For most of us, the name Patch Adams conjures up the 1998 movie, in which comedian Robin Williams plays a doctor who cares for patients with warmth, affection, laughter and clown-ish antics. The character is, in fact, real: Patch Adams is the physician who was born Hunter Doherty Adams. His unconventional approach -- based on the idea that humor and play are crucial to health -- may not be as zany as it might seem.
The idea that laughter can have a positive impact on health is quite old. Even the Bible states that "a merry heart doeth good like medicine" (Proverbs 17:22). However, for those of us with gray hair, the term "laughter is the best medicine" conjures up the section by that name in Readers Digest. More recently, the concept entered the wide public consciousness in 1979, with the publication of Anatomy of an Illness (As Perceived by the Patient) by Norman Cousins, a literary light and progressive political activist of the fifties and sixties. In the book, Cousins chronicles how he self-treated an acute, life-deteriorating rheumatoid disease with a combination of laughter -- induced by watching Marx Brothers films -- and vitamin C. While the evidence he presented was anecdotal, it raised the question that still is asked today: are humor and laughter beneficial to health and well-being?
Humor Versus Laughter
A number of studies have investigated the effects of humor and laughter on both physical and psychological health. But first, it's important to distinguish between humor -- largely based on whether one perceives something to be funny -- and laughter, the outward expression of finding something humorous.
The cognitive process that leads us to think something is funny -- or not -- is complicated. Imaging tests show multiple areas of the brain are involved in the process of humor, including regions associated with positive emotions and reward. Tests also show that "high functioning" areas of the brain are activated, such as the frontal lobe, presumably because the identification and appreciation of humor is a complex process that often draws from one's past experiences.
In any case, it is generally agreed that we, as humans, are drawn to humor because it is emotionally pleasant. And once we perceive something to be funny, we usually laugh. Whether we chuckle, giggle or break into tear-inducing guffaws, laughter is associated with several potential benefits.
Laughing Away Stress and Anxiety
When we laugh, our oxygen intake increases, activating the lungs, heart rate and various muscles. But once we stop laughing, the overall effect of the experience actually is relaxing; one early study reported this post-laughter relaxation period can last up to 45 minutes. Heart rate, respiratory rate and blood pressure also decrease in the relaxation period. This process of firing up one's engines in a pleasurable way, then immediately cooling down, can have a short-term stress-relieving and mind-clearing effect.
It's well-documented that chronic stress and anxiety can lead to health problems, including a weakened immune system, high blood pressure, digestive disorders and other susceptibilities. A 2008 study found that participants who anticipated laughter exhibited a reduction of cortisol, epinephrine (also known as adrenaline) and a metabolite of dopamine, three types of stress hormones. Another research team found that those with heart disease were 40 percent less likely to laugh compared to comparable well people, suggesting the ability to laugh may have heart health implications; or, maybe people with heart disease are too "shell-shocked" to laugh. Humor as a form of complementary or alternative therapy also has been shown to have an overall emotionally positive influence on patients, helping to reduce anxiety and improve attitude. Humor therapy, or therapeutic humor, often is used in medical settings, especially with children -- we all know what a strategically placed Whoopee cushion can do on a child's (or parent's, or doctor's) mood.
While such evidence is promising, further investigation is needed to establish a scientifically valid link for humor, laughter and their effects on specific long-term health conditions. Because the definition of humor is so varied and complex, it has been difficult to pinpoint its direct, lasting effects on any specific disease process. The studies that have looked at the effect of humor or laughter on physiological processes such as the immune response and disease states have been fraught with methodological problems, resulting in conflicting information and difficulties in interpretation of the results. For instance, experiments have shown that exposure to comedy leads to an increase in the threshold for feeling pain and increased tolerance to pain. However, so do negative emotional control stimuli, suggesting that it is distraction and not specifically humor that is responsible for the positive effect.
In any case, there's certainly one thing we can all agree on: a good, hearty laugh simply feels good. And even in the hasty, crazy, conflicted world we live in, the perspective and stress-relief that can be gained in great humor is intrinsically worthwhile. Perhaps our mantra should be, "A laugh a day will keep the doctor away."
Follow Glenn D. Braunstein, M.D. on Twitter: www.twitter.com/CedarsSinai