by Dr.Harald Wiesendanger– Klartext
Nowhere is the earthly vale of tears deeper than between Flensburg and Passau. And it should be downright abysmal where the therapy camps of my Ways Out Foundation take place; because, in each case, up to two dozen seriously ill children and adults come together, accompanied by more than fifty serious diagnoses and up to thirty worried, burdened relatives. There’s nothing to laugh about, is there?
Adults laugh on average 15 to 20 times a day, and children 200 to 400 times. And participants in a “way out” camp? At every turn, one encounters extreme health needs: physically and mentally severely handicapped children, some of whom cannot even turn their heads, fix their eyes, reach for objects, make any sound, let alone sit, walk, or speak. You meet wheelchair users who must be prepared for their paralysis to progress inexorably. You get to know psychologically traumatized people who have been haunted and depressed by experiences of violence, abuse, or loss all their lives. How can it be that in places like this, happy laughter, sometimes even roaring laughter, can be heard every day: in the ritual “morning circles,” during meals together, at the graduation party, in spontaneous chats during treatment breaks, and in the evening?
Laughing at the seriousness of the situation does not happen at our camps unintentionally, inappropriately, or by the way – it is part of the concept, it is an essential part of the “way out” medicine, and we provoke it to the best of our ability. We always incorporate strange stories, hearty jokes, cartoons, and funny magic tricks into our “morning circles.” We’re running a contest in which each participant contributes their favorite joke; At the end, we select the “Camp Oberwitzbold”(Joker champion) by voting, who is presented with a prize to thunderous applause. On our wish list for future camps is hiring a “clinic clown”: one of now several hundred professional clowns who go by exotic names like Dr. Schnickschschnack or Dr. Hutzelbutzel have recently also appeared in German hospitals and care facilities to cheer up small and large patients, the elderly and the disabled. Humankind owes the Nobel prize-worthy impetus to Michael Christensen, the co-founder of the New York City Circus. In 1986, he had the fabulous idea of “clown doctoring,” which quickly became popular and has caught on in many countries worldwide.
It’s not just about entertainment. Humor can be used to drive away negative thoughts, relieve tension and give joy in life. What’s more, laughter is healthy. It may not be “the best medicine,” as the saying goes, but it is incredibly effective.
Scientific evidence for this comes from a young branch of medical-psychological research, which we owe indirectly to the comedy duo Stan Laurel and Oliver Hardy – more precisely to the film in which the two “Dick und Doof,” Stan and Ollie, push a bulky piano up the hill – as well as the fact that an American psychiatrist from Stanford University in Palo Alto, William F. Fry, “loved” this episode. (1) In the early 1960s, around 40 at the time, he watched this film (“The Teasing Piano Transport”) with a cannula in his arm, which he used to draw blood at regular intervals. He then had the blood sample chemically analyzed. He wanted to find out what happens in the body when you laugh. Why didn’t he just use laughing gas? “If you want to study the moons of Jupiter, you don’t study balloons. I’m interested in natural laughter.”
Fry, who died in May 2014, is now considered to be the founder of gelotology (from Greek gélos “laugh”), which initially struggled to be recognized as a serious science in specialist circles. “There were people,” Fry recalls, “who just took me seriously enough to suggest that I enter a comic book contest. I had a few glasses of sherry one night and thought to myself, hell, why not? The brief was a strip with two angels on a cloud, and you had to come up with some lyrics.” What did Fry come up with? “One angel says to the other, ‘Oh, these clouds are wonderful for my hemorrhoids.’ The judges were so thrilled – they probably had hemorrhoids themselves – that they gave me first prize.”
In the half-century since Fry’s first studies, scientists have amassed impressive evidence that humor is a medically serious matter:
Each “Hahaha” stands for a significant physiological event of immense complexity: 17 muscles in the face alone contort, up to 80 in the whole body; Shoulders, abdomen, and diaphragm shake, leg, and bladder muscles slack. (Small children sometimes fall over or wet their pants when they laugh because of this.) The air hisses through the lungs at gale force, at speeds of up to 100 km/h. As a result, breathing becomes freer, and we take in more oxygen. The heartbeat accelerates, blood pressure rises, and the body releases more hormones; Certain brain activities increase, including in the hypothalamus and parts of the frontal cortex. The fact that we sometimes cry when we laugh particularly heartily has anatomical reasons: air pressure increases in the upper part of the nose and presses on the tear ducts.
Laughter has a positive effect on the mind and psyche.
But laughter relaxes not only the muscles but also rigid thought patterns. Perspectives change: Patients can see their situation, those involved, and themselves with more distance and from a different perspective to reconsider and find new solutions to problems. It often opens up a way out of a seemingly inescapable dilemma: a conflict, an oppression, a fear. Because one of its primary triggers is the sudden recognition of connections, the inner tension is released as laughter.
Laughter is calming: A study has found that one minute of laughter is just as refreshing as 45 minutes of relaxation training. It is because happy hormones, so-called endorphins, are released, thanks to which tensions are released even under heavy workloads. At the same time, there are fewer stress hormones: less cortisol, less adrenaline, fewer dopamine metabolites, and less somatotropin.
Cheerful people who often laugh also meet their environment differently than pessimistic-serious ones. You are more relaxed, less nervous, more sociable, more popular with others, and therefore more successful, both in your private life and work world. Evolutionary biologists start with this social aspect to explain why 10 to 16 million years ago, the common phylogenetic ancestors of humans and great apes included laughter in their behavioral repertoire: It soothes fellow species (“Look, I’m nice, so do it me nothing”), expresses great joy about their appearance, their presence or their behavior, communicates positive feelings. If you consider that Neanderthals were cannibals, laughter could also have become fashionable as a clever deception: “Come closer so that I can eat you better.” (2)
In addition, laughter makes you more creative. Why are companies now sending their employees to outrageously expensive laughter seminars? Laughter breaks the routines of controlling thinking and acting. And it makes you more alert: Electrochemical processes that are typical of heightened alertness are increasingly taking place in the brain.
Laughter has a beneficial effect on the body.
It improves blood circulation, thus preventing cardiovascular diseases. How? Laughter stretches and widens the endothelium: the tissue that lines the inside of blood vessels; it regulates blood flow and the internal pressure of blood vessels and blood clotting. As a result, it plays an essential role in the development of arteriosclerosis and vascular hardening. Hearty laughter trains the heart muscles about the same as fifteen minutes on a stationary bike or ten minutes on a rowing machine. “Twenty seconds of laughter is equivalent to the physical effort of three minutes of fast running,” Fry observed. “Laughing is jogging while sitting,” assures the German psychotherapist Michael Titze (3), co-founder of HumorCare, a non-profit organization for “promoting humor in therapy, care, and counseling.” (4) A study published in 2009 by the University of Baltimore recorded 300 test subjects, half of whom had already had heart disease, up to and including a heart attack. What characterized the healthy study participants? They laughed much more often about everyday situations. (5)
Pain sufferers can experience relief after just a few minutes of laughter that sometimes lasts several hours. Why? Laughter boosts the production of beta-endorphins: hormones produced by the body that acts like an analgesic without any adverse side effects. The US doctor Howard Bennett sees “the most promising use of laughter as therapy” in fighting pain. In an overview article on the state of research (6), he reports, among other things, on a study in which 78 newly operated patients needed significantly fewer analgesics when they watched funny videos. (7)
However, the effect is more indirect: those who are mentally stressed, sad, or anxious concentrate more on their pain and feel it more intensely. Humor distracts; let’s forget mental stress – at least temporarily. The American science journalist Norman Cousins tested this connection on himself: he treated his painful spondylarthritis – a chronic inflammatory rheumatic disease in which joints stiffen, also known as “Bechterew’s disease” – with funny films and funny books, which regularly provoked fits of laughter in him. He found that after ten minutes of laughing, he was primarily pain-free, after which he was able to sleep for at least two hours without problems. In the 1970s, his book The Doctor Within Us (7) helped laughter research in the USA suddenly gain public attention and recognition; Laughter therapies, laughter yoga, laughter clubs, and laughter congresses became socially acceptable. World Laughter Day has been celebrated on the first Sunday in May every year since 1998.
In laughing people, the blood levels of gamma interferon, killer cells, and antibodies also increase significantly: essential players in the immune system. The endogenous hormone-like substance gamma interferon activates and coordinates the production of several endogenous antibodies while so-called killer T cells destroy already infected cells. The antibodies immunoglobulin A and B lymphocytes, a type of white blood cell (leukocyte) that are the only cells capable of forming antibodies, also occur more frequently when laughing.
However, Fry believes it is premature to draw far-reaching therapeutic conclusions from such remarkable results: “We must not make the mistake of first trumpeting sensational findings and then starting basic research afterward. That would be like putting on our pants first and then slipping into our underpants” – and to that extent, “I’m still in diapers” .9 All the beneficial effects mentioned seem to occur only briefly, for a few hours at most; in the long term, they benefit our health more indirectly – depending on how well we can cope with stress. Stress measurably damages the protective layer in the blood vessels that supply the heart. And this can lead to severe vascular inflammation there, up to and including a heart attack. Sunny people are more resistant to this because they deal with pressure more relaxed – and happy people laugh more.
Laughter only helps our immune system in the long run if it expresses a personality that can cope well with stress. At the beginning of the 1990s, 394 healthy people were first asked how they felt when they felt tense and then infected with rhinoviruses, typical cold pathogens, using nose drops. The result was clear: the immune system of those who were more resistant to stress defended itself more effectively against the virus – those who were easily stressed, on the other hand, were more likely to catch a cold. (10)
As such, every joke you heard during those days of camp was made with therapeutic intent and hopefully with beneficial consequences that aren’t limited to short-term convulsions in your diaphragm but have made your overall mind a little lighter, more relaxed, and more resilient to stress. As a reminder and to ensure a certain sustainability (smiley!), we have put together a selection of the best camp jokes and anecdotes on the following pages; more will follow in future editions of this book, and that much is certain.
With the laughing break on –
How far can humor go?
Pretty cheeky, this “Dr. medical Heckmeck”: For half an hour, he has been making up white, with a red cardboard nose, in the dining room of an old people’s and nursing home and has been fooling around with forty elderly residents – as a trained and qualified “clinic clown,” paying member of the “clowns in Medizin und Pflege Deutschland e.V.” Brazenly he grabs a wheelchair in which he tries in vain to sit down with grotesque contortions and repeated miserable attempts; Finally sitting down, he demonstrates how stupid one can be in such a vehicle. He cleans the bald head of a puzzled older man with a feather duster.
Knowing full well that a large part of his audience has dementia, he mimics the forgetful: With growing desperation, he looks for a key five times, which he had put in the side pocket of his costume five times a few seconds earlier. He acts as if he urgently needs to pee, but persistently overlooks the chamber pot that is between his legs. For depressives, he mimics the sad dumpling that bursts into tears every few seconds for the most trivial of reasons: even the hanging flower of a potted plant, a wallpaper pattern, and a polka dot dress make him cry. As if he didn’t realize that everyone present here is facing their near end, he takes a scythe from an invisible Grim Reaper and kicks him in the buttocks, tongue out and middle finger erect.
All of this is definitely going too far, isn’t it? Is it permissible to make fun of weaknesses, stress, fears, and limitations due to age, illness, or disability in such an unrestrained and insensitive manner, especially in the presence of those affected? Doesn’t that offend them?
At least dr Heckmeck’s audience doesn’t seem to see it that closely. Again and again, there is loud laughter, and the clown’s antics are interrupted by spontaneous applause. A single senior shakes his head, angrily waves his hand, and demonstratively leaves the hall. The others seem amused, even enthusiastic.
How far humor can go when people are in poor health was also up for debate during two “Ways Out” therapy camps in 2015. In the daily “morning circles,” the moderator held a multi-part “lecture” on the basic medical concept of the camps – in satirical form, illustrated with cartoons, which he projected onto a large screen. Of the 70 patients and relatives who took part, the presentation seems to have amused 68: neither verbally after these events, nor in the diaries kept during the camp days, nor in questionnaires to be filled out at the end, nor in subsequent letters and telephone calls she the slightest criticism. Only two protested: some drawings are pretty much “below the belt,” one said; Another left anonymously in the “complaint mailbox” that she found “some of the jokes very inappropriate and macabre”; our program must be “supported by love and community, not by sarcasm and black humor.”
However, there was strong resistance in the team of therapists. A majority decided that one should not be so bold and, without the necessary sensitivity, sometimes hurtful, that one shouldn’t tease those seeking help. The risk of getting wounds is too significant.
“And if there were a special camp for religious neurotics of various denominations, shouldn’t we be allowed to show caricatures of Mohammed?” argued the moderator. “You’d say, ‘For God’s sake, don’t! In doing so, we deeply offend religious feelings. Apart from that, we risk unannounced visits from Islamist explosives experts.’ I counter that we should – as long as we put caricatures of Jesus and Buddha next to them.”
Nevertheless, the “lecture” disappeared from the program of the following camps. Right?
The “clinic clowns” success story provides ample evidence that sufferers generally do not react insulted to humor that comes at their expense – they laugh along, including at themselves. Even terminal cancer patients do it, as do war victims in refugee camps in the Third World: “Clowns without borders”, who amuse you there from time to time, exceed all taste limits without batting an artificial eyelash. How can such audacity do good to sufferers? The clown helps them to distance themselves for a short while: from themselves and their awkward situation, which they often perceive as hopeless—the perspective changes. The clown’s nonsense makes them alternately not take themselves, their depressing living conditions, too seriously; they create a relieving counterpoint to all the whining and strife, suffering and self-pity that characterizes everyday life in hospitals, nursing homes, palliative care, and hospices – mills of fate whose rules, which are not always comprehensible, most feel at the mercy of, powerless and incapacitated, of any private and deprived of privacy.
Why aren’t hospital clowns ever accused of mean amusement at the expense of others? It lies in the secret of their unique comedy: the clown makes you laugh by always showing off his own incessant pitiful failure, exposing it to ridicule – and at the same time rising above it, grimacing and smirking. He exposes himself. It doesn’t matter at whose expense he pulls practical jokes: in the end, the dumbest one is himself, literally the idiot, because the word “clown” is derived from the Latin colonus, which means “country bumpkin.” In the role of “dumb August,” he embodies people’s constant failure, inadequacy, vulnerability, and unfitness for life, over which he triumphantly rises with self-mockery. The controversial “Morning Circle Lectures” followed this principle: Every third cartoon made fun of the therapists and camp organizers alike.
So why didn’t we stick with it? A single patient who feels mocked, mocked, violated in his dignity is one too many – no matter how overwhelming the majority is, where the humor is brilliantly received. Because we are not concerned with statistical averages but with each individual. And persistent differences of opinion in the team of therapists, even if they only concern a peripheral aspect of what is happening at the camp, inevitably impair its unique spirit – and thus indirectly also the atmosphere within the entire camp community. Ultimately, the therapeutic value of humor is not determined by the statistical relationship between laughter and teasing but rather by whether it supports treatment goals in every case rather than jeopardizing them by impairing the therapeutic relationship. Clowning around in places where the sick seek help must not leave a “bitter aftertaste” anywhere and cause no “collateral damage.” If they performed, it wasn’t worth even the best jokes.
(Harald Wiesendanger)
Support “Ways Out Charity“! With your support, we can help us move forward. > https://bit.ly/3wuNgdO
Remarks
1 Fry in an interview with SZ-Magazine, December 10, 1999.
2 Fry in the SZ interview, loc.cit.
3 In an interview with the news magazine Der Spiegel, January 17, 2014.
4 See www.humorcare.com
5 University of Maryland, Baltimore press release, July 2009 (“Laughter is the Best Medicine for Your Heart”)
6 “Humour in Medicine”, Southern Medical Journal 96 (12) 2003, pp. 1257-1261.
7 James Rotton/Mark Shats, “Effects of State Humor, Expectancies, and Choice on Postsurgical Mood and Self-Medication: A Field Experiment,” Journal of Applied Social Psychology 26(20) 1996, pp. 1775-1794.
8 Anatomy of an Illness As Perceived by the Patient, New York 1979; German: The doctor in us. The story of an amazing healing – against all gloomy forecasts, Reinbek 1984.
9 In the SZ interview, loc.cit.
10 Sheldon Cohen et al.: “Psychological Stress and Susceptibility to the Common Cold”, New England Journal of Medicine 325/1991, pp. 606-612.
This article first appeared in the book by Harald Wiesendanger: Ways out – helping the sick differently (2015).