Is laughter really the best medicine?
Laughter may not be the best medicine after all and can even be harmful to some patients, suggests the authors of a paper published in the Christmas edition of The BMJ.
Researchers from Birmingham and Oxford, in the UK, reviewed the reported benefits and harms of laughter. They used data published between 1946 and 2013. They concluded that laughter is a serious matter.
They identified benefits from laughter; harms from laughter; and conditions causing pathological laughter.
Some conditions benefit from ‘unintentional’ (Duchenne) laughter. Laughter can increase pain thresholds although hospital clowns had no impact on distress in children undergoing minor surgery (even though they were in stitches). Laughter reduces arterial wall stiffness,which the researchers suggest may relieve tension. And it lowered the risk of heart attack, so “reading the Christmas BMJ could add years to your life”.
Clowns improved lung function in patients with COPD and ‘genuine laughter’ for a whole day could burn 2000 calories and lower the blood sugar in diabetics. Laughter also enhanced fertility: 36% of would-be mothers who were entertained by a clown after IVF and embryo transfer became pregnant compared with 20% in the control group.
Is Laughter the Best Medicine or Any Medicine at All?
The promotion of humour and laughter as medicine is a burgeoning business and an increasingly popular avocation. There are video- and audio cassettes, books, journals, magazines and newsletters, workshops, symposia, and entire conferences and societies devoted to the celebration and promotion of humour and laughter as the road to physical and mental health.
The idea that humour and laughter benefit health is not new; it has long been a part of folk wisdom. Shakespeare wrote in The Taming of the Shrew, “And frame your mind to mirth and merriment, which bars a thousand harms and lengthens life.” And from Proverbs 17:22, “A merry heart doeth good like a medicine; but a broken spirit drieth the bones.”
What is new is the use of a medical model and the fervent and organized promotion of allegedly therapeutic humour under the banner of this model. Given the perennial public interest in both health and humour coupled with the tendency of the popular media to oversimplify, delete qualifiers, and extrapolate when reporting research, it is inevitable that false and unsubstantiated claims abound.
Some of the most distorted claims surround Norman Cousins, who became the virtual poster boy of the movement after reporting his use of a “humour intervention” during his recovery from a serious and painful collagen disease in 1964. Some early reports made in the medical and popular press were the beginnings of the enduring myth that he cured himself with laughter. In 1979 he published Anatomy of an Illness as Perceived by the Patient because he “thought it useful to provide a fuller account than appeared in those early reports” (p. 27). The major themes of this book, which he elaborated in two later books on healing (1983, 1989), were the power of the body to heal itself and the importance of positive emotions, of the will to live, and of the patient-physician partnership.
However, laughter can also have adverse effects. One woman with racing heart syndrome collapsed and died after a period of intense laughter and laughing ‘fit to burst’ was found to cause possible heart rupture or a torn gullet. A quick intake of breath during laughing can cause inhalation of foreign bodies and can provoke an asthma attack. Laughing like a drain can cause incontinence. And hernias can occur after laughing: rapture causing rupture.
The authors’ list conditions that cause pathological laughter and this may help in diagnosis. Epileptic seizures (“gelastic seizures”) are the most common cause.
The researchers say that their review challenges the view that laughter can only be beneficial but do add that humour in any form carries a “low risk of harm and may be beneficial”. They conclude that it remains to be seen whether “sick jokes make you ill, dry wit causes dehydration or jokes in bad taste [cause] dysgeusia (distortion of sense of taste)”.
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Stephanie Burns
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44-020-738-36920
BMJ-British Medical Journal