The Best Medicine
Cindy Lauren was lying on the gurney at UCLA Medical Center, scared out of her wits. There she was, surrounded by specters in masks and gowns, and soon they were going to cut into her breast and remove a cancerous lump.
As she was trundled toward the operating theater, her surgeon, Dr. Susan Love, walked with her, holding her hand and treating her to joke after ribald joke. Lauren arrived at the theater in giggles.
“It was one of the most terrifying moments of the whole ordeal--but it was also one of the best,” she recalls. “She made me feel so much better about the whole thing. I will thank her till my last breath for that.”
Roger Boesche was feeling miserable. A displaced neck bone was poised to crush his spinal cord if he jerked his head suddenly. A metal contraption screwed into his skull was protecting him--but immobilizing his head and drawing stares wherever he went.
In a moment of self-pity, Boesche rented a violent action thriller so he could find some soul worse off than himself.
“My wife would hear a scream or a rat-a-tat-tat, and she’d say, ‘How about those guys? Are they worse off than you?’ ” he recalls. “Pretty soon we were laughing about things, and I felt better.”
When people have serious illnesses to deal with, being able to laugh can help them. Dr. Patch Adams, the doctor-clown played by Robin Williams in Universal Pictures’ new movie, knows this full well. But he’s not the only one. Long before Adams, the ancient Greeks built their healing houses next door to their theaters, so that the sick could enjoy the comedies performed there.
“A merry heart,” wrote King Solomon, “doeth good like a medicine.”
Today, there are many health care professionals, clowns and other performers who think just like Solomon and are doing their best to bring some levity to the lives of sick people. Some are everyday doctors and nurses who just naturally banter and quip as they go about their jobs--perhaps as much to help themselves, not just their patients, cope with the hardship and stress of medicine. Some are patients who have turned to stand-up comedy or the humor to be found in support groups to help themselves and others better deal with hard times.
In fact, there’s even a society devoted to mirth in medicine, called (a tad somberly) the American Assn. for Therapeutic Humor. Next month, the society will present Patch Adams with an award for his work. And they’ll round off the conference with a “joke jam,” with past and present officers and the audience pitching in with their favorite anecdotes and one-liners.
These people aren’t saying that serious illnesses like cancer are a great big ha-ha. More important, they’re not saying that humor is a substitute for proper medications, medical skills or compassion, or that all you need to do is laugh 10 times a day or put on a clown nose and everything will be fine. But they do think that humor’s an essential part of the medical tool kit.
“I can’t change a person’s diagnosis,” says Patty Wooten, a nurse-humorist from Santa Cruz who travels the world giving talks to hospital nurses. “But I know that I can improve the quality of their life. If I’m with a patient who’s had a tough day, and I can at least get them to laugh, then at least they’ve had a bit of joy amidst all the stuff that I can’t do anything about. And if people feel joy, and hope, and optimism, more of the positive emotions, they tend to fare better in their illness.”
The idea that humor could not only improve a patient’s mental state but also their medical outcome was espoused two decades ago by writer-editor-philosopher Norman Cousins in his bestselling book “Anatomy of an Illness.” Cousins had developed a rare, degenerative disease of the connective tissues. With his doctor’s permission, he took himself off his painkillers and embarked on a very different regimen: mega-doses of vitamin C and a program of humor therapy.
He watched “Candid Camera” and Marx Brothers movies. He had nurses read him humor books betweentimes. Cousins’ pain and illness dissipated, and his death, in 1990, was from an unrelated medical condition.
We probably won’t ever know what cured Norman Cousins. But the idea that the mind can affect the body is no longer outrageous. It’s a respectable research field, with its own, decidedly unwieldy name: psychoneuroimmunology. Our minds, scientists are finding, can “talk” with our immune systems and other organs, using chemicals and electrical signals from nerves.
There are studies suggesting--tantalizingly--that this might make a difference to disease. Studies showing that people under stress (such as medical students and elderly people caring for sick spouses) have somewhat weakened immune systems, and are more likely to catch colds or the flu. Others suggesting that psychological support can improve survival in patients with various kinds of cancer. Still others, on the flip side, showing that negative emotions like anger, insecurity and distress can increase one’s risk of heart disease and stroke.
Clowning Around in a Nursing Home Can Help
Few studies have focused on humor itself, but here, too, there are hints. In a series of experiments, researchers Lee Berk and Dr. Stanley Tan, both of Loma Linda University, drew blood from college students who were watching funny videos. They found that levels of disease-fighting antibodies and immune cells went up. Levels of cortisol--a stress hormone--decreased.
A lot more research is needed before we really understand the effects of humor and mirth on our health, says Margaret Kemeny, director of UCLA’s Norman Cousins Psychoneuroimmunology program, which was founded by Cousins himself. “But I think it’s a really important thing to study,” she says.
And it’s really important to laugh, stresses Wooten. Becoming a clown had a miraculous effect on her own life. It was 1973, and a grim time. Her husband had left her. She was struggling to support herself and a 3-month-old baby boy.
“I decided I needed to jump-start my spirit to get the laughter back into my life,” she recalls. “So I went to clown school. And it was wonderful. I didn’t just learn how to apply makeup, do magic; I learned how to approach situations differently. Clowns approach everything with joy.”
Pretty soon, Wooten brought her clowning skills to the nursing home where she worked. The residents--Alzheimer’s and stroke patients who spent hours each day staring at walls--loved her japes. “The nurses said, ‘Wow, we’ve never seen the patients with such energy,’ ” recalls Wooten. “ ‘They’re starting to talk and smile. Could you teach us?’ ”
Today, she’s still teaching nurses and patients how to bring humor into their lives--all over the U.S. and abroad--and still clowning, dressed up as one of two personae: sweet, genteel Nurse Kindheart, or brash, balloon-breasted Nancy Nurse, bedpan strung from her belt. Nurses, not just the patients, need humor to help cope, she says. Nurses’ burnout is a serious issue in health care.
But one doesn’t have to be a clown or performer to inject humor into the care of a patient. Some people, like Dr. John Messenger, cardiologist at Long Beach Memorial Medical Center, just do it.
“Ha ha ha ha,” is heart surgery patient Michael Rivard’s first response when he’s asked about Messenger. The second is unbridled enthusiasm. He can’t quite put his finger on what Messenger does (it’s “real cornball stuff,” says Messenger) but he knows it makes him feel better.
Messenger wondering aloud why surgeons are so fussy about incisions only to “yank out the chest tube so it looks like a gunshot wound.” Jollying a teen who’s depressed about getting a pacemaker with “Hey, give it a name,” and “Just think: Now you can walk round those long airport security lines.” And laughing at himself in a way that too many doctors don’t.
Steve Moulios (a.k.a “Dr. Moo”), a physician at a Kaiser hospital in Bellflower, doesn’t find it hard; he finds it useful. For instance, patients with weight problems often try to blame it on their hormones or their thyroid, he says. Moulios has only to wave at himself (he admits he’s not the sveltest) and say, “Come on, which is it, the Carl’s Jr. or the McDonald’s that you like?” Patients laugh and more readily agree to a diet.
“Medicine can be really sad, and dry, so any time you can put things in to make a patient or yourself feel better, that’s important,” he says. Anyway, his mother insists on it. “She told me, ‘Don’t you ever change and become one of those cold doctors who’s too big for their britches. That’s someone’s mom or wife you’re dealing with,’ ” he says.
Humor really matters, says heart patient Rivard. “My wife says, ‘I don’t know how you can make jokes through all this stuff’--but if I lose my sense of humor, it gets ugly,” he says.
Jane Hill, who discovered she had breast cancer six months after taking a stand-up comedy class, feels much the same.
Seven years and four surgeries later, Hill, who lives in Santa Ana, has made a second profession out of stand-up comedy, performing for cancer patients and health care workers at fund-raisers and conventions around the country. She’s one of a number of cancer patients who’ve turned hard times into humor this way. Cancer has provided her with a wealth of material--more, needless to say, than she ever needed or wanted.
Prosthetic breasts floating out of her swimsuit at the pool. Ghastly wigs. HMO horror stories. Sufficient hours in the surgery to rack up “enough frequent gurney miles for a free operation.” Much of the humor is dark. But often, says Hill, that’s just what helps.
Laughter and humor, caution Hill, Wooten and others, should not be foisted on people. Many, especially in the first shock of dealing with a serious diagnosis, aren’t ready to see the macabre or funny side of what they’re going through.
Humor is also very individual, they say: You need to find out what works for you, or the person you’re trying to help. And patients should never feel that they’re to blame for their disease because they didn’t laugh enough, or their disposition wasn’t sunny enough.
“People should not feel that they have to be smiling all the time when they have cancer--that’s what some of my patients call ‘the prison of positive thinking,’ ” says Dr. David Spiegel, a psychiatrist at Stanford University.
Just use humor and laughter where it helps, agree caregivers and patients alike.
“I have learned to laugh a lot at not very funny things,” Hill says. “It has made a tremendous difference to me. You can’t always choose your life--but you can control how you react to things. Many times, you can’t laugh at something while it’s happening. But in the end, it becomes your best story.”