Go ahead and laugh about it

By EDMUND MEINHARDT

VIEW ON HEALTH

It feels good to laugh. The average adult laughs 17 times per day. A good laugh eases stress and can help strangers bond; discovering that someone shares your sense of humor can quickly form a powerful connection. But there is developing evidence that laughter does more than just make us feel good. It can relieve our pain, reduce stress, improve our circulation, protect our hearts and strengthen our immune systems.

Why do we laugh? The philosopher John Moreall speculated that laughter may have originated with the relief at the passing of danger. It may also indicate trust in one's companions.

Laughter has long been known to provide health benefits. Norman Cousins, a journalist who suffered from a painful spine condition, wrote in his best-selling 1981 book "Anatomy of an Illness" that 10 minutes of laughing at Marx Brothers films afforded him two hours of pain-free sleep. According to an article published in the Journal of the American Medical Association in 1989, laughter can "improve the quality of life for patients with chronic problems" and has "an immediate symptom-relieving effect."

There is a dark side to laughter, however. In "The Evolution and Functions of Laughter and Humor," published in the December 2005 Quarterly Review of Biology, researchers Matthew Gervais and David Sloan Wilson observed that dominant individuals such as bosses and tribal and family leaders use humor more often. This is "controlling laughter." When everyone laughs at the boss' joke, it is known as "appeasement laughter." Laughter can become a way of controlling the emotional climate; it can deflect anger or serve as a conciliatory gesture. It can even change the behavior of others. If a threatening person joins in the laughter, the risk of a confrontation is diminished.

"Laughter therapy" and "humor therapy" are moving slowly into the mainstream of health care, part of a larger category of healing practices called "mind-body medicine." Laughter's benefits are acknowledged by the medical community, but much is still unknown about the mechanisms that enable laughter to heal.

Dr. Lee S. Berk, a laughter researcher in Loma Linda, Calif., has found that laughter increases natural killer or "NK" cells, a type of white blood cell, and antibodies such as immunoglobulin A in the mucous of the nose and respiratory passages. Laughter has been shown to decrease levels of the stress hormones cortisol and epinephrine.

According to the American Association of Therapeutic Humor, laughter "may enhance work performance, support learning, improve health, or be used as a complementary treatment of illness to facilitate healing or coping, whether physical, emotional, cognitive, social, or spiritual."

Dr. William Fry, a professor of psychiatry at Stanford Medical School and an expert on laughter, says laughter is a natural physiological process, not a learned behavior.

"The old story is that we learned to laugh from our parents," Dr. Fry said. "That's not true. It can occur in infants born blind or deaf. Within a week or two a smile can appear, weeks later the first laugh appears. Mirth is an inherent part of the human condition."

Laughter exercises the abdominal muscles and lungs. During a "belly laugh," the heart rate can increase quickly. Dr. Fry observed in his own experience that after one minute of hearty laughter, his heart rate was equal to the rate he achieved after 10 minutes on a rowing machine.

Dr. Michael Miller, director of the Center for Preventive Cardiology at the University of Maryland Medical Center and associate professor of medicine at the University of Maryland School of Medicine, recently found that laughter may be a significant factor in protecting heart health. In a study of 300 people, half of whom had either undergone coronary artery bypass surgery or suffered a heart attack, he found that people with heart disease laughed less in everyday situations. He concluded that regular laughter should be added to the list of healthy behaviors like exercise and adhering to a healthy diet.

Dr. Miller has also conducted research which shows laughter helps blood vessels to function more efficiently. In the December issue of the journal "Heart," Miller published a study that shows during laughter, the endothelium, which is the inner lining of the blood vessel, allows blood vessel walls to relax and expand. This increases blood flow and circulation without increased stress on the blood vessels.

In 1995, inspired by Cousins' book and Dr. Berk's research, a family physician in Mumbai, India named Madan Kataria decided to integrate laughter into his practice. He formed the first "laughter club" by persuading four strangers in a park to join him in improvised laughter exercises. The group grew to more than 50 in a few days.

At first, members of the group took turns telling jokes. The humor grew stale and even offensive after about two weeks, and people started to leave the group. Refusing to give up, Dr. Kataria made an important discovery: it is possible to skip the jokes and proceed directly to the laughter. People began by simulating laughter, which in a group setting quickly becomes genuine, spontaneous laughter.

With this discovery, Dr. Kataria's School of Laughter Yoga was born. Today, the Kataria School of Laughter Yoga boasts clients such as UBS Bank, Hewlett-Packard, Volvo and GlaxoSmithKline.

Dr. Kataria's efforts spread across the globe like giggles rippling through a somber lecture hall. Steve Wilson, a psychologist, participated in a laughter club while giving a lecture in India and decided to launch the World Laughter Tour in 1998 with his wife, Karyn Buxman. Together they gave lectures in 14 cities advocating the benefits of laughter for health and world peace, and demonstrating methods for conducting group laughter sessions.

Wilson serves as president of the World Laughter Tour and refers to himself as "Cheerman of the Bored."

"I've always been interested in humor and laughter," Wilson said. "It became a calling."

Many people disconnect from laughter as they age and yield to social pressures to resist the urge to laugh. "Laughter is very natural, but we often teach our children that to grow up you have to grim up," Wilson said.

The World Laughter Tour now certifies "laughter leaders" who form laughter clubs and conduct laughter sessions. "We train people systematically in the therapeutic uses of laughter and humor," Wilson said.

The method involves combining familiar and fun movements with laughter. In one exercise, leaders encourage participants to laugh while moving "as though someone had put an ice cube down the back of their shirt," Wilson said. The movements combined with the laughter get the heart rate up and provide some aerobic benefit.

"Laughter seems to counteract physiology," Wilson said. "You digest food better. It loosens muscles, normalizes blood pressure, helps arterial blood flow."

There is also some evidence that laughter can help diabetics process glucose. A May 28, 2003 article published in "Psychology Today" reported that a Japanese study of type 2 diabetes found that laughter was linked to lower blood sugar readings after a meal. This was true for diabetics and non-diabetics alike. As in much of laughter research, the link has been well-established but the exact mechanism is not yet understood.

Most of us already know laughter makes the workplace more pleasant. Now many employers are trying to reap the institutional benefits, such as increased productivity and decreased absenteeism, that increased workplace laughter can provide.

"Work is a killer," Wilson said. "The American workplace is dangerous to your health."

Michael Kerr, a Canadian humorist, laughter leader and motivational speaker whose Web site bills him as a "workplace energizer," says 72 percent of laughter club members report improved interpersonal relationships with co-workers, 85 percent say it has improved their self-confidence and 66 percent say it has improved their ability to concentrate.

"The bigger the group, the easier it is to get people to laugh," Kerr said.

Kerr encourages employers to use humor and laughter as customer service tools and as ways to recognize employees for good performance.

Laughter therapy is even catching on at the Pentagon, which has formed laughter groups as part of its program to support the families of actively deployed military personnel. In 2005 the program was directed by Col. James Scott, who is a certified laughter leader.

Laughter is part of an overall approach Wilson developed called "Good-Hearted Living," which calls for the adoption of daily practices that make more room for laughter in everyday life.

"Don't forget to relax," Wilson said. "The idea is to prevent hardening of the attitudes."