Laughter and Healing: Effects on the Immune System and Health

Introduction

In the United States, billions of dollars are spent every year on medical treatments (Diggs, 2004). However, according to Diggs, people often overlook the coping mechanisms with which they have been endowed. The human body has innate mechanisms that provide self-care, which is often more effective than drugs. The Bible says: "A merry heart doeth good like a medicine, but a broken spirit drieth the bones."

There has been a great deal of research on the effects of laughter on a person's physical and mental health (Diggs, 2004). These studies show that when we laugh, there is an actual chemical change in our bodies that eases pain and releases stress. Laughter serves as a coping mechanism for the normal stress of life and may even aid the healing process.

There are two types of stress: distress, which is negative stress, and eustress, which is positive stress (Diggs, 2004). While distress increases stress hormones such as beta-endorphin, corticotrophin, cortisol, growth hormone, prolactin, and the catecholamines, eustress lowers those hormones and increases the activity of natural killer (NK) cells that prevent disease and promote healing (Berk & Tan, 1996). Distressful events and major life changes often have a negative impact on a person's health. Stress depletes the immune system's ability to fight disease.

Several studies have examined the stimulating effects of laughter on the circulatory and respiratory systems, as well as the psychoneuroimmune system and its connections within the body. Researchers have found a pattern of stimulation from laughter followed by relaxation of various body systems. Still, while humor is one of the most prevalent forms of human social behavior, it remains among the least studied or understood.

The purpose of this paper is to address the question of whether laughter plays a role in the healing process. The literature review includes studies on laughter and humor in the medical field, followed by a discussion of the mechanisms by which humor and laughter are believed to affect health.

How Laughter Works

Laughter is a type of eustress that releases the negative emotions responsible for harmful chemical effects on the body (Berk & Tan, 1996; Diggs, 2004). Similar to exercise, laughter has two stages: the arousal phase — when the heart rate increases — and the resolution phase — when the heart rate returns to rest. A person's heart rate can increase to 120 beats per minute (bpm) while laughing. Laughing can lower blood pressure, increase vascular flow, and improve immune function. It exercises the diaphragm, abdominal, intercostal, respiratory accessory, and facial muscles. Laughter also releases endorphins in the brain, which are the body's natural painkillers (Wooten, 1995).

Nearly 2,000 years ago, the physician Galen observed that cheerful women were less likely to develop cancer than depressed women (Simonton, 1978; Diggs, 2004). John Steinbeck wrote: "A sad soul can kill you quicker, far quicker, than a germ." Laughter's pain-killing properties and its ability to support disease resistance have opened a new area of research in oncology. Researchers O. Carl Simonton, M.D., and Stephanie Matthews-Simonton (1978) demonstrated that a person's emotional status affects their likelihood of developing or overcoming cancer. If people were to relieve stress through laughter before illness sets in, there might be a reduction in the total number of cancer cases.

According to Christopher Kent (2001): "A frequent question asked by patients and practitioners is, 'To what extent do intent, attitude, and touch affect health outcomes?' Although these issues may seem unrelated to the technical aspects of health care, a growing body of evidence suggests that such factors may significantly affect the healing process." A study by Bunnell (1999) examined whether "healing with intent" had a proven effect on pepsin enzyme activity (Kent, 2001). The rate of breakdown of egg albumin by a one-percent pepsin solution was measured across 20 separate trials. This assessment method eliminated the possibility of a placebo effect. The reaction rate of samples "healed with intent" was measured against "unhealed" controls. The samples "healed by intent" revealed significantly greater reaction rates than the controls.

Similarly, studies on healing through laughter have yielded remarkable results (Kent, 2001). Berk et al. (2000) studied how humor-associated laughter modulated certain neuroimmune parameters. Fifty-two healthy men participated in the study. Blood samples were taken 10 minutes before the subjects watched an hour-long humor video. Additional blood samples were taken 30 minutes into the video, 30 minutes after viewing was completed, and 12 hours after viewing. Increases were found in natural killer cell activity, Immunoglobulins G and M, with several immunoglobulin effects lasting 12 hours after viewing the humor video. Other effects lasting at least 12 hours included increases in leukocyte subsets and cytokine interferon gamma (Kent, 2001).

The study concluded: "Modulation of neuroimmune parameters during and following the humor-associated eustress of laughter may provide beneficial health effects for wellness" (Kent, 2001).

Berk's findings were met with some skepticism. Robert R. Provine, a psychology professor at the University of Maryland Baltimore County and author of Laughter: A Scientific Investigation (Lee, 2001), criticized Berk's research methods. "It's impossible to know whether the reported effects are produced by laughter, humor, or something not considered, like watching the video," Provine suggested. "My not unreasonable concern is that a study about laughter should observe laughter."

Review of Existing Literature

Berk and Tan have completed a great deal of research in psychoneuroimmunology (PNI). PNI holds that the immune system is directly connected to the brain and is therefore influenced by emotions (Diggs, 2004). One of Berk and Tan's experiments revealed that immunosuppressive hormones — those that harm the immune system, such as epinephrine and cortisol — were lower in participants who laughed than in those who did not (Wooten, 1995). Another experiment performed by Berk and Tan (1996) demonstrated that laughing while watching a funny video increases the amount of NK cells.

Indirectly, stress is one of the greatest threats to human health (Diggs, 2004). It is both physically and mentally harmful, breaking down the immune system and making people more susceptible to sickness and disease. While many doctors concentrate on treating the disease itself, it is equally important to treat the underlying cause.

In many cases, stress cannot be fully eliminated, as its sources cannot be removed from a person's life (Diggs, 2004). Laughter can help reduce the burden of that stress. As Mark Twain once said, "The human race has only one really effective weapon, and that's laughter. The moment it arises, all our hardnesses yield, all our irritations and resentments slip away, and a sunny spirit takes their place."

In a separate study by Kimata (2001), allergy patients who watched a Charlie Chaplin comedy had skin welts shrink — an effect that did not occur in control subjects who watched weather reports instead (Kent, 2001).

Dr. Lee Berk and fellow researcher Dr. Stanley Tan of Loma Linda University in California have studied the effects of laughter on the immune system (Holistic Online, 2004). Their research suggests that laughing lowers blood pressure, reduces stress hormones, increases muscle flexion, and boosts immune function by raising levels of infection-fighting T-cells, disease-fighting proteins called gamma-interferon, and B-cells, which produce disease-destroying antibodies. Laughter also triggers the release of endorphins, the body's natural painkillers, and produces a general sense of well-being.

Berk's 1996 research on the effects of laughter on the immune system revealed that the physiological response produced by belly laughter was opposite to what is typically seen in classical stress, suggesting that laughter is a eustress state — one that produces healthy emotions (Holistic Online, 2004).

Studies show that, after exposure to humor, activity within the immune system tends to increase, including (Holistic Online, 2004):

An increase in the number and activity level of natural killer cells that attack virus-infected cells and some types of cancer and tumor cells. An increase in activated T cells (T lymphocytes) — there are many T cells awaiting activation, and laughter appears to signal the immune system to "turn it up a notch." An increase in the antibody IgA (immunoglobulin A), which fights upper respiratory tract infections. An increase in gamma interferon, which signals various components of the immune system to activate. An increase in IgB, the immunoglobulin produced in the greatest quantity in the body, as well as an increase in Complement 3, which helps antibodies pierce dysfunctional or infected cells. The increase in both substances was not only present while subjects watched a humor video; there was also a lingering effect that continued to show elevated levels the following day.

Berk's study also found a general decrease in stress hormones that constrict blood vessels and suppress immune activity (Holistic Online, 2004). These hormones decreased in the group exposed to humor. For instance, levels of epinephrine were lower both in anticipation of humor and following exposure to humor, and epinephrine levels remained low throughout the experiment.

Dopamine levels (as measured by DOPAC) also decreased (Holistic Online, 2004). Dopamine plays a major role in the "fight or flight" response and is associated with elevated blood pressure. Laughing is aerobic, exercising the diaphragm and increasing the body's ability to use oxygen.

These studies suggest that laughter enhances positive emotions that can aid conventional treatments (Holistic Online, 2004). However, it is not believed to replace conventional treatment; rather, it is viewed as a tool that can help fight disease. Many experts agree that, when used alongside conventional treatment, laughter can not only support the healing process but also help lessen pain.

In a study published in the Journal of Holistic Nursing, medical staff members told jokes to their patients after surgery and before painful medication was administered (Holistic Online, 2004). Those exposed to humor perceived less pain than patients who did not receive humor as part of their treatment.

Medical professionals are not the only ones who have launched research projects on the effects of laughter (Jacobson, 2000). Television executive Sherry Hilber observed studio audiences convulsed with laughter on sitcom sets. "I'd see them leave at the end of the show and think, 'Maybe for the rest of the night something is happening inside their bodies.'" Intrigued, Hilber read the limited literature about humor's effects on physical health and found an incomplete mix of studies.

Determined to apply her knowledge of comedy for a greater cause, Hilber started Rx Laughter, a nonprofit project aimed at helping the ill through humor and supporting scientific research on the subject (Jacobson, 2000). As a result of her fund-raising efforts, researchers at the University of California, Los Angeles became involved in a research project investigating whether funny videos can promote healing.

The UCLA/Rx Laughter researchers screened videos assembled by Hilber for 100 elementary school children to determine what they found funny (Jacobson, 2000). Initially, they monitored how often each child laughed and asked subjects whether they found the video funny, looking for correlation.

According to Jacobson (2000), investigators then planned to examine nervous and immune system effects of laughter: heart rate, blood pressure, and the presence of the stress hormone cortisol in saliva, before and after the funny videos. Eventually, the researchers expected to explore whether comedy changes how children perceive and respond to pain. Ultimately, they aimed to determine whether humor can change children's actual health outcomes — not just their stress hormone levels. For example, they considered measuring how fast wounds heal after surgery and how fast white blood cells rebound to normal levels after being lowered by chemotherapy.

"You have to pass the 'so what?' test," said the study's co-director, Margaret Stuber, M.D., a UCLA professor of psychiatry and biobehavioral sciences (Jacobson, 2000). "It may be very interesting to us that we can change salivary cortisol, but does that actually change anything that matters?"

The idea that humor could improve health is supported by prior medical research (Jacobson, 2000). Studies reveal that anger, depression, and pessimism have a negative effect on the immune response, increase surgical recovery and wound-healing times, and may even result in higher mortality rates.

Many researchers believe that humor and laughter may counter a negative outlook (Jacobson, 2000). "Humor and distressing emotion cannot occupy the same psychological space," says Steven Sultanoff, Ph.D., a clinical psychologist and president of the American Association for Therapeutic Humor.

Despite methodological questions, studies continue to support laughter's physiological benefits. A letter in the Journal of the American Medical Association by Hajime Kimata, a Japanese physician, reported that allergy patients who watched Modern Times, a Charlie Chaplin film, showed reduced swelling of skin welts (Lee, 2001).

The extent of laughter's healing potential remains an open question, but researchers have not identified any harmful side effects. Laughter therefore remains a useful tool for therapeutic programs.

Conclusion

The health benefits attributed to laughter are numerous, though all require further study. One major area of ongoing research in this field is pain management (Healtheon, 2000). As demonstrated by Norman Cousins' experience, the endorphins released through laughter may help reduce pain intensity in those suffering from ankylosing spondylitis, arthritis, or muscular spasms. Migraine and tension headaches may also be relieved. Laughter could likewise help with postsurgical pain.