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| Joyce Hoffman The Tales of a Stroke Patient |
A stroke comes with many non-pleasures, like annoying leg spasms, itchy feet, and a wide ass from sitting so much. Oftentimes, a post-stroke survivor will laugh or cry for no good reason. I have done both -- laughing and crying, sometimes in the same scenario -- and it has embarrassed me. I thought it was a temporary thing, but it has been going on a little over 3 years. But now, the real condition has a name -- Pathological Laughing and Crying, or PLC in acronym form.
You might not notice it at first. When something unfunny is said, I'll laugh, and continue to laugh for as long as 5, maybe 10 minutes. The same with crying. I bawl so hard, I hyperventilate, a condition which I never had done pre-stroke. Why do these laughing/crying jags happen? I'll give you some background.
PLC, to put it simply, is a condition in stroke patients which is uncontrollable without medication. Antidepressants, known as selective serotonin reuptake inhibitors (SSRIs), have been sort of successful as the treatment for PLC. The syndrome involves uncontrollable motor expressions -- i.e., laughing and crying -- often in the absence of related feelings of happiness or sadness. Although it is convenient to reflect on the presence of depression in people who have PLC, most people with PLC do not demonstrate depressive symptoms at all. PLC tapers off after the first year, but the syndrome's still there, just not as often.
Some people only suffer from Pathological Laughing (PL); some only Pathological Crying (PC). Most neurological researchers think that right frontal damage and brain stem lesions are associated with PLC, but so far, they really don't know all the triggers. Estimates of the prevalence of PLC are over 50% among stroke survivors, with percentages even higher in inpatient populations during the post-stroke interval. (I know. I know. I blame a lot of things on the CNAs, but they're not responsible this time).
A study was conducted at the University of Toronto, Department of Psychiatry, in which a total of 93 people with PC were given antidepressoant drugs. The results showed that 96% of patients who received the SSRIs showed at lease a 50% reduction in the number of crying episodes at the end of the clinical trial. In follow-up data, most stroke patients gradually improved over time even though they still had to take anti-depressants. (The Canadians, who have universal health care, have time to test conditions like PLC because they're not arguing with insurance companies over exclusions like the Americans. Just a thought. But I'm digressing).
The slow waiting period for the PLC to subside is difficult to tolerate, both for the stroke patient and those who interact with them. Most people who've had strokes agree: PLC presents itself as a social disability, laughing uncontrollably when angry or frustrated, or bawling and hyperventilating, for example, when encountering a pleasing situation. Depression may be a factor, too, but depression is its own factor, not to be in any way connected with PLC. In a depression syndrome, crying is a sign of sadness, whereas the crying which occurs in PLC is often in contrast to the actual situation. In other words, the crying in depression is for a reason whereas in PLC, the crying is episodic and doesn't match the mood.
Education of patients, families, and caregivers is mandatory for all of them to recognize PLC. Crying with PLC may be incorrectly diagnosed as depression; laughter may be diagnosed as mania. It is crucial for families and caregivers to recognize that PLC is both involuntary and somewhat manageable with medication.
As a sufferer of PLC, here are some examples, taken right out of the Hoffman Archives. You'll see how my feelings did not match the PLC-driven behavior even though I still take an anti-depressive drug every day:
Issue: A Man Who Lost His Job
Result: Maniacal Laughing
I was gathered around a table recently with friends and acquaintances when a man announced to the crowd, for the first time, that he had lost his job. The crowd was stunned. Some people stared at the table; two people left the room; others looked at him sorrowfully, with creased brows and wry smiles. And me? I laughed so hard, I thought I would break another blood vessel. I was embarrassed and appalled at my behavior. I wanted to step away and leave my body, but I couldn't. All the attention shifted to me because of my laughter. I was unaware of PL then and couldn't explain my mirth. But I looked damn stupid. So to all those people who witnessed it, I'm sorry. And to the man who lost his job, I'm really sorry.
Issue: The Friend Took Me on a Shopping Trip
Result: Crying hysterically
We were going to have a pleasant day, just two ladies on a shopping mission. We took the wheelchair in case I got tired because we had a lot of ground to cover. About an hour in, we were looking at T-shirts and I started to cry. I don't know what triggered the crying, but I found the shirt and went into the dressing room to try it on, with mascara streaked all over my face. As I sat and waited for the PC to subside, I was so ashamed, wiping the mascara which streaked it more. After using a horde of tissues, the crying stopped. I left the dressing room without trying the shirt on and returned it to the shelf. My friend, who by now had some notion there was something wrong with me, mentally speaking, said that hunting for the shirt must have made me sad. I didn't argue with her, but it's the hunt that makes shopping a fun challenge. She obviously didn't know about PC. For that matter, neither did I.There are more examples, but they're all sort of the same -- laughing for no reason, crying for no reason. As the results of the study said, my PLC is less than it was before when I first had my stroke. But the chance of the PLC leaving altogether is not probable. I have to concentrate on two things: getting up and leaving the room when I start to feel laughter or crying coming on and not wearing mascara -- ever again.
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