Copyright The HUMOR Project, Inc 1990 -- All rights reserved
This first appeared in Laughing Matters Volume 6, Number 4

I first had the good fortune to rendezvous with Bernie Siegel, M.D., when we were both speaking at a conference in 1982 on "Love and Laughter." I am delighted that Bernie will be the lead-off keynote speaker at our fifth annual conference on "The Positive Power of Humor and Creativity."

In between these two conferences, Bernie has had two nationwide best-selling books, LOVE, MEDICINE & MIRACLES and PEACE, LOVE & HEALING (just released in paperback this week).

In 1978, Bernie started ECaP (Exceptional Cancer Patients), a specific form of individual and group therapy utilizing patients' dreams, drawings, and images. ECaP is based on "carefrontation", a loving, therapeutic, true "social security" system which facilitates personal change and healing.

Drawing from the work of Carl Jung, Milton Erickson, and Woody Allen, Bernie explores the role of hope, unconditional love, laughter, spirituality, and unconscious beliefs in the healing process. A much- sought-after public speaker, Bernie shares his many experiences with people who have risen to the challenge of chronic or catastrophic illness.

He believes that "love, laughter, and peace of mind are physiologic" and that there is no such thing as "false hope." Bernie encourages people to "play an active role in their health care, not demanding that they get well. Exceptional patients don't try to die. They try to live until they die. Then they are successes, no matter what the outcome of their disease, because they have healed their lives. It is important that we realize that we can never cure everything...but we can, as doctors, as family and as friends, care for everyone."

Bernie cares a lot about Bobbie, his "traveling companion" for over 35 years. Bobbie playfully describes herself as Bernie's accessory cerebral cortex. Together, they have co-authored many articles and five children. Their home resembles a cross between a family art gallery, a zoo, a museum, and an automobile repair shop.

Here's a chance for readers of LAUGHING MATTERS to open your eyes, mind, and heart and to take in some of Bernie's serious prescriptions and comic spirituality.

Joel Goodman: In your work over the years with exceptional cancer patients and others, what have you learned about the difference between curing and caring?

Bernie S. Siegel: As many of them have said, "I didn't set out to cure myself; I set out to experience love before I died." What's powerful about these people is that they have seen their mortality clearly not as a death sentence, but as a life sentence. Science is catching up now-- we're beginning to say that it's scientific to feel good and to love and laugh. Love and laughter are physiologic.

Money is always being donated to cure disease, so people will die of something else. I think if we spent as much money on caring for each other as we do on trying to cure things, we would have a lot of people living a lot longer and many fewer would get sick in the first place, because their lives would heal.

I'm always amazed at how many groups I talk to...the lawyers call me, the librarians call me, the school teachers call.... Everybody's got the same question: How do I find happiness at my work and in relationships?

JG: Your notion is that "Happiness is an inside job." How could we use this important concept inside a serious health care facility?

BSS: LOVE, MEDICINE AND MIRACLES stirred the waters and created change. That's why there is music in virtually every operating room in New Haven today, although when I first brought in my tape recorder I was considered an explosion hazard.

I would love to put a closed-circuit television program in the hospital with preoperative preparation, meditation, laughter, healing imagery, music. I mean this literally-- you could save millions of dollars, people would go home sooner and have less pain. Wellness is cost-effective! But when you're trying to do it in a private hospital, you get through the board meetings and the this meeting and the that meeting, and "It will cost us a couple thousand, and we'd rather buy a new machine to diagnose something."

I'd like to walk into a hospital and say, "Look folks, do you want to save a fortune? Give me your television; I'll set up a program for you." It will be available for the patients' educational process. Then their surgery would, in essence, be a guided imagery. They would watch somebody go to the operating room, come out again, and be discharged perfectly well. You'd be familiar with the place and sounds and the people, and it would be a successful imagery. And then there would be the meditation and laughter that could be sequential.

There is a movement today to reintroduce medical students to their patients as human beings, not diseases. That movement will spread, because it will be successful for both patient and doctor. If nothing else, today's consumer-conscious patients will pass the word among themselves, and the doctors who have gotten the message will get their business.

JG: Since the publication of your books, what kind of messages have you been receiving? Does everybody see your point of view? Is "seeing believing" or is "believing seeing?"

BSS: Another way of putting that is that if everybody is an addict, they are addicted to beliefs, so that you never see what you don't believe. I mean that literally. I learned a lot about the unconscious from using artwork with people. They do a drawing and don't see what they put on the paper until later. And the same thing is true of physicians. You can give them articles to read, and what they don't believe they literally don't see. Getting back to shifting belief systems was more important than throwing statistics at people. When you shifted their beliefs, then they began to see and you had something you could talk about, because then they were open. Anecdotes didn't upset people, because they would leave a conference saying, "Well, that's only an anecdote." And I'd say, "That's right, but anecdotes are true. And if an anecdote walks into your office, don't kill it." And then we'd begin to share.

JG: One of the things that we've been doing through The HUMOR Project is sharing, because one of the beliefs I have is "what goes 'round comes 'round. What you put out there will come back with interest." So, we've given money in the last couple years to 36 different organizations. What we have been discovering is that the anecdotes that come back-- along with the statistical research-- are so powerful and so encouraging, that just the volume of them is helping develop some additional momentum.

BSS: The next book that we write should be "Letters to Bernie." Our mail is incredible. If I could get every doctor to read my mail, there would be nothing to argue about.

JG: Maybe that could be one of the courses in med school-- "Letters to Bernie 101." By the way, have you written any letters to yourself?

BSS: The book, ALL I REALLY NEED TO KNOW I LEARNED IN KINDERGARTEN, is about everybody's life. If we keep notes on our life, we'd have a book.

A number of years ago, because of my unhappiness, I started keeping a journal. It was spontaneous-- something I now tell everybody to do. What I realized, more from Bobbie who had read my journal, was that I left the humor out. She would said, "You know at dinner, you would tell the kids all the funny things that would happen at the hospital, and then before bedtime you sit there and write about all this pain." I realized I forgot what kept me going, how I got through the day. What gets you through it, a lot of times, are those little moments of craziness and laughter.

When I teach love and I pull up behind a car that says, "Honk if you love Jesus," and I honk and the guy turns around and gives me an obscene gesture-- that's the stuff that makes you laugh and gets you through the day. I think that's the part that I began to realize and then started saying to people, "Pay attention to the laughter. Make notes about what was funny in the daytime."

One woman in the hospital said, "I'm dying. I was just told I'm dying." And I said, "What are you doing here?" She looked at me like I'm nuts, and I said, "Well, if I were dying I wouldn't sit here. I'd get up and go home and sit on my porch." You could see life come back into her. Suddenly she said, "You know, it's a good idea." Five days later she didn't die and was discharged.

JG: I know that you like to leave people with something to smile about.

BSS: I don't say I've got to have a joke for people today. It's just what's happening in the moment. A friend of ours (a stockbroker) had cancer. I looked at his hospital door one day, and he had all the vital signs, so I wrote the Dow Jones average and put that in with blood pressure, temperature and pulse, because I thought that's as important as everything else. People should know if his vital signs change, it may hurt the Dow Jones average and not his disease. When he came out and looked at his door, he also laughed.

Our daughter Carolyn handed me a cartoon one day that showed a gentleman waking up and saying, "I feel great, what a beautiful day, I'll call in sick." Of course, we often think we have to get sick in order to get the rest or pleasure we need in our lives. Bobbie and I therefore taught our children when they were younger that if they needed a day off from school, they should just say that and take a health day, not a sick day. That made them look at life differently. I think all of us need to rethink our attitudes toward health and sickness. When one of our kids was in the hospital, I tied a whole bunch of rubber gloves together and labeled each one as part of his attending staff that were coming in. I strung them together with balloons on the door with the names and expressions, and I did it just to get people to understand that it's okay to smile here. You know, there's a human being inside.

JG: What about the child inside your human being?

BSS: Out of adversity came good, and I think my parents always saw things as redirections and humor was always a part of it. Even in my college-- with all the lab work and homework-- it was hard work. When I go back to college reunions, people say, "I remember you. You were smiling all the time." I thought, "I was smiling all the time?" I don't remember smiling all the time, but I guess there was always this part of me that came through, so it's always been a big part for my life.

Another part of me-- the sensitive part-- felt everybody's pain, because obviously, even though I smiled, I think if I weren't hurting it wouldn't have happened either. I can remember as a camp counselor when we'd have a baseball game, I'd pick the worst players first-- the kids who were totally clumsy, couldn't catch, couldn't hit, couldn't do anything. And then their parents would come in and say, "Stewart has hated camp until this year," and I realized it was because somebody had said, "Hey Stewart, I love you. You can be on my team." We'd always lose, but who cared. The kids were so thrilled that they weren't standing at the end, you know how you feel when you're at a game and you're the last kid. "Oh, we got to take him now."

I was always noisy. We had a big extended family-- lots and lots of relatives. Bobbie was the one who helped me realize just how noisy my family was, because for us it was normal. If you came into a room, you just talked-- louder. You didn't wait for somebody to finish; you just talked. And everybody would end up talking, so by the time the thirtieth person arrived, you just shouted.

JG: It sounds like a scene from a Woody Allen movie. I know that Woody Allen is one of your mentors, models and teachers....

BSS: I think that he uniquely puts together the pain and the humor. In the movie, SLEEPER, he wakes up in the future saying, "Where are my friends? They're dead. How could they be? They ate organic rice." And then there's his line, "When I die, I'm taking a change of underwear; I don't know if there's a life after death."

JG: Woody Allen had a great article in THE NEW YORK TIMES back in 1979. It was called, "My Speech To The Graduates." It opens with, "More than at any other time in history, humankind faces a crossroads. One path leads to despair and utter hopelessness. The other, to total extinction. Let us pray we have the wisdom to choose correctly."

BSS: When we finish our workshops, everybody is in a big circle, and we tell that one.

JG: You talk about how important it is to accept ourselves, and self-acceptance being the initial ingredient in healing. Are there parts of yourself that require a laughter prescription?

BSS: I still feel that I am working on me. Though I'm lovable, I'm still a heck of a problem. On certain days, you might say I find it difficult to go up on the stage unless I'm living it, and so I try to live the message and do all the things I'm asking people to do, so I know the difficulties, I know the struggle, and keep working at it.

When people say, "How are you?" I say, "Better". And then they say, "Oh I didn't know anything was wrong," and I say, "I didn't say anything was wrong. I said I'm better, and I'll be better tomorrow." It's coming up with answers that people don't expect.

JG: What about negaholics-- folks who are always negative?

BSS: Pessimists may have a more accurate view of the world but they get sicker and die faster. So I would rather be an optimist with a less accurate view of the world. It's healthier, that's all. It's like looking at disease, concentration camps. What is survival about? Survival is about loving, laughing, caring, living in the moment, not worrying about next week.

Woody Allen said, "Life is full of opportunities and pitfalls, and our job is to seize the opportunities, avoid the pitfalls and be home by 6:00." Life is to be enjoyed. I know from all the people I've worked with that I can survive any event that happens.

One day I was reassuring a woman in her hospital room about what a wonderful challenge she faced in trying to exercise control over her illness, her life and even her death. Finally, I got so carried away with my theme that I blurted out, "You can even survive dying." I suddenly realized how absurd this was as she just busted out laughing, and everything was fine.

I also use paradox. Some people come into the operating room in total fear and panic. One lady looked around-- I could see the fear-- and she said, "Thank God all of you wonderful people are taking care of me." I leaned over and whispered in her ear, "I know them. They are not wonderful people." She took a look at me and then suddenly...the laughter erupted and the fear was gone.

Genuine humor is therapeutic. There was a woman with carcinoma of the tongue who had extensive radiation, and I had promised I'd visit her. On the way to give a lecture I stopped at her house. The sight was horrendous; her head was like a mellon with edema. She had her head tilted so one eye would stay open so the edema would settle down, her neck was bulging, her tongue was out of her mouth with swelling. When I stood in the doorway, my thought was, "How am I going to get out of here in five minutes without hurting her feelings?" I sat down, and she picked up a yellow pad because she couldn't talk, and wrote something to me. I read it, wrote an answer, and I gave it back to her. Then she wrote on it and gave it back to me. When I read it, it said, "You can talk." Then, I just broke out in a big smile and literally, an hour later I gave her a hug and kiss because she became transformed into something beautiful at that moment. She was more alive and had a better sense of humor in the midst of this than I had.

JG: It's really wonderful to me how you have learned from and with your patients and by passing on these lessons, you reach and teach many others.

BSS: I think that's what happens. My success is based on being a good listener, that's all. I think that I have an ability to pull together a lot of things. That's probably one of the things I'm good at-- listening to science, to survivors, and integrating it in my mind and presenting it in a way that other people can hear other people.

I weave people between science and spirituality. So I can take physicians and start talking about neuropeptides and science and weave back into spirituality and feelings, and they hang on. When it's a certain point, you say, "OK, I've got to move back now towards science, or I'm going to lose them." You keep doing that, and the other is weaving between tragedy and humor, because people can only handle... There are audiences where there is a total hush, and you know everybody is in pain. They can only take that for so long, and you bring them into humor. They go home saying, "I laughed and I cried. Thank you." I think a lot of the thanks I get are from people whose family members have died. They're not thanking you because you cured Uncle Joe but because you helped them deal with and get through the death and loss. That's what humor helps people do-- humor brings people back from tragedy.

I just pass the word, and I think when we go to AIDS conferences, when we go to cancer meetings and meeting people that I call survivors...again, it doesn't have to do with cure. It has to do with surviving life's difficulties, so they're up there sharing their humor. One patient said, "I was a vegetarian... I had Haagen Daas, coffee and French bread. And I still got sick!" These people have wit and charm and laughter in the midst of all these catastrophes. I'm seeing the effects of consciousness that we're beginning to study. When we send love and laughter into the world, we're changing the world consciously. Those who choose to be lovers and laughers are helping the world. The point I also make over and over again is that if you meet somebody who is genuinely happy, it is not because God missed them. They are choosing that.

Every time I say this I think of the maintenance worker at the hospital who was an incredibly wonderful, loving man. My comment was, "I guess if you work in a sub-basement God misses you and you get out of it." My thought was, "Here is a guy who is an exception to the rule. Great life, no problems-- that's why he is this way." Then I was invited to speak to a group made up of the parents of children who had died. When we each introduced ourselves, that same man told how his two-year-old had just died of leukemia, and I couldn't believe it-- the beauty of this man. I realized what a beautiful, powerful man he was. He had made a choice about how he was going to live his life.

I see many people who make life-affirming choices about how to respond to events. Being human means you get to share a lot of laughter as well as hugs and kisses. One of my partners, Bill McCullough, who is a human being as well as a surgeon, was doing some rectal surgery and asked Maureen, the nurse, to shine the light on the asshole. She replied, "Which one?" Nurses like that are really an enormous help to us. They help us to deal with our pain as surgeons, they let us know they care, and, in case we forget, they remind us that we're human. You know when that kind of humor can come out, you have made it.

What is it about us physicians that makes us want to play God? Woody Allen says it's because we have to model ourselves after someone. Like most doctors, I have to try to remember that I am merely a facilitator of healing, not the healer himself--a frequent source of confusion for doctors! That's why I've asked my patients to call me by my first name. As Bernie, I'm a human being whom my patients and the people I work with can relate to.

Because there is always the danger that I will revert to the old doctor roles, Gwen, one of the nurses in the O.R., often greets me by asking "Who's here today, Bernie or Dr. Siegel?" JG: We've all heard the expression, "No pain, no gain." Is it also true, "No pain, no humor"?

BSS: One cannot get through life without pain. Carl Jung tells us the reason for therapy is to open the road "to a normally disillusioned life," and Woody Allen said, "Life is full of miserableness, loneliness, unhappiness, and suffering-- and it's all over much too quickly." Norman Vincent Peale tells of meeting a friend on the street in New York who bemoaned his terrible life. Norman said, "I know a place in the Bronx where there are twenty- five thousand people with no problems." His friend said, "Norman, take me there," and Norman said, "It's Woodlawn Cemetery."

My belief is that coincidence is God's way of remaining anonymous. This is related to experiences I call "spiritual flat tires." Diseases can be our spiritual flat tires-- disruptions in our lives that seem to be disasters at the time but end by redirecting our lives in a meaningful way.

Lab reports and statistics too often are used to take away hope. There's the Mark Twain quip about the three varieties of dishonesty, each worse than the one before-- "lies, damned lies and statistics."

I like what the receptionist in my office told the woman who announced that "statistically" she was supposed to die soon: "Statistics are for dead people. You're not dead." Wouldn't it be nice if those two were teaching a communications course at medical school? I also liked the approach one of my patients took to statistics: When I told him he had cancer, he said, "I guess that means I have five or ten thousand miles left." Don't let statistics tell you when to die.

Researchers in the new discipline of psychoneuroimmunology, a modern-day synthesis of the four previously separate disciplines of psychology, neurophysiology, endocrinology and immunology, are looking into the links between learned emotional patterns and illness. George Solomon was one of the earliest researchers in the field who has studied the impact of stress on the immune system. Solomon and his colleague, Lydia Temoshok, defined an "immunosuppression-prone" personality pattern in AIDS patients. They have tentatively identified a number of personality traits that actively enhance survival: a sense of meaning and purpose in life, a sense of personal responsibility for one's health, an ability to express one's needs and emotions and a sense of humor.

JG: How can humor help us to survive and thrive-- especially in tough times?

BSS: When you think about it, it's amazing how much power we allow events to have over us. One minor example is the phenomenon of the odd sock. We tend to think that the washing machine ate its mate, and maybe curse the machine, right? Well, that wasn't the way one of our ECaP members saw it. After doing the wash she told her husband with great delight that she now had several "extra" socks. We are in control of our thoughts!

A teenager named Susan moved to a new house and her mother insisted she do volunteer work during the summer. She went to the local nursing home, where they asked her to read to Mr. Johnson. Susan went to his room and introduced herself to him and asked him how he was. "I'm alright so far," he told her. "What does that mean?" she asked him. "I'm like the guy who falls out of a window at the top of a thirty-story building. Each floor you go by, people lean out and say, 'How are you,' and you say, 'I'm alright so far.'"

Brendan O'Regan passes along a story about a woman who was told by the doctor that she had a terminal illness. The woman simply said, "What does he know, he's only an expert!"

JG: We all expire sooner or later. You have invited people to tap their own internal expertise and to inspire themselves.

BSS: I'm reminded of a story that Elisabeth Kubler-Ross tells of a critically ill woman who was in the hospital and begged the doctors to help her survive long enough to attend her son's wedding. If she could just get to the wedding, she said, it would be all right to die right after that. So they infused her and transfused her to build her up. The day of the wedding all her intravenous lines and tubes were removed. She was dressed up and made up until she looked beautiful, and off she went to the wedding. When she returned to the hospital, everyone was expecting her to stagger onto the ward, lie down and die. Instead, she came back on the ward and said, "Don't forget, I have another son."

As George Santayana has said, "There is no cure for birth and death save to enjoy the interval." Only through the acceptance of mortality and love can we enjoy the interval.

I know this sounds crazy-- first I talk about illness as a gift, and now it's death as a challenge. To make matters worse, I'm not just talking about death as a challenge for the physician, but for the family and friends and ultimately for the dying person. One of my exceptional patient group members said one day, "Fatal isn't the worst outcome." Not living is the worst outcome.

The greatest gift of all is that we don't live forever. It makes us face up to the meaning of our existence.

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