Thursday, November 21, 2013

Don’t prescribe laughter; you’ll only get stitches

Oh, hackneyed phrase! ‘Gad damnable cliché that demands the very least of us! Piss-weak shorthand! Lowest common denominator of meaningless adage!!

There is no statement so glib as “laughter is the best medicine”. A platitude such as this demeans us all, comparing comedians to surgeons, pranksters to pharmacists and clowns to biochemists.

Laughter is a reflex. Medicine is medicine.

Of course, laughter is lovely. A frothy burst of mirth that issues involuntarily from the subject is a joy to behold, experience and cause.  The snort laugh (with or without snot), the chuckle, the giggle, the guffaw, the belly laugh, the bladder-incontinence laugh, the laugh with accidental fart, the whinny and the Muttley are all expressions of merriment and humour which are up there with the best of the abstract nouns and certainly desirable from time to time in one’s life.

But is it all good news? Under the influence of laughter I have suffered painful muscle spasms. Laughter has also on occasion caused me to fall down (admittedly I may also have been drunk).  Laughter can make my eyes leak and my speech unintelligible. Laughter can make me dribble, choke, cry and wee (I’m sure it’s the same for you. Isn’t it? Please say it is so). These all seem to be symptoms of a terrible affliction. Is more laughter the cure for these bodily irregularities?

Nietsche, the philosopher, amoralist, atheist and paradox, identified the alternative purpose of laughter, that which we now identify as schadenfreude[i]. Laughter can be sarcastic, derisive, wry, mocking. A snicker, a crow, a howl and a titter reveal the dark side of laughter, the side “they” (the ones who spaketh the idiot utterance) don’t want you to know about. This is the seedy underbelly of wit, to wit: to laugh in one’s face or behind one’s back, to cackle wickedly (“I’ll get you my pretty”). A laugh can be scornful, jeering, villainous (think mwahahahaha!) and who can forget the laugh of The Joker? Laughter can be as sick as it gets – unsettling, disquieting, stress-inducing; presaging injury, even imminent death. And to cure this ill, we apparently need MORE laughter? Nuh-uh.

There are times when laughter is very necessarily contraindicated. In the case of abdominal or pelvic malady (or any kind of “down there” misadventure, one presumes), laughter is the very definition of pain. When a respirator enables breathing, chortling is not advisable - gags may very well lead to gagging, as it were. And I should imagine that if your chest had been cracked open to access your heart, lungs or any other vital equipment, a peal would have absolutely no appeal.

Based on language alone, laughter might as well itself be a disease, ravaging the body by splitting your sides and leaving you in stitches. People have been known to crack up or convulse with laughter. Contributing to this pandemic is the fact that laughter is contagious, and sadly, there is the suggestion that people actually die laughing. Where are all the public health warnings? Instead, we get a bunch of hippies banging on about mind-body connections, endorphin release and laugh therapy.

Medicine is a directed course of treatment for specific illness, disease, mishap or injury. It is not a joke. And a joke is not medicine.

Do you have a malignant tumour? Planning to just ‘laugh it off’? Not sure about that funny lesion on your back? Not finding it all that ‘funny’, really? Instead of tittering like a loon you may like to receive the BEST medicine, which happens to be medicine. Your medical professional (a term which excludes aromatherapists, colour therapists and clairvoyants, also sitcom writers, breakfast radio personalities and court jesters) will approach it in a manner indicated by scientific study, tested in rigorously controlled trials, and ratified by other members of her highly educated profession.

I won’t deny that when lying on a gurney in preparation for surgery, one might enjoy trading puns with the anaesthetist prior to going under. But a dirty joke is not what will bring you back.

Some argue that laughter has similar benefits to exercise, improving blood flow and strengthening the immune system. I can allow that laughter can lighten the mood, create a positive frame of mind and support mental health, but studies into laughter being an effective therapy do not demonstrate that the effects of laughter are any different to the effects of similar actions - screaming[ii], for instance, which can also be executed whilst lying on a gurney. Sure, we can intuit that sharing a joke can create a sense of connection, stave off depression, reduce the effects of stress and boost vitality, essentially making the pain of existence bearable. But it cannot fix a broken leg.

Laughter is NOT the best medicine, but you should do it anyway.

And consult a professional (during surgery or comedy club hours) if pain persists.


Saturday, October 12, 2013

Notes from a slow learner


“with shrunken fingers
we ate our oranges and bread,
shivering in the parked car;

though we know we had never
been there before,
we knew we had been there before.”

There are a number of movies that revolve around the premise of reliving events in order to get them right, or that there are crucial points in life (or a plot) where decisions can be made where things will go “right” instead of “wrong”. Groundhog Day is probably the best known example, Sliding Doors looks at the path not taken, and there is a new movie being released, About Time, which looks like it is in a similar vein.  Recently I read a book by Kate Atkinson, Life After Life, which rewrites the life of the main protagonist not so much that she gets it right but so that a huge range of different eventualities are explored. The idea is compelling, which is likely why many films and books use repetition or re-creation to re-invent a life.

The notion of reviewing and redoing can be attractive when you have the time and inclination to look back on your life. I often wonder what might have been if I had started trying to have children in my 20s instead of my 30s. Others might wonder “what if” they had followed their passion for art or music instead of gaining a sensible qualification in economics or business, or whether they would have studied at all. Our experience of time is linear, despite what we would like to think or believe, as we experience events in succession without the power of rearranging them or travelling back. So we’re stuck with our choices and the path they lay out for us.

But what if your past kept being thrown back at you involuntarily, and you kept reliving it without being able to change it?

We all experience moments where we groan and intone “Groundhog Day” as we commit a familiar faux pas, repeat a mistake, play to type and realise that our choice has come back to bite us on the backside. Moments of déjà vu are common, where we feel like we’ve been here before and done this thing. The mind tricks us into believing, erroneously, that we are reliving a moment.

It tricks us all the time. On one hand, the human brain is capable of great learning capacity. It can absorb, process, sort, analyse and evaluate information - both trivial and important - instantaneously and in a constant stream, recalling it (mostly) when needed. Like my brother-in-law’s savant-like recall of songs and bands of the 60s, 70s and 80s, or his children’s ability to chant the names and numbers of the entire Hawthorn Football Club playing list. On the other hand, the mind is capable of great deception, hiding things from you and locking things away instead of adequately filing and accounting for them, only to throw them back into play when least wanted.

Such trickeries of the mind can become episodic or endemic. There are people who live with the past constantly knocking on the door of their psyche, and as much as they ignore the insistent banging they cannot help but relive events from yesterday. History never repeats? Well, tell that to sufferers of PTSD.

It is estimated that up to 10% of people will suffer from Post Traumatic Stress Disorder at some point in their lives[i]. Post Traumatic Stress Disorder is exactly what you think it is – people experience or witness a traumatic event and then have it recur in their minds later on, as if surviving it the first time wasn’t enough. It’s a cruel trick of the mind that goes way beyond déjà vu or Groundhog Day. When the past gets relived in this way it is recognisable by the clinical symptoms of anxiety or depression that accompany it. People who live through bushfires or other natural disasters, witness road trauma or violent death, or experience combat or torture are just some of the likely candidates for this syndrome.

Until recently my knowledge of PTSD was limited to a memorable episode of Aaron Sorkin’s West Wing. Josh Lyman, Deputy Chief of Staff to President Bartlet, survived a shooting incident and later suffered from irritability, anxiety and a dangerous lack of regard for personal safety due to recurring memories of the attempt on the President’s life and his own life-threatening bullet-wound. His memories were triggered by live music being played in the White House, which his mind confused with sirens from the night of the traumatic event. He no doubt experienced the physical reactions to memories of the event - 'pounding heart, rapid breathing, nausea, muscle tension, sweating'. Maybe he had nightmares or flashbacks, and certainly there was intense 'emotional distress when reliving the event'.[ii] Tricksy mind - even if it is fictional.

It was suggested to me over a week ago that I may be experiencing PTSD – a suggestion I rejected immediately on the grounds that I have never been in a warzone or witnessed a murder, nor have I survived a bushfire or had to give CPR to a road accident victim. I cannot conceive of the magnitude of trauma that soldiers, paramedics and police officers must endure. I abhor the very thought of comparing my stresses to theirs. But my psychologist would say it’s not about comparing, it’s about the individual experience of events in your life.

Six weeks ago I had a return episode of Meniere’s Disease. To summarise Meniere’s briefly – it is a disease of the inner ear presenting with dizziness, vertigo, nausea, vomiting, lack of balance and tinnitus (ringing in the ear). When you’re standing up you’re not sure whether you’re swaying or if the earth is moving suddenly and unpredictably, so it is better to be lying down. I haven’t had a prolonged episode like this one since I was first diagnosed back in 2010.

2010 was my monster year, as anyone who knows me would be aware. Short version – pregnant after many years of trying, miscarriage, Meniere’s Disease, cancer, bowel operation, liver operation. From miscarriage to liver surgery was 6 months.

Firstly, miscarrying broke my heart. I can’t say any more about it here.

Secondly, Meniere’s Disease left me bedridden for 5 months in 2010 and robbed me of my independence, balance and physical condition. It may not be traumatic in terms of seeing someone die, but it was hugely stressful.

And thirdly, cancer came from nowhere. Suddenly you’re 38 and have stage 4 cancer. What the hell is that about?

When Meniere’s came back 6 weeks ago, I can concede that it is possible that I began to relive my somewhat traumatic past.

If there was a trigger, like Josh Lyman’s Christmas Carols by bagpipe, feeling off-balance would seem to be it, on both literal and figurative levels. I believe Meniere’s was brought on by stress and overwork (totally self-inflicted, and I had a good time getting there) but since then my tears have been on tap and my emotional state has me questioning my purpose, my life, and my future. The feeling of powerlessness returned in full force, along with the futile questions of “how long will this last?” and “is there something else going on here?”

It may also be because when you have medical history like mine and front up to the doctor with dizziness and headaches they tend to take your symptoms seriously and give you a thorough going over. I had a brain CT and an MRI and was referred to a neurologist. It was all clear, so nothing to worry about. But when my headaches could not be explained by anything else, the neurologist suggested counseling and the GP ran me through the Mental Health Care Plan Questionnaire. Apparently I was only mildly depressed and moderately anxious (or the other way round, who cares) but each time I relate my history to a doctor I still burst into tears. The GP thought I was suffering PTSD and the psychologist seems to agree.

Reading the symptoms of PTSD I still don’t think I fit the description, but for one line on one website: “Sense of a limited future – don’t expect to live a normal life span”[iii]. Talk to any cancer survivor and I’m sure they’d feel the same way, especially if they haven’t got to the magical five-year milestone yet. So the jury is still out.

But if I’m not exactly reliving the past and just recalling it, perhaps I can get something out of it. In Groundhog Day, Bill Murray wakes up on the same day to learn how to live his life more selflessly (after a detour towards helplessness and suicide, but let’s skip over that). The loop of Groundhog Day has lessons for him.

I mentioned to my psychologist last week that when I went though all this last time I used my blog to help me learn my lessons and process my experiences. She asked me what those lessons were, and I couldn’t name anything except for “ummm…there was something about being patient…” So I returned to my blog for revision. Like Bill Murray learnt from his experiences, maybe that’s why I’m mentally reliving events now. It could be that my version of PTSD is simply SWOTVAC.

So in order to review and redo, here are some of the lessons from Sweet Blog Therapy that resonate and warrant repeating in the now, PTSD or no PTSD:

Lessons for Review 2013
1.     The future:
Right Now: “The only thing we can count on is the present: who we are right now, what we know right now, what we're capable of right now, what we have to give right now, who we care about, right now.”
Great Expectations: “There is no beginning or end, only cycles. There are no successes or failures, only cycles.”

2.     Work
Unoccupied: “I know my brain has the capacity for work but (sometimes) my body does not.”

3.     Wellness
English or Chemistry? Both: “Actually, I can’t remember what “normal” is.”
All About Men…iere’s Disease: “Patience is required: it has to be cultivated. Like a Frenchman. Ooh la la.”

4.     Mental Health
Great Expectations: “We are constantly changing, through experience, time and circumstances, so when we are down, we come out of it; when we grieve, time takes away the sting; when we are happy, it can fade to nothing; even a steady contentment requires constant maintenance for it to linger for any space of time. And then it fades. Nothing is static in human life and our experience of it. There are only cycles.”
Getting SomeRetro-Perspective: “…my forebears went through shit too.”

Repeat ad nauseam.