A team of researchers from Western General Hospital in Edinburgh and the University of Edinburgh recently published the results of interviews with eighteen stroke survivors in both inpatient and outpatient settings. Their goal was to gain insight into patient experiences of post-stroke emotionalism, a dysregulation of emotional expression that can occur following stroke.

Post-stroke emotionalism is thought to be caused by damage to the prefrontal cortex as well as the corticobulbar tract, the pathway between the cortex and the medulla. Inputs from this pathway to the cerebellum are involved in coordinating the motor aspects of emotional expression. If this sounds familiar, another condition involving corticobulbar damage is pseudobulbar affect, which director Todd Phillips reportedly used as the inspiration for the titular character’s uncontrollable laughter in 2019’s “Joker.”

The lonely reality of post-stroke emotionalism

In the real world, such conditions can be extremely distressing to those who experience them, with many who experience post-stroke emotionality later developing mood disorders. The Edinburgh team found that most of the interviewees were unaware that their emotional dysregulation was a result of stroke, instead believing that their mental state was deteriorating or that they were losing inner discipline. Participants reported confusion and alarm at the incongruence between their emotional expression and their actual emotional state.

Post-stroke emotionalism can also be isolating, with participants reporting avoidance behaviors to prevent a public display of symptoms. Gestures of compassion from others often exacerbated distress because the compassion was offered in response to an emotion that the participant was not in fact experiencing. Participants often mentioned the broader stigma surrounding emotionality, such as the belief that men should not cry. For some, these concerns were strong enough to cause them to seldom leave their home.

Participants described a variety of coping mechanisms, both positive (acceptance, humor) and negative (self-criticism, avoidance). Ultimately, participants reported a gradual improvement in their symptoms over time.

Equipping patients with knowledge to improve outcomes

The authors propose that improved clinical awareness of post-stroke emotionality may improve patient outcomes because practitioners could better inform patients about the condition, preventing misinformed beliefs that contribute to further distress.