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Being Brought to Tears

PseudoBulbar Affect and Uncontrollable Emotional Outbursts

· Dementia,Dementia Challenge,PseudoBulbar Affect

On a walk last week, I found myself brought to tears by a sappy instrumental movie score playing through my headphones. The music was sad, slow, and heart wrenching, to say the least. My eyes welled up and then, without any warning, a teardrop fell to my check, followed by more and more tear drops, until I found myself in full sob.

The odd thing about the situation was that there were no corresponding thoughts that brought on my obvious sadness, I was just taken over by the music. I was emotionally incontinent.

As I strode closer and closer to home, still in mid- cry, I decided to relish in the emotional release and make this cry really count. I felt a little odd that the sobs were unjustified, thinking that I needed to have a good reason to cry this fiercely so I racked my brain for something that would make sense.

Once I did, the tears came stronger, my nose started running and I developed audible hiccups in my breathing.

If I ran into anyone on my way home, I would have a justified reason for my emotional breakdown, not that I would stop to explain it to them… it’s just that I felt I needed an excuse… just in case.

Reflecting on this, I question why I felt this way. Whenever I have seen a stranger in tears, I have not felt the need to approach and ask for clarification, for a reason. In fact, I have found it more comfortable to steer clear of the uncomfortableness of the situation. I must admit, however, that I have found myself staring at the distraught person wondering what has brought them to their knees in tears

The same is true for laughter. In a public space, observing a person break into hysterical laughter, I have never approached to hear the punchline of the joke. I do engage in a double take, smiling at the humor of the situation. I may even giggle to myself, assuming they are laughing at something they saw or a comment said by the person on the opposite end of their Bluetooth headset.

What I do not avoid, however, is the “rubbernecking”. As uncomfortable as it is to witness a personal display of emotion in public, I cannot help but want to see it all. I want to know what is bringing a person to tears or laughter, I want to live in the story that we make up about them in order to self soothe.

Gawking at someone who cannot control their emotions, for whatever reason, can cause the distressed person to feel ashamed of what they are doing, why they are doing it and why they cannot control themselves. It can create isolation and exacerbate withdrawal. An example of a condition that creates “emotional incontinence” is the pseudobulbar affect.

Common among persons living with specific forms of dementia, including Alzheimer’s disease, the pseudobulbar affect (P.B.A.) can impact the person’s ability to control emotions, impact their desire to be in public and negatively affect their social experiences in a crowd. With little or no rhyme or reason to the emotional outbursts experienced by a person living with P.B.A., gawking at their emotional display can create an isolating experience that hinders connection.

So, what is the best way to react to a person overtaken by emotions that make no sense to you?

First of all, catch yourself if you are judging their situation. You have no idea what brought them to their breakdown and you are the last person to decide if it is legitimate.

Secondly, be empathic to the need for personal space. Consider how you would feel if you were being stared at by a stranger during a vulnerable time. Would you want them to approach? Nod with a smile of understanding? Give you a hug? Your approach, or lack thereof, may vary among persons and situations. Just consider what you may want and be understandable of their reaction to you.

Finally, always be in agreement with where they are. If someone you know with PBA is laughing, join in with a giggle and a smile. Maybe even point something out in the environment that is funny. Everyone wants to be validated in their feelings and emotions (regardless of the origin). If you encounter someone with PBA in the midst of a crying spell, gradually approach with a subdued, calm demeanor. Encourage a shoulder to cry on. Offer a tissue. Validate that you are there for them, no matter how long it takes.

PBA is a neurological disorder that emerges from the disconnection of neurons in the brain that regulate messages regarding the expression of emotions and the control of emotions. A person with PBA cannot change what they are experiencing and do not need additional disconnection from the world around them. Educate yourself on the disorder and remind yourself that everyone is going through something, even if they cannot express it.

- Cathy Braxton, CDCS, Chief Education Officer Silver Dawn Training Institute

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