Saturday, June 17, 2006

I'll Give You Something To Cry About...

     My mother used to say that title line to me all the time whenever she felt my fits or crying spells as a child were unwarranted or feigning for attention.  It’s funny how everyone reacts so viscerally to tears or laughter.  It is almost as if these two expressions of emotion are somehow “hot wired” into our systems as either dualistically “good or bad”, “weakness or strength”, or “appropriate or inappropriate”.  Let’s face it…we all got in trouble in school, too, if we broke out in uncontrollable laughter!

     We spend a great majority of our formative years learning to “control” our emotions.  Controlling emotions somehow equates to mastery over them, leading us to believe emotions are a force to be reckoned with…something that will make or break us in any given situation.  Certainly I suppose this could be true in poker and politics!

     But current research suggests our emotions and the expression of them are far more complex than we, as higher functioning human beings, ever imagined.  Our emotions truly ARE “hot wired” into our brains and affect every aspect of our daily lives, from our circulatory system to our immune system.  Controlling our emotions can be a daunting task and even an unhealthy one in some circumstances.  UNDERSTANDING our emotional responses might serve us better in the long run for positive health.

     No one understands the effect our emotions have on us and those around us better than people with brain damage…and that includes Multiple Sclerosis, folks!  It IS, after all, a disease of the central nervous system that creates lesions/interrupts neuron transmissions in the brain and spinal cord.  It is believed people with certain types of brain damage, mainly to the prefrontal cortex of the brain where emotions are controlled/expressed, lack an ability to “control” their emotions because of this brain damage.  In other words, we cry and laugh at times for no real apparent reason…and you just thought you were going crazy, didn’t you???

     There are a lot of fancy terms out there for this lovely part of the disease process of MS.  You will hear it called “Labile Affect”, referring to the pathological expression of laughter, crying, or smiling.  Some may call it “emotional lability”, “emotional incontinence”, or it’s clinically appropriate term:  Pseudobulbar Affect.  Whatever you choose to call it, understand you can’t help it and probably can’t control it…it’s brain damage kids!  I like to call mine my “Mood Ass Moments”.

     Pseudobulbar Affect is no laughing matter, however.  It can be very frustrating and unfortunately is believed to affect as many as 10% to 50% of those of us with Multiple Sclerosis.  It can lead to lengthy explanations, embarrassing moments, coping problems at work, and social phobias.  It’s just not “pretty”.

     Currently, the only treatment available (and I stretch to use the word “treatment”) is the use of anti-depressants in low to moderate doses.  The drug Neurodex is being studied in open-label trials in the USA and appears to be promising, but it is far from meeting FDA approval.  My understanding is this drug’s primary ingredient is dextromethorphan, a cough suppressant used in over-the-counter cold remedies…at least it USED to be until the Meth labs began cooking it down and selling it on the streets!  Neurodex is a combination of dextromethorphan with an enzyme inhibitor, quinidine, which seems to help sustain levels of “dex” in the body. 

     But once again, we are asked to rely on the pharmaceutical companies to sustain our quality of life, which is something I for one resent, yet acknowledge and feel trapped by the need.

     So how do we cope with Pseudobulbar Affect with or without pharmacology?  Unfortunately, I’ve got no easy answer.  I never do.  I can only offer suggestions that “might” help you based on my own experience.

     First and foremost I had to recognize I wasn’t going (or had gone) crazy.  Nor was I profoundly depressed, suffering from bipolar disorder, or any other convenient and easily medicated label.  I have brain damage.  It’s a simple fact.  I can’t control it.  It’s not my fault.  I don’t LIKE it, but there’s not a whole hell of a lot I can do to reverse the lesions in my brain, so I might as well work on understanding and accepting the process…of course, digging my heels in all the way and kicking and screaming (I am far from “self-actualized”!).

     Second, if it’s not harming anyone and especially not ME, why do I care?  So I might make someone else uncomfortable?  So what?  We’re all “big kids” now and no one is going to throw me out of class because I am crying or laughing uncontrollably.  Besides, I can always throw in the MS Card and embarrass their lack of understanding, trumping my own embarrassment!  People HATE to be seen as politically incorrect when it comes to gimps (Oops!  Was that a politically incorrect term?!?)  I can’t HELP it, so sue me.  If I can’t stop, I can choose to leave the situation, excuse myself, or any number of things to do damage control.  But I can’t stop it until my brain stops it.  It’s just a biochemical expression folks…perhaps incongruent to the situation, but nothing more than an emotion.

     Third, fatigue seems to add to my Pseudobulbar Affect.  The more tired I am, the more likely I am to be susceptible to emotional misfiring.  This was true before I knew I had brain damage!  Recharging those emotional batteries is a must, whether this means taking some quiet time for yourself or even napping.  The world always “seems” clearer to me when I amwell rested.  And it is true…an agitated nervous system makes an agitated person!  Do what soothes you.

     And finally, you may want to try a drug.  I take Wellbutrin, an anti-depressant, for several reasons.  It increases my mental clarity in the morning, decreases my fatigue, keeps me from becoming “depressed”, and may even be helping with my affect regulation caused by the MS…who really knows?  It really doesn’t matter as long as I believe it is helping me and I do.

     I wonder if my mother would believe me today if I could tell her, “Hey Mom?  I really DO have something to cry about now.”  But I suppose she already knows that in spirit, wherever she is…and she’s probably laughing uncontrollably at the silliness of her statement!


For a more detailed summary of this topic, I recommend the following National MS Society link:



sbbridges said...

Finally someone has put into words what I have been trying to explain to people around me.  Non-MSer's just don't get it and it can be so frustrating to the point it makes things worse for me.  I have printed out a copy of your posting and I am just going to give it to everyone to read when I feel an explanation is needed from me.  Thanks for your writings.  I do find them very helpful.  Keep up the good work and thank you so much for taking the time to share with all of us out here in cyberspace.

sonyasuzanne said...

Like the person above me, I'm printing this one out too.  Mostly for my family, and in particular, Loving Hubby.  He says "Your a roller coaster of emotion".  HA!  IF ONLY HE KNEW!!  

I was seriously going to ask my doctor upon my next visit if I was INDEED BIPOLAR, because thats exactly how I feel!  And now I know, from learning from your post, that this is basically normal for those of us that have 'brain damage' due to lesions on our brain from the MS.  

Ahhh......learn something new everyday, and thanks to you, it's much easier to understand than I thought!  =o)