May 13, 2005 — -- Maybe that guy at the office who deliberately laughs at the boss's jokes has it right. A carefully cultivated ability to giggle might help you and the people around you feel better.
In hospitals, nursing homes and private clubs all around the country, "certified laughter leaders" are teaching the therapeutic value of mirth, not by telling jokes, but simply pretending to laugh, so that forced hee-hee-hees eventually become honest-to-goodness giggles.
At the Midwestern Regional Medical Center in Zion, Ill., part of the Cancer Treatment Centers of America, laughter leader Katherine Puckett has patients pretend to put ice down each other's backs. At first, the patients pretend to laugh. Then it becomes so easy that they're cracking up unself-consciously.
"Remember that feeling you had giggling uncontrollably as a kid?" said Puckett, the hospital's director of mind-body medicine. "You still need it, especially if you're ill."
A growing body of research supports the theory that laughter has a therapeutic value. A good gut-buster not only helps the spirit, it gets the blood pumping, just like jogging -- only it's a workout that even hospital patients can enjoy.
Laugh on a regular basis, and you can even boost your immune system, according to some research.
A study of 20 men and women conducted at the University of Maryland School of Medicine found that 95 percent of the volunteers experienced increased blood flow while watching a funny movie, such as "There's Something About Mary," while 74 percent had decreased blood flow during a heavier picture, such as "Saving Private Ryan." The benefits lasted about 12 to 24 hours.
The results, presented at a March meeting of the American College of Cardiology, point to a strong connection between laughter and cardiovascular health.
"The recommendation for a healthy heart may one day be to exercise, eat right and laugh a few times a day," said Dr. Michael Miller, who conducted the study.
To be sure, America has no shortage of goofball comedies, and most of us spend enough time watching them. But sometimes that's not enough.
"Jokes are great. But you watch TV shows and movies, even really good ones, you generally don't laugh for any sustained period," said psychologist Steve Wilson. "You laugh more when you're in a comfortable environment with friends."
Wilson trains and certifies "laughter leaders" like Puckett to go into hospitals, hospices and help centers for the disabled. These instructors teach the art of chortling -- largely by pretending to chortle. A good part of the lessons involve students repeating the key phrases "ha-ha-ha," "hee-hee-hee" and "ho-ho-ho."
"What we do is go through exercises that help people learn to get themselves in a frame of mind to laugh harder and more frequently," said Wilson.
He started the World Laughter Tour after traveling in 1998 to India, where he met Dr. Madan Kataria, a physician who originated laughter clubs.
"Eastern meditation has always stressed breathing exercises, and laughter works as a form of breathing that massages your internal organs, and relaxes the muscles," Wilson said. "In India, you'll find laughing gurus, and I thought that this teaching could be adapted for Americans."
Since 2000, Wilson said, he has trained more than 1,500 laughter leaders who have created about 200 laughter clubs, a large number of them associated with hospitals, nursing homes and churches.
At the Angela Hospice and other care centers in Michigan, laughter leader Mike Millington works with patients who suffer from Alzheimer's disease, cancer and other illnesses.
"You obviously have to adapt laughter therapy to the group you are dealing with," he said. "But laughter is so primal, that you can really have breakthroughs. I've seen people who are confined to wheelchairs and dragging around IV poles laugh so hard their mood improves, and they get a pretty good workout."
Laughter leaders don't need to be stand-up comics, but a sense of humor about your vocation doesn't hurt. That still doesn't mean the therapy can't be useful for people in the most serious of situations.
At the Pentagon, U.S. Army Reserve Col. James Scott says his laughter programs give family members of those serving in the National Guard a guilt-free opportunity to relax and have a little fun, especially when a loved one is deployed overseas and facing a dangerous assignment.
"Laughter is an important stress-management tool," he said. "When you laugh, the brain stops thinking. It's a proven way to keep your mental balance."
Scott says he begins his programs in uniform, explaining the benefits of laughter with a PowerPoint slide show. Then he leaves briefly, changes into shorts and a T-shirt, reintroduces himself as "Col. Laughter" and invites everyone to "get silly." Many choose to watch, rather than participate, and then later join in.
In the last two years, the colonel has suffered only one "laughter casualty" -- and that phrase is not military jargon that he's cooked up to adapt his workshop to Army life.
A laughter casualty is anyone in a laughter workshop who leaves with a bad case of uncontrollable giggles. Perhaps it's the only sort of casualty the Army -- or Wilson's World Laughter Tour -- doesn't regret having to report.
Scott's classes have gone well enough for him to train 15 to 18 Army Reserve officers to bring workshops on a more regular basis to military families in Kansas, Texas, Idaho and Indiana.
The medical world started taking note of the possibilities of therapeutic laughter after Norman Cousins book, "Anatomy of an Illness," came out in 1979. In it, he describes how watching Marx Brothers movies, "Candid Camera" and other comedies helped him fight ankylosing spondylitis, a life-threatening disease of the joints and connective tissue, that left him in excruciating pain with few options for treatment.
One of the things Cousins documented was that a 10-minute belly laugh could give him two hours of painless sleep. "What you begin to appreciate is the profound effect that positive emotions can have on the physical body," said Alex Zautra, professor of psychology at Arizona State University.
Zautra recently conducted a long-term study of 124 women with osteoarthritis and related illnesses. While many would assume that patients in good spirits would be better able to deal with pain, Zautra's research, published in the April issue of The Journal of Consulting and Clinical Psychology, suggests the ability to manage and conquer pain can largely be predicted by a patient's frame of mind.
"It's true that some people are naturally happy, and they tend to do better than others," Zautra said. "But even if you factor out different temperaments, it seems that people who are not as jovial can learn to better handle pain if they work toward improving their mood."
Of course, Hollywood has taken the issue to heart. The Robin Williams movie "Patch Adams," highlighted the approach of Dr. Hunter Adams, who made comedy part of his patients' medical treatment, donning a clown nose to help entertain patients.
Through the years, celebrities have a time-honored tradition to make hospital rounds to raise spirits, if only to build their own public image. But entertainment -- especially laughter -- is more and more becoming hospital routine.
On staff at New York's esteemed Memorial Sloan-Kettering Cancer Center is Dr. Stubbs the Clown, aka Michael Christensen, co-founder of the Big Apple Circus Clown Care Unit. Since 1986, he's spearheaded a program that has placed 93 clowns in 17 hospitals around the country, making 200,000 bedside calls a year.
Allison Crane, a nurse from Illinois, furthered the effort in 1987, founding the Association for Applied Therapeutic Humor. She had earlier belonged to a focus group called Nurses for Laughter and wanted to expand the program so that all health-care professionals could realize the healing benefits of humor.
Among the AATH's missions is to compile research, and among the most promising studies comes out of Loma Linda University in California, where doctors have been studying laughter's benefits on the immune system.
A 2000 study of 52 male medical students found that when they watched humorous videos, their stress levels, as measured by T-cell activity in the blood, tended to rise, according to Dr. Lee Berk. T-cells, also called "natural killer cells," jump-start the body's immune system by attacking viruses.
In another study, Berk followed two groups of cardiac patients through a yearlong rehabilitation program. All the patents received standard care. But one group also watched 30 minutes of comic videos each day. Berk found that laughter decreased disease-related symptoms, such as arrhythmias.
"It's more than a little ironic that we're quickly realizing just how important humor is to the healing process, because doctors have always had the reputation of being the most humorless of people," said Dr. Greg LeGana, who maintains a duel career in medicine and show business.
LeGana and fellow doctor Barry Levy, a school chum from New York's Cornell Medical College, created the New York cabaret show "Damaged Care," a musical comedy about the medical profession. They've performed before health-care professionals and general audiences throughout the country.
"Anyone who's ever made people laugh knows that they are soothing a soul," said LeGana. "It's great that research seems to be bearing out something we've always known in are hearts to be true."
For more information on the Association for Applied and Therapeutic Laughter, click here.
To learn more about the World Laughter Tour, click here.