Maybe Laughter is the Best Medicine After All

Bill Strubbe,

Medical science is slowly getting the message that maybe the proverb is right when it says “a merry heart does good like a medicine.

Wandering through the public gardens at Lokhandwala Park in Mumbai, India in early morning, you might cross paths with a mirthful group of folks contorting their faces and laughing in unison. Fifteen or twenty minutes of deep breathing and ho-ho-ha-ha’s, followed by a variety of simulated laughter like hearty guffaws, quiet tee-hee’s, roaring lion laughter, silent laughter, and tittering cocktail laughter……and the group disperses, beginning their day with a smile.

The 80 some laugh clubs in Mumbai, India — and over 900 across the country — are the inspiration of Dr. Madan Kataria who observed while working as a family physician that patients' immune systems and general well-being improved following bouts of laughter. Kataria eventually left his medical practice and gradually fine-tuned to a near-science his daily regimen of “thought-free” laughter, creating yoga laughter classes that have now spread from India to the Far East, Europe and North America where there are now over 100 groups.

Kataria’s methods have found a strong supporter in the U.S. “I felt a great calling, a synchronicity with the information, and felt I needed to deliver this message,” says Steve Wilson of Cleveland, OH, a psychologist of 40 years who met Kataria and is now one of America’s leading joyologists. Wilson has certified more than 100 laugh leaders — among them high school students and inmates at King County's North Rehabilitation Facility in Washington state. “I was astonished how much research had been already done that substantiated what I thought to be true,” he says.

Within the burgeoning field of gelotology (from the Greek gelos, or laughter), the scientific study of laughter, an expanding body of research is being compiled. Over 500 academicians belong to the International Society for Humor Studies, and increasingly doctors, psychiatrists and mental health professionals prescribe "laughter therapy" as another tool for helping people cope with physical, mental and spiritual issues.

What’s So Funny?

Philosopher John Morreall conjectured that laughter among early humans might have begun as an acknowledgement of mutual relief at the passing of danger. Neuroscientist V.S. Ramachandran in Phantoms of the Brain suggests a similar origin: “The main purpose of laughter might be to allow the individual to alert others in the social group that the detected anomaly is trivial, nothing to worry about.” Elaborations on these ideas propose that the release of tension after laughter counters the biological fight-or-flight response and helps indicate trust in one’s companions, thus strengthening communal connections.

Primates, including humans, gorillas, chimpanzees and orangutans, are the only mammals known to create audible laughter. As observed in the wild and at the Yerkes Primate Research Center in Atlanta, GA, primates frequently engage in chase and tickle behaviors that elicit panting sounds, a series of rapid respiratory expirations somewhat similar to the human laughter pattern, but lacking the familiar “ha-ha” vocalization.

Tickling games with their attendant laughter are seen as important bonding experiences between older people and small children, among small children, and between romantically inclined couples. In such circumstances, “a very intense personal interaction takes place, creating a high level of intimacy, or bonding,” explains Dr. William F. Fry, a psychiatrist and emeritus clinical professor in psychiatry at Stanford University. Fry has studied humor since the 1950’s and was among those who in 1963 coined the term gelotology. “Not only does the person who makes you mirthful meddle with your emotions, but also he or she plays with your bodily processes. When you joke and kid around, you make others’ hearts beat faster, increase their circulation, change their breathing pattern, change the hormone and immune elements in their blood streams and make certain muscles to be active and others relaxed, so they feel physically weakened.”

A person in a dominant social position — the company boss, family patriarch, or village chief — tends to use humor more frequently than underlings. By controlling the laughter of a group one exercises power, controlling the group’s emotional mood. For example, in a potentially humiliating or threatening situation, laughter may serve as a conciliatory gesture or as a method to avert anger. If the menacing individual succumbs to the laughter, the confrontation is likely diverted.

Laughter is triggered when something strikes us as “humorous,” which generally falls into three categories: relief, superiority, and incongruity. Relief would have been exemplified historically by our predecessors for whom laughter signaled the passing of a life and death threat. Today, authors and film makers regularly rely on the humor of relief by creating episodes in which tension and suspense build to a crescendo until the reader or viewer is allowed to release pent-up emotion through the interjection of an aside comment or a sight gag. Similarly in real life, when faced with stressful, sometimes even dangerous situation, the release of laughter allows a person to better cope.

Incongruity humor arises from logic and familiarity being replaced with things that don't normally go together. When a joke or situation suddenly takes an unexpected turn the incongruity of two sets of incompatible thoughts and emotions simultaneously strikes us as funny. Hence the humor of puns, talking duck jokes, and many other — often bad — jokes.

Superiority humor comes into play when we laugh at jokes that focus on someone else's mistakes, stupidity or misfortune. We feel superior to this person, experience a certain detachment from the situation and so are able to laugh at it.

“Mirth is one of the basic human emotional experiences. It is found throughout the human race,” says Fry. “No person or group of persons has been found to lack a sense of humor, except on a temporary basis….This demonstrated ubiquity of humor is compatible with the contemporary view of how deeply humor is bred into human existence. Rather than being regarded as learned, as it was previously, humor is now considered to be a genetic, biological characteristic of the human race.”

The approach that prominent laugh researcher Robert Provine, a professor of neurology and psychology at the University of Maryland, takes to understanding laughter is: “What would an alien think of this odd sound emitting from our mouths and faces?” Provine and his associates have spent a lot of time eavesdropping on adults and children in stores, in malls, restaurants, and on the street, noting their laughter, chuckles, and guffaws. In lab settings he records people's laughter and analyzes the data in an acoustic laboratory.

“Cross-cultural evidence suggests that males are the leading humor producers and females are the leading laughers,” said Provine. “These differences are already present by the time that joking first appears around six years of age.”

Other laughter facts he’s gathered are: Less than 20% of laughter is in response to anything resembling a joke, but rather most laughter occurs in the context of conversation (often following very lame remarks); People are 30 times less likely to laugh alone than in a group — hence, television’s dependency on laugh tracks.

Laughter on the Brain

Though gelotologists still do not fully understand how the brain processes humor, they do know that puns are “understood” by gyri (bumps on the cerebral cortex, the deeply folded outer portion of the brain) on the left side of the brain. Other complex, non-wordplay jokes are processed by right side gyri, then trigger activity in other regions of the brain. It seems that the left side “sets up” the joke while the right side emotionally “gets it.”

Peter Derks, professor of psychology emeritus at William and Mary College hooked up research subjects to an electroencephalograph (EEG) that monitored their brain activity when they laughed. In each case, the brain produced a regular electrical pattern. Within four-tenths of a second of exposure to something potentially funny, the EEG recorded a positive electrical pulse moving through the cerebral cortex. Laughter was associated with episodes in which the original positive pulse became coupled with a negative component making a whole wave. The negative component appeared to be associated with incongruity detection. No laughter ensued if the initial positive pulse lacked a negative counterpart. The negative pulse was definitive, so that Derks could identify laughter inducing episodes merely by reading the brain wave record.

Derks’s studies, conducted together with a group of researchers from NASA-Langley at Hampton, Virginia, confirmed that laughter is associated with many regions throughout the brain, unlike emotional responses which appear to be confined to specific areas of the brain. During the experiment, for example, the researchers observed activity in the left, front, right; and rear sides of the cerebral cortex as well as in the motor sections of the brain a narrow strip running from the top center of each hemisphere part way down toward the base of the cortex .

The limbic system, a network of structures nestled beneath the cerebral cortex, also appears to be central to laughter. It controls such essential behaviors of reptiles and mammals as self-preservation and finding food. In the alligator, for example, the limbic system plays an important role in smell, defending territory, and hunting, while in humans the limbic system’s functional arenas include motivation and emotional behaviors.

A rare opportunity to explore brain-driven laughter and mirth was had when a young seizure-prone woman was examined by Itzhak Fried, Director of Epilepsy Surgery at the UCLA Medical Center. When a restricted area of her left frontal cortex was electrically stimulated, she consistently laughed and perceived whatever she happened to be looking at as “funny.” Low levels of stimulation made her smile, while higher levels elicited belly laughs.

Laughter and Health

Though research into the healing benefits of laughter dates back to the 1930s, it was the 1978 book Anatomy of an Illness written by journalist Norman Cousins, suffering from ankylosing spondylitis (a degenerative connective tissue disease), that cracked the door open so this fringe idea could begin to enter the mainstream. By watching and laughing heartily at funny films, Cousins achieved considerable easing of his crippling pain and other symptoms of the disease. Researchers hypothesize that endorphins released as a result of laughter may have helped Cousins and similarly may help others in reducing the intensity of pain of arthritis, spondylitis and muscular spasms of the body.

Psychoneuroimmunology, a relatively new field of medical research, explores how emotions impact the immune system. Experiences of negative emotions and stress are correlated with immunosuppression, as partially measured by increased epinephrine and cortisol blood levels. These stress hormones also increase the number of blood platelets (which can cause obstructions in arteries) and raise blood pressure.

In 1989, Dr. Lee Berk, associate director of the Center for Neuroimmunology and Dr. Stanley Tan, assistant professor of medicine, both at Loma Linda University in California, began a series of studies on how laughter changes the levels of epinephrine, cortisol, and natural killer cells (NKA — responsible for the early recognition and removal of virus and tumor cells). In their experiment, subjects watched a 60-minute humorous video while the control subjects did not. Blood samples were obtained from each subject before (baseline), during, and after (recovery) the viewing. NKA increased significantly from baseline to recovery for the experimental group but there was no significant change in the control group. For all phases, epinephrine levels in the experimental group were significantly lower than in the control group. Cortisol levels decreased more significantly from baseline in the experimental group than in the control group. Berk’s and Tan’s results are supported by similar research conducted by Mary Bennet, assistant dean of the School of Nursing at Indiana State University.

Berk and Tan also have reported experiments documenting that laughter increases levels of Gamma-interferon (a disease-fighting protein); T-cells, which are a major part of the immune response; and B-cells, which make disease-destroying antibodies. Laughter also increases the concentration of salivary immunoglobulin A, which defends against infectious organisms entering through the respiratory tract. The stimulating effects on the immune system can, in some instances, be observed for several hours after the laughing bout.

Laughter generally commences with the vigorous expiration of air, and in a given bout of laughter more expiration occurs than inspiration, hence laughter is one of the best exercises for those suffering from asthma and bronchitis. It improves lung capacity and blood oxygen levels. Blowing forcefully into an instrument and blowing balloons are common asthmatic exercises to help dispel mucous from the respiratory passages. Laughter performs the same job, though more easily and free of cost.

Additionally, exercise devotees will be happy to hear that according to Fry: “Muscles throughout the body are exercised by mirthful behavior. Smiles produce activity of facial, neck and scalp muscles. Chuckling and laughter stimulates the muscles in the thorax, shoulders, abdomen as well as the diaphragm and sometimes the arm, leg and pelvic muscles. All the well-documented health values are recognizable in mirthful muscle activity, and it does not differ in any crucial fashion from aerobic exercise.” Which is why an evening a comedy club can leave you pooped! For sedentary people and those confined to bed or wheel chair, laughter can actually be a viable workout.

Laughter to the Masses

With the growing awareness of the therapeutic benefits of laughter and humor, in 1987, the American Association for Therapeutic Humor (AATH) was incorporated as a non-profit organization, and has since produced numerous bibliographies, sponsored annual conferences, created a popular "Speakers Resource" to educate health care professionals and lay audiences about the therapeutic uses of humor and laughter in the work setting, and publishes a bi-monthly newsletter.

Initially, most AATH members were health care professionals, but there’s been a steady increase in membership from those working in pastoral care, social work, education and business communities. “Now that the effects of laughter are being quantified, we can begin to qualify the importance of humor and laughter in the health care setting, either as an adjunct therapeutic tool for patients or as a self-care tool to offset the harmful effects of job stress,” says Patti Wooten, author of Heart Humor and Healing and Compassionate Laughter: Jest for your Health. “Further research is needed to study more directly the effects of humor on health care worker burnout and sick time, and patient length of hospitalization and compliance with treatment plan. Now that we have solid scientific research it makes it easier to approach administrations for funding and staff.”

Two years ago, Steve Wilson closed his psychology practice in order to devote himself full-time to laughter and created World Laughter Tours that teaches people how to create positive work places, and how to manage health and stress through humor. Laughter sessions vary from leader to leader, but typical of Wilson’s is a combination of stretching, stimulated laughter exercises and yogic deep breathing, which helps stimulate the calming branch of the nervous system (parasympathetic system) by rhythmic movement of the diaphragm and abdominal muscles. Deep breathing and laughter help to increase the net supply of oxygen, massage the digestive tract and improve blood supply to the internal organs, stimulate blood circulation, and strengthen the respiratory apparatus which supplies oxygen to the body.

In 1998, Wilson traveled to India and met the original “guru of giggles,” Dr. Kataria. “In the West we were proceeding on the mistaken notion that to receive the benefits of laughter, you had to be laughing as a result of humor,” Wilson explained. “You run out of jokes, or they flop, but in India, Dr. Kataria took the approach of bypassing the humor and getting directly to the laughter by creating a deliberate way to laugh.”

Medical research shows that even if you pretend laughing or act happiness your body produces “happy chemicals.” The human body does not know the difference between thinking about doing something and actually doing it. Laughter, whether spontaneously or as a form of exercise, leads to the same set of physiological changes. Although laughter in a group may start out as an exercise, laughter’s infectious nature can quickly turn the group’s experience in one of mirthful laughter.

Laughter is a strange brand of medicine. It’s outside the box of medical treatments. It’s simple, satisfying and free. Yet, scientists have already documented its positive physiological effects, and the new research arena is clinical studies to document its possible therapeutic effects. These studies cost more, they take much more time to conduct, and they are generally off the scope of medical research funding sources.

Nonetheless, with therapists, scientists, physicians, and public promoters rallying around laughter’s promise, the mirthful exercise may well gain entry into the field of legitimate medical research — and we all may find new reasons for appreciating the people who make us happy.

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Bill Strubbe is a freelance writer residing in Oakland, California.

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