By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
“Laughter is part of the human survival kit.”- Comedian David Nathan
You’ve probably heard someone say “laughter is the best medicine.” Maybe you were feeling sad, disappointed, angry, or hurt, and a friend or family member tried to cheer you up by taking you to see a funny movie or telling a silly joke. Perhaps they managed to tickle you out of your funk so that you could once again appreciate the simple and beautiful aspects about everyday life and experience gratitude for all that you have. With an uncontrollable smile and laughter escaping your lips, you probably agreed that there’s definitely something to the adage about laughter.
The Patch Adams Prescription for Health
Hunter Campbell, M.D., the American physician whose life inspired the 1998 movie “Patch Adams,” took laughter therapy to a new level. In 1971, Dr. Campbell and several others opened a free hospital in a six-bedroom home, a pilot health care facility through which thousands of patients received unique, humor-infused care over the next twelve years. This hospital-home evolved into the Gesundheit Institute, a not for profit health care organization which currently offers volunteer programs like humanitarian clowning trips to hospitals, orphanages, refugee camps and prisons, as well as educational programs designed to help medical students develop compassionate connections with their patients. “We’re trying to make compassion and generosity the center core of what medicine is,” says Campbell about the organization.
Dr. Campbell’s ultimate goal, pending adequate financial support, is to open a free, full-scale hospital which offers allopathic and complimentary therapies, and inspires other medical facilities to move beyond traditional methodology. Intending to increase engagement with life for both patients and staff, Dr. Campbell also envisions incorporating performing arts, crafts, nature, agriculture, recreation, and social service into this integrative facility. For more information about the Gesundheit Institute, visit www.patchadams.org.
Laughter As Common Sense Medicine
“Hazardous to illness, humor leads to laughing, smiling, and good feelings” (Bakerman). It’s undeniable – both humor and laughter can make you feel good and take the edge off of seemingly difficult situations. Humor is a great communication tool to relieve tension between people and facilitate relationship-building. As a coping mechanism, humor helps people diffuse difficult emotions such as anger, fear, grief, and sadness. In hospital settings humor can help both patients and their families by giving everyone permission to laugh and relax.
Humor and/or laughter can also alleviate emotional stress, which enhances health by helping to prevent stress-related illness. Remember that the sustained release of stress, or “fight or flight,” hormones can contribute significantly to hypertension, nervous system disorders, and other health complications. Besides diminishing stress, humor and/or laughter can simply make us feel better and put us in good spirits.
Norman Cousins, an author, professor, and journalist, laughed his way out of the hospital many times. Cousins believed that the biochemistry of emotion was the key to combating illness. He used laughter (as well as mega-doses of Vitamin C) to fight his heart disease and help neutralize his incurable arthritic condition.
While laughter is well-accepted by the public as common-sense medicine, the exact physiological mechanisms through which humor / laughter enhance health are unknown. At this point, we can see the big picture of laughter as good medicine, and understand aspects of the physiology of humor and laughter, but don’t yet fully understand how all the pieces of the picture fit together, and maybe it’s just better this way. To form any conclusions based on scientific evidence, though, more controlled research on the issue is necessary.
Humor vs. Laughter
We do know that it may not be humor, itself, which promotes health. Humor, is a cognitive stimulus which involves emotional, behavioral, psycho-physiological, and social aspects. Laughter, on the other hand, is a psycho-physiological response, a common expression of a humorous experience which results in a positive psychological shift. While humor alone can tickle your funny bone, the physical act of laughing has shown greater measurable physiological benefits in clinical studies, e.g. enhanced immune function.
Laughter, Nervous System Activity and Bioenergetic Psychotherapy
The case for “laughter being ‘healthier’ for you than humor” may be made by considering the positive effects laughter can have on the parasympathetic and sympathetic branches of the autonomic nervous system. Laughter tends to reduce sympathetic nervous system (SNS) activity while engendering softening, expanding, and relaxing parasympathetic nervous system (PNS) activity. One possible explanation for increased PNS activity is that diaphragmatic movement may stimulate the nearby vagus nerve.
Not only does laughter help prevent SNS activity by assuaging emotional stress, but it also helps discharge aggressive, negative energy trapped as tension within the body as a result of past SNS over-activity. According to Alexander Lowen, the father of bioenergetic psychotherapy, uncontrolled laughter creates convulsive reactions which free up muscular tension within the body, and charge and mobilize the voice and breathing. Through release sessions, bioenergetic therapists try to facilitate anger, crying, and even laughing as a way of healing the body through the spontaneous release of energy.
In bioenergetic therapy circles, tension within the chest cavity is known as “armoring.” Release of this armoring, or previously locked in chronic defensive holding patterns, makes possible the redirection of freed energy and emotions toward healing the heart. Laughing can often lead to crying, the most healing modality for the cardiovascular system. Like laughing, crying induces endorphin release. Tear analysis also demonstrates that crying causes intricate hormonal reactions. Laughter and other spontaneous emotional releases such as crying also promote respiration, and thus bring much needed oxygen to the heart.
Laughter’s Immune and Cardiovascular System Benefits
Other than making you simply feel more relaxed, connected to others, or just better, humor and laughter can create positive immune and cardiovascular system effects. Vigorous laughter can result in physiological changes that are similar to those achieved through moderate exercise. Studies have shown that intense laughter can cause heart and respiratory rates to rise, as well as increased respiratory depth and oxygen consumption. Immediately following these changes are relaxed muscles and a corresponding decrease in respiratory rate, heart rate and blood pressure. That being said, a bout of uncontrollable laughter is no substitute for regular, moderate exercise.
Laughter also positively affects hormones. By increasing endorphins, hormones which assuage the sympathetic nervous system, laughter facilitates a state of peace in the body. It also raises DHEA (dehydroepiandrosterone) levels. Many researchers consider high levels of DHEA, a steroid hormone produced by the adrenal glands, a marker of health in the body. Studies indicate that DHEA, which declines with age, has anti-aging, anti-cancer, and anti-obesity effects and can enhance mental abilities.
PNI and Richard Prior: Studies Show Watching Comedy Is Good for You
Some researchers explain funny-bone medicine through a psychoneuroimmunologic (PNI) lens; PNI is an emerging field exploring the nexuses between psycho-emotional states and the nervous and immune systems. Some PNI enthusiasts have theorized that laughter improves immune function by decreasing stress hormones: epinephrine, norepinephrine, and cortisol. Since we have just recently started exploring the frontier of PNI, though, more research is necessary to conclusively determine why humor and/or laughter seem to boost immune system function.
Though the exact mechanism of how laughter boosts immunity remains unclear, studies demonstrate that humor and/or laughter generate subtle biological changes which serve as markers of immune system activity. By exploring humor-induced variations in salivary IgA (SIgA) levels and natural killer cell cytotoxicity, PNI researchers have connected humor and/or laughter to immune system enhancement.
In a randomized crossover design study, ten college students were shown two videos: one informational and one humorous. The subjects demonstrated significantly higher SIgA levels after watching Richard Pryor Live, indicating that sense of humor and humor response (laughter) can affect one measure of immune activity. Again, though, more research is necessary to form any solid conclusions based on SIgA variations.
PNI researchers have found another indicator that laughter improves immune system function: increased natural killer (NK) cell cytotoxicity. NK cells are lymphocytes (white blood cells) that can distinguish cancerous and virally-infected cells from normal cells, and can destroy the former without harming the latter. As lower levels of NK cell activity are correlated with metastasized cancer, higher levels indicate better resistance to disease.
To investigate the effect of humor on NK cell activity, researchers (Berk, et al.) evaluated blood samples taken from 52 healthy males during and after watching a one-hour humorous video. The subjects demonstrated increased NK cell activity as well as sustained increase in immunoglobulins G, A, and M. Through similar studies, researchers have determined that laughter trumps humor when it comes to improved immune system function. In a controlled study (Bennett, et al.) in which researchers compared the effects of humor on NK cell activity in 33 healthy, adult women, subjects who laughed aloud during a humorous video showed greater increases in NK cell activity and lower stress levels than women who just smiled or did not experience any type of humorous response.
Just What the Doctor Ordered
While the evidence in the abovementioned studies is not enough to prove that laughter will protect us against, or cure, disease, it does indicate that laughter has merit as a medicinal tool. Does it really matter, though, why laughter improves our states of well being as long as we’re still enjoying it? As a healing force, laughter exemplifies the reasoning behind the “why ask why?” (originally introduced to advertise Budweiser beer in the early 1990’s) and “just do it” (Nike sneakers) slogans. While we’re often not able to explain why certain situations or phrases strike us as funny and make us laugh, we certainly feel good when they do. The emotional buoyancy and stress relief brought on by laughter simply improves our quality of life. Whether we master it or not, laughter, on its face, is good, common-sense medicine.
While, at this point, we cannot recommend that one substitute laughter for any conventional medicinal procedure, we do absolutely suggest its use as a vital complimentary therapy to boost one’s immune system function as well as one’s spirits. In this light, some yoga studios are even starting to offer “laughter yoga” classes. Since research suggests that the physiological mechanism of laughter appears to better promote health than humor alone, let the laughter fly. Since laughter tends to be contagious, you could actually help improve someone else’s health.
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