Baylor University Medical Center Proceedings July 2017 - 380

himself up in a hotel room and, monitored by a sympathetic
physician, instituted a new regimen, which consisted primarily
of massive doses of vitamin C-later research would show that
the analgesics he had been receiving could block absorption
of this vital substance-and equally large dollops of laughter
induced by exposure to such entities as Marx Brothers movies
and episodes of Candid Camera. Gradually his symptoms began
to recede. Cousins even felt he could quantify the amount of
improvement with the degree of laughter engendered. The only
objective gauge of his status that he kept was the red blood cell
sedimentation rate, an indication of the amount of inﬂammation within his body. This dropped precipitously from very high
levels toward normal as his condition improved.
News of Cousins's remarkable recovery resulted in great
interest and considerable celebrity. He became an invited lecturer at conferences throughout the country and even received
a faculty appointment as adjunct professor of medical humanities at the medical school of the University of California in
Los Angeles. He died in 1990 from coronary heart disease and
congestive heart failure, 26 years after his experience with inﬂammatory spine disease.
A less dramatic but nonetheless moving testimonial to
laughter was recorded by Joseph Heller and his friend Speed Vogel
in the book No Laughing Matter (9). In 1981 he was felled by
a crippling paralytic disease (Guillain-Barré syndrome). Heller
recounts how his many friends assisted in his recovery by contributing their presence at the bedside with encouragement and
an endless stream of anecdotes, gossip, and jokes.
In 1982 paleontologist Stephen J. Gould, then 40 years old,
was found to have an abdominal mesothelioma. This is a rare
but aggressive tumor, and Gould learned the median survival
time was only 8 months. If this held for half of the patients so
aﬄicted, there were the remaining patients, including some who
might survive much longer. Rather than sink into hopelessness
and despair, Gould decided to ﬁght with proper attitude lined
up with excellent medical management. He survived 20 years
following the diagnosis, ﬁnally succumbing to unrelated metastatic lung cancer in 2002. Gould never gave up. He wrote about
that ﬁrst battle with cancer in 1985 in a paper entitled "The
Median Isn't the Message" (10). In it he concluded, "The swords
of battle are numerous, and none more eﬀective than humor."
An unusual approach to alternative therapy has been practiced by Dr. Hunter D. "Patch" Adams. For over 45 years, he
has been donning a clown costume to entertain and raise the
spirits of severely ill patients, especially children (11). His work
continues thanks to the Gesundheit Foundation he established
for this purpose. Adams has urged other physicians to join him
in the movement, which he describes as "a dedication to gooﬁness." He claims, "Laughter is the white noise of happiness. . . .
Comic relief is a major way for happy folk to dissipate pain."
However, most physicians are constitutionally incapable
of smearing on grease paint and donning rubber noses, baggy
pants, and oversized shoes in preparation for ward rounds.
There are those, like Osler, however, who manage to sustain
their youthful sense of wonder and use this to communicate
particularly to the sick children and others who come under
380

their care. But how do you quantify all this? How to measure
the width of a smile? How to determine the weight of a guﬀaw?
We live in a medical world of statistics and worship at the altar
of the randomized prospective trial-and if double blinded so
much the better. And every once in a while some brave soul will
attempt to present a sober assessment of the problem. Such a
one is Robin Nunn who, in 2011, entitled a PhD thesis "How
Do We Know What Is the Best Medicine? From Laughter to
the Limits of Biomedical Knowledge" (12). In it, the author
wrestles with the vagaries involved in such eﬀorts without really resolving the diﬃculties in undertaking such a project. Not
surprisingly, no hard conclusions are reached, and certainly none
that would have dissuaded enthusiasts from establishing the Association for Applied and Therapeutic Humor and hundreds of
"laughter clubs." These have spread all over the world, with all
of them dedicated to the proposition that laughter can extend
the joy of our healthy years as well as ameliorate the burdens
of illnesses when they do befall us.
Finally, I feel compelled to provide my own testimonial as to
the eﬀects of humor on illness as well as comment on my role
as a sometime humorist writing for the enjoyment of others.
Some years ago, following extensive surgery, I was given
a humorous novel to cheer me up during my hospital convalescence. Some passages were screamingly funny and elicited
uncontrollable bursts of laughter. Even though these produced
painful stretching of the recently applied sutures holding me
together, I nonetheless felt, on balance, that these sessions had
unequivocally speeded up the stages of recovery, much in the
way that early ambulation does for postsurgical patients.
Looking back on over a hundred articles and chapters I have
written on various topics over the last four decades, I found only
a half dozen purely comedic in intent. One of these, composed
back in 1979, was especially instructive and pertinent to the
unpredictable role of humor (13). It was an article submitted
to the magazine New Jersey Monthly recounting-in an amusing
way, I thought-my responses to a program of major dental
reconstruction. Although the piece was cast in a comic mold,
I was unrelenting in depicting my ignorance and naiveté as a
patient.
I recalled a visit to the diagnostic clinic at the dental school
where the director took one look inside my mouth and reeled
at the extent of the wear and tear he beheld. Only in betel
nut-chewing South Sea islanders and Eskimos who softened
seal skin with their teeth had he seen such a sight. In my case it
was the result of lifelong grinding of the teeth (bruxism). With
my permission he invited a group of students to my side, where
they could gaze within, barely suppressing their "oohs" and
"aahs" over the scene of dental devastation that greeted them.
What disturbed me the most, however, was my ignorance
over the stratospheric costs involved in restoring my teeth to
a functional state. One night, the evening before I was to visit
with the prosthodontist to be informed about the cost of this
reconstruction, I awoke in a cold sweat, nearly knocking my
wife out of bed. I had dreamt that the cost would be $7000.
My wife reassured me that this was just a result of my exuberant
imagination. It could not nearly be that expensive. The next day

Baylor University Medical Center Proceedings

Volume 30, Number 3

Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings July 2017