Articles from prior issues of The Advocate

September/October, 1999

It’s No Joke: Humor Heals

by Patricia Barry

IT IS HARD TO IMAGINE a more anxious scene: A child about to have a heart transplant waits with her anxious parents in a room at Columbia-Presbyterian Hospital in New York City. But then a clown is invited in and makes a suggestion: “I think we need to perform a red-nose transplant.” The clown measures the parents’ noses, then offers a selection of scarlet globes: “OK, go ahead and pick your nose.” Or, if one drops and rolls on the floor. “Can’t use that one - it’s a runny nose.” The child laughs, the parents relax, the mood in the room lightens perceptibly. The power of humor is at work, consoling and healing. Or take another example: An 82 year old patient at Morton Plant Hospital in Clearwater, Fla., who has suffered chronic hip pain for seven years, confides in her doctor that she’s always wanted to be a clown. So, he writes out a formal prescription. “Send this lady to Clown School.” She takes the class and joins the hospital’s volunteer comedy team. On one of her wig-and-makeup days, someone asks how she is, and she replies, “I feel no pain right now.” Such scenes are slowly becoming more common as health professionals begin to accept the value of mirth as a vital force in care and recovery. A small but growing number of American hospitals, nursing homes, and recuperation centers now bring in clowns, provide “humor carts” to distribute funny books and videos or send patients to “humor rooms” for daily doses of jokes and laughter. “Humor undoubtedly has positive health benefits,” says Steve Sultanoff, a California psychologist and president of the 600 member American Association for Therapeutic Humor (AATH). “It changes our emotional state, our perspective on life and, through laughter, our physiological state.” The idea is scarcely new. “A merry heart doeth good like a medicine,” says the Bible. And lightening up makes anyone feel better. But it is only over the past decade that humor in medicine - to the extent of joking around with seriously ill patients - has gained respectability. It is promoted by organizations like the AATH and the Humor Project, Inc. through international conferences and training workshops. Journals, newsletters and Web sites are devoted to it. Lists of jokes are posted on the Internet. Now, with actor Robin Williams playing the true story of Patch Adams, a Virginia doctor who defied medical gravitas for three decades to make patients laugh, there’s even a movie. Much of the impetus for today’s humor advocacy began almost 30 years ago when writer Norman Cousins published “Anatomy of an Illness,” an account of how he fought intense pain and beat a deadly disease by deliberately dosing himself with humorous books and reruns of “Candid Camera.” His story raised a new question: Can humor actually modify the effects of disease, and, if so, how does it do it? Real understanding will not come until scientists have unraveled the complex biochemistry of emotion. But research by such pioneers as William F. Fry, Jr., M.D., emeritus professor of clinical psychiatry at Stanford University, and Lee Berk and Stanley Tan of Loma Linda University, Calif., already suggests that “mirthful laughter” does much more than we think. It can:

l Provide exercise by increasing the heart rate, stimulating blood circulation and breathing, and improving muscle tone. Fry found that he could double his heart rate while convulsed by Laurel and Hardy and calculated that 100 laughs equals 10 minutes on a rowing machine. Cousins called it “inner jogging.”

l Reduce pain, probably by firing the release of endorphins, the body’s natural painkillers. Several studies show that laughing lessens the need for medication and shortens recuperation time.

l Reduce stress by lowering levels of cortisol, a stress hormone that can weaken the immune system.

l Stimulate the immune system, probably in complex ways. Berk and Tan found “significant increases” of interferongamma, a hormone that fights viruses and regulates cell growth, in a group of health men while they watched a 60-minute humorous video - and that levels remained higher than normal 12 hours later.

l Stimulate mental functions, such as alertness and memory, perhaps by raising levels of adrenaline and other chemical that prepare the body for action. One study recorded a wave of electricity sweeping through the entire brain half a second after the punch line of a joke.

Fry says that such basic research has declined in recent years, but the clinical applications have grown. Most people who use humor therapeutically, however, say they don’t need to know the “why” of it because they can see every day that it works. Judy Goldblum, one of the country’s best known humor therapists, says she recognized it at the age of 5. “My first memory was telling jokes to family members who were Holocaust survivors. I noticed, even at that age, that when people laughed, the agony faded and their faces relaxed.” When she was 6, her physician father began taking her on hospital rounds to tell his patients jokes. She’s been doing so ever since. Now a permanent member of the University of Maryland Medical Center, better known in her persona as “Dr. Lollipop,” Goldblum works with children hospitalized for cancer. Currently, her teen age patients are helping her write a book called 101 Fun Things to Do When You Have No Hair. “Once children can make fun of what they’re most afraid of, they’re more in control,” she explains. Paul Cothran agrees. He runs the Big Apple Circus Clown Care Unit in New York, which rigorously trains professional entertainers and sends them into 11 children’s hospitals in Eastern and Midwestern states. Begun in 1986, the unit now has 65 performers making 163,000 bedside visits a year. The red-nose transplant is a standard Big Apple game. So are chocolate milk “transfusions,” plate-spinning “platelet tests,” and a band called Bedpandemonium, which converts stethoscopes, syringes and even rubber gloves into musical instruments. “While the doctors treat what’s wrong with the child, we treat what’s right,” Cothran says. But, he adds, the fun is infectious. “Even doctors have begun to join in and make play a part of their treatment.” Adults, too, appear to reap the benefits. Leslie Gibson, a nurse who directs the Comedy Connection, a humor program at Morton Plant Hospital in Florida, says that over 60 percent of her patients report decreased pain, and some write later to say they actually enjoyed their stay in the hospital. Her team of volunteers - aged 9 to 90, average age 75, - even gets calls from the intensive care unit. In general, doctors have been slower than nurses to use humor. Those who do so often discover that it builds closer relationships with their patients. “But in the medical mainstream, it’s still not accepted,” says Chicago psychologist and “laughologist” Ed Dunkelblau. Patch Adams himself pokes fun at the cautious way medical institutions package and label the concept of “therapeutic humor.” “In order to get validity in a hospital, you have to call it something,” he says. “Art therapy. Music therapy. Redundant words! Of course, music is therapy. And when isn’t humor therapeutic?” But Adams, - whose speech rhythms and comic timing are very much like those of Robin Williams - has a spontaneity that is rare. For most doctors, Dunkelblau says, “the concept of being silly runs counter to everything physicians have learned. We want our patients to know that we’re taking their illnesses seriously. We don’t want to risk being thought frivolous or incompetent. And thirdly, we’re concerned we won’t be funny, that we won’t be good at it.” One doctor trying to break those barriers is Clifford Kuhn, M.D., clinical professor of psychiatry at the University of Louisville School of Medicine in Kentucky, who works mainly with cancer patients. In 1991, Kuhn took a six-month sabbatical and toured 22 cities as a stand-up comic. Later, he joined forces with veteran comedian Jerry Lewis and together they have taught the art of humor in 30 medical schools across the nation. Kuhn began this quest not only to train doctors but also to find out if we can sharpen our capacity for laughter - to use it, in fact, as preventive medicine and to create a reservoir on which to draw in times of crisis. He thinks we can. You don’t have to be Jerry Seinfeld, he says, or even to tell jokes. “Just concentrate on having fun.” Fry has long recommended building a home library of books and videos to fit your own “humor profile,” pointing out that belly laughs need no prescription. Kuhn also advises a daily workout. “Raise your eyebrows as high as you can. Close your eyes as tightly as you can. Grimace as deeply as you can. Smile and grin as broadly as you can. Stretch all the major laugh muscles.” Five year olds naturally laugh about 250 times a day, he notes. But as we age, flabbiness can affect mirth as well as girth. “My whole pitch is to try to get people back in touch with their sense of humor,” Kuhn says. “It just happens to be one of the most powerful healing sources. It doesn’t cure anything that I know of, but it does so many good things for the immune system and stress levels in the body that we’re really sitting on a gold mine if we suppress it.”

For a good time, call...

* American Association for Therapeutic Humor: professional training, information, speakers. Call (314) 863-6232. Website: www.aath.org * Humor Project, Inc. humor resources and products, information, speakers. Call (518) 587-8770. Web site: www.humorproject.com

* Comedy Connection, Morton Plant Hospital, 323 Jefford Street - MS 16, Clearwater, Fla. 33757:information packets and tours explaining how a volunteer humor program works. Call (727) 462-7841

* Humor and Health Journal: Web site offers articles on therapeutic humor and links to other sites: www.intop.net/~jrdunn/