THIS STORY HAS BEEN FORMATTED FOR EASY PRINTING

The crying man

The neuroscience of easy weeping

By Dr. S. Allen Counter
February 6, 2011

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One man crying has become news. 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. Many have mocked his crying. Others honestly wonder why the congressman slips so easily into tears when he comes to an emotional subject. A writer at Politics Daily wondered whether Boehner was “depressed” or “drinking too much.”

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. There are several medical conditions that seem to interfere with the brain’s crying circuitry. For example, traumatic brain injury, multiple sclerosis, a stroke, or other brain injury can all leave a patient more prone to crying. It’s a fascinating, if still deeply mysterious, corner of medicine.

I had the opportunity to witness one such case with the noted Harvard neurologist Dr. Raymond D. Adams during his weekly team rounds. We saw a patient with pseudobulbar affect, an “affective disinhibition brain disorder.” The patient, a rugged outdoorsman, surprised us with a sudden, inexplicable exhibition of uncontrollable crying. He had recently suffered a stroke, from which he had ostensibly recovered, but he had developed a type of emotional lability that was most remarkable for his low threshold of crying. Even the slightest hint of sadness would evoke in this patient episodes of profuse crying. At one point while he was reciting his case history, he mentioned the loss of a relative in the military and immediately descended into a fit of crying that lasted several minutes.

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.” In the early 20th century, these affective displays were referred to as an “emotional disinhibition” or “release syndrome.” While the underlying neuropathology of pseudobulbar affect is not fully understood, it has been shown that this brain anomaly involves damage to several specific areas of the brain. 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.

While public crying may be viewed by some individuals and cultures as a sign of weakness, others may take a different view. For example, one man with apparent pseudobulbar affect as a result of his multiple sclerosis asserted that he had greater success in relationships because of his tendency to cry at the slightest poignant moment. “Some acquaintances,” he said, found him to be “more sensitive and appealing.” Knowing that crying can have a physiological cause might, perhaps, generate a measure of sympathy for Boehner. But does there even need to be a medical explanation? What, really, is wrong with a man crying?

Dr. S. Allen Counter is a medical scientist and professor of neurology at Harvard Medical School and a neurophysiologist at Massachusetts General Hospital. He is also an adjunct professor of neuroscience at The Karolinska Institute in Stockholm.