Brain (1975) 98, 399-412
COMPREHENSION AND APPRECIATION OF HUMOROUS MATERIAL FOLLOWING BRAIN DAMAGE BY
HOWARD GARDNER, PAUL K. LING, LAURIE FLAMM AND JEN SILVERMAN (From the Aphasia Research Center and Psychology Service, Boston Veterans' Administration Hospital, 150 S. Huntington Avenue, Boston, Mass., 02130)
FOR theoretical as well as practical reasons, it is crucial to determine the degree of impairment of cognitive and affective status following damage to the brain. With few exceptions, these two facets of the individual have been examined in complete independence of one another. Cognitive sequelae to brain damage have been investigated in detail—both the more general cognitive defects (Teuber, 1960; Russell et ah, 1970) and those associated with injury to particular sites in the brain (Mountcastle, 1962; de Reuck and O'Connor, 1964; Kinsbourne, 1971). Also, pertinent information is available on the overall emotional effects of brain damage (Goldstein, 1938; Jackson, 1932), as well as on the affective consequences of lesions in specific sites (Gainotti, 1973; Nauta, 1971; Davison and Kelman, 1939). Yet hardly, if ever, have these two traditions of research been related to one another. The division between cognitive (or intellective) and affective (or emotional) facets is at best a convenience. Examination of processes and situations where these aspects are coordinated or fused would seem a necessary prerequisite for a comprehensive understanding of the consequences of injury to the brain. Of the various domains where such an interplay can be observed, the realm of humour seems particularly appropriate (Freud, 1960; Bergson, 1911; Eysenck, 1942; Goldstein and McGhee, 1973). An assessment of the ability of the brain-injured patient to comprehend various humorous displays, and an inventory of his personal reactions to such displays, should cast fresh light upon the experiential world of the braininjured individual. Scattered reference can be found to the sense of humour among brain-injured patients. For instance, certain varieties of aphasia seem to exert particularly devastating eflfects upon the individual's ability to synthesize the elements involved in a joke or cartoon (Head, 1926; Critchley, 1971; Luria, 1970; Isserlin, 1936). References to inappropriate attempts at humour and to a blurring of the line between the serious and the comic can also be found (Weinstein and Kahn, 1955).
400
H. GARDNER, P. K. LING, L. FLAMM AND J. SILVERMAN
Generally, however, such evidence is anecdotal; little, if any, systematic evidence has been gathered on the ability to appreciate humour among patients with various brain lesions. Accordingly, with the aim of securing information about this topic, a test of humour was devised and administered to a population of brain-injured patients. The test sought information on the following questions: (1) To what extent are aphasic and other brain-injured patients impaired in their understanding of humorous displays? (2) How do such patients react affectively to humorous displays ? (3) Can systematic differences in comprehension and reaction be linked to site of lesion ? (4) What are the effects of verbal captions on humour appreciation among different groups of brain-damaged patients? (5) Is response to humour heightened or reduced when the patient must attend to fine differences among displays ? In addition to these general questions, information was also sought on the respective responses and strategies of patients with different types of aphasia, and on the particular difficulties attending specific items on the test. MATERIAL AND METHODS
Subjects.—The brain-damaged population consisted of 60 right-handed subjects, all in-patients at the Boston Veterans' Administration Hospital or the Massachusetts Rehabilitation Center. Of these 41 were aphasic patients; 24 had lesions restricted to the posterior (post-Rolandic) region of the left hemisphere, and 17 had lesions restricted to the anterior (pre-Rolandic) portion of the dominant hemisphere. The aphasic patients in each group were further subdivided on the basis of their auditory comprehension into two groups: slight comprehension defect and significant comprehension defect. Patients with z-scores greater than 0 on the auditory comprehension subtest of the Boston Diagnostic Aphasia Examination (Goodglass and Kaplan, 1972) were considered to have mild comprehension defects; those with lower scores were considered to have significant comprehension defects. The remaining 19 subjects had lesions confined to their right hemispheres. Site of lesion in the left hemisphere patients was ascertained by several indices, including EEG records, surgeons' reports, clinical evidence (hemiplegia, field defects, etc.), and brain scans, the latter being available in nearly all cases. It was not possible to secure localizing information on a majority of the right hemisphere patients, who have therefore been grouped together. None of the patients showed released laughter or other disturbances of emotional expression as a result of their lesions. In addition the test was administered to 14 normal controls, individuals of comparable age (mean 52), educational background (secondary schooD, and socio-economic class (working) selected from non-neurological wards at the Boston Veterans' Administration Hospital. Materials.—The test consisted of twenty items, each a set of four cartoons mounted in a square array upon a 12 in. x 18$ in. heavy paper display board. Half of the stimulus items featured a caption under each of the cartoons; these cartoons could only be apprehended if captions were understood. The remaining half of the items featured no captions. The purpose of this variable was to contrast patients' sensitivity to displays which required linguistic understanding with their sensitivity to those items which could be apprehended on a non-verbal basis.
COMPREHENSION OF HUMOROUS MATERIAL
401
Items were also varied systematically on the relationship to one another of the four cartoons in a set. In half the cases (the Same Arrays) all four cartoons were essentially identical; the only difference was a single "tell-tale detail" which appeared in only one cartoon (the correct choice). For the remaining half (the DiflFerent Arrays) the four cartoons in the array differed markedly from one another. The purpose of this variable was to indicate the relative case of detecting humorous content when the general context of the humour was evident but attention to detail was essential, as compared to situations where any of four disparate contexts might potentially provide amusement. Each set was so constructed that only one of the cartoons featured significant humorous content. The cartoons were selected from popular magazines, such as Playboy and the New Yorker. Those included in the Same Arrays were altered so that the tell-tale detail only appeared in one cartoon, while equivalent but non-humorous details were incorporated into the remaining three cartoons. All cartoons were then photo-reproduced so that traces of the alterations were no longer evident. Captions appeared at the bottom of the respective cartoons, drawn in large letters. Specimen items appear in figs. 1-4.
FIGS.
1-4.—Sample stimulus items representing the four types of cartoons.
FIG. 1.—Same Array with Caption.
402
H. GARDNER, P. K. LING, L. FLAMM AND J. SILVERMAN
Procedure.—Initially, a lengthier version of the test was administered to a group of 10 nonneurological patients. Responses on this pilot version led to the selection of the final 20 test items. These test items were selected on the basis of their comprehensibility, consensus among subjects as to the source of the humour, and matched difficulty across the variables of interest. Choices and reasons given by at least 7 of the pilot subjects were considered to be the correct responses in the test phase of the study. In all cases the choices of the subjects coincided with those of the experimenters. All test subjects were instructed to point to that cartoon which they found funniest and to indicate the reasons for their choices. A number of practice items were then administered and the
Fio. 2.—Same Array without Caption.
COMPREHENSION OF HUMOROUS MATERIAL
403
patients were shown how to point to the "funny" cartoon and to offer justification for their choice. Most patients readily acquired a "set" of pointing to one of the four cartoons and of indicating, through verbal report or designation of a tell-tale detail, the reason for their choice. No patient was permitted to proceed with the test itself if there were any doubts that he understood the required procedure. The order of presentation of the test items was counterbalanced across subjects within each subject group. Scoring.—The number of correct choices (selection of the single "funny" cartoon in each set of four) constituted an overall quantitative score for each subject. In addition, complete notes were
FIG. 3.—Different Array with Caption.
404
H. GARDNER, P. K. LING, L. FLAMM AND J. SILVERMAN
kept on "mirth responses" by subjects to each item: smiling, laughing, giggling, etc; all verbal comments made by the subject; and any gestures, behaviours, or other reactions of interest. During the pilot phase of the research, two experimenters took running notes on the patients' mirth reactions during the testing sessions. Once adequate interjudge reliability had been attained, subjects were run individually by each experimenter. These supplementary indices made possible further comparisons among particular items, and among the subject groups included in the study.
In
I /
Fio. 4.—Different Array without Caption.
i(\ If -V-
COMPREHENSION OF HUMOROUS MATERIAL
405
RESULTS
General performance on the humour test.—A 3 x 2 x 2 repeated-measures analysis of variance was performed on the scores of the normal and brain-damaged patients. The variables were, respectively, Lesion Site (No Lesion v. Left Hemisphere Lesion v. Right Hemisphere Lesion), Caption (Presence v. Absence), and Arrangement (Same Array v. DiflFerent Array), with repeated measures being taken on the latter two variables. There was a highly significant effect of Lesion Site (F= 10-42, df=2, 71 P
COMPREHENSION AND APPRECIATION OF HUMOROUS MATERIAL FOLLOWING BRAIN DAMAGE BY
HOWARD GARDNER, PAUL K. LING, LAURIE FLAMM AND JEN SILVERMAN (From the Aphasia Research Center and Psychology Service, Boston Veterans' Administration Hospital, 150 S. Huntington Avenue, Boston, Mass., 02130)
FOR theoretical as well as practical reasons, it is crucial to determine the degree of impairment of cognitive and affective status following damage to the brain. With few exceptions, these two facets of the individual have been examined in complete independence of one another. Cognitive sequelae to brain damage have been investigated in detail—both the more general cognitive defects (Teuber, 1960; Russell et ah, 1970) and those associated with injury to particular sites in the brain (Mountcastle, 1962; de Reuck and O'Connor, 1964; Kinsbourne, 1971). Also, pertinent information is available on the overall emotional effects of brain damage (Goldstein, 1938; Jackson, 1932), as well as on the affective consequences of lesions in specific sites (Gainotti, 1973; Nauta, 1971; Davison and Kelman, 1939). Yet hardly, if ever, have these two traditions of research been related to one another. The division between cognitive (or intellective) and affective (or emotional) facets is at best a convenience. Examination of processes and situations where these aspects are coordinated or fused would seem a necessary prerequisite for a comprehensive understanding of the consequences of injury to the brain. Of the various domains where such an interplay can be observed, the realm of humour seems particularly appropriate (Freud, 1960; Bergson, 1911; Eysenck, 1942; Goldstein and McGhee, 1973). An assessment of the ability of the brain-injured patient to comprehend various humorous displays, and an inventory of his personal reactions to such displays, should cast fresh light upon the experiential world of the braininjured individual. Scattered reference can be found to the sense of humour among brain-injured patients. For instance, certain varieties of aphasia seem to exert particularly devastating eflfects upon the individual's ability to synthesize the elements involved in a joke or cartoon (Head, 1926; Critchley, 1971; Luria, 1970; Isserlin, 1936). References to inappropriate attempts at humour and to a blurring of the line between the serious and the comic can also be found (Weinstein and Kahn, 1955).
400
H. GARDNER, P. K. LING, L. FLAMM AND J. SILVERMAN
Generally, however, such evidence is anecdotal; little, if any, systematic evidence has been gathered on the ability to appreciate humour among patients with various brain lesions. Accordingly, with the aim of securing information about this topic, a test of humour was devised and administered to a population of brain-injured patients. The test sought information on the following questions: (1) To what extent are aphasic and other brain-injured patients impaired in their understanding of humorous displays? (2) How do such patients react affectively to humorous displays ? (3) Can systematic differences in comprehension and reaction be linked to site of lesion ? (4) What are the effects of verbal captions on humour appreciation among different groups of brain-damaged patients? (5) Is response to humour heightened or reduced when the patient must attend to fine differences among displays ? In addition to these general questions, information was also sought on the respective responses and strategies of patients with different types of aphasia, and on the particular difficulties attending specific items on the test. MATERIAL AND METHODS
Subjects.—The brain-damaged population consisted of 60 right-handed subjects, all in-patients at the Boston Veterans' Administration Hospital or the Massachusetts Rehabilitation Center. Of these 41 were aphasic patients; 24 had lesions restricted to the posterior (post-Rolandic) region of the left hemisphere, and 17 had lesions restricted to the anterior (pre-Rolandic) portion of the dominant hemisphere. The aphasic patients in each group were further subdivided on the basis of their auditory comprehension into two groups: slight comprehension defect and significant comprehension defect. Patients with z-scores greater than 0 on the auditory comprehension subtest of the Boston Diagnostic Aphasia Examination (Goodglass and Kaplan, 1972) were considered to have mild comprehension defects; those with lower scores were considered to have significant comprehension defects. The remaining 19 subjects had lesions confined to their right hemispheres. Site of lesion in the left hemisphere patients was ascertained by several indices, including EEG records, surgeons' reports, clinical evidence (hemiplegia, field defects, etc.), and brain scans, the latter being available in nearly all cases. It was not possible to secure localizing information on a majority of the right hemisphere patients, who have therefore been grouped together. None of the patients showed released laughter or other disturbances of emotional expression as a result of their lesions. In addition the test was administered to 14 normal controls, individuals of comparable age (mean 52), educational background (secondary schooD, and socio-economic class (working) selected from non-neurological wards at the Boston Veterans' Administration Hospital. Materials.—The test consisted of twenty items, each a set of four cartoons mounted in a square array upon a 12 in. x 18$ in. heavy paper display board. Half of the stimulus items featured a caption under each of the cartoons; these cartoons could only be apprehended if captions were understood. The remaining half of the items featured no captions. The purpose of this variable was to contrast patients' sensitivity to displays which required linguistic understanding with their sensitivity to those items which could be apprehended on a non-verbal basis.
COMPREHENSION OF HUMOROUS MATERIAL
401
Items were also varied systematically on the relationship to one another of the four cartoons in a set. In half the cases (the Same Arrays) all four cartoons were essentially identical; the only difference was a single "tell-tale detail" which appeared in only one cartoon (the correct choice). For the remaining half (the DiflFerent Arrays) the four cartoons in the array differed markedly from one another. The purpose of this variable was to indicate the relative case of detecting humorous content when the general context of the humour was evident but attention to detail was essential, as compared to situations where any of four disparate contexts might potentially provide amusement. Each set was so constructed that only one of the cartoons featured significant humorous content. The cartoons were selected from popular magazines, such as Playboy and the New Yorker. Those included in the Same Arrays were altered so that the tell-tale detail only appeared in one cartoon, while equivalent but non-humorous details were incorporated into the remaining three cartoons. All cartoons were then photo-reproduced so that traces of the alterations were no longer evident. Captions appeared at the bottom of the respective cartoons, drawn in large letters. Specimen items appear in figs. 1-4.
FIGS.
1-4.—Sample stimulus items representing the four types of cartoons.
FIG. 1.—Same Array with Caption.
402
H. GARDNER, P. K. LING, L. FLAMM AND J. SILVERMAN
Procedure.—Initially, a lengthier version of the test was administered to a group of 10 nonneurological patients. Responses on this pilot version led to the selection of the final 20 test items. These test items were selected on the basis of their comprehensibility, consensus among subjects as to the source of the humour, and matched difficulty across the variables of interest. Choices and reasons given by at least 7 of the pilot subjects were considered to be the correct responses in the test phase of the study. In all cases the choices of the subjects coincided with those of the experimenters. All test subjects were instructed to point to that cartoon which they found funniest and to indicate the reasons for their choices. A number of practice items were then administered and the
Fio. 2.—Same Array without Caption.
COMPREHENSION OF HUMOROUS MATERIAL
403
patients were shown how to point to the "funny" cartoon and to offer justification for their choice. Most patients readily acquired a "set" of pointing to one of the four cartoons and of indicating, through verbal report or designation of a tell-tale detail, the reason for their choice. No patient was permitted to proceed with the test itself if there were any doubts that he understood the required procedure. The order of presentation of the test items was counterbalanced across subjects within each subject group. Scoring.—The number of correct choices (selection of the single "funny" cartoon in each set of four) constituted an overall quantitative score for each subject. In addition, complete notes were
FIG. 3.—Different Array with Caption.
404
H. GARDNER, P. K. LING, L. FLAMM AND J. SILVERMAN
kept on "mirth responses" by subjects to each item: smiling, laughing, giggling, etc; all verbal comments made by the subject; and any gestures, behaviours, or other reactions of interest. During the pilot phase of the research, two experimenters took running notes on the patients' mirth reactions during the testing sessions. Once adequate interjudge reliability had been attained, subjects were run individually by each experimenter. These supplementary indices made possible further comparisons among particular items, and among the subject groups included in the study.
In
I /
Fio. 4.—Different Array without Caption.
i(\ If -V-
COMPREHENSION OF HUMOROUS MATERIAL
405
RESULTS
General performance on the humour test.—A 3 x 2 x 2 repeated-measures analysis of variance was performed on the scores of the normal and brain-damaged patients. The variables were, respectively, Lesion Site (No Lesion v. Left Hemisphere Lesion v. Right Hemisphere Lesion), Caption (Presence v. Absence), and Arrangement (Same Array v. DiflFerent Array), with repeated measures being taken on the latter two variables. There was a highly significant effect of Lesion Site (F= 10-42, df=2, 71 P
