In the film “Joker”, which has just been released in cinemas and whose performance everyone salutes the performance of the actor, Joaquin Phoenix who embodies the main character, this one laughs at all times, for no apparent reason. In fact, he emits sounds resembling a giggle, quite disproportionate to the situation, when he should be expressing something else: sadness, disappointment, anger, impatience… This behavioral problem really exists.
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Laughing at the Joker: the pseudo-bulbar syndrome, a neurological impairment
This is a rare syndrome, the pseudobulbar syndrome. It is linked to an existing or past neurological disease, such as multiple sclerosis, Parkinson’s, head trauma, stroke or, in the majority of cases, amyotrophic lateral sclerosis (ALS). This syndrome occurs when there is a disconnection between the brain lobes and the brainstem. The first are responsible for thoughts, logic, reason, while the second contains automatic functions such as reactions.
This “short circuit” deprives the person of inhibition, he knows that he is losing control, but cannot do anything about it. Note that this can manifest itself in the form of laughter, as in the case of the villain character of the Joker, but also of tears. Cases of pathological crying are also more frequent. The prevalence of this syndrome is between 5 and 50% in people with a neurological disease.
Another characteristic: laughter is spasmodic. It’s a laugh that comes from beyond the grave, on a frozen face. He can make you lose your breath, even choke, as in the case of the Joker.
Socially, uncontrollable laughter is a disaster
Of course, this can be very disabling. Socially, it’s incapacitating. People will tend to isolate themselves to avoid finding themselves in this situation. Discomfort, embarrassment, shame, guilt… The rate of depression is high in people with neurological diseases and this is no exception in the case of pseudo-bulbar affect.
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