HUMR.2009, Biti Ismejan

Gelotophobia: The fear of being laughed at

MICHAEL TITZE

Abstract

Gelotophobia may be considered as a specific variant of shame-bound anxi-

ety. 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 re-

peated exposure to ‘‘put-down,’’ mockery and ridicule in the course of so-

cialization. Gelotophobes constantly fear being screened by others for evi-

dence 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 o¤ense, and a result-

ing social withdrawal (Titze 1995, 1996). The origins and consequences of

gelotophobia are described, and a model of specific treatment is presented.

Keywords: Gelotophobia; humordrama; involuntary clown; Pinocchio com-

plex; ridicule; shame-bound anxiety; social phobia.

1. Introduction

Laughing at people who are perceived as inferiors is an essential ingredi-

ent 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, de-

formations, weakness and ugliness in fellow-men (cf. Janko 2002). In

Plato’s analysis of comedy, entitled ‘‘Philebus’’ (Plato 1993), the percep-

tion of failures, su¤erings 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

Humor 22–1/2 (2009), 27–48 0933–1719/09/0022–0027

DOI 10.1515/HUMR.2009.002 6 Walter de Gruyter

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 ethol-

ogists as well. Eibl-Eibesfeldt (1975) suggested, for instance, that the orig-

inal significance of laughter was a threatening gesture, having its phyloge-

netic 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 ridicu-

lous object for others through ‘‘mechanical encrustation’’ of living dy-

namics, i.e., of the flexibility and elasticity of the body’s postures, ges-

tures, 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 (2004) 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 su¤ering 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, accompa-

nied, 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 ef-

fect on the observer. Therefore, the objectivized person, on principle, is a

ridiculous object: In this way shame is generated.

3. Shame-bound anxiety

Wurmser (1994: 73) states that shame, analytically seen, is a type of anx-

iety, namely shame-anxiety. He illustrates this contention with the follow-

28 M. Titze

ing 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 ex-

pect rejection by others, and thus they su¤er 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 care-

fully scanned.

Because the human face is a primary organ of communication (cf.

Ekman and Friesen 1975), being mimicked is the main target of avoid-

ance by patients su¤ering from shame-bound anxiety. The (unconscious)

purpose is to protect the self from enduring the shock of being disparaged

or sco¤ed at by others. Thus, the preventive function of shame-bound

anxiety is to avoid those social situations that, subjectively (and fre-

quently 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 be-

havior is a primary feature of gelotophobia. Additionally, gelotophobes

assume they are completely ridiculous in the eyes of their peers. (There-

fore, 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 convic-

tion that such situations invite ridicule and, thus, could disclose the con-

cealed stigma of being a contemptible outsider. Consequently, the main

purpose of individuals su¤ering from gelotophobia is to protect them-

selves from being laughed at by others. Precisely this timidity, then, opens

up the risk for being the permanent butt of mockery and derisive laugh-

ter. 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 distur-

bance. For those being a¤ected by gelotophobia, the closeness and the intimacy

that occur when laughing with others have such an uncontrollable and menacing

e¤ect that they become deeply frightened. (translation by the author)

Gelotophobia 29

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 emo-

tional 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 dis-

tress. [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., pre-

occupation with fear of negative evaluation or embarrassment, a ten-

dency to avoid social situations, and physiological dysfunctions such as

palpitations, trembling, nausea, and blushing). Yet no special e¤orts 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 bi-

ased 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 en-

dure is the punishment for this failure.’’ In regard to such function disor-

ders, the self is evaluated only in a secondary step; it is not itself the pri-

mary focus of negative evaluation. This seems to suggest that the theory

30 M. Titze

of social phobia focuses on specific inexcusable failures of the person con-

cerned (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 expe-

rienced their early reference person/s (in many cases su¤ering from gelo-

tophobic problems as well) as lacking a smiling face. The face geloto-

phobes recollect from childhood, therefore, can be likened to the stony

countenance of a sphinx, having a blank expression and appearing disin-

terested 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 re-

flecting a cheerful and self-confident imperturbability. Rather, their fel-

lows seem to be hostile strangers who treat them in a cold, sarcastic, and

disparaging way. One decisive weapon these strangers might use is deri-

sive 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 laugh-

ter 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 con-

stantly send nonverbal cues that indicate that they feel very uneasy.

Therefore, muscular tension and sti¤ness, as a consequence of emotional

panic, are frequently developed. Also, specific physiological symptoms

Gelotophobia 31

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 dis-

criminating 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 sponta-

neous 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-Ruppell 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 facili-

tated by specific childhood conditions, having their roots in early parents-

child interactions (cf. Schneier et al. 2004; Sellschopp-Ruppell 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 con-

form 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 ex-

posed to parenting styles that are overprotective, involve little display of

a¤ection, and use shame as a method of discipline (Schneier et al. 2004).

Further etiologic details have been listed by Sellschopp-Ruppell and von

Rad (1977: 359):

32 M. Titze

(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 be-

lief 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 par-

ents may respond with shame-inducing punishment in the form of love

withdrawal, disregard and, above all, ridicule. This punishment is to en-

sure conformity to the parental demands and thereby stabilize the idio-

syncratic structure of the family. Not fitting into this normative configu-

ration 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 de-

veloped 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 pu-

berty. 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

di¤ers 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.

Gelotophobia 33

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: ch. 3). In this

context, the preservation of group norms is another function of disparag-

ing humor. Those behaving contrary to prevailing group norms will expe-

rience a ‘‘punishing laughter,’’ which forces them back to the group’s nor-

mative expectations.

Youngsters, however, who lack the capability of anticipating and un-

derstanding 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 dispar-

aging 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 compari-

sons.’’ He states, ‘‘In comparison terms humor a¤ords the audience an

opportunity to assuage their own insecurities through favorable compa-

rison with another person’s misfortune, frustration, foolishness, imper-

fection, blundering, embarrassment, posturing, or stupidity.’’ Zillmann

(1983) concluded that all forms of destructive humor are directed at indi-

viduals who are perceived in a negative, o¤-putting way. This applies spe-

cifically 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: 36¤ ) states that a scapegoat fulfills an important

task in the dynamics of the group. He or she is assigned all the weak-

nesses and illnesses of the group. By making the scapegoat the victim of

disparaging humor, other group members can gain a feeling of superior-

ity. 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

34 M. Titze

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 anxi-

ety when interacting with others, constant lowering of self-esteem, feel-

ings of insecurity, self-consciousness, sadness and shame, and, as a conse-

quence, 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 los-

ing control [ . . . ].’’

8. Clinical vignette

A 30-year-old female patient sought clinical treatment because of multi-

ple psychosomatic problems: tension headache, sleep disorder, stomach-

cramps, vertigo, hot flashes, and trembling. Gradually it became evident

that the patient was su¤ering from severe shame-bound anxiety, accom-

panied by paranoid fears, problems with blushing and psychomotor sti¤-

ness. 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 a¤ectively re-

strained and awkward. Thus the diagnosis of a ‘‘Pinocchio syndrome’’

(cf. Section 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 be-

haved di¤erently 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 conse-

quence was that, since pre-school, other children made fun of her.

Gelotophobia 35

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 su¤ering: A classmate started to call me ‘Miss Gar-

like’. 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 sco‰ng 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 o¤. 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 ‘en-

dure’ 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 scorn-

ful laugh, crossed pencils against me — as if I were a vampire!

I grew more and more sti¤ out of shame. And I constantly asked myself the ques-

tion, ‘What is so terrible with me? Am I a complete monster?’ This negative solil-

oquizing 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 in-

formed about it. So strong was my shame! (translation by the author)

9. Current personality studies

New evidence about gelotophobes stems from personality studies. For ex-

ample, Ruch (2004) reported that gelotophobes tend to be introverted

36 M. Titze

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 this issue). 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 experi-

ence with these patients. Later, those impressions are formalized into a

facet model (cf. Section 10.1), and finally, a questionnaire assessment is

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, di‰culty 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 geloto-

phobia 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 con-

text, they mostly will react ‘‘agelotically,’’ i.e., their face will grow sti¤

and their possible polite smiling will freeze. In the treatment professional

person, a specific ‘‘counter-transference’’ might emerge, containing am-

bivalent 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 geloto-

phobia were defined (Ruch and Titze 1998). This was achieved by associ-

ating the constitutive nosological elements of gelotophobia with typical

statements of gelotophobic patients:

– Traumatizing experiences with laughter and mockery in the past: ‘‘During pu-

berty I avoided contact with peers so that I wouldn’t be teased by them.’’ —

‘‘When I was in school, I was teased quite often.’’

Gelotophobia 37

– 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 pos-

ture 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 di‰cult 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 some-

where, 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 unidi-

mensional (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 geloto-

phobia (¼ GELOPH 46) was compiled (Ruch and Titze 1998) and used

to explore di¤erences between various clinical groups and normal con-

trols. 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

2008a). Applying several criteria helped to identify a subgroup of state-

ments that allow for a short, e‰cient and valid separation of the groups.

While the list of statements is much shorter, its reliability was not im-

paired (Ruch and Proyer 2008b). 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;

38 M. Titze

Proyer et al. 2005). However, more information regarding validity needs

to be provided.

11. Treatment of gelotophobia

Those who su¤er from gelotophobic symptoms inevitably find themselves

in the position of involuntary clowns: individuals who make others 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. Sec-

tion 6) due to its puppet-like appearance.

Sellschopp-Ruppell 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 suf-

fer 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 embar-

rassed 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 ratio-

nality plays a central role in RET, it is quite obvious that Ellis (cf. 2001)

uses important Dadaist elements in his therapeutic approach. One exam-

ple 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

Gelotophobia 39

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) say-

ing something lecherous, e) asking a shoemaker for a wristwatch, f ) call-

ing out the stops in a loud voice while riding a bus or trolley, and g) ask-

ing other passengers what day it is.

11.2. Humordrama

Sellschopp-Ruppel and von Rad (1977: 361) recommend a group therapy

setting that should take a direction ‘‘away from their compulsion to adapt

to the norm.’’ 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 im-

plement 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 hu-

mordrama. They aim at invalidating the perfectionist attitude of individ-

uals who want to avoid potentially ridiculous situations. During the past

fifteen years, this author has applied humordrama to patients with cir-

cumscribed 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 Stutt-

gart (Germany) from 2000 to 2003. However, the e‰cacy of this proce-

dure 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 psychother-

apy as elaborated by Salameh (1987). In this context, immediate occur-

rences (the here and now of the group therapy situation) are linked up

with recent life events, which are then connected to significant events dat-

ing back to the patient’s early childhood years. Once these linkages are

made, the focus shifts to the experiencing of specific feelings or events re-

40 M. Titze

lated 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 inte-

rior world.’’

In this scenario, the therapeutic clown stands by the patient as an aux-

iliary 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 di¤ers significantly from earlier authority figures that may have fos-

tered the development of the patient’s shame-bound behavior patterns.

By facilitating this liberating e¤ect, 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 behav-

ioral attitudes a clown has. In this way they can regain control over igno-

minious patterns of conduct, which were lost in the course of their social-

ization. This repeated experience of self-determination gives rise to an

immunization against the specific helplessness that is the noxious after-

e¤ect of the fear of laughter.

11.4. Clownish reduction

Clowns usually act out on the level of children who have only limited ver-

bal capabilities. Precisely this reduced competence is adapted in therapeu-

tic clownery. The clown’s performance proves that a ridiculous appear-

ance not only triggers amusement but can also function as a means of

joyful assertiveness. Thus, the clown is the figurehead of funny individ-

uals. The clownish performance mirrors the mechanical sti¤ness or ab-

sentmindedness of ridiculous humans. Clowns behave like infants who

Gelotophobia 41

cannot control their body functions or are 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’ imme-

diately 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 my-

self (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 some-

thing 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 demon-

strates 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

42 M. Titze

scarves, which make walking and moving more di‰cult. This impediment

then becomes the prerequisite for putting on a clownish gait (a la Charlie

Chaplin, for instance).

While staging shameful experiences, the patients involved are encour-

aged 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 real-

ized 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 su¤ered from a speech impediment, heart pal-

pitations, mouth dryness, breathing di‰culties, 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 dis-

paraging 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 dis-

posal. The staccato of crazy shouts that rained down on me was totally unimpor-

tant 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

Gelotophobia 43

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, humor-

drama groups encourage patients to act in the opposite direction of their

dysfunctional patterns. All the hyper-rationalistic problem-solving pat-

terns related to the patient’s shame-bound socialization are eliminated

and reduced to the simple playfulness of a light-hearted child. The thera-

peutic 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 Koans or other apparently nonsensical stories or ques-

tions that help deactivate the obsessive explanatory web woven by the ra-

tional 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 o¤

plenty of creative energy. The variable arrangements and the determined dedica-

tion 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 man-

age to go to work in a relaxed manner. Before this internal switch was turned o¤,

there was an almost insurmountable wall of pressure to perform and many fears

and expectations in my head. (translation by the author)

44 M. Titze

12. Conclusion

The neurotic obsession with hypercritical self-control, which is typical for

gelotophobes, can hardly be resolved at the level of cognitive reorienta-

tion. It requires a holistic change of attitude including the a¤ective 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 di¤erent color: This

laughter is no longer experienced as derision but as an appreciative con-

firmation of the patient’s success at creative humorous acting. As evi-

denced 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 geloto-

phobic symptoms.

HumorCare, Germany

Note

Correspondence address: [email protected]

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