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Risibility. The Superior Therapeutic Intervention?

Dad always thought laughter was the best medicine, which I guess is why several of us died of tuberculosis.

~Jack Handey, “Deep Thoughts

We have a saying in medicine that you can’t kill a jerk.  Not that we try to kill anyone, but that particularly unpleasant individuals, rife with psychopathology, survive whatever illness comes their way.  The corollary is that particularly nice people are prone to having horrible diseases with unpleasant outcomes.  We all know intellectually that it is not true, but there is an ongoing feeling in health care providers that somehow patient personality determines the consequences of their diseases.  As an aside, I am often  left with the explanation for patients that the reason for their odd infection comes down to bad luck.  Everyone responds something to the effect that “Typical. I get all the bad luck.”  I have never had a patient say, “That’s odd, I am usually so lucky.”

On the question of nurture versus nature, raising two children has convinced me of the relative lack of importance of nurture in the personalities of my children.  While abusive/pathologic environments will certainly lead to pathologic personalities,  for the average child raised in middle class America I can’t help but think that, to quote Popeye, “I yam what I yam and that’s all what I yam.”  I expect to be schooled in the comments on that subject.  Yes, I read the Blank Slate and have some understanding of the literature.  And yet.  My kids, my friends kids.  I watch them grow in what is (and isn’t) a similar environment and end up with diverse personalities that often appear present before they can speak.  I am well aware of the multiple logical fallacies that lead to that conclusion.  Parenthood and medical practice (where people seem to do the same damn stupid things over and over) have lead me to the conclusion that free will is mostly a myth and we are mostly programmed to behave the way we do. Discuss.  It is not the main point of the post, but my bias.

“Nothing shows a man’s character more than what he laughs at.” ~Johann Wolfgang von Goethe

One personality trait is a sense of humor.  No one admits to being a bad driver and I have never met someone who admits that they lack a sense of humor.   Humor is, of course, personal.  I find Seinfeld irritating, not funny.  The rest of my family does not share that assessment.  During Pulp Fiction, my wife and I realized that we were the only ones in the theater laughing during the scene when they are doing a cardiac injection to revive Uma Thurman after her drug overdose.  I once read that in choosing a mate, the best indication of long term compatibility was whether or not you both share a understanding of the essential hilarity of Bob and Ray.  I would agree and wonder if eHarmony uses that in their compatibility tests.  What would those examples say about whether or not I have a sense of humor and if so what kind?

What effects, if any, does a sense of humor have on health?  Emotional states alter physiology, some for the better, some for the worse. The popular opinion is that laughter is of benefit; there is a reason Reader’s Digest didn’t call their column ‘Schadenfreude, the Best Medicine.’   Are funny people or people who laugh easily more prone to better health because they have a sense of humor or laugh?  Or it is an association without causation, that whatever personality that laughs easily also leads to improved health outcomes?

“Whoever said ‘laughter is the best medicine’ never had gonorrhea.”  ~Kat Likkel and John Hoberg

Perhaps the topic of laughing your way to health gained the most traction with the publication in 1979 of Norman Cousins book, Anatomy of an illness as perceived by the patient: reflections on healing.  The book, which I read thirty years ago, details how, after being diagnosed with ankylosing spondylitis, Cousins left the hospital for a nice hotel, where he treated himself with good food, high dose vitamin C, and laughter from watching Marx brothers movies.

Did he have  ankylosing spondylitis?  The interwebs suggest he did not, and I can’t find the diagnostic criteria that were used to make the diagnosis and ankylosing spondylitis is a disease that can spontaneously resolve.  So causality is particularly problematic in Cousins’ case, since the diagnosis is uncertain. Even though I am an avowed Marxist, I would be suspicious of the power of Duck Soup to alter the course of disease for the better, as is the popular misconception of Mr. Cousin’s book.  I would not doubt that a good laugh will help decrease the perception of the severity of pain, as Mr Cousin’s suggested.

Is laughter medically beneficial?  Is a sense of humor medically beneficial?  Not the same question.

“Perhaps I know best why it is man alone who laughs; he alone suffers so deeply that he had to invent laughter.”  ~Friedrich Nietzsche

Laughter, of note, is not limited to humans :

Vocalizations referred to as “laughter” also occur in great apes engaged in tickling and social play. Vettin and Todt have shown key similarities in the respective acoustics of play- and tickling-induced vocalizations in juvenile chimpanzees (Pan troglodytes) and tickling-induced laughter in adult humans.

They estimated that laughter has been present in the human lineage for 10 to 16 million years.  I would estimate that is also how long humans have been farting.  Still nothing funnier to my children.

And some suggest that rats have a laughter equivalent with play and tickling.  Tickling rats.  I laugh at the mental image.  Is that laughter, if not the best medicine, a useful therapeutic intervention?

Laughter decreases blood glucose two hours after eating in type 2 diabetics.  I prefer eating in restaurants.   Laughter leads to vascular relaxation and decrease in serum cortisol,  decreases renin in type 2 diabetics, and increases natural killer cell function.

Some studies seemed needlessly perverse:

Twenty-four male patients with atopic eczema viewed a humorous film (Modern Times, featuring Charlie Chaplin). Just before and immediately after viewing, semen was collected, and seminal B cells and sperms were purified. Seminal B cells were cultured with sperms and IgE production was measured, while expression of galectin-3 on sperms was assessed.

RESULTS: After viewing the humorous film, IgE production by B cells cultured with sperms was significantly decreased. Moreover, expression of galectin-3 on sperms was reduced.

I can’t access the complete reference to discover the rationale behind the study, except, perhaps, to induce giggling.

“I am thankful for laughter, except when milk comes out of my nose.”  ~Woody Allen

Are there clinical correlates to these  physiologic effects? Sort of.

Laughter may help the depressed (why wouldn’t it?) and cheer up the schizophrenic (what a surprise).  Pello the clown, with his noted a humor intervention, decreased air trapping in COPD patients and laughing decreases the bronchial responsiveness in asthmatics.

That is about it for the medical application of laughter.  A smattering of small studies, rarely repeated, with small numbers of patients published in the more obscure journals.  I would not doubt the laughter is of benefit, but the benefit is small.

What is more interesting are the pathologic laughter syndromes: some (Angelmans) are genetic and some due to central nervous system strokes or tumors.  I suppose the silver lining for these unfortunates is the beneficial physiologic effects  of the continued laugher. Somehow the potential health benefits do not seem worth it.

These studies involved making people laugh, usually with movies.  Humor is not without its dangers in the medical field, given the idiosyncratic nature of what people find funny.

When used sensitively, respecting the gravity of the situation, humor can build the connection among the caregiver, patient, and family. However, insensitive joking is offensive and distressing, and experience suggests a variable acceptance of humor by patients with life-threatening illnesses, making humor a high-risk strategy.

So if laughter is the best medicine, it is best used sparingly and with the knowledge that as an intervention to cause lasting physiologic change, laughter has had little support.

“A sense of humor always withers in the presence of the messianic delusion, like justice and truth in front of patriotic passion” ~ Henry Louis Mencken.

Maybe it is not laughing that is important, but the more vague idea of having a sense of humor, that is important to health.

Four studies have tested the association between sense of humour and longevity. One reported that comedians and serious entertainers on average die earlier than authors. Two publications from the Terman Life-Cycle Study reported a negative association. Cheerfulness (sense of humour and optimism) was the index variable in the first study. In the second study, optimism was taken out, but the negative association prevailed. The fourth study reported a 31% reduction of mortality risk among patients with end-stage renal failure provided that they scored above the median on a test of sense of humour.

Dr Sven Svebak evaluated a sense on humor based on three questions and looked at survival in a large cohort of Norwegians who were being followed for long term health, much like the Framingham study.  The questions he used were

“Do you easily recognize a mark of humorous intent?” (Cognitive; N = 53,546; standardized item alpha = .91, item correlating .87 with sub-scale sum);

“Persons who are out to be funny are really irresponsible types not to be relied upon” (Social; N = 52,198; standardized item alpha = .91, item correlating .88 with sub-scale sum); and

“Do you consider yourself to be a mirthful person?” (Affective; N = 53,132; standardized item alpha = .74, item correlating .78 with sub-scale sum).

The participants responded to four-step scales (labeled for the three items respectively: very sluggishly – very easily; yes indeed – not at all; not at all – yes indeed).

Not an impressive criteria for determining a sense of humor and this is noted in the discussion of the article.  ”It may be regarded a hazardous task to assess psychological characteristics by use of three items.”  However, they felt that similar studies in depression validated the approach.

These questions  measure  friendly humor. The test is not sensitive to humor that creates conflicts, is insulting or that is a variation of bullying.  So much for laughing at my posts as evidence of a sense of humor.

What they found was those with a friendly sense of humor as judged by these three questions were more likely to survive compared to those that scored low on a sense of humor.

The authors are quite thoughtful on the applicability of this study:

There is a semantic point in the affective item where “mirthful” was used in the present study instead of “cheerful.” In Norwegian as well as English language “cheerful” and “mirthful” (Norwegian equivalent “munter”) can refer to a subjective state of mirthfulness as well as to the overt expression of mirth through smiling and laughing. The present assessment was by subjective report that may have addressed both the subjective and the expressive tendencies of an individual for being mirthful. A subjective state of mirthfulness appears to be closely related to cognitive processes, whereas expressive display is often triggered by social context. Support to this view came from the relatively high coefficient of correlation between scores on the cognitive and the affective items (r = .40: Table 4). In prospective studies of positive wellbeing, subjective state appears to have been at focus and has proven to reduce mortality. This association has been a fairly consistent pattern of outcome in prospective studies of healthy populations as well as of diseased populations.

In light of these findings for positive wellbeing, as well as of the complex conceptual content of sense of humor, it is possible that sense of humor is best conceived of as one aspect of a broader psychological characteristic that facilitates a general state of wellbeing, rather than a specific emotional state of mirthfulness.

Emphasis mine. I think this is interesting and have little argument with the study except in on interview, Dr. Svebak stated “He adds that a sense of humor can be learned and improved through practice.”

There I have my doubts.  I cannot find evidence that people can learn to appreciate humor or learn to become humorous.  In my experience (do I dare use those words?) the capacity for understanding and producing humor appears fixed.

That has therapeutic implications.  If a sense of humor can be developed, the humorless grouch can be taught to laugh and experience the benefits of humor.  More likely, your sense of humor, like your ability to run the mile or learn French, is mostly static in the adult.

Being thoughtful, the authors conclude

There is a risk of taking the present humor findings too far as a booster of longevity. The role of confounding variables is hard to precisely assess in multi- variate approaches, partly because of the often opportunistic availability of such variables in population research projects as well as all the potentially relevant variables that may have been included, but were left out for many reasons, such as lack of funding and time consuming data sampling procedures. The present study included quite a range of variables that are well established in the scientific community as influencing health hazard. A cautious approach is to directly compare hazard ratios across the range of variables, including traditional risk variables as well as an index of sense of humor.

An interesting study with a nuanced discussion. However, a molehill of interesting information does not prevent some doctors for making a mountain of advice.  The You Docs are hard at work again.

“Analyzing humor is like dissecting a frog. Few people are interested and the frog dies of it.” ~EB White

In this new Norwegian study, researchers who tracked the health of 70,000 people found that those who scored highest on sense-of-humor tests were twice as likely as dour sorts to still be alive — and laughing — seven years later. You didn’t have to be the type that laughs at the drop of a hat, either. All sorts of humor styles boosted survival. “A twinkle in your eye can be more than enough,” notes lead researcher Sven Svebak of the Norwegian University of Science and Technology.

Oh, for that twinkle in the eye, the key to health.  The study, based on three questions, makes no conclusions based on humor styles.

What’s behind humor’s life-prolonging powers? For one thing, laughter is a mini-workout. Ten to 15 minutes of mirth burns up to 40 calories and exercises your abdominal muscles.

About the same as is burned during 15 minutes of sex.  For a real work out combine the two as has been what my partners do… I may be oversharing here.  Everything can be considered a “mini workout” and is a lame reason to suggest laughter as medicine. Given how much I laugh, where is my 6-pack?

The You Docs evidently reviewed the same marginal literature and discovered that

A good belly laugh also boosts your immunity, motivating natural killer cells in your bloodstream to work harder.

In one study, watching a funny movie relaxed the endothelium — the fragile inner lining of your arteries — enough to boost blood flow by 15 percent. Laughter eases stress and reduces levels of the high-anxiety hormone, cortisol. In people with diabetes, it can even help keep blood sugar lower and steadier.

Then there’s resilience. Laughter helps you build and maintain friendships, eases fears and gives you a hand at coping with whatever life throws your way. It may also thwart the flu and protect against cancer.

The last two I cannot find the reference for, but protecting against cancer? My goodness.  They make it sound so all encompassing, rather than the limited results I found.  And they never mentioned the sperms.

“What soap is to the body, laughter is to the soul.”  ~Yiddish Proverb

The You Docs end with suggesting by suggesting you get a daily dose of humor for its health benefits, and they give multiple ways to find a good laugh.  It is interesting how the authors of the study suggest that humor is part of an over-arching personality, whilst the You Docs go for simplistic and overwrought advice:

Get your daily quota of yucks. Check in with yourself at lunch time: Have you chuckled today, or maybe even gotten that tingly “this is hysterically funny” feeling? If not, do something about it. E-mail or call your funniest friend. Plan to watch your favorite sitcom or wise-cracking commentator tonight. The Web is loaded with joke sites, bookstores are brimming with humor books, video stores offer thousands of comedies and stand-up comic shows. Make it a point to learn at least one new joke a week, then tell it to your friends.

See the humor in your life. You took the stray cat you rescued to be spayed and discovered that she’s a he? Trade funny stories: Make it a habit to ask friends and family about the most ridiculous thing that’s happened to them today, this week, this month.

Discover what really tickles your funny bone. Your sense of humor is as unique as your fingerprints, so stop laughing at what you think you ought to find amusing (Who does that? Besides Ed McMahon?  If he had heeded that advice, he would have lived longer than 86 years) and do a little research into what really hits your sweet spot. Try watching, reading or listening to types of humor that are new for you. You may discover you prefer political humor or cowboy jokes, martini-dry wit or a really bad knock-knock (Or the You Docs).

It is always curious how a few studies of limited scope get inflated.  Sad advice really. Research what makes you laugh.  That is one of many annoyances of the alt med life style recommendation: the medicalization of the joys of life.  Drink red wine because it is good for you, not because it is joy in a bottle. Eat chocolate because it is a natural medicine, not because it is delicious.  Laugh because it improves your health, but not because it soothes your soul.  I prefer to laugh and eat and drink and work for the significant pleasures these things provide, not for their minimal health benefits. Live a good life and you will reap the rewards.  I see a lot of people at the end of their lives. When people look back, the regrets they express  are not for the time they wished they had spent laughing to manage their sugars, but the time they did not spend laughing with their loved ones.

Fortunately I read the You Docs: they provide me yucks, in both senses of the word.  As a result I expect I am never going to get ill, never get cancer and will live forever.

So tell me.  Are you healthier after reading this blog?

Posted in: Clinical Trials, Faith Healing & Spirituality, Humor, Science and Medicine

Leave a Comment (58) ↓

58 thoughts on “Risibility. The Superior Therapeutic Intervention?

  1. Michelle B says:

    I am more able to deal with ill health after reading your post.

    What, am I the only one who admits to being a bad driver! I am so bad a driver that I have voluntarily given it up for the safety of others. I am amazed that I was ever given a driver’s license and truly wonder about what other unqualified drivers my driving test examiner has set loose on the highways.

    Yes, laughter is delightfully fantastic for the same reason any pleasurable experience is. May be trite, but in France where I live, it is the little happinesses (les petits bonheurs) which are cherished.

    People who demand big things for them to be happy, the so-called A types, are the ones perhaps that are slated to die young, and really, since they don’t enjoy life, it is really wasted on them!

  2. What a lovely, meandering article. Thanks!

    A couple comments, Firstly, perhaps I’m misunderstanding the part where you mention “The Blank Slate”, (Pinker? right, same book?) But it seems you suggest that he disagrees with you, when as far as I read (I only got halfway in the book) he’s straight on nature over nurture, a bit defensive about it, I’d say.

    Secondly, You may not be able to teach a sense of humor, but one can learn to lighten up. I was brought up by a rather humorless dad and mom who was a worrier. She actually had a wonderful sense of humor and fun, it just wasn’t a priority. It took me well into adulthood to learn to stop taking everything SO seriously. Oh well, I guess I’m still learning.

    Thirdly, also on learning a sense of humor. The developmental aspect of humor is interesting. My kids are in the stage of telling endless knock, knock jokes without really understanding what makes knock, knock jokes funny. “Knock, knock, – Who’s there? – Chicken – Chicken, who? – Are you a chicken head?” Gales of laughter.

    Oy.

  3. Shelley says:

    LOL!!

  4. Anarres says:

    @Michelle B

    (…it is the little happinesses (les petits bonheurs) which are cherished)

    Same in Spain, “el placer de las pequeñas cosas”.

    @micheleinmichigan

    I got the third point http://www.youtube.com/watch?v=yL_-1d9OSdk

  5. Epinephrine says:

    Ah, nature vs. nurture, the unending squabble. My courses on the subject are from nearly a decade ago, but my impression then (as now) is that this is a false dichotomy. I had to look up the reference, as I had forgotten the source – it was Gaulin and McBurney (2001), in the text Psychology: An Evolutionary Approach, who said it most clearly, “Wouldn’t it be ridiculous to claim that bread is 75% ingredients and 25% heat? Bread is what happens when the right kind of ingredients are exposed to appropriate temperatures. Either one without the other yields nothing useful at all because bread is the product of the interaction.”

    We don’t gain much from trying to tie changes to one or the other of these factors – both clearly have an effect. (Self-indulgent example follows) My eldest daughter (7) has a keen interest in biology, and we recently defleshed/dissected a pig head together. She found it fascinating, and wasn’t at all repulsed – but I don’t doubt that if I had fed* her (seemingly innate, but perhaps instilled?) curiosity with physics and mechanics for the past few years she may well have become squeamish and preferred inert materials to the biological.

    *Interesting how we have “feeding” of information and experience as a metaphor in English. Nobody would doubt that food determines to some extent biology, at the very minimum by either providing or not providing required nutrients.

    Anyway, I would agree (from personal experience, at least) that sharing or at least appreciating your spouse’s (partner’s) humour is important – my wife may not laugh at all the same things I find funny (and vice versa), but she at least finds my sense of humour amusing, and we poke fun at one another’s eccentricities. Whether humour/laughter contributes to health is another question entirely – and I suspect far to difficult to assess with surveys, due to the sheer number of confounding variables, not to mention the difficulty in coming up with a measure of humour in the first place.

  6. phren0logy says:

    > “particularly unpleasant individuals, rife with psychopathology, survive whatever illness comes their way”

    I’m going to give you the benefit of the doubt that you used the word “psychopathology” inaccurately. Please make sure this is the word you intended to use.

  7. Anarres – hehe and oh dear.

    If I showed that to the kids I’m afraid my head would explode from the number of times I would hear “chicken” in a day.

  8. wales says:

    Thanks for the laugh MC.

  9. phren0logy: your comment piqued my curiosity, as I carry a certain amount of psychopathology myself and I didn’t see anything wrong with Mark Crislip’s phrasing. So I looked up “psychopathology” and came up with a few definitions:

    http://dictionary.reference.com/browse/psychopathology
    — the conditions and processes of a mental disorder.
    — a pathological deviation from normal or efficient behavior; psychosis.
    — disordered psychological and behavioral functioning (as in mental disorder).

    Nothing in these definitions suggests an inherent incompatibility between unpleasantness and psychopathology. In my experience, unpleasant people who are also disordered are more difficult to cope with than unpleasant people who are not disordered. Depending on the psychopathology, it could even make someone unpleasant. Perfectly nice people can be unbearable when they are depressed, which is a fairly tame disorder.

    To my mind, unpleasantness and psychopathology are not moral judgements. If you know that you don’t have a good time when you hang out with me — let’s say I usually spend our time together spitting at you and accusing you (falsely) of sexually abusing my children and stealing my toilet paper — you can improve our relationship if you think I’m not well. Rather than becoming angry and trying to defend yourself, you can try to take actions that will set us both more at ease.

    If you are an ED doctor treating me, recognizing that you find my company unpleasant (countertransference) alerts you that I am probably unhappy too — at the very least, that something is out of kilter — and may help you focus on my needs, or perhaps on securing our mutual safety. People with psychopathology may have more needs that are more diffiucult to meet in an ED setting, and we may both continue to be distressed despite your most professional efforts.

    Not everyone who is unpleasant is “rife with psychopathology,” and not everyone with a mental disorder is unpleasant. But being both unpleasant and disordered is more difficult that being either alone.

  10. … and of course, doctors prefer patients who are not unpleasant. It makes their jobs easier and more fun. Except when the dreaded “nice person sign” is a lead-up to a diagnosis of metastatic cancer or something.

  11. TBRech says:

    As a former STD clinician and nurse epidemiologist, I almost had coffee coming out of my nose as I read: “Whoever said “laughter is the best medicine” never had gonorrhea. ~Kat Likkel and John Hoberg.”

    My wry witted father said I came into the world laughing. My RN mother said it was just gas. She made him change the diaper (or so I was told.)

    This column made me smile. What makes us laugh and smile is (in MY experience) also quite personal. Medical humor always got me laughing but then I was exposed early in life to my mother’s profession. Later I worked in a hospital morgue while in college and a darker variant emerged. Then there was the Communicable Disease clinic and Epi field investigations. Seems this area attracted clinicians and investigators who all shared a rather odd twist of what was amusing. So which came first? Our odd twist, or interest in pathogens? Microhumor? Can syphilis and or chlamydia make YOU giggle? (Out of the earshot of clients/patients of course.) It is a darkfield and I will slide out of this quickly without a whiff or too many more measly remarks!

    The Oz men out AKA pop docs seem UnRoizenable. Their thought culture is somewhat amusing however seems dangerous because so many non critical thinkers in the general population like to find panaceas. Reminds me of the clients who tried homeopathy to “cure” STDs.

    As we age together, my engineer spouse and I find similar things amusing, we both even like puns. He gets the medical humor and I find his drier wit delightful. The best part is that we can laugh at ourselves, which may not improve our health, but it does make challenging days easier to take.

    I find that listening to informative podcasts laced with a dose of bad puns daily helpful if not healthful. Thanks Doc Crislip…

  12. Calli Arcale says:

    micheleinmichigan:

    Thirdly, also on learning a sense of humor. The developmental aspect of humor is interesting. My kids are in the stage of telling endless knock, knock jokes without really understanding what makes knock, knock jokes funny. “Knock, knock, – Who’s there? – Chicken – Chicken, who? – Are you a chicken head?” Gales of laughter.

    My eldest has grasped the “pun” aspect of the knock knock joke now, at long last.* But my youngest has not; she is in the “knock knock jokes are supposed to be funny, therefore they are” and laughs without even completing the joke. “Knock knock.” “Who’s there?” “Um . . . shirt!” “Shirt who?”

    I think it’s highly unlikely humor can actually cure anything. But it does do a darn good job of *distracting* people, and that can be helpful. It is not alone in this, of course; all entertainment is distracting. (That’s often it’s main point.) And that can be useful in a clinical setting. Pediatricians know this, and many of them have a “toolbox” of little tricks and jokes they can use to distract children or briefly win their trust, and that could work with adults as well. Studies seem to mostly focus on distracting children, perhaps because we are all so sympathetic to the plight of children who require painful medical interventions. But I would think you could improve outcomes by better distracting the adults as well. If nothing else, humor can relieve boredom, and it is unpleasant to be bored. I would think that would be mostly relevant for hospitals, though the waiting room at a clinic can be outright psychological torture if it’s a very long wait and you’ve had to bring along your children, especially as many clinics are removing the toychests out of fears of disease transmission.

    * Though her current favorite isn’t a pun; it’s the “interrupting cow” one. “Knock knock.” “Who’s there?” “Interrupting cow.” “Interrupting c. . . ” “MOO!” It got old on about the third iteration. We’re up to about 50 by now.

  13. Epinephrine says:

    Calli Arcale:

    Though her current favorite isn’t a pun; it’s the “interrupting cow” one. “Knock knock.” “Who’s there?” “Interrupting cow.” “Interrupting c. . . ” “MOO!” It got old on about the third iteration. We’re up to about 50 by now.

    Oh, tell me about it. We’ve had interrupting chickens, interrupting pigs, pretty much anything that makes a sound gets substituted into that joke.

    My favorite though is the version from irregularwebcomic.

  14. I had forgotten about “interrupting cow”. I think I will wait and share that one when they understand the value of quality over quantity.

    Regarding psychopathology, between my siblings we used to have ongoing discussions regarding the generally difficult personality of my father. Although we could agree that there was probably a diagnoses there and that he mostly couldn’t help it, none of us had enough background in psychology to know the diagnoses or what exactly to do about it. I believe this sort of analysis could be described as buttheadology (the study of the care and maintenance of, well, you get it.) Buttheads, of course are people who seem quite functional, but manage to undermine the function of those around them. I’m guessing they are difficult patients.

  15. hoogejc says:

    I’m not sure if I’m healthier after reading this…that would probably be mere anecdote anyway.

    Perhaps a double blinded study with a reasonably-sided control group is called for.

  16. hoogejc says:

    I’m not sure if I’m healthier after reading this…that would probably be mere anecdote anyway.

    Perhaps a double blinded study with a reasonably-sized control group is called for.

  17. Joe says:

    Remember, it only takes nine muscles to smile; while it takes 43 muscles to flip the bird.

  18. Pieter B says:

    Thanks for making SBM a place to come to for the lulz as well as solid medical information and anti-woo.

    I find Seinfeld irritating, not funny.

    My brother!

    I’ve coined a term for the condition in which older humans do not find funny things that humans half their age or younger find hilarious — “Alzhoumor’s disease”

    I use humor as a means of coping with stress, which sometimes causes problems with people who don’t, so I have to be careful in the workplace. If you’re in a very diverse workplace, you have to be even more careful, as some impromptu jokes don’t translate well. It’s easy to give offense where none was intended.

    .

    My favorite knock-knock joke is “I heard a great knock-knock joke; you start it.” “Knock knock”"Who’s there?”"Uhhhhh . . . “

  19. If the three most dangerous word in the medical profession are, “In my experience…”, where do the three words, “In one study…” rank?

    Is anyone else tired of seeing some specific position or idea supported by citing a single, lone study?
    ——————————————————————————-
    On another note: Read two Mark Crislip posts and call me in the morning, you’ll be fine.

  20. Alexie says:

    The real study that needs doing is whether a sense of humour in the practitioner gets a better patient outcome.

    I’m undergoing chemotherapy in dour Germany, where laughs are spaced a long way from one another. My partner and I, being Australian, see no reason not to make jokes about cancer, as we do about everything else. Some medical staff find this very shocking and have even been disapproving. But the doctors who ‘get’ it and are prepared to have a laugh are the medical staff I am most likely to listen to, and who I trust with my most serious questions and embarrassing conditions.

    I hadn’t heard the interrupting cow joke – gave me a laugh.

  21. Mark Crislip says:

    Alzhoumor’s disease. Tell me about it. My 13 yo thinks adam sandler is the funniest movie ‘star’ ever; he makes me want to gouge my eyes out (sandler, not my child)

    I read Blank Slate when it came out, I remember it as a 50:50 evaluation.

    As always, I forget about children; my job is adult oriented, I never considered that humor is learned in children.

  22. Kausik Datta says:

    I don’t know if laughter can extend your life, but it can sure make you feel good about living.

    The major problem that I see with these purported sense-of-humor studies is that – just as Mark noted somewhere – different people find markedly different things funny. It is perhaps impossible to apply a universal standard of ‘fun’ for all the participants in such a study.

    However, (personal anecdote alert!) it is perhaps possible to lack a sense of humor congenitally. I do know of a person who – while otherwise a normal, intelligent and friendly person – seems to be utterly devoid of any sense of humor. She is always the person in any group who doesn’t get the pun, the twist or turn of phrase, or the point of a joke, and is surprised why people around her are laughing uproariously. Does that indicate some sort of a personality trait, or even disorder? IDK.

  23. Ray Greek MD says:

    The link provided in your statement “Laughter, of note, is not limited to humans” does not seem to work. If you don’t mind, please post the url. Thanks!

  24. Dr Benway says:

    Seinfeld has a lot of vicarious cringing in it, which I sometimes cannot endure.

    That is one of many annoyances of the alt med life style recommendation: the medicalization of the joys of life.

    Oh I do so agree.

    Imagine living inside a head that divides all the world’s nouns into “boosts the immune system” or “toxic.” How terribly, terribly tedious.

    Sometimes I wanna shout at the alties, “Could you just take five from contemplating your ‘wellness’ or your BMs or whatever? Your subjectivity is like an elevator fart. You might find it endlessly fascinating. Others are less impressed.”

  25. Taylor says:

    “On the question of nurture vrs nature, raising two children has convinced me of the relative lack of importance of nurture in the personalities of my children.”

    Agreed. And I would argue there is a lot of scientific evidence to back this up as well.

    But if you don’t believe in the so-called blank slate, how can you be a Marxist?

  26. “But if you don’t believe in the so-called blank slate, how can you be a Marxist?”

    I didn’t know Dr. Crislip was a Marxist. Is he of the Carl or Groucho variety?

  27. Mark Crislip says:

    I hate explaining a joke, but Duck Soup is the best marx brothers movie, in context I am the groucho kind.

  28. Chris says:

    Hmmph! Laughter kills! It killed my dad’s stepmother. She was having a grand time at the club’s casino night and broke a blood vessel in her brain from laughter. So, she literally died laughing.

    And ruined the evening for everyone else.

    While the story is true, the previous tone is sarcastic. It was an appropriate way for my Nana to die… literally by laughing well into her 80s. She was a fun lady with great stories.

    Oh, I think I blocked the interrupting cow knock knock jokes from my memory. I think there was a period when I thought that phase would never end.

    But they are more grown, and the child who moved out came over today asking if he could take our toilet plunger and get a ride back to his apartment. Um, no. I did drop him off at the hardware store a block from his apartment.

    Truthfully, I think a sense of humor helps in dealing with young children. Sometimes they drive you crazy, and then the only thing is to laugh (even when the boys neglected to tell me the upstairs toilet was flooding, I noticed the dripping into the laundry room). Now I need to go back to sorting their childhood photos, especially the ones to give to their future mates. The ones that include a three year old boy with birthday present ribbons all over his head, the four year old daughter covered from head to toe in mud and all three of them (ages two to seven) staring at the new front loader washing machine working.

  29. Sastra says:

    Get your daily quota of yucks. Check in with yourself at lunch time: Have you chuckled today, or maybe even gotten that tingly “this is hysterically funny” feeling? If not, do something about it.

    Yes, indeed — you must do something, damn it. The You Docs are advising their patients to set out and Find Things Funny with grim determination. If they don’t, then so much the worse for them. The results, will not be funny.

    In her book Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America, Barbara Ehrenreich draws what I thought was an unexpected parallel between the so-called New Thought movement, and Calvinism. Both groups tend to blame illness and trouble on personal flaws in the victim: ‘sin’ in the religious case, ‘negative thoughts’ in the new-agey case. Each individual is supposed to search inside themselves relentlessly, to find out what they’re thinking wrong — so that they gave themselves cancer.

    The dark side of the Humor Cure is that it tends to blame the victim for not cheering up and laughing enough, in the face of adversity. You would get better, if you just did that. That’s a heavy burden to bear, I think. particularly when the evidence for it seems pretty thin.

  30. # Mark Crislipon 30 Jul 2010 at 5:46 pm
    “I hate explaining a joke…”

    Sorry, some days my memory is not great.

  31. phren0logy says:

    Alison:

    My concern is that, unless you only look for psychopathology in people who are unpleasant, I don’t think there’s a strong correlation. Certainly, I would estimate there is less of a correlation than with people in pain. The exception is a few types of personality disorders, but that is one very small part of the broad spectrum of people with psychopathology.

    The reason for my comment is that psychopathology seemed to be added in needlessly. Perhaps that’s my bias as a psychiatrist, but really I haven’t met many people with, for example, OCD, who struck me as particularly unpleasant.

    It struck me as a bit of a pot-shot at the mentally ill, and I’m not sure they need another kick while they are down. Perhaps it was in reference to those with personality disorder, but then more precise wording would have been helpful.

  32. Mark Crislip says:

    Until the final draft I had the phase “flaming asshole dirtballs” but changed it to rife with psychopathology as not appropriate for SBM.

    Wasn’t thinking of the mentally ill at all.

  33. Until the final draft I had the phase “flaming asshole dirtballs”.

    Flaming asshole dirtballs, would require shocking anecdotes to illustrate the description.

    A while back my former boss posted a story about his wife who is a medical specialist. Apparently she had an appointment with a man who upon seeing her promptly walked out muttering something about “I don’t see foreign doctors” (She is filipino).

    I suppose there could have been some psychopathology involved, but the FAD decription sounds more appropriate. :)

  34. Taylor says:

    <>

    OMG, as a staunch Mark Crislip fan, I have always snickered at those who don’t appreciate his humor and take him too seriously. Now I am the one who missed the joke….how could I forget Duck Soup??????

    I feel very embarrassed and as penance promise to write some good reviews of my favorite podcasts…the quackcast, the puscast and gobbet of pus…..as soon as I get home from vacation.

  35. tmac57 says:

    I think I found the cure for the ‘knock knock’ joke assault :
    “Come in”. (It drives the little ones crazy.)

  36. Kultakutri says:

    I’m depressed. Like, clinically depressed, on an off since I was 15 or 16. I do have a sense of humour, that sort where even the twinkle in the eye doesn’t appear – like when I persuaded a bunch of art historians on a field trip that black cows yield black milk which gets processed to the famous Coal Cheese, so appreciated by connoisseurs. I love to poke this sort of evil fun on people, I greatly appreciate a good sarcasm… and I still need my citalopram or what’s the drug de jour. Neither it seems that my knee improves with laughter.
    And, if I laugh hard, I get a bronchospasm and when I can’t stop coughing, I throw up… is that healthy, I wonder?

  37. Fifi says:

    Cuasic – “However, (personal anecdote alert!) it is perhaps possible to lack a sense of humor congenitally. I do know of a person who – while otherwise a normal, intelligent and friendly person – seems to be utterly devoid of any sense of humor. She is always the person in any group who doesn’t get the pun, the twist or turn of phrase, or the point of a joke, and is surprised why people around her are laughing uproariously. Does that indicate some sort of a personality trait, or even disorder? IDK.”

    Is she high functioning autistic perhaps? (Maybe undiagnosed because generally women compensate better for mild autism socially.) Being very literal and not being able to think metaphorically would get in the way of understanding a pun and many other jokes and it’s symptomatic of autism. That doesn’t mean that autistic people can’t have a sense of humour, it just means that it will be different and not based on the kind of metaphor or unexpected association that much general humor is made of.

  38. tcw says:

    “Parenthood and medical practice (where people seem to do the same damn stupid things over and over) have lead me to the conclusion that free will is mostly a myth and we are mostly programmed to behave the way we do.”

    Umm. . . who wrote in a prior blog on SBM that the most dangerous words in medicine are “in my experience. . .”

    To validate humping all the “partners” we want, a reductionistic view of the human mind is essential. Pretend that science is a philosophy (it isn’t, it is a method), and with all lab geek acumen, anticipate the sunny day when we map our neurons and reveal the utopia that is entitled us. Only those religionists stand in the way of progress, with all their talk of Aristotle and Aquinas and other washed up ancient texts! We are programmed to burn them!

  39. ScarySkwerl says:

    This title sounds exactly like something Sheldon Cooper would say.

  40. phren0logy says:

    > Until the final draft I had the phase “flaming asshole dirtballs” but changed it to rife with psychopathology as not appropriate for SBM.

    Well, there’s a lot to be said for your original wording. It certainly leaves little room for ambiguity. Thanks for clarifying.

  41. Bogeymama says:

    Laughter may be able to induce labour – I was watching “There’s Something About Mary” years ago on my due date – the OB had told me earlier that day that I was still a week or so away, but my water broke while I was laughing really hard – can’t remember the scene.

    I was at work, having a good laugh with a colleague, who was about 32 weeks long … and her water broke. The hospital where we worked confirmed that it wasn’t just urine, and she delivered later that day.

    Not scientific, but I still sometimes recommend a really good chuckle to those patients that are past due!

  42. The Blind Watchmaker says:

    “Comedy is the art of making people laugh without making them puke”
    Steve Martin

  43. BillyJoe says:

    Thanks to all for the following…

    “I find Seinfeld irritating, not funny.”

    Yes, but, for real irritating you cannot, CAN NOT, go past….oh, wait for it, I know you’re going to disagree…The Simpsons!
    I simply cannot watch that show.
    And I have never, ever, used that three letter word…and please kill me if I ever do!

    ““The Blank Slate”…(I only got halfway in the book)”

    You did really well, michele!
    Congratulations.
    I thought I just HAD to read that book, but I never got past the first chapter.
    Daniel Dennett he is not.

    “Knock, knock, – Who’s there? – Chicken – Chicken, who? – Are you a chicken head?” Gales of laughter.”

    Actually that’s pretty funny.
    You shouldn’t explain a joke but this works because you’re expecting something funny, but it’s so…stupid!…which is funny!

    I got the third point http://www.youtube.com/watch?v=yL_-1d9OSdk

    That was so unexpectedly, hilariously funny it bought tears to my eyes….couldn’t believe he could stretch the joke out for nearly five minutes!
    It has to be the funniest video I’ve seen in my entire life!
    The differential equation at the end nearly killed me off.

    “…many of them have a “toolbox” of little tricks and jokes they can use to distract children …”

    What?
    Oops, sorry, I thought you said chicken :D
    …as you were.
    (I think I’m going to see chickens everywhere for a while)

  44. BillyJoe says:

    Seriously now…

    “free will is mostly a myth and we are mostly programmed to behave the way we do. Discuss. It is not the main point of the post, but my bias.”

    My joke about free will:
    There is no basis for it!
    (Sorry, it’s not that sort of joke)

    And that’s about all that needs to be said.
    …except for an explanation!

    Free will cannot be based on anything, otherwise it would not be “free”.
    Therefore, it cannot be based on deterministic cause and effect relations within the brain. In fact, that is the whole point isn’t it? That it is not deterministic.
    Similarly, it cannot be based on random quantum events (somehow randomly vetoing/not vetoing, the brain’s deterministic output) otherwise it is not “free”; and it cannot in any case be based on random events otherwise where does “will” come in?

    Free will is therefore an illogical concept.

    …unless you are as dualist.
    Then there’s not hope for you.

  45. mikee says:

    “have lead me to the conclusion that free will is mostly a myth and we are mostly programmed to behave the way we do”

    Might I suggest that the moment one recognises that “we are mostly programmed to behave the way we do” we have the opportunity to override that programming.

    As others have suggested nature and nurture isn’t a duality. For me the two are intertwined. I can point to parts of my behavior that has changed through my experiences and occasionally to rationally thinking through what I want out of life.

  46. BillyJoe says:

    mikee,

    “Might I suggest that the moment one recognises that “we are mostly programmed to behave the way we do” we have the opportunity to override that programming.”

    How does this opportunity to override arise?
    Magically? Out of thin air?

    Or is it perhaps new input into the brain – including the realisation that we are programmed – produces a new, or modified, program with the process being just as deterministic as that which produced the old program?

  47. SueW says:

    (Who does that? Besides Ed McMahon? If he had heeded that advice, he would have lived longer than 86 years)

    What a dumb thing to say. How do they know how long he “would have lived”? 85 is still pretty old. Ed McMahon spent every night listening to Johnny Carson, one of the funniest guys ever.

    Maybe being unhealthy destroys your sense of humor. Who knows?

  48. BillyJoe,

    Hey, I’m a dualist, but your description of the problem of free will is pretty much what I’ve got. (So maybe there is hope?)

  49. BillyJoe says:

    Alison,

    :(

    The other thing about free will is this:

    The brain evolved over a period of 600 million years to take in information from the environment and produce an output appropriate to the organism’s continued survival.

    What possible advantage could free will have in this scenario?

    In fact, how could free will be anything but detrimental to the organism? Vetoing brain outputs that have been tuned to environmental inputs by 600 million years of evolution.

  50. Yes, yes and… maybe. The evolutionary argument doesn’t hold up that well. Evolution supplies a variety of strategies that organisms can deploy because their environments are not constant. Individual organisms of a species can be better adapted to one environment than another, but as long the species keeps propagating a pool of genes evolution doesn’t care that much about the individual. Free will could be argued to be a good thing for the individual when, say, an individual adapted to war has to cope with times of peace, and vice versa.

    But that just takes you back to the definition of free will. It’s a convention. Even if it doesn’t exist, we act as if it does – at least to an extent.

  51. BillyJoe says:

    Alison,

    “The evolutionary argument doesn’t hold up that well…Free will could be argued to be a good thing for the individual”

    Say the brain is 99.9% efficient at keeping you alive. If free will is not based on anything, if it is random vetoing of the brain’s output, the efficiency would drop to 50% every time free will is invoked. How could such a feature gain traction in an environment full of predators that need to be avoided and of prey that needs to get caught?

    “Even if it doesn’t exist, we act as if it does”

    Yes, the illusion-of-freewill is pretty convincing.
    In fact, it is indistinguishable from the real thing. The bonus is that, wheras freewill tries to kill you with 50% efficiency, the illusion-of-freewill is actually part of the brains efforts at keeping you alive.

  52. I disagree with the 50% efficiency bit for a couple of reasons:
    1) If going with the flow is working for you, why would you invoke free will to do something different?
    2) Even if you believe in free will, you probably don’t believe it applies to everything.

    … but I can’t find anything else to disagree with in your last paragraph.

    This digression reminds me of an old study that the US Army did on sleep and creativity, in which it was determined that sleep deprivation makes people more creative. The study went something like this:
    1) Well-rested people were given a long, boring task requiring concentration but no thinking. (I don’t know, something like sorting a constant stream of numbers into odd and even. Or something equally tedious.)
    2) People who hadn’t slept in twenty-four hours were given the same task.
    3) The sleep-deprived people made more mistakes.
    4) Ergo, sleep-deprivation enhances creativity.

  53. BillyJoe says:

    Alison,

    I did say “50% every time free will is invoked”. :)

  54. Calli Arcale says:

    BillyJoe:

    What possible advantage could free will have in this scenario?

    In fact, how could free will be anything but detrimental to the organism? Vetoing brain outputs that have been tuned to environmental inputs by 600 million years of evolution.

    You might as well ask how mutation can be anything but detrimental to the organism. Most mutations are either useless or harmful; why, therefore, are some organisms (bacteria, virii) so prone to it? What possible benefit could it have? And the answer is that though they evolved over millions of years to fit their environment, their environment is always changing (which is, of course, why it took millions of years to get to where they are). Therefore, no organism is perfectly tuned, and even if it’s very close to perfectly tuned, it probably won’t be forever. The capacity to change either ones’ progeny or ones’ behavior in unforeseen ways is therefore adaptive.

    Indeed, it is the ability to do this that allows a word like “adaptive” to really mean anything at all. If you can’t change, then you can’t adapt. Being able to change one’s own brain (by training it) is what allows an organism which evolved to live on the African savannah to flourish in the incredible population density and visual stimulation of Tokyo, or the frigid winters of Tromso, Norway, or the punishing dry heat of the Chilean high deserts.

    So free will, while it can make us do stupid things, gives us the flexibility to survive in an astonishing variety of habitats — and the ability to change these habitats not to suit the way we evolved but to suit the way we *want* to live. Which may or may not be the best way for us, but it at least seems to be working out for now, which is the basic evolutionary test.

  55. BillyJoe says:

    Calli,

    You are not describing free will. You are describing something that is dependant on the brain’s function. Which means that you are not contradicting anything that I have said.

    My point is that free will (where “free” means “independant of brain function”) would be the equivalent of placing a random veto function at the end of the brain’s output – an output that has been fine tuned through 600 million years of brain evolution. That has to be detrimental. Imagine being faced with a problem and coming to a solution that is likely to successfully resolve the problem….and then having that well thought out solution randomly vetoed!

  56. mikee says:

    @BillyJoe

    “Or is it perhaps new input into the brain – including the realisation that we are programmed – produces a new, or modified, program with the process being just as deterministic as that which produced the old program?”

    A good point, but if the modified program is consciously modified to be based on rational thought it would certainly be an improvement on some of the more “instinctive” programming?

    Recognising that our behavior is the result of biological programming, one could always introduce a random factor such as the tossing of a coin to make decisions?

  57. BillyJoe says:

    Mikee,

    “Recognising that our behavior is the result of biological programming, one could always introduce a random factor such as the tossing of a coin to make decisions?”

    Free will has to be more than a coin toss, surely?
    In any case, your “decision” to use a coin toss would also be the result of deterministic processes in the brain

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