By Jim Upchurch
“I think, therefore I am” was written in the 1600s by the famous French philosopher, mathematician, and physicist Descartes (that’s pronounced day-KART for us non-French speakers). It was his attempt at defining our existence in the world. In other words, the fact that we can think about whether we exist is proof that we do exist. A much less famous philosopher, medic, and physician once wrote “I am, therefore I laugh” in an attempt to define existence in the sometimes harsh realities of the practice of medicine. In other words, to laugh is to survive.
Some folks believe you cannot die while laughing; that may be true, but I would refrain from testing that theory by laughing at the wrong person, in the wrong place, at the wrong time. For most of us, laughter is a pleasant experience but it can be abnormal or pathological when it is uncontrolled and unwanted.
Pathological laughter is uncommon but can be caused by a long list of diseases that affect the brain such as epilepsy, brain tumors, meningitis, trauma, psychiatric conditions, etc. And then there is idiopathic pathological laughter. Idiopathic means we have no clue as to the cause of a particular disease or disorder.
Laughter may also cause medical problems such as laugh syncope; that’s right, you laugh till you pass out; or laughter induced dysrhythmias, including aystole. Both of these conditions are rare and are due to an over-sensitive parasympathetic vagus nerve. The vagus nerve is normally responsible for putting the human machine at idle to conserve energy partly by decreasing heart rate and contractility, and decreasing vascular tone, thus producing a lower blood pressure at rest.
In these folks, laughter induces excessive vagal discharge, leading to excessive vasodilation and/or bradycardia that may be severe enough to induce syncope. Laughter can also trigger an asthma attack and is thought to be similar to the exercise trigger, so if you have asthma, you may want to take a hit on your inhaler before heading to your favorite comedy club or picking up a copy of Steve Berry’s “I’m NOT An Ambulance Driver!”
Medical humor has made people laugh since ancient times as evidenced by the Philogelos (The Laughter Lover), a Roman joke book written in Greek during the third or fourth century AD. This book contains many types of jokes — including those on medicine — as in joke number 27: An intellectual, falling sick, had promised to pay the doctor if he recovered. When his wife nagged at him for drinking wine while he had a fever, he said: “Do you want me to get healthy and be forced to pay the doctor?”
Some things never change. Most of the written medical humor through the ages targets the downside of medicine such as pompous providers, misdiagnosis, ineffective medications, and strange treatments. Only relatively recently, as in the last century or so, has medical humor been viewed from a more positive perspective.
There has been much written about the medical effects of humor, most of it without adequate supporting evidence. A few valid studies show possible benefit from humor in decreasing pain, improving patient-medical provider relationships, and decreasing stress in the medical environment for patients and providers.
Have you ever made a wise crack or smart aleck comment during a true emergency situation to break the tension? Or used black, dark, sick, or gallows humor to deal with a particularly tragic event? If you answer yes, then you are in good company as this type of humor is frequently used by emergency providers in crisis situations to deflect stress and its potential ill-effects. And fortunately most of us do this without disrespect or harm to our patients or co-workers. Laughter on a daily basis is clearly therapeutic for us. Did you hear the one about the two EMTs that...
References
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