The laughter cure

A good chortle eases pain and boosts immunity. Sacha Bonsor on the latest research that shows mirth is medicine

Fast-forward an hour and a half: Jayne is moving freely around the room, bright-eyed, smiling broadly and without even the tiniest tremor.

The secret? John is a laughter coach, and he had made Jayne laugh. By asking each patient to step to the front of the room and carry out simple role-play exercises — repeating the same number in any way they like, staging a bank robbery — John is a regular witness to the transformation of fear-fuelled patients into invigorated, buoyant beings.

Humour is first cousin to hope, it has been said — what we can laugh at, we can rise above. But Cremer’s work is not tailored just to the ill or the needy. Big corporations such as Legal & General, Bank of America and Airbus employ him and his troupe to work with employees in groups 200 strong, simply to reduce them to a state whereby 17 muscles contort around their mouths, their eyes are reduced to slits and they emit a series of short vowel-like notes, each about 75 milliseconds long and repeated at regular intervals, 210 milliseconds apart.

“A merry heart doeth good like a medicine but a broken spirit dries the bone,” runs the proverb. But a wealth of recent research has shown that merriment and medicine are more closely aligned than we had previously assumed.

Dr Lee Berk, associate director of the centre for neuroimmunology at Loma Linda University Medical Centre, southern California, is one of the world’s leading authorities on what he calls “mirthful laughter” — “happy laughter as opposed to coping laughter or black or derogatory humour”.

His most significant research on the healing effect of laughter is in the field of psycho-neuroimmunology, which looks at the effect of the mind on the brain and the immune system.

Since 1990 Dr Berk’s laboratory has been acquiring cellular and neurochemical samples from subjects via four measures: before, during and after laughter, and the next day. They have shown that laughter increases the number of activated Tlymphocytes and the number of T-cells with helper/suppressor markers, otherwise known as happy cells, which help to prevent infection. Some of these happy cells divide and secrete in a way that regulates or helps the immune response, while others are crucial for the maintenance of immunological tolerance.

Dr Berk’s tests have also found that laughter increases a type of immune cell called natural killer, or NK, cells, which go after virally infected and tumour cells.

“The method we used to test this was to take blood samples from the experimental group before and after mirthful laughter. We put the peripheral mononuclear blood cells in test tubes with a type of tumour cell line — and we found that laughter could, in some way, modulate a significant immunological cell like NK cells.”

Dr Berk might stop short of claiming that laughter is a panacea — but it should at least be taken seriously, he says. “I’m making quantum leaps here, but many studies have shown that for women who have breast cancer, those with better NK activity have a better prognosis. The activity of NK cells can be increased as a result of laughter. And if you have a population of individuals who are exposed to the same pathogen, why is it that some get sick and some don’t? I think it’s because immune systems are at different levels. So it makes sense to keep those systems optimised — and that’s when laughter starts to make a whole lot of sense.”

Although Dr Berk’s work is gaining recognition now, it was not always thus. When he started out in the Seventies, he submitted a paper to the American College of Sports Medicine stating that exercise could be beneficial to the immune system. It was summarily rejected.

“Now, of course, it is widely accepted as fact. I see laughter in the same light — it’s real biology.” And the biology is compelling. Over the past ten years, Dr Berk has carried out tests to show both that the immune system is optimised with the use of laughter, and that stress hormones are reduced by it. The latter could account for the IVF patients whose improved fertility was reported earlier this year. Using a professionally trained clown to make the patients laugh, scientists at the Assaf Haro-feh Medical Centre in Zerifin, Israel, found that the rate of successful pregnancies increased from 20 to 35 per cent.

“That doesn’t surprise me at all,” says Dr Berk. When he took blood samples via intravenous angiocatheters as subjects watched a pre-selected comedy video, the samples showed that levels of stress hormones decreased substantially after laughing.

“It is these stress hormones, such as cortisol, that modify progesterone levels and could affect the implantation of a foetus,” he says. “We did a similarly compelling experiment, published in The American Journal of the Medical Sciences, when we selected about 60 diabetic heart patients at high risk of a second heart attack and split them into two groups. Around 30 underwent standard cardiac rehab therapy, the other half watched a video they found funny for at least 30 minutes a day, Monday to Friday. We monitored the two groups every month over a year and we noticed substantial decreases in detrimental stress hormones in the laughter group, who ultimately needed less medication and had fewer recurrent heart attacks than the other group: 42 per cent versus 8 per cent.

“If you or I had come up with a pill that did that, we would be on our way to Sweden to collect a major prize. Yet laughter has the ability to do that.”

It works, says Dr Berk, because there is a connection between the brain, hormones, the nervous system and the immune system. “Laughter produces all kinds of things that help our immune systems. Each immune cell has a receptor which looks like a satellite dish, and when substances such as endorphins or growth hormones are plugged in, cells are told to increase activity. Adversely, if cortisol generated from distress is plugged in, activity is decreased.”

Laughter and pain relief is another area being explored. Down the road from Dr Berk, Margaret Stuber and Lonnie Zeltzer, two cancer researchers at the University of California (UCLA), head a project dubbed Rx laughter, a non-profit charity that researches and implements laughter initiatives to improve medical conditions.

One such project is looking at how laughter affects the pain levels of patients aged between 7 and 18 who are facing life-threatening illness. They have already found that the children can deal with a painful medical procedure significantly better while laughing at a comedy show, and by taking low-invasive measurements of the children’s heart rates, blood pressure and hormones, they hope to establish why.

“I think we are going to learn that exposing yourself to humour will not only change mood and stress hormones but also influence serotonin levels, which are involved in the pain control system,” says Zeltzer. “That would mean that laughter could have an effect on chronic pain over time and enhance immunoreactivity, as well as helping with depression and sleep and anxiety disorders.”

In a way, it was Cremer’s realisation that laughter had healed him that catapulted him into his chosen career. Having suffered from depression 12 years ago, he realised that his work as an improvisation comedian made him feel better physically as well as mentally, so he became a laughter coach. He sees no difference between paying to see a stand-up comedy show at the Edinburgh Fringe and attending a laughter class in your lunch break.

“There is a huge demand for laughter, and I see it as a symptom of how far Western societies have lost themselves,” he says.

“We live in an isolated world with no sense of community. As well as all the mental and physical benefits that laughter brings, it has been said to be the shortest distance between two people, and I think that this social element is one of its keys. We never laugh alone. Is it odd that we need to pay someone to encourage us to laugh? I think it’s great that we are realising the power of laughter and encouraging it, rather than sitting at home in front of the television.”

Dr Berk couldn’t agree more. “People think that the concept of getting together to laugh for no good reason is silly — but take going to the gym. Where are they all running to? Medical science needs to get serious about silliness — and the sooner it does so, the healthier we will be.”

DOCTOR, DOCTOR, HOW CAN I LEARN TO LAUGH MORE?

You can’t teach yourself a sense of humour but you can teach yourself to laugh more.