Day 786: The Pun Disease – When You Think A Seizure Is A Roman Emperor

originally published February 24, 2014

Did you hear the one about the kleptomaniac? His doctor told him to take something for it.

How about the painter who was hospitalized for too many strokes?

Or what about the lady with amnesia who had to re-learn how to walk up the stairs, step by step?

These and other such acts of depraved punnery come naturally to me due to a junior high penchant for class-clownery. Fortunately my sense of humor has evolved slightly, at least to the point where I’m now aware that puns are best used as a means of torturing my family to induce the awkward glares that serve to fortify my position as the dominant male of the household. Puns are the true test of familial loyalty.

But what if the puns came not as a conscious effort to fill the surrounding air with groans, forehead slaps and loathing? What if there was some sort of medical condition that exhibited itself through involuntary pun-making? And what if a guy who was allergic to cats were to rush out and buy one anyway? Would it be considered a rash decision?

I make no apologies for the fetid stank of wince-worthy humor in this introduction. There is simply no better way to unfurl the horrors of witzelsucht.

Imagine if you will a 30-year-old theological scholar, an intellectual man with a solid reputation. He is admitted to the department of neurology due to some inexplicable irritability, a nasty case of hyperphagia (meaning he can’t stop eating), and some really unusual behavior. He spouts puns like most of us drop small-talk pleasantries. This occurs more frequently during stressful moments, like when nurses come in to take some blood or when his doctors are doing their rounds. Maybe he comments on how his back used to hurt, but that’s all behind him now. Perhaps he expresses his dislike for needles, as they really get under his skin.

The doctors, in addition to resisting the urge to smack this patient, are stumped. He has a slight decrease in mobility and fine motor skills on the right-hand side and a scan reveals decreased blood flow in the right frontoparietal area. Something went wrong with his brain, and somehow one of the side effects of this damage was an unstoppable stream of terrible word-play.

Another case: a 56-year-old man is admitted for a putaminal hemorrhage, which means a blast of unwanted blood-stuffs around the Basil Ganglia in his brain. He has difficulty swallowing and the expected stroke-induced paralysis on his left side. After a few days he is fully alert, and with this weird wide smile he is cracking gags about his medical situation. Often if his jokes make others laugh, he won’t show the slightest hint of a grin. When someone else makes a joke, he’ll display absolutely no response.

Then comes the hypersexuality. While this term commonly refers to nymphomania (at least in the movies I watch at work when my boss isn’t around), in this gentleman’s case it exhibits itself in the form of inappropriate, almost lecherous comments hurled Dan-Fielding-like at nurses and/or any other nearby women. When gasps and disgusted looks would shoot back in reply, the patient shows zero response. He doesn’t understand that he has been inappropriate, even when he is told so.

Can a stroke really have such a direct impact on one’s sense of humor?

Of course it can. The right side of our think-meat is responsible for problem solving and humor processing. Patients suffering from witzelsucht have a problem processing complex humor, but they can find great joy from puns, non sequiturs and slapstick humor. Stuff that doesn’t require a lot of setup or the integration of content across a number of sentences. A punchline means nothing to these poor people – they can’t connect it with the rest of the joke. Also, due to their disassociation between their humor muscles and their thinking muscles (to put it in the most non-medical parlance I can muster), they show no emotional reaction to humor.

So even if they understand that a joke has been told, and if their instinctive reaction is that the joke was funny, they show no reaction to it. No smile, no chuckle, no chortle, no guffaw. This ties in with their ability to empathize or take on the perspective of others, which probably explains why they’ll toss out inappropriately blue comments around a woman without realizing just how shittily they are behaving.

Witzelsucht is a rare condition, and luckily for those afflicted, it’s even more rare for the hypersexuality component to develop. But when one suffers damage to one’s frontal lobe, it’s not uncommon for such drastic alterations to one’s personality to occur. Take the case of Phineas Gage, who had a spike rammed through his head and lived to tell the tale. He began to swear more often, became impatient and prone to elaborate schemes that he’d drop the moment his attention shifted. A lot of who we are is packed into those frontal globs of brain-goo.

And hey, I got to reference my first article in this project! Not relevant, but it gives my chuckle-juices a little titter of delight.

Anyway, the right frontal lobe also keeps our episodic memory in line. This means if we need to remember something we’ve seen or done in our past in order to understand a joke, damage to this region will stifle it. So it appears that witzelsucht is simply a massive uppercut to our ability to process or create humor. As blindness is to sight, witzelsucht is to our personal sense of comedy, more or less.

When hypersexuality enters the picture, that might mean that another part of the brain is suffering. The amygdala is our response center, oozing our affective responses to emotional stimuli and essentially allowing us to interact in a social setting without making armpit fart noises at inopportune moments. The amygdala also ties in emotional significance to sexual behavior. When our humor-control office is boarded up and our affective-response office is dealing with structural damage, it’s not surprising that a free-flowing stream of inappropriate and undesirable word-spews might flow from our tongues.

Witzelsucht shouldn’t be confused with a laughter disorder. Its sufferers don’t laugh uncontrollably or inappropriately, they simply allow rotten one-liners to ricochet off their cheeks and into the air around them. It’s a disorder of mirth or humor, not a disorder of laughter.

Fortunately, venlafaxine, a serotonin and norepinephrine reuptake inhibitor, has been proven to combat this unfortunate affliction. When the aforementioned 56-year-old was given venlafaxine four months after his stroke, it took a couple of months but his nasty sexual outbursts and gushing puns were mostly curtailed.

Thankfully, the treatment wasn’t anything as drastic as having to remove part of the brain. As the chronic alcoholic was known to say, “I’d rather have a bottle in front of me than a frontal lobotomy.”

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