G FUN LIN N EE Y F ?

I was funny once. At least, I once made Tommy Smothers laugh. I was tagging along with a college friend to a party at the great comedian’s house in Los Angeles. When Smothers asked me what I did, I told him I was a monkey vivisectionist. He was so delighted that he gave me a bottle of cabernet sauvignon from the Smothers Brothers Vineyard. Sadly, though, I had not intended to be funny: my doctorate was in pri- mate electrophysiology. I had made Smothers laugh merely because he had expected to be bored, and I had caught him by surprise. While I spent college low on the evolutionary ladder, vivisecting slugs, that same college friend, Rob LaZebnik, was slaving over spoofs for the Harvard When someone slips on Lampoon. Most evenings found me on Premed Parkway, an infinite row of science library carrels whose monas- a banana peel, why do we tic underground cement walls magnified every cough and crunch, while Rob more religiously spent his sometimes laugh—and evenings watching Johnny Carson and David Letter- man. Taking notes. While Rob and his Lampoon friends sometimes call the doctor? like Conan O’Brien struggled to wedge themselves inside the door of such shows as Saturday Night Live, my premed friends and I went on to medical school as pas-

PHOTOS: GRAHAM GORDON RAMSAY (ALICE FLAHERTY); JAMES BALOG/THE IMAGE BANK (CHIMPANZEE) sively as cattle on a conveyer belt.

by ALICE FLAHERTY

14 HARVARD MEDICAL ALUMNI BULLETIN Mel Brooks argues that what separates comedy from tragedy is simply one’s perspective: “Tragedy is if I cut my finger. Comedy is if you walk into an open sewer and die.”

Stephen Bergman ’73 wrote under the Keeping the primates amused was As for the notion that laughter is the pseudonym Samuel Shem. Generations of deemed to be good for their health— best medicine for humans, too, several premeds, and even normal people, have pant-hoots, the ape equivalent to laugh- recent research papers show that laughed out loud reading it—although, ter, as best medicine. The entertainment watching comedies such as that Marx after residency, the book seems less like also kept the monkeys from masturbating Brothers classic, Duck Soup, can decrease satire and more like simple reportage. all day, which was thought to be bad for pain perception. Then again, so can We doctors could perhaps argue that graduate student morale. watching tragedies like Hamlet. Or even we’re not funny because our work is so Ramachandran’s false-alarm hypothe- watching something merely gory, like bound up with tragedy. Comedy is not sis fits with what little we know about Night of the Living Dead. Apparently the the opposite of tragedy, though. The two how the brain controls humor percep- primary factor is that the stimulus be are enmeshed; they are both the opposite tion. Of great importance are parts of the distracting and arousing enough. of flatness. Comedian Mel Brooks medial forebrain that help detect incon- Control of the expression of humor is argues that what separates comedy from gruity. Perceiving humor also activates relatively well localized, much further tragedy is simply one’s perspective: the same centers for drive and pleasure back in the brainstem than is the percep- “Tragedy is if I cut my finger. Comedy is that kick in during such wayward pas- tion of humor. Pseudobulbar affect, the if you walk into an open sewer and die.” times as gambling and cocaine use. uncontrolled release of laughter or tears Larry David, co-creator of Seinfeld, believes that comedy is related to tragedy because in comedy, as in Olympic diving, you get points for difficulty. Making jokes about death becomes funnier because of its sheer riskiness—it provides your French Twist audience with an extra frisson from the likelihood that you will hit your head on olière managed to twist tragedy into a comic medical masterpiece. the diving board on your way down. The Imaginary Invalid is usually presented as a play about a healthy The neurologist V. S. Ramachandran man who wants to be sick. For Molière, who wrote it as he was in the draws his metaphor not from athletes, but M throes of tuberculosis, it must equally have been about his own desper- from apes. He proposes amused laughter ate desire to be a hypochondriac rather than a dying man. His doctors had urged him as a primate false-alarm call, a revocation to abandon the theater because the exertion was hastening his death, but his farces of the need for help. If someone in your were his life. He continued to work—indeed, he wrote the Invalid so he could also tribe slips on a banana peel and breaks his star in it, able to remain seated throughout the play, on a commode, coughing. PHOTO: RAY MASSEY/STONE leg, you don’t laugh—you call the doctor. Medicine didn’t save Molière; no doctor would come to his deathbed because of his But if he slips and gets up immediately, scurrilous play—which portrayed physicians as tricksters profiting from making their patients From Rob I learned that although grounds—the great physician William But comic and medical phenotypes you laugh—at least if you’re a monkey, believe they were ill—and it was just as well, since the preferred treatments of the day were laughter may well be the best medicine, Osler and the rubber-faced comic Jim remain distinct: Conan once told me or a human with a taste for slapstick. bloodletting and high colonics. But comedy didn’t save him, either: on the fourth night prescribing Lipitor is much easier. Even Carrey grew up in neighboring small how, during high school, his father had My chief exposure to primate humor— of the hugely successful now, when Rob is a well-established towns in Ontario, and the Brooklyn shepherded him into a summer job car- or, rather, nonhuman primate humor— play, Molière suffered writer and producer of sitcoms, the immigrant community that produced ing for mice in a Brigham and Women’s came in graduate school. When bored, I a lung hemorrhage strain he feels from having to be funny Nobel-Prize–winning neurologist Eric Hospital laboratory. One slow day would make rounds with the head vet in and died, perhaps from ten hours a day makes me grateful for my Kandel also gave us Woody Allen. Conan put his murine charges on a tray, the animal facility, a huge underground the effort of projecting hospital’s cheering atmosphere. This An even thinner wall separates Conan tied helium balloons to the corners, and zoo of frogs, mice, and primates. On those his voice to the laughing feeling—which comes from being sur- O’Brien, renowned for his comic genius, sent it wafting down the corridor. Fif- rounds the vet acted as simian play ther- audience. Still, his rounded by people whose problems from doctors. He spent the first 18 years teen minutes later the tray floated back apist, carrying a tin lunchbox of toys use of comedy as PHOTO: RON CHAPPLE/TAXI dwarf mine—borders on schadenfreude. of his life in the Brookline home of his with a note: “Please return these mice to that he rotated with godlike impartiali- a defense left us the We can perhaps make a case that the father, Thomas O’Brien ’54, a Harvard their cages.” That was the end of Conan’s ty through the cages to keep the monkeys greatest collection wall dividing comedy writers from doc- Medical School microbiology professor. medical career. from becoming bored. More successful of enema jokes in tors—masters of tragedy and propri- Conan’s personal story would seem It’s not that doctors are never funny. than his slinkies and rubber balls, though, Western literature. ■ ety—is not that thick. Comedians and to control for both environmental and There is The House of God, for example, was the television set he kept tuned to doctors often emerge from similar back- genetic influences. the blackly comic bildungsroman that reruns of Wild Kingdom and The Monkees.

16 HARVARD MEDICAL ALUMNI BULLETIN • AUTUMN 2004 AUTUMN 2004 • HARVARD MEDICAL ALUMNI BULLETIN 17 close them down. Once I watched John copy down the clinical pearls the neurol- Herman, director of clinical services in ogy attendings uttered. Soon I had a the hospital’s psychiatry department, spin-off column in which I was record- interviewing a depressed woman who ing the funny things they muttered. The Glad humor activates the same centers for drive and had never seen a psychiatrist before. first column became a handbook of neu- Although she was ashamed to be there, rology; the second would have to be pub- pleasure that kick in during such wayward and guarded, his humor relaxed her. She lished under a pseudonym. Nonetheless, was soon describing her feelings so open- funny bits from the second column kept Science pastimes as gambling and cocaine use. ly that she was on the point of tears. He trying to creep into the first. My editors quickly made a joke, and she collected rooted out most of them. One fragment herself. Afterward he asked me why I that escaped the censors into the hand- People with heart disease are 40 thought he had cracked the joke. book, though, was the jingle Michael percent less likely than healthy “Because you’re a guy! Guys hate to Schwarzschild ’85 composed for the people to laugh often and to use see people cry,” I replied, with all the Movement Disorders Consult Service: humor to extricate themselves from without any experience of the appropri- of us too, transforming the large-bowel makes it harder to treat them. Was the psychiatric insight that comes from Trouble with tone? uncomfortable situations. ate triggering emotion, can occur when obstruction in Room 818 into a character 83F w/ COPD, CAD s/p CABG, and CRI being a neurologist. Just pick up the phone. [International Journal of Cardiology, brainstem function is altered. One of my from Molière’s The Imaginary Invalid. the one with ALL=PCN? If the note- “No!” he exclaimed, delighted that I Jerky or stiff? 2001;80:87–88] patients, after having a stimulator placed For most doctors, the preferred writer had impolitely quoted the patient’s had fallen into his pedagogical trap. We’re there in a jiff. in her brain to control Parkinson’s dis- defense against patients’ suffering is to description of how taking penicillin “Some patients like to cry; they find it Unfortunately, when the jingle hit the ease, reported a new, involuntary giggle scrub it out of our minds. Nowhere is “made me swole up,” you’d remember. cathartic. But not this one. Self-control Spanish edition it was translated literal- Primary care physicians with no that embarrassed her at the golf club. this avoidance more evident than in Wise families of ICU patients put up was very important to her. If she had ly, as straightforward clinical advice: “If medical liability claims filed against When I changed the voltage on her stim- patient notes. These desiccated husks of photos of the patients when they were cried, she would have been so embar- you are experiencing muscular rigidity, them tend to laugh and to use humor ulator, the giggle disappeared. patients’ lives are dry not only because young and healthy to appeal to our sense rassed that she would never have utilize the telephone, please.” I have not more often with patients than those Other pseudobulbar patients weep we must write them quickly, but also of tragedy and motivate our efforts to save returned for her follow-up appointment.” yet had the nerve to find out what hap- with claims against them.

when they should laugh. One PHOTO: PHOTOFEST what may otherwise look like The king of psychiatric humor at our pened to the poem in the Japanese edi- [JAMA, 1997;277:553–559] construction worker with a shells of their former selves. Simi- hospital may be Ned Cassem ’66, the tion; I hope it became haiku. brainstem stroke, who sobbed larly, the patients who engage former department chief. Cassem, a Later, when giving talks about a sec- every time I made a mild witti- us with humor get more of our Jesuit priest, does much of his work in ond book, I was pleased that the audi- One study found that skin welts cism on rounds, would then sob attention and therapeutic effort. end-of-life issues; he even heads the ence generally laughed much harder than shrank in allergy patients who for real because his tears morti- When we respond to our hospital’s Optimum Care Committee, the jokes deserved, but I was taken watched Charlie Chaplin’s classic fied him. patients only in measured tones, usually called the God Squad. Is his aback to find that their laughter was so comedy Modern Times, but not in Perhaps this anatomical link our advice is less memorable and ability to be funnier than usual in a role tinged with relief. “Thank you so much patients who watched a video about between laughter and tears could our patients are less compliant. that is gloomier than usual simply one for being funny,” one woman said after the weather. be used to argue, however fal- Humorlessness deadens human more piece of evidence for the link one of my talks. “When I saw you were a laciously, that a little comedy communication, which is, after between comedy and tragedy? doctor I was sure this would be boring.” [JAMA, 2001;285:738] should be added to the daily all, propelled by emotion. Rather Cassem uses humor to make teaching I found that the tighter I rolled my practice of a profession as tragic than spending millions of dol- points memorable to residents, as when bun and the duller I dressed, the more as medicine. Humor may be lars developing a new blood he reminds them, with an aphorism, that my humor caught the audience off guard. The nucleus accumbens—the merely an inappropriate psycho- pressure medicine that is mar- a family history of suicide escalates a An advantage that doctors have over same region of the brain that has logical defense against suffering, ginally more effective than last patient’s suicide risk: “Suicide is putting comedians, then—besides better job been shown to be activated by but even black humor is less cor- year’s model, we should com- your skeleton in other people’s closets.” security—is the element of surprise. rewarding drugs such as cocaine rosive than numbness. I learned municate warmly and vividly He makes his advice memorable to Because no one expects doctors to be and amphetamines—is activated MARXIST EVOLUTION: Groucho Marx exploited the comic when a person sees or hears this from a surgical chief resident potential of impersonating a doctor not only in A Day at enough to our patients so that patients in similar ways. Once, for exam- funny, our patients are grateful for even who had one of the wickedest the Races, shown here, but also in Monkey Business. they even bother to take the ple, he was asked to speak to a family who, the mildest joke. And, although stress- something funny. senses of medical humor I have pesky pills in the first place. for religious reasons, wanted medical related illnesses and depression are high- [Neuron, 2003;40:1041–1048] ever encountered. On rounds, before we because we intentionally strip everything Of course, it’s not fair to say that treatment withheld from a relative. er in both comedians and doctors than entered a patient’s room he would dissect tragic or comic from them. Whether our all doctors are white-coated pillars of “We know that Jesus is watching over in the general population, at least we that patient—and the rest of the team— dryness stems from a desire to be polite, grimness. At Massachusetts General her,” the son told Cassem. doctors know better how to work the Researchers have found a relationship more accurately than any scalpel could. to avoid litigation, or to stand on a Hospital, where I work, psychiatrists “I’m sure He is,” Cassem replied, “but medical system to get ourselves treated. between a decline in cognitive abilities Yet as soon as he crossed the threshold, pedestal of ponderous scientific rhetoric seem to be the best at putting humor I’ve checked, and He’s not leaving notes in Then again, we never get invited to in the elderly and a higher error rate his bedside manner was unsurpassingly aimed at rendering our pronouncements to use. George Murray, for example, has the chart. So for day-to-day management, host the Oscars. ■ in picking out humorous punchlines gentle. He never ignored the suffering of more authoritative, by writing dull notes earned renown for progress notes that I think He’s leaving decisions to us.” and cartoons. an opiate addict who was hypersensitive we do our patients a disservice. will burn a patient into the reader’s Non-psychiatrists sometimes dismiss Alice Flaherty ’94, PhD, a neurologist at Mass- [Journal of the International to minor pains, or the qualms of anxious If our notes leave out everything that is memory forever. Unfortunately, the humor, along with the other emotions, achusetts General Hospital, is author of The Neuropsychological Society, patients with dozens of questions. human—such as the silk scarf an elderly best are too scatological to repeat in an as psychiatric turf. Studies have shown, Massachusetts General Hospital Hand- 2003;9:855–863] Although his Janusian character troubled Boston Brahmin has improbably found to alumni publication. though, that even pathologists and neu- book of Neurology and The Midnight me, at least he was alive to his patients. coordinate with her johnny—we make In the psychiatric interview, humor rologists can be funny on occasion. On Disease: The Drive to Write, Writer’s And he brought them alive for the rest our patients less memorable, and that can open patients up—or intentionally rounds when I was a resident, I used to Block, and the Creative Brain.

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