Editorial - (2023) Volume 8, Issue 1
Crying is a physiological response with an emotional component. We review the literature on crying and raise questions about the role of crying and its positive and negative effects. The act of crying is poorly understood. The current accepted definition of crying focuses on the production of tears and does not mention an emotional component to the physiological process of crying. Data exploring the emotional component of crying exists and is examined considering the currently accepted definitions. The concept of crying as a physiological response with an emotional component, and an emotional experience that is greater than the production of tears is explored. Correlation of crying and different disease processes are reviewed. The authors advance a hypothesis that crying comes out of feelings of helplessness, loss of control and externalization of an experience. Hormonal involvement in crying and the differences between pediatric crying and adult crying are discussed. The authors look at the data on patterns of crying within individuals, cultures and how current patterns of crying could predict future crying behavior in individuals.
A cry is a physical reaction ignited by an emotional cascade of bodily responses that we feel is more than the production of tears. Medically, crying is currently defined as the production of emotional tears triggered by that which is not an ocular irritant [1]. These emotional tears are unique to humans and differ from the basal tears that lubricate the eyes or the reflexive tears that respond to irritants [2].
Crying begins when tears go from basal tears which are high in protein and rarely stream out of the eye, to emotional or reflex tears of low osmolarity that will flow outside of the eye and down the face [3]. The act of crying lives on a spectrum ranging from protective to reflexive to emotional with both positive and negative aspects. While one episode may be protective, continual or episodes that override other physiological functions like regular breathing, could have deleterious effects [4].
If you do not see tears, then technically a person is not crying, which we call out as a technical foul on the complexities of a unique mind/body/spirit interaction. People with dysautonomia, Sjogrens syndrome or even severe dehydration will not be considered to have the ability to cry [5,6]. Does this disqualify these individuals from fully experiencing that which commonly elicits emotional tears? Do these people have a non-tear based reaction to emotion? While some data shows that without tearing there may be a blunted emotional range [7], we doubt that it eliminates this specific emotion.
As people who have cried, we note the experience to be more than the production of tears. We call on other physicians to acknowledge a person's crying as a combined emotional and physiological signal for help. Try not to discredit the significance of a sob simply because you understand the physiological mechanics in the production of tears and consider the source may be more important than the assembly of this particular secretion. Crying is a unique occurrence where autonomic function can be overridden or altered, while demanding attention to a stimulus that may or may not be apparent [8]. Crying can be an indication or a symptom in a multitude of disease processes. In infants with untreated hypothyroidism, they were found to have fewer voiceless and partially voiced cries than their normal counterparts [9]. Crying can also trigger an increase in cortisol, a stress hormone, which could be a contributing factor to the development of post-cry sinus, tension, and migraine headaches [10,11]. Cystic fibrosis patients can actually have a decrease in crying due to processes subsequent to a dysfunctional CFTR gene that cause thickened tears and hypo secretion of tear fluid [12]. Patients with dry eye syndrome can have instability of tear formation or production and this can be a manifestation of disease processes with sources ranging from systemic to hormonal or inflammatory [13]. Another study analyzing whether or not excessive tear production can be utilized as a diagnostic sign of cocaine-induced mood disorders showed that patients within their sample group exhibiting disproportionately more tearing were significantly more likely to have recently used cocaine. This was reflective of the concept that a discontinuance of the cocaine would cause a rebound in parasympathetic tone leading to further tear production [14]. Hyper phonated cries signal stronger need for perceptual reactions: hungrier infant-higher pitched cry [15,16].
Still to mention:
• Hypocalcemia
• Preleukemia
• Non-small cell lung cancer
• Vit B12 deficiency
• Myasthenia gravis
• Post head injury Dementia
• Cocaine Withdrawal
• Lead poisoning
• Conditions leading to muscle fatigue and weakness
While crying can manifest in a number of varying conditions across the human dimension, it has an explicit place and critical role in the communication and signaling between individuals rooted deep within the corridors of our neurological fortress known as the mind. The exploration of the linkage between the human cognition and the emotional realm have been speculated and researched with great fervor, but crying continues to remain constant in varying degrees even through turmoil or siege of the brain. Incidents such as a stroke create a newer field of exploration for the physiological response and necessity in regards to crying with phenomenon such as the pseudobulbar effect [17]. Alongside strokes, we see a variety of other disorders and neurological issues that have direct leads to overexpression of crying such as Parkinson’s, Alzheimer’s, multiple sclerosis, and amyotrophic lateral sclerosis to name a few [18]. While enduring these disorders, the embodiment of the human condition does not cease the function but instead preserves it and amplifies this. This innate function cannot be silenced and remains a staunch advocate for the individual and seems to serve a higher purpose.
In his book The Expression of the Emotions in Man and Animals, Charles Darwin minimized the human action of crying, calling it incidental and as purposeless/worthless as the tears shed, noting that crying is a mostly human activity [19]. For reasons that he did not elaborate upon he claimed that crying was a unique behavior that fell outside of his theory that behaviors have an adaptive purpose or they will disappear. Emotional crying must have been beneficial to both inter-individual and intra-individual populations for it to maintain its place alongside evolution and seems to have been utilized as a pro-social tool [20]. But Mr. Darwin neglected to note that deer have been noted to cry when they are hunted and a bear cry is thought to be an admission of impending death, and giraffes cry when wounded. Mr. Darwin did note that elephants tended to weep when put in situations of distress or despair, and monkeys cry easily when distressed [19,21]. To the modern reader, it could seem that he contradicted his own realization that beyond the suffering of basic survival there is a tenderness unique to the human experience with his stark conclusion that emotional tears are purely incidental. But the cries we’ve experienced, watched, and heard do not feel incidental. Labeling this tender occurrence as an “incidental result” significantly reduces its weight and may have led proceeding physicians/scientists astray in their treks to investigate what it truly means to emotionally cry. Not all of these animal equivalents are tear based, but are noted to be similar bodily expressions and responses.
Hippocrates described crying as the purgation of excess humours through the eyes; the tears were theorized to be the vapors from the heart as it boiled with emotion that vaporized to the brain and eventually out of the eyes [22,23]. While probably not completely true, the concept that the emotion travels to and affects multiple areas of the body has a lot of value in how we look at crying.
Crying can be an emotional release and an activity of addressing a stressor or impending change (personal experience of author). The role of helplessness and lack of control sometimes feels like a cofactor for certain emotional tears. Interestly, it is through these vulnerable and helpless moments that we learn our most important boundaries and what/ whom we cherish the deepest. Even through these lessons, the fear of these boundaries being breached and the loss of our cherishment’s keep these tears on a metaphorical standby.
Then there are the differences in crying between genders. Women are more likely to cry and cry more frequently than men across their male counterparts [24,25]. As male/female stereotypes seem to emerge in middle to late childhood, young men are often taught to internalize emotion to void off any image of helplessness; boys are discouraged from crying and can be teased if there is evidence of lack of control of their emotions [26]. Stadel and team showed that a male’s reluctance to acknowledge helplessness and ask for help is reflective of the data that men are less likely to cry [27]. Due to men displaying less help-seeking behavior, studies have also shown a link to increased mental illness and suicide rates [28]. These and other similar studies show that the emotional element of crying is synonymous with the willingness to be vulnerable and subsequently make meaningful connections. The disservice of instilling that vulnerability and needing help is representative of weakness results in potentially devastating and even lethal effects. Is the difference in crying between genders a result of social constructs? Are there biological mechanics that inhibit and/or excite the physiological pathways of emotion between genders?
From childhood crying that could be calls for attention, a response to anxiety, an expression of hunger, or a response to unpleasant or unfamiliar stimuli we recognize the value of crying in communicating urgency and attention. Crying in childhood usually includes sobbing and other vocalizations as well as muscular movements that differ from other muscular actions. There are theories that as we age, aspects of our crying grow with our grasps of empathy and our cries turn from acoustic to more silent [29]. This could be because as we learn by experience, the shock factor of occurrences resulting in pain or failure are increasingly replaced with the motivations and tools of problem solving; we learn how to avoid dangerous obstacles and become capable of predicting outcomes to help us make safe and successful decisions. The reasons we cry go from signaling a fundamental inability to complete survival tasks, to expressing vulnerability in moments of ncredibly complex emotional depth. It’s as if the reasons that we cry adapt with us as we wade through variations of independence and grand life experiences such as the birth of a child, our wedding day, or finding happiness in others.
It is surprising to the authors that crying has not been studied more and that there is not a standard definition or scale to define a pre-crying phase, crying phase and recovery phase. We don’t know the natural history of a crying episode in children or adults. While we may think that “kids will cry themselves out” and stop, it is also possible that crying can be a successful intervention or like shivering, both adaptive and maladaptive, depending on when and how the crying occurs. Emotional crying is thought to be utilized as a form of “self-soothing” that aims to counteract distress and return an individual to homeostasis [30]. Is the sobbing element of self-soothing key to neutralizing such intense discomfort or distress? If this is the case, can crying neutralize anger and aggression? Physicians should not focus on the single symptom such as tear formation, rather they should look at the entire experience of the emotional purge that culminates in excessive lacrimation. Emotional tears are the exclamation point attached to the depth of an experience. Crying is complex and includes overlapping pieces of biological, psychological and sociocultural forces. What is crying in one culture can differ from practices in another culture. Would a loss of the ability to cry affect our ability to cope with certain stressors, to develop empathy, or affect how we communicate with each other? How would a loss of this behavior affect us? And what is the opposite of crying? Is it laughing?
We call on our colleagues to pay attention to crying in ourselves and our patients. Crying should never be considered an expression of emotional incontinence. This behavior has biological, chemical, emotional, and cultural aspects that complicates its study. This complexity will make studying crying difficult and more important to understand as we appreciate the complexity of the issue.
We also suspect that if we understand this phenomenon we may sleep better, enhance human immunity and ultimately be able to shed the tears of joy we experience when conquering new knowledge or concepts.
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Citation: Cymet, T et al. A Cry to Look at Crying Differently. Med Rep Case Stud. 2023, 08(01), 001-003
Received: 19-Jan-2023, Manuscript No. mrcs-23-85264; Editor assigned: 20-Jan-2023, Pre QC No. mrcs-23-85264 (PQ); Reviewed: 29-Jan-2023, QC No. mrcs-23-85264 (Q); Revised: 01-Feb-2023, Manuscript No. mrcs-23-85264 (R); Published: 03-Feb-2023, DOI: 10.4172/2572-5130.8.01.1000234
Copyright: ©2023 Cymet, T. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
