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July
14, 1999
"Rx Laughter" Project
Scientific Promise of Potential Link Between Humor/Laughter and Health
By: Michael H. Joseph, M.D., Assistant Clinical Professor, Pediatrics,
UCLA Pediatric Pain Program
This letter is meant to outline the scientific validity of the "Rx Laughter"
Project which Sherry Hilber, as an entertainment industry executive, created and brought
to UCLA.
We often hear the old adage that "laughter is the best medicine." In 1979, Dr.
Norman Cousins decided to test this idea. He used laughter as a treatment for the spinal
disease ankylosing spondylitis, first calling attention to the medical community of humor
and laughter as therapy. Dr. Cousins then spent the rest of his life investigating the
role of positive emotions and health, eventually working at the UCLA School of Medicine
and establishing the Humor Research Task Force. In the years since then, some studies have
suggested that stress and negative emotions can have negative impacts on health. The past
two decades have given rise to more interest in the subject which has become an integral
part of the expanding field of psychoneuroimmunology: humor.
In 1985, it was found by Dillon and Baker that viewing a humorous video boosted the level
of an immune system protein called salivary immunoglobulin A in subjects' bodies. The
effect of humor was found to be greatest in people who strongly appreciated and used humor
(Lefcourt et al, 1990). These findings were interesting because salivary immunoglobulin is
one of our bodies' first-line defenses against the potentially harmful infections to which
we expose ourselves with every breath.
Laughter may be able to stimulate our immune systems and counteract harmful effects of
stress. An increasing amount of scientific research about the role of stress in human
health has accrued over the years. High levels of stress may have a deleterious effect on
immune systems in particular. In 1989, L. Berk showed that laughter may lower stress
hormone levels and increases the numbers of immune defense cells in the blood.
In 1994, another research group led by H.M. Lefcourt found that activity of certain immune
cells known as "natural killer" cells can be increased by laughter.
It has also been shown that humor can have a positive psychological influence on children.
In a 1995 study by L. Cohen, children receiving immunizations displayed less distress when
they were coached to focus on watching an animated feature of their choice. Even the
nurses and parents of theese children reported feeling less stress during the procedures.
However, other studies have challenged some of the results we mentioned above. For
example, a 1997 study by T. Kamei et al found that NK cell activity actually decreased
after subjects watched a comedy video - thus contradicting Berk's results. Kamei also
found that neither stress nor viewing a comedy video made any changes in immune cell
numbers. Unfortunately, this study used a small number of subjects and therefore the
validity of the results is suspect.
Although many studies have been conducted, the truth is that not enough work has been done
for anyone to have the "last word" on humor in health. More research is
warranted because the current findings, though incomplete, seem promising. However, for
one thing, we need to conduct more studies outside the commonly-studied areas. For
another, we also need to find out more about the basic nature of humor.
We know from our clinical work that funny videos can be potent distractors during painful
events in the hospital. They reduce pain perception and anxiety while creating positive
memories. These positive memories help to reduce anxiety in the future, and promote a
sense of controllability of the child's life and hospital treatment. Unfortunately, these
are only anecdotal findings and have not been shown scientifically.
More studies are needed because, in the end, we would like to know about humor's OVERALL
effects on human health, not just its effects on isolated systems. Even though we know
that humor may cause increased in immune system proteins and cells in the body, we still
need to find out whether or not such changes are actually translated into better overall
health for people. For instance, how might humor affect duration and quality of sleep? How
might it modulate anxiety or depression? How might it affect disease outcome?
In addition, the nature of humor itself must be explored. Since "humor in
health" research is still in its infancy, previous studies were - by necessity -
fairly crude. Studies using "comedy videos" or "humorous cartoons" do
not really tell us what it is about humor which mediates the observed immune responses. Is
it the physical act of laughing itself? Is it the brain pathways which are activated?
Additionally, there are many types of humor. For example, sarcasm appears to be funny in a
different way than knock-knock jokes are funny. More refined studies may also enable us to
maximize the effects of humor therapy by allowing us to concentrate on those aspects of
humor which are most beneficial.
As medical care costs go up and as members of the general public become more interested in
taking control of their own health, it is more and more important to find effective
methods to manage disease and to avoid them in the first place. Humor and laughter can be
found everywhere - from television programs to situations in our own lives. There is now
increasing evidence that a good laugh may not only FEEL good, but also BE good for you.
Michael H. Joseph, M.D., Assistant Clinical Professor, Pediatrics, UCLA Pediatric Pain
Program.
References:
Berk L. "Neuroendocrine and Stress Hormone Changes During Mirthful Laughter,"
American Journal of Medical Science, 1989: 298: 390-396.
Cohen L. et al, "Nurse Coaching and Cartoon Distraction: An Effective and Practical
Intervention to Reduce Child, Parent, and Nurse Distress During Immunizations,"
Journal of Pediatric Psychology, 1997; 22(3): 355-370.
Itami J. et al. "Laughter and Immunity," Japanese Journal of Psychosomatic
Medicine,
1994; 34:565-571.
Kamei T. et al. "Changes in Immunoregulatory Cells Associated with Psychological
Stress and Humor," Perceptual and Motor Skills, 1997;' 84:1296-1298.
Wooten P. "Humor: An Antidote for Stress," Holisitic Nursing Practice,
1996; 19(2); 49-56
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