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LAUGHTER IS THE BEST MEDICINE By Laura M. Santoro, RN BSN CCRN
Humor is a word of many meanings. From the Latin word "umor", meaning liquid or fluid, it was referred to as an energy that was thought to relate to a body of fluid and an emotional state. This energy was believed to determine health and disposition. Hence the saying "he's in bad humor". In the middle ages, there were four humors. A sanguine humor was cheerful and associated with blood. A choleric humor was angry and associated with bile. Phlegmatic humor was apathetic and associated with mucous. A melancholic humor was depressed and associated with black bile. Webster's Dictionary defines humor as: "the quality that appears to a sense of the comical or the absurdly incongruous" (Webster's 1951); the mental faculty of discovering, expressing, or appreciating wit or comedy. Humor can be kindly and gentle, or sarcastic and bitter; it can be intellectual and witty, or broad, slapstick and visual. The acknowledgement of humor leads to laughter. (Dossey, 1995). Humor is credited with wellness as far back as the bible, "A merry heart hath a cheerful countenance." (Proverbs 15:13). And the phrase "laughter is the best medicine" is rumored to have been started when a lovely young woman lay dying from a throat abscess. Her husband, in an effort to see her smile and ease some of her fears, told her a joke. She laughed so hard; she burst the abscess and lived. Freud at the turn of the century felt humor could be used as a coping mechanism to lower anxiety and decrease tension, and laughter as a means of releasing energy. In the medical field, however, the focus on laughter as a therapeutic modality was not popular until William F. Fry, J conducted extensive research studies in the 1970's. His studies were primarily directed at the physiological effects of laughter on respiration. Fry maintained that laughter has a positive effect on respiration in that it increased ventilation, thereby increasing blood oxygen concentrations. His more recent research (1992) concluded that laughter helps to exercise the heart muscle by increasing arterial and venous circulation resulting in increased movement of oxygen and nutrients to tissues. In his JAMA article of April 1992, he also indicates that aiding ventilation and clearing mucous plugs would help many patients with chronic respiratory conditions such as emphysema. " He also reported that this approach was more favorably received by patients than conventional pulmonary toilet. He writes "humor respiration -- laughing and chortling -- helps disrupts the normal cyclic breathing pattern, increases ventilation, and accelerates exchange of residual air, thereby enhancing blood oxygen levels". (Fry, 1992). Gelotology is the scientific term for humor physiology, which includes "those events occurring in our bodies in association with humorous experiences" (Fry, 1986). Paskind, who studied the effects of laughter on muscle tone, and Lloyd who examined the respiratory mechanism of laughter conducted the first studies in the United States in the 1930's. In most instances mirthful responses are positive and beneficial. Laughter is a motor reflex usually present by four months of age, which requires the coordinated movement of fifteen muscles in the face as well as changes in the normal breathing pattern. The laughter response is a predictable physiological reaction affecting facial muscles and causing spasmodic skeletal muscle contractions, tachycardia, changes in breathing, and increased catecholamine production." (Cushner, 1989). Initially the laughter response is a stimulant which elevates pulse and respiratory rates; and then the laughter subsides, and a relatively brief relaxation phase ensues. In bedridden patients, a hearty laughter is clinically useful because it provides conditioning exercises. The relaxation phase, following laughter, helps ease muscle tension and breaks the spasm-pain cycle seen in neuralgia and rheumatism (Fry, 1992). The increases in heart rate and blood pressure that occurs during laughter can exercise the myocardium and increase arterial and venous circulation, causing an increased movement of oxygen and nutrients to tissues. This promotes the movement of immune elements and phagocytes throughout the system and helps the body fight infections. The enhanced venous return -- in part activated by the venous milking action of the active muscles and by the bellows action of the laughing thoracic cavity -- helps reduce vascular stasis and diminishes the risk of thrombus formation. Exceptions to the generally favorable physiological effects of mirth and laughter are few, but a small number of people do respond with neurological symptomatology -- seizures and cataplectic and narcoleptic attacks. Mirthful laughter may be accompanied by a large sudden increase in blood pressure of relatively brief duration. Although no studies have been published in the medical literature, anecdotal evidence indicates that in a small number of people laughter is associated with cerebrovasuclar accidents (in those already at risk because of pre-existing arterial hypertension and cerebral vascular fragility) and myocardial infarction. The large increases in abdominal and thoracic pressure secondary to laughter are reasons to discourage patients from laughing immediately following abdominal or pelvic surgery after acute orthopedic distress such as rib or shoulder girdle fractures, and when they have an acute respiratory disease such as asthma. (Fry, 1992). Norman Cousins first described the therapeutic effects of humor and laughter in 1979 when he used laughter during his treatment for ankylosing spondylitis (chronic inflammatory disease of unknown origin progressing to eventual fusion of the involved joints). Cousins believed that negative emotions had a negative impact on health, and therefore positive emotions should have a positive effect on health. He established the Humor Research Task Force, which coordinated and supported worldwide clinical research on humor. (Cousins, 1989). Beck, 1996, conducted carefully controlled studies showing that the experience of laughter lowers serum cortical levels, increases the amount of activated T lymphocytes, increases the number and activity of natural killer cells, and increases the number of T cells that have helper/suppresser receptors. In short, laughter stimulates the immune system, offsetting the immunosuppressive effects of stress. I have experienced first hand the benefits of laughter in the Intensive Care Unit. As a critical care nurse, I am often faced with sadness. Patients, families, friends, and nurses overwhelmed with serious illness and often-poor outcomes. I know the value of a shared smile, or giggle. I know the loss of control a person faces when in the Intensive Care Unit as family or as a patient. With the monitors and highly technological equipment, humor is often lost. I make a personal effort to speak to each and every client, in a cheerful, pleasant way. Although there are times when laughter is not appropriate, more often than not I find it welcomed. Having been a family member with a dying parent, I understand both sides of the situation. I have faced many an ethical dilemma regarding ventilated patients and the process of weaning them off of the ventilator. I find it difficult to understand that the first line of sedation is always medication. The medication used always debilitates the respiratory response. How then, do we successfully wean a patient from a ventilator when the coping method we use makes the goal we are trying to achieve nearly impossible? It is my opinion that as a professional, a nurse should be able to pool her/his resources and develop a more appropriate course of action. Research studies to date have been conducted with some detail to physiologic responses to laughter and humor therapy. There were little, if any, research studies with quantitative data to support the benefits of humor therapy in such a way as to change nursing and hospital policy. The use of humor will not only increase patient outcomes but also aid in the nurse-patient and nurse-family relationships. As Socrates once commented on the medical theory of his day, "As it is not proper to cure the eyes without the head, nor the head without the body; so neither is it proper to cure the body without the soul."(Moody, R) INTERNET LINKS OF INTEREST - The Humor Institute - the source of humor for the professional world. - American Association for Therapeutic Humor.
REFERENCES Beck, Cheryl Tatano. (1996). Humor in nursing practice: a phenomenological study. International Journal of Nursing Studies. 334,5, 346-352. Cousins, N. (1989). Head First -- The Biology of Hope. New York, NY; Dutton. Cushner, FD, Friedman, RJ. (1989) Humor and the Physician. Southmed Journal. 82:51-52. Dossey, Barbara, et al. (1995) Holistic Nursing a Handbook for Practice. Gaithersurg, MD. Aspen Publishers. Fry, William F. Jr. (1992). Humor, Physiology, and the Aging Process. Humor and Aging. Orlando, FL. Academic Press. Moody, R. (1978). Laugh after Laugh, Jacksonville, FL; Headwaters.
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