When you have had as many strokes as I have, you are constantly being surprised about what was damaged in the brain. You’re cruising along with everything being easy to do until suddenly you hit a brick wall and you simply can’t do the next behavior, no matter how hard you try. Well some of these brick walls are obscure and barely noticeable to anyone other than those who know you best. Then there are the walls that you didn’t even know you had but are noticeable to others. Welcome to part three of my series on the mental health aspects of living with Systemic Lupus and Antiphospholipid Syndrome.
I have something known as Pseudobulbar Affect disorder. It basically means my emotional states do not match up with the emotional tenor of a conversation or how I feel inside. I can be prone to laughing or smiling at random or in response to something that should bring about another emotional response. Alternately I can be found crying for no reason, though for me it’s often laughing in appropriately.
I had no idea I had anything wrong, but should have been suspicious when my boyfriend’s mother got all upset with me accusing me of laughing at her when she was talking about something serious. I was of course defensive because I would never laugh at someone in crisis. But then my boyfriend pointed out to me that I do either grimace inappropriately or smile at the wrong times. Complaints I never had to worry about prior to my strokes.
The good news is they have medication that treats it called Nudexta (one of a few on the market; this is the one I take). It’s not often when you are dealing with a chronic illness to have a medication that actually works 100% of the time. And to top it all off, it seems to diminish my depression and my body dysmorphic symptoms. Miracle drug!
What is important about PBA is that it suggests there is an often-neglected part of the brain that inhibits emotions at cellular level. It highlights that crucial taken-for-granted part of the brain that discerns what emotion should be deployed in the current situational context. PBA either effects the inhibition of emotions or the social perception of what emotions to apply to a given situation. In either case, it is difficult to diagnose because we are often quick to dismiss individuals who are incongruent with their social environments, designated as misfits, eccentrics, or un-insighful. Thinking that there may be a biochemical problem or brain injury is the last thought on people’s minds. But it is the first thought on my mind.
Today my PBA is a managed by a rust-colored capsule I take twice a day. I wouldn’t change this for the world. It keeps me in sync with the outside world around me. I no longer telegraph a sense of disconnect between me and the world around me.
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