As a first-year medical student in 1972, I took a course in the Physiology of the Eye (or in layman’s terms, how does the eye work). I was fascinated with many things – why is the cornea clear, how does the lens focus light, how does the retina receive and process images for the brain, does the eye really have six muscles to control movements, and so many more questions. I was particularly intrigued by tears.
I learned that tears are made in a gland (lacrimal) just under the upper eyelid. They bathe and nourish the eyeball in a continuous silent waterfall that drains out via the tear duct. The tear duct lies at the corner of the eye near the nose and drains into the nasal passages. So long as this production and drainage system works well, there is no spillage over the eyelids. (I subsequently learned as a pediatrician that the tear duct in infants clogs easily and can lead to the accumulation of yellow gunk [a precise medical term] that is easily cleared away with some help.)
But think about this for a minute. When you are starting to get upset and maybe even cry, what is the first thing that happens? There is excess accumulation of liquid in your nose and you grab a tissue to blow your nose. The excess production of tears is now flowing into the tear duct and into the nose. Only when the tear duct drainage is overwhelmed do tears spill over the eyelids and onto the cheeks.
So now, over 50 years later, I have developed a renewed interest in tears, how they are produced and what they signify in our lives. This quest was recently piqued by three things.
I have developed a renewed interest in tears, how they are produced and what they signify in our lives. Click To Tweet
First, my recent blog about laughter and tears as being potent salves reminded me about tears as a rinsing agent.1 I interpreted tears “as the presence of humility and sincerity in sharing the emotional ups-and-downs (often mostly the latter) that are the challenges of our daily lives. The ability to share these tearful moments as parents (accepting and understanding another’s emotional turmoil) can provide that sustenance that is so clearly needed to help build resilience in our lives and the lives of our children.”
Second, I had the good fortune to see the musical “Come From Away” last week. This play chronicles and puts to music and song the lives of many folks that were on planes diverted on 9/11. Thirty-eight planes landed on Gander, Newfoundland, Canada, and the stories of the those on the ground that came to the aid of the stranded passengers and those passengers were truly riveting for me—all bathed in the cloud of destruction from the tragedies in NYC, Washington DC and Shanksville, PA. The stories and songs were funny and sad, comical and tragic – that is, they were human stories. The play lasted over 100 minutes without an intermission, and I felt like I cried happy and sad tears for the whole time. Then, the band played a jig during the curtain calls, and I was uplifted even more.
Finally, as I was contemplating the effect of the play (happy and sad tears almost at the same time), I was struck by the multiple ways that tears are a manifestation of our emotions, our interpersonal interactions and our social interactions. If tears are such a vital manifestation of our lives (in addition to serving as rinsing agents for our children1) and so much more than just the basic physiologic function of bathing our eyes, I felt that it would be worthwhile to suggest some ways that tears help us and how tears should be acknowledged as a tremendous aid on our life’s journey.
- Happy tears – That moment when pure joy is seen (the birth of a child, a graduation, a pinning ceremony, the recognition of a significant accomplishment) we often experience emotions that are hard to describe other than to cry with glee. This glee is not necessarily a joyful outburst but rather usually a delight that is gloriously expressed with tears. And these silent tears are clearly an overt sign of intense pleasure.
- Sad tears – The passing of a loved one is one of the most difficult times in our lives. It represents an intensely emotional time and tears easily flow as we react to the situation. And these emotions can last for some period of time and recur frequently in the days and even years ahead. Sad tears can also arise as we consider the circumstances of others and the heartache and grief they might be feeling. Learning of the loss that others are experiencing and even considering the tragedies of complete strangers can also evoke such a response. We might be putting ourselves in their shoes, exhibiting empathy (‘em’ [within] ‘pathos’ [suffering]).
- “I don’t know why” tears – I think we have all had circumstances where we have tears but cannot truthfully figure out why. I would contend that this is okay. One might try to probe their inner feelings to find an explanation, but I am fine with just accepting the tears as a part of our emotional makeup without always seeking an answer. The mysteries of life are sometimes the joys of life.
- “I can’t take it anymore” tears – Boy, we have all had this type of tears, sometimes referred to as meltdowns. I distinctly remember having one such episode during my intern year in pediatrics. It was 3 AM and the chief resident came by the workroom to tell me that my fourth admission of the night was in the ER. I was in the midst working up my first admission and could not see how I could possibly take on more. The profound but fortunately brief deluge of tears was so therapeutic. I was able to step back, regroup and finish the tasks at hand. Now “I can’t take it anymore” tears do not always lead to a positive outcome, but they sure do help.
- “I’m so scared” tears – At times of intense fright, tears might seem like the only solution. We have all been there. But as a pediatrician and one particularly interested in trauma-informed care, it really affects me to see such a display from children. Their emotions are in a state of constant evolution hopefully guided by the steady hand of their parents. When they are in a state of emotional dysregulation, the “I’m so scared” tears are present and cry out for us to do everything we can to help.
I’m sure that other categories exist. I did not include reflex tears that occur to temperature or environmental factors. My wife would argue that I am subject to the “highly emotionally charged holiday commercial (usually a grocery chain)” tears, and I would have to plead guilty. Perhaps this category would be classified as “sentimental” tears, but I really think sentimental tears are those that come forth when we are actively practicing empathy as noted above in sad tears.
Tears are so important in our lives. While we might try to stifle them at times (to keep our emotions in check and/or to avoid embarrassment), I would argue that it is healthy and therapeutic to let the tear duct gland overproduce and to overflow the tear duct with overt tears noted around the eyes or on the face. Let’s let them rinse our emotions – grieving together, celebrating together, being nonjudgmental – as we support each other. The chemicals in tears bathe and protect the eye. The stimuli for tears likewise bathe (rinse) and protect our psyches in the moment and in the days and years to come.