PBA

I was playing some music the other day. I don’t usually do this in the middle of the day because music for me is not a suitable background for reading or, especially, writing, but rather something I have to fully attend to. But this day I had decided that I wanted to hear a piece that I had first delved deeply into in college—the Eroica Symphony by Beethoven. It’s his third symphony and a pathbreaker, one I learned intimately in a freshman music-appreciation course, and hence came to love. So I searched it out on youtube and found what seemed to be a decent rendering by Daniel Barenboim leading a BBC orchestra. Though he took the first movement a bit too slow for my taste, the rest was splendid. And then came the surprise. When I heard the third movement, it brought me to tears. I don’t mean that in a figurative sense. I mean real tears; I was bawling. And when I got over that, some parts of the fourth movement did the same thing: tears, real crying. In the course of listening, I noticed another Beethoven piece I thought I’d also like to hear: the Sonata Pathetique (#8 in C minor). This is one that I also knew well, having practiced and learned to play it moderately well. It was first played for me by a cousin, and my brother also played it, especially the lovely, slow second movement. So I found a rendering by Valentina Lisitsa, a pianist I’d never before heard of, and it was equally gorgeous. She is a wondrous artist, with flawless technique and expressiveness. But that isn’t the real point. Once again, I cried like a baby. Especially during that luscious, slow second movement. My emotions were simply out of control. And I could perhaps see why that movement might affect me, since it brought back memories of my older brother who died some years ago. 

            Now, I have been moved to tears by music before. I used to sing with the Berkeley Community Chorus, and near the end of my stint with them, we sang the Bach B-Minor Mass, one of the most transcendent pieces of music ever written. I loved doing it, but sometimes, even in rehearsal, I found myself focusing not on my bass part exclusively but on the other parts, all of them, sopranos soaring at the top, with tenors and altos beautifully complementing them—the whole of the profound, intricate interweaving of voices. And at such times, I found that the sound of all those voices soaring in counterpoint together was so stirring that I couldn’t sing my part. The emotional involvement in what I was hearing was so great that I choked up and tears came to my eyes. So I know what emotional involvement in music feels like. But this was different. This was not just being choked up and unable to sing. This was deep racking and grimacing sobs—and I knew not whether it was joy or pain or regret.   

            Actually, I have experienced this sudden upwelling before—recently. When I was in the hospital not long ago, I found that when I tried to explain to visitors that some nurse or therapist had been particularly comforting or solicitous for my care, I would get so choked up that I could not speak. Several times I was racked with that same kind of sobbing that went on for long minutes, and I would have to stop relating whatever event it was. Sometimes I would try to explain what was happening, but would usually have to stop that too, and then apologize for the strange outburst. And when I had to say goodbye to my therapists at CPMC, I was again struck dumb with tearful emotion. At other times I had outbursts of laughter that seemed out of proportion to the stimulus, embarrassingly strange laughter that I’d never had before. Those who have worked with stroke patients—I had had a stroke in August—reassured me that these outbursts were a kind of side effect stemming from what they called the ‘emotional lability’ following a stroke. I accepted that explanation at the time, but after my music-listening episode, I searched online for more specific information about the phenomenon. 

It’s called PBA, which stands for Pseudobulbar Affect. The word ‘bulbar’ itself means what it sounds like: a bulb-shaped organ, specifically the medulla oblongata portion of the brain. And the bulbar area of the brain is said to be “composed of the cerebellum, medulla and pons.” Further explanation on Wikipedia notes that “the bulbar region is made up of the brain stem minus the midbrain and plus the cerebellum…and is responsible for many involuntary functions that keep us alive.” That means that the pseudobulbar affect (PBA) has something to do with brain injury, often from stroke, but also affecting patients with other brain debilities such as Alzheimer’s or Parkinson’s. PBA is said to be characterized by “episodes of sudden uncontrollable and inappropriate laughing or crying.” Of course, that’s not exactly what I have—responding emotionally to music is not always inappropriate—but it pretty much describes my situation in general. Especially the involuntary part. 

So now, I had the explanation I sought. My stroke(s) were located in the left pons area of my brain, right above the medulla, as it happens. It affected mostly my motor functions, mainly my left arm and left leg, both of which were, and still are partly disabled. The function of both is coming back with lots of rehabilitation therapy, but I’ve still got a long way to go. I’m prepared for that. What I was not prepared for was the emotional stuff. My emotions have usually been held mostly in check, consistent with our emotionally-constrained culture. Big boys don’t cry. Or laugh inappropriately. And certainly not in response to the kindness of strangers, or to music. But since my stroke, I have been doing all of that. And it’s not clear to me if this is a good thing or a bad thing. 

            Perhaps I don’t need to know whether it’s good or bad. Perhaps I don’t even need to know when I’m going to get over this affect, or whether I’ll get over it at all. This makes me think of Jill Bolte Taylor, the Harvard neuroscientist who, at age 37, had a massive stroke and lost most of her cerebral and muscular functions. So severe was her disability that it took her a full eight years of intense rehab to fully recover. But recover she did, and then wrote a best-selling book, My Stroke of Insight, in which she recounted the details of her stroke and recovery, and her gratitude for what the stroke revealed and did for her. As she put it in a recent interview,

It took away all my stress circuitry. Who doesn’t want that? My left-brain emotional system went offline, and with that went all my negative judgment. It took away all my emotional baggage from the first 30 years of my life. And it set me on a new path of possibilities. (cited from www.thecut.com, 9/25/19 interview by Erica Schwiegershausen.)

In her book, Bolte Taylor is even more specific about how her stroke changed her:

I shifted from the doing-consciousness of my left brain to the being-consciousness of my right brain. I morphed from feeling small and isolated to feeling enormous and expansive…All I could perceive was right here, right now, and it was beautiful (68).

I also think of Homer’s Odyssey and Iliad and how Homer repeatedly sings of the Greek heroes like Odysseus as yielding to the relief of shedding hot tears. It is clear that for the ancient Greeks, there was nothing unmanly about this. Rather than indicating weakness, tears are treated as natural to men, even men at war, as a natural part of the male domain of passionate emotion. 

            So perhaps this side effect of stroke is not so shameful or embarrassing after all. Perhaps it is serving to clear away the stroke victim’s “stress circuitry” and opening up some more ancient circuits in the brain that have been covered over by cultural inhibition. Perhaps music and the kindness and love of strangers is meant to be met with emotion. Whether it is or not may not be the issue in any case. For that is what is happening to this stroke survivor, and so far, he seems none the worse for it. 

Lawrence DiStasi