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THE AMAZON
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Is laughter the best medicine?
The cargo plane we’re sitting in lurches and bucks as it hits a patch of turbulence somewhere above the Andes Mountains. Mechanical whistles and squeals unlike any we’ve ever heard fill the long, hollow cargo hold. I tighten the safety belt strapping me to the cargo netting and distract myself by focusing on the tiny circle of sky I can see through one of the few windows in the fuselage. Pete slips on a sleeping mask and earphones to try to nap. I consider passing the time by chatting with my seatmates, but the deafening roar of the aircraft’s four propellers makes conversation difficult. Plus, I don’t know what to say to them. They’re all clowns.
Next to me, a lady dressed as a giant bee fiddles with her red clown nose. Across the aisle, a young woman weaves rainbow-colored pipe cleaners into her dreadlocks. Bubbles float through the cargo hold, and a bright yellow smiley-face balloon bops here and there like we’re at a birthday party. Someone starts up a round of “Oh! Susanna,” and others join in on kazoos. Pete’s nap is a lost cause.
We’re in a Peruvian Air Force cargo plane headed into the heart of the Amazon with 100 clowns, to answer a simple question: is laughter the best medicine? Yes, humor can tear nations apart and help inspire revolutions—but can it heal? Across the globe, careers have been launched, fortunes have been made, and medical practices have been transformed based on this idea—that laughter cures. To find out if that’s true, Pete and I are tagging along with the hospital-clown version of a biohazard team—an elite group of buffoons and pranksters who are planning to romp, frolic, and mime through one of the most beleaguered and destitute places on earth. They’re happy to have us along, on one condition: we have to become clowns ourselves.
I cross my arms and huddle down in my seat, trying to keep warm. The Peruvian Air Force, as a gesture of goodwill, arranged transportation for us. But their method of transport leaves something to be desired. Sitting on the runway back in Lima, the plane’s cargo hold had been airless and stifling. Once airborne, the unheated cabin turns frigid, freezing our sweat-damp clothes. Around me, people pull out jackets and wool hats and huddle under swim towels. Shivering, I think about what my wife, Emily, said when I told her about this trip. She’d patted my arm and said, “You’re not going to be a good clown.” I haven’t mentioned her prediction to Pete. He’s been a bit distracted. Ever since we arrived in Peru a few days ago, he’s been focused on inserting the words “Lake Titicaca” into as many conversations as possible.
With a stomach-roiling dip, the cargo plane begins its descent. The clowns begin to clap in unison. With a jolt and a cheer, the aircraft touches down. We’ve arrived in Iquitos, a city in the Peruvian rain forest. Upon landing, the cargo hold reverts to a sweltering oven. Stripping off sweaters and jackets, everyone piles out of the plane and into the Amazonian heat, the air thick with humidity. Waiting for our luggage in Iquitos’s bare-bones airport, our colleagues use the baggage carts as bobsleds, pushing each other across the concourse. Others are strumming on banjos and washboards. One clown takes a rubber pig he’s been pulling around on a leash and places it on the baggage carousel. Others coo and pet it lovingly as it glides by.
“I’m really having fun,” exclaims Pete. I’m inclined to agree—but then again, we haven’t had to put on our clown suits yet.
Our journey into the Amazon began several months earlier, when we were sitting in a grand hotel conference room in Chicago, Illinois, listening to a welcome speech presented by a sock puppet.
“Welcome to the Annual Association for Applied and Therapeutic Humor Conference,” said the sock puppet, attached to the hand of AATH president Chip Lutz, sweeping its googly eyes around the several hundred people in attendance—men in loud Hawaiian shirts, women in sparkly flapper dresses. “The sock puppet has good eye contact,” noted Pete.
Shenanigans like this are par for the course at the AATH conference, one of the oldest and largest gatherings associated with the therapeutic humor movement. At an evening cocktail reception, where we mingled with social workers, nurses, doctors, and professional speakers from all over the world, a typical icebreaker was, “Are you a Certified Laughter Leader?” Perusing the AATH conference store, we found table upon table covered with books like Laughter: The Drug of Choice, This Is Your Brain on Joy, and What’s So Funny about . . . Diabetes? Nearby stalls offered up water balloon launchers, light-up detachable ears, and bumper stickers that read, “Clowning for Jesus.” One afternoon, I stepped into a hotel elevator with a woman who had what looked like a butterfly sprouting from her head. “Nice wings,” I said. She looked at me like I was a pervert.
Considering the current enthusiasm for therapeutic humor, it’s easy to forget that for most of recorded history, humor and health were considered to have nothing to do with one another. The ancient Greek founders of Western medicine had a whole lot to say about all sorts of therapeutic concepts, but were noticeably silent on laughter’s role in health, other than a stern warning that those plagued by too much mirth should take up a steady diet of boring lectures.1
Everything changed, however, with the publication in 1979 of Anatomy of an Illness as Perceived by the Patient, journalist Norman Cousins’s account of laughing away a possibly fatal degenerative disease of the joints with a steady diet of Candid Camera and Marx Brothers films. As Cousins wrote in his bestseller, “I was greatly elated by the discovery that there is a physiologic basis for the ancient theory that laughter is good medicine.”2
He wasn’t the only one excited about his discovery. Since then, a booming industry has sprung up around the idea of healthy humor. Clown programs, comedy carts, and humor rooms have become common hospital elements. A variety of therapeutic humor conferences and consulting businesses compete with AATH in the business of teaching people how to infuse trauma and tragedy with humor.
And then there’s laughter yoga, a movement that now involves 16,000 laughter clubs in 72 countries, offering people the world over a chance to chuckle their way to physical and mental health. To experience laughter yoga for ourselves, Pete and I had stopped by one of the weekly meetings of the Denver Laughter Club. In a downtown Unitarian church, we joined a dozen or so club members being led by two so-called laughter leaders (“Jovial Jeff” and “Crazy Karen”) through a surreal chain of exercises. We began with “greeting laughter,” moving around the room and shaking each other’s hands with a hearty, forced chuckle. Then we carried on extended conversations in nothing but gibberish, and imitated lawn sprinklers while others pretended to run through our spray. Other drills followed—“bumper-car laughter,” “happy pills,” “laughter bombs”—each designed to encourage so much fake laughter that everyone broke down for real. At one point, I passed an imaginary laughter bong to a gray-haired grandmother, from which she took a deep drag and burst out cackling.
“I do feel more energized than I did an hour ago,” admitted Pete when it was over. I, on the other hand, felt like I’d gone through a trial run for living in a loony bin. Still, the regulars, a welcoming and normal-seeming bunch, seemed to be getting a lot out of it. “You don’t need stand-up comedy or movies or plays,” one of them told us. “You can just laugh.”
That’s the point, said Madan Kataria, the doctor who developed laughter yoga in 1995 and is now recognized internationally as the “Guru of Giggling.” When I reached him via Skype in his home base of Mumbai, India, he told me, “Laughter was always conditional and dependent on jokes, comedy, life happenings. For the first time, in laughter yoga, laughter has been disconnected from our daily lives, because there are often not enough reasons to laugh. My discovery was that laughing without reason was enough to give people benefits.”
According to Kataria, those benefits include decreased stress, better immune-system function, improved cardiovascular health, enhanced mental states, stronger social ties, and a more spiritual approach to life. Those are far from humor’s only purported medical benefits, which have expanded far beyond anything ever suggested by Cousins, who passed away in 1990. These days, you can find claims that laughter and humor relieve headaches, provide good exercise, ward off coughs and colds, lower blood pressure, prevent heart disease, mitigate arthritis pain, ameliorate ulcers, vanquish insomnia, combat allergies and asthma, prolong life spans, protect against AIDS, and help cure cancer.3 Some go so far as to suggest that clowning improves pregnancy rates for in vitro fertilization—although fair warning: if you try wearing a clown nose to bed, there might not be any fertilization.4
As humor has become increasingly “healthy,” it’s also become increasingly lucrative. While Kataria stipulates that all laughter yoga clubs must be free, he makes money from laughter leader trainings and other related enterprises, and in Bangalore, India, he’s now building the first of what he hopes are many Laughter Universities. At the AATH conference in Chicago, the schedule was packed not just with seminars titled “How to Establish an Intergenerational Laughter Club” and “Holy Hysterics: Laughter and Joy in Your Community of Faith,” but also “How to Turn Laughter into Revenue.” Many of the attendees had figured out how to do that. At the conference’s ritzy awards dinner, a signed portrait of comedian Red Skelton—which resembled one of those bad clown paintings you find at the back of a thrift store—was auctioned off for more than $1,600.
Is all this attention and investment worth it? For his book The Psychology of Humor, Rod Martin looked into the matter, reviewing the dozens of scientific studies dealing with humor and physical health. What he found was far from encouraging. As he puts it, “Those who advocate humor and laughter as a pathway to better health seem to have moved too quickly to promote their views on the basis of rather flimsy research evidence.” So far, none of the most common claims about humor and laughter—that they boost immune-system function, stave off various illnesses, and decrease heart-disease risk—have been substantiated by rock-solid research findings. Some studies have found the opposite—that laughter and humor appeared to decrease empirical indicators of good health.5
Ten years ago, to settle the matter once and for all, a professor from the Norwegian University of Science and Technology named Sven Svebak included a brief sense-of-humor questionnaire in one of the largest public-health studies ever performed: the HUNT-2 study, in which members of the entire adult population of the county of Nord-Trøndelag in central Norway were surveyed about their blood pressure, body-mass index, various illness symptoms, and overall health satisfaction. According to Martin, it was “the largest correlational study of senses of humor and health ever conducted.” In 2004, Svebak and his colleagues unveiled the results: there was no connection at all between sense of humor and any objective health measures.6
“Well, we have anecdotal evidence that humor helps with cancer patients,” argued one nurse at the AATH conference when confronted about such research. Sure, replied Pete, “But we also have anecdotal evidence that supports the existence of ESP.”
Still, Pete wasn’t willing to write off humor’s healing effects just yet. That likely had something to do with his relationship with psychologist and “joyologist” Steve Wilson. Founder of the Ohio-based World Laughter Tour therapeutic laughter program, Wilson has been working in humor and health for more than 25 years, and he held court at the Chicago conference in his polka-dot clown hat like a wise old Jedi master. He was eager to welcome us into the fold, since he’s known Pete for years. When Pete was pursuing his PhD from Ohio State University, Wilson and his wife, Pam, welcomed him into their family.
Understanding humor and its therapeutic benefits, Steve Wilson told us, isn’t as simple as taking saliva samples and comparing blood-pressure readings. “We don’t claim any cures,” he said. “If we have to claim anything, it is adjunctive therapy. It is something that a person can engage in to help a primary treatment work better. The secret to a happy life is balance. If you are running away from humor and laughter all the time, you are going to miss the balance.”
Maybe Wilson was right. But we weren’t going to take his word for it. To find out for ourselves, we decided to track down the most famous hospital clown of all.
At the end of the 1998 Hollywood blockbuster Patch Adams, in which Robin Williams portrays real-life clown-doctor Hunter “Patch” Adams and his attempt to inject compassion and humor into the American medical system, the audience is told that Patch ends up launching a medical practice that treats patients without payment, malpractice insurance, or conventional health facilities, just as he always dreamed, and that construction of his world-changing “Gesundheit! Hospital” is under way.
What the movie never says is that after twelve years of operation, Patch’s medical practice shut down because of doctor burnout and lack of resources. Raising the millions needed to complete the Gesundheit! Hospital in West Virginia has proven next to impossible. To help raise attention to his cause, Patch and his colleagues launched Gesundheit Global Outreach, an international service organization that has sent clown brigades to 60 countries on six continents. Since 2005, Gesundheit Global Outreach has focused much of its attention on one venture in particular: an annual, multiweek project involving international clown groups, government organizations, and NGOs, all focused on helping the community of Belén, a slum on the edge of the Peruvian city of Iquitos that’s one of the most impoverished communities in the Amazon. The Belén project is one of the largest and most ambitious international clown endeavors anywhere.
Which is why we’re standing in the lobby of our hotel in Iquitos, a building that has been overrun by clowns. The building has become the Belén project’s makeshift headquarters. All around us, folks are in their clown costumes, ready for the first activity of this year’s endeavor: a celebratory parade into the heart of Belén. Meanwhile, Patch Adams is standing at the front of the crowd, lecturing on the dangers of sunburn.
“Put on sunblock!” demands Patch, gesturing for emphasis with the rubber fish in his hand. “Here’s what happens if you don’t: ‘Ow, ow, ow!’ ” He cringes in mock agony, rubbing at a make-believe sunburn all over his body.
This is the latest in a long list of instructions Pete and I have been given about joining the Amazonian clown brigade. John Glick, one of Patch’s closest friends and the calm-and-composed director of Gesundheit Global Outreach, was happy to have us along when I first contacted him. But he warned me, “Organizing clowns is like herding kittens.” That meant we were in for a lot of organizing. Soon we were receiving e-mail after e-mail detailing all the things we’d have to do to get ready for the trip. Make sure your vaccinations are up to date for all third-world communicable diseases, we were told, which led me to spend a colorful morning at my local travel health clinic, learning all the unpleasant yet fascinating ways my body could implode in the middle of the Amazon. (“You don’t want any diseases that end with ‘osis,’ ” I was instructed. “ ‘Osis’ means ‘worm.’ ”) Then we were schooled in the basics of Amazonian “clown fashion,” the more colorful, garish, and humidity-friendly the outfit, the better. For starters, Pete and I raided thrift-store racks of their most outlandish Hawaiian shirts. Then my five-year-old son, Gabriel, decided to contribute one of his prized possessions: He offered up his extra-large polka-dot dress-up tie, solemnly handing it over like it was one of the Crown Jewels.
Last but not least, we were told to get clown noses. “The nose is your most important feature,” noted one of the organizers in an e-mail. “Your magic. Your power. Your passport into the world. It opens doors for you and allows you to do things you never imagined yourself doing.”
I had no idea what the organizer meant, but I was referred to someone who would: Jeff Semmerling, a Chicago-based mask maker who crafts noses by hand for Gesundheit and similar organizations. Semmerling, I was told, is the Ralph Lauren of red schnozzes.
“Some say the clown nose is the most evolved mask,” said Semmerling when I called him in Chicago a few weeks before our trip. It’s so simple and elegant—slip a red bulb over your nose, and people the world over know you’re a clown. Semmerling offers a catalogue of nearly two dozen varieties in neoprene and leather, from rotund bulbs to diminutive nose caps to elongated missiles. Since I couldn’t choose, I sent Semmerling photos of Pete and myself and asked him to do the honors. He selected a big round nose for me and a large button cap for Pete, then sent them along with a warning: “Don’t be surprised what you might find yourself doing or becoming when you release your clown.”
And now here we are, at the start of the parade into Belén, red noses on and ready to release our clowns. Everyone is far too hot and sweaty here to bother with clown makeup, although many never paint their faces at all. “The face is more open without the paint, thus allowing more intimacy,” Glick tells us. “Plus it tends to freak out the clown-phobes less.” Patch is nearby, and he seems to notice my apprehension. He catches my eye and grins like a maniac. “Are you ready to go nuts?”
With a cacophonous eruption of drums, whistles, and the blaring horns of a Peruvian Navy marching band that’s volunteered to lead the parade, we’re off. A rainbow-colored river of tutus, suspenders, and baggy tie-dyed pants streams through Iquitos—a city whose existence here doesn’t make a whole lot of sense. While Peru is most commonly associated with llamas, mountaintop ruins, and other images of the Andes, a good 60 percent of the country is taken up by the jungle fed by the gargantuan Amazon River system. And here, in the heart of this vast, nearly uninhabited wilderness, lies a city of half a million people where no city of half a million people should be. Iquitos is the largest community in the world that doesn’t have any roads to it. The only way to get here is the way we did, via aircraft. Or you can take a long, slow boat ride.
The city blossomed here because it was an epicenter for the rubber boom of the late nineteenth and early twentieth centuries. But that golden age has come and gone. Now grimy three-wheeled motor taxis clog the streets, and the city’s grand European-style river promenade is decorated with billboards demanding “No child sex tourism.” The rubber barons’ once-opulent, porticoed mansions have been gutted, their interiors filled with grocery stores and curio shops.
But the shabbiness of downtown Iquitos resembles Beverly Hills compared to what comes next. The parade route makes a left at an intersection, snakes past a fragrant open market, and slopes downhill toward the river. The street becomes a packed-earth lane lined with open-air sewage ditches, and the brick and cement buildings shift to thatch-roofed wooden shanties perched on ten-foot-tall stilts or resting on horizontal logs lashed together like rafts. We’ve reached the slums of Belén. The 60,000 inhabitants, we’ve been told, live in destitution. Rampant unemployment. Minimal electricity and no sanitation system. Spotty health care and extensive malnutrition. Widespread alcoholism and drug use. Wide-ranging family violence and crime, with no official police presence.
Each year, during the rainy season between January and June, the river here rises several meters, which is why the houses are built on stilts and rafts. But this year, the area experienced 100-year floods. Marching past the stilt-legged homes of Belén, we can see water stains and washed-away paint reaching halfway up the houses’ walls, marking where a few months earlier, the buildings were half-submerged. Scores were killed, and hundreds more were forced out of the area, relocated to schools and shelters. When they returned, they found new disease epidemics taking hold, including dengue fever and leptospirosis.
In other words, we’re in the poorest part of the poorest part of a country that’s fairly poor to begin with. And right now, this situation is worse than ever.
Stomping down these dusty streets, something happens to me. Maybe it’s the beat of the parade music, or the infectious glee of 100 marching fools. Maybe it’s the delighted smiles of the barefoot children who flock to us, or the shy grins and waves from the adults who peer down from the porches of their homes. Maybe it’s just heatstroke. For whatever the reason, I begin to clown.
I traipse past throngs of onlookers, slapping high fives left and right. I chase children beneath the buildings, leaping over the sewage ditches and weaving through support beams. In the hazy afternoon light, I dance with other clowns as a loudspeaker jerry-rigged to a motor taxi blasts the clown expedition’s theme song: an up-tempo tune about washing your hands to prevent dying from dengue fever. At one point, a little girl in a purple shirt takes my hand, and she never lets go. We march through Belén, side by side, and eventually I’m carrying her in my arms.
When it’s all over, when the parade music wraps up and the purple-shirted girl scampers away with a smile and a wave, Pete looks at me and grins. “Your dad training is coming out.” Pete, in his goofy floppy hat and shiny red nose, didn’t do too badly himself.
“That place came alive,” he says as we trudge back to the hotel. “You see the difference, with all the smiles and laughter.” On the other hand, he adds, “What a monumental problem this is. You need millions of dollars to help Belén. You essentially have to move the whole city.”
“It’s worse than I ever expected,” he concludes. How can a bunch of clowns ever hope to make a difference?
Clowning in the Amazon, it turns out, is like summer camp—if summer camp came with a moderate risk of malaria.
There are “clownings” all over Belén and other spots around the city, including an old-folks’ home, a shelter for abandoned children, even a local prison (don’t bring your “stabby” toys, prison-bound clowns are warned). Some activities involve teaching kids how to hula-hoop, make shadow puppets, and bang out rhythms on plastic-bucket drums. Others take the form of door-to-door clown interventions, hammering the importance of throwing away trash and tossing out stagnant water through pratfalls and squirt-gun gags. Many clownings are just about gathering up a group of street kids and having fun.
While most of the 100-clown squad are in their twenties, many among this assortment of college students, social workers, nurses, and professional circus performers are still relative old-timers, coolly reminiscing about Belén escapades from years past. (“Remember that time Levi and David had stolen earrings planted in their luggage in El Salvador and had to spend a week in prison before paying off the right officials? Those were the days!”) Others are newcomers, timid and awkward, trying to find their standing among the clown pecking order.
Complicating matters are the different clown styles among the group, far more than we knew existed. The South American clowns, from professional squads in Peru and Argentina, are practiced and polished, with carefully tailored jester costumes and refined routines. They’re the New York Yankees of clowns. And then there’s us, the ragtag Americans under Patch Adams.
For the Gesundheit clowns, many of whom have never clowned before, there are no crash courses in buffooning, no how-to handbooks or ironclad rules. Patch doesn’t believe in it. “It’s too restricting,” he says. “I don’t want any mystique about it. I want everybody to be a love revolutionary.” He’s less like the group’s leader and more like a very bad influence, delegating logistics to others so he can focus on the work of play. After growing up as a troubled, bullied kid, Patch says that one day in high school, “I decided to serve humanity and be happy the rest of my life.” He’s been clowning every day since then—clowning through med school, clowning during the twelve-year operation of the Gesundheit! Clinic, and now clowning all over the world.
He’s doing so in Iquitos and Belén, clowning everywhere we look. One moment, he’s eating lunch at a ceviche restaurant wearing underpants on his head. The next, he’s sauntering down the street sporting a face-distorting set of false teeth beneath his handlebar mustache. Later, he’s chasing after squealing children with his half-gray, half-blue ponytail flapping in the wind, stopping only to wrap up elderly ladies in big, sweaty hugs.
During what turns out to be one of many long, rambling conversations I have with Patch, I discover formal clown training isn’t the only thing he doesn’t believe in. He doesn’t believe in the cold, corporate machinations of Western medicine, or much else about capitalism. He doesn’t believe in computers, instead responding to each of the hundreds of monthly letters he gets by hand. He doesn’t believe in organized religion, preferring the more basic spirituality of love and compassion. He doesn’t believe in traditional family structures, figuring we’d all be better off living in communes. And he doesn’t believe that humanity has much chance of long-term survival. “Nothing I’ve studied suggests we will stop our extinction soon,” he tells me, scratching at the underpants he’s wearing on his head. “Humans are an embarrassment.”
There’s one other thing Patch doesn’t believe in. “I never said laughter is the best medicine,” he declares the first time we talk. Instead, he believes the key to a healthy life is connected, loving relationships with anyone and everyone, and he sees humor as the perfect tool to break down the social mores, boundaries, and anxieties that often get in the way. After all, he points out, clowns are all about shaking things up: “The jester is the only person in the king’s court who can call the king an asshole.”
It’s true. Clowns, like comedians, are outsiders and rebels. All over the world and through most of civilization, clowns, jesters, tricksters, and picaros have stood apart from the crowd, with full license to break all the rules. They can spit in the face of conformity. They can say what no one else dares to say.
Maybe that’s why in the United States, the image of the clown is now often associated with the dark and the scary, a staple of haunted-house rides and serial killer stories. After all, the chaotic and disorderly nature of clowns can be frightening. (It doesn’t help that in the 1970s, two different amateur clown performers—Paul Kelly, aka “Weary Willie,” and John Wayne Gacy, aka “Pogo the Clown”—killed multiple people.)7 A few years ago, a study at the University of Sheffield in England found that 250 children, aged four to sixteen, all believed clown images were too scary for hospital décor.8 Of course, there’s a difference between a clown painting on the wall when you’re trying to sleep in a hospital ward and a real clown face peeking around your door during visiting hours, wanting to know if you want to play. Maybe that’s why a follow-up study at a British children’s hospital found that children, their parents, doctors, and nurses all agreed that clown interventions at the facility were beneficial.9
The rebellious nature of clowning is likely why, maybe for the first time ever, my wife is wrong. I’m not a bad clown. I throw myself into games of hide-and-seek and jump-rope contests, play peekaboo with giggling babies, and chase rumbling taxis down the street like a maniac. After one of the clownings, Gesundheit director John Glick approaches me. “You’ve got it, man,” he says with a grin. “You are a regular Patch.” I soak up the compliment, not minding that I’m drenched in sweat and probably sewage, that my mouth feels like it’s been sandblasted, that I look like a fool. Jeff Semmerling was right: the red nose gave license to my clown, stripping away all the hang-ups I’ve accumulated over the years.
The best part of my clown costume, the biggest hit among the youth of Belén, is the clown tie loaned to me by my son Gabriel. The children never tire of tugging on it, of using it to lead me around like I’m a pet buffoon on a leash. Their love of this game makes sense. These children are some of the most put-upon, least-powerful people in the world. And thanks to a clown costume, they have complete power over a grown white American man. Their world is turned upside down.
Pete gets into the action, too, albeit from a different direction. Because these projects are all about clowns letting loose their inner child in environments that are none too hospitable to any kind of children, someone has to be there to look out for them, to make sure they don’t fall into sewage pits or pass out from dehydration or get kidnapped by Amazonian gangsters. Someone who thrives on responsibility and order, someone who’s always thinking about what might go wrong. So Pete retires his red nose and becomes one of the civilian guides assigned to watch over the clowns.
Pete comes along as one of the civilian guides when we travel to a mental hospital on the outskirts of Iquitos one afternoon. While most of us clown around in a tree-dotted courtyard, dancing and playing catch with giggling patients, Pete shadows a blue-haired Argentinian clown named Ramiro as he explores the hospital’s rudimentary living quarters. In a bare, dingy room, Ramiro finds an old woman cowering in her bed, covers drawn over her face. As Pete watches from a window, Ramiro sits on the edge of her bed and begins playing his harmonica. After a while, he stops. “Move your foot if you like the music,” he says in Spanish. A foot wiggles beneath the blanket. He continues to play.
This continues for 30, 40 minutes—Pete watching from the window, Ramiro playing his harmonica, the woman lying in her bed. As time passes, a face emerges from beneath the blanket. Finally, when it’s time to go, the woman rises from the bed and clasps Ramiro in a long, silent hug.
Later, when we all meet for a debriefing session at an open-air bar near our hotel, Pete raises his hand to speak. “I didn’t know a lot about clowns before I came here. But I saw a lot of beautiful things today.” His voice cracks with emotion. “What you’re doing is really important.”
A big, matronly Argentinian clown named Lorena leaps from her seat and wraps Pete in her arms. “Bienvenidos al grupo de payasos,” she says as she squeezes him tight. “Welcome to our clown family.”
About halfway through the trip, Pete and I realize we’re having a lot of fun. And that doesn’t make any sense.
We’re not grumbling about the lack of fresh vegetables in our repetitive meals of fried fish and hamburgers. Or the National Geographic–worthy world of critters that infest our beds each night. Or that our hotel room is draped with sweat-damp clothes that never fully dry in the sticky heat.
“If this were just the two of us . . .” I say to Pete one morning.
“. . . we’d be freakin’ miserable,” he replies, finishing my sentence.
But it’s not just the two of us—we’re surrounded by people even more crazily upbeat than we are. The clowns here are not at all like the hammy, squirting-flower bozos we’d imagined, the sort of clock-punching performers who transform into beaten-down old men once their clown shifts are over. Instead, they’re as energetic and loving and generous as a company of young evangelicals, never ceasing to clown around with everyone they see. So why aren’t we all miserable? Maybe it’s because we’re too busy clowning around to focus on how miserable we should be. Humor and coping, after all, seem to go hand in hand. Successful humor inspires all sorts of positive feelings and emotions, which can act as a psychological buffer when things go wrong. Not only that, but as we’ve learned, humor is all about shifting one’s perspective, reassessing situations, and, as Pete would say, transforming violations into benign violations. So by cracking jokes about our Peruvian bedbugs and gross clown clothes, we’d found the perfect way to keep our spirits up, not to mention defuse what would otherwise be a total bummer.
Over the years, several compelling studies have suggested that these theories aren’t just theories, that humor and coping really are intertwined. In one especially touching experiment, researchers interviewed a group of widowers six months after the death of their spouses. Those able to smile and laugh about their marriage during this time of lingering sadness had fewer problems with grief and depression in the years that followed.10
There’s also evidence connecting humor and coping from the USS Pueblo incident in North Korea, courtesy of all those POWs flashing Hawaiian peace signs at their captors. When researchers examined the 82 survivors once they’d been released from captivity, they found that those who best handled the ordeal relied on a variety of defense mechanisms such as faith, denial, and, yes, humor.11
This research is a step in the right direction, says Pete, but when it comes to data like this from the real world, there’s a hitch: none of it proves that humor is a coping mechanism. These studies are correlational. It’s unclear whether the humor helped people cope with their hardships, or whether the people who were already better equipped to cope with adversity had an easier time joking about their problems.
That’s why psychology researchers are turning to wonderfully devious lab experiments to untangle the relationship between humor and coping. In one study, researchers had participants narrate a thirteen-minute safety video featuring dramatized versions of grisly wood-mill accidents. Those asked to come up with a humorous narration reported less stress afterward than those who described it seriously, and readings of skin conductance, heart rate, and skin temperature suggested the comic narrators were less physiologically stressed, too. (Unfortunately, the subsequent paper didn’t include examples of how the narrators came up with quips about industrial ripsaws.)12
Not surprisingly, sadistic research like this appeals to Pete. He’s especially interested in what he calls humorous complaining. As we know, tragedies big and small can lead to comedy, so humor can be a common outcome of stuff worth grumbling about—a missed flight, an unfair parking ticket, a crummy meal at a high-priced restaurant. Pete, in collaboration with graduate students Christina Kan and Caleb Warren, scrutinized hundreds of business ratings on Yelp.com. They found that negative reviews, especially those accompanying one-star ratings, were rated by other consumers to be significantly funnier than positive reviews. But Pete believes griping in a humorous way is not only natural, it’s beneficial. It makes the complainer feel better than if they just grumbled negatively, and it makes other people feel better about the complainer, too. Pete is hoping to prove this by subjecting people to painful situations and having them complain humorously about it. While research is still in progress, all I know is that when Pete had me stick my hand in a bucket of ice water for five minutes, all the going-down-with-the-Titanic jokes I cracked didn’t stop my right pinkie from feeling numb for weeks.13
We don’t need any buckets of ice water here in Peru to appreciate the connection between humor and coping. We see it everywhere thanks to all the clowns. Their shenanigans don’t just help the residents of Belén deal with their problems. They help the clowns cope, too.
Gesundheit Global Outreach director Glick is the yin to Patch Adams’s yang. While Patch is rowdy and provocative, Glick is gentle and serene. There’s always a peaceful smile below his well-worn clown nose, always a few supportive words to pass along. He’s so full of bliss that we’re surprised when Patch summons everyone to the hotel lobby one night for a special “clown healing” for Glick. It’s only once everyone has arranged themselves in a wide circle in the lobby and Glick stands in the center that I notice that Glick’s right hand is trembling. The problems started four years ago, he tells us, his smile never fading. “Something funny happened with my hand,” he says, gazing at his shaking fingers. He asked a neurologist friend what was going on. The man looked him in the eyes and said, “This is Parkinson’s disease.”
As a physician and acupuncturist, Glick had worked with people with Parkinson’s, people who couldn’t keep still, who couldn’t talk, couldn’t swallow. “What is it like in there?” he wonders out loud. “Trapped inside this body that won’t let you do what you want it to do?” I look over at Patch and realize he’s weeping, wiping his eyes on the sleeve of his fluorescent-colored shirt.
“There are two of me now,” continues Glick. “My ego is on this side,” he says, pointing to his left side, the side that doesn’t shake. “I am in control here. I like to be in control. I’ve spent my whole life wanting to be in more control.” But, he adds with a smile, “My shaking side has a different agenda. My shaking side tells me to let go. My shaking side says, ‘This is my soul.’ And what happens when I let go is Patch comes to me.” He looks at his old friend. “And Santiago comes to me.” He glances at another clown in the circle. “And Paula and Kelly and Anya and David and Shlomo and Levi . . .” He looks in turn at each clown. There’s hardly a dry eye in the room.
Patch enters the circle and places his arms on Glick’s shoulders. “I think clowning is special healing magic,” he says. And he wants us to give Glick some of that magic all at once. “Like electrocution.”
Patch has Glick lie on the floor and asks everyone to crowd in close, resting their hands on his arms, legs, head, all over his body. Then Patch and others begin to sing: “Amazing grace, how sweet the sound . . .” Here’s Patch Adams, a guy who doesn’t believe in religion, belting out one of the most impassioned versions of “Amazing Grace” I’ve ever heard.
When the song is over, there’s one last procedure to perform. “Wiggle your fingers at Glick,” Patch commands. “Boogiewoogiewoogie!” holler 100 clowns, waggling away.
“That,” concludes Patch, “is clown healing.”
I don’t see it coming. No one does. On our last day in the Amazon, there’s a full-fledged clown emergency. And I’m stuck in the middle of it.
In the world of Gesundheit, Carl Hammerschlag looms large. Two decades ago, Hammerschlag, a six-foot-six Yale-trained psychiatrist, heard Patch speak at a dental conference, and he’s been clowning with the man ever since. Here in the Amazon, the 73-year-old Hammerschlag, who’s more often than not wearing a pink tutu and tights, has assumed the role of “street psychiatrist.” He’s assembled a rag-tag group of clowns who in their normal lives work in therapy, nursing, chiropractic, and other health professions, and he’s staging medical clinics in various neighborhoods devastated by the flooding.
That morning in Iquitos, I tag along with Hammerschlag’s clinic, dressed in my now-well-worn clown outfit. A squadron of motor taxis deposits us at our location for the day: Punchana, a poor neighborhood at the edge of Iquitos hard hit by the floods. As a gray, overcast sky looms overhead, we make our way down rutted, muddy streets strewn with trash and debris, past houses bowing precariously on waterlogged stilts. In some places, homes have collapsed altogether. The scene resembles a war zone.
We set up shop in Punchana’s central plaza: a bedraggled, puddle-strewn square of dirt with rough-hewn soccer goals at each end. Another organization is working here, too, a grassroots veterinary clinic. Families begin to wander in—far more than expected. Crowds press in tightly around the volunteers handing out free vitamins. Therapists struggle to find a quiet corner to host ten-minute, one-on-one therapy sessions with residents. The air is filled with the howls of local dogs being spayed and neutered in full view in the veterinary tent. The situation is spiraling out of control, and it’s made worse by the dozens upon dozens of children lured to the plaza by the commotion, running about and getting in everyone’s way.
“Somebody’s gotta do something about the kids,” says Hammerschlag in his deep, commanding voice. He looks to the only two clowns who aren’t working at the clinic: me, and an older guy named Mark. We know what we have to do.
On the far side of the plaza, we get to work. As nearly 100 children gather about, I pull out every gag, game, and prank from my limited bag of clown tricks. I dash about the square, splashing through the mud as I grab squealing tykes around the waist and lug them under my arm like I’m running a football play down the field. I stage bullfights with my ratty handkerchief, hollering, “Toro! Toro!” as I twirl about the charging tykes. I borrow another clown’s face-painting crayons and begin decorating forearms, the children crushing around me and demanding in Spanish for their tattoo of choice: “Flor!” “Mariposa!” “Anaconda!” “Corazón!”
Eventually, Mark and I scramble onto a nearby porch and begin fashioning rudimentary balloon animals. We assemble endless flowers, swords, and poodles and toss them to the screaming horde below, working until our bag of 100-plus balloons is empty. And still, the children keep coming. And coming. And coming.
Three hours later, as the clinic winds down and the tidal wave of kids subsides, my clown clothes are in tatters. My Hawaiian shirt is ripped beyond repair; my polka-dot tie dangles from my neck, having been yanked far too many times. I should be exhausted, but I’m also elated.
Hammerschlag comes up to me. “That was a stroke of clown genius,” he exclaims, beaming. We kept the kids occupied, but we also did something else: “You presented the message that in the middle of all this trauma, we can still find a way to play.”
Just as my clowning in Punchana worked in conjunction with the efforts of the medical clinic, Pete’s come to believe that humor is most helpful when it’s combined with other approaches to health. Maybe it’s a doctor working a few jokes into a checkup routine, or a hospital integrating a clown program into its children’s ward, or people weaving a good sense of humor into a lifestyle geared toward happiness and well-being. It’s like how physicians recommend exercise and a nutritious diet as part of a healthy daily routine. Maybe it’s time they start telling their patients to have a little more fun in their lives.
“Humor is not the only tool,” concludes Pete, “but it is an important tool in the tool kit.” It’s a lesson we’ll take home with us from the Amazon—along with potentially something else.
Not long after we depart Peru, we receive a message from John Rock, one of the Gesundheit organizers. Apparently right after we left, skin rashes and excessive itching broke out among the clowns who remained, causing dozens to be quarantined.
“You probably have scabies,” Rock tells us. “Clowns are the best!”
A week after we return from the Amazon, Pete gets a call from the police. His mother, Kathleen, has been found dead in her home in New Jersey.
The news is sudden, but not unexpected. Pete’s mom had been in and out of hospitals for years, struggling with pain and health problems, and rejected nearly all attempts at help. As Pete would put it in her obituary, “Kathy lived life the way she wanted, with determination and spirit.” As a single mother, that tenacity helped her survive and rubbed off on her only son, inspiring him to pursue his own idiosyncratic route in life. But it also made her increasingly difficult to get along with. By the time of her death, Pete had become her primary caregiver, as no one else in his family maintained regular contact with her.
“Taking care of my mom has been one of my biggest challenges, and it’s also one of the things I’m most proud of,” Pete tells me. Even though she lived nearly 2,000 miles away, she was always in the back of his mind, like a stereo speaker that always has a slight, constant hum, whether or not music is playing. That hum could be concerns that surfaced at night as he lay in bed, or a voice mail message from her on his phone that might or might not be bad news. “And now,” he tells me, “for better and worse, that hum is gone.”
In lieu of a funeral, Pete flies to New Jersey to scatter his mother’s ashes at her favorite beach, accompanied by his sister Shannon. Pete shares a similar and sometimes twisted sense of humor with his sister, which came in handy during a childhood that wasn’t always easy. And it comes in handy now. During their drive from their mother’s house to the Jersey Shore, the two crack up over shared memories, like how for family trips to the beach, their mother would pack their Ford Pinto so full of coolers, umbrellas, and boogie boards it was a wonder there was any space left for the three of them. Or how, to save money, their mother often wouldn’t buy admission tags for her kids to play at the shore, which meant that whenever she’d spot beach employees wandering down the sand, she’d send Pete and Shannon into the ocean and tell them to stay there until the workers were out of sight.
When Pete and Shannon arrive at the beach that day, they stand at the water’s edge on a quiet stretch of sand, taking turns sprinkling ashes into the waves. Pete also tosses in a colorful bracelet he purchased in Peru, a present he was unable to give his mom. It’s a quiet, tearful moment, but then Pete gets a sudden urge to lighten the mood.
“Make sure you get everything,” he tells his sister as she scatters the remaining ashes. “Don’t leave behind a toe.”
“That was wrong, but it was funny,” Pete tells me later. They both needed the levity, and it helped make for what turned out to be a touching and pleasant afternoon.
Pete doesn’t feel bad about using jokes to help him deal with his grief. If there’s one thing our time in the Amazon with a bunch of clowns has taught us, it’s that in difficult situations, humor can help.
No, laughter can’t live up to all the claims put forward by Norman Cousins and his disciples. It’s not going to reverse a degenerative disease, stop a heart attack, or cure cancer. But while science doesn’t yet support the idea that humor improves people’s physical health, there is evidence that it improves emotional health. As we’ve found, it helps people cope with their problems, it distracts from dispiriting thoughts, it creates an escape from what ails you, whether that be the loss of a loved one, a diagnosis of Parkinson’s, a lifetime of suffering in a place like Belén, or just a crummy day. While that’s not the same as lowering blood pressure or jump-starting the immune system, improving your outlook can be a good thing.
Yes, says Pete, Patch is right: laughter is not the best medicine. But he’s convinced that laughter is medicine, even if it’s not the best.
That’s why I plan to keep my clown nose handy. Just in case of emergencies.
