Is Laughter and Good Humor a Necessity for Living a Healthy Life?

When thoughts arise about improving or maintaining one's good health, the terms "diet" and "exercise" often first come to mind. Though diet and exercise are certainly staples in health enhancement and physical maintenance, there may be another valuable, yet often ignored, aspect of physical up-keep. There is evidence that the use of humor, along with resulting laughter, may be key in bettering an individual's mental and physical health. The two have been shown to be vital components for patient recovery, physical well-being, and sustaining psychological soundness. Laughter and the proper use of humor is vital to physical health and emotional well-being, therefore it should be recognized as legitimate medicine in both physical and psychological therapy.

Humor, and its desirable effects, has seemed to center on the entertainment aspect of life as shown by the popularity of working comedians, television sitcoms, syndicated radio broadcasts and literature. Finding something to laugh about is as easy as turning on one's television, radio, or opening the newspaper to the comic pages to obtain that one source of entertainment that will produce humor to its audience and convert it into laughter. Though the values of humor and laughter in the entertainment industry are obvious in a sense of popularity and even monetary profit; the abstract values of humor and laughter in everyday life may be taken for granted. It appears that humor and laughter can contribute to maintaining a person's good mental and physical health, for speeding recovery from illness, and even, to an extent, helping to cure disease and the prevention of heart disease, although the medical reasoning for this is unknown.

It is important to understand that humor and laughter are two different entities. Humor is defined, in The American Heritage Dictionary, Fourth Edition, as "the quality that makes something laughable or amusing" (415). As an attribute to human emotion, humor is one's "ability to perceive, enjoy or express what is amusing or comical" (415). Laughter is the physical reaction to the understanding of humor and is defined (laugh) in the same publication as an expression of "mirth, delight, or derision by a series of inarticulate sounds" (481).

The therapeutic use of laughter could be considered to be a form of alternative medicine and, perhaps, even "new-age". However, the idea of using humor and laughter to benefit health does not appear to be a new theory at all. As documented in the on-line publication, "The Quotations Page," writer/poet, Lord Byron, (1788 - 1824), once said, "Always laugh when you can. It is cheap medicine" (par. 15). Also, Norman Cousins said, "Laughter is inner jogging," (par. 19). Cousins was a man who, according to Athena du Pre's book Humor and the Healing Arts , credited laughter as being a key component to his recovery from a life-threatening illness ( 4). Noted psychiatrist, Sigmund Freud, seemingly was an early advocate for the therapeutic use of humor. Kevin Meyer pointed to this in his dissertation, The Relationship Between Therapists' Use of Humor and Therapeutic Alliance where Freud has been quoted as saying that humor, "is the greatest of all defense mechanisms a person can utilize" (20).

The therapeutic use of humor and the benefits of laughter may not be limited to physical medicine. Humor can be used to treat a person psychologically, as well. It has been documented that humor can change behavior, reduce or relieve stress and helps to connect individuals who, otherwise, would find solace in a psychological state of solitude. Humor has also been shown to assist in couple and family therapy, facilitating the development of therapeutic alliance between therapist and patient (Meyer). In an on-line article from the Association for Applied and Therapeutic Humor, "What is Humor?", Steven M. Sultanoff, PhD writes how humor has been shown to offer mental patients with a confirmation of identity and a sense of belonging to a group. Humor alleviates emotional distress and provides people with necessary mental tools to cope with life's many pressures and demands. According to Sultanoff, individuals lacking a sense of humor tend to have tunnel vision, seeing and concentrating only on the cause(s) of his or her stress and eliminating alternate, healthy means to feel better. Without humor, a person's sense of self esteem is much lower that that of a person with a healthy cognizance of humor. An example of a healthy sense of humor is the ability to laugh at oneself in a non degradatory manner (4). This shifts one's focus on viewing a personal dilemma in a different light, making this stressful situation one that is not so powerful. Laughing at oneself in a positive way is essential for self-acception and self-respect, key aspects for good mental health.

Connecting with peers is an essential human need. A sense of fitting in with a particular group is important for one to establish his or her personal identity. Sharing a similar sense of humor may assist with that connection. Humor and laughter provides a sense of understanding between friends, sharing mutual comprehension among the persons involved. An individual with one or more close friends is more apt to express his or her emotions openly and, through humor, reduce stress levels.

Therapeutically speaking, humor can be a valuable asset to a person's mental health. Humor equips people with tools needed to to deal with emotionally traumatizing situations and efficiently manage their emotions. Since humor can replace emotional distress, an individual can use humor to reduce distress. For example, a person who is under emotional distress can visualize a humorous situation to mentally replace an event, (past or present), in his or her life that causes anxiety. Humor can teach individuals to see stressful situations in different perspectives, allowing them to accept reality rather than allowing a distorted view of their anxiety cloud his or her judgment (Sultanoff 4).

The realm of psychological therapy utilizes humor in counseling sessions as a communication device; a tool that strengthens the patient/therapist relationship, building bonds of trust, caring, and a sense of understanding in both group assemblies as well as individual therapeutic sessions. Therapists employ humor as a method to display objectivity to the patient(s); to show that group sessions will not be viewed one way or the other by the therapist and to assure patients that judgment, via favoritism, will not be made (Meyer).

Humor presents many therapeutic tools for patients and therapists to use in order to maintain a healthy psychological and mental state. Therapists use humor to separate themselves from the issues of the patient and to display objectivity, further strengthening the patient to therapist bond. People can use humor to reinforce personal identity, form friendships which offer a sense of belonging, and replace woes caused by stressful episodes in their lives.

When it comes to physical health, there may be some truth in the adage, "Laughter is the best medicine". Laughter and humor seems to play an important role in physical well-being. According to a 2000 report from the University of Maryland Medical Center, "Laughter is the 'Best Medicine' for Your Heart", laughter assists in protecting humans against heart disease. Evidence from this report points to laughter, along with an active sense of humor, as being an effective tool in the prevention of heart disease. Though the direct reasoning for the conclusion of this study is uncertain, what is known is that mental stress can instigate damage to the protective barrier which lines blood vessels called, endothelium. Depletion of this lining can lead to inflammatory reactions that may cause a heart attack due to fat and cholesterol build-up in coronary arteries ("Laughter" par 3).

A test in the study described in the aforementioned article consisted of two questionnaires. To determine test subjects situational laughter, a test with multiple choice questions was used. The second questionnaire utilized fifty true-false answers to measure test subjects' amount of hostility and anger. Three-hundred test subjects were used in this study where one-half of the participants had a history of heart disease or heart related surgery, while the other half was participants, age-matched and in good health. The conclusion of the tests determined that those with a history of heart disease were less apt to recognize humor and not likely to utilize humor in order to stray from undesirable situations. It was determined that, even in situations termed as positive, members of this group were not likely to laugh as much as those with a history of good health ("Laughter " par 4-5).

In this report, Dr. Michael Miller, director of the Center for Preventive Cardiology at the University of Maryland Medical Center, pointed out , "We know that exercising, not smoking and eating foods low in saturated fat will reduce the risk of heart disease. Perhaps regular, hearty laughter should be added to the list" (par 6). Dr. Miller further advocates the physical benefits of laughter by adding, "The recommendation for a healthy heart may one day be - exercise, eat right and laugh a few times a day" (par 7).

Laughter, theoretically, is a physiological response known only in human beings. As far as absolute evidence, there is, at this time, very little to know about how the human brain works when humorous stimulus is presented. However, according to an on-line article from PubMed, there may be an eventual understanding of this. In this article, "Humor and Laughter May Influence Health", there is some information which concludes that the supplementary motor area of the brain is involved in understanding and recognizing humorous situations that result in laughter. In tests, laughter could be produced when electrical stimulation is introduced to the anterior part of the human supplementary motor area of the brain. In theory, this should map-out the effects laughter has on stress management and immune system functioning, but further studies are required to determine how these neurological fluctuations affect physical reactions to stressors, and positively effect the body's immune functioning ("Humor" 3).

A method for analyzing the body's ability to fight off illness is to assay a patient's salivary secretions for the presence of IgA, (immonoglobin A), a natural substance found in the body that combats viruses. There is evidence that finds a growth in the amount of IgA in those test subjects who watch humorous videos. Patients who use humor regularly show more stable and higher levels of IgA and those who are dubbed "high-humor user" are at less of a chance of experiencing chronic stress. Data shows that IgA levels decreased during periods of high anxiety for low humor users while patients who utilize high amounts of humor, the IgA levels stay consistent (du Pre 20).

It is a belief, in certain medical circles, that endorphins, a chemical found in the brain, are released during the action of laughter. The release of endorphins can ease physical pain and present a feeling of euphoria to the body, much like the effect of codeine and morphine. Unfortunately, there is no evidence indicating that endorphins are released during laughter. According to Sultanoff, there is also no research indicating that humor and laughter heals illness. The evidence linking humor to the reduced risk of heart disease is strongly supported by the fact that humor replaces depression and stressful situations, which are closely related to heart disease. Therefore, theoretically, it is not humor or laughter that can heal, it is the reduction or, even elimination, of negative stress that contributes to ridding the body of illness (Sultanoff 3).

Though the above statement is strong in theory, Norman Cousins may disagree. Norman Cousins, according to a report written by William T. Jarvis, Ph.D., appropriately entitled, "Norman Cousins", was praised by doctors, in more than three-thousand letters (par. 1), for his self-treatment of a disease that, at the time, took the lives and/or paralyzed four-hundred, ninety-nine out of five-hundred people (du Pre 4). Cousins, believed to have developed ankylosing spondylitis , a degenerative disease of the connective tissue and, after suffering negative reactions to most of the drugs prescribed to him, checked himself out of the hospital and into a hotel room, under doctor's cooperation. Cousins ignored all medicinal recommendations, except for Vitamin C in intravenous form, and subjected himself to humorous films and books. Though there was no absolute diagnosis for what caused Cousins' affliction, (nor was there any sufficient documentation of whether his recovery was because of his method of self-treatment or due to his body's eventual overcoming of the illness), Norman Cousins nearly accomplished a full recovery, getting back the majority of the motor skills which he lost due to the, alleged, ankylosing spondylitis (Jarvis par 1).

In Athena du Pre's book, several methods and scenarios are introduced to exhibit how humor could be effectively utilized in the doctor/patient relationship. Similar to the effects in the patient/therapist bond in psychological treatment, humor could be vital during physical examinations. It is not uncommon for patients to see their physician merely as a heartless professional whose job is to repair their ailments. The entire visit to the doctor's office may seem troubling, (from the first step to the reception desk, to the time spent in the waiting area, and to the actual examination). Anxiety and, perhaps, a bit of intimidation could actually build proverbial walls between the doctor/patient relationship. The use of humor may prevent this barrier (du Pre 100-109).

Humor in the doctor's office has benefits in the form of many faces. The common ground is communication - speaking and listening. Both the patient and the physician can use humor to benefit one another. A doctor may use humor to ease a patient's anxiety - to show the patient that a sense of humanity lies behind the stethoscope and lab coat. Much like the opening humor allows in psychotherapy, this allows the patient to feel a connection with the physician in turn, building a sense of trust in the relationship (du Pre 100-109).

This bond of trust allows the patient to expose themselves, openly and with a lesser chance of reluctance to reveal personal knowledge that could be termed "shameful" in his or her everyday life. When the physician exposes his or her humanity through humor, it exhibits to the patient that no personal judgment is going to be made against them; that there is nothing to be ashamed about in whatever will be discussed during the visit (du Pre 100-109)..

Humor is an effective tool for a physician to utilize to minimize a patient's physical anxieties, as well. While it may be difficult for patients to open up verbally, it could be just as difficult, (if not, more so), for the patients to reveal themselves physically. A doctor that uses effective humor can alleviate a patient's fear of exposing body parts for examination or, at most, relieve anxiety during a procedure that requires the patient to completely disrobe. When the patient feels that the doctor is at ease, the apprehension of exposing one's flesh is subsided, allowing the physician to comfortably carry out the procedure (du Pre 100-109).

A physician may use humor to show the patient that their suffering is understood; that there is a shared understanding that the patient's pain is real. This form of humor can be expressed in facial expressions, words, or inarticulate sounds; again, displaying human characteristics that allow patients to feel comfortable in dealing with their ailment. The doctor can utilize humor in this fashion to show recognition regarding the patient's pain or other anguish, (physical and mental), that may come with illness, thus strengthening the bond between patient and physician (du Pre 100-109).

A physician needs also to understand a patients use of humor in the doctor's office. Patients often use humor to comfort themselves in stressful situations and/or to deal, mentally, with serious medical conditions. A patient can use humor to lessen anxiety during the physical examination which may require uncomfortable situations of answering embarrassing questions, or physical nudity. Humor, in this case, is a comfort tool, making the visit to the doctor a more tolerable experience. A physician may also see a patient use humor as a tool for coping with a serious, even life-threatening, physical issue. The patient's use of humor in this fashion displays knowledge of the situation and acceptance of what could result from it (du Pre 100-109).

The use of humor in medicine, (along with some benefits of resulting laughter), has shown to have viable results. In psychological medicine, a healthy sense of humor has shown to reduce stress levels in patients that utilize it on a regular basis. Humor has been shown to be an effective tool in psychological therapy, offering an affiliated approach between patient and therapist to deal with mental, emotional, and psychological issues. Psychologically speaking, humor presents an acceptance of identity and may help a person decide who their friends are and assist in choosing their individual lifestyle.

Humor and laughter offers benefits to the improvement, maintenance, and well-being of the physical sense. Studies have shown that laughter, the physical reaction to the cognizance of humor, can increase blood flow in the body and benefit the health of the human heart. Evidence points to laughter as being a benefactor to increased immune system functioning as well as acting as a natural pain reliever. The physical benefits of laughter may even lead to the natural healing of disease. In the case of Norman Cousins, laughter may have played a vital role in his near-complete recovery from ankylosing spondylitis. Humor and laughter, in psychological and physical therapy, has been shown to be an effective, economically-friendly method for treating physical and psychological illness, therefore its medicinal purposes should be acknowledged and practiced with utmost confidence.

Works Cited

Bennett, Mary Payne and Lengacher, Cecil A. Evidence-Based Complementary and Alternative Medicine. 16 Jan. 2006. 8 Apr. 2009

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16550224>.

du Pre, Athena. Humor and the Healing Arts. Mahwah, New Jersey: Lawrence Erlbaum Associates, Inc., 1998.

"Humor." The American Heritage Dictionary . 4^th ed. 2001.

Jarvis, William T. PhD. "Norman Cousins". 1 Dec. 2000. 8 May 2009.

http://www.ncahf.org/articles/c-d/cousins.html>.

"Laugh." The American Heritage Dictionary . 4^th ed. 2001.

"Laughter Good for Heart." University of Maryland Medical Center. 9 Mar. 2009. 29 Apr. 2009 http://www.umm.edu/news/releases/laughter.htm>.

"Laughter Helps Blood Vessels." University of Maryland Medical Center. 9 Mar. 2009. 29 Apr. 2009 http://www.umm.edu/news/releases/laughter2.htm>.

Meyer, Kevin M.S. Dissertation for Master's Degree.

The Relationship Between Therapists' Use of Humor and Therapeutic Alliance. 2007. 8 Apr. 2009. The Ohio State University.

Moncur, Michael. "The Quotations Page." The Quotations Page. 2007. 29 Apr. 2009 http://www.quotaionspage.com/subjects/laughter/>.

Sultanoff, Stephen M. PhD. "What is Humor?". Association for Applied and Therapeutic Humor. 1995. 11 Apr. 2009 http://www.aath.org/articles/art_sultanoff01.html>.