A superfit football player who was left brain damaged after an unprovoked attack now has a bizarre condition meaning he laughs when he wants to cry.
Paul Pugh, 37, from Carmarthenshire, suffers from ‘pathological laughter’ because of the brain injury caused by four men punching and kicking him in the head.
It first emerged when Mr Pugh was told the extent of his brutal injuries during a meeting with medics – because he just laughed.
Paul Pugh, 37, from Carmarthenshire,(pictured as a fit and healthy footballer before the attack) suffers from ‘pathological laughter’ because of the brain injury caused by the four men hitting him in the head
The electrician felt like he was sobbing as he was dealt the news – and went on to be diagnosed with pathological laughter.
The condition happens when neurological pathways controlling emotion are damaged.
Mr Pugh, who spent 13 months in hospital, said: ‘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.
‘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.’
Mr Pugh was attacked as he left the Old Cross pub in Ammanford, Carmarthenshire, after a night out with his football teammates.
Mr Pugh was attacked as he left the town centre pub after a night out in Ammanford, Carmarthenshire, with his football teammates. He is pictured in hospital after the assault
He was knocked on the floor and repeatedly kicked in the head, leaving him unable to talk or use the left side of his body.
Four men aged between 20 and 24 were jailed for the brutal assault, with their sentences ranging from 18 months to indeterminate.
Describing the attack, Mr Pugh told Wales Online: ‘I remember that I was first out [of the pub] on this particular night, and I’m always last.
‘But I do remember walking out of the pub and I was attacked from behind.
‘I don’t remember how many times I was hit but they got me to the floor and I didn’t even know how many of them there were at the time. But I do remember they kicked me to the head.’
His mother asked Mr Pugh’s brother to follow the ambulance on the way to the hospital, where he ended up in a coma.
His skull was fractured and he fell into a coma for more than two months after the attack in January 2007.
A 10cm by 4cm blood clot formed on his brain and he was left with slurred speech, chronic fatigue and mobility difficulties – meaning he had to use a wheelchair.
Mr Pugh said: ‘I’ve had to learn to walk and talk again and come to terms with the fact that I will never fully recover.’
The footballer suffered his first laughing fit after four months but his family even thought he was ‘making a scene in public, pleading for attention’.
It took years before his fits of ‘full-on laughter’ were diagnosed as pathological laughter or the Pseudobulbar Affect.
The condition 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.’
Mr Pugh’s mother has become his full-time carer to help with his mobility issues.
His father, 72, still works and his brothers – Simon and Matthew – have both had a hand in helping him over the past decade.
Mr Pugh had to give up work as an electrician and now spends his time in therapy or visiting the charity Headway Carmarthenshire.
Mr Pugh, pictured playing football before the attack, had to give up work as an electrician and now spends his time in therapy or visiting the charity Headway Carmarthenshire
In 2014, he started Paul’s Pledge – a campaign to educate people about alcohol-fuelled violence which Dyfed-Powys Police is also involved in.
The four men responsible for Pugh’s attack were jailed for between nine months and four years.
Mr Pugh added: ‘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.’