Emotional Lability insights

[halfin]

Emotional lability (EL) is the most interesting symptom of ALS that I've experienced. Weakness and stiffness are just frustrating, as are speech problems. But unusual emotional displays are quite unexpected in a disease which is said to not normally affect thinking. It seems odd that the same brain systems that when damaged produce muscle weakness can also somehow make you laugh and cry.

I had EL come on pretty suddenly about a month ago. There were some hints earlier, slight exaggerations of normal emotions, but then suddenly I was crying ten times a day, and had several episodes of laughter in sad situations. Fortunately the meds I am on have helped quite a bit, eliminated 80-90% of it. But I still feel it somewhat.

What I learned was very interesting. The emotions are actually real, or at least based in reality, but normally I completely suppress them. The case of laughter in sad or unhappy situations brought home the embarrassing realization that I actually do find something funny about them. In fact, if you look at what things people laugh at, especially low-brow, unsophisticated humor, it is often someone getting hurt or suffering some misfortune. Think of old movies like the Three Stooges or the Little Rascals. I'm sure young people can find plenty of examples on youtube. Sad but true, people laugh at the misfortunes of others. Normally we completely suppress it, so much that we are unaware of it. But with the EL, it comes out. That is how it seemed to me. (Note that I have not been even a little bit tempted to laugh at my own injuries!)

The tears are interesting as well. Conventionally, we say that people cry when they are sad, but that is not the whole truth. People also cry when they are happy. In fact I believe that tears are a common expression of a wide range of emotions, if they are sufficiently strong. Most of the time, when I get tears as a result of EL, I am neither happy nor sad. I am experiencing an emotion which is hard to describe. It is a common emotion, and in retrospect I can recognize that it has always given me a feeling of warmth that might cause a slight tendency for my eyes to moisten, but in the past I was always able to suppress it. Again, I was hardly aware of it.

This emotion is kind of a combination of happiness and sadness, and comes on when I think or talk about something amazing, surprising, inspiring, moving, or any combination of these. The closest word I can come up with for the emotion is awe. Usually we associate that emotion with strong feelings, but I find that I feel something like awe many times a day, to a small extent, and those are the things that make me cry when my EL is acting up.

In fact I do find myself quite amazed and awe-struck to find myself in the bizarre and unexpected situation we all share, going from the prime of life to the sudden realization that this disease will bring total disability in a relatively short time. It is sad but it is at the same time utterly amazing.

 

[hopingforcure]

Wow, you are such a gifted writer, and have a way of really capturing what I feel. I really am grateful for your post, and think it is so true and so informative. The best post I have ever seen on EL. My husband did think I was serious when I called it Emotional Liability.

 

[brooksea]

Very insightful and interesting! Makes a lot of sense! And you know what? When my husband laughed uncontrollably during a serious talk about funeral arrangements, I also began laughing as I could see the humor. But it was still startling and disturbing at first.

 

[BethU]

The most interesting EL experiences for me have been the bouts of euphoria, which were mind-bending. (I say were, because unfortunately, my EL meds have eliminated them too.) They came about in situations where I felt I was seeing the world for the first time, and it was like the first day in Eden. These completely new, mind altering perceptions were extraordinary, and happened in the most mundane situations... the grocery store, riding in a car, etc. After a while I found that I could call up these altered perceptions, and that scared me a little, because I figured I'd get arrested if I stood in the store too long looking around me in amazement.

Another EL I've experienced is rage, and as Hal said, once it was triggered by a logical event. (Most of my breakdowns haven't been.) At the neuro clinic, during an EL drug trial, I was trying to tell the doctor that the latest issue of meds were different and were not working (must have been a bad batch), I got weepy, and she tried to sooth me ... "There, there, I know how it is." And I screamed "THE HELL YOU DO! YOU DON'T KNOW A GODDAMN THING ABOUT WHAT IT'S LIKE HAVING ALS ..." etc. And lunged at her. Of course, this was with 90% of my speech gone, but she got the message and ran for help with me still screaming. Then the emotion passed, but the screaming, weeping, shrieking, went on uncontrollably for about 20 minutes, while I typed "This is just EL and don't worry about it, it will stop by itself" as people stood around and stared at me.

What I have experienced is that the EXPRESSION of emotion is completely unnatural, to me, at least, and that's what I was told by my neuro happens. Feeling emotions and expressing them happen at two different places in the brain, and the part that is messed up is the expression. I've walked through stores and parking lots shrieking the most gawdawful sounds and sobbing uncontrollably because the bag boy remembered that I take paper and plastic, and I was so touched, I broke down and the EL just took off.

I've never had the laughter, but the sounds I make crying and in anger scare the heck out of me. It's like something pre-human. If I didn't have meds, I'd never leave the house, as there is no warning and it's so humiliating.

 

[Zaphoon]

Hal and Beth, those were two very insightful posts on EL. Thank you!

I'm just going mad. No EL, just mad and I think it has to do with the constant crappy feely from continual cramps and spasticity. I get annoyed by people doing stupid things where as before, I'd hardly notice stupid people. In fact, stupid people were my friends! Now I even call them names (names I wouldn't have called them before). I also mutter things under my breath.

We had company over recently - my wife had to have these folks from church over for lunch on
Thursday. This couple came over with their kids and there wasn't enough room for everyone at the table. I wanted to get the card table out but couldn't find it and uttered that four letter "S" word under my breath. The dear, saintly church mother must have heard me because she had this look of shock on her face.

What do you do? Are you suppose to confirm your suspicions that you've been heard muttering a slight nasty. "Excuse me, sainted person, but did you just hear me utter what I think you heard me utter?"

With me, my subconscious is overwhelmed by what my conscious mind is supressing, that being the constant, nagging muscle cramps and stiffness. Suddenly, things flood into my conscious from my subconscious and I say things I ought not, mainly to myself.

In my case, I don't think I have true EL, just a worn and frazzled mind from trying to ignore all of the "discomfort".

Zaphoon

 

[paleshia]

so i have been wondering about the whole EL thing for a couple of days, thanks for your post Hal.....i do laugh a lot, uncontrollably even, but at funny stuff...like i had an idea on halloween that was (to me) so funny i couldn't even share it until the laughing passed. we stopped in for the free black jack tacos they were giving away at taco bell and i thought; wouldn't it be funny to go home and print off coupons for free black jack tacos (expiring that day, of course) to give out to trick or treaters. ok, maybe i do have EL, because that just struck me as hilarious.

so for the serious side, i can't really talk about my ALS, how I am doing, about how my kids are doing without crying...but is that EL or just that the whole darn thing is just plain old sad. It really is cry worthy, but if i can't share with people, is the disease robbing me of more and am i missing some kind of purpose? is it time for meds? but i am really afraid of not being me on the meds, i don't want to miss out on things i need my emotions for...like the other day when my 6 year old and i watched leaves fall off the trees and just marveled at how they seemed to dance all the way down.

 

[John1]

Some really thoughtful and insightful posts here. Thank you.

I think that I have a mild case of EL. My responses to situations are exaggerated but generally appropriate in a conventional sense. It tends to move me more toward tears than laughter but at both sad and happy events. And I think even when I laugh at "inappropriate" situations, there really is an underlying humorous cause but normally I would have suppressed it for convention's sake.

Overall, I rather enjoy my EL because it puts me more in touch with my feelings.

 

[tajmom]

I just started meds for EL and I am looking forward to a lessening of symptoms. Parenting is difficult when you laugh at your kids when you are upset with them. I also laugh when my kids cry which makes them feel bad. Doc tells me I will see results within days!

 

[Erica]

Hal and Beth, thank you very much for such insightful and thoughtful posts.
My EL is more geared toward crying: I cry numerous times thru out the day. I starded Lexapro 10 days ago, but so far no results.

 

[pvale]

I think I also had a mild case, but I would laugh or cry at the stupidest things. The Amitriptiline Hydroxide the Dr has prescribed me seems to put a stop to most of it. I don't know how to write my feelings as well as some in earlier posts, but it's one of the most confounded symptoms of ALS there is.

Perry

 

[Zaphoon]

My last post on this thread probably wasn't as insightful as those of Hal or Beth - my apologies for lack of introspection.

Is anyone else willing to confess (gotta love that word) that your emotions have been altered not by EL but maybe by just becoming tired of the constant crappy feeling. Anyone else get worn to the bone like this?

The cramps have picked up a notch, really bad in the mornings with my leg muscles shape shifting. Oh joy!

On top of that, (another confession here folks) I'm guilty of holding back the mini Hershey bars from the trick or treaters and handing out the mini tootsie rolls instead. The Hershey bars wound up in my freezer for "you know who".

I'm just really bad lately. I would like to apologize to all of the kids I cheated on Halloween night.

Zaphoon

 

[rose]

Like John, I'm in the "mild" category. At first, before diagnosis, I thought maybe it was approaching menopause. Some things that trigger it, always seem to trigger it. Like, if I'm remembering back about what it was that upset me, it will do it all over again. (for a while)

I remember the very last trip I worked, (although at the time I didn't know it was my last trip) I was standing in the hotel lobby, waiting to be picked up in the crew van and taken to the airport, and there were these little stuffed animal cats in the window of the gift shop in various poses, and they started me to crying - what it touched in me emotionally I'm not so sure, I like cats, but come on! Anyway, that's when I thought to myself that no way that it was menopause doing it.

I can go a long while without episodes, but when I have one, it takes me a period of time before I can put it past me. Music, especially touchy feely songs, or ones that have special meaning to me are triggers.

 

[BethU]

PZ ... Absolutely, we all get upset, angry, depressed at the whole condition with its frustrations and feeling lousy, and many things bring on anger and weepies.

What distinguishes EL for me is the uncontrollable and unnatural expression of the emotions.

As Rose said, looking at a stuffed animal may make normal people go "aaaahhhh, how cute/touching/sweet" but when you find yourself crying hysterically over it, that's EL. Or, when a dear friend tells you they have cancer, and you burst out laughing, that's EL. Or, when you find yourself lunging and screaming at your neuro, (hopefully) that's EL. :lol:

It's not having normal emotional reactions to a scary, frustrating, maddening disease. It's having abnormal emotional reactions, or out-of-control, unnatural emotional expressions in everyday situations. There really is a big difference.

Here is a link that shows exactly how I get in a "rage storm." The episodes leave me exhausted for a day or so. This was a woman missing her plane in a Hong Kong airport, and is from Youtube. And all the time your brain is saying, "OMG, what is wrong with me? Why can't I stop this?" Your body is completely out of control AND YOU CAN'T STOP YOURSELF FROM DOING WHAT YOU'RE DOING. It's like a seizure.

Another medical term for the condition is "emotional incontinence," which maybe makes it clearer.

YouTube- Hong Kong woman's airport hysterics

 

[John1]

Rose I'd forgotten about music. I've spent a small fortune in recent months buying CDs. Mostly female vocalists and mostly love songs and string and piano classical music from the romantic period. Listening to them offers a whole new intensity level. My daughter once told me that a Chinese friend of hers can't listen to Western classical music because it is too emotional. Now I understand what she meant but I love it.

 

[GlenBrittle]

Wow , look at all of that information. I have to ask "Where did you hide the spycams in my house ?"

I confess that the emotions are a little on edge lately. Anger, which usually takes a lot to surface, has been turning on like a switch. I have had to guard against it.

I am on meds for the EL and they are working well. I was crying at little kids , the bad guys getting shot , stupid commercials , and anything that would even come close to touch your heart. I am glad to be not doing that anymore.