Laughing at a Funeral: Pseudobulbar Affect and Inappropriate Laughter
LMAO, But What's So Funny?
Giggles at A Funeral: Just Tell Me It's Not True
Most people would say that it takes a dark, twisted heart to get a case of the giggles at someone's funeral. But I did it. And the last time I checked, my heart wasn't dark at all.
My husband and I were sitting in the front row at the funeral for his elderly father. It was a small service of about 40 people. His father had survived a massive stroke 36 years prior, and against all odds he had learned to walk and talk again—only to have died as a result of a hip fracture.
And here I was about to bust a gut at the funeral of this long-suffering man. I had no good explanation for it. I wish it were not true.
I was fine until the singing started.
My husband's uncle (a priest) delivered the eulogy, then an aunt (a nun) joined him in singing a hymn. However, instead of singing in unison, the two siblings sounded deadpan awful. Both were tone deaf and oblivious. And they sang with gusto, as if my father-in-law's entrance to Heaven's gates depended on it.
PBA: Laughing Your Head Off In the Wrong Situation
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Do you know anyone who has a habit of laughing inappropriately?
As they belted out their celebration of our loved one's recent entry into Heaven, I felt an irrepressible urge to laugh. Each time they sang the line, "Oh, Death, you have no power!" it was like holding back a sneeze.
As I bit my lip, I instinctively pressed my chin to my chest, trying to conceal any facial expression with my long hair. My shoulders shook. I squeezed my husband's hand hard, and he squeezed back knowingly.
Luckily, the song ended and I pulled myself together before I bellowed aloud.
It wasn't the first time this had happened.
Uncontrollable Fits of Laughter
Laughing at a Sad Movie: "What Is Wrong With You?"
I vividly recall the first time I was overcome by a case of inappropriate laughter. I was in a crowded theater watching a tear-jerker movie, "My Life."
The 1993 movie, starring Michael Keaton and Nicole Kidman, is about a man with terminal kidney cancer who is about to become a first-time father. The man makes videos of life lessons so that his son will some day know his father, even if it's only through film.
Now, I'm not hard-hearted. I was just as sad as everyone else about the story line. But you'd never know that from what happened next.
There was a man in the row ahead of me who had been crying, and just as Michael Keaton's dying character embraced his newborn child, my muse in the audience loudly inhaled—no, he gasped for air in what sounded like a snort.
Somehow, this struck me as hilarious. I cannot explain it.
I burst out laughing. I didn't just chuckle. I guffawed, and I couldn't stop. There were people in the crowd who shushed me. My husband elbowed me and asked "What is wrong with you?" My inappropriate cackling continued for about 10 minutes.
I was mortified and could not account for myself. Ten years later, I was diagnosed with multiple sclerosis, a condition that often coexists with pseudobulbar affect (PBA).
Had you ever heard of Pseudobulbar Affect before reading this?
What Is Pseudobulbar Affect (PBA)?
Pseudobulbar affect (PBA) is a neurological disorder involving unpredictable and uncontrollable emotional displays of laughing, crying, or both.1 Less commonly, PBA may be referred to as emotional lability, pathological laughing and crying, or emotional incontinence.2
PBA entails difficulty with emotional expression and regulation due to problems with a person's neurotransmitter systems. An individual with PBA experiences emotional eruptions that are disconnected from their inner feelings of happiness or sadness.
Although sometimes the emotional displays may be prompted by something funny or sad (e.g., off-key singing), the fits of laughter or tears may be particularly intense and last an inappropriately long time.
Emotional Incontinence: Crying Jags For No Reason
Who Gets PBA?
The condition is a separate neurological disorder which accompanies existing neurological damage.3 PBA affects as many as 7 million people who have neurodegenerative diseases and neurological conditions such as the following:
- Parkinson's disease
- Multiple sclerosis (MS)
- Lou Gehrig’s disease (ALS)
- Traumatic brain injury (TBI)
- Alzheimer's disease/other types of dementia.4
A conservative estimate is that 10% of people with the preceding medical conditions also experience pseudobulbar affect.5
People who experience PBA often experience frustration, embarrassment, worry, and confusion about their inappropriate displays of emotion. The condition may interfere with relationships, social activities, and employment. Symptoms can range from mild and occasional (like mine) to debilitating and constant.
Men have greater prevalence rates of inappropriate laughing, while women tend to suffer more from episodes of inappropriate crying. The type of emotional expression is also related to the location of a patient's brain lesions. Onlookers may sometimes confuse PBA sufferers' emotional outbursts as mental illness, particularly because patients cannot explain their behavior.
The condition is not widely recognized and thus is underdiagnosed, although there is now medical treatment available for it.
In 2010, the U.S. Food and Drug Administration (FDA) approved the drug Nuedexta for the treatment of PBA. The medication can control as much as 80% of inappropriate displays of emotion.
If you know someone with one of the above neurological conditions, and you notice inappropriate emotional displays, encourage them to talk to their doctor.
Tips: How to Deal With the Uncontrollable Emotional Outbursts of PBA
If you (or a loved one) experiences PBA, here are some techniques that may help when inappropriate outbursts crop up:6
- Get distracted. Have someone knead or rub your shoulders or arm to help relax and distract you. For example, at my father-in-law's funeral, I found it helpful to squeeze my husband's hand and have him squeeze mine back. This allowed me to maintain just enough control to avoid bellowing out loud.
- Leave the room. Remove yourself from the situation. Go to a quiet place and play some calm music if you can.
- Practice 7-7-7 relaxation breathing. Close your eyes. Then inhale deeply, slowly counting to 7. Hold your breath, slowly counting to 7. Slowly breathe out as you once again count to 7. Repeat as necessary. This simple technique is effective at inducing calm in a variety of situations.
- Mood incongruence. If dealing with laughter, for example, think of something mood-incongruent—angry thoughts, something disgusting, etc.
- Educate others. If you have PBA, let those around you know before any uncomfortable incidents. A little advance education is better than hard feelings and profuse apologies later.
A Great Explanation of Pseudobulbar Affect
1. National Stroke Association. "Effects of Stroke - Pseudobulbar Affect (PBA)." Last modified May 2013. http://www.stroke.org/site/PageServer?pagename=pba.
2. Minden, Sarah. "Pseudobulbar Affect (Uncontrollable Laughing and/or Crying)." National MS Society: National MS Society. Last modified 2012. http://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Transcripts/transcript-Uncontrollable-Laughing-and-Crying.pdf.
3. Allen, Jane E. "Involuntary Laughing, Crying Disorder Pseudobulbar Affect." ABC News. Last modified November 4, 2010. http://abcnews.go.com/Health/DepressionTreatment/involuntary-laughing-crying-disorder/story?id=12028237.
4. Work, S S., J. A. Colamonico, W. G. Bradley, and R. E. Kaye. "Pseudobulbar affect: an under-recognized and undertreated neurological condition." National Center for Biotechnology Information. Last modified June 6, 2011. http://www.ncbi.nlm.nih.gov/pubmed/21660634.
5. King, R R., and J. P. Reiss. "The epidemiology and pathophysiology of pseudobulbar affect and its association with neurodegeneration." Dove Medical Press. Last modified May 2013. http://www.dovepress.com/the-epidemiology-and-pathophysiology-of-pseudobulbar-affect-and-its-as-peer-reviewed-article-DNND-recommendation1.
6. Larkin, Carole. "Alzheimer’s or Pseudobulbar Affect." Alzheimer's Speaks Blog. Last modified July 29, 2013. http://alzheimersspeaks.wordpress.com/2013/07/29/alzheimers-or-pseudobulbar-affect/.
Sometimes, You Just Have to Go With It
Questions & Answers
How can you tell if someone has Pseudobulbar Affect (PBA) or they're just laughing because they are rude, childish or insensitive?
Pseudobulbar Affect is characterized by sudden, frequent, uncontrollable fits of laughter or crying. These bouts don't match the emotion one feels (e.g., uncontrollable crying but not sad or uncontrollable laughing but only slightly amused). Bouts of crying are more common and may turn into bouts of laughter, or vice versa, and these episodes last minutes.
People who have PBA have an underlying brain condition or neurological injuries, including stroke, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), traumatic brain injury, Alzheimer's disease, and Parkinson's disease. Since neurological diseases are not always a visible disability known to others, you may not be able to discern why someone is behaving so outrageously. This may cause onlookers to jump to conclusions that someone is mentally ill, immature, or rude.
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