To print this page, select "Print" from the File menu of your browser salon.com > Health & Body Sept. 8, 1999 URL: http://www.salon.com/health/feature/1999/09/08/laughter Laugh track Someday doctors might be replaced by Marx Brothers movies. - - - - - - - - - - - - By Susan McCarthy 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." salon.com | Sept. 8, 1999