Humor, Laughter, Illness, and Health

At first thought, one might wonder what humor and laughter have to do with illness; it doesn’t seem like a very likely mix.  But on closer examination, humor and laughter have a large role to play in the ability to cope with an illness and the capacity to maintain a sense of wellness in an ever more challenging world and pressurized lifestyle.  In fact, the role of humor has been recognized for a long time in the world’s literature.

Donald M. Friedman, MD
Donald M. Friedman, MD

King Solomon in Proverbs 17:22 said, “A cheerful heart is a good medicine, but a downcast spirit dries up the bones.”  In the 14th century the French surgeon Henri de Mondeville wrote “Let the surgeon take care to regulate the whole regimen of the patient’s life for joy and happiness, allowing his relatives and special friends to cheer him, and by having someone tell him jokes.”

The French playwright Voltaire, certainly a man with a strong sense of humor and a keen insight into the foibles of human nature, proclaimed, “The art of medicine consists of amusing the patient while nature cures the disease.”  In more modern times, Victor Borge, the beloved and accomplished pianist-performer, commented on the potential laughter has for human connection when he said, “Laughter is the shortest distance between two people.”  Bill Cosby made an astute observation about humor by observing, “If you can find humor in anything, you can survive it.”

And finally, Norman Cousins, the erudite and insightful editor of The Saturday Review singlehandedly in the 1980’s encouraged the examination of humor and laughter as a means of healing, after discovering that by looking at Marx Brothers movies and Candid Camera episodes, as well as other comedy videos, and by reading humorous literature that the symptoms from his ankylosing spondylitis, a painful inflammatory disease of the spine, improved.  In The Anatomy of an Illness, a classic book on this subject, he wrote, “I made the joyous discovery that ten minutes of genuine belly laughter had an anesthetic effect and would give me at least two hours of pain-free sleep.”  His underlying belief was that laughter could be a positive factor in changing his body chemistry so that healing would be more likely to occur.

So the idea of humor, and the laughter it can produce, as a positive healing force is not a new idea.  There has now been research that documents humor can make a difference, and its physiological and emotional effects have actually been studied.  While some of the reports are anecdotal, one still can have a sense that humor has a potentially positive effect on people’s lives, whether they are ill or not.  And the wonderful truth is that humor is available for anyone to embrace, even under difficult circumstances, and in addition,  the cost is totally free.

Humor has various functions.  Allen Klein, in his book The Healing Power of Humor, discusses how humor can help one get through losses, setbacks, disappointments, and illness.  In a way, humor gives us a sense of power and a means of dealing with these difficult situations.  In fact, humor and the ability to laugh at ourselves and the situations in which we find ourselves can sometimes make these situations better and even turn them around.  Klein also notes that humor can help us deal with the suffering coming from pain, be it emotional or physical, and make it more bearable.  In short, humor can make life more pleasurable and less stressful.

In the book, Klein shows how humor can help us all function more effectively.  He mentions four areas where humor can be healing : coping, perspective, balance, and suffering.  Humor can definitely help us cope.  Finding humor in difficult situations can allow one to function better and have a sense of well being while going through that situation.  That sense of well being can help one deal better with an illness and even aid in the recovery from that illness.  Klein states that “Much of the suffering we experience is not a result of our difficulties, but how we view them.  It is not so much the actual event that causes us pain as how we relate to it” (p.71).  Humor can help us relate better to painful or stressful events, and it can promote a more positive attitude towards them.  Having a positive attitude might make it less likely that the stresses, losses, and disappointments will result in a physical illness.  Humor can also allow us to disconnect from painful events, and this aids in getting over them easier.

Humor also provides perspective so that we can look at situations in new ways and gain a different viewpoint.  Klein also points out that humor can defuse upsetting situations, making them seem less important so that we can begin to see the bigger picture.  Humor can sometimes point out the absurdity of some situations and allow us to see ourselves in a new way.  This can lead to novel insights and even better solutions to the problems.  Humor also keeps us balanced.  Henry Ward Beecher, an American clergyman, said, “A person without a sense of humor is like a wagon without springs – jolted by every pebble in the road.”  By making things lighter, humor keeps us from getting caught up in our own situations.  Humor can also help us look at our own imperfections, accept them and even embrace them, and not take them so seriously, realizing that we have many good points too.  And finally, humor is a way to deal with suffering.  Klein states that “When we can allow some humor to be part of our pain, we are not as directly involved in our suffering…..It is not that our pain itself has diminished; it’s just that the space around it has gotten bigger” (p.21).  In other words, it’s possible that humor and laughter can allow us to transcend our suffering.

Humor and laughter have been shown in the medical literature to have definite positive physiological effects on the body.  Some of the findings have been well documented, while others have not been fully accepted by the scientific community because of study design or because evidence was more anecdotal.  Some of the physical effects of laughter and humor are boosting the body’s immune system, lowering the levels of stress hormones, decreasing pain, relaxing muscles, and preventing heart disease.

As for the immune system, some research has shown that after human subjects are exposed to humor, there was an increase in number and activity of natural killer cells that attack viral-infected cells and cancer cells.  There was also an increase in activated T lymphocytes and the antibodies IgA and IgB as well as gamma interferon, a protein which can stimulate the immune system.  All these changes indicate that the immune system has been activated.  Exposure to humor and laughter can also lower the levels of cortisol, a stress hormone that can weaken the immune system and elevate blood pressure.  Lower levels of other stress hormones such as epinephrine and dopamine have been found in people exposed to humor.

Laughter has also been shown to cause pain reduction, as Norman Cousins had noted with the symptoms of his ankylosing spondylitis.  Some people feel the pain-lowering effect is directly related to increased release of endorphins, the body’s natural pain killers; others suggest the muscle relaxation that can occur with laughter is the reason for the pain reduction.  There is also the possibility that humor and laughter can distract one from the source of pain.  It is important to remember that laughter and humor do not reduce the pain of everyone, but even if they don’t, they can still lift one’s spirit, bring some temporary joy, and make pain more bearable.  Another helpful effect of laughter is total body relaxation.  Vigorous laughing can relieve physical tension and stress, leaving muscles in a more relaxed state.

Finally, humor can have a positive effect on the health of the heart and circulation.  A study from the University of Maryland Medical Center in Baltimore found that laughter and an active sense of humor may actually protect against a heart attack.  The study found that people with heart disease were 40% less likely to laugh under different circumstances compared to people of the same age who had no heart disease.  People who had heart disease responded with less humor to life situations.  They laughed less, even when their lives were going well, and they showed more anger and hostility.  Other studies have shown that chronically depressed people have a significantly increased chance of having a heart attack.  It’s not clear how humor and laughter are cardioprotective, but some feel that mental stress can be associated with defects in the blood vessel lining leading to easier clot formation in the arteries.  In addition, laughter is a form of exercise where pulse rate and blood pressure go up, the breathing rate increases, and more oxygen goes out to tissues.  Actually, 10 to 15 minutes of laughter can burn 50 calories.  Because of all this,

Dr. Michael Miller, a cardiologist involved with the study at the University of Maryland suggests that incorporating laughter into our daily activities by watching a humorous video, reading something funny, laughing at a joke or situation, or laughing at ourselves may be a heart-healthy activity.

Humor has positive emotional benefits as well.  Dr. Steven Sultanoff, a practicing psychologist who writes for the website of The Association of Applied and Therapeutic Humor and the website talks about why humor is so important for an individual’s mental health.  He points out that a person can use humor to decrease stress, and this in turn makes it easier to manage emotions.  In fact, some feel a sense of humor can change our emotional response to stress.  An ability to be aware of and appreciate humor can promote better mood responses to negative events.  Also, as already mentioned above, humor can reduce stress by giving one a perspective on how to view the world and what has happened.  Humor can cause a shift in thinking so that events perceived as being difficult become less meaningful and powerful.  Dr. Sultanoff also points out that humor can help replace uncomfortable emotions such as anger, guilt, and depression with more pleasurable feelings.  You can’t experience any of these negative feelings and humor at the same time.  Depressed people report that when they laugh, their depression improves.  Anxious people have related that humor helps them reduce their anxiety and cope with it better.  A good sense of humor can reflect one’s being able to laugh at oneself, one’s behavior, and one’s life.  This involves self-acceptance and self-respect.  People with low self esteem frequently have no sense of humor.  Humor can also help us connect with others;  it is a way of relating to others and sharing with others.  When humor is shared, there tends to be more vitality and joy.  It can lead to more closeness.  Laughter and humor can unite people during difficult times.

So, humor, in supporting a positive attitude and upbeat approach to daily living and its challenges and struggles, can be an important part of maintaining mental health.

Humor has a significant role to play in fostering resilience.  Resilience is the ability of a person to bounce back from stressful situations or events, such as an illness or an emotionally traumatic occurrence.  In the specific situation of illness, it is important for the patient to live in the present and what is going on around him/her;  humor helps to focus on the present and even aid in making the present more acceptable and bearable.  Humor can thus enable the ill individual to deal with the more difficult aspects of an illness so that he/she can bounce back more easily.  The moments of happiness humor can engender make the bouncing back more likely.  Humor can also help a patient connect with family, friends, and healthcare providers.  It can improve communication and help support people feel more comfortable with the patient and his/her illness.  In other words, humor can promote honesty when it is needed most.  If a particular therapy is difficult, such as chemotherapy and its challenging side effects, humor about those side effects may be able to lessen the associated stress.  Humor can also offer the encouragement to move forward and maintain hope, rather than getting stuck focusing on misery because one is ill.  Shifting one’s perspective, as mentioned above, and finding any bright side at all are powerful tools.  And finally, being able to laugh at oneself can help find the strength to go on, frequently because it helps point out the strengths one has underneath.

Brett Leake
Brett Leake

I cannot finish without mentioning Brett Leake, a standup comedian whose workshops I had the good fortune to attend during The Humor Project’s 53rd International Conference on The Positive Power of Humor and Creativity in June, 2010.  Brett has had muscular dystrophy since childhood and in spite of that disability has done standup comedy for 27 years.  He has an amazing wheelchair that elevates him from a sitting to a standing position and gets him around.  He also has a specially equipped van in which he drives around the country doing his gigs.  He was the first comedian with disabilities to appear on the Tonight Show and has been back there numerous times.  One of his workshops at the Humor Conference was entitled “When Life Throws You a Punch, Make Punchlines” in which he commented on how humor takes the fear out of things.  He also emphasized how humor allows us to talk about difficult subjects and realities we might not be able to talk about otherwise.  Humor also helps us to understand the person who has the problem or disability.  Brett’s basic tenet is that it’s the things in life that don’t make sense that are a source of great joy and humor and can ultimately give our own lives some meaning.  Examples are people who use the expression “Needless to say” and then say it anyway or “Junk mail printed on recycled paper” is actually junk put out as trash coming back as junk.  If something doesn’t make sense, you can have fun with it, and that fun gives you the joy and energy to tackle bigger problems, and it can also make those problems easier to deal with.  In short, Brett says, “We have a way through humor to deal with the problems of our life – lightness is an answer to darkness.”  Brett’s stated goal has been to learn to love his life.  He is well aware that he is not defeating his progressive disease, but he is “making room for the evolving possibilities of life.”  Brett is a magnificent example of using humor to enable oneself to grow and recover one’s life despite the limitations of a disease.  He clearly states, “I am no longer an observer of disease, but a participant of disease.”  It was very inspiring to be in his presence during the workshop, and also, very importantly, I laughed a lot as well.

So how do you promote humor and laughter in your own life?  Some people are blessed with good senses of humor that allow them to laugh easily and see all the funny things that occur in every day life.  If you’re not one of those people, you can still open yourself up to developing your sense of humor by exposing yourself to funny material such as sitcom reruns like I Love Lucy, humorous books or other writings, comedy shows on television or in clubs, or movies that make you laugh.  Also, learn to look for the humor all around you – it’s everywhere, but you have to learn to search for it with a comic vision.  Spend time with people who love humor, may be funny themselves, or just love to laugh.  Don’t forget that laughter is contagious.  Try to allow yourself to let go and rid yourself of inhibitions.  Practice smiling.  Ask people if anything funny happened to them during the day.  Be playful and be very sure to laugh at yourself, particularly if you’ve had embarrassing moments which can be very funny.  Look for humor even in bad situations, and, as Brett Leake does, laugh at the absurdities of life.  All of this is particularly important

if dealing with an illness, but humor and laughter in and of themselves, can promote good health too and a sense of well being.  And you don’t even have to be a good joke teller.  Just work on seeing and appreciating the wonderful and rejuvenating humor around us all the time.

And so, humor, laughter, and a willingness to be playful can offer great advantages, even when dealing with an illness or disappointment or loss.  As O. Carl Simonton, M.D. says in the forward to The Healing Power of Humor (p.xiv), “Laughter and play are important tools: they help us to think more creatively, to suspend limitations, and to experience the situation at hand with increased resourcefulness.”

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