Sunday, February 6, 2011

The neurology of uncontrollable crying

John Boehner, the Ohio Republican and Speaker of the House, has become the subject of widespread attention because of his proclivity to cry publicly. The Washington Post has reported that Boehner cries at gala dinners, during retirement speeches, and even during victory speeches, and that people “brace themselves each year for Boehner’s tear-filled speeches.” A New York Times article pointed out that Congressman Boehner cried during a 2007 debate over a military spending bill. Recently, he drew national curiosity when he wept uncontrollably during a “60 Minutes” interview with CBS correspondent Lesley Stahl. ...

While I have no reason to suspect that a medical condition is behind Congressman Boehner’s weeping, it turns out that there are indeed afflictions that can lead to crying, and they are unrelated to depression or drinking alcohol. ...

Pseudobulbar affect has been described in patients since the 19th century. For example, Charles Darwin observed that several distinct types of brain lesions could “induce weeping.” ... Neurological studies have shown that the electrical stimulation of certain deep brain structures around the brainstem induces crying that persists until the stimulation is terminated. The brain damage involved in pseudobulbar affect appears to disrupt the communication between the frontal lobes, where the emotion of crying may be controlled, and the “crying center” in these deep brain structures. The result is a loss of control, as if a driver could no longer work the brakes. (In some cases, the result is uncontrollable laughter, an equally disturbing anomaly.) It should be pointed out that pseudobulbar affect is amenable to treatment, and some patients have been treated successfully with the recently FDA approved drug Nuedexta.
--S. Allen Counter, Boston Globe, on a pill to treat your weepiness

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