Ina Carlson still laughs at life despite two heart attacks and quadruple bypass surgery. "Why not?" she asks with a chuckle. "That's what keeps me going. Wouldn't it be awful if I sat back and cried?"
No wonder she is the poster patient and spokeswoman for one of a growing number of hospitals putting humor into health care amid new evidence suggesting that laughter may benefit the ill as well as the healthy.
"Laughter indeed may be like a good medicine," said Dr. Lee Berk, of the School of Medicine at Loma Linda University.
"Those patients who had the will to live had a sense of humor and were able to use their humor in fighting their illness," said Kathy Knight, a nurse at University Hospital in Albuquerque, N.M., who founded "Humor And Hospitals Are Healthy Allies,"--"HAHAHA"--the program that Ina Carlson represents.
"I forget about myself when I can laugh with somebody or at somebody," said Carlson, an 80-year-old widow, adding that a good joke "makes me feel better. I forget that I'm just living on pills."
Carlson, who has been a patient at University Hospital, was having a serious picture taken with three doctors for a medical school recruitment brochure when Knight decided to have some fun. She put Minnie Mouse ears on Carlson, and Goofy, moose and chicken hats on the doctors. "Today, cheer someone up," her poster says.
"You can't help but look at that picture and laugh," Knight said.
Programs such as University Hospital's are spreading, bringing humor to patients on their walls and on wheels--special carts loaded with everything from balloons to bubbles, from comic books to comedy videos.
"Research findings are beginning to accumulate that suggest . . . laughter might be therapeutic and could be used to reduce disease symptoms," said Lars Ljungdahl, of the Lyckorna Primary Health Care Center in Motala, Sweden.
Preliminary findings in a study of six women suffering painful muscle and bone disorders suggested that humor therapy can increase quality of life and relieve some chronic symptoms, said Ljungdahl, whose findings were reported in a January letter to the Journal of the American Medical Assn. He noted that clinical evaluation still is lacking and that further studies are needed.
A new study of 10 people who watched a humor video for two hours and had blood samples taken every 10 minutes found decreases in the hormones cortisol and epinephrine, or adrenaline, which are released during stress, Berk said. The overall effect was a healthy drop in blood pressure, heart rate and stress.
Those hormones also can weaken the immune system and counter the "good" hormone endorphin, a painkiller and mood elevator, Berk said. By reducing the flow of cortisol and adrenaline, laughter counters the weakening of the immune system and allows endorphins to work on pain unopposed.
Joseph K. Neumann, a psychologist with the Veterans Administration in Johnson City, Tenn., said more controlled studies are needed. "A lot of people who have published in this area have reported on case studies or studies with groups of people who haven't had an experimental control group."
While agreeing that humor is therapeutic, Neumann said it may not be more effective than anything else that would induce a pleasant experience, such as relaxing music. He studied two groups of patients who underwent surgery under a local anesthetic while awake. One group listened to a tape of an old Jack Benny radio show and the other group listened to relaxing ocean sounds. "Basically there weren't any consistent or significant differences."
Humor is serious business to people such as Joyce Anisman-Saltman, assistant professor of special education at Southern Connecticut State University in New Haven, and Joel Goodman, head of The HUMOR Project in Saratoga Springs, N.Y.
Their message on why it is healthy to laugh and how to bring more humor into work and life is taken so seriously that they are in big demand by organizations ranging from IBM to the Massachusetts Turf Growers Assn.
Major corporations are putting humor into training programs, believing that it sparks creativity. "When the world is closing in, you've got to do something to change your mood so you can function creatively by looking at a favorite cartoon, remembering some silly line, trying to find something silly going on in daily life," said Monsanto Co. researcher Robert Z. Greenley in St. Louis.
Anisman-Saltman, who gives five to 10 lectures a week across the country, tells audiences to avoid "energy suckers, people who grab you in the hall and only have terrible things to tell you about that drag you down. Surround yourself with positive people."
Problems can be handled when they are in perspective, she said. "A sense of humor helps you take a step back from the problem that looks really terrible up close. When you have a little distance from it, it looks less terrible."
"I think people are really coming to their senses of humor," said Goodman, who has a network of 100 people across the country working with The HUMOR Project. "People are realizing humor is not just kid stuff. People are realizing humor can do many good things for us."
Anisman-Saltman, a funny teacher and briefly a stand-up comic, got on the lecture circuit six years ago when the library in her hometown of Cheshire, Conn., was running a series on healing and invited her to speak.
But stark reality nudged Goodman into a life of humor. In 1977, his father was stricken with a life-threatening aneurysm and facing surgery in Houston. A funny thing happened to him on his way to the hospital to visit his father: The driver of the hotel van, a man named Alvin, made him laugh, easing the stress.
"A couple of months later when Dad was successfully recovering, I got to thinking what a wonderful gift Alvin had given us. I began to wonder, 'Do we have to wait for the Alvins of the world to cross our paths just when we need them by luck or should we be more intentional about this thing called humor.'
"I began to think it was too good to leave to chance so in 1977 I started The HUMOR Project, which was not designed to analyze humor to death but to answer my own curiousity about whether there are practical ways of bringing humor to life."
In the last dozen years, more than a quarter of a million people have attended HUMOR Project programs, Goodman said. In the last three years, the project also has given grants to 36 hospitals and groups to help develop their own programs.
Goodman, the author of eight books, tells audiences to look for humor in reality and in very serious places such as newspapers and church bulletins. "That is where humor is most absent at first glance and where it's most needed."