SHARES
“Why so serious?”
There was a time when we hear people repeat that phrase from 2008’s movie, The Dark Knight. Over the 80 years since his debut, the Joker has had many origin stories. Yet, the most profound for me could possibly be the latest film. Joker (2019) movie explores the villain’s origins once again. This time with a darker twist that deviates far from past versions of his backstory.
In the Joker movie, Joaquin Phoenix plays Arthur Fleck, a man struggling with a number of mental illnesses. Specifically, his inability in controlling his laughter.
The movie opens with the Clown Prince of Crime laughing uncontrollably – a strange pain emanated from that laughter – chilling almost. While the movie did not reveal the medical condition behind the Joker’s now famous laugh, these fits of uncontrollable laughter are symptoms of Pseudobulbar affect (PBA).
Understanding Pseudobulbar Affect (PBA)
People with Pseudobulbar affect have no control over their incongruent moods. As a result, they may burst suddenly into exaggerated, episodes of uncontrollable and inappropriate laughing and crying. Some people describe the condition as emotional incontinence.
Treatment often involves antidepressants and SSRI drugs (selective serotonin re-uptake inhibitors) which may reduce the frequency of the fits. Nuedexta (dextromethorphan hydrobromide + quinidine sulfate) is the only approved treatment, specific to PBA.
Yet, there is no cure.
Usually, Pseudobulbar affect (PBA) presents in individuals with amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), brain tumours, ADHD, and even traumatic brain injuries. It is also the lesser known symptom of other brain conditions such as Stroke, Alzheimer’s, Parkinson’s. A documentary “Beyond Laughter and Tears: A Journey of Hope” follows the life of people with PBA.
Recognising the Triggers of Pseudobulbar Affect (PBA)
For the most part, Pseudobulbar affect (PBA) episodes may occur without any reason. Sometimes situations or events are the triggers.
According to Prof Edward Lauterbach a neuropsychiatrist PBA specialist from Mercer University, Georgia, momentous events or situations can trigger PBA. “For one of my own patients,” recalls Dr. Lauterbach, “an unfortunate event of profound sadness actually triggered unrestrained laughter that was greatly embarrassing to her.” Knowing the triggers helps you avoid being in such high stress and emotional situation. Although, it can catch you off guard.
Coping Strategies With PBA When Emotions Erupt
The sudden, often inappropriate outbursts can be very embarrassing, stressful and socially debilitating. However do not isolate yourself as loneliness will set in, itself a trigger to a PBA response. To begin with, tell other people around you about PBA, so they don’t get confused about your behaviour, but understand what you are going through.
If you feel a PBA episode coming, use these strategies to cope:
- Distract yourself. Shift focus to something else, switch the subject to divert your mind away from the outburst. Look out of the window, talk about an art on the wall or interact with a pet.
- Shift your body position. Do the opposite of whatever you are doing. For instance, if you are standing, sit down, if you are sitting, stand up, walk away.
- Relax your body. Take slow deep breaths. Release tension in forehead, neck, jaw and shoulders. Try gentle massage of these muscle groups as you feel an episode erupting
Conclusion
In conclusion, the Pseudobulbar affect (PBA) got its name because PBA symptoms are similar to those caused by lesions in the medulla oblongata. There is a rough estimate of 2 million people suffering from PBA from the US alone!
PBA is treatable but symptoms are problematic, interfering with the patient’s social life in particular. Additionally, more understanding from family, friends and people around, would help limit its impact allowing PBA sufferers to cope and live a normal life.
Although the Joker commits despicable acts of violence in the movie it’s not hard to sympathise with him. His childhood trauma caused him to be constantly being in a state of fight or flight resulting in an overstimulated medulla which now looks for and perceives danger everywhere.
Although, does it justify his actions? I’ll leave that to you to decide.
by Yashwini Ravindranath
Born & raised in Malaysia, Yashwini earned her M.D. studying in Moscow's Russian National Research Medical University. With an affiliation towards research, all things coffee and the startup ecosystem, she now contributes articles to GetDocSays View all articles by Yashwini Ravindranath.
