The Best Medicine After All

By Bill Strubbe

Originally published in Body Sense magazine, Autumn/Winter 2004.
Copyright 2004. Associated Bodywork and Massage Professionals. All rights reserved.

I have AIDS, I have AIDS,” James Green repeats aloud, then bursts into mock laughter. Admittedly most people don’t consider AIDS a laughing matter, but Green, a longtime survivor, doesn’t buy that there’s anything you can’t chortle about. In fact, chuckling at adversity, he proposes, “helps by empowering you and broadening your perspective.” And, as recent scientific research proves, actually boosts the immune system.

“I had CMV (cytomegalovirus), was losing my eyesight, had been on IV acyclovir for 17 months, and I was desperate for anything that could help me,” recalls the 41-year-old San Antonian. “I bought a book and video about the power of laughter and started laughing on my own. And I felt better.”

Then in 1997, Green heard of Madan Kataria, M.D., who was conducting a World Laughter Tour. While working as a family
physician in Mumbai (Bombay, India), Kataria observed that patients’ immune systems and general well-being improved following bouts
of laughter. This “Guru of Giggles,” who eventually left his medical practice, fine-tuned to a near-science his daily regimen of “thought-free” laughter and created yoga laughter classes, of which there are now more than 1,500 across India.

Wandering through the public gardens at Lokhandwala Park in Mumbai, you might cross paths with a mirthful group of folks contorting their faces and laughing in unison. Twenty minutes of deep breathing and ho-ho-ha-has, followed by hearty guffaws, quiet tee-hees, roaring lion laughter, and tittering cocktail laughter ... and the group disperses, beginning their day with a smile.

Kataria’s methods found a strong supporter in the United States, and there are now approximately 100 laughing groups in North America. “I felt a great calling, a synchronicity with the information, and felt I needed to deliver this message,” says Steve Wilson of Ohio, a psychologist of 40 years who left his practice and is now one of America’s leading “joyologists.” Wilson has certified more than 150 laugh leaders — among them high school students and inmates in rehabilitation facilities. “I was astonished how much research had been already done that substantiated what I thought to be true.”

Witty Research

Within the burgeoning field of gelotology, the scientific study of laughter, an expanding body of research is being compiled. More than 500 academics 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.

Though research into the healing benefits of laughter dates back to the 1930s, it was the 1978 book Anatomy of an Illness by journalist Norman Cousins that cracked the door open for this fringe idea to enter the mainstream. Cousins suffered from ankylosing spondylitis (a degenerative connective tissue disease). By 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, Lee Berk, M.D., associate director of the Center for Neuroimmunology, and Stanley Tan, M.D., 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. These 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.

And a boon for those too lazy or tired to exercise: Laughing 100 times mimics an aerobic workout equivalent to 10–15 minutes on an exercise bike. For sedentary people and those confined to a bed or wheel chair, laughter can actually be a viable workout. According to William F. Fry, professor emeritus at Stanford University: “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, and 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.” And there’s soon to be a study on the caloric consumption of laughter. Anyone ready to try the Giggle Diet?

Taking Form

With the growing awareness of the therapeutic benefits of laughter and humor, in 1987 the Association for Applied and Therapeutic Humor (AATH) was incorporated as a nonprofit organization, and has since produced numerous bibliographies, sponsored annual conferences, created a popular “Speakers Resource” to educate healthcare professionals and lay audiences about the therapeutic uses of humor and laughter in the work setting, and publishes a quarterly newsletter.

Initially, most AATH members were healthcare 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 healthcare 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 healthcare worker burnout, sick time, 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.”

Wilson says, “I felt I needed to pay more and more attention to growing and making these laughter club programs systematic and self-sustaining.” Wilson’s group teaches people how to create positive work places and how to manage health and stress through humor. “There’s a big mission here, more than I can accomplish in my lifetime, so I want to create an organization that can outlive me.”

Laughter sessions vary from leader to leader, but typical of Wilson’s is a combination of stretching, simulated 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 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. Medical research shows that even if you pretend laughing or act happy your body produces “happy chemicals.”

“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.” Wilson chuckles when he remembers when Kataria told him: “Indians are so depressed that if we waited for them to get a sense of humor they’d never get laughing.”

To garner laughter’s health benefits, you don’t have to subject yourself to a stream of bad jokes or I Love Lucy reruns. The human body does not know the difference between thinking about doing something and actually doing it, leading to the same set of physiological changes. As practiced in the laughter yoga classes, the act of mimicking laughter through a series of exercises is enough to rev up the immune system. Although laughter in a group may start out as an exercise, its infectious nature can quickly turn into a mirthful experience.

Green, who leads laughter workshops in Texas, explains how it works. “The mind can’t hold two opposing thoughts at the same time,” he surmises. “If you go around in an angry state of consciousness, you’re not healing. When we’re happy and we’re laughing, the body is producing all these immune-enhancing chemicals and the healing is more profound.”

A preschooler laughs up to 400 times a day; the average adult chuckles a mere seven to 15 times. Getting people to laugh isn’t always easy. “One guy who attended my laugh class at the HIV Wellness Center in San Antonio said ‘laughing all sounds good, but I’d rather take my Xanax,’” Green recalls. “Another guy is yelling out ‘this is a cult, this is a cult.’”

One particularly tough laughter workshop for Green was at an inpatient drug rehab center. “I walked in and happened to notice that a few guys had bruises, but didn’t think much of it. Usually people eventually warm up to it, but among these guys, who were there by court order, participation was minimal and some were even vulgar,” Green recalls. “As I was leaving, I learned that the night before they had a big rumble involving 20–30 guys. A couple approached me afterward saying they admired my determination.”

Green says, “I used to spend an hour or more a day in the screwed up traffic in Austin, and I’d laugh. When I got to work, I wasn’t all twisted about the guy that cut me off. Laughing is about not getting sucked into negativity of the past, which might actually boil down to a simple formula: Tragedy + Time = Comedy.”