The triceps on the back of your hand weighs about a kilogram, has a cross-sectional area of 25 square cm, and can deliver up to 2,000 newtons of force in a single punch, enough to break the jawbone of a challenging opponent in a boxing ring. In contrast, the small zygomaticus, a muscle attached to your cheekbone, weighing around a gram and with a cross-sectional area of just 0.1 square cm, generates a force of 1 newton when it contracts, pulling up the angle of your mouth and producing a smile. Brute power grabs the spotlight, while a cute smile hides behind the curtain.

As another World Laughter Day passed on May 3, let us look at how a cute smile stacks up against strong-arm tactics

Evolution of smile

After nine long months of lugging the weight in her protruding abdomen, marked by bouts of nausea and vomiting, and finally the excruciating labour pain, the mother receives a gift of a wet, howling lifeform. Her first reciprocation, a social smile by the sixth week, magically changes everything. The mother falls for it, and the baby quickly learns to use it as her best defensive tool to disarm the parents when she carries out all his naughty deeds, from broken mementoes to handprints on the wall, simply by offering a cute little smile. It is estimated that a three-year-old child smiles and laughs around 300 times a day, but as she grows into adulthood, this number drops to a meagre 20. By the time a doctor dons the “white coat” and the “black stethoscope”, the number approaches zero. It is often said that “the only doctor who smiles is one who features in the toothpaste ad”.

Our neighbour, an elderly man, had been bedridden for a long time. One morning, a small crowd and a black flag in his courtyard confirmed the inevitable: he was no more. I was a medical student and accompanied my parents to his house. People sat in chairs scattered across his front veranda, talking in hushed tones. I noticed two children playing rock-paper-scissors in a corner, occasionally giggling, but no one really cared. Inside the room, the body lay in a glass case, covered with flowers and wreaths. People silently went around, stood for a while, and prayed. A middle-aged gentleman entered, helped by others, suggesting he was perhaps unwell. He looked almost on the brink of tears. Suddenly, he started laughing loudly, looking at the body. It was not a chuckle but belly-busting laughter. Everyone was stunned and taken aback. He was escorted out of the room. I understood that it was very, very inappropriate. A decade later, my professor of medicine would teach me that he was most likely suffering from a neurological disease called pseudobulbar palsy, a condition in which inappropriate bouts of laughter are interspersed with crying as part of the disease. No one thought the giggling children did anything inappropriate, but the adult who laughed was shown the door.

A medical student is thrust into a clinical posting right after learning the basics of anatomy, physiology, and biochemistry. A clinical posting revolves around rounds and discussions at a patient’s bedside, where the hierarchy is as strict as an army parade. The serious-looking professor converses with the junior staff. Questions fly to the postgraduates, and their every answer is mocked and criticised, while the scared medical students, orbiting close to the Milky Way, get the message loud and clear — this is serious business with no place for humour, a smile, or laughter.

We were taught all the skills to elicit a clinical sign, but were never taught that “appropriate” humour, in the right doses, could make a patient smile or laugh, could create a stronger bond with the patient, and enhance therapeutic benefit, especially in non-critical situations.

But things are changing. Many top medical universities, including Columbia University (New York), McGill University (Montreal), and King’s College London, offer dedicated courses in humour in medicine within their humanities programs. Applying humour in a hospital setting, among suffering and sick people, is not easy, but it is worthwhile; it could improve workplace safety and physician burnout. Now we see a massive increase in the number of gyms and fitness centres in the city, and people flocking to keep themselves in good shape. Let us take an oath that while developing biceps and strengthening triceps, we will not neglect the zygomatic muscles that make us smile better.

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