Image by Greg Mercer

“What’s wrong with death sir? What are we so mortally afraid of? Why can’t we treat death with a certain amount of humanity and dignity, and decency, and God forbid, maybe even humor. Death is not the enemy gentlemen. If we’re going to fight a disease, let’s fight one of the most terrible diseases of all, indifference.”

As the above quote from the movie Patch Adams indicates, there may be something to the familiar adage that “laughter is the best medicine.” Instead of just treating the disease afflicting a person, perhaps healthcare professionals can work to treat the person as well.

However, humor in the medical profession is a slightly controversial topic. Humor as used in the media and by some health care professionals is not representative of humor’s place in mainstream medicine. Critics of humor therapy say that experiments on the topic are not well designed, with poor controls and inadequate sample populations [1]. There are, however, numerous studies that have been recently published on how humor and laughter can lead to increased health and better immune function. In fact, articles on humor have been published for more than one hundred years in medical literature. Many of these articles, however, rely on anecdotes and opinions instead of concrete scientific evidence [1]. The idea of humor in health, though, has been so powerful that professional associations, like the American Association for Therapeutic Humor, have been organized to study and promote humor in healthcare [2].

Before looking at the research that has been done on the benefits of humor on health, it is important to define humor and to examine its many dimensions. The American Heritage Dictionary defines humor as “the quality of being amusing or comical, the ability to perceive, enjoy, or express what is comical or funny, a state of mind; mood, a sudden inclination; whim.” Thus, it is seen that humor has both mental and behavioral aspects. It is important to note is that humor is a universal quality, though degrees and types of humor among people inevitably differ [3]. In addition to a personality trait, humor can be looked at as a situational stimulus, a mental process, or an emotional response like laughter [2]. These different modes of feeling or being humorous must be taken into account when reviewing the medical research that has been done on health and humor [2].

There are four general mechanisms by which humor can contribute to improved health [2,3]. One mechanism is by way of rigorous laughter, which can lead to reduced muscle tension and exercise for the heart, as well as to endorphin production and enriched blood. This mechanism suggests that laughter in itself is the crucial component by which health is improved. As a result, supporters of this view believe that humor without a physical response component (laughter) is not effective.

The second mechanism by which humor can improve health is by evoking positive emotions [2]. Supporters of this view believe that anything that can spur positive thoughts can act as humor does—such that humor is just one means. Other favorable feelings like love and success can also produce similar results [2,3].

The third mechanism by which humor is thought to enhance health is by reducing stress [2]. This mechanism thus presents humor as an indirect means of improving one’s health. Because stress has been shown to produce adverse effects on the body, such as increasing one’s risk of infectious disease, anything that can work to reduce it, like humor, will work to counteract these negative effects [2,3].

In addition to these three mechanisms, another view, held by Martin [2], is that the health benefits of humor are heightened in individuals with a greater sense of humor. Because of their innate sense of humor, these individuals are more socially desirable, and thus they have a larger support system that is both satisfying and comforting [2].

Humor affects patient-physician communication. By reducing the stress level of patients and medical professionals, humor tightens interpersonal gaps, conveys caring, and relieves the anxiety and fears associated with medical care [1]. In addition to relieving stress in the medical workplace, humor creates good working relationships and improves morale for the medical professionals. Patients use humor as a guise to express their true concerns and disappointments with the medical care system, so doctors should be alert to this less-obvious form of communication [1].

Studies have shown that when doctors spend more time with their patients, their patients feel more satisfied and are thus more likely to listen to the doctor’s orders [1]. Patients like it when doctors spend time talking to them about issues other than their health, such as the weather, or telling them jokes. A recent study also shows that in addition to spending more time with their patients, doctors who used humor with their patients had less or virtually no malpractice suits against them compared to doctors who didn’t [1].

When it comes to children, humor is also a powerful tool. It relieves tension and fear or doctors, and it gives children a feeling of control over their environment [1]. Acts as simple as providing small toys for them, tickling them, or playing peek-a-boo can reduce children’s uncertainty about the doctor visit and their own vulnerability to disease or pain. Older children like slapstick humor such as running into curtains or playing around with medical tools [1].

Humor helps to distract the patient from physical pain, if even for a brief period of time [3]. But humor should never be forced onto the patient [3]. Moreover, patients themselves also use humor to ease their situations. By making fun of doctors and their own conditions, they “transform individual complaints into group pleasure,” and create a more enjoyable social atmosphere in which healing is better supported [1].

Despite these benefits, however, there are delicate medical situations in which humor should be avoided, Bennet recommends [1]. In terms of patient care, ethnic and sexist humor should be avoided, as well as sarcastic humor [1]. Cynical humor has been shown to be less effective than humor that puts things in perspective or reduces seriousness [1]. Also, “gallows humor,” the type of morbid humor used to discuss tragedy and death, should be avoided so that patients do not feel medical professionals are cruel or uncaring [1,3].

New research shows that, in addition to psychological effects, laughter has physiological benefits as well. The experiments that claim this, however, have not been carefully carried out [2]. Scientists say that laughter reduces stress levels, lessens depression and improves mood, increases activity of defense immune cells like T-cells that attack and destroy tumors and viruses, and increases production of interferon, a hormone that fights viruses and regulates cell growth [2,3]. Stress, however, has been shown to lead to the production of cortisol and aldosterol, which can reduce the T-lymphocyte cell number [3]. Laughter has also been shown to boost antibody activity, provide physical exercise to the muscles, lungs, and other organs of the body, oxygenate blood, speed up respiration and blood circulation, stabilize blood pressure, improve digestion, and provide emotional cleansing [2,3]. Laughter can reduce pain by stimulating the creation of endogenous opioids like beta-endorphin [2,3]. Also, laughter has been shown to enhance the function of the immune system [2]. The tears that laughter produces are different from those brought about by sadness; they are actually toxins that the body gets rid of through the laughter response [3].

Research has shown that patients handle pain much better after having watched funny movies [1]. In one well-controlled study, orthopedic patients requested less postoperative pain medication after watching comical movies [1]. This study showed that after the first day of operation, there was no change in pain perception due to the movies, but that on the second day, the requests for minor medications and over-the-counter pills decreased by 61%. An interesting aspect of this study, however, shows that patient choice greatly affected the impact of humor. Those patients who were not allowed to pick a movie of their choice showed no increase in pain tolerance, whereas those patients who were allowed a preference of films did. This suggests one of two things — that perhaps personal freedom of choice is an important factor in the reduction of pain or that choice was an issue because those patients who were not allowed to choose did not even think that the movies they were shown were funny.

Although there is a good amount of literature written on the topic of humor and health, it must be read with a critical eye. Often, the experiments that claim that laughter has both psychological and physiological benefits have not been carefully performed [2]. Many of these experiments need better control groups and manipulation checks. Experiments that have patients completing self reports on measurements of humor are poor in reliability and validity. Also, because many of the experiments have methodological problems, one cannot easily draw firm conclusions. The empirical evidence is weak because of the inconsistency among experiments [2].

The question of whether humor really does affect the body in a positive way is still subject to more research and ultimately to opinion. Perhaps humor is never a bad thing when used in good taste and at the right moments. Evidently humor makes the process of dealing with our health a little easier by putting life into perspective. But it still cannot be a replacement for solid medical assistance and for keeping the patient informed. Humor currently should only be used as a supplementary tool [3]. As Mel Brooks once said, “humor is just another defense against the universe.”