Laughing for Health and Happiness

In 1964 Norman Cousins, the well-known editor of the Saturday Review, was hospitalized with a mysterious autoimmune disease.  He suffered high fever, severe pain, and near-paralysis. Mainstream medicine offered little hope of improvement, so he took matters into his own hands. He had his nurses read him columns by humorists, such as Mark Twain and E.B. White, and show him reruns of funny Candid Camera TV shows, Laurel and Hardy shorts, and old Marx Brothers movies.  He noted that he “. . . made the joyous discovery that 10 minutes of genuine belly laughter had an anesthetic effect and would give me at least two hours of pain-free sleep.” He was on the road to recovery. 

Cousins waited  years before making  his story public, because he wanted to make sure he wasn’t going to give others false hope. But he became convinced. In 1976 he wrote a famous article about his healing journey, titled Anatomy of an Illness (As Perceived by the Patient), and The New England Journal of Medicine published it. He wrote that he had, “laughed my way out of a crippling disease that doctors believed to be irreversible.” In 1979, after 30 years at the Saturday Review, Cousins began his second career at the University of California at Los Angeles School of Medicine as a professor of medical humanities and  researcher into the physiology of emotions. UCLA now hosts the Norman Cousins Center for Psychoneuroimmunology, where researchers continue Cousins’ scientific and humanitarian pursuits.

Laughter and what makes something funny have puzzled mankind for thousands of years. Aristotle believed that the incongruous and unexpected are funny, but that we also laugh at the foolishness and inadequacies of others. Charles Darwin saw laughter as an evolutionary development that defuses the excess nervous energy that arises with the inability to deal with the unexpected.  He saw the roots of human laughter in the behavior of the great apes. Sigmund Freud even published a book on the subject, Der Witz und seine Beziehung zum Unbewußten, with the English translation, Jokes and their relation to the Unconscious. (In case you are wondering, it’s not a terribly funny book. Freud spent an entire chapter discussing why a poor man bragging about being treated with “famillionarity” by a very rich man is funny. If you think the joke is funny at the start, you won’t by the end of his analysis.)  He saw humor as an agreed upon safe-space to share playful, aggressive, sexual, or self-deprecating impulses that would otherwise be too threatening to reveal. Humor and laughter were thus means to deflate the power of painful or embarrassing truths. The great comedy writer, Mel Brooks, simply quipped, “When I fall into a man hole, it’s tragedy. When you fall into a man hole, it’s comedy!”

Although we still don’t fully understand what makes something funny, we have learned a great deal about how laughter affects us and how it can be used to heal the mind and body.  An hour of strong laughter decreases blood levels of the stress hormone, cortisol, and chemicals such as adrenaline that mediate the fight or flight response. It increases numbers of helpful immune cells and levels of infection-fighting antibodies. It also triggers the release of the reward chemicals, endorphins, in the brain. In patients with rheumatoid arthritis, an hour of hearty laughter lowers levels of chemical mediators of inflammation in the blood while increasing anti-inflammatory substances.  Biweekly sessions of “laughter therapy” over 6 weeks lowered fasting glucose levels in obese women. A similar program of laughter therapy reduced insomnia and improved sleep quality in elderly subjects.

Such effects of laughter helped Norman Cousins and others overcome their physical ailments. However, our expanded understanding of the underlying causes of Major Depression leads us to expect that the physical benefits of laughter—the stress reduction, anti-inflammatory effects, strengthening the immune system, increasing insulin sensitivity, and improving sleep—might also improve symptoms of Major Depression and anxiety.

In studies of elderly care home residents, several months of weekly entertainment by “Laughter Bosses” and “Elder Clowns” brought improvements in depression, agitation, and cognitive function. A more active group method is laughter yoga. At first, participants fake deep laughing. But as the session progresses, the laughing becomes real and contagious. Breathing exercises and mindfulness meditation are usually added between laughing sessions. Studies have shown this technique to significantly improve depression and anxiety across groups as varied as cancer patients, patients in hemodialysis, retired women, immigrants, women suffering infertility, nursing home seniors, and college freshmen.

Along with benefitting from the physiological effects of simple laughter, humor can be integrated into more traditional forms of psychotherapy to facilitate changing one’s perspectives on life. There is even an organization, The Association for Applied and Therapeutic Humor, that studies and promotes such use. Some purists have seen humor as undermining the seriousness of psychotherapy. However, studies have found that humor can improve the therapeutic relationship between client and therapist, enhance participation, instill hope, and improve effectiveness of therapy. Indeed, humor and laughter may sometimes be the only way to come to terms with the otherwise insoluble absurdities, paradoxes, and cruelties of human existence. If nothing else, humor can add flexibility to the way we deal with the unavoidable vicissitudes of life. As Groucho Marx once famously declared, “These are my principles! If you don’t like them . . . well, I have others.”