language, your eyes and your mouth.

But you have an injured brain. That filter does not always work properly. Rather than calming down the emotion to a socially acceptable expression, it just lets it go right on through. It could result in laughing uncontrollably, crying uncontrollably, anger or, even, sexual expression. (Be sure to read our article about Sexual Dysfunction and Sexual Performance.)

There is a very good chance this occurs most often when the brain is tired. (A tired brain is discussed in depth in our book, Brain Injury Survivor's Guide.) You may need to limit your social activity to times after your brain has been at rest. Listening to music is a great way to rest your brain. So is taking a nap. It is not your fault when you cry uncontrollably, or laugh uncontrollably. It is a sign that your brain is misfiring. You can certainly say, "Oh, well, I guess my brain’s filter is taking a break."

I cannot tell you how many times during the past twenty years that Beth has said something that caused me to look at her and ask, "Was that filtered or not?" That simple question allows us to think for a moment and, many times, it forces us to smile. Sometimes all you need is a moment to reflect before going any further.

Some people say you should count to ten before saying anything. But if you have already said or done the "socially inappropriate" thing, you can diffuse it by mentioning the filter problem. And you probably should count to ten before saying anything else.

Keeping a journal can help. You would want to write down what was done, the time of day it was done, how your body was positioned, and what circumstances might have led to your action. Over time you may be able to see a pattern of uncontrolled emotions. That would allow you to develop a strategy to compensate for your brain.

For instance, if the pattern relates to time of day, you might want to limit social activity at that time. That might be a time you should devote to resting your brain. As a writer I suffer brain fatigue quite often. Fortunately, there is a family of squirrels that play in our backyard every day. I can watch them through the window and forget about everything else going on in the world. I’m sure you can find numerous things that allow you to relax your brain.

Let it rest. Let it heal itself on its own schedule. The brain is an amazing organ. With your help, I believe it can eventually overcome most anything. Beth today is so much "better" than Beth twenty years ago. I encourage you, every day, to remember the title on the back of Brain Injury Survivor’s Guide: Never Give Up!

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