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The Real Condition Behind the Laughing Fits in ‘Joker’

Even if you haven’t watched the box-office hit, I’m sure you’ve seen images like these circulating around:

Image via Reddit.

These pictures depict the character Arthur Fleck (pre-DC Universe villain) from ‘Joker.’ The movie documents Fleck’s struggles with mental illness and his subsequent turn to violence after being isolated and outright rejected by society.

Image via Youtube.

Throughout the movie, though, we spot a recurring detail: Fleck’s random laughing fits. While starting his stand-up comedy routines and even simply sitting on a bus, Fleck laughs uncontrollably, leading him to carry an information card to explain his laughter to strangers during one of his episodes.

The Joker’s laughing spells are, actually, based on a real condition. Its name? Pseudobulbar affect.

What is pseudobulbar affect?

Pseudobulbar affect (PBA), also known as emotional incontinence, is a neurological condition characterized by episodes of sudden laughing or crying. Breaking the word into parts gives us -pseudo (meaning false), -bulbar (relating to a specific part of the brain) and -affect (referring to expression of emotion).

Episodes of PBA are usually mood-incongruent, meaning that someone with PBA might laugh uncontrollably while sad or cry while feeling amused. PBA patients may have episodes lasting seconds to minutes for any reason.

Image via Youtube.

Crying appears to be a more common manifestation of PBA than laughing.

How common is PBA?

Recent estimates suggest that around 2 to 7 million people in the United States have PBA, depending on the criteria used to distinguish PBA from other syndromes.

How might someone acquire PBA? How does it occur?

Pseudobulbar affect typically occurs as a result of a neurological condition or brain injury, such as multiple sclerosis, stroke, Alzheimer’s disease, Parkinson’s disease or traumatic brain injury.

The Joker’s information card. We can see that it mentions his condition “can happen in people with a brain injury or certain neurological conditions.” Image via Reddit.

Injury to the parts of the brain that regulate emotional expression are thought to bring about PBA. A malfunction of the cerebellum (which ensures emotional responses are appropriate for social situations), for example, may create this lack of control over an individual’s emotions.

Alterations of neurotransmitters like serotonin and dopamine (responsible for controlling mood and feelings of pleasure) are also believed to play a role in PBA.

What is it really like to have PBA?

The documentary Beyond Laughter and Tears: A Journey of Hope sheds light on what it’s really like to have PBA. It opens with a viral clip of a man, Scott Lotan, laughing at what appears to be nothing for nearly 3 minutes.

Scott was diagnosed with multiple sclerosis and later realized that his laughter was beyond his control. Laughing attacks in restaurants, during important meetings at his job and in other untimely situations have affected his life to a point where they’ve nearly started physical fights. Scott believes most people just assume he’s high or there’s something seriously wrong with him, an unfortunate consequence of having PBA.

Deanna Hurley, also featured in Beyond Laughter and Tears, suffered a stroke. Since then, Deanna hasn’t been able to stop her crying unless she shifts her thoughts to a different topic, which can be difficult for some PBA patients to do. Her physician mistook her crying for depression and told her to see a psychiatrist, but she knew her crying spells were something else.

Deanna’s case brings up an interesting point: patients with PBA are often mistaken for having depression. Dr. Jeffrey Cummings, a neurologist and the Director of the Cleveland Clinic Lou Ruvo Center for Brain Health, states that “the most common misdiagnosis of PBA is to identify the patient as being depressed. It’s only when you begin to realize that that’s not the way the patient feels that you discover this PBA syndrome.”

Although Scott Lotan’s and Deanna Hurley’s experiences have been far from easy, their input in Beyond Laughter and Tears is helping to raise public awareness of PBA. Hopefully, movies like ‘Joker’ will continue to do so.

Featured image via Youtube.

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