APRIL 2016|| 41NEUROPSY Tim Hannan
The Soul of Wit
Laughter may be the best medicine,
but some jokers may be incurable.
Just in time for the Melbourne Comedy Festival, a new
study has explored the phenomenon of incessant joking
by patients with brain injuries. First described in the
1880s, the pathological compulsion to tell jokes is known
in the scientiic literature by the German term Witzel-
sucht. Patients with this aliction are relentless in their
attempts to make humorous remarks, which include
puns, slapstick or other forms of lowbrow humour.
Some repeatedly utter sexual or scatological comments
in socially inappropriate situations.
Sufferers appear unaware that their behaviour is
abnormal, and do not modify their joke-telling in
response to feedback. While inding their own jokes
and stories immensely amusing, they generally don’t
ind other peoples’ jokes funny at all.
In February clinicians from Los Angeles described
two cases of Witzelsucht in the Journal of Neuropsychi-
atry and Clinical Neurosciences(tinyurl.com/hqxcyot).
One was a 69-year-old man with a 5-year history of
compulsively telling jokes to his wife. To prevent him
from repeatedly waking her during the night to tell jokes, she
persuaded him to write them down, resulting in 50 pages of
chiely sexual or scatological humour such as:
Q.What is a pill-popping sexual molester guilty of?
A.Rape and pillage; and
Q.What did the proctologist say to his therapist?
A.All day long I am dealing with a**holes.
His compulsion to joke was attributed chiely to the effects
of damage to both the left caudate nucleus and a lesion to the
right frontal cortex, both caused by cerebrovascular accidents.
The second case described a 57-year-old man whose joke-
telling increased over a 3-year period, accompanied by the devel-
opment of childish or inappropriate behaviour. Like the irst
patient, he found his own jokes hilarious while the jokes of
others didn’t amuse him. On investigation he was found to
have atrophy in the frontal regions as a result of Pick’s disease,
a form of frontotemporal dementia.
The leading contemporary approach to understanding
humour is the “incongruity-resolution model”, which suggests
that humour appreciation requires the integration of multiple
pieces of information. In most cases, a joke involves conlicting
propositions that the person must detect and then resolve. Thus
“getting the joke” involves appreciating the incongruity of the
punchline with what precedes it, and the discovery of a way to
make these congruent gives rise to emotionally pleasurable
responses experienced as humour.
Damage to speciic brain regions is presumed to disrupt these
cognitive mechanisms. Previous experimental studies conducted
with neurological patients had found that those with right
frontal damage regions preferred punchlines that are simplistic
and don’t require the integration of multiple pieces of infor-
mation. The present study’s authors propose that those with
Witzelsucht also have a problem integrating information, so
they cannot readily resolve incongruities in complex jokes. This
explains their preference for simple humour such as children’s
riddles and puns, and probably results from damage to the right
frontal regions.
The compulsive nature of the joke-telling in Witzelsucht is
thought to result from a second deicit in inhibition systems
mediated by connections between the frontal lobes and sub -
cortical systems. This explanation is consistent with the brain
damage documented in the recent cases, with both having right
frontal damage along with frontal-subcortical involvement.
The authors note that appreciating humour is not the same
as laughing, and that Witzelsucht is to be distinguished from
pathological laughter, a condition in which patients start
laughing in the absence of any discernible cause, are unable to
stop, and where the laughter is incongruent with their apparent
mood. In Witzelsucht, patients are amused by their own jokes,
even if not by the jokes of others.
A/Prof Tim Hannan is Head of the School of Psychology at Charles Sturt University, and the
Past President of the Australian Psychological Society.Tseytlin/Adobe