Saving Your Life May Be a Laughing Matter

On American Bandstand recently, Steve Schaffer talked about the importance of his line of work.

“Laughter is good for you,” the 33-year-old comedian and actor said. “It can prolong your life. It’s true. There was a man, Norman Cousins, who cured himself of a fatal disease watching Marx Brothers movies. He wrote a book about it, so it’s documented.

“This,” Schaffer said wryly, “could change the face of medicine.”

Schaffer, a former social worker from Philadelphia, then launched into a hospital scene with wacky Three Stooges effects. It was much funnier than it reads here.

“Paging Dr. Bozo, Dr. Bozo . . . and his assistant Flippy the Seal . . . We have an emergency! Get this man in here! . . . Scalpel . . . sponge . . . bald head wig! Woo woo woo woo woo! . . . We’re losing him! We’re losing him! Quick, the banana cream pie!”

That may sound ridiculous, but it is not a joke.

Marx Brothers Shown

In a touch of irony, the week Schaffer’s monologue appeared on television, Cousins was in Houston to help dedicate a new cancer wing at St. Joseph’s Hospital. Central to the new wing was a room where cancer patients go to watch Marx Brothers movies.

“It works,” said Cousins, the former Saturday Review editor who fought bouts of disease with hoots of laughter and wrote about it in “The Anatomy of an Illness as Perceived by the Patient” and “The Healing Heart.”

“In Houston,” Cousins said, “they’re getting results.”

The new “Living Room,” on the ninth floor with a panoramic view of the city, is an expanded version of a similar room created at St. Joseph’s in 1980: a place cancer patients can go to feel good.

Humorous videotapes--Marx Brothers and Pink Panther movies are favorites--play on television, while some patients sit in overstuffed chairs reading from a large selection of funny magazines and entertaining books. Local comedians stop by to tell jokes from time to time, and Marvin Hamlisch has played the room twice. There are also games, but there have yet to be any pie fights.

“I deliberately named it the ‘Living Room,’ because it is a place for the living,” said Dr. John S. Stehlin, head of oncology at St. Joseph’s. “We have a lot of dying people come into the Living Room, with IV bottles hanging off their arms, but you wouldn’t know it (that they’re dying).”

Stehlin, along with a small but growing number of physicians and scientists, believes that laughter not only makes people feel good, it may help them get better.

Perhaps a dozen or more hospitals and nursing homes around the country have humor centers modeled on the Living Room. A handful of national organizations are also devoted to spreading the good word about laughter.

“It’s astounding to see what happens when you get people really laughing,” Stehlin said. “If you see these people, and if I would tell you the (medical) status of some of these people, you just wouldn’t believe it.”

Whether laughing makes the dying healthier, makes them feel that way or look it is the subject of some debate. Nevertheless, the point is that there seems to be improvement, period.

“Laughter really is the best medicine,” said Joel Goodman, founder of the Humor Project, a 10-year-old organization that promotes the uses of humor and publishes the quarterly journal, “Laughing Matters.”

“But it’s not like we’re inventing sliced bread here. Reader’s Digest has been saying it for years,” Goodman remarked, referring to the magazine’s regular collection of anecdotes, “Laughter, the Best Medicine.”

There is, however, a difference between saying something, even believing it, and proving it to the satisfaction of the always critical scientific community.

“We do know this,” Stehlin said. “We do know that if we play these humorous videotapes at night, people sleep better. And we know that they don’t need as much pain medication. That’s obvious.”

“The problem,” he said, “is documenting that sufficiently to satisfy the statisticians. That’s not easy to do, and the pitiful part about it is when you mention laughter, most people won’t even take you seriously.

“I’d say 98% of the scientific community still thinks it’s frivolous, but it’s very serious to us.”

Happily, the remaining 2%, if it is indeed that much a minority, is beginning to get attention. A number of research projects, some sophisticated biochemical studies, are finding that laughter and a sense of humor can overcome stress, bolster the immune system, give the heart a good workout, and perhaps even prevent the common cold.

“The scientific verification is coming in that the positive emotions do have positive effect,” Cousins said. “He who laughs, lasts.”

Sigmund Freud had his ideas about humor, as did Charles Darwin.

“When the sensorium is strongly excited,” Darwin wrote in a description of laughter in 1872, “nerve force is generated in excess, and is transmitted in certain definite directions, depending on the connection of the nerve cells and partly on habit.”

Laughter, Darwin seemed to be saying, was a way of letting off steam. Freud believed as much, too, but couched it in his own psychoanalytical terms. Neither explanation has proved very satisfactory, nor very useful.

But for a long time, it was all there was.

“In 1953, when I first became interested in this, I remember looking in a physiology textbook and there was no reference, and I mean none, to laughter and humor,” Dr. William Fry said. “You would think they would have something.”

Fry, a professor of psychiatry at Stanford University Medical School, has since corrected that deficiency with dozens of articles and numerous books on the subject. He is now considered one of the nation’s top authorities on the physical effects of laughter. But his scientific endeavor has not been without a price.

“I think in all the time, I received maybe one grant to study this,” Fry said. “I have depended, mostly, on the kindness of colleagues, who have lent me equipment when I have needed it.

“I’ve also always had to make a differentiation between my clinical work and my research work,” he said. “When I started out in psychiatry, I was taught that you don’t laugh with your patients; your patient may laugh, but you just sit there stone-faced.”

Met Similar Resistance

Dr. Walter E. (Buzz) O’Connell, another specialist in the humorous sciences, remembers encountering similar resistance while seeking his master’s degree in psychology in 1950.

“It cost me an extra year in graduate school,” O’Connell said. The problem continued when he took a position with the Veterans Administration in Houston.

“Here I was studying humor, which people thought was just plain silly,” O’Connell said. “I had a very hard time just explaining what I was doing; I kept having to put together report after report justifying myself.”

O’Connell has developed a whole system of psychotherapy, the theory of “the natural high,” that seeks to treat people by restoring their sense of humor.

The idea, O’Connell said, is to free people from their “awfulizing attitudes”--tendencies to worry and imagine the worst--and help them “develop a sense of worth that is not contingent on anything.”

“The sense of humor is the criterion for individuation, self-actualization and even salvation,” he said.

Although O’Connell has written half a dozen scholarly books on the natural high, he said he still has some trouble getting respect.

“People think I tell jokes and dress in a clown uniform,” he said.

Legitimacy was brought to the scientific study of humor, ironically, by a layman.

In 1964, Cousins developed ankylosing spondylitis, an excruciatingly painful, crippling and often fatal disease of the connective tissues. Under the guidance of his physician, Cousins developed his own holistic therapy, including vitamin C and heavy doses of Marx Brothers before bedtime.

“I found that 10 minutes of solid belly laughing would give me two hours of pain-free sleep,” he said.

Cousins beat 500-to-1 odds and became well. And in 1976 he wrote a widely read and hotly debated article for the New England Journal of Medicine. That article, “Anatomy of an Illness,” in expanded form became a best-selling book in 1978. He went on to have a heart attack in 1980, survive it, and write “The Healing Heart,” espousing many of the same principles.

Cousins’ experience has gone beyond the anecdotal. Now an adjunct professor at UCLA Medical School, he teaches about holistic approaches to medicine and conducts research to validate his personal observations.

He also emphasizes he is neither suggesting one can simply laugh illness away, nor that laughter is the only healing emotion.

“Laughter is an integral part of a much larger totality,” he said. “It’s only one part of the doctor’s kit. And it’s a mistake to separate humor from the other positive emotions--love, home, faith, will to live.

“Humor really is just a metaphor for these positive feelings,” Cousins said. “But it is true that laughter, on its own terms, does confer benefits.”

Recent research bears this out on several levels. At its most basic, laughter is simply good exercise.

“It’s an aerobic workout,” Fry said. “Even with a smile, you get some muscular behavior; when you go all the way up to the belly laugh, that’s real conditioning. You work your heart, your chest, your stomach, your neck, your face and your shoulders.

“You jog for your heart’s sake; why not laugh for your heart’s sake?” Fry asked.

Laughter is also unusually beneficial to the respiratory system, Fry said. When people laugh, they empty their lungs, including the stale residual portion at the bottom that tends to collect carbon dioxide.

“Laughter dips down into your lungs and just cleans them out,” Fry said.

Other research seems to suggest that laughing increases levels of beta-endorphins, natural pain-killing chemicals in the brain. This could explain why the chronically ill patients at St. Joseph’s require less medication to sleep.

But perhaps the most intriguing, and bizarre, research into the physiological effects of laughter is being done at Loma Linda University, the heart transplant center in Riverside.

Videotapes Aid Studies

Dr. Lee Berk recently put catheters into the veins of 10 medical students there and took periodic blood samples while they watched a videotape of a man smashing watermelons with a mallet.

The man, a comedian named Gallagher, is very funny, or at least the medical students thought so. They laughed heartily, and as they did, their cortisol, dopamine and epinephrine levels decreased, and spontaneous blastogenesis--reproduction--of white blood cells increased.

An earlier study, at Western New England College in Springfield, Mass., found increased levels of immunoglobulin A, a vital immune system protein, in the saliva of students who watched a videotape of “Richard Pryor Live.”

These biochemical changes during laughter are significant, Berk said, because “they’re almost exactly the opposite of what happens to a body that’s under distress.”

Epinephrine, or adrenaline, is released by the brain and throughout the body when a person is angry, frightened or anxious. It creates the so-called “fight or flight” reflex that allows people to call on their biological reserves in an emergency.

Reserves Used Up

But when epinephrine is released in high quantities over a long period of time, such as when a person is under stress, there is a cost. Reserves of white blood cells, needed to fight off infection and disease, are used up prematurely without being replaced.

Berk said the fact that epinephrine--and the related transmitters dopamine and cortisol--are owered during laughter means the body can relax and concentrate on creating new white blood cells. The fact that blastogenesis occurs seems to confirm this. Ergo, laughter boosts the immune system.

“I call it eustress,” Berk said. “Good stress.

“Now, it’s been well-documented that distress can deplete the immune system and promote disease,” he explained. “The best example is widows and widowers who tend to become ill and die shortly after losing their spouse.

“It would follow, then, that eustress, since it apparently bolsters the immune system, might help prevent or even fight disease,” he said. “But that really remains to be proven.”

At Oberlin College in Ohio, psychology researcher Albert Porterfield has been attempting to prove just that. He recently tested 240 college students on their “mirthfulness,” a measure of the likelihood a person would be amused by a wide range of situations and the degree to which they used humor in their everyday life.

Able to Survive Stress

Of 140 subjects followed a year later, he found that those who were mirthful and used humor in their lives were more likely to make it through stressful periods of their life without becoming depressed or ill.

Cousins and his colleagues have recruited 80 cancer patients into a positive attitude program to determine whether laughter, love and other good feelings will lead to better medical outcomes. Their final analysis is not in.

And in Houston, Stehlin is gathering breast cancer patients for a similar study he hopes to complete in the next year.

“Nobody is claiming that laughing will cure cancer,” Fry said. “But it might help, and it can’t hurt.”

If laughter really is the best medicine, there are still relatively few state-of-the-ha-ha facilities across the country. But advocates are seeking to change that.

The Humor Project, based in Saratoga Springs, N.Y., has awarded grants to seven organizations in the last year to help them implement projects using humor creatively. Among the grant recipients is the Northeastern New York AIDS Council.

“AIDS is not something to laugh about, but if people with AIDS can laugh, maybe they’ll live longer,” project director Goodman said.

In his 10 years with the project, Goodman estimated that he has worked with and spoken to more than 100,000 individuals, helping them to “diagnose their funny bone,” and learn to use humor effectively. IBM, AT&T; and Monsanto are among the corporations that have solicited his advice.

Goodman also recently surveyed people from around the country and looked at the nature of humor in health care settings. The study was financed by Humana Inc., the Louisville-based medical giant.

“Across the board, physicians, health care professionals and patients all perceive humor as a positive ingredient,” Goodman said.

However, physicians generally don’t use humor as much as they think they should, Goodman said, either because they believe that they aren’t good at it or they believe that it won’t be perceived as professional.

That attitude may be changing. Goodman said he recently heard from a hospital that decided to have him lecture after they read a study finding that doctors with friendlier personalities and better bedside manners are far less likely to be defendants in malpractice suits.

“Doctors are beginning to see a bottom-line implication in all this,” he said.