Levi Shapansky was at the family Seder when his son, Chezky, slipped off of his chair after sampling some wine. The boy was fine, and the incident sent Levi into a fit of hysterical laughter. The rest of the table joined in—until Levi started choking. After a few sips of water, the choking subsided, but his wife, Sheva, saw Levi’s sweat-sheened face had begun to break out in hives. Sheva’s gut told her something was wrong. “Levi’s always been in perfect health—he never even got colds—but I could tell this was serious. I got him to lie down and then I called 911.” When the EMTs got there, they took one look at Levi and told Sheva they would need to take him to the ER. His blood pressure was skyrocketing, and they feared he would have a stroke. Off they sped to the hospital, where the doctors, thankfully, were able to stabilize him. “What happened to him?” Sheva asked them after the commotion had died down. Their response was the last thing she expected to hear. “Your husband had a reaction to a laughing attack,” said one of them. She thought it was a joke. “Are you saying my husband almost laughed himself to death?” “Actually, yes.” Since then, joke-telling has never been the same in the Shapansky house. Levi Shapansky is just one of a surprising number of people who have either died or almost died from laughter. We all know about laughter’s many health benefits, including increasing oxygen intake and blood flow, boosting the immune system, helping control blood sugar levels and even bolstering fertility (one study showed that women undergoing fertility treatment who were entertained by clowns—not a joke—had a 36-percent chance of becoming pregnant, compared to the clown-deprived women whose chance of becoming pregnant was only 20 percent.) But less commonly known are the studies that have found that laughter is fraught with hidden dangers.
A recent study published by the British Medical Journal, which collected decades of research, cited a number of potential risks that laughter poses, including asthma attacks, esophogeal rupture, cardiac rupture, protrusion of abdominal hernias (literally, “side-splitting laughter”), headaches, fainting, jaw dislocation, stress incontinence and interlobular emphysema. Laughter is especially risky for those with cataplexy, a rare condition related to narcolepsy, because it can sap them of their muscle strength and cause them to collapse. And, according to Dr. James Hamblin, MD, in a 2011 article, “If you happen to be walking around with an aneurysm in your brain (one to six percent of us, most unknowingly), a single laugh could cause that aneurysm to rupture.” The same goes for someone with coronary heart disease. “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,” Hamblin writes. “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)…but die instead.” As for laughing with others, while it may deepen the relationship, it can also wreak havoc on your health by the spread of germs. So infectious laughter, it seems, is actually infectious—though the researchers maintain it is preventable by laughing up your sleeve. While laughter presents risks in and of itself, it can also be a sign of a deeper problem.
Epileptics, for example, may dissolve into a fit of laughter right before a seizure. In fact, there is a type of seizure, called a gelastic seizure, which is known as the “laughing seizure” because people who are having one, in fact, look like they’re laughing uncontrollably (they’re not). Laughter can also be a prelude to a stroke or the side effect of cerebral tumors, Angelman syndrome, multiple sclerosis, or motor neuron disease. Throughout history, there have been cases of people who have met their demise as the result of a laughing spell. In the 3rd century BCE, the philosopher Chrysippus laughed himself to death after getting his donkey intoxicated, while the Greek painter Zeuxis apparently found one of his own works so amusing that he choked from hysterical laughter. In 1410, Martin of Aragon met his end from a combination of indigestion and a laughing fit, and in 1660, Scottish aristocrat Thomas Urquhart died from laughter after learning that Charles II had become king. Even entertainment can be dangerous, as shown by a Mrs. Fitzherbert, who passed away during the intermission of an opera in 1782 after a funny scene she couldn’t seem to get out of her head. More recently, something similar happened to British bricklayer Alex Mitchell who, in 1975, laughed for 25 minutes straight after seeing a funny skit on a television show until his heart gave out. (His wife actually wrote to the producers to thank them for bringing joy to the end of her husband’s life.) Just as recently as 2003, a Thai man named Damnoen Saen-um died from either asphyxiation or a heart attack after laughing in his sleep. Still, the general consensus is that cases of death by laughter are pretty few and far between.
Generally, not enough information in these cases is known to determine whether the laughter was a coincidence or a cause of death. The phenomenon is prevalent enough, however, to have made an impact on the English language. Variations of the expression “dying of laughter” have been batted about for centuries; according to the Oxford English Dictionary, its roots stretch all the way back to 1596, when the following phrase was recorded: “Went they not quickly, I should die with laughing.” We’ve even gone so far as to use death to illustrate humiliation (“I died from embarrassment”), anticipation or longing (“I’m dying to try that new babka from Zusha’s”), and greatness (“Those shoes are to die for!” And while we use these expressions without a second thought, it’s sobering to think of what it means in the instances when they’re true. Much more prevalent than death is laughter-induced syncope, or fainting. The reason for this is the contraction of muscles around the heart, which may slow blood flow and the distribution of oxygen in the body. Hyperventilating can also do the trick. Those who have gone through the experience maintain that it’s anything but funny. Jim Dailakis, a 41-year-old comedian from Queens, has blacked out a number of times over the years due to laughing fits. “The first time it happened, I thought I was going to die,” Dailakis told NBC News. “I was on my knees laughing, and then suddenly I couldn’t breathe. It was scary and freaky but I couldn’t stop laughing.” Within a minute or so, Dailakis saw stars and lost consciousness. “The next thing I knew, I was lying down and looking up.” A 2004 report in Cardiology Review describes a 63-year-old man who fainted 10 times in 20 years after bouts of hysterical laughter.
His wife described the episodes, which usually occurred at mealtimes, when her husband would begin laughing intensely and then pass out. While undeniably intense, cases like these, says Harvard University professor of Neurology Dr. Martin Samuels, do not pose any long-term risks. “[They are] most likely benign and unlikely that it would lead to death.” In any case, says Dr. Samuels, it’s not just laughter that can take a toll on the body; it’s any intense emotional experience. “Happy news is just as dangerous as sad news with regard to the risk of sudden death,” he says. “I have cases of people who died after hitting holes-in-one, after bowling perfect 300 games and upon hearing the words ‘not guilty.’ Ecstasy, happiness and good news are definitely risky.” The reason for this is human instinct. “Extreme excitement, whether that be sadness or happiness, activates the part of the brain that’s responsible for the flight or fight response to threats in the wild,” says Dr. Samuels. “This releases a natural chemical—adrenaline—which in large animals can be toxic to various organs, in particular the heart.” So it seems that not just laughter poses a risk; any intense emotion, good or bad, can affect the heart to the extent that it goes into arrest. At the end of the day, however, the fact remains that the benefits of laughter far outweigh the risks. Aside from the physical benefits of pain relief and improved immune systems, laughter’s psychological effects can actually be life-saving. Laughter lowers the secretion of cortisol, the stress hormone, which lifts the mood and sends anxiety packing. For many patients dealing with long, grueling illnesses, laughter is sometimes the most effective treatment. So while the rare soul may meet his or her end from a burst of laughter, don’t let it put a damper on your sense of humor. After all, in the words of Charles Dickens, “There is nothing in the world so irresistibly contagious.” We would all do well to get “infected” more often.