by Brian Luke Seaward, PhD
In the past three decades the medical world has begun to take more serious notice of the healing power of humor and the positive emotions associated with it. Humor and laughter are currently being employed by psychotherapist....s and other care givers as tools to promote and maintain health, as well as intervention and rehabilitation tools for a host of maladies and illnesses related to stress and life-style.
Although this empirical medical approach is relatively new, the study of humor has revealed a complex psychological phenomenon. Senses of humor have been categorized in types associated with personality. Humor has many styles and can be found in almost any situation, on any occasion. Theories of humor include the superiority theory, the incongruity theory, the release/relief theory, and the divinity theory.
Laughter has many clinical benefits, promoting beneficial physiological changes and an overall sense of well-being. Humor even has long-term effects that strengthen the effectiveness of the immune system.
In healthcare, humor therapy can help relieve stress associated with disease and illness. It serves as a diversionary tactic, a therapeutic tool for disorders such as depression, and a coping mechanism. It also is a natural healing component for care givers trying to cope with the stress and personal demands of their occupations.
Feelings are chemical, they can kill or cure. --Bernie Siegel, MD
For centuries people have said that laughter is the best medicine, but until recently this fact remained scientifically unproven. However, since 1964, when Norman Cousins incorporated humor therapy in his treatment of ankylosing spondylitis,....the medical world has begun to take more serious notice of the healing power of humor and the positive emotions associated with it.
The relationship between stress (negative emotions) and disease and illness has proven to be profound, with approximately 70 percent to 90 percent of disease and illness strongly associated with stress. Cousins’s premise and subsequent health philosophy was this: "If negative thoughts can have negative physiological repercussions, can positive thoughts produce positive effects throughout the body?" This hypothesis planted seeds for the development of a new medical discipline, psychoneuroimmu....nology, the study of the mind-body relationship.
Humor and laughter are currently being employed as tools to promote and maintain health everywhere, from the classroom to the boardroom. In addition to its use in preventive medicine, humor also has a role as an intervention and rehabilitation tool in the clinical setting for a host of maladies and illnesses related to stress and life-style. Although alone it is no replacement for clinical medicine, humor’s supplementary use is now recognized as a powerful aid for both patients and healthcare professionals.
THE HISTORY OF LAUGHTER
Many a truth be told in jest. --Geoffrey Chaucer
Even in the biblical days, humor was considered a tool of therapeutic medicine: "A merry heart does good like medicine, but a broken spirit drieth bones" (Prv 17:22). Greeks included shades of humor in their dramas, with comedy balancing the theatrical scale with tragedy.
The Latin origin of the word "humor" means fluid or moisture. According to medieval physiology, the body hosted four primary humors, each associated with a mood: choler, anger; bile, melancholy; blood, confidence; and phlegm, apathy. An excess of any one of these humors brought on poor health and often ridicule, whereas a correct balance was indicative of "good humor," or health.
Some cultures used humor and laughter to lift spirits and promote health, employing individuals like the European court jesters or Native American shamans. However, humor was not always thought of as good for one’s health. Some cultures associated laughter with the work of the devil. In Puritan times, laughter was considered a moral sin, regardless of the occasion, and even smiling was prohibited.
THE PSYCHOLOGY OF HUMOR
A smile is the shortest distance between two people. --Victor Borge
Although this empirical medical approach is relatively new, the study of humor has revealed a complex psychological phenomenon. Like love, humor has proven difficult to define, with no consensus among scholars. Suffice it to say, humor is the quality of being funny or appreciating funny thoughts or acts, manifesting in smiling or laughter.
With rare exceptions, everyone has and demonstrates a sense of humor. In fact, senses of humor have been categorized into types associated with personality, including "good sport" (laughter at one’s own expense), conventional (eye-to-eye humor, where two or more people laugh at the same thing), creative (imaginative wit), and "life of the party" (an extrovert who makes people laugh).
People have always been curious about what causes laughter, from the incongruous to the ironic. Moreover, humor has many styles, including slapstick, black (gallows) humor, parody, satire, and the lowest form of humor, sarcasm (which literally means to tear flesh). Humor, it seems, can be found in almost any situation, on any occasion. For example, Bernie Siegel writes that once, while performing surgery for a cancerous tumor, he heard Frank Sinatra’s voice on the radio crooning, "Why Not Take All of Me?"
Paralleling the four components of wellness-....-mind, body, spirit, and emotions--are four theories of humor, suggesting that humor is an important factor in the integrity of the wellness paradigm. The oldest theory of why people laugh is the "superiority theory," an emotion-based theory credited to Plato. It suggests that laughter is a socially acceptable outlet for aggression, where laughter at someone else’s expense elevates one’s own self-esteem (e.g., Dan Quayle jokes).
A more recent theory is the incongruity theory, a cognition-....based theory that laughter is triggered by the connection of two or more concepts that seem absurd or incongruous-....-for example, years ago Charlie Chaplin entered a Charlie Chaplin look-alike contest and got third place. Research indicates that stroke victims with right-sided brain damage are unable to laugh at cognitive-....based jokes, supporting the theory that humor is a right-brain cognitive function.
Sigmund Freud, in his study of laughter, suggested the release/relief theory, explaining that laughter is a physical manifestation of repressed thoughts of taboos such as sex and death. This theory may account for the continued popularity of sexual jokes.
Finally, the newest theory on humor is the so-called divinity theory. It suggests that humor has the ability to make order out of chaos, promote unity and connectedness through shared laughter, uncover the naked truth of a situation, and lift one’s spirit. In essence, the theory goes, humor is a gift from God.
Although humor is classified as a perception rather than an emotion, it can produce many positive emotions, including joy, mirth, hope, confidence, and an overall sense of well-being. It is this expression of emotions which has healing potential. Humor can serve as a positive coping strategy, often used to diffuse feelings of anger or impatience by acknowledging the absurdity of the threat to the ego. Likewise, humor can be used to dispel fear, including fear of the unknown, fear of death, and fear of failure, by providing a perspective and clearer focus on the situation. Humor is often used to communicate these feelings to oneself and others by diminishing the stress in an acceptable way. In many ways, humor is a universal language.
THE PHYSIOLOGY OF HUMOR
Laughter, like a virus, is contagious. --Art Buchwald
Physiological research in the field of humor and laughter has uncovered amazing results, suggesting that, indeed, laughter has many clinical benefits. In the short term, laughter promotes many physiological changes; most notably, it stabilizes blood pressure, massages inner organs, stimulates circulation, facilitates digestion, increases oxygen supply to muscles, decreases muscle tension, and promotes an overall sense of well-being. In fact, laughter produces similar, if not identical, responses to those associated with progressive muscular relaxation, a widely recognized relaxation technique used to reduce muscle tension.
In addition, tears produced by laughter differ from those produced by sadness and depression in that they contain toxins the body tries to release through the laughter response. The most remarkable effect laughter may produce is the release of neuropeptides, including the beta endorphine, which act as pain reducers. Cousins, in his now famous testimony, said that ten minutes of laughter gave him two hours of pain-free sleep during his recovery.
Perhaps most interesting are the long-term effects of laughter and the positive emotions that accompany it. Current evidence indicates that cells associated with the immune system (the lymphatic system) are activated through a complex mind-body feedback mechanism. Stress-....produced emotions trigger the release of cortisol and aldosterone, which in substantial amounts may actually decrease the T-lymphocyte cell count, thereby impairing the immune response. Conversely, positive thoughts and feelings increase the effectiveness of the T-cells and, hence, strengthen the ability of the immune system to operate against illnesses from common colds to cancer.
Thus laughter and positive emotions, including joy, love, faith, hope, confidence, and will, contribute to the strength and integrity of the immune system. Although researchers have yet to identify an intensity-........frequency-....duration formula for the exposure to laughter as with physical exercise, conventional wisdom suggests that daily encounters with humor are beneficial to total well-being.
HUMOR IN HEALTHCARE
Humor is mankind’s greatest blessing. --Mark Twain
Comic relief, now widely viewed as a viable preventive technique for coping with stress, is also being used in many clinical settings as a supplemental tool in the healing and recovery process for everyone from alcoholics to cancer patients.
The difference between clinical medicine and humor therapy is most notably found in their application. Whereas clinical medicine is prescribed by a physician and administered by healthcare givers, the use of humor therapy is often more subtle and much less formal. Comic relief arises from the ironies and incongruities acknowledged in everyday life, experiences in which inhibitions are suppressed, allowing a natural flow of emotions. Healthcare givers must be extremely sensitive to the patient’s needs and moods and not force this mode of therapy. Instead, they should take advantage of opportunities initiated by patients to help relieve stress associated with disease and illness.
Humor provides several ways in which it can help patients in healthcare facilities or clinical therapy.
HUMOR AS A DIVERSIONARY TACTIC
In many ways the hospital setting is the antithesis of the home environment. Illness and death often cast a shadow of intense seriousness, interfering with the expression of the full range of emotions. Experts suggest that on average a person laughs approximately 15 times a day. In the hospital, however, this number can drop to zero.
Several hospitals across the country, particularly those with oncology wards, are developing humor programs for their patients. These offer rooms with videocassette recorders and compact disc players, in-house humor cable channels, library shelves filled with humorous books, and movable humor carts with a host of resources to promote laughter. Clinical staff note that the primary benefit of humor therapy is it serves as a diversionary tactic, taking patients’ minds off their illness and related moods of depression, thus promoting a balanced expression of emotions.
HUMOR AS A THERAPEUTIC TOOL
Psychotherapist....s have discovered humor as an aid in the treatment of several clinical disorders, most notably depression. Although opinions are divided on this issue, humor has been reported to strengthen the bond between client and therapist in the treatment process, increasing the progress toward recovery. Currently, humor is used as both an assessment tool, to help the therapist learn what topics the client wishes to discuss, and as a therapeutic tool, to help dissolve psychological defenses inhibiting recovery.
HUMOR AS A COPING MECHANISM
Both anger and fear surface in the fight against life-....threatening illnesses such as cancer, and care givers can use humor to help patients control these emotions rather than becoming the victim of them, as described by comedian Gilda Radner during her visits to the wellness community. Similarly, in the rehabilitation of persons recovering from substance addictions, humor can help them express negative emotions in a positive light, thus relieving feelings of despair and helplessness. Many addictions are related to low self-esteem. Although humor does not necessarily build self-esteem, the ability to laugh at oneself can be a crucial transition in the basic stages of recovery.
Humor therapy in this context is generated by the patient, not the therapist. It is important to distinguish between laughing with a patient and laughing at a patient. Care givers also need to be cautious about--or even refrain from--using sarcasm, since it may be a direct reflection of latent anger. Sarcasm is an inappropriate form of humor in healthcare because it may promote stress rather than reduce it. On the other hand, positive humor can provide ammunition to deal with stress and the emotions surrounding it: anger and fear.
HEALING FOR THE CARE GIVER
Comic relief is a natural healing component not only for patients, but also for care givers. In her book Humor and the Health Professional, Vera Robinson cites the need for healthcare professionals to incorporate humor into their lives to cope with the stress and personal demands of their occupations.25 Humor helps balance the scale of emotions in a hospital setting where morbidity and mortality often cast a dark shadow. Although professionalism.... is expected in the healthcare industry, an absence of humor is now viewed as unprofessional,.... supporting the trend to take one’s job seriously, but oneself lightly.
The use of humor therapy on the oncology ward of Shady Grove Adventist Hospital, Rockville, MD, resulted in a significant decrease in employee burnout and attrition for nurses in that ward over a two-year period.26 Professionals can integrate humor into their life-style by making a point to find one humorous thing a day, laughing at themselves, recognizing moments of fallibility, exaggerating events to the point of ridiculousness,.... looking for life’s ironies, and starting a "tickler notebook"--a collection of cartoons and jokes.27 This is particularly important for the healthcare professional working with AIDS patients or others facing death, as physicians and nurses often transfer their somber emotions to their patients. It is important to balance the workday with supplemental activities that add joy to life.
GOOD MEDICINE
It’s never too late to have a happy childhood.
--Tom Robbins
Science is beginning to prove what many people have known all along: that, indeed, laughter is good medicine. Humor and laughter enhance positive feelings and emotions to balance the preponderance of negative emotions that surface during stressful times. Humor and laughter appear to have many healing qualities. The introduction of humor therapy and comic relief programs in many clinical settings as a rehabilitation tool, and in work settings as a prevention tool, reveals the strong mind-body connection associated with humor, which can promote well-being for patients and care givers alike.
