Uncontrolled Joker Laughter, Recognize Nerve Disorders That Become The Cause

Credits: Warner Bross "Joker"

The Joker film was released in Indonesia on October 2, 2019, ago. The film played by Joaquin Phoenix tells the story of a man named Arthur Fleck. Arthur has a condition he calls illness. On IMDb, the Joker review scored 9 out of 10.

Yes, Arthur experienced a PseudoBulbar Affect (PBA), a condition in which he could not control his laughter or sadness. In the Joker film, Arthur was given a lecture by his mother, Penny Fleck to always smile and laugh because he was born to give laughter to those around him.

However, said Bandari, at least 1 million people in America laugh and cry suddenly, without control, and often not on time. This is not because they are happy or mellow, but due to a nervous breakdown called the pseudobulbar affect (PBA). For that reason, Arthur wants to be a comedian and even became a clown. In his daily life, Arthur often experiences laughing attacks that he cannot control. Once, after being reprimanded by a mother whose child was invited to play Arthur on the bus, Arthur laughed.

According to the mother, there was nothing funny, but Arthur could not stop laughing. Arthur also issued a paper that read his laughter due to the condition or the disease he was experiencing. For that, Arthur please understand and ask others to return the small paper to him.

In fact, this PseudoBulbar Affect (PBA) made Joker made fun of three Thomas Wayne employees who got drunk on the train. Seeing the behavior of three people who tease women, Arthur laughed as a form of concern. Arthur who ultimately wanted to be called a joker (giver joke or contrarian) was considered mocking the three drunks.

When asked what was funny, Arthur could not explain why he was laughing so hard. Unfortunately, Arthur did not give a small paper mainstay until he was persecuted, beaten, and insulted which led to the brutal actions Arthur shot the three people.

Because of his uncontrollable and unclear laughter, Arthur is often considered strange by those around him, Bun. This is one of the reasons why Arthur, who was originally a good and entertaining figure, became a violent killer. In the Joker trailer Arthur is also depicted laughing loudly several times, without cause.

What kind of conditions and the causes?

condition of laughter or crying without control experienced by Arthur Feck, aka the Joker is the PseudoBulbar Affect (PBA). Quoted from Web MD, clinical psychologist Smitha Bandari says crying and laughing are a normal part of a healthy life. When we grieve we cry, and when we are happy we laugh. Even if there is something very funny, we laugh out loud.


"PBA is also called emotional incontinence, emotional lability, unconscious crying, laughing and crying pathologically," Bandari said.

In people with this disorder, the symptoms shown are they laugh or cry in the wrong situation. Then, the duration of them laughing or crying is longer than most people laugh or cry. In fact, without reason, they can cry or laugh very loudly, without control.

Symptoms of laughter or tears that can suddenly stop or change are often mistakenly considered symptoms of depression or bipolar disorder. So, what causes PBA?

Bandari said, some scientists believe PBA is caused by damage to the prefrontal cortex. This is an area of ​​the brain that helps control emotions. Also, changes in brain chemicals related to depression or excessive mood (Manisa) can play a role.

Trauma or illness that affects the brain can also trigger the pseudobulbar effect (PBA). About half the people who have a stroke experience this condition, Bun. Other brain conditions commonly associated with PBA are:

1. Brain tumors
2. Dementia
3. Multiple sclerosis
4. Amyotrophic lateral sclerosis (ALS)
5. Parkinson's disease

Diagnosis of pseudobulbar affect (PBA)

If your mother or family has a relative or someone who is crying or laughing for no reason, they can consult a doctor. PBA is usually difficult to diagnose because it is often mistaken for symptoms of depression or other mood disorders.

"When going to the doctor, tell me how the symptoms are, including when laughter or tears suddenly occur and how long they are. Usually, doctors will not do blood checks but do electroencephalogram (EEG) to see brain waves," said Bandari.

Two questionnaires help determine whether someone's laughter and tears are symptoms of pseudobulbar affect, namely:

1. Pathological Laughing and Crying Scale (PLACS)

The doctor will ask how long laughter and crying lasts and how laughter and crying are related to mood and social conditions, plus how stressed you are.

2. Center for Neurologic Study-Lability Scale (CNS-LS)

People suspected of having PBA answer questions about their symptoms. Including how often it happens and what is experienced for example you feel easy to laugh or you can laugh easily.

Treatment of pseudobulbar affect (PBA)

"Doctors will usually prescribe antidepressants to control PBA symptoms, although this drug does not always work. In 2010, the Food and Drug Administration (FDA) approved dextromethorphan or quinidine as first-line PBA therapy. Studies show this helps someone control laughter and tears in people with MS and ALS

Living with pseudobulbar affect (PBA)

For people who have pseudobulbar affect (PBA), Bandari said they can feel anxious or ashamed while in public places because they are concerned about their laughter or crying. the unnatural reappeared, and as a result, some people preferred to shut themselves up.

It is also important for patients to control their health. Do not hesitate to discuss your condition with family and people around. So, they are not afraid, worried, or shocked.

"The National Stroke Association recommends taking a lonely position when the laughter or crying attack will appear. Try to take a deep breath slowly when there is laughter or crying until you can control yourself. Don't forget to relax. Because emotions can make muscles tense," said Bandari.

Meanwhile, for the caregiver, the person who takes care of PBA patients, can feel confused or frustrated by what the patient does. The caregiver's emotional burden can affect recovery and quality of life. Therefore, Bandari stressed that the welfare of the caregiver oun must be considered.

Pbainfo.org writes, pseudobulbar affect (PBA) occurs in
- 48 percent of people with traumatic brain injury
- 39 percent of people with Alzheimer's
- 28 percent of people with troke
- 46 percent of people with multiple sclerosis
- 50 percent of people with ALS
- 24 percent of people with ALS with singer Parkinson's

PBA and depression are very different. PBA is a neurological condition due to damage to the nervous system, while depression is a condition related to emotions and mental disorders. Then, people with PBA certainly have neurological problems. Meanwhile, depressed people can have neurological disorders or not.

For patients, this condition can be frustrating. Because, when we are not sad, weep suddenly. Likewise, when there is nothing pleasant, laughter suddenly comes out as a reflex. Now, because PBA symptoms can also occur due to other neurological conditions or brain injuries, patients still find it difficult to reconcile with this condition.

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