An Ocean of Emotion: Mood Swings, Anger, and Uncontrollable Laughing and Crying.

Some people call these MS symptoms "emotional incontinence". Joella Vreeland calls them embarrassing:

"At lunch hour a colleague was telling us that he was very disappointed as he had applied to the reserves and had been rejected because of a heart condition. I laughed.

"`It's not funny!' he said--and I apologized. But why had I laughed? I was as puzzled as he was.

"I do a lot of speaking--often from the podium--at my church. I was telling a story about a pine tree that had died. And I started crying--could not control it--and sat down.

"`Well,' said my friend later. `It was a sad story.'

"`Not that sad!' I replied. I have MS, and I was experiencing a problem. I could no longer speak about my mother, my son, or even myself, without getting so choked up that I couldn't continue. Though this was new for me, I had read about it in an MS publication. Someone had referred to it as `emotional incontinence'. I remembered that it meant overreaction: laughing when it wasn't that funny and crying when it wasn't that sad."

"`Emotional incontinence' is not a great term, even though it captures the issue," said Dr. Sarah Minden, assistant professor of psychiatry at Harvard Medical School, who sees people with MS at Brigham and Women's Hospital in Boston. "It's embarrassing, distressing, and stressful for people with MS to lack control over their emotions."

For best treatment, determine the cause

According to Dr. Minden, it's difficult to know what causes these emotional symptoms--uncontrollable laughing and crying, angry outbursts, or rapid mood swings. They could be the result of lesions in the brain and abnormalities in the brain chemicals directly caused by MS. They could just as easily be due to emotional disorders or situational problems. Dr. Minden believes it is very important that the cause of an emotional problem be clarified, because a diagnosis will determine which treatment approach should be most effective. A correct diagnosis can be made by a neurologist or psychiatrist who is familiar with these kinds of MS symptoms. Only then can the right combination of medications, counseling, and, possibly, behavioral therapy be prescribed.

Dr. David Mohr is assistant clinical professor and director of medical psychology at UC San Francisco's Mt. Zion MS Center. Dr. Mohr believes that some people may be predisposed to developing these kinds of problems because they have certain genes.

Blame and shame

Dr. Randolph Schiffer has a lifelong professional interest in the behavioral aspects of MS. He is chair of the department of Neuropsychiatry at Texas Tech University. "Any cognitive loss is anxiety-producing," he said. "People may not understand why they're having trouble functioning at work or at home. The pattern can be subtle. It's easy to blame yourself for not doing things as well as you formerly did.

"Our culture is more tolerant of physical disability than of mental impairment, in many situations," Dr. Schiffer added. Both the person with mental or emotional symptoms and the people around her or him may be struggling with a sense of shame.

"We tend to see emotions as separate from our bodies, but they are not. It's important to acknowledge that emotions are biological processes," Dr. Mohr said. "How you think about things influences neurotransmitters in the brain. There is increasing evidence that how people feel may affect their MS directly. The good news is that people can learn to cope with emotions. You may need a mental health counselor to help you identify the pattern of your thoughts and behaviors and learn how to change the ones that contribute to stress or depression."

Cynthia Arnold, who herself has MS, is a freelance writer and an English professor at a college in Western Massachusetts.