Laugh track

Someday doctors might be replaced by Marx Brothers movies.

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One of the great discoveries of the wealthy society is that almost
anything can be packaged as therapy. Fun free stuff is a great
profit center, since you can obtain your product at no expense, put
a bow and a “THERAPY” sticker on it and charge whatever the
therapy-hungry masses will pay. Back rubs, sex, even the rock-bottom
staple of therapy, a sympathetic ear, all form the basis of one
therapy or another. (Nasty stuff can be packaged as therapy too,
but it’s a harder deal to close. Only really charismatic
salespeople can market fasting, electric shocks or solitary
confinement in a giant thermos bottle.)

It was inevitable that laughter come in for its share. Today
laughter therapists are everywhere, pushing their chipper message
through every possible medium: Laughing is good for you!
Quantifiably good, the message continues. Don’t just laugh because
you want to, laugh because it boosts your immune system, lowers
your blood pressure and floods your system with endorphins.

Norman Cousins is the god of laughter therapy. In 1979, Cousins,
editor of the Saturday Review, published “Anatomy of an Illness,” an
account of his unconventional response to sudden, severe illness.

In 1964 Cousins was stricken with a mysterious fever, followed by
pain, weakness and great difficulty in moving. He could hardly
open his jaws. Nodules appeared on his skin. He was hospitalized
and given a discouraging diagnosis of ankylosing spondylitis, a
disease of connective tissue. Doctors said he had only one chance in
500 of recovery.

Cousins rebelled. My own reverence for Cousins stems from his
reaction when asked to give four blood samples in a day. He put a
sign on his door saying he would give one blood sample every three
days, and if testers wanted his blood, they had better be there
with their vial. Later he left the hospital, which he considered
unhealthy, and checked into a hotel for better food, quieter
conditions and a lower bill.

But the part of Cousins’ self-therapy that stuck in everybody’s
mind was the laughing. Obsessed with the idea that his adrenal
glands might be exhausted, Cousins decided to quit taking aspirin,
to mainline Vitamin C and to control pain by harnessing positive
emotions: by a rigorous course of watching “Candid Camera” and Marx
Brothers movies.



In a widely quoted passage, Cousins wrote, “Ten minutes of genuine
belly laughter had an anesthetic effect and would give me at least
two hours of pain-free sleep.” (I myself have often had my genuine
belly laughter cut off by the realization that my g.b.l. is less
like the silvery bells so often mentioned in the older literature
and more like a zoo at feeding time, a sort of gak-hork sound. But
better a coarse guffaw than cold silence, I am always saying.)

Cousins had an almost complete recovery. (He died 26 years later,
in 1990.) He freely admitted that the placebo effect might have
been part of his cure. If so, that was fine with him, since his
pain was mostly gone, his fatigue was gone, he could turn his neck
and play the piano again, he discarded his metal braces, and the
gravelly nodules on his neck and the backs of his hands shrank.

Cousins wrote his book in response to people asking “whether it was
true that I ‘laughed’ my way out of a crippling disease that
doctors believed to be irreversible.” The parts about aspirin,
vitamin C and hand-to-hand combat with overzealous phlebotomists
aroused little interest in comparison to the Marx Brothers cure.
Many people were drawn to the idea of laughing their way (or in my
case, gak-horking my way) to good health.

The elegance of Cousins’ story has been somewhat marred by doubts
about his diagnosis of ankylosing spondylitis. He did have
something, but it may not have been AS. But ever since then, people
with AS have been hearing about how they should chuckle their woes
away.

Jane Bruckel, executive director of the Spondylitis Association of
America,
has AS. “If you’re having problems with it, and people say all you have to do is laugh, it doesn’t go over too well,” Bruckel says, with admirable gentleness.

Bruckel is in favor of laughter and calls Cousins’ book worthwhile,
but doesn’t include comic videos in her recommendations for AS
therapy. “In general, and particularly in this disease, laughing –
not taking life as seriously as we sometimes do — can help your
mental health and sometimes your physical health. So it doesn’t
hurt, but I wouldn’t say that people should go out and do that
specifically.”

There was laughter as therapy before Cousins. Dr. William Fry, a
psychologist who has made an extensive study of laughter, points to
the Shriners’ children’s hospitals. “The original [hospital] clowns were the
Shriner clowns. That goes back to the 1930s when kids were getting
polio by the scores,” Fry says. “They introduced clowning for kids
who were hospitalized for long periods.”

But Cousins kick-started what is now a booming industry in laughter
administration. Most laughter experts do not actually do therapy so
much as motivational speaking, extolling the benefits of laughter
to tittering crowds. These experts generally list a degree or two
after their names just to let us know that their speaking fee was
well spent. Some have books, some have Web sites and many have
both.

Enda Junkins, L.M.S.W.-A.C.P., B.C.D., who has the desirable URL
laughtertherapy.com, provides laughter through “speeches, workshops and trainings.” In addition to tapes and copies of her speeches, she sells toilet key chains through her Web site.

Stephen Braveman, M.A., M.F.T., CST [sic], is available for lectures, and can help you identify your style of laughter: Tee- Hee, Ha-Ha, Ho-Ho or Uhh-Uhh. No mention of Gak-Hork.

I was relieved to note that, although Sue Little Dip M.T., C.P.N.L.P.,
C.P.T.L.T.’s workshops,
Whole New Beginning Laughter Therapy Playshop, offer cancer
therapy, they don’t rely exclusively on laughter — they also offer
an internationally renowned nutritional product!

Such a promising field would not be complete without a winsome nun,
and we have
Sister Mary Christelle Macaluso, R.S.M. O.F.N., Ph.D., who gives 100 talks a year. She is known, she writes, as the Fun Nun.

The best-known laughter therapist is
Dr. Hunter “Patch” Adams, the author of books about change in
health care and the subject of a recent Robin Williams film. I felt compelled to view this opus as research for this story, and in my view it doesn’t do justice to Williams or Adams. Adams (a frequent and popular
speaker at medical schools and conventions) attacks
American medicine on far more scores than
humorlessness, but you don’t see much of that in the
movie, though the public (if not the critics) seemed to love the
heartwarming story of a zany doctor with an
enema bulb on his nose and bedpans on his feet.

Movie receipts aside, the pleasures of cracking up
aside, what are the medical benefits of laughter? In response to frequent claims
about laughter’s health benefits, laughter researcher Willabald
Ruch
told writer Sara Abdulla, “I have never seen any convincing,
statistically significant proof that laughter affects the immune
system, endorphin levels or blood pressure.”

Dr. William Fry, clinical associate professor emeritus in
psychiatry at Stanford and co-author of “The Handbook of Humor and
Psychotherapy,” though a big laughter booster, says, “Statistically
significant? I would agree totally [about] the endorphin levels.
There’ve never been any studies, even on a basic science level,
that have demonstrated effects on endorphin level.”

That laughter lowers blood pressure is also not well-substantiated.
In fact laughter creates a temporary rise in blood pressure, and
those people who show a longer-term lowering tend to be people with
labile blood pressure, anyway. Immune system effects have been
documented in laboratory experiments at Loma Linda University, Fry
says, with increases in antibodies and immune cell counts, but
whether this translates statistically into less illness is untested
and unknown.

While Fry says that claims have been overstated, he still believes
laughter has health benefits. “Yes, I do — this is my personal
point of view,” Fry cautions. He is writing about the idea that
humans have historically “tended to create situations to amplify
humor exposure at those times when sun deprivation is at its
greatest extent … when systemic vitality is diminished by
deficiencies of sunshine.” What situations? “Festivals, carnivals
and saturnalias.”

What the boom in laughter therapy really represents, Fry says, is
one facet of a growing interest in the effect on health of treating
patients nicely. “What you’re talking about now is the very
undeniable and very welcome effect of the increase in [attention
to] the quality of life.” Fry compares laughter therapy to studies
– largely ignored except by architects, he says — finding that
hospital patients whose rooms have windows with nice views have a
higher survival rate than those whose windows face walls.

“Yet that’s hardly ever taken into consideration by physicians:
‘You make sure that my patient has a sunny room’?”

Concern for a patient’s quality of life is the sort of thing that’s
often associated more with nursing than with doctoring. Nurses,
like doctors and lawyers, take continuing education courses to keep
their skills and credentials current. Delving into the world of
laughter therapy, I came across the catalog of Nursing Education of
America.

Their courses are worrisomely varied. On one hand are courses like
“Emergency Care,” “First-Hour Clinical Trauma” and “Diseases &
Interventions,” which teaches, among other things, the symptoms of
Hantavirus Pulmonary Syndrome. On the other hand are courses in “Aura-Soma” (“spiritual and
pyschological healing through the medium of colored essences …
Chakra adjustment is described”); “Assertiveness in Patient Care”; and
“Aromatherapy.” Nestled between “Infection Control Practices” and
“New Drugs ’99″ is “Laughter Therapy.” “Presents techniques to
help people laugh.”

These courses give me the willies. I cannot tell you how strongly
I prefer the nurse who recognizes the symptoms of my Hantavirus
Pulmonary Syndrome to the one who’s yukking it up with little bottles of
colored water and grabbing assertively for my chakras. The only
thing more uncongenial than an incense-waving nurse is an incense-
waving nurse who’s making patchouli jokes.

But I forged ahead. Yes, I confess my shame. I took a self-help course in
laughter therapy, passed the final and now possess a certificate.
This is about the most humiliating thing a humorist can do, short
of being videotaped offering the sexual favors of an unknowing
third party to Bob Hope in order to gain access to his gag file.
Still, I signed up and duly received a small book written by
Annette Goodheart, Ph.D., M.F.C.C., “Laughter Therapy: How to Laugh About Everything in Your Life That Isn’t Really Funny.” Goodheart is hip-deep in the industry, offering
classes, seminars, workshops, in-services, audio cassettes, video
cassettes, week-long professional training programs, consultations,
“laughing weddings” and “Silly Sermons.”

My task was to read the book and take a 15-question multiple-choice
open-book test. The book, while not actually amusing, certainly
contains some noteworthy points. Downplaying her degrees, Goodheart
says her real credentials are “the pain I have incurred in my
lifetime,” and so it’s important to know that she was sexually
molested as a child, is a compulsive overeater and was married to
an alcoholic. Top that, Fun Nun!

However, Goodheart also has extensive experience in alternative
psychotherapies and a master’s in psychology. In the peer
counseling organization where she started, the focus was catharsis.
But “laughter was given minor lip service. The big thing was to
cry.” While working on her degree, she heard about Cousins and
arranged to meet with him. She came away pitying his lack of a
theoretical framework, and decided “to go public with laughter.” To
join a “growing group of giggling gurus.”

Unlike some laughter therapists, Goodheart can cite acts of
individual therapy, but she apparently devotes most of her time to
her speaking career. I would like to have seen the workshop she did
at a police department, where she divided them into two groups who
took turns bellowing, “WHAT ON EARTH AM I DOING HERE?” Not to
mention the way she begins each presentation: by facing the
audience and laughing for up to three minutes. Many people “become
extraordinarily uncomfortable,” she notes: They have “succumbed to
those myths that prevent us from catching the contagion.”

Around this time my friend Cynthia called and wanted to know what
was wrong. “You sound so tired.”

“Um, I’m reading this book on laughter therapy,” I started to
explain.

“Ohhh — you’re depressed!”

I hadn’t even come to the passage titled “Throw a Unique Party.” A
slumber party I can handle, though I was alarmed by Goodheart’s
assertion that males might prefer a farting contest. But then I
read about the party where you invite 10 or 12 friends over and tell them, when they arrive, that “it is
going to be an evening of sharing embarrassing moments.” She warns
against serving food or drink (distracting) and says you may have
to get the ball rolling with your own tales. “As a result of this
kind of sharing, your friends will laugh more and leave your house
knowing each other better and feeling closer to one another.” Yes,
I suspect they will feel closer, because they will have shared the
experience of dousing me with lighter fluid, setting me afire and
tipping me out the window, and who can blame them?

Goodheart dislikes actual jokes, classing them on the dark side of
laughter along with teasing and tickling. Hearing her profession,
people often “pounce on me with ‘Want to hear a funny joke?’ “My
face lights up and I respond with a delightful ‘NO!’”

Goodheart’s advice for difficult situations includes the mantra, “[blank], tee-hee.” Thus, if you are having a hard time in school, make
a point of saying, “School, tee-hee.” She seems to be confronting
her own fears in the section titled “The Scientific Method, Tee-Hee.” I think her finest moment is this passage on boredom: “If you
experience boredom while reading this section of the book, it may
not be my lack of writing ability, but rather a triggering of your
own stored-up boredom. In order to combat this, as I write about
boredom, I am going to remind you to stop and say, ‘Boredom, tee-hee.’”

As a writer I have nothing but admiration for this technique.
Skepticism, gak-hork.

Unless you plan a speaking career, there is a basic problem with
laughter therapy. The reaction to attempted acts of humor is quite
individual. One person laughs at the sight of Dan Quayle slipping
on a banana peel and another draws in his breath with humane
concern. (Please don’t argue with me about this. I have a
certificate.)

I posed the issue of differing reactions to Patty Wooten, R.N., B.S.N.,
C.C.R.N. (aka Nancy Nurse),
who makes
clown rounds and gives presentations and seminars on health and
humor. “The sense of humor is highly individual,” Wooten agreed.
“You have to read an audience, pick up on the nonbverbal cues on
whether people want you to be anywhere near them. Especially in a
hospital, where you feel vulnerable, where people may feel they
have no way to say no.”

“When clowns are in hospitals they ask permission,” she stressed.
This was a relief, since I know many people who dread clowns and
would rather be entertained by dancing cockroaches. Wooten
described how a clown in a hospital may ask permission via a
puppet. “The puppet will peek around
the corner ["I'd kill myself!" exclaimed my spouse,
backing up in horror at the thought] and then the
clown will step in. Then the clown will talk to
the puppet: ‘Well, do you think we should stay here? Well, I don’t
know, maybe if they scratch their head …’” If the response isn’t
good, clown and puppet go to the next room.

Wooten got started in laughter therapy when, during a time of
personal stress, she went to the Ringling Brothers clown school for
her own pleasure. She was then asked to clown at nursing homes and
got rave reviews. “Nurses began to say, ‘Can you teach us to do what
you just did?’”

She can’t teach everybody, she concedes. Even more individual than
the reaction to acts of humor is the ability to dispense humor.
“Sometimes — they mean well, in their heart they know that
laughter’s good, and they want to make people feel good, but they
don’t know how … Other people think they’re funny and they really
haven’t got a clue how to be funny.”

It’s true. Just because I crack up at Marx Brothers movies doesn’t
mean I’ll crack up if someone dressed as Harpo appears at my
bedside honking a rubber bulb.

I’m not sure I’d even want the real Harpo there. He grabs people!
Groucho would probably make puns at my expense, and in my weakened
condition Chico would certainly be able to sell me something I
don’t need. Such as a course in laughter therapy. I think I’d
prefer to have that restful lady Margaret Dumont there, stroking my
brow dreamily, with a noble expression.

Some laughter therapy tries too hard to be open-minded — to accept
that serious situations can be viewed humorously, to encourage
people to joke around rather than critiquing their sense of humor — and somewhere in the process it’s possible to fall into a slough
of unfettered whimsicality, random puckishness and toilet key
chains and never climb out.

Will laughter therapy continue to make strides in an era of managed
care? Maybe, if the research is there, says Wooten. “What we
haven’t yet proven is that it’s cost-effective. If we could prove
that we could write our own script in any hospital.”

In that event, we may all want to add clauses to our Living Wills.
Some will austerely request: “No respirator; no heroic measures; no
Abbott and Costello.” Others will be fighters: “Do everything
possible to save me; I hereby authorize any and all surgery, life support, saturnalias, bedpan slippers and toilet key chains. In
the event death appears imminent I request the intervention of
Janeane Garofalo, whether or not covered by my insurance.”

Susan McCarthy is a San Francisco freelance writer and the author, with Jeffrey Masson, of "When Elephants Weep: The Emotional Lives of Animals."

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