LAUGHING MATTERS

We have all heard that “laughter is the best medicine.” It took a while for science to show the truth behind this old axiom, but studies indicate that laughter can reduce cortisol and increase endorphins, leading to higher morale and many other improved patient outcomes. Physicians in fields ranging from psychiatry to oncology now hail its healing benefits. However, some experts caution that humor can do more harm than good when used incorrectly. Knowing when to drop a one-liner and when to stay sober is an imperfect science, and often more difficult than it sounds.

At the Schwartz Center for Compassionate Healthcare at Massachusetts General Hospital, resources are dedicated to promoting positive relationships between caregivers and patients. Richard Penson, MD, MRCP, clinical director of medical gynecologic oncology, and his colleagues meet there once a month to discuss different topics related to patient care. When the subject of humor came up, the group had a lot to say — so much so that Penson decided to do some research of his own. He wrote a commentary piece based on his findings for The Oncologist, titled, “Laughter: The Best Medicine?”

During the group meeting at Massachusetts General, there were two presenters: a nurse who was famous at the hospital for her laugh, and a doctor who was known for his quick wit. “They talked about how at one end of the spectrum you have high-risk humor, like gallows humor, and the rather more dangerous things about humor — how you could hurt people. At the other end of the spectrum, how it can be really engaging and make the process of modern healthcare humane and personal,” says Penson.

The group decided to categorize humor as a “high-risk” form of interaction. Because of this, Penson warns physicians and other medical professionals to tread carefully when cracking jokes around patients. He summarizes the upsides and downsides of humor in his review, writing that, “When used sensitively, respecting the gravity of the situation, humor can build the connection among the caregiver, patient, and family. However, insensitive joking is offensive and distressing, and experience suggests a variable acceptance of humor by patients with life-threatening illnesses, making humor a high-risk strategy.”

Not Everyone’s Laughing

Although humor has been found to be a dicey form of patient interaction, Penson does think it works for certain people. “I’m not much of a joke teller, but I always have a few patients who come in wanting to trade jokes,” he explains. He likes to tell a go-to zinger about a seeing-eye Chihuahua, but generally he recommends that patients focus on diet, exercise, and attitude instead.

“People who would use humor should use humor,” Penson continues. The lesson he emphasizes is that the interaction should feel natural — not forced — and physicians should be cognizant of their patient’s personality when considering a joke. “You can’t get someone who has a somber perspective to reframe their situation with an element of humor when they have a diagnosis of cancer,” he says.

All in all, Penson’s answer to incorporating humor comes down to individual comfort. A good joke can break the ice and form an instant connection with a patient, so if that method of interaction comes normally to a physician, he or she should continue to use it. But if witty banter is not one’s regular style, it should be avoided.

All Kidding Aside

Not all experts are hesitant to try for laughs, though. Ramon Mora-Ripoll, MD, PhD, Spanish Network for Research in Science of Laughter, believes that humor can be easily integrated into treatment plans without risk. With his method — simulated laughter — jokes are not required.

He has studied the use of humor and witnessed positive outcomes firsthand. His interest in the subject began when his colleagues commented on his own funny personality and how it lightened their work environment. Mora-Ripoll decided to investigate the chemical processes behind these effects. “Laughter triggers the release of hormones and neurotransmitters that cause physiological and psychological benefits,” he explains. The release appears to be true of both spontaneous and simulated, or fake, laughter.

“Simulated laugher is a form of therapeutic laughter that can be elicited at will. No humor or other stimuli are needed,” he says. “Its effects are similar to spontaneous laughter, since the body cannot distinguish one or the other.” Mora-Ripoll claims that simulated laughter is widely practiced as a form of therapy, and that fake laughter will feel more and more real over time. Simulated laughing may seem strange at first, but patients find themselves feeling happier from the experience nonetheless.

A good belly laugh sets off a number of neurotransmitters, especially serotonin, norepinephrine, and dopamine. Since these chemicals distract from pain and stress, patients are able to forget their suffering for a period of time. Mora-Ripoll does not call laughter a cure, of course, but sees it as a therapeutic supplement to regular treatments. He wrote a guide to the use of laughter by medical doctors, titled, Medicine and Laughter Therapy Handbook.

Based on his research, Mora-Ripoll maintains that the evidence is strongly in favor of using laughter with nearly all patients. “Laugher as a form of therapy can be universally applied with almost every patient. Very few counter indications exist,” he says, adding that the lowering of cortisol is key to laughter’s success. By decreasing this stress hormone, a patient might also experience decreases in blood pressure, blood sugar, and cholesterol — making it especially helpful for obese patients and people with diabetes.

Jokes: PRN

Still, Penson argues that laughter can be equaled by other activities when it comes to improving patient outcomes. He says that common sense steps like diet and exercise will have similar effects, and he also suggests that prayer and meditation can be extremely beneficial to the well being of patients and caregivers. The most valuable tool, though, is information.

“Being well informed is the single most important thing,” Penson claims. Although patients with post-traumatic stress disorder (PTSD) or similar psychological sensitivity concerns may find any information terrifying, most will feel empowered and in control when armed with knowledge. Penson specializes in cancer, but the same advice can apply for any patient facing a serious disease or disorder.

Despite the risk of a bad joke, there is still something to be said for the old adage about laughter. It may not always be the best medicine, but laughter’s hormonal benefits are undeniable and there are few interventions that are less invasive. Genuine or fake, a good laugh lifts spirits. Practitioners should consider offering laughter therapy as a complementary treatment to modern medicine, and perhaps keep a few good, clean jokes in their pocket to entertain humor-driven patients.

— Mapes is a freelance writer based in Washington, D.C., and a regular contributor to Endocrine News

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