At What Point Does Too Much Crying Mean a Prescription is Needed?
Originally published on June 12, 2013. The drug Dr. Tillman writes about, Nuedexta, is the subject of a recent CNN investigation published on October 12, 2017.
In the New York Times, Jackie Ashton, who lives in San Francisco, wrote a very moving and evocative account of her mother’s death from a brain aneurysm when the author, Ms. Ashton, was nine years old. She spoke about her initial bewilderment in the days and weeks following her mother’s death, and then doing well throughout school, college, marriage, and the birth of her two children. After having children, in her mid-thirties her grief came roaring back. Ms. Ashton eloquently describes the onset of panic attacks, howling pain, crying, rage and other emotional experiences she is able to so clearly link to her excruciating loss. She gives an account of this experience, and her emergence from it, without pathologizing her grief or espousing a medication to make it all go away.
Two weeks ago, I attended the American Psychiatric Association’s annual meeting where one of the drugs being most aggressively promoted is a drug named Nuedexta. This drug is designed to treat pseudobulbar affect, the name given to a type of inappropriate or excessive crying or laughing that may, in rare cases, occur in patients who have experienced a stroke. Seeing intense advertising at a psychiatric meeting and not a neurology meeting led me to believe that perhaps the makers of Nuedexta were hoping to boost off-label prescriptions for people who cry too much. My question is too much for whom? Why (other than a brain lesion) might people cry too much? Who suggests to a person that they are crying too much–a doctor, or a family member? Perhaps it is a person who is not so sure why they are crying and cannot put words to what may be grief and sadness, who feels overwhelmed by weeping.
There are public accounts of crying, grief, pain and the sense of “too much” emerging almost daily. Will the children who survived Newtown, or the survivors of the Boston bombings, or the Oklahoma tornadoes suddenly be hit by crying spells in 20 or 30 years? Will the return of their childhood pain feel like it will break open their hearts with fresh grief? What about our terribly traumatized soldiers and veterans? Will their tears be attributed to the high rate of traumatic brain injury that we know they have endured? Will the deeply moving and meaningful link of their tears to their trauma be obliterated by a rush to a medication to reduce the tears? How are we all being encouraged to think of our most basic human emotions—some of which are temporarily disabling being repackaged as pathology? How does normal, expectable, meaningful searing and show-stopping human emotion become something to be eradicated? This question is worth asking. Some pain is indeed totally debilitating for a long period of time and an effective remedy in the form of a pill may be the very best option. But before such an option is exercised, our humanity requires that we have some way to put our pain into words, to tell ourselves and hopefully someone we trust our confusing story, and to have a chance to grieve well. As the psychoanalyst Margaret Little said in an interview: “Yes, you work through anger, self-pity, and remorse, and so on, until you arrive eventually at a relatively peaceful state of pure grief. But, I said, mourning is for life, and every now and then the original thing just jumps up and hits you again and knocks you flat, and for the time being everything else is knocked out.”
This is the normality and humanity of grief and its long shadow. There are no shortcuts, only grief delayed.