I recently saw a four-month-old baby boy for his well child checkup.
Newborns are oblivious to the environment around them. They can perceive sights (though everything is quite blurry), sounds, and other bodily sensations, but they don’t interact socially with their parents or their doctor.
However, three things stand out in my mind over the years about four month-olds: they love to stand (with assistance), often bobbing up and down as if dancing; almost all have become “droolers”, and they usually seem to love to laugh.
During my visit with this baby boy, I found myself particularly affected by his laughter as I engaged him in social smiling. His laugh was natural and pure. Watching his eyes, it seemed to me that he was thoroughly enjoying this moment he was sharing with me.
That moment got me to thinking about laughter in general. What makes something funny to us? Why do some of us laugh at almost anything, including goofy movies filled with bathroom humor, while others of us have a higher “laughter threshold”? Why is it often hard to consciously override and stifle laughter that arises in situations where it might be considered socially inappropriate? Are we more likely to laugh in a group or in our solitude? Does our ability to laugh dampen as we age?
Most of us enjoy laughing. I personally love laughing, though I would probably put myself into that group of people who fall into the “high threshold” range of what will trigger laughter. Why though do any of us laugh at all, and how and why do we respond to others laughing around us? I think laughter is hard wired into us. I’m sure that humor and laughter serve to divert our attention from either physical or emotional pain we might be dealing with; “I’d rather be laughing than crying, Doc” is an expression I’ve heard many times over the years. Laughing is cathartic. Laughing with others is a bonding experience, a way of connecting to others when small talk might be uncomfortable. And there are so many kinds of laughter:
- The smirk: Slight, often fleeting upturning of the corners of the mouth, completely voluntary and controllable;
- The smile: Silent, voluntary and controllable, more perceptible than a smirk; begins to release endorphins;
- The grin: Silent, controllable, but uses more facial muscles (e.g., eyes begin to narrow);
- The snicker: First emergence of sound with facial muscles, but still controllable;
- The giggle: Has a 50 percent chance of reversal to avoid a full laugh; sound of giggling is amusing; efforts to suppress it tend to increase its strength;
- The chuckle: Involves chest muscles with deeper pitch;
- The chortle: originates even deeper in the chest and involves muscles of torso; usually provokes laughter in others;
- The basic laugh: Involves facial and thoracic muscles as well as abdomen and extremities; sound of barking or snorting;
- The cackle: First involuntary stage; pitch is higher and body begins to rock, spine extends and flexes, with an upturning of head;
- The guffaw: Full body response; feet stomp, arms wave, thighs slapped, torso rocks, sound is deep and loud; may result in free flowing of tears, increased heart rate, and breathlessness; strongest solitary laughter experience;
- The howl: Volume and pitch rise higher and higher and body becomes more animated;
- The shriek: Greater intensity than howl; sense of helplessness and vulnerability;
- The soar: Lose individuality; i.e., the audience roars!
- The convulsing laugh: Body is completely out of control in a fit of laughter resembling a seizure; extremities flail aimlessly, balance is lost, gasp for breath, collapse or fall off chair;
- The silent, shaking laugh: can become painful in the abdominal and chest muscles if continued too long;
- To “Die laughing”: Instant of total helplessness; a brief, physically intense, transcendent experience; having died, we thereafter report a refreshing moment of breathlessness and exhaustion with colors more vivid and everything sparkling; everything is renewed.
Laughter is contagious. Laughter in groups spreads from one person to another, even if the chain of “laughers” weren’t privy to the original thought or comment that triggered the laughter in the first place.
One of the things I enjoy the most about being a doctor is the fun I get to have with patients. Of course, it’s true that serious, heart-wrenching events do occur in all our lives, and in these moments, the time I spend with patients is a different kind of connection, where we come together to share worry, uncertainty and sometimes great sadness. But most of the time I find myself enjoying the laughter that patients and I can experience together about our lives. The laughter is good for the patient and it’s good for me. These sorts of moments reinforce to me the idea I’ve always had that visits with your doctor should be a two-way street – each should benefit from the time spent together. I’ve had many visits over the years where I felt that I should pay the patient for the time we spent together, because I personally got so much more out of the visit than I felt the patient did!
As doctors, we spend many years learning how to diagnose and treat “disease”. We spend woefully insufficient time trying to understand what it is to be healthy; certainly, not enough time figuring out how we can help move ourselves and our patients to a state of better health. Patients are appropriately concerned with important questions which shouldn’t be ignored: “How much exercise do we need”? “Should we be eating low carb or low fat”? “What should our blood pressure be”? And of course, “Why can’t you doctors agree on all of this?”
After over two decades as a physician, I think I have acquired enough knowledge to give sound answers to those important questions about how we should live to be healthy and to “avoid disease”. But, as our scientific knowledge improves, no matter what answers we do discover about the right diet, the best exercise, the optimal body measurements, or the optimal blood pressure, I think that there are also some simple elements to being “healthy” that we shouldn’t lose sight of, one of which I discovered again with the help of my four-month old “teacher”.
Laugh. Laugh every day. Laugh hard. Don’t stifle the smirks, grins, snickers, or giggles. Find people with whom you can laugh together. Fully enjoy the howling, shrieking and convulsing. Die laughing so that you can live to laugh again another day. Go ahead — let it go…