Humor - International Journal of Humor Research, 2009, 22: 1/2. p. 27-48
Gelotophobia: The fear of being laughed at
MICHAEL TITZE, HumorCare, Germany

Gelotophobia may be considered as a specific variant of shame-bound anxiety. It is defined as the pathological fear of being an object of laughter. This fear can be traced back to early childhood experiences of intense and repeated exposure to «put-down,» mockery and ridicule in the course of socialization. Gelotophobes constantly fear being screened by others for evidence of ridiculousness. Thus, they carefully avoid situations in which they feel exposed to others. Gelotophobia at its extreme, therefore, involves a pronounced paranoid tendency, a marked sensitivity to offense, and a resulting social withdrawal (Titze 1995, 1996). The origins and consequences of gelotophobia are described, and a model of specific treatment is presented.

Keywords: Shame-bound anxiety, social phobia, gelotophobia, ridicule, Pinocchio complex, involuntary clown, humordrama.
1. Introduction
Laughing at people who are perceived as inferiors is an essential ingredient of the so-called superiority or disparagement theories (cf. Keith-Spiegel 1972). These theories date back to Aristotle, who suggested that laughter arises primarily in response to the perception of deficiencies, deformations, weakness and ugliness in fellow-men (cf. Janko 2002). In Plato's analysis of comedy, entitled «Philebus» (Plato 1993), the perception of failures, sufferings and humiliations of others is judged as the main source of a hearty laughter. On the threshold of the modern age, Thomas Hobbes (1981) stated that the passion of laughter is nothing but the sudden triumph arising from the realization of superiority in ourselves, compared to the infirmity and weakness of others (cf. Zillmann 1983). The relevance of this degradation theory of humor is confirmed by ethologists as well. Eibl-Eibesfeldt (1975) suggested, for instance, that the original significance of laughter was a threatening gesture, having its phylogenetic roots in an aggressive snarling of teeth. Furthermore, Fry (1988) described various forms of the «fear of laughter».

2. The causes of appearing «funny»
Henri Bergson (2004) explained the phenomenon of becoming a ridiculous object for others through «mechanical encrustation» of living dynamics, i.e., of the flexibility and elasticity of the body's postures, gestures, and motions. If an individual looks ridiculous, her or his living body will appear as a «mere mechanism». As a result, the fundamental contrast of man and machine will inevitably create a funny impression. Bergson (ibid.) illustrated this phenomenon through the example of a public speaker repeating head and hand movements stereotypically, thus giving the impression of a mechanical automatism. One also may imagine the unlucky person slipping on a banana peel, or the actor in a tragedy having violent hiccups, or a patient suffering from a nervous twitch: In all of these cases, voluntary control of the harmonious interplay of vital functions is lost. Instead, an involuntary fright comes about, accompanied, so to speak, with the freezing of physical motility: The living body takes on a peculiar «robotic appearance,» and the natural claim of being a part of human community is, in this moment, suspended. Therefore, the person's subjectivity gets lost and, instead, he or she is integrated into the inanimate world of objects. This objectivization regularly has a funny effect on the observer. Therefore, the objectivized person, on principle, is a ridiculous object. In this way, shame is evoked.

3. Shame-bound anxiety
Wurmser (1994: 73) states that shame, analytically seen, is a type of anxiety, namely shame-anxiety. He illustrates this contention with the following soliloquy: «I am afraid of an impending exposure and, therefore, of a humiliation.» Shame-anxiety may show itself, in Wurmser's words, «in form of a slight signal or an overwhelming panic.» (translation by the author)

Shame-bound anxiety results in increased self-observation and self-control, serving the general purpose of avoiding inappropriate («funny«) performance in social situations. Such individuals, therefore, come to expect rejection by others, and thus they suffer from feelings of inferiority, insecurity, self-contempt, and other facets of shame. In this context, all clues of possible contempt from the social partners at hand are very carefully scanned.

Because the human face is a primary organ of communication (cf. Ekman and Friesen 1975), being mimicked is the main target of avoidance by patients suffering from shame-bound anxiety. The (unconscious) purpose is to protect the self from enduring the shock of being disparaged or scoffed at by others. Thus, the preventive function of shame-bound anxiety is to avoid those social situations that, subjectively (and frequently by mistake!), are evaluated as being harmful for one's self-esteem (cf. Lewis 1992; Wurmser 1994).

A common trait of individuals who experience shame-bound anxiety is the deep conviction that something essential is wrong with them. This behavior is a primary feature of gelotophobia. Additionally, gelotophobes assume they are completely ridiculous in the eyes of their peers. (Therefore, occasionally the term «catagelophobia,» derived from the Greek «katagelos,» meaning contemptuous laughter, is used in this context.)

Their underlying shame-bound anxiety coerces gelotophobes into avoiding social activities because it is their pathologically biased conviction that such situations invite ridicule and, thus, could disclose the concealed stigma of being a contemptible outsider. Consequently, the main purpose of individuals suffering from gelotophobia is to protect themselves from being laughed at by others. Precisely this timidity, then, opens up the risk for being the permanent butt of mockery and derisive laughter. William F. Fry (2000: 67) states:
«In gelotophobia, shame plays an important role (i.e., the fear of being shown up or ridiculed by others). Gelotophobia has to be understood as a serious disturbance. For those being affected by gelotophobia, the closeness and the intimacy that occur when laughing with others have such an uncontrollable and menacing effect that they become deeply frightened.» (translation by the author).

4. Social phobia and shame-anxiety
The concept of «social phobia» was introduced by Marks in 1969. Since then, extensive research has been carried out to determine both the emotional and physical symptoms as well the causes of this anxiety disorder. In 1980, the research results were incorporated into the «Diagnostic and Statistical Manual of Mental Disorders.» Meanwhile, the revised edition of this manual (DSM-IV: APA 1994) defines social phobia as «[...] a marked and persistent fear of one or more social or performance situations in which a person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing [...] The feared social and performance situations are avoided or else are endured with intense anxiety or distress. [This] interferes significantly with the person's normal routine, occupational functioning, or social activities or relationships [...].»
Veale (2003: 259) notes that «social phobia overlaps with the concept of shame, although the two sets of literature have largely ignored one other.» Social phobia and shame have certain common features (e.g., preoccupation with fear of negative evaluation or embarrassment, a tendency to avoid social situations, and physiological dysfunctions such as palpitations, trembling, nausea, and blushing). Yet no special efforts have been made to synthesize the common element of these two disorders. Even prominent publications on social phobia (cf. Heimberg et al. 1995; Schneier et al. 2004) do not refer to shame-specific literature. This may be because shame-bound anxiety focuses on the self as the central object of evaluation, thereby constantly confirming the shameful conviction that this self is fundamentally damaged. Correspondingly, gelotophobia (as a specific variant of shame-bound anxiety) is derived from the person's biased belief that her or his self is intolerably ridiculous.

Social phobia, as defined by the Diagnostic and Statistic Manual of Mental Disorders (DSM-IV: 300.23), does not meet this requirement. It is instead directed to the evaluation of specific embarrassing failures and inexcusable lapses, subsequently giving rise to severe self-reproach. In this context, the patient's respective soliloquy could be: «I failed miserably in a social or performance situation. Therefore, the humiliation I have to endure is the punishment for this failure.» In regard to such function disorders, the self is evaluated only in a secondary step; it is not itself the primary focus of negative evaluation. This seems to suggest that the theory of social phobia focuses on specific inexcusable failures of the person concerned (cf. Lewis 1992: 76-77).

5. The agelotic attitude of gelotophobes
The general state of gelotophobes is «agelotic», i.e., they are not able to appreciate the benefits of laughter. The origin of this state derives, in many cases, from the fact that the individuals in question frequently experienced their early reference person/s (in many cases suffering from gelotophobic problems as well) as lacking a smiling face. The face gelotophobes recollect from childhood, therefore, can be likened to the stony countenance of a sphinx, having a blank expression and appearing disinterested and distant. When infants are confronted with such a face, the «interpersonal bridge» (Kaufman 1985: 11-15) cannot be constructed. The children in question experience themselves as being unconnected to others. They do not interpret laughter as a positive element of shared identity. Thus, these children can hardly develop pro-social emotions reflecting a cheerful and self-confident imperturbability. Rather, their fellows seem to be hostile strangers who treat them in a cold, sarcastic, and disparaging way. One decisive weapon these strangers might use is derisive laughter.

Thus, gelotophobic patients react to the mimic and vocal expressions constituting laughter and/or smiling in an aversive way. Thereby, they express non-verbally that they feel very uneasy, thus indicating their fear of being humiliated by those who face them in a laughing and/or smiling way -- irrespective of their true motives.

6. The appearance of gelotophobes
Gelotophobic patients lack liveliness, spontaneity, and joy. Frequently, they appear distant and cold to their peers. Above all, humor and laughter are not relaxing and joyful social experiences for them. Henri Bergson (2004) compared individuals who are the butt of ridicule or disparaging laughter with wooden puppets or marionettes. Such individuals constantly send nonverbal cues that indicate that they feel very uneasy. Therefore, muscular tension and stiffness, as a consequence of emotional panic, are frequently developed. Also, specific physiological symptoms may arise (e.g., racing heartbeat, muscle twitches, trembling, blushing, perspiring, shortness of breath, and dry throat and mouth combined with speech impediments). Such symptoms are typical for social anxiety/phobia as well (cf. Heimberg et al. 1995). The specific criterion for discriminating gelotophobic patients, however, is their congealed expression, the most conspicuous part of their appearance. When experiencing acute (shame-bound) anxiety, the facial expression of gelotophobic patients is typically motionless and inanimate, like a wooden mask. Furthermore, the arms and legs of these individuals may not always move in a spontaneous way as they try to deliberately control their spontaneous body movements.
This «wooden appearance» has been referred to as the «Pinocchio-Syndrome.» This is a central feature of gelotophobia and, thus, a crucial criterion for its assessment (cf. Sellschopp-Rüppell and von Rad 1977; Titze 1995, 1996, 1997, 1998).

7. Origins and consequences of gelotophobia
Gelotophobia, in general, originates from repeated traumatic experiences of being ridiculed or «put down» during childhood and adolescence. There are etiologic indications that these traumatic experiences are facilitated by specific childhood conditions, having their roots in early parents-child interactions (cf. Schneier et al. 2004; Sellschopp-Rüppell and von Rad 1977; Titze 1995).

7.1 Shame-bound pressure for interpreting reality in families
Parents of gelotophobic patients exert strong pressure on the child to conform unconditionally to a specific interpretation of reality that is related to normative ideals that have, in most cases, only private validity. In this way, a rigid, obsessive super-ego is created, giving rise to severe feelings of guilt and, in particular, of shame. Furthermore, children may be exposed to parenting styles that are overprotective, involve little display of affection, and use shame as a method of discipline (Schneier et al. 2004). Further etiologic details have been listed by Sellschopp-Rüppell and von Rad (1977: 359):
  • (1) «An exaggerated demand for loyalty binds the patient to his family, and this leads to an insoluble conflict with other love objects. The parents cannot live without the child; the patient is, however left alone when he himself needs help.
  • (2) We often find a pseudo-strong father and an unstable, unreliable mother.
  • (3) An overstated and unyielding ideology of what is right and good, and a belief in their own selflessness hardly allow any feelings of guilt to arise in the parents.»
    When the child shows disobedience to these normative demands, the parents may respond with shame-inducing punishment in the form of love withdrawal, disregard and, above all, ridicule. This punishment is to ensure conformity to the parental demands and thereby stabilize the idiosyncratic structure of the family. Not fitting into this normative configuration will evoke a fear of failing which, again, strengthens the readiness for adaptation to familial demands. Janes and Olson (2000: 476) confirm that ridiculed individuals are more conforming and more afraid of failing: «Ridicule shapes children's behavior [...].» The consequence is that the child will fit more and more into the family's normative micro-universe, thus eventually losing the connection to extra-familial socialization agents. Thus, a firm sense of belonging to a larger community is not developed during childhood, and the acquisition of social competence is poor.

7.2 Social competence is poorly developed
As a result of the above-mentioned parental pattern, such individuals are not capable of fitting into social groups in an inconspicuous and relaxed way. So he or she will tend to separate from social activities in order to avoid being embarrassed because of the conviction that he or she is being perceived by others as involuntarily funny. This, however, is a decisive precondition for being the butt of ridicule.
The most sensitive developmental phase for the gelotophobic is puberty. In this phase, juveniles carefully examine how others behave and how they react to them. Thereby, young persons try to identify with their peer group's predominant role behavior (cf. Erikson 1980). If a juvenile differs from group norms in terms of clothing style, taste in music, use of slang words, or relationships with the opposite sex, he or she might easily be cast in the role of an outsider who is liable to be ridiculed.

7.3 Ridicule shapes behavior
Ridicule has an important impact on the interpersonal relations in peer-groups. First of all, mutual laughter bands the members of such groups together, thus serving a cohesive function (cf. Ziv 1984, chapter 3). In this context, the preservation of group norms is another function of disparaging humor. Those behaving contrary to prevailing group norms will experience a «punishing laughter», which forces them back to the group's normative expectations.

Youngsters, however, who lack the capability of anticipating and understanding the normative expectations of their peers, will not be able to correct their unconventional behavior. Being unfamiliar with extra-familial group norms, they will, inevitably, get into the position of a «funny outsider» and become the permanent target of ridicule and disparaging humor. Schneier et al. (2004: 73) suggest that having been teased and bullied during childhood «can continue to have an impact in adulthood.»

7.4 Being traumatized by ridicule
Wills (1981: 263) establishes a connection between the phenomenon of humor and the self-enhancing tendency towards «downward comparisons.» He states:
«In comparison terms humor affords the audience an opportunity to assuage their own insecurities through favorable comparison with another person's misfortune, frustration, foolishness, imperfection, blundering, embarrassment, posturing, or stupidity.»

Zillmann (1983) concluded that all forms of destructive humor are directed at individuals who are perceived in a negative, off-putting way. This applies specifically to gelotophobes whose appearance is, as previously described, not very engaging. The suspicious and defensive impression they make on others inevitably leads them into the position of powerless, despicable scapegoats. Ziv (1984: 36ff) states that a scapegoat fulfills an important task in the dynamics of the group. He or she is assigned all the weaknesses and illnesses of the group. By making the scapegoat the victim of disparaging humor, other group members can gain a feeling of superiority. Janes and Olson (2000: 478) mention that intentional embarrassment is typically employed «to establish or maintain power and control over others.» One study of victimization (Doerner and Lab 2005) indicates that victims are the target of constant abuse and are not expected to defend themselves against this maltreatment, which -- in the case of gelotophobes -- takes the form of social abuse. This frequently causes the victim emotional harm and may evoke severe symptoms like overt anxiety when interacting with others, constant lowering of self-esteem, feelings of insecurity, self-consciousness, sadness and shame, and, as a consequence, a pronounced tendency toward social withdrawal and isolation. In an article dealing with various forms of «sado-humor,» Salameh (2006: 6) states:
«In the threatened victim, this traumatization is usually coupled with telltale physiological signs related to phobia such as nausea, lightheadedness, feelings of derealization or depersonalization, fear of losing control [...].»

8. Clinical vignette
A 30-year-old female patient sought clinical treatment because of multiple psychosomatic problems: tension headache, sleep disorder, stomach-cramps, vertigo, hot flashes, and trembling. Gradually it became evident that the patient was suffering from severe shame-bound anxiety, accompanied by paranoid fears, problems with blushing and psychomotor stiffness. In her medical history, there had been aggravating problems with colleagues and superiors in the patient's professional life. She described this as «mobbing.»

Altogether, the patient gave the impression of being affectively restrained and awkward. Thus the diagnosis of a «Pinocchio syndrome» (cf. 6.) was appropriate. Further investigation into her medical history revealed no definite biographical hints that could have explained the gravity of the syndrome. The patient was brought up as an only child by her single mother, a refugee from Eastern Europe. Her mother never adjusted to her new homeland and was quite isolated. Thus, her daughter was the only reference person for her. The connection between them was very close or, in other words, symbiotic. The patient had to function as a substitute partner for her lonely, grieving mother. Thus, the child had to identify with her mother, whose unmet needs, which stemmed from the loss of the customs and roles of her former homeland, the patient tried to fulfill, causing her to become her mother's «alter ego.» Thus, she behaved differently from other children in her surroundings. This must have given a strange or even odd impression to her peers. In this context, she gradually got into the position of a «funny outsider.» The consequence was that, since pre-school, other children made fun of her.

The following experiences were so humiliating that the patient could not share them with the therapist until one year after psychotherapy had begun. She did this by writing the following report:
«This was the beginning of my suffering: A classmate started to call me 'Miss Garlike'. The reason could have been that my mother used to flavor all her meals with garlic. She did this irrespective of the fact that this causes a bad odor. I must have reacted in an inappropriate, strange way, but I was not aggressive at all. Anyway, soon other mates joined in making fun of me. They cried 'boo!', 'yuk!' and 'fie!' whenever they caught sight of me. This derision spread in such a way that even youngsters who hardly knew me started scoffing at me. As soon as they caught sight of me they started grinning in a filthy way. Frequently they cried things like 'ugh!'. At the schoolyard and even on an open street they turned off. They did not stop pretending to be horrified by catching sight of me. Some covered their face with their cap or their school bag, only to demonstrate that they could not 'endure' my look. Their diabolic laughter is still sounding in my ears! After the break was finished in the schoolyard, they joined in a race -- just to arrive before me in the classroom. When I passed the door they imputed that I had infected the door. Those arriving later at the classroom pretended that they didn't dare to enter the classroom. And the others who were already in the classroom held, with a scornful laugh, crossed pencils against me -- as if I were a vampire!

I grew more and more stiff out of shame. And I constantly asked myself the question, 'What is so terrible with me? Am I a complete monster?' This negative soliloquizing resulted in a rapid decreasing of my self-confidence. The result was that I grew more and more awkward. During school lessons I was completely passive and dejected. I grew increasingly sensitive. Everyone facing me with a smiling face caused me to panic. Therefore, I carefully avoided eye contact. This went along with my head and my shoulders hanging down. I did not disclose myself to any reference person, not to my teachers and, especially, not to my mother. She would have remonstrated me by saying, 'You simply have to be friendlier to others, instead of behaving in that stuck-up way, etc.' For this reason, I avoided going into town with my mother: She should never witness how I was derided by my fellows. Therefore, I always stayed at home and faked being unwell, having stomachaches, etc. The reason for all these furtive maneuvers was my burning shame. Until a few months ago, I was convinced that all of this had inevitably ruined my life and had broken me inside. So this derision remained for all these years a big secret. I felt no one on earth, even you, as my therapist, should be informed about it. So strong was my shame!» (translation by the author)

9. Current personality studies
New evidence about gelotophobes stems from personality studies. For example, Ruch (2004) reported that gelotophobes tend to be introverted and neurotic with slightly elevated scores in early psychoticism measures. Also, they seem to have experienced intense shame in their lives, and they experience shame and anxiety during a typical week. Gelotophobes feel negative emotions when hearing others laugh (cf. Ruch, Altfreder and Proyer, 2009). The formulation of a tentative model of the causes and consequences, as derived from the clinical studies, might facilitate putting forward hypotheses for empirical tests in further studies and experiments.

10. Criteria for the assessment of gelotophobia
Proper assessment of gelotophobia is essential for both research and therapy. Initial identification of gelotophobes stems from clinical experience with these patients. Later, those impressions were formalized into a facet model (cf. 10.1), and finally, a questionnaire assessment was undertaken.

Clinicians who meet gelotophobic patients for the first time generally recognize their typically bashful bearing. This defensive attitude may be expressed by very formal conduct, difficulty in maintaining eye contact, speaking in a low voice, displaying an obsequious demeanor, and by an awkward posture. An important criterion for the assessment of gelotophobia ultimately is the patients' pronounced sensitivity with regard to any kind of humorous remarks. Obviously, gelotophobic patients are not able to deal in an uninhibited way with humorous material: In this context, they mostly will react «agelotically,» i.e., their face will grow stiff and their possible polite smiling will freeze. In the treatment professional person, a specific «counter-transference» might emerge, containing ambivalent feelings such as uneasiness, amusement, pity, and disdain.

10.1 A facet model derived from prototypical statements
In one research project, additional criteria for the assessment of gelotophobia were defined (Ruch and Titze 1998). This was achieved by associating the constitutive nosological elements of gelotophobia with typical statements of gelotophobic patients:

  • Traumatizing experiences with laughter and mockery in the past: «During puberty I avoided contact with peers so that I wouldn't be teased by them.» - «When I was in school, I was teased quite often.»
  • Fear of the humor of others: «Others seem to find pleasure in putting me on the spot and embarrassing me.» - «It takes me very long to recover from having been laughed at.»
  • Discouragement and envy when comparing oneself with the humor competence of others: «I feel inferior around quick-witted and humorous people.» - «When I participate in discussions I often think that my statements are ridiculous.»
  • Paranoid sensitivity towards alleged mockery by others: «I get suspicious when people laugh in my presence.» - «When strangers laugh in my presence, I often think that they could be laughing at me.»
  • Dysfunction of the harmonious interplay of physical motions: «When I smile in someone's company, I feel like my facial muscles are cramping.» - «My posture and my movements are somehow peculiar or funny.»
  • Dysfunction in appropriately expressing verbal and non-verbal communications: «If I wasn't afraid of making a fool of myself, I would speak much more in public.» - «It is very difficult for me to come up and meet others in a free and easy way.»
  • Social withdrawal: «When I feel I've made an embarrassing impression somewhere, I never return to the same place again.» - «I avoid participating in funny activities at festivals because I feel myself becoming cramped inside.»

These criteria were shown to converge very well and to be largely unidimensional (Ruch 2004). Only traumatizing experiences with laughter and mockery in the past yielded slightly lower intercorrelations with the other facets.

10.2 Questionnaire assessment
A list of 46 statements related to the above mentioned facets of gelotophobia (= GELOPH 46) was compiled (Ruch and Titze 1998) and used to explore differences between various clinical groups and normal controls. It turned out that most of those statements were able to be used to discriminate well between gelotophobes (as assessed by clinical judgment) and shame-based and non-shame-based neurotics (Ruch and Proyer 2008 a). Applying several criteria helped to identify a subgroup of statements that allow for a short, efficient and valid separation of the groups. While the list of statements is much shorter, its reliability was not impaired (Ruch and Proyer 2008 b). The convergence of clinical criteria and questionnaire data found in the initial study speaks in favor of the construct validity of the measure. The various contributions in the current special issue provide some evidence for criterion validity (cf. Platt 2008; Proyer et al. 2005). However, more information regarding validity needs to be provided.

11. Treatment of gelotophobia
Those who suffer from gelotophobic symptoms inevitably find themselves in the position of involuntary clowns: individuals who make others unintentionally laugh. (Voluntary clowns, like professional jesters, expose themselves in public with the clear intention of making fools of themselves [cf. Palmer 1994]). When gelotophobes act as involuntary clowns, they regularly display an awkward posture that has been called the «Pinocchio syndrome» (cf. 6) due to its puppet-like appearance.

Sellschopp-Rüppell and von Rad (1977: 360) state that therapeutic work with patients having said Pinocchio syndrome must make «semi-verbal possibilities» available. The authors stress the necessity of staging the patient's determining conflicts. This implies, above all, an unlimited, exaggerated acceptance of what is feared by the patient. Patients who suffer from gelotophobic symptoms, therefore, can benefit from enacting a «paradoxical intention» in the sense that Viktor E. Frankl (cf. 1960) wrote about. Frankl (1959: 164) states, «The doctor must not feel embarrassed to tell the patient about the courage to be ridiculous, and he has to demonstrate this ridiculous behavior as well.»

11.1 Shame-attacking exercises
In this context, Albert Ellis deserves credit for his pioneering work. At the beginning of his professional career, Ellis was trained in psychoanalytic therapy. His training analyst was Richard Huelsenbeck, who was also one of the founders of the Dadaist movement (cf. Titze 2006). In 1955, Ellis developed Rational-Emotive Therapy (RET), which has become one of the most influential therapeutic systems of our time. While rationality plays a central role in RET, it is quite obvious that Ellis (cf. 2001) uses important Dadaist elements in his therapeutic approach. One example is his «shame-attacking exercises,» which have proven to be especially successful in the treatment of social phobia. During the course of these exercises, clients are encouraged to be foolish and engage in «shameful» acts such as: a) saying something stupid, b) confessing an embarrassing weakness like: «I can't spell», c) acting funny, such as singing aloud when one has an awful voice or using a black umbrella on a bright day, d) saying something lecherous, e) asking a shoemaker for a wristwatch, f) calling out the stops in a loud voice while riding a bus or trolley, and g) asking other passengers what day it is.

11.2 Humordrama
Sellschopp-Rüppel and von Rad recommend a group therapy setting that should take a direction «away from their compulsion to adapt to the norm.» (1977: 361) This intention can be well achieved through humordrama, which is a paradoxical procedure that incorporates the sphere of body movements and emotional expressions. Humordrama was designed to implement Frankl's paradoxical intention into the setting of group therapy (Titze, 1995, 1996, 2007). This procedure was best accepted by patients when a second therapist, acting as a non-threatening and encouraging therapeutic clown, was present.

Clownish reduction and playful assertiveness are the basic tools of humordrama. They aim at invalidating the perfectionist attitude of individuals who want to avoid potentially ridiculous situations. During the past fifteen years, this author has applied humordrama to patients with circumscribed gelotophobic symptoms. The technique has been described (Titze 1995, 1996, 1998, 2007) and presented at professional congresses (Titze 2002). A training program was conducted in the Hospitalhof Stuttgart (Germany) from 2000 to 2003. However, the efficacy of this procedure has not yet been empirically evaluated.

Humordramatic treatment is based on a psychodynamic rationale and makes use of the patients' assertive resources. A fundamental issue is the working-through of incidents in the protagonist's everyday life that are associated with feelings of shame and experiences of being ridiculous. These experiences are then linked up with earlier shame-related events that occurred during the patients' formative years. This treatment approach sticks to the principles of an uncovering dynamic psychotherapy as elaborated by Salameh (1987). In this context, immediate occurrences (the here and now of the group therapy situation) are linked up with recent life events, which are then connected to significant events dating back to the patient's early childhood years. Once these linkages are made, the focus shifts to the experiencing of specific feelings or events related to the fear of doing or saying something wrong. Such experiences are, in a second step, staged by the protagonists by means of creative «clownish reduction» (cf. Titze 1996).

11.3 Paradoxically intending to be a «real clown»
Psychoanalyst Martin Grotjahn (1966: 107) observed that each clown is a creative artist and, like an analyst, an interpreter as well. But in contrast to a scientist, a clown does not explain the objective facts of the external world. Rather, he or she interprets the subjective perceptions of «the interior world.»

In this scenario, the therapeutic clown stands by the patient as an auxiliary ego. He or she functions as an impudent model of identification that paves the way for a joyful and assertive conduct of life. By doing so, he or she differs significantly from earlier authority figures that may have fostered the development of the patient's shame-bound behavior patterns. By facilitating this liberating effect, the therapeutic clown is completely in line with the native American-Indian trickster tradition (Radin 1987).

In this context, the protagonists learn to deliberately behave as «real clowns«: as persons paradoxically doing everything in their power to make others laugh. In order to achieve this goal, these patients have to take up the same cognitive pattern and the same emotional and behavioral attitudes a clown has. In this way they can regain control over ignominious patterns of conduct, which were lost in the course of their socialization. This repeated experience of self-determination gives rise to an immunization against the specific helplessness that is the noxious aftereffect of the fear of laughter.

11.4 Clownish reduction
Clowns usually act out on the level of children who have only limited verbal capabilities. Precisely this reduced competence is adapted in therapeutic clownery. The clown's performance proves that a ridiculous appearance not only triggers amusement but can also function as a means of joyful assertiveness. Thus, the clown is the figurehead of funny individuals. The clownish performance mirrors the mechanical stiffness or absentmindedness of ridiculous humans. Clowns behave like infants who cannot control their body functions or are not able to speak correctly. As Constantin von Barloewen (1981: 92) observes, «clowns can do without language, rather they replace correct speaking by muteness and stammering, which will eventually prove to be more eloquent, the more it appears incomprehensible.»

The clown's nose is an important tool in humordrama, since this false nose is used to indicate that the sphere of «normal adult life» is set aside. As soon as a patient uses this nose, he or she takes on the identity of a clown. Thus, the patient is assuming the identity of a small child whose skills originate from another sphere than that of adult everyday routine. A female patient, aged 48 years, who had been sexually abused during childhood, wrote about her clown nose:

«The clown nose is a mask, and my mask is the clown nose. Most important is the fact that I can mask my face with this false nose. The idea of 'losing face' immediately loses its fright when I put on the clown nose because I lose the face I am ashamed of. This is not at all disgraceful but rather liberating. Because I lost my dignity during childhood, I have had to live my everyday life shamefully. Thus, my everyday face indicates to everyone that I lost face when I was a child. But the clown nose frees me from this shame. It frees me from my 'lost face'. This red, spherical, artificial nose allows me to block my shame. This nose gives me the feeling that my old hated face has disappeared, except for my eyes and lips of which I am ashamed. When I put on the clown nose, a new illusion is created as I become another person -- a new, released human. It's amazing how I can free myself (of my foisted image of an abused and 'fallen' girl) when these 5 square inches of red rubber cover my nose! I can also put it this way: With my usual persona, with which I have identified since childhood, I desperately try to uphold something that, paradoxically, causes my shame. But the clown nose opens the way to a new identity: It frees me from an impinged image. The clown removes my old, hated persona. Oh, how easy, how full of joie de vivre is a clown's life! And how hostile, how depressing is a life with the shameful mark of Cain on my face.» (translation by the author)

During humordrama group treatment, the therapeutic clown demonstrates the essentials of clownish reduction. For example, he or she may significantly slow down his or her gesturing so that his or her arm and head movements now proceed in slow-motion. Furthermore, the clown may take small, choppy steps, with straightened arms and knees, creating body movements that are just as amusing as the clumsy trials of an infant attempting to walk.

In order to help clowning patients to grow into this routine, they may, for instance, be encouraged to bind their legs together with ribbons or scarves, which make walking and moving more difficult. This impediment then becomes the prerequisite for putting on a clownish gait (à la Charlie Chaplin, for instance).

While staging shameful experiences, the patients involved are encouraged to change their speech rhythms. They may, for instance, put their tongue between their teeth or take in some water and keep it in their mouth while speaking. Another possibility is to consciously mumble, speak with a twang, or breathe in while speaking.

With this clownish reduction, even the most depressing biographical events can be qualitatively reshaped in a sweeping and humorous way. A 28-year-old male patient made the following comments about these techniques:

«Speaking was connected with great fears and shame. I felt inferior in relation to my colleagues and friends, in a way that was intolerable for me. As soon as I realized I had started to stammer or stutter, a deep despair came over me that further increased my shyness. While exercising clownish reduction, I noticed that I am able to intentionally (and with great joy and fun!) produce exactly the same strange and pressured behavior. The laughter I cause thereby no longer goes against me. It is the acknowledgment of my success as a comedian.» (translation by the author)

A similar reaction was reported by a female patient, aged 37 years, who is a teacher by occupation:
«At one of the first group meetings, I presented my big problem, which was that I had to address a parents' meeting! I suffered from a speech impediment, heart palpitations, mouth dryness, breathing difficulties, and, above all, the fear of a panic attack. In humordrama, I had to play that I was addressing the parents' meeting. The other group participants played the roles of very annoyed, critical, and disparaging parents. In my own role as a teacher, I had to exaggerate all of my symptoms as comically as possible. So I tried my best to clearly let out signs of my shame-anxiety. Simultaneously, the 'parents' sitting in front of me did their best to create turmoil. I gradually seethed with rage! My rage was additionally boosted by the therapeutic clown. She goaded me with all the means at her disposal. The staccato of crazy shouts that rained down on me was totally unimportant for me - the only thing I was concentrating on was my rage! Weeks later, I actually lived this situation during another parents' meeting. Now I stood in front of these people, and I suddenly recollected this role playing. At that moment my rage came up again. I took on the role of the impudent clown and heard myself say: 'Dear parents, I stand here before you in full, hopeless shame ...' I spoke these words with a clear, firm, and vigorous voice. And when I saw them laughing in disbelief, I knew I had won! I clearly recognized that they were not laughing at me. Rather, they were laughing at a really funny joke. The rest of the meeting was completely problem-free. This wonderful experience was a turning point. Since that time my self-confidence has grown enormously!» (translation by the author)

11.5 Stepping out of line
With the help of the therapeutic clown (acting as a non-threatening co-therapist), the patient is literally encouraged to joyfully step out of line. Usually, the patient's life history would have dictated that embarrassing incidents should be covered up, with patients forcing themselves to act in an unflappable manner so as to appear «normal.» However, humordrama groups encourage patients to act in the opposite direction of their dysfunctional patterns. All the hyper-rationalistic problem-solving patterns related to the patient's shame-bound socialization are eliminated and reduced to the simple playfulness of a light-hearted child. The therapeutic clown physically and symbolically acts out this position and helps patients to identify with this attitude.

The therapeutic clown's specific role is to ensure that the patient's self-controlling patterns and hyper-rational thinking are excluded from the range of possible responses. This goal can be achieved by distracting the patient with diverse means. For instance, when the patient exhibits self-controlling patterns, the clown may grab the patient's arm and run, dance, or hop with him or her for as long as the pattern lasts. In order to divert the patient, the clown may also encourage him or her to babble in «Chinese» or «Kisuaheli.» This work follows the same «logic» as the practice of Zen Kôans or other apparently nonsensical stories or questions that help deactivate the obsessive explanatory web woven by the rational mind and its attendant behavioral compulsions (Salameh, 1995). A 33-year-old male patient described his reactions to this type of work as follows:
«This is a very useful exercise that I practice very gladly and that helps me set off plenty of creative energy. The variable arrangements and the determined dedication of the therapeutic clown impress me again and again. I have learned to face a multiplicity of problem situations in a much more spontaneous way. Now I manage to go to work in a relaxed manner. Before this internal switch was turned off, there was an almost insurmountable wall of pressure to perform and many fears and expectations in my head.» (translation by the author)

11.6 Conclusion
The neurotic obsession with hypercritical self-control, which is typical for gelotophobes, can hardly be resolved at the level of cognitive reorientation. It requires a holistic change of attitude including the affective and corporal sphere. This can be readily facilitated with humordrama, which was designed to activate the creative resources within the patient. Thus the laughter that patients elicit in this context has a different color: This laughter is no longer experienced as derision but as an appreciative confirmation of the patient's success at creative humorous acting. As evidenced by the self-reports above, each of these patients was successful at presenting himself or herself as a «real» clown, i.e., a person who is «ready for the stage.» By experiencing this assertive success, a productive shift may frequently occur, resulting, moreover, in a reduction of gelotophobic symptoms.


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