Laughter is not always the best medicine: sometimes a plaster cast is what's needed. All right, I'm being pernickety, and yes, I accept that laughter denotes and promotes physical and mental wellbeing, and confers distinct health benefits…but humour can be a double-edged sword.
For example, I laughed on the day my mother died. At some point the television was on, and I found myself laughing out loud at an inane sitcom that usually left me cold. I was a victim, I suppose, of neurotic laughter, a notion supported by Beaumarchais in the Barber of Seville, 'I laugh so that I may not cry.'
When comedian Frankie Boyle performed to an audience in Reading in 2010, he did a routine on children with Down's syndrome. When he asked a lady in the front row why she was talking, she told him she was upset at his jokes because she had a daughter with Down's syndrome.
There can also be a sinister aspect to laughter/humour highlighted by Dr Sophie Behrman in the British Medical Journal (7 May 2013). The title of Dr Behrman's piece was 'Have you heard the one about the man with Alzheimer's disease?' Although warning that humour can be misinterpreted as threatening by people with dementia, she emphasised that humour, properly used, can help vulnerable patients.
A good example of this was described by Dr John Stevens, writing about standup comedy in Dementia (2012, 11: 61-73). He described performance, improvisation and stand-up comedy as therapy for people with dementia. He underlined the therapeutic potential of such an approach, which led to improvements in memory, learning, sociability, communication and self-esteem.
So, there is a place for humour in primary care; it just needs imagination and sensitivity. For instance, the Ladder To The Moon theatre company effectively use interactive drama in dementia care settings, demonstrating that humour can be life-affirming. Humour can help, when used in the right way.