No Laughing Matter

By CodingStrategies on April 13th, 2018

A doctor, a lawyer, a little boy and a priest were out for a Sunday afternoon flight on a small private plane. Suddenly, the plane developed engine trouble. In spite of the best efforts of the pilot, the plane started to go down. Finally, the pilot grabbed a parachute, yelled to the passengers that they had better jump, and then he bailed out. Unfortunately, there were only three parachutes remaining. The doctor grabbed one and said "I'm a doctor, I save lives, so I must live," and jumped out. The lawyer then said, "I'm a lawyer and lawyers are the smartest people in the world. I deserve to live." He also grabbed a parachute and jumped. The priest looked at the little boy and said, "My son, I've lived a long and full life. You are young and have your whole life ahead of you. Take the last parachute and live in peace." The little boy handed the parachute back to the priest and said, "Not to worry, Father. The 'smartest man in the world' just took off with my back pack!"

Did it make you laugh? Gelotology is the study of laughter and its effects on the body, from both a psychological and physiological perspective. Laughter is a physical reaction in humans, consisting of rhythmical, generally audible contractions of the diaphragm and other parts of the respiratory system that results in a series of inarticulate sounds produced as an expression of emotion, usually happiness or mirth. Laughter is a part of human behavior regulated by the brain, helping humans clarify their intentions in social interaction and providing an emotional context to conversations. In general, laughter is a voluntary reaction to external stimuli, but what if someone can’t stop laughing?

In early 1962, three girls at a mission boarding school in Tanganyika (now Tanzania) began laughing uncontrollably during a morning class. The teacher panicked and rang the bell, summoning all the students to a small field outside the class. Although her intent was to calm the three students down, something else happened. When other students looked at the laughing girls, they too broke into irresistible laughter. What appeared to have started as a joke was on the verge of becoming a bizarre full-blown epidemic.

The school in Kashasha village had 195 students in January of 1962. Although it began with three laughing girls, 92 more would be involved by the time the school was closed on March 18, 1962. The teaching staff were not affected, but reported that students were unable to concentrate on their lessons.  The school was re-opened again on May 21 only to be closed again at the end of June after 57 additional students were recruited to the cackling ranks. Laughter, which is in some sense contagious, suddenly became a real medical problem no one understood. By the end of March, the village of Nshamba reportedly had about 217 more people infected with the laughing disease. This soon spread across several more neighboring communities, and about 1000 people were reported to have been involved by the time the last person chuckled, sometime between the end of 1963 and June 1964. If indeed June 1964 was the end of the epidemic, the laughing disease would have engaged these communities for more than two years.

Could this really happen? Yes, and no; obviously individuals weren't laughing continuously for a year. Consider the physiology of laughter: no one can laugh for more than about 20 seconds because laughing is such a strain on breathing. However, two local health officers proposed a theory regarding why laughter, normally a sign of happiness, became a dreaded disease among these people. Those affected did not just laugh uncontrollably. They also showed signs of hysteria, with short bouts of laughing and crying, including random screaming, followed by periods of calm and then a recurrence. There were rashes (ICD-10-CM code R21, Rash and other nonspecific skin disruption), pain (Code R52, Pain, unspecified), and respiratory problems (Code R09.89, Other specified symptoms and signs involving the circulatory and respiratory systems), but no fever or other physical symptom. Some participants said they saw things moving around their heads, and also showed signs of paranoia. Some even fainted (Code R55, Syncope and collapse) as a result of exhaustion (Code R53.83, Other fatigue).

 

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The villagers had their own theories, most of them revolving around witchcraft, poisoned maize flour, and effects of the atomic bombs dropped in Japan at the end of World War II. But, there was no virus, bacterial presence or chemical detected in the environment, the water supply or the food supply. The disease seemed to affect primarily adolescent girls who then spread it to the female members of their families. Adult men demonstrated some form of immunity, but young boys were at times included in the epidemic. The laughing sickness also seemed to affect only the lower classes of society, and none of the public servants who worked with these individuals, including those in jobs such as teaching, police work or medicine was ever affected.

According to researchers, the reason for events such as laughter epidemics is the presence of an underlying shared stress factor. It is especially higher in people of low status, or those who perceive they have no control over their lives. Now known as Mass Psychogenic Illness (MPI), this form of mass hysteria becomes a psychological last resort by people to express stress when something is very wrong. People who are involved in MPI (Code F45.8, Other somatoform disorders) have real signs of illness that are not imagined, but these symptoms are not caused by a toxin or germ.

Something did happen in Tanganyika, and it had nothing to do with humor. There was no cheerfulness, and laughter was but one of many symptoms. In addition, the Tanganyika Laughter Epidemic remains the only one of its kind on record. As author and humorist Erma Bombeck noted:

There is a thin line that separates laughter and pain, comedy and tragedy, humor and hurt.