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The laughter prescription.

THE LAUGHTER PRESCRIPTION

The telephone call was from the Associated Press correspondent stationed in Chicago.

"How does it feel to be fully vindicated?" he was asking.

I drew a blank and said so.

"There's a report in the new issue of JAMA [Journal of the American Medical Association] providing scientific evidence that you were right when you wrote that laughter is useful in combating serious illness," he continued. "It's by Swedish medical researchers whose experiments show that laughter helps the body to provide its own medications. Let me read from the report: 'A humor therapy program can improve the quality of life for patients with chronic problems. Laughter has an immediate symptom-relieving effect for these patients.'

"Since you were heavily criticized by some physicians when your article first appeared in the New England Journal of Medicine, it must feel pretty good to have this verification."

Of course I was gratified by the report in JAMA. In Anatomy of an Illness, first published in 1976, I had reported my discovery that ten minutes of solid belly laughter would give me two hours of pain-free sleep. Since my illness involved severe inflammation of the spine and joints, making it painful even to turn over in bed, the practical value of laughter became a significant feature of treatment.

Dr. William Hitzig, my physician, was as fascinated as I was by the clear evidence that laughter could be a potent painkiller. He tested this proposition by comparing my sedimentation rate before and after my response to amusing situations in films or books. The sedimentation test measures the extent of inflammation or infection in the body. Since my sedimentation rate was in the upper range, any reduction was to be welcomed. Dr. Hitzig reported to me that just a few moments of robust laughter had knocked a significant number of units off the sedimentation rate. What to him was most interesting of all was that the reduction held and was cumulative.

Even more encouraging, the retreat of pain was accompanied by a corresponding increase in mobility. At that time, little was known about the ability of the human brain to produce secretions with morphine-like molecules--endorphins and enkephailins. Looking back now, in the light of this knowledge, I realize the laughter probably played a part in activating the release of edorphins.

In writing of this experience, I was careful to point out that I didn't regard the use of laughter as a substitute for traditional medical care. I also emphasized that I tried to bring the full range of positive emotions into play--love, hope, faith, will to live, festivity, purpose, determination.

Obviously, what worked for me may not work for everyone else. Accumulating research points to a connection between laughter and immune enhancement, but it would be an error and indeed irresponsible to suggest that laughter--or the positive emotions in general--have universal or automatic validity, whatever the circumstances. People respond differently to the same things. One man's humor is another man's ho-hum. The treatment of illness has to be carefully tailored to suit the individual patient.

But not unnaturally, perhaps, the laughter aspects of the recovery made good newspaper copy. I was disturbed by the impression these accounts created that I thought laughter was a substitute for authentic medical care. In fact, my principal reason for writing the article about my illness in the New England Journal of Medicine wa to correct this impression. I emphasized that my physician was fully involved in the process and that we regarded laughter as a metaphor for the full range of the positive emotions.

Perhaps I might have been a lot less defensive if I had known then what I know now. Medical researchers at a dozen or more medical centers have been probing the effects of laughter on the human body and have detailed a wide array of beneficial changes--all the way from enhanced respiration to increase in the number of disease-fighting immune cells. Extensive experiments, working with a significant number of human beings, have shown that laughter contributes to good health. Scientific evidence is accumulating to support the biblical axiom "A merry heart doeth good like a medicine."

Of all the gifts bestowed by nature on human beings, hearty laughter must be close to the top. The response to incongruities is one of the highest manifestations of the cerebral process. We smile broadly or even break out into open laughter when we come across Eugene Field's remark about a friend "who was so mean he wouldn't let his son have more than one mesale at a time." Or Leo Rosten's reply to a question asking whether he trusted a certain person: "I'd rather trust a rabbit to deliver a head of lettuce." Or, as Rosten also said, "Let's go somewhere I can be alone." Or Evan Esar's definition of love: "A comedy of Eros." These examples of word play illustrate the ability of the human mind to jump across gaps in logic and find delight in the process.

Surprise is certainly a major ingredient of humor. Babies will laugh at sudden movements or changes in expression, indicating that breaks in the sequences of behavior can tickle the risibilities. During the days of the silent films, Hollywood built an empire out of the surprise antics of its voiceless comedians--Harold Lloyd swinging from the hands of a giant clock, Charlie Chaplin caught up in the iron bowels of an assembly belt, or Buster Keaton chasing a zebra.

It has always seemed to me that laughter is the human mind's way of dealing with the incongruous. Our train of thought will be running in one direction and then is derailed suddenly by running into absurdity. The sudden wreckage of logical flow demands release. Hence the physician reaction known as laughter.

Consider the story of the two octogenarians on a park bench. Once asks the other:

"Do you believe in reincarnation?"

"Well, Joe," replies Harry, "I've never really thought much about it."

"Maybe we ought to start thinking about it," says Joe. "One of us is going to go first. Let's agree that the one who is left behind will come to this park bench every Wednesday at 11:00 a.m., and the one who has departed will find a way of getting a message to him at that time about reincarnation and all those other things that are beyond our ken."

Harry agrees.

One month later, Joe dies peacefully in his sleep. Every week for several months, Harry takes up his station at the park bench at 11:00 a.m.

Then one Wednesday, at the appointed hour, he hears a voice, as though from afar.

"Harry, Harry, can you hear me?" the voice says. "It's Joe."

"Joe, for heaven's sake, what is it like?"

"You wouldn't believe it, Harry, about the only thing you do up here is make love. They wake you up at seven in the morning and you make love until noon. After lunch and a nap, you're at it again right through until dinner time."

"Good gosh, Joe, what are you and where are you?"

"I'm a rabbit in Montana!"

The brain accommodates itself to the collision of logic and absurdity by finding an outlet in the physiological response we recognize as laughter.

Does humor make a difference in one's approach to challenging situations? According to some medical studies, public speaking is one of the most stressful experiences in any catalog of human activity. I have no way of confirming that fact scientifically, but I can attest, on the basis of some 2,000 lectures during the past 40 years, that both speaker and audience seem to get along much better with a little humor.

The first formal lecture I gave was in New York City's Town Hall, then the mecca for public speakers. After I completed the talk, Bennett Cerf, the boo publisher and collector of jokes, came up to greet me.

"That was a good talk," he said, "considering it's your first try. But you're a little too serious. You've got to warm up your audience. Start with a humorous story. It's always a good idea to involve yourself in the anecdote, especially if a celebrity or two figures in the story. Hasn't anything funny happened to you recently that also involves someone who's famous?"

I told Bennett I had spoken in Albany only a week earlier at a special convocation of the Board of Regents to welcome General Eisenhower in his new role as president of Columbia University. I sat next to General Eisenhower and tried to compose myself for my talk. My discomfiture must have been apparent to the general. He leaned toward me and spoke in a whisper.

"What's the matter? You look a little pale."

I whispered back that my appearance was not deceptive, and that the prospect of speaking to so many educators in their university gowns was a little intimidating.

"Do as I do," he said. "Whenever I feel nervous before I speak I use a little trick."

"Trick? What trick?"

"I just transfer my nervousness to the audience," he said.

"And how do you do that?"

"Very simple. I look out at all the people in the audience and just imagine that everyone out three is sitting in his tattered old underwear!"

Bennett Cerf was entranced with this account.

"Great, great!" he exclaimed. "Now, the next time you speak, just begin your talk with the Albany story and the advice given you by General Eisenhower. You'll see what a difference it makes."

Two weeks later I spoke in St. Louis, and I began my talk with the Eisenhower anecdote. It didn't produce even a ripple. The audience was stony faced. The rest of my talk was uphill all the way.

Following the lecture, a man came up to me.

"That story about General Eisenhower," he said. "Are you sure it happened to you?"

"Yes," I said. "Of course it did."

"That's strange," he replied. "Bennett Cerf lectured here last week and said it happened to him."

Even so, I can testify that Bennett Cerf gave me good advice. People who come to hear a talk tend to be a little more attentive if the speaker illustrates his points with occasional amusing references or anecdotes. If, on the other hand, you keep pounding away at an audience with solemn pronouncements, you can expect to be rewarded with a collective glaze.

Cerf was right, too, about the strategy of involving yourself in the stories. I got a lot of mileage at the beginning of my talks by referring to something that happened to me when I went to Kansas City on a rainy night for a talk at the Convention Hall. The structure consisted of several auditoriums of various sizes--including a prizefight arena and a hall capable of accommodating six or seven thousand people. people.

I went in through the main entrance, checked my raincoat, and went to the third-floor auditorium, as specified on my itinerary sheet. I walked down the side aisle and noticed that the stage had no approaching steps. I asked a member of the audience if he could tell me how to get backstage. He pointed to a side door, then told me to go inside and turn left.

As directed, I went through the designated door--then spun around to catch it behind me, thinking it might be bolted from the inside. I was too late. The know didn't turn, In the dim light I could see that there was no passageway to the left--something I should have realized about Kansas City in the first place--only a stairway, the bottom of which was lost in darkness.

I rapped on the door behind me; it had a heavy metal thickness, and I knew that continued rapping would produce only sore knuckles.

There was nothing to do except to make the great descent.

I came to the bottom, turned left into the darkness, and found myself stumbling through the remains of old stage sets. Eventually, I spied a thin line of light along the floor and groped my way toward it, thinking it might be a door. I was right, I turned the knob, opened the door, and stepped out in the brilliantly lighted platform of a poultry convention being addressed by H. V. Kaltenborn. A gasp went up from the audience. Mr. Kaltenborn turned around, recognized me, and asked what was happening.

"I'll explain later," I said and backed out again into the catacombs of Kansas City, resuming my encounters with old stage sets. Eventually, I came to another door. It had a bar handle. I pushed, the door opened, and I found myself on the street on the far side entrance to the building.

The rain had become a downpour. I had to choose between a retreat back into the catacombs or a wet platform presence. It was an easy choice. I made a run for it. Several hundred yards later, I reentered the structure and proceeded to the third-floor auditorium, where an attendant asked for my ticket.

"I realize I don't look much like it at this point, or perhaps at any point," I said, "but I happen to be the speaker."

The attendant looked at the thoroughly soaked figure in front of him.

"Look, bud," he said, "the speaker already went inside 20 minutes ago."

His facts were unassailable.

"How do I get in?" I asked wearily.

The attendant pointed to the box office.

"You pay your way in, same as everyone else," he said.

I did as directed but not without resentment, being forced to pay three dollars for a talk I had hear before. I perceived, however, a certain redeeming feature of this episode. It occurred to me that the country might have far better lectures if the lecturers occasionally had to pay their way in to hear themselves.

Such misadventures give me ammunition for the beginning of my talks. Audiences seem to relish accounts involving mishaps to speakers. The Kansas City story puts them in a relaxed and receptive mood.

Dr. Novera Herbert Spector, the neurophysiologist, sent me an account written more than a half-century ago of the physiological benefits of laughter. It was by Dr. James Walsh, then the medical director of the School of Sociology at Fordham University in New York.

Dr. Walsh reported on his research showing that hearty laughter stimulates internal organs, "making them work better through the increase of circulation that follows the vibrating massage that accompanies it, and heightens resistive vitality against disease." Dr. Walsh then particularized by detailing the beneficial effects of laughter on lungs, liver, heart, pancreas, spleen, stomach, intestines, and the brain. He wrote that laughter has the effect of brushing aside many of the worries and fears that set a stage for sickness.

Dr. William Fry, Jr., of the Department of Psychiatry at Stanford Medical School, likens laughter to a form of physical exercise. It cause huffing and puffing, speeds up the heart rate, raises blood pressure, accelerates breathing, increases oxygen consumption, gives the muscles of the face and stomach a workout, and relaxes muscles not involved in laughing. Twenty second a laughter, he has contended, can double the heart rate for three to five minutes. That is the equivalent of three minutes of strenuous rowing. rowing.

Just in psychological terms, laughter can confer benefits.

In the 1950s, Dr. Gordon Allport, psychologist-teacher at Harvard University, theorized that humor, like religion or climbing a mountain, provides a new perspective on one's place in society. Dr. Annette Goodheasrt, a psychologist in Santa Barbara, confirmed this view in her own work. She found that humor helps an individual to confront personal problems in a more relaxed and creative state. Along the same line, Dr. Alice M. Isen, of the Department of Psychology and Johnson Graduate School of Management at Cornell University, said that laughter increased creativity and flexibility of thought. One of her studies involved individuals who failed to tack a candle onto a corkboard wall in such a way as to not drip was on the floor while it burned. Those persons who had just seen a short comedy film were better able to devise innovative approaches to the task than those who had "creative flexibility" after seeing the film. In tests of mental acuity, Isen has also found that positive feelings, induced by humorous films or the giving of a candy gift, enable persons to use language more colorfully.

Laughter has been shown to help reduce "discomfort sensitivity." Drs. Rosemary and Dennis Cogan, et al., Lubbock, randomly assigned 40 undergraduates to four groups: (1) laughter, (2) relaxation, (3) informative narrative, and (4) no-treatment control. Members of groups one, two, and three each listened individually to a 20-minute audiotape appropriate to their group. The discomfort was produced by pressure from the automatic inflation of a blood pressure cuff. Subjects could withstand the highest level of discomfort after being exposed to humorous material; the next highest level after being exposed to a relaxation technique. The Cogans and their colleagues suggest that humor can be particularly useful in alleviating the pain of injections a patient must receive, as well as postoperative pain.

If laughter can improve one's perspective on life and on pain, it follows that it might be helpful in combating unusual stress. Drs. Rod A. Martin and Herbert M. Lefcourt, then of the University of Waterloo in Ontario, Canada, studied the connection between humor and adjustment to major life stresses. They gave 56 undergraduates four tests designed to measure the capacity to enjoy humor under a variety of circumstances. Three out of four tests showed that those who valued humor the most were also most capable of coping with tensions and severe personal problems.

Drs. Martin and Lefcourt subsequently studied 67 students and found that those who had the greatest ability to produce humor "on demand" in impromptu routines are also best able to counteract the negative emotional effects of stress.

Dr. James R. Averill, then of the Department of Psychology, University of California, Berkeley, measured a number of physiological reactions accompanying various emotional states. Fifty-four undergraduates were divided into three groups--a sadness group, a mirth group, and a control group. The sadness group watched a film about John F. Kennedy; the mirth group saw a Mack Sennett-type silent comedy; and the control group viewed a non-arousing documentary film. Measurements of blood pressure, heart rate, finger and face temperature, finger pulse volume, skin resistance, and respiration were taken during the showing of the films. Averill found that laughter produced respiratory changes, and that sadness yielded changes in blood pressure. The main conclusion of the study was that emotions produce measurable physiological change.

Dr. Paul Eckman and colleagues, of the University of California at San Francisco, School of Medicine, measured physiological differences during six emotional states--surprise, disgust, sadness, anger, fear, and happiness. They asked 16 individuals--actors and scientists--to mimic prototypical emotional facial expressions and then to experience each of the six emotions by reliving a past emotional experience while measurements of heart rate, hand temperature, skin resistance, and muscle tension were taken.

The results were striking. Not only did significant physiological differences between the negative emotions and the positive emotions turn up, but different emotions produced different effects. For example, anger was characterized by a high heart rate and hand temperature increases, whereas fear was accompanied by high heart rate increases and decreases in hand temperature. Happiness was associated with low rises in heart rate and hand temperature.

Some of the researchers involved in these studies sent me reports of their work, saying they had been prompted by my experience as reported in Anatomy of an Illness to seek scientific accounts from hospitals of new facilities that featured humor and creativity as integral parts of the hospital program.

The first to respond was St. Joseph's Hospital in Houston, Texas. I received a telephone call from Dr. Joh Stehlin, oncological surgeon and medical researcher, asking if I would come to Houston to participate in the dedication ceremonies of a new feature of the hospital called the "Living Room." He said that the cancer floor had been redesigned to accommodate a large room furnished with easy chairs, hi-fi equipment, an art corner, video and audio sets, and a library.

"You can't imagine a setting more unlike a hospital," he said. "You would enjoy seeing how a pleasant environment can brighten the mood of the patients. Amusing films are one of our main props. You will enjoy meeting the nuns. They like the idea of making laughter a regular part of the hospital's philosophy."

Three weeks later, I went to Houston for the dedication ceremonies. The entire hospital was in a festive mood for the occasion. The media exhibited a strong interest in the Living Room and the idea behind it. Television crews were setting up their cameras at the entrance to the hospital and in the Living Room itself.

I judged Dr. Stehlin to be in his mid-50s. His appearance was tall, trim, athletic, hearty. He took me into his office and told me that the hospital's experiment with laughter had been highly successful. The patients were relaxed and responsive; they appeared to be making fewer demands on the hospital staff. I met with at least a dozen patients whose arms or legs had been saved from amputation by procedures developed by Dr. Stehlin and his associates. The affected limb would be tourniqueted, protecting the rest of the body from the chemo-therapy, which was then free to attack the malignancy without penalty to the rest of the body.

The Living Room was in high favor with both ambulatory and wheel-chair patients. They kept the videotape machine busy, viewing comedy films that Dr. Stehlin was able to get directly from the film companies with their compliments.

Dr. Stehlin said that he found himself stealing time away from his desk to look at the comedies.

"You have no idea how good it makes me feel just to see the patients laughing and enjoying themselves," he said. "This place is getting to be unrecognizable as a hospital--and that's all to the good. Now, before we go to the Living Room, I want you to meet the nuns, especially Mother Romano. She's almost 80 but is spry and energetic. She has fallen in with this new approach and makes a point of telling the patients funny stories. Just yesterday she was telling them about an incident at a nightclub. It seems that the headwaiter was looking around the room and saw a man slide off his chair. He rushed over to the table. "'Madam,' he said, 'your husband has slipped off his chair and fallen under the table.'

"'Sir,' she said, 'my husband has just come into the room.'"

I trailed after Dr. Stehlin as he led me to the Living Room, stopping along the way at the rooms of cancer patients, where he introduced me, saying that Anatomy of an Illness was the hospital's inspiration for the Living Room.

We met Mother Romano, a wisp of a woman but a human dynamo. She pumped my arm vigorously when we wee introduced and rhapsodized over the patient's response to the Living Room. She accompanied us on visits to other cancer patients, then looked at her watch and said the dedication ceremonies were about to begin.

The Living Room was jammed with people--patients, hospital personnel, trustees, civic leaders, and press representatives. I guessed there were between 150 and 200 people. The room was brightly decorated. As Dr. Stehlin had said, it was the antithesis of everything that is popularly associated with a hospital.

Dr. Stehlin spoke first, then introduced Mother Romano, who described the suspicious effect of the new room not only on the patients, but on the nurses and other members. of the hospital staff. Then Dr. Stehlin introduced me to the audience.

I said the obvious things--how grateful I was that my hospital experience played a part in the decision to create the new facility at St. Joseph's. I described the research going on at UCLA and elsewhere showing laughter could produce auspicious physiological change.

The meeting with Dr. Stehlin led to a close friendship. We used some of the funds placed at my disposal to support his research at the hospital in studying the salutary effects of the psychological environment surrounding the treatment of cancer patients.

The Living Room at St. Joseph's was only the first of two dozen or more similar programs at hospitals throughout the country. At St. John's hospital in Los Angeles, a special channel on the TV sets in each room enabled the patients to turn on comedy films day or night. As at St. Joseph's, the hospital acquired a considerable library of amusing motion pictures. I relished the opportunity given me by the nuns at St. John's to dedicate the new comedy channel.

I participated in six or seven similar ceremonies at hospitals in the Los Angeles area. At the L.A. County Hospital, Joseph Barbera, creator of Huckleberry Hound and Yogi Bear, presented the children's division with life-size replications of the characters made famous in his TV cartoons.

UCLA redecorated the hospital's children's floors, replacing the drab whiteness with bright colors and amusing drawings. UCLA also used art throughout the entire hospital in a program devised by Devra Breslow.

Cedar Sinai Hospital, in Los Angeles, accepted the proposal of Marcia Weismann, a prominent art collector, to decorate the walls of the hospital with superb reproductions of outstanding art. Mrs. Weismann also arranged for art lectures at the hospital.

Good Samaritan Hospital of Los Angeles instituted a humor channel for patients' TV sets, along the lines of the program instituted at St. John's. Dr. David Cannom, head of cardiology at Good Samaritan, arranged for piano concerts at the hospital by Mone Colabek, an outstanding local artist.

Perhaps the most far-reaching program of all is the use of not just humor but also music, art, and literature in the treatment of the seriously ill instituted by the Duke University Comprehensive Cancer Center in Durham, North Carolina. The word "comprehensive" is to be taken literally. All the aspects of treatment are taken into account--the emotional needs of the patient; the interests or hobbies of the patient that can improve the climate of medical care, inside or outside the hospital; the use of a "laugh wagon" that is just as evident in the corridors of the hospital as the "pill carts" of the nurses; the services of volunteers to provide companionship or solace or to carry out errands for the patients--all these are integral to Duke's program. Dr. Robert Bast, the director of the center, believes that the psychosocial factors are no less important than medical prescriptions in the structure of a hospital and medical school.

At Duke, I learned of two examples of how humor can be used to lessen the problems caused by illness.

A patient at the university hospital suffered from a severe case of otitis media (inflammation of the middle ear). The nurse, recognizing that the emotional state of the patient was important, read him stories by Woody Allen. The patient's sense of delight blocked any nervousness, which the nurse felt might have interfered with the efficacy of the medication. Whether or not her strategy could be verified by physiological measurements, her awareness that psychological factors could enhance or impair medical treatment won the commendation of the hospital authorities.

Another example concerned a man who suddenly developed what is known as a paroxysmal tachycardia--a wildly beating heart. Ordinarily, the condition is temporary, but when it is also marked by an irregular pulse, prompt medical attention is required.

The man's wife telephoned the family physician, who said he would rush over to the house. In the meantime, he instructed the wife to do everything possible to keep the patient free of panic, the effects of which could intensify and complicate the underlying problem. The woman played a videotape of "Candid Camera" reruns, one sequence of which showed Buster Keaton at a lunchroom counter struggling to keep his eyeglasses and his toupee from falling into his soup. Her husband fell to laughing over the absurdity and completely blotted out any trace of panic. By the time the doctor arrived, the pulse had settled back to normal. The doctor credited the wife with having helped to avert a potentially serious situation.
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Author:Cousins, Norman
Publication:Saturday Evening Post
Date:Sep 1, 1990
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