The lost art of joy – Laughter

(and part 2 – https://youtu.be/cZ4R4e_f3-c)
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I was lectured by Patch Adams once. He took his pants off.

When I was in medical school in the early 1990’s at the University of Queensland, Patch Adams gave a guest lecture. He was originally booked on a speaking tour and sadly, his other engagements cancelled, but he was extremely generous with his time, and visited our humble university anyway, to share his life story and his less-than-conventional views on practicing medicine. This was before the movie based his life was released (it came out in 1998), where he was portrayed by none other than the great Robin Williams.

It took a little while for the audience of young, idealistic, somewhat naive medical students to warm up, and in order to engage us, Patch took off his pants.

Everybody laughed!

It had the desired effect. He had everyone’s attention and it broke down the pretence and barriers. He later put on a pair of clown pants and continued to use humour to communicate his message of laughter, advocacy and social justice.

For the record, I have never taken my pants off to enable better communication with my patients, just so you (and anyone from the medical board who’s reading this) knows. It was the first and only time in my whole seven years of medical school that anyone ever delivered a lecture in their boxer shorts, and it’s not a customary way of engaging with one’s audience. Still, he made us laugh, and it was once of the most memorable lectures I have ever been to.

Laughter connects us. It certainly helped Patch Adams engage with people from all walks of life. Laughter equalises, because it is one of the most ubiquitous and natural of all human emotions.

And laughter is the best medicine, as the saying goes. According to the Mayo Clinic, laughter can lighten your load mentally and induce physical changes in your body. Laughing increases your intake of oxygen-rich air and stimulates your heart, lungs and other muscles. Laughter increases the endorphins that are released by your brain.

A good belly-laugh can also stimulate circulation and aid muscle relaxation which can help reduce physical symptoms of stress. Over the longer term, laughter can improve your immune system. Humour can actually release neuropeptides that help fight stress and potentially more-serious illnesses.

Laughter may even help to relieve pain by stimulating the body’s production of endorphins. Laughter can also make it easier to cope with difficult situations – like the saying goes, you either laugh or you cry. Laughter is also thought to lessen depression and anxiety.

Laughter is even thought to improve your cognitive function. As cognitive neuroscientist, Dr Scott Weems says, “Comedy is like mental exercise, and just as physical exercise strengthens the body, comedy pumps up the mind.”

It sort of goes without saying that laughter increases our joy levels. But it’s worth mentioning, because sometimes in the serious business of adulting, we can start taking things too seriously, and sometimes we just need a good laugh.

As always, it comes down to balance. There are times when we need to be serious, but we can’t be serious all the time. There are times when we just need to (metaphorically) take our pants off.

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Scars

I’ve spent a lot of time in trees.

When I grew up, there was no such thing as video games. In those days, we were lucky to have a colour TV and four channels, but watching it was a privilege. Instead, I would usually be outside, bare foot and naive, exploring the creek behind my house and the thin ribbon of bushland that guarded it, or climbing the tree in my backyard, or picking up sticks from the ground and using them as weapons so I could fight off pretend villains like the superheroes I aspired to.

Eventually I discovered cricket and learnt to ride my bike, which changed my outdoor pass times. If I wasn’t practising my cricket skills, I would ride for hours on the footpaths and bikeways that criss-crossed my neighbourhood. There were no bike helmets in those days, and still no shoes. It was an innocent time.

My adventurous spirit and lack of protective equipment invariably resulted in injuries. Once when playing with a stick in the front yard, I somehow managed to dig the sharp end into my right leg, gouging a chunk out of my lower thigh. A few years later when riding my bike, the handlebars of my BMX came loose and trapped my legs so I was unable to peddle. It also stopped me from using the footbrake and steering properly, and there was nowhere else for me to go except into a pole next to a low concrete bridge over the creek, and then over the handlebars and onto a causeway which was covered in large rocks and debris. Amongst the injuries sustained was a large graze to my elbow, which my teenage sister helped tend and dress for me. Unfortunately no one had taught her that the dressing needed to go cotton side up, not onto the wound. A few days later, the scab had to be torn off to remove the dressing.

Several decades later, I would also find myself being thrown off a bike, but this time after a man driving a 4-Wheel Drive didn’t notice that I was riding on the footpath and kept coming out of the driveway he was in. Thankfully this time I was wearing shoes and a helmet, though it still didn’t help much when face smacked into the bitumen after bouncing of his windscreen and sprawling five metres through the air. I wasn’t that beautiful to start with, so my bitumen face didn’t matter too much and the scars eventually healed. But three weeks later when I couldn’t move my arm properly, I suspected that there was something wrong and the MRI showed a fracture of the head of my left radius (bone near my elbow).

The common link in each of my war stories was the eventual outcome – scars. I’ve now got a collection of scars ranging from small to obvious, internal and external. Scars are an interesting though rarely considered part of our normal function. Our body faces assault in various forms all the time. Usually we’re able to stop infections before they take hold. Sometimes, an infection or injury will still get the better of us, but our body will be able to heal our tissues completely, fully restoring our function and appearance as if nothing ever happened. Sometimes, there’s just too much damage, and our body has to do the best it can. It has to fill in the gap left by the irreparable tissue to maximise the structure and function of that tissue. To do that, it uses a scar.

Microscopically, scar tissue is made up of collagen, a dense fibrous tissue that’s also found in tendons. When a breach in the tissue occurs, there are three distinct phases that are followed to create a scar: the inflammatory phase, the fibroplastic phase, and the remodelling phase. The boring, intricate scientific details don’t matter for this essay, but essentially the phases are needed for cleaning up the debris, laying the scaffolding, and reinforcing the scar.

What’s more interesting are some other characteristics of scars that we don’t often appreciate. Firstly, scars hurt. Ok, so that sounds obvious … it always hurts when the injury first happens. The inflammatory phase is the time that a wound hurts the most, but in physiological terms, this phase only lasts about 48 hours. As time goes on, the scar hurts less and less, and in most scars, the pain eventually goes away completely. However, there are a few scars that are still sensitive when touched, sometimes for years.

Some people have a tendency to form bigger scars than others. This is called keloid scarring, and is a process of excessive inflammation of the forming scar tissue which causes too much collagen to be laid down. Keloid scars can be large, itchy and painful. Keloid scarring is thought to have a genetic component to it.

Even if you’re lucky to avoid keloid scarring, scars are usually considered ugly and unwanted. Maybe it’s because they’re associated with pain, or they ruin our otherwise perfect skin. Either way, many people don’t like their scars.

Scars are also weaker than normal tissue, though not by much. By the time a wound has completely healed, the scar strength is about 98% of that of the normal tissue.

Sometimes we’re afraid of getting scars, probably for the same reasons I’ve described. Doing things that are risky might lead to getting hurt, and those scars are a permanent reminder of how we not only failed but also how we hurt ourselves in the process.

Although, I think we have the wrong ideas about scarring. Sure, sometimes scars can be ugly, or painful, or weak. But scars can also tell us a lot about ourselves if we’re willing to look past the superficial and see what they really represent.

Scars can show our bravery to others, remind us of our courage, help us learn from our mistakes, and remember our successes. They can enable empathy, and remind us of our vulnerability and our humanity. They prove that we’ve overcome adversity. Altogether, they tell us our history.

When I see my scars, I remember how I should be careful with sharp objects, or to dress wounds carefully, or to watch out for 4-Wheel Drives. The caesarean scar on my wife’s abdomen reminds me of the mix of fear and joy at the birth of my two children. My scars help me to remember what others are going through in their journey. They remind me that I’m not invincible. When I ask my patients about their scars, they often tell me of how they overcame desperate illness and survived.

At Easter time, we often focus on the power of the resurrection, and so we should. Through the resurrection, we have the opportunity to embrace eternal life with a loving God, who sacrificed his own son to give us that chance.

But one thing that always intrigued me about the Easter story was that after Jesus was resurrected, in his glorious new body, he still bore the scars of the crucifixion. John gives a clear account in the gospel of John 20:24-27, “Now Thomas (also known as Didymus), one of the Twelve, was not with the disciples when Jesus came. So the other disciples told him, ‘We have seen the Lord!’ But he said to them, ‘Unless I see the nail marks in his hands and put my finger where the nails were, and put my hand into his side, I will not believe.’ A week later his disciples were in the house again, and Thomas was with them. Though the doors were locked, Jesus came and stood among them and said, ‘Peace be with you!’ Then he said to Thomas, ‘Put your finger here; see my hands. Reach out your hand and put it into my side. Stop doubting and believe.’”

Before I fully understood the significance of this verse, I had assumed that Jesus’s resurrected body was supernaturally perfect. He had just experienced the power of the resurrection after all. It sort of threw me when I realised that Jesus’s supernatural body was still scarred. And if scars are considered ugly, painful and weak, then it doesn’t seem to make sense.

I’ve come to realise that God knew exactly what he was doing. Those scars on Jesus’s hands, feet and side demonstrate that he gave up his deity to embrace humanity. They show his amazing sacrifice by taking our place on the cross. They prove that that he overcame the power of sin and death. They will remind us of his amazing love for us for the rest of eternity.

Yes, our scars seem ugly, painful and weak on the outside, but they are signs of our struggles, our strength, our victories – things that we have learnt from, and things that we can be proud of.

Scars aren’t a sign of weakness, but of our humanity. Scars are evidence that we’ve overcome adversity, that we are strong. Scars are a permanent reminder of the gift of God to man. Scars are nothing to be ashamed of.

Don’t look at your scars as a sign of weakness and shame, but instead, see your strengths through the story of your scars.

Bibliography

Gauglitz, G. G., Korting, H. C., Pavicic, T., Ruzicka, T., & Jeschke, M. G. (2011). Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med, 17(1-2), 113-125. doi: 10.2119/molmed.2009.00153

Hardy, M. A. (1989). The biology of scar formation. Phys Ther, 69(12), 1014-1024.

Dr Caroline Leaf and the case of the killer reactions

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Stress! Believe the media and seemingly every disease known to man is in some way linked to it. Heart disease = stress. Cancer = stress. Flatulence = stress.

Dr Caroline Leaf, Communication Pathologist and self-titled cognitive neuroscientist, has been of a similar opinion for the last couple of decades. Dr Leaf must have been kind enough to read my book, because after teaching for the last fifteen years that stress is toxic, a subtle shifting under the weight of evidence has appeared.

In her 2009 book [1], Dr Leaf wrote,
“The result of toxic thinking translates into stress in your body.” (p15)
“Stress is a global term for the extreme strain on your body’s systems as a result of toxic thinking.” (p15)
“Stress is a direct result of toxic thinking.” (p29)
“These stages of stress are scientifically significant because they illustrate how a single toxic thought causes extreme reactions in so many of our systems.” (p39)

In 2013, her position on stress hadn’t really changed that much: “Even a little bit of these negative levels of stress from a little bit of toxic thinking has far-reaching consequences for mental and physical health”, and “The association between stress and disease is a colossal 85 percent.” [2: p36-37]

Again in her 2009 book [1], Dr Leaf devotes an entire chapter to the alleged effects of the toxic stress pathway on our body (chapter 4, p39-43).

Now in her latest social media update, tucked in amongst the gratuitous selfies and holiday snaps, comes something that’s actually about mental health: “Stress does not kill… is good for us! Its our negative reactions to stressful events that pushes into negative stress…and this is what kills! Sistas 2014 NZ”

The problem for Dr Leaf is that any stress, whether it’s caused by our “negative” reactions or not, doesn’t actually kill us.

There is a phrase used in science, “Correlation does not equal causation”. This simply means that just because two things occur together, one doesn’t necessarily cause the other. For example, do my red watery eyes cause my hives? They always appear together, but they don’t cause each other. The common element that causes both of them is actually the cat that I’ve just patted.

Just because stress is correlated with certain illnesses does not mean that stress causes or contributes to those illnesses. In fact, one of Dr Leafs own pivotal references, an article by Cohen and colleagues in the Journal of the American Medical Association in 2007, discussed the weakness of assuming that stress causes most diseases. As they say, “Although stressors are often associated with illness, the majority of individuals confronted with traumatic events and chronic serious problems remain disease-free.” [3]

Even if it were true that it how we react to stress contributes to the outcome of that stress, Dr Leaf’s statement about our killer reactions incorrectly presumes that both how we cope with stress, and the physical outcome of stress are the result of our choices.

Our levels of stress, and the way we cope with our stress, is mostly caused by our genetics. Some people will be naturally less stressed, and some people will be naturally better at coping with stress (see chapter 5 of my book [4] for a full discussion on the science of resilience). Just because you’re more prone to stress doesn’t mean that it’s all down to your bad choices. Assumptions like these only add to your already high levels of stress.

That’s not to say that we don’t have a way to improve our responses. For those of us at the stressed end of the spectrum, successful psychological therapies such as Acceptance and Commitment Therapy will help to improve our coping, and certainly have been shown to improve (not cure) mental illnesses like anxiety and depression, and other chronic conditions like chronic pain (see [5] for a review).

ACT and other modern psychological therapies recognise that trying to change our thoughts doesn’t make any difference to how we cope. So like I said before, it’s partly true that how we react to normal life experience will help us live full and productive lives, but it’s not about fighting or changing our thoughts. It’s about being mentally flexible enough to make room for our thoughts and fears and move forward towards meaningful action. I’m sure that the ladies at ‘Sistas 2014’ wouldn’t be hearing that from Dr Leaf.

Anyways, I’m glad that Dr Leaf is changing her tune on stress, but there’s still more room for change before she meets up with current scientific understanding.

For an in-depth review of the teachings of Dr Leaf, visit http://www.smashwords.com/books/view/466848 where you can download a free copy of “Hold That Thought: Reappraising the work of Dr Caroline Leaf.

References

  1. Leaf, C., Who Switched Off My Brain? Controlling toxic thoughts and emotions. 2nd ed. 2009, Inprov, Ltd, Southlake, TX, USA:
  2. Leaf, C.M., Switch On Your Brain : The Key to Peak Happiness, Thinking, and Health. 2013, Baker Books, Grand Rapids, Michigan:
  3. Cohen, S., et al., Psychological stress and disease. JAMA: the journal of the American Medical Association, 2007. 298(14): 1685-7
  4. Pitt, C.E., Hold That Thought: Reappraising the work of Dr Caroline Leaf, 2014 Pitt Medical Trust, Brisbane, Australia, URL http://www.smashwords.com/books/view/466848
  5. Harris, R., Embracing Your Demons: an Overview of Acceptance and Commitment Therapy. Psychotherapy In Australia, 2006. 12(6): 1-8 http://www.actmindfully.com.au/upimages/Dr_Russ_Harris_-_A_Non-technical_Overview_of_ACT.pdf