Living with a brain injury...


Paul Pugh was in the most critical meeting of his life. He was being told what his future would be like after receiving a brain injury in a brutal assault. He laughed the whole way through the discussion but, to him, it felt like he was sobbing. He would later be diagnosed with pathological laughter.
Pugh, now 38, had been on a night out with his Cwmaman Football Club teammates in January 2007 when he was targeted in an unprovoked attack on a cold January night.

As he left a pub in his home town of Ammanford in Carmarthenshire, west Wales, four men he didn't know rounded on him and repeatedly punched and kicked him.
Pugh's skull was fractured and he fell into a coma for more than two months. A blood clot which measured 10cm x 4cm formed on his brain and he was left with slurred speech, chronic fatigue and mobility difficulties which resulted in him having to use a wheelchair.

"I've had to learn to walk and talk again and come to terms with the fact that I will never fully recover," he says. "Life has been a struggle for me and my family, but we're ploughing through it."
Pugh spent 13 months in hospital, but it wasn't until month four that he had his first laughing fit.
"It was a serious meeting with my consultant, rehabilitation therapists and my family to discuss what my life and future was going to be like," he says.

"When they started talking about me, I was frightened and it triggered something off in my brain and I laughed right through the meeting.
"I was actually crying my eyes out, but it came out on the surface as laughter."
At first, no one understood his behaviour, his family even thought he was "making a scene in public, pleading for attention".

It took several years before Pugh's fits of "full on laughter" were diagnosed as pathological laughter or the Pseudobulbar Affect (PBA).
The condition arises 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. It's a real crossed-wires moment.
PBA can affect those with neurological conditions or injuries such as stroke, multiple sclerosis, or Alzheimer's disease.

Andy Tyerman, consultant clinical neuropsychologist of brain injury charity Headway, says: "The term refers to uncontrolled expression of emotion that is disproportionate or inappropriate to the social context and may be inconsistent with what the person is actually feeling.
"A person might also appear very distressed about something that would previously have been only slightly upsetting."

Paul Pugh with his twin nephewsImage copyrightHEADWAY
In Pugh's case, he laughed when he thought he was crying.
"I know when I'm laughing or crying, but other people don't," he says. "Some have been upset and reacted by being sarcastic with me or even aggressive and try to hurt my feelings because they think I'm laughing at them.

"It's amazing how important laughing is. You take it for granted but it has a really powerful effect, if you share a joke with someone it's special."
Pugh says his family are very understanding. His mum has become his full-time carer to help with his mobility issues, his dad, aged 72, still works and his brothers - Simon and Matthew - have both had a hand in helping him over the past decade.

He says the diagnosis "hit me hard" and sometimes attracts unwanted attention but he can now sense when an episode is imminent.
"I feel a laugh coming a few seconds before it happens - sometimes I can control it but a blip can happen. 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 has developed his own method to avert an episode by "thinking of something or someone bad without giving it feeling" and estimates he can control nine out of 10 laughing fits.

It's been an "extremely tough 10 years" since the assault, he says.
He had to give up work as an electrician and now spends his time in therapy or visiting the charity Headway Carmarthenshire which, he says, gave him an "insight of being with people with brain injury" and reassurance he wasn't on his own.

"Since the incident we've met the most incredible people you'll ever meet, all wanting to help me," he says. "On the other side of the dice, I feel like I'm under house arrest because the injury affected my mobility and balance, therefore I need assistance whenever I go outdoors."
In 2014, Pugh started Paul's Pledge - a campaign to educate people about alcohol-fuelled violence which Dyfed-Powys Police is also involved in.

He makes visits to schools, colleges and youth clubs and has had an "absolutely fantastic" response because "they can see that it's real and not theatrical".
"This is my life now - I've moved on from what happened," he says. "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."

The four men responsible for Pugh's attack were jailed for between nine months and four years.
Pugh says: "The one that kicked me in the head with full force from point blank range, almost killing me, was let out. What about me? Ten years later, I'm still serving my sentence."

Comments

  1. Thanks for sharing Paul Pugh's story.

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    1. I recognise the way he feels. It's happened to me lots of times. I always explain that I can't help how my body reacts. It's why I'm reducing my visitors.

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  2. i think it is remarkable that Paul learned to manage his pathological laughter, laughing at t he wrong time could be a big liability

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    1. It makes people think you don't care when in fact you do. I speak from personal experience. I've been in that situation.

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  3. A powerful story, Terry. And the light sentences given to the perpetrators seems completely wrong.

    One of the men at my father's nursing home had a somewhat similar problem - he laughed at almost everything. He couldn't talk, so maybe in his case it was the thing that came out when he tried to communicate. It made interaction difficult.

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    1. I told them many many years ago that I couldn't control myself. It's not something I'm very proud of and is why I don't like to have visitors.

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    2. Thank you for helping to shed insight into areas we might never learn about otherwise. This will be tucked away and someday may help me understand my fellow man better.

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    3. I found that I suffer the way he does.

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  4. It is so, so very wrong...the victim is penalised far longer than the perpetrator...it happens again and again and again. The justice system gets it wrong all too often.

    Thank you for telling this story, Treey. And, by the way, it's good to "see" you. I've been concerned because it's been a while...great to have you back! :)

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    1. Thank you Lee. I'm just saying how the ordinary become the disabled through no fault of their own. Having to live with the consequences is awful.

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  5. Sadly Paul, like you, received a life sentence.
    Thank you for bringing the very different effects that can follow a brain injury into focus.

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    1. The effects need to be explained so that people know what to expect and don't jump to the wrong conclusions, EC. Unless you're disabled yourself it's very hard to understand sometimes.

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  6. What a tragic story. The victim got a worse sentence than the criminals. That is awful.

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    1. That will happen sometimes, Martha. Being made disable is bad enough. Losing the ability to communicate is even worse.

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  7. Isn't that always the case? Even if these monsters got the death sentence, Paul is living his own sentence for the rest of his life. Angers me. And Terry, I've never heard of the laughter illness, isn't that interesting though...our brains are so complex. I can see how it would make his life difficult and confusing. And I agree with what you said above, that unless you are disabled yourself, it's very hard to understand. Nice to see you blogging again :)

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    1. I suffer from it myself, Rain. You laugh as if you're watching a Laurel and Hardy film. It's not even funny. I tried to get help for it at Leamington Hospital

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  8. I think quite often people who inflict that sort of extreme violence have never even thought about what the consequences might be for the victim. If it's brought home to them just what suffering and despair the victim goes through, they can sometimes be unexpectedly horrified and remorseful. Not that that helps Paul Pugh very much in his struggle to salvage something from his shattered life.

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    1. Violence isn't the answer to anything, Nick.

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