You have heard that laughter is the best medicine, but have you dwelt on how laughter heals?

Let's start with the admission that pain and suffering exists, which his why we need healing at all. Medical doctors have determined that there is truth in the expression that laughter functions like medicine. But I'm not talking about acute medical problems. I'm interested in relief from existential dread. We live in a world where the Ignorant are in charge and fully committed to setting the conditions for maximal, pervasive distress. Given the severity of the wound, we're going to need a lot of laughter. As I argue in my new book, we need a certain kind of laughter, one that fully embraces the pain as it simultaneously points the way to a new mode of being.

Consider the headline from The Onion above. Again, let's start with suffering. The joke hurts because it presses on a few sore points. First, schools aren't really helping young people learn how to learn. Kids are great at doing school, but, as Mark Twain pointed out long ago, that skill is actually getting in the way of education. So, on one level, the headline hurts because it reminds us that the institution of education in the U.S. has largely failed to cultivate new generations of critical thinkers. Second, of all the subjects of study to lose their grip within the halls of primary and secondary education, history is perhaps the one we ought to grieve the most. True, the joke appears to be about literacy and grammar. But by cutting the "past tense," that means that not only will students need to learn how to read in a new way but they will also lose access to the past. Level two of the joke appears here: we've already lost access to that. Texas textbook revisionism coupled with too strong of a reliance on logical positivist approaches to the past has created a shallow presentism. If history seems to repeat itself, that's because we, as a nation, can't seem to recall the history of mistakes we keep making and the poor decisions we keep making on purpose. Third, and finally, the joke hurts because funding cuts are now chipping away at our vocabulary. If we cut the past tense out of our language, that'll let us function on only 2/3 of our budget, right?

Wrong. And yet we laugh. What kind of laugh does The Onion produce here? I call the kind of humor at work here a humor of congruence. Dialectically related to the dominant incongruity theory humor, which states that comedy often arises from the incommensurability of two or more side-by-side people, ideas, or situations, my congruent theory of humor suggests we laugh when something reveals precisely how something is. The formula shifts from "this does not equal that" to "this is this." In the headline, even though the scenario is exaggerated, the exaggeration reveals precisely what is the case; namely, the headline reveals how bad off we are in the present due to the failings of the educational institution. The laugh produced astride the recognition of what is the case is a laugh of recognition, and recognition is the first step toward healing. We can't get get better if we don't know we're sick.

As a mental health counselor, I often bring this theory of humor into the group therapy environment. I distribute humorous images and wait for the laughter to erupt. Once people laugh, I ask the question: what's so funny? Take this Alice In Wonderland image, for example. The theory of incongruity suggests that the humor arises from the divergent meanings of "mad." The Cheshire Cat means "we're all crazy here," but Alice thinks she's done something wrong: Are you "mad" (Angry) at me? But this incongruity (mad ≠ mad) is not the only reason, or even the main reason that healing laughter arises after encountering this meme. 

Whether we're in a therapeutic setting or not, insecurities abound. Insecurities come from beliefs about ourselves that we safeguard and try to keep from view. Despite our best efforts, however, the beliefs do in fact show themselves, often through our speech and our behavior. When Alice interprets the cat's "mad" to mean that she's already done something wrong, she is showing us one of her insecure beliefs. She must have done something wrong because that's her thing. She's the one who has always already done something wrong. And the cat et al. know it. In my group therapy sessions, people laugh as they identify themselves with the same core belief. If people don't have that core belief, they tend not to "get" the joke right away. People who suffer from this kind of insecurity access the healing laughter first, maybe because they're the ones who need it. Presumably, the person who made this meme is one of these insecure people. It was made for the purpose of naming this common problem. What is the case? Many people enter spaces with the presumption that they are in the wrong and that everyone either knows it already or will soon find out. 

Invisible and privately held beliefs become visible, and the healing begins. I feel like Alice. Oh, you, too? Oh wait, whoever made this meme really gets it. There's a whole community of us! Uh oh, that's not good. This feeling is a thing. A common thing? Is that what this group is about? Of course it is. I'm laughing in multiple ways now. I "get" the joke + the joke's on me + the joke's not funny + I'd rather not be the person who gets the joke. Do I drink alcohol because I feel this way? No. That's can't be it. Is it? 

Step two of the healing process of this particular kind of laughter reveals itself at this point. Step 1: laughter makes what it is the case visible. Step 2: once visible, laughter unites people who typically suffer in silence and alone. 

Step 3: Healing doesn't just happen. You make it happen.

Once something typically hidden becomes visible and we verify that, yes, this is the case, and once we unite with others who suffer in similar ways with us, then we can turn to the work of producing healing. One of the many drawbacks of Western medicine's reliance on pharmacology is that the pervasiveness of pills and prescriptions fabricate a false belief that something outside of us will fix us. But the pill doesn't do the healing. The recognition that help is required and the behaviors of seeking out and asking for help are the actions that led to the acquisition of the medication that will play a part in the treatment of whatever ails you. Similarly, when it comes to existential dread, the remedy will come about through concerted action. It is not enough, in other words, to sit in a room with people and agree that we "get" a joke about a cycle of thinking that ultimately defeats us, makes us depressed, produced anxiety, or whatever. "I'm amazing. I hate myself. I'm not real. That's exactly how it goes." Good. We have words to name a feeling and a process, but more steps are required. For starters, we need to intervene in the cycle.

One way to do this, after introducing the meme to a group, is to challenge people to ask each other a question throughout the day, "Where are you in the cycle right now?" I hear the question, I laugh, and I respond: "Ha. I'm amazing right now." "Give it time," you'll say. "Let me know when you don't exist." We laugh together. And at what are we laughing? We are laughing now at three things: 1. It is true that I think in this self-defeating and perplexing way. 2. I know others see me thinking in this way, and I know they can see me because they, too, think in this way. 3. We're working together to do something about it. One laugh moves through many states, from the surprise of recognition to the joy of connection with others to the hope of producing a different mode of being. 

Want to carry the work of healing from a group therapy room or a small cohort of friends to the world at large? Don't worry. There's a meme for that.

If I walk through the mechanics of the healing laugh with a group of people in Asheville, NC, and then show them the Tattoo Artist/People Who Need Therapy meme, lots of healing laughter erupts. Working in a substance use treatment center was hands-down the greatest place to produce such laughter because everyone in there, me include, is covered in tattoos. Everyone has some knowledge of the intriguing, medicinal pain that comes through tattooing, and everyone knows that money will sooner go toward the next tattoo than it will toward the deductible on your insurance that enables you to keep going to therapy. 

This meme does quite a lot of work. It draws attention to a visible mark that will show itself out on the streets, and once it makes itself visible there it will have the power to continue the healing work started in the therapy room. I'm walking on the sidewalk and I pass in front of a tattoo parlor. I remember, "Ha, I wonder if anyone in there should be getting therapy instead?!" I look at my own tattoos. I need therapy. This is how it is. The work is continuous, and so many people would benefit from doing it. The knowledge produced through this train of thought is almost totally overwhelming. In certain cases, I would be crying as I thought about how many people are suffering, how many institutions perpetuate suffering, how many individuals seek out remedies, often through non-sustainable means. But right now I'm laughing as I face the same kind of overwhelm. 

Laughter has the power to heal provided that the laugher rides the wave of the laugh into action for sustaining change in a world that prefers repetition of the same to revolution-like interventions. For something to change, a full-on political revolution is not always needed. The change can start from a tiny laugh in a small room with others who are suffering. As long as you know that that the laugh is awaiting you in the world, that you can and should seek it out, and that, once you find it, you will gain a short-lived boost of energy to intervene, then you are prepared to produce the work of healing in the world.  

In The Sublime Object of Ideology (1989), Slavoy Žižek treats William Tenn's (aka Philip Klass) 1955 story, “The Discovery of Morniel Mathaway.”

An art historian living in the 25th century builds a time machine to go back and encounter a man who was entirely unknown in his time period—our present day—but later became regarded as the greatest painter of all time. The historian made his career studying this artist’s work and acquired recognition as the de facto expert on this famous but mysterious historical person.

Using the time machine, the historian travels back, eventually locates the artist, and learns that the man is an absolute disaster. He is, basically, in mania all the time. He is deceptive and unruly. He doesn’t care about anything except himself. Eventually, the man steals the historian’s time machine, leaving the historian stranded in the past.

After freaking out a bit, the historian comes up with a plan for how to keep himself sane, stranded, as he is, hundreds of years in the past, broken off from his family, and alone. He decides to paint the famous artist’s works from memory. He teaches himself how to paint and acquires all the materials. Gradually, he reconstructs all the paintings that he had dedicated so many years to studying and interpreting.

After accomplishing this task, it dawns on the historian that it was he himself all along who was the famous painter. The original “man” he had spent so many years studying was himself, though he couldn’t have known that until enacting the time travel, getting stranded, determining to paint the paintings from memory, etc.
Yet, what then is “memory” or “history”?

It's 9am on a Thursday in a substance abuse treatment facility. How do you solicit interest from clients? Try this out:

In 1898, the American author Morgan Robertson wrote a novel called Futility, or The Wreck of the Titan. It features a boat called the Titan that has the following specifications:

• 800 ft [244 m] long 
• Capacity for roughly 3,000 passengers
• Lifeboats for only a fraction of that number of people
• Capsizes after hitting an iceberg in the Atlantic Ocean as it sailed from Ireland to the United States

On April 15, 1912, the Titanic (actually) struck an iceberg in the Atlantic killing most of the 3000 passengers on-board. Here were its specifications:

• 882 ft 9 in [269 m] long
• Lifeboats for only a fraction of that number of people
• Similarly upper-class passengers

I then ask the clients two questions. 1.) How is it possible that an author envisioned a significant historical event in advance? 2.) Which of the two events came/comes first?

Voodoo Dolls have a rich and often misunderstood multifaceted history that branches off into different cultures. Rarely does this history intersect with western therapeutic strategies. This group sought to change that.

​Németh (2018) reports that "The earliest extant reference to magic dolls is made in the foundation oath of the settlers of Cyrene [Libya]" (179). These dolls, in fact, show up in fragments of text throughout the classical Greco-Roman world. But these dolls, while similar in purpose and effect, at least on first glance, to the "Voodoo Doll" of African and Afro-Caribbean figures, are in fact quite different. When we approach the topic of magic dolls and the Voodoo religious practices, we run into difficult territory. David Frankfurter (2020) explores these difficulties at length. He argues that term often applied to hand-sized, human-like dolls made of fabric or straw, and used for the purposes of inflicting harm on a human identified by the miniature effigy, is "fundamentally misleading in its history of applications and especially egregious in the current debate over the openness of classics to people of color."

His argument is worth citing in some detail because the primary points of contention are all valid. First, he shows how "the term Voodoo Doll implies that it is the law of sympathy (“like affects like”) that is the prevailing assumption of the artifact’s users. But these laws of sympathy belong not to the various worlds in which people have used ritual figurines and curse-poppets but rather to the “armchair” synthetic theories of Frazer’s Golden Bough, which strove to comprehend primitive religion in a general, if uninformed, way" (53–54). Second, citing the work of Joan Dyan (1995), he acknowledges how “anything diabolical, irrational, or superstitious became materialized [starting in the 18th century] as the spirit of blackness" (cit. 54). Ultimately, Frankfurter's claim is clear and simple understand: "The term Voodoo Doll should be abandoned, as many more precise ones have long been available to scholars" (54).

​I don't disagree, but I also chose to use the oft-misused, sometimes offensive word for the title of this group. I had two primary reasons for this choice. First, the milieu of group therapy in substance use treatment facilities is populated by many types of people. The effort to find a "common language" while also teaching and doing valid therapeutic work is substantial. I gravitate toward scholarly sources such as Frankfurter's essay, but I have learned through thousands of hours of experience that most of my clients do not. Since I am well-trained in the art of teaching and have the ability to translate scholarly concepts into different modes of discourse, I frequently lead groups on heady and challenging topics. But, I always pepper those groups with copious pop culture terms and references in order to speak to as many people as possible all at once. In the case of this group, "Voodoo Doll" is accessible as a concept, and so I used its accessibility as a rhetorical gambit to entice clients (aged 19–61) into the hard emotional work that I'll explain below. 

Second, if and when matters of race, gender, sexuality, stigma, offensiveness, political discord, religious trauma, etc., come up, which they do quite frequently, then whatever gets initially branded as "offensive," regardless of who says it, becomes an invitation to a therapeutic discussion about the emotions that arise around the particular brand of offense one experiences. Nothing occurs in the treatment environment that is devoid of therapeutic value. All problems, especially racism and similarly charged -isms, have the power to reveal something that was previously invisible to one or more clients, even to the clinician(s). So, having hazarded the use of "Voodoo Doll," I was prepared to drop my plan for the group and pivot to a processing group on racism and cultural appropriation. As it turned out, that need did not arise.

Clients were at first hesitant about the prompt to construct Voodoo Dolls, but the hesitance dropped away as I provided the set-up and rationale for the group. I began by talking about the difference between self-defeat and self-destruction. Clients were quick to point out the main difference. Self-defeat is a thought-based, self-talk problem. Self-destruction is a behavior that causes harm. For example, self-defeating thoughts take the form of core beliefs such as "I'm not worthy of love." One self-destructive behavior that could follow from that belief is the self-imposed prohibition on making any attempt to connect meaningfully with other people. The harm caused by this behavior is the harm of isolation. Without meaningful connection, the self fails to grow. Another self-destructive behavior, however, could be much more severe. To prove to oneself that one is not worthy of love, a person could inject fentanyl into their neck with the hope of numbing the pain caused the lack of meaningful interpersonal love. In either case, the self-destruction hurts. What's more, self-defeat and self-destruction work together like tag-team wrestling partners. The behavior often doubles as proof that the core belief is correct, when in actuality the "proof" is made for the purpose of reifying the belief. My plan was to use Voodoo Dolls to address this problem, a problem with which all clients were very familiar.

I proposed that anger is the primary emotion that accompanies self-defeat and self-destruction. The problem with anger, in this case, is often that it gets directed toward the self instead of directed towards the actual instigating object. With this possibility in play, I asked clients to make a Voodoo Doll that represented a person or a specific situation toward which they had unresolved anger and rage. Once they made the doll, the clients were to use thumb-tacks, scissors, and markers to make surgical wounds on the dolls. Each mark or stab had to relate to a specific instance of anger. I asked clients not to hold back. And they didn't. A few minutes into the creation process and the clients were expressing their anger.

But then I introduced a twist. I reminded them that the name of this group is "You will suffer." Offered as a fact, not a threat, the group, as the clients know by now, derives its name from Buddhist approaches to wellness and recovery. Suffering exists. It only causes more suffering to pretend that isn't the case. What would it look like to operate from the certainty that suffering will happen instead of avoiding suffering or refusing to admit that we all suffer? In accordance with Buddhist principles, however, each act of violence we direct toward others is an act of violence committed against ourselves (since there is no real self-other/subject-object divide). With that thought in mind (treating it as true), I invited clients to take another look at their dolls. I asked them to watch as the identity of the doll transforms from someone else or some outer situation and becomes a representation of themselves. I asked them to notice: You are already dinged up. Your anger has hurt you. Following from that, I asked them to add more marks to the doll. I asked them to add a new mark/cut/tear for each self-defeating belief and self-destructive behavior they’ve enacted in the past 6 months.

Each person in the room groaned and audible sighed. The weight of the idea landed in their bodies. Perhaps reluctantly, each client took up the invitation and made their marks.

Another twist. Buddhist approaches to recovery also invite us to meet suffering with compassion. We suffer more when we fail to accept that we cause harm, that we defeat ourselves, that our self-defeat leaks out onto others. As such, I instructed the clients to take a look at their dolls and slowly, with great care, attempt to return the doll to its starting shape as one (or more) plain piece of paper. I asked them to smooth out the wrinkles the best they could. I asked them to do this with the same sensitivity that you might use to wash a baby. In a metaphorical sense, that's exactly what they are doing. They are caring for their dinged-up and disheveled selves, and they are offering the care because they are deserving of it. 

Next, we observed the wrinkled paper. We imagined ourselves as the wrinkled paper. I said, take a look at that paper. It’s you. You are wrinkled and torn. And since we can never untoast the toast, so to speak, we will never return to a state of pristine paper. But the clean sheet is an illusion anyway. Nobody ever attains it (addict or otherwise). Unless we start from where we are, meaning in this wrinkled and torn state, we cannot truly accept ourselves. I then asked them to keep looking at the paper while I asked some questions. I invited them to feel what comes up when I asked: Do you think anyone wants this wrinkled piece of paper? Do you want to be the paper in this shape? What allows or prevents you from accepting that this is it?

If you'd like to see what kinds of responses arise after a session of this sort, I invite you to try out the group in your own environment. This was the second time I conducted this group, and the pleasant surprise that hit me this time came at the very end as I pondered what to do with all the paper and related material. It felt charged. I didn't want to throw it away. To preserve the memory, I gathered it all together and invited clients to think about the pile as our collective pain. When most people think of anger, they think of the color red, of punching and kicking, and of steam coming out of cartoons' ears. But nobody thinks about this tattered stack of paper. And yet, in under 60 minutes, our group had created a beautiful representation of collective suffering.

References:
Dayan, Joan. 1995. Haiti, History, and the Gods. Berkeley: University of California Press.
Frankfurter, David. "" Voodoo Doll": Implications and Offense of a Taxonomic Category." Arethusa 53.1 (2020): 43-58.
​Németh, György. "Voodoo dolls in the classical world." Violence in Prehistory and Antiquity (2018): 179-94.

Therapeutic references:
Feen-Calligan, H., McIntyre, B., & Sands-Goldstein, M. (2009). "Art therapy with substance abuse clients: Evidence-based support for a model program." Art Therapy: Journal of the American Art Therapy Association, 26(3), 104–110.
Kabat-Zinn, J. (2003). "Mindfulness-based interventions in context: Past, present, and future." Clinical Psychology: Science and Practice, 10(2), 144–156.
Malchiodi, C. A. (2005). Expressive Therapies. Guilford Press.

Client's don't often come into treatment with any knowledge of (or interest in) art history, so I try to find as many opportunities as I can to introduce them to visual art. Today's art therapy group drew inspiration from the Impressionist Berthe Morisot and the Expressionist Erich Heckel. I showed them Morisot's Psyché and Heckel's Männerbildnis because I wanted them to use Impressionist and/or Expressionist visual language to produce self-portraits. There was, however, a catch. The two self portraits had to be conceived from the perspective of two people: a stranger and someone who knows you well. This constraint, in addition to the artistic mode of expression, produced the therapeutic effect of the group; namely, creating self-portraits through others' eyes helps to make visible how we see ourselves, how we hide parts of our emotions from view, and how we yearn for others to see the parts of ourselves that we hide. 

Research supports the use of art therapy as a means of fostering emotional regulation, enhancing insight, and promoting psychological flexibility (Kimport & Robbins, 2012; Gussak, 2007; Slayton et al., 2010). The dual self-portrait exercise specifically encourages clients to explore the discrepancy between internal and external perceptions of self, which can be particularly valuable for individuals in recovery who may struggle with shame, self-stigma, and identity confusion (Mezo & Short, 2012; Kim et al., 2017).

Since most clients are highly judgmental, especially when it comes to their own perceived lack of artistic skill, I provided a few extra words of guidance:

• Use of Color: Participants should represent affective states and emotional intensity through color choice (Moon, 2010).
• Use of Line: Use lines to show your measure of self-cohesion and mindfulness regarding present-moment awareness.
• Background Setting: Let the background image or texture act as a metaphorical tool for exploring underlying values, personality traits, and environmental influences on identity.

Here are some of the results: