What if you never smile

Pathological laugh

Laughter as a disease

For some people, laughter is not fun. You suffer from an illness that experts call "pathological laughter". "Those affected laugh without a recognizable trigger," says Torsten Kratz, senior physician for geriatric psychiatry and psychotherapy in Berlin.

So nobody cracked a joke. The person concerned has to laugh because his body forces him to do it. "Imagine that you are very sad and inevitably have to laugh out loud without knowing why," says Kratz. He has conducted studies on patients suffering from pathological laughter.

Surprised by your own laughter

When a person laughs, he takes a deep breath, the auxiliary breathing muscles begin to work, and the breathing rate changes, as does the facial expression. He makes noises.

For people who suffer from pathological laughter, this program also runs, albeit independently of their own mood. The person concerned is taken by surprise with laughter - always with full intensity. The patients do not show nuances of laughter in these moments.

"Laughter has a physical and an emotional part," says Kratz. The physical part of laughing is purely mechanical via certain brain regions. In patients with pathological laughter, these centers have suffered damage, for example from a stroke or multiple sclerosis.

The seemingly random fits of laughter of the person concerned have a bizarre effect on the people in the vicinity. "Many people think the same: This or she is crazy," says Kratz.

Those affected are irritated themselves

Those affected are visibly irritated that they cannot control their laughter. After the laugh attack, they often start to cry suddenly (this is why one speaks of "pathological laughing and crying").

The organic cause of the disease can hardly be treated, as the patient's brain regions have usually suffered irreparable damage. The frontal lobe of the cerebral cortex, certain midbrain areas and the brain stem are affected.

Doctors can treat these areas with drugs that act on the cell walls of the nerve cells and thereby stabilize them. These are active ingredients that are used in the treatment of epilepsy, for example. Other doctors prescribe psychotropic drugs and antidepressants to help stabilize the patient's mood.

It is difficult to estimate how many people are suffering from the symptoms. "Doctors know very little about the disease and there is hardly anything about it in the literature," says Kratz. As a result, pathological laughter is rarely diagnosed and adequately treated. There are hardly any case descriptions and overview studies.

However, these would be an important basis for improving patient treatment. The symptoms are probably much more common than the scientific publications suggest, says the physician from Berlin.