INT. SUBURBS – DAY – A CHILD’S PARTY
We see a FANCY CLOWN from the perspective of the SEATED CHILDREN, all dressed in suits and floral prints. A string quartet is out of view. The SEATED CHILDREN laugh politely at the balloon animals and seltzer water. They are too old for this and would prefer to be sexting, but they are still intrigued by the plight of the struggling artist.
Suddenly RANDY, the birthday boy, erupts into hysterical laughter. The other SEATED CHILDREN support his move and begin to laugh harder, but they can’t match his intensity. Laughter overtakes his whole body, and he falls from his chair, flailing. Ambient mirth turns to confusion and then to terror. SALLY lets out a deafening shriek as she notices blood trickling from the corners of RANDY’S eyes. The room falls silent. A wayward breeze rattles the shutters and blows out the birthday candles.
* * *
Some people say laughter is the best medicine. The health benefits of laughter have actually been studied pretty extensively, with lots to support its value. But, like any medicine, it can also kill you. And if something can kill you, it probably will.
Laughter can kill you in a number of interesting ways. For example, if you happen to be walking around with an aneurysm in your brain (1-6 % of us, most unknowingly), a single laugh could cause that aneurysm to rupture. Laughing increases the pressure inside your cranium, which puts stress on that aneurysm (which is basically an over-filled water balloon sitting right next to important parts of your nervous system). While people do survive ruptured aneurysms all the time, if it was big enough to rupture because you laughed, you’d probably die pretty promptly.
By a similar mechanism of pressure changes, laughing could also kill you by bowel death. When you laugh, you contract your stomach muscles and increase the pressure on your abdominal wall. That force can cause little parts of your bowel to poke out through small holes in your abdominal and pelvic wall — a hernia. Hernias are common, and lots of people live with them, but if you’re laughing really hard and the hernia gets strangulated (the bowel loop gets trapped in the little hole and it’s blood supply gets cut off) that can be intensely painful and require urgent surgery. If you don’t get to a hospital quickly, it’s quite possible that you could die.
Even more common than that, the chronically ill and infirmed can be killed by laughter with little to no warning. People with severe congestive heart failure or COPD don’t have much room to spare in terms of backup cardiac function and lung volumes, so they might not not be able to compensate for the normal physiologic changes of a typical bout of laughter. That’s what apparently happened to an english bricklayer named Alex Mitchell after watching an episode of The Goodies. But, these are the people who could die if they had to walk up half a flight of stairs, so it’s not too surprising that getting too worked up over anything could be fatal.
Similarly, if you have bad coronary artery disease (like millions of Americans), anything that gets your heart rate up can potentially cause some atherosclerotic plaque in your coronary arteries to rupture, dislodge, and block the arterial blood flow. That’s a heart attack, which can of course kill you. This would happen to the same people you read about who never exercise and suddenly decide to shovel snow (1,200 American deaths annually) or have sex, but die instead.
Even just by the fact that it changes your heart rate abruptly, laughing could drive you into a cardiac arrhythmia like atrial fibrillation. This shouldn’t kill you, but it could make you get lightheaded and even pass out. If you’re riding a motorcycle at the time, then, yes, you could die. You should not tell jokes on motorcycles.
Laughter itself can also cause you to pass out. This "laughter-induced syncope" is related to unexpected nervous system firing and a sudden drop in blood pressure. There's also a similar phenomenon called catalplexy, where people will suddenly lose all muscle tone when they laugh. They don’t lose consciousness; they just sort of slink to the ground like a squid. Same as above, if you were landing a plane while this happened, you and everyone else on board would die. Air traffic controllers should not tell jokes.
More relatably, laughter could simply interrupt your concentration and coordination at a very delicate time. If you are walking on a high wire and you overhear someone on the ground, 100 stories below, tell a very funny joke, the reflexive contraction of your abdominal muscles could jounce the wire, causing you to lose balance and fall to your death.
Sometimes the laughter itself may not kill you, but laughing can be a sign of something really bad that will. Some people will erupt into a fit of "pathological laughter" as the first sign of a stroke. In others, outbursts of unexpected laughter may actually be the manifestation of seizure. These "gelastic seizures" may be the first sign of brain tumors, tuberous sclerosis, hydrocephalus, and other stuff that can and will kill you.
In Papua New Guinea, a disease called kuru (an infectious degenerative disease of the brain similar to Mad Cow Disease) is also known as “laughing sickness” because these people, whose brains are being eaten by things called prions, will often develop pathological laughter as a symptom in the later stages of the disease.
So how do you know if you are just laughing a lot or having a stroke or seizure or brain infection? Well, your best bet is to check out the stimulus of the laughter. If you’re laughing as someone is tickling you or telling you a funny joke, it’s probably healthy normal laughter. But, if you find yourself walking along the street some sunny day just kind of smiling and laughing to yourself for no apparent reason, you probably have a brain tumor.
In summary, all of these things are likely going to kill you. But we're all going to die somehow, and there are worse ways to go. So keep laughing, but do it with conviction and a passion that tells the world you’re ready for this to be the last thing you ever do.
Jim Hamblin is a physician and writer in Chicago.