October 2, 2000
The Mind-Body Connection:
Will Researchers and Comedy Legends Demonstrate
the Therapeutic Qualities of Laughter?
By A.J.S. Rayl
humor cause a positive physiological impact? Could the gags, quips,
and shtick of such legends as Charlie Chaplin,
Bud Abbott and Lou Costello, and
the Marx Brothers, or some of today's comedians,
really be medicinal? During the last couple of decades--since the
best-selling author Norman Cousins made headlines
by laughing himself well--researchers have been working to uncover
the physiological impact of laughter at the cellular and neurochemical
level. By all indications, the eons-old notion is grinning and bearing
Cousins was diagnosed with ankylosing spondylitis, a degenerative
connective tissue disease. Bedridden and so weak he could barely
raise his fingers, he was given a one-in-500 chance of complete
recovery. He could sleep, he discovered, only after watching Marx
Brothers comedies and Candid Camera episodes. It seemed to reduce
his pain. Then, somehow, in the process of laughing, Cousins began
to heal, eventually making an against-all-odds recovery.1,2
Now University of California, Los Angeles (UCLA), cancer researchers
Margaret Stuber, professor of psychiatry and behavioral
sciences, and Lonnie Zeltzer, director of the Pediatric
Pain Program at Mattel Children's Hospital, have launched a five-year
study--dubbed Rx Laughter--to investigate the impact of humor and
laughter on the immune systems of dozens of healthy children and
children confronting life-threatening diseases. The first physician-researchers
to look at the impact of comedy on both healthy and sick children,
Stuber and Zeltzer are calling on the talents of comedy's legendary
heroes to help them out.
"We're not hypothesizing that humor will be curative or that
it is going to take the place of any other kind of therapy, but
we [believe] that humor is going to have an additional benefit over
and above simply removing or reducing stress," explains Stuber.
"What I'm hoping is that we'll actually be changing the level
of arousal in the autonomic nervous system, so we'll get the children
to relax at that central level."
Adds Zeltzer: "If you're laughing, you feel better in general.
And since it elevates your mood, it should do something physically
in your body to create that feeling of well-being. I think we're
going to learn that exposing yourself to humor in life will not
only change mood and reduce stress hormones but also influence serotonin
levels, which are involved in the pain-control system. That would
mean laughter could have an effect on chronic pain over time and
enhance immunoreactivity, as well as help with depression and sleep
and anxiety disorders."
Stuber and Zeltzer will measure direct physiological responses
of the autonomic nervous system. Initially, they will take low-invasive
measurements of the children's heart rates, blood pressure, and
stress hormones. They plan to extend the tests, adding blood surveys,
among other things, to investigate the impact of humor on the immune
system and on additional hormones, neurotransmitters, and natural
killer (NK) cells. The researchers will also try to differentiate
which comedies work best for which
disorders or diseases and what types of individuals respond better
to different types of humor.
The Rx Laughter study will add to the positive-thinking research
that has been ongoing for the last 20 years at UCLA's Norman Cousins
Center for Psychoneuroimmunology, endowed by the renowned writer
in the late 1970s. It will also expand on the basic
science investigations of Lee S. Berk, associate
director at the Center for Neuroimmunology at Loma Linda University
Medical Center, also in southern California. Berk and colleagues
have been at the forefront of investigating the concept of eustress,
or good stress paradigms, beginning in the 1970s with studies of
Actually, it was Cousins who set up Berk and colleagues with pilot
study funds to begin investigating laughter as a "real eustress
metaphor," says Berk. With a small cohort of mostly medical
students, they established the parameters of the study and took
blood samples via intravenous angiocatheters as the subjects watched
a preselected, self-selected humor video, Over Your Head by comedian
Gallagher (Paramount Home Video) to measure impact on the neuroendocrine
They found that mirthful laughter--which Berk defines as "happy
laughter as opposed to coping laughter or black humor or derogatory
humor"--reduces stress hormone levels.3 "The neuroendocrine
responses produced were opposite to what is seen in classical stress,"
he says. "We fell on the floor in disbelief that something
from our own apothecary could actually have such an impact. This
silliness is really serious stuff. It's real biology."
The publication of those findings drew notable media attention,
including a segment on CBS's 60 Minutes. Given that kind of notice
and the age-old adage, perhaps the most surprising thing is that
more researchers didn't jump on the bandwagon. "To my surprise,
there are really minimal studies looking at the impact of humor
on sick individuals, and nothing in children," says Zeltzer.
the amount of research into eustress and positive emotions has been
The reason, suggests Berk, "is because there were very few
people who could bridge the gap across the borders of immunology,
behavioral sciences, and the technologies of psychoneuroimmunology."
Of course, funding was also an issue. "If you turned in a grant
request for a project that crossed multiple boundaries, as I often
have, nobody knew what to do with it," he adds. Berk, however,
continued to add slowly to the knowledge base with his small cohort
Bill Marx, Harpo Marx's son, makes a
"Harpo" face for Justin Ybarra, a patient at the Mattel
UCLA Children's Hospital during the RxLaughter advisory board tour
It Came from Hollywood
If the scientific community at large was hesitating, the idea that
laughter could help heal began emerging on other fronts. Rx Laughter
actually came straight from Hollywood, the brainstorm of Sherry
Dunay Hilber, a former ABC and CBS network programming
executive who oversaw such hit sitcoms as Home Improvement, Roseanne,
Coach, Who's the Boss?, and Cybill. The study even has its own Web
site: www.rxlaughter.org. Hilber came up with the study idea about
two years ago in the midst, she says, "of looking for some
more meaningful way of using my abilities, something beyond worrying
about the ratings of last night's show." She pitched her concept
to Stuber and Zeltzer, who immediately came on board as the co-principal
investigators and honed the study plan, and then enlisted the support
of the offspring of comedy's legends. Included on Rx Laughter's
Advisory Board: Josephine Chaplin, daughter of
Charlie Chaplin; Chris Costello, daughter of Lou
Costello; Ronald J. Fields, grandson of W.C. Fields;
Melissa Talmadge Cox, the granddaughter of Buster
Keaton; and Bill Marx, son of Harpo Marx of the
For a scientific investigation, it is a unique teaming. But the
descendants of comedy's pioneers needed no convincing. Growing up
in the whirlwind shadows of their famous forebears, they learned
early that comedy was a potent and powerful force. "You grow
with what you know, and I grew up with some wackos who taught me
that when you have a sense of humor, you automatically have an option
in your view of life," says Marx. Fields agrees and adds, "Humor
is nothing but extreme positive thinking."
With their support and assistance, Hilber secured all the necessary
rights and permissions from the studios, free of any licensing charges--something
that almost seems unbelievable. But, as Chris Costello puts it:
"There are some things you just can't put a price tag on."
One reason Hilber, Stuber, and Zeltzer agreed on the works of Chaplin,
Costello, Fields, Keaton, and the Marx Brothers was that they had
withstood the test of time. "We figured there's got to be a
reason for that, and so we felt pretty safe going with those,"
"When I was a child, I never really understood the impact
of what my father did, but I was watching The King in New York recently
and it is true: These films haven't gone out of date. And if they
haven't gone out of date by now, they never will," says Josephine
The Rx Laughter team also figured that these movies and shorts
would serve to establish a more objective reaction, because the
chances are good that most of the children have not seen many, if
any, of them.
For funding, Hilber contacted Comedy Central, which several years
ago had established its Comedy Rx program to promote the positive
effects of laughter. The cable network responded enthusiastically
by putting up the initial $75,000.
'Who's on First?'
The impact of laughter on the immune systems of children has "just
been waiting to be tested scientifically," says Zeltzer. "It
seems like such a no-brainer." The concept may be obvious enough,
but designing the parameters of a study like this is most certainly
not a no-brainer. Comedy is highly subjective, while science strives
to be objective beyond question. The levels of complexity in a study
like this are as numerous as they are intricate, and there are a
lot of critical, basic questions to consider, including:
* How does one determine what will be viewed as funny across the
* Does it matter how much somebody laughs versus how funny they
think something is? In other words, is the physical act of laughter
an operative factor?
* How does one test for differences across gender lines? Ethnicity
lines? Age demographics?
In adult populations, says Berk, "We learned that there are
a lot of potential pitfalls in selecting comedy. Self- selection
of material is important, because what is funny to one person is
not necessarily funny to someone else. If you don't like slapstick,
you will experience a very different biology than I would."
Researchers investigating the impact of humor must also control
for various other issues. "You have to be really pure when
you do this kind of research," says Berk, based on his previous
studies. "Our subjects [had nothing to eat or drink] for six
to eight hours prior to beginning the study. They could not have
exercised, or had coffee or any drugs or chocolate, and sex was
not allowed." For his research, whether the subject(s) had
seen the video before was less of an issue. "I'm looking for
the conditioned response," he says. Actually, he found that
the conditioned phenomenon is real. "In other words, we found
positive effects from the anticipation."
Rx Laughter is a study of children, so theoretically, the researchers
will be dealing with a less socially conditioned, less biased population.
Although the investigators are in the first phase of selecting the
videos and finalizing study parameters, Stuber and Zeltzer have
already begun initial second-phase testing on healthy children to
establish a baseline. In a third phase, they will look at the impact
of laughter on children with cancer, HIV, and other life-threatening
diseases or disorders.
"In terms of selecting the comedy videos, part of what we
have been going for are things that are consistently funny and things
that no parents are going to object to," says Stuber. That
is actually harder than one may think. "We have to be careful,
because today, in the 21st century, we have different eyes for some
of these things than people might have had originally."
On request from the researchers, the offspring of the legendary
comedians made initial suggestions. Chaplin, for example, suggested
The Circus. "I thought it was the funniest one for this project,
and that's the one we offered first," she says. Costello recommended
Abbott & Costello Meet Frankenstein, but then offered up all
the duo's projects. Regardless of how parents might
view slapstick comedy, compared to today's humor there is, she suggests,
"a certain purity of form" in these classics. "When
you watch any of these great legendary comics, the fun they poke
is always brought back to themselves."
'Mikey Likes It'
"When we took a tour at the UCLA children's hospital, we discovered
that many of these kids never had seen vintage comedy," says
Costello. "Before they had turned the videos on, the room was
quiet, with just the humming of machines, and then suddenly the
sound of laughter was everywhere. To watch those children sitting
there and laughing over what was purely slapstick was so wonderful.
It kind of gets you choked up, because this is comedy that was done
50 years ago, before their parents were even born."
For now, the classics are producing the needed laughter, which,
along with the internal physiological responses, is exactly what
the researchers are eager to investigate. "It's long been clear
to me that people who are able to distance themselves have a sense
of humor, [and people] who have more perspective and who don't get
so absorbed in all the tension of the moment, generally feel
better," says Stuber. "Now some of that obviously is psychological.
But we know that most of the psychological feelings that we have
are actually biochemically based."
A few years ago, Peter Derks, now professor emeritus
of psychology at the College of William and Mary, and colleagues
used 21-electrode EEG topographical brain mapping to look at brain
activity related to humor. He found that laughter affects substantial
and significantly unique electrical activity, and that the whole
brain is involved.4 "Because there is substantial electrical
activity in the brain associated with laughter and humor, suppositionally,
there must be appropriate neurochemical activity," contends
Berk. And that is exactly what he and his colleagues at Loma Linda
Since 1990, Berk's lab has been investigating the impact of laughter
on the immune system, acquiring cellular and neurochemical samples
via four measures: before, during, after, and the following day.
They have documented and shown that mirthful laughter increases
the number of activated T lymphocytes and the number of T cells
with helper/suppressor markers. They have also found increases in
NK cell activity, as well as increases in the actual numbers of
NK cells, "very significant" in terms of
"The method we used to test this was to take blood samples
from the experimental group before and after mirthful laughter,"
Berk explains. "We literally put the peripheral mononuclear
blood cells in test tubes with a type of tumor cell line .... It
is astounding that
something as simple as mirthful laughter could in some manner modulate
a significant immunological cell like NK cells." Berks stops
far short of suggesting that mirthful laughter is a panacea or that
it will eradicate cancer. "The point is," he says, "mirthful
laughter modifies the physiology and the chemicals that affect natural
cells and increases their numbers and activity."
Based on his research, Berk maintains that none of these changes
would have occurred had there not been changes in neuroendocrine
components, and that the neuroendocrine components would not have
been changed had they not been affected from higher centers of the
brain and central nervous system. "The fit is there relative
to laughter and humor as a eustress state, and that impinges on
our psychophysiology as well as our psychoneuroimmunology."
It will be about two years before preliminary results from Rx Laughter
will be available, with definitive data due in about five years.
Meanwhile, initial test subjects are already laughing, and everyone
is betting that positive biologic responses will be found.
Whatever the specifics of the scientific outcome, "Is there
anything you could say [is] bad about making somebody laugh and
feel good?" wonders Bill Marx, who was part of his father's
act for a number of years. "I don't think you can--and you
can't say that about a whole lot of things in the world. If anything,
the Rx Laughter study will take the kids' minds off what they're
there for and offer them an option. Perhaps, too, it will help them
realize somewhere down the line that humor and having a good attitude
will help strengthen them physically and mentally. If kids are taught
the importance of laughter--and encouraged to laugh more--we'll
have a better world."
Berk concludes: "There is a very serious side to humor, and
that is [that] what you wear on your face is what you have inside
your body. The question of what happens physiologically when we
experience mirthful laughter forms the basis for a new frontier
of health care/medical research looking at positive emotional or
eustress states and their consequence to health and disease.
Science is, however slowly, now producing the hard evidence that
laughter is a powerful potion. Five years from now, says Rx Laughter's
co-principal investigator Zeltzer, "Maybe the prescription
will include finding what the patient's favorite funny program is,
prescribing it, and then looking at the impact on both symptoms
and physiology." Imagine a prescription that reads: One Abbott
& Costello, followed by doses of Charlie Chaplin, W.C. Fields,
Buster Keaton. Wash down with Marx Brothers. Repeat as necessary.
Call me in the morning.
A.J.S. Rayl (email@example.com) is a freelance writer in Malibu,
1. N. Cousins, The Anatomy of an Illness,
New York, Bantam Doubleday Dell, 1991.
2. N. Cousins, "The laughter connection,"
Head First: The Biology of Hope and the Healing Power of the Human
Spirit, New York, Penguin Books, 1989.
3. L.S. Berk et al., "Neuroendocrine
and stress hormone changes during mirthful laughter," The American
Journal of the Medical Sciences, 298: 390-6, 1989.
4. P. Derks et al., "Laughter and electorencephalagraphic
activity." Humor, 10:285-300, 1997.
5. L.S. Berk et al., "Eustress of mirthful
laughter modifies natural killer cell activity," Clinical Research,