REAL LIFE: This man was diagnosed with Pathological Laughter

Imagine if every time you cried you burst into hysterical laughter - this is the problem that Paul Pugh lives with every day.

By Bettina Tyrrell
When Paul Pugh cries, to everyone else on the outside, he is laughing. So, 10 years ago, when Pugh’s doctors first explained what life would be like living in the aftermath of a serious brain injury, he laughed. He laughed although he was frightened. But Pugh wasn’t laughing at all, he was crying.
The BBC explains, this incident was the first time Pugh experienced an unexpected outburst of laughter. For years he would live like this, laughing instead of crying and not knowing why, until finally he would be diagnosed with Pathological Laughter.
On a cold night in January 2007, Pugh, now 38, was enjoying a night out with his football teammates in his home town of Ammanford in Wales, when he became victim of an unprovoked attack.
WATCH: CCTV footage captures fatal one-punch attack. Article continues after video...
As Pugh left his local pub, four men he didn’t know cornered him and repeatedly punched and kicked him, fracturing his skull and sending him into a two-month long coma. Pugh’s injuries left him in a wheelchair with a blood clot on his brain, slurred speech and chronic fatigue.
"I've had to learn to walk and talk again and come to terms with the fact that I will never fully recover," he said, speaking with charity Headway.
"Life has been a struggle for me and my family, but we're ploughing through it."
Paul Pugh sustained serious brain injuries that left him in hospital for 13 months after four men attacked him. Image: Headway.
Pugh's attackers were given jail sentences between nine months and four years.
Pugh spent 13 months in hospital, but it wasn’t until his fourth month that he had his first outburst of laughter. Thinking back to that meeting with the doctors, Pugh says he was frightened and his fear triggered something in his brain.
"I was actually crying my eyes out, but it came out on the surface as laughter."
He said that no one understood his behaviour, not even his family. He said they thought he was making a scene and looking for attention.
"I know when I'm laughing or crying, but other people don't," explains Pugh who was eventually diagnosed with Patholgoical laughter or Pseudobulbar Affect (PBA).

What is Pathological Laughter?

Pathological laughter is condition where uncontrollable episodes of laughter, crying or both occur. PBA can occur in people with a neurological disorder or brain injury.
It’s believed the disorder presents when there is a disconnect between the frontal lobe of the brain - which keeps emotions in check - and the cerebellum and brain stem - which regulate the expression of emotion.
Pugh’s says his family are all very understanding and although his laughing episodes attracts unwanted attention, he now sense when a laughing fit coming on and does his best to control it. But he isn’t always successful.
"The laugh doesn't last long, a minute at the most, but it can cause a lot of problems if people don't understand."
Pugh had to give up his job as an electrician and instead spends his time and therapy or visiting charity Headway Carmarthenshire.
In 2014, Pugh started a campaign to educate people about alcohol-fuelled violence called Paul's Pledge. He visits to schools, colleges and youth clubs to tell his story.
"There are many things I can't do - but this [campaign] I can do. I think it sends a powerful message to the world. I don't want to see anyone, nobody in the situation it left me and my family in."