Laughter: Some Eminency in Ourselves

Read a chapter from Shapeshifters, the new book by GP and author Gavin Francis, exploring the changes that our bodies constantly go through over the course of our lives.

7th May 2018
Laughter: Some Eminency in Ourselves (Shapeshifters by Gavin Francis is available no (£16.99, Wellcome/Profile)) © Getty Images

We will try to avoid the error of those who in their subtle disquisitions on the comic idea forgot that laughter is a bodily act.

- James Sully, An Essay on Laughter, 1902

At eighteen I had a job as a nursing assistant at a long-stay residential hospital specialising in learning disabilities. I wore a lemon-yellow uniform, and my job was to bathe and dress male residents and help them with their meals. The hospital had been built in the late 1960s, with four hundred beds for the long-term care of those labelled ‘mentally deficient’. Many had entered as children; I met one who’d been committed for stealing a bicycle, another told me he’d been locked up for climbing on roofs. Both, as children, had been slow at school, and their parents had complained of bad behaviour at home. My colleagues said it was doubtful whether they’d manage now beyond the walls of the hospital. I learned the bitter reality of the word ‘institutionalised’.

For some of the residents there was a genetic background to their difficulties: it was my job to feed a boy with Cornelia de Lange syndrome, who didn’t have any hands and couldn’t speak. Every morning I’d help dress an elderly man with Fragile X syndrome, a genetic disorder that may lead to learning disabilities. I struggled to get his legs into his trousers or socks on his feet – he had a beatific, amiable tolerance of my clumsiness. The other assistants knew that I was a medical student and at tea break they’d ask me about the details of genetic syndromes, or the drugs we helped dish out. I couldn’t help them (I was in first year) but the job, and their enquiries, forced on me an early appreciation of the subtlety and fragility of the mind. Our brains are delicately calibrated, I realised, and there’s a multiplicity of ways in which their potential can be frustrated. I had been living independently for only a few months; now I had an insight into the lives of those who never do.

On the ward was Henry, who according to the notes had the intellect and speech of a three-year-old. He had a bald head, stubby yellowed teeth, and a nose like a Roman general, as well as a tremendous and uninhibited capacity to laugh. He had a powerful, resplendent laugh, deep and sonorous, which he delivered sporadically throughout the day. When he wasn’t laughing he’d usually be smiling – his expression at rest was one of irrepressible mirth. He loved dancing and music – the accordion music of Jimmy Shand was a favourite – and when music was playing he would take to the floor and whirl me around until he was gasping in great gales of laughter – I’d end up laughing alongside him. Afterwards, we’d sit back down to catch our breath, and there was a sense of some tension having been released, of some appreciable change for the better.

Now and again, in the throes of a full-bellied laugh, something would come over Henry, and that laughter would turn to a sob. Tears would bead at the corners of his eyes, and a choke would catch at his voice. ‘What’s the matter,’ I’d ask him, ‘is anything wrong?’ He’d shake his head, shoulders shuddering, and I’d wait. A few moments later he’d be chuckling again, as if life was a joke to which tears or laughter were equally appropriate.

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There are broadly two kinds of laughter: the kind that floods out in response to something funny, and the kind of laugh that we put into conversation, to ease social interaction. As we get older we get better at distinguishing the two – the ability to tell the difference goes on improving into our forties. Both kinds of laughter are the ally of health: those who laugh regularly report less pain, anxiety and depression than others, as well as better sleep, energy and feelings of well-being. Laughter dilates blood vessels, dwindles heart disease and rallies our immune systems, making us less allergic but better able to fight infections. Many paediatric hospitals employ clowns, or ‘giggle doctors’, to ease tension and aid healing among attending children. ‘Laughter is the best medicine,’ goes the joke, ‘unless you’ve got diarrhoea.’

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We don’t have much idea as to why we laugh. It’s evidently a physical process – breathing is disturbed, the face becomes flushed, and we’ve all known the feeling of our sides aching with laughter. And there are mysterious physical changes associated with hearty laughter – I’ve known patients for whom a comedy show invariably brings on an asthma attack.

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In 1900, the French philosopher Henri Bergson wrote an essay that was later translated as Laughter: An Essay on the Meaning of the Comic. For Bergson, human beings live in two worlds: the physical world that we perceive with the senses, and the social world of meanings, hierarchies, love, hate and mockery. He thought we laugh only in company, which isn’t true – we do laugh alone, but we are thirty times more likely to laugh when we’re with others, particularly with people we like, and who we want to like us (hence the ‘canned’ laughter on sitcom soundtracks). As human beings, he went on, we’re on shifting social sands, constantly trying to figure out where we are situated with respect to those around us. Laughter reconciles us to the fact that we’re changing social animals in a restless world; it allows us to smooth the roughness of dynamic social exchange. It’s cathartic of social tensions, and its work is to reinforce connections between individuals. Absent from Bergson’s sophisticated theory is any robust attempt to integrate theories of laughter with the evident truth that small children laugh often, and with gusto, long before they’ve developed the intellect required to understand the meanings of jokes or care much about the opinions of others.

Charles Darwin, that master of unprejudiced observation, begins his study of ‘high spirits’ with children in mind: ‘Laughter seems primarily to be the expression of mere joy or happiness. We clearly see this in children at play, who are almost incessantly laughing.’ Laughter can also be provoked when there are incongruities between different associations of meaning, such as in the classic gag by Mae West: ‘Marriage is a great institution, but I’m not ready for an institution.’ Babies can be just as sensitive as adults to incongruities – a baby who laughs when she sees a tower of blocks fall over is observing that one moment the tower is stable, and the next it isn’t – it could be the non-verbal discontinuity that provokes the laughter. Tickling too involves a kind of incongruity, as it’s a mock ‘attack’ by a trusted person. Darwin thought a great deal about tickling:

"The anthropoid apes, as we have seen, likewise utter a reiterated sound, corresponding with our laughter, when they are tickled, especially under the armpits … Yet laughter from a ludicrous idea, though involuntary, cannot be called a strictly reflex action. In this case, and in that of laughter from being tickled, the mind must be in a pleasurable condition; a young child, if tickled by a strange man, would scream from fear." 

Darwin noticed that the movements involved in laughter – short, interrupted vocalisations on breathing out, with long drawn-out gasps on breathing in – are the precise opposite of those uttered when screaming with distress – so laughter acts as a powerful social signal of good humour. The transformative effect of a gale of laughter imposes a temporary paralysis that renders other actions, or the communication of other emotions, impossible.

Laughter to ease social relationships can be fake, or exaggerated, but it still serves a useful purpose. It marks our alignment or disalignment with others, and displays our affinity with those around us much more quickly than is possible with words. Aristotle thought that getting amused was a virtuous, social activity, as long as it was carried to the right extent, at the right time. He even had a word for it, eutrapelia, coming from the Greek meaning ‘able to turn well’. If individuals can be imagined as cogs in a social machine, wittiness and humour are the grease that enables the machine to turn smoothly.

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For Henry, the frontier between tears of sorrow and tears of laughter was permeable and fragile – the two emotions seemed to have a common origin, and merge seamlessly from one to the other. One of oldest surviving books of medical case studies, the Epidemics of Hippocrates, noted how laughter and tears may erupt spontaneously in situations of extreme stress, almost as if they are interchangeable methods of coping: ‘she used to wrap herself up … scratching and plucking out hair, and alternately wept and laughed.’ Darwin commented that these transitions between tragedy and comedy, even in prominent social situations, are widespread among other cultures: ‘Mr. Swinhoe informs me that he has often seen the Chinese, when suffering from deep grief, burst out into hysterical fits of laughter.’ In western cultural traditions those rapid transitions between tears and laughter are restricted for the most part to babies and toddlers, though in situations of extreme stress they’re observed in adults too. Darwin cites the ‘recent’ siege of Paris (his book was published in 1872): ‘the German soldiers, after strong excitement from exposure to extreme danger, were particularly apt to burst out into loud laughter at the smallest joke.’ Many people report the impulse to laugh at funerals, for example, not out of insensitivity, but from some inarticulate need for catharsis and to release tension from the grief of the situation. Perhaps the humour in bleak comedies arises from a similar kind of discomfort.

Among neurologists, the common origin of tears and of laughter is widely accepted – in the 1920s a syndrome called PLC, ‘Pathological Laughter and Crying’, was described: uncontrollable episodes of laughter or crying, or both at the same time, triggered by the most insignificant stimuli. For someone with PLC, sobs of distress might be provoked by having a hand waved in front of your eyes, or fits of giggles brought on by being given a plate of food. PLC can result from stroke, certain kinds of epilepsy, brain tumours, multiple sclerosis, and even the infusion of antiepileptic drugs, and seems quite separate from any subjective sense of mirth or well-being. It’s apparently triggered by the activation of a kernel of tissue near the base of the brain that coordinates the muscular movements involved in both kinds of emotional expression. It’s likely that the idiosyncrasies of Henry’s brain led to the activation of this centre on the slightest of stimuli. The cerebellum – the ‘little brain’ beneath the nape of the neck – is also involved in laughter in some way: one of its functions is to coordinate not just appropriate movement, but the appropriateness of emotional expression.

In 1903, a French neurologist described a syndrome of Fou rire prodromique – ‘anticipatory crazy laughter’. In this case uncontrollable, unemotional laughter caused by disinhibition of the brain centre was the herald to a stroke that led on rapidly to death. In an afterthought to his long poem Briggflatts, Basil Bunting relates a Persian tale of a stone in Tibet, the mere sight of which causes any viewer to descend into paroxysms of laughter ‘which continues till they die’.

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Many years after I’d stopped working as a nursing auxiliary, I had a job providing medical cover to a hospice. Whenever I passed the day room there would be a funny movie, or a stand-up comedy routine, playing on the television. After the nurses took around their trolley of pills and suppositories, a trolley of comedy DVDs followed – a consolation, even a tonic, for patients and clinicians alike. Tea breaks and ward rounds were informal affairs – you could tell that the staff of the hospice were devoted to their work. There were just a few yards of hospital linoleum to walk between each bedside, but on passing between patients we would traverse mountain ranges of emotions. At one bedside there’d be solemnity, sadness and a frank discussion of death’s approach; at the next we’d all be chuckling about constipation, or the eccentricities of hospital wheelchairs.

The philosopher Thomas Hobbes thought that laughter was a ‘sudden glory arising from some sudden conception of some eminency in ourselves’. If he was right, perhaps there was laughter in the hospice to show superiority to the imminence of death. There was plenty of cathartic laughter to relieve tension; perhaps without it we could have been paralysed or overburdened by pity. We laughed at the absurdities and incongruities thrown up by the proximity of death in a society which reveres youth and health. We’d sometimes laugh to share solidarity with both colleagues and patients, and I’d sometimes hear laughter erupt from rooms at visiting time, perhaps easing tension between members of a family already wrapped in grief. The laughter wasn’t cynical, or hard-hearted – it was changing the atmosphere, giving courage and a sense of togetherness, helping patients, doctors and relatives adapt to a new reality, when words no longer seemed enough.

Shapeshifters by Gavin Francis is available no (£16.99, Wellcome/Profile)
Shapeshifters by Gavin Francis is available no (£16.99, Wellcome/Profile)

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