Humoring the Sick
Article published by the Raleigh News and Observer
10/15/98
Staff Photo By Scott Sharpe
Nola Nurse, R.N. (for 'Really Nutty'), a k a Mona Webb, spreads a little humor at Rex Hospital as she checks for a pulse on cardiac patient Sharon Chavis.
Patients, doctors and health-care professionals are all finding that laughter may indeed be the best medicine.
By JOYCE CLARK HICKS, Staff Writer
When Cindy Brown Bair found out that she had breast cancer, the diagnosis hit her like a ton of bricks. First, she was speechless. Then she cried for two days. Finally, on the third day, she did something that took her friends, family and even her doctors by surprise.
"I laughed," says Bair. "I found myself laughing in doctors' offices -- actually in doctors' faces -- and in waiting rooms." When doctors laid out her treatment options -- chemotherapy, radiation, surgery -- she laughed again.
"I just found it absurd," says Bair, a 37-year-old Cary resident. "It's like they said, 'I'm so sorry that you're sick. Let me cut a piece out of you and make you feel better.' " She felt she had two options:"To be terrified and submit to the terror or to find the absurdity and laugh at it."
She chose to laugh. A lot. It's one of the things she credits most in getting her through the grueling chemotherapy and side effects. Not only did Bair find that it boosted her self-esteem and morale, she says it made her feel better. Fifteen months since her diagnosis, Bair's cancer is in remission.
Bair's story comes as no surprise to researchers such as Dr. Lee Berk of Loma Linda University in California. For years he and fellow researcher Dr. Stanley Tan have been studying the effects of laughter on the immune system. To date their published studies have shown that laughing lowers blood pressure, reduces stress hormones, increases muscle flexion, and boosts immune function by raising levels of infection-fighting T-cells, disease-fighting proteins called Gamma-interferon and B-cells, which produce disease-destroying antibodies. Laughter also triggers the release of endorphins, the body's natural painkillers, and produces a general sense of well-being.
One of the best-known success stories in humor therapy occurred in 1964, when Norman Cousins, then editor of The Saturday Review, laughed his way out of an acute case of ankylosing spondylitis, a degenerative inflammatory disease. Cousins later documented his story in a book he called "Anatomy Of an Illness."
Today, interest in humor's effects has grown so much that the field has a name -- psychoneuroimmunology, the study of how psychological factors, the brain and the immune system interact to influence health.
"If you took what we now know about the capability of laughter to manipulate the immune system, and bottled it, it would need FDA approval,"Berk says.
Staff Photo By Scott Sharpe
Dr. I. Fixem, a k a Lin Webb, has a special badge. Nola Nurse and Dr. I. Fixem are familiar figures in the halls of Rex Hospital.
Which is not to say that laughter is a panacea. The idea, he says, is that the positive emotions laughter brings can enhance -- not replace -- conventional treatments. "It's part of the arsenal helping you fight the disease," he says. "You bring your own apothecary -- your own chemical pharmacy -- to the table."
When used as an adjunct to conventional care, Berk and Tan believe that laughter can reduce pain and aid the healing process. For one thing, laughter offers a powerful distraction from pain.
In a study published in the Journal of Holistic Nursing, patients were told one-liners after surgery and before painful medication was administered. Those exposed to humor perceived less pain when compared to patients who didn't get a dose of humor as part of their therapy.
Furthermore, Berk adds, laughter is free and has no negative side effects.
The Universal Language
Laughter is infectious. As word of the possible link between humor and healing has spread, hospitals around the country have begun incorporating formal and informal laughter therapy programs into their therapeutic regimens. In countries such as India, laughing clubs -- in which participants gather in the early morning for the sole purpose of laughing -- are becoming as popular as Rotary Clubs in the United States.
The subject has become the focus of numerous workshops and seminars in health care and the workplace. On Nov. 7, a seminar at the Center for Creative Self-Discovery in Durham offers volunteers an opportunity to become certified humor therapists. On Nov. 10, the Albert Schweitzer Fellows will sponsor a symposium on humor and healing at the Center for Documentary Studies in Durham.
"Humor is a universal language," says Ruth Hamilton, a certified humor therapist and executive director of the Carolina Humor and Healing Association (a k a Carolina Ha Ha). "It's a contagious emotion and a natural diversion. It brings other people in and breaks down barriers." When everything else in life is awry, "humor is the one thing we can have control over."
In 1986, Hamilton and Dr. David Kleinbaum, then an epidemiologist at the University of North Carolina at Chapel Hill Hospitals, teamed up with Duke Oncology Recreational Therapy to set up the Duke Humor Project. They designed a Laugh Mobile, a roving cart equipped with books, tapes, games, videos and humor props such as rubber chickens, yo-yos, water guns and zany glasses that they would wheel into cancer patients' rooms. Then, after interviewing patients about their humor preferences, Hamilton devises a humor prescription: read an uplifting book, watch funny videos, blow bubbles or do smile push-ups. The Laugh Mobile still makes rounds.
Hamilton recalls one patient who would ask the nurses to delay her pain medication until she had her humor therapy treatment. When the woman's head began itching incessantly, Hamilton suggested that the woman make goofy faces and scratch her head in an exaggerated form like a wild gorilla. When Hamilton returned a half-hour later, the patient was laughing and reported that her head no longer itched.
"I don't know of anything else that has the same effect," says Hamilton. "Sometimes the patients get tears in their eyes. It opens them to all kinds of emotions."
Spreading the Laughter
Recently, hospitals all over the country have followed suit with Hamilton's Laugh Mobiles and other "humor intervention" programs popping up in medical centers in Phoenix, San Diego, Philadelphia, Dallas and Brooklyn as well as Greensboro, Wilmington and Fayetteville. Rex Hospital in Raleigh has volunteer clowns who go around in wacky uniforms to spread cheer on the cancer, heart and pulmonary wards.
Staff Photo by Keith Greene
At Duke Hospital, humor therapist Ruth Hamilton prepares for rounds with the 'Laugh Mobile.'
"When someone is laughing, negative emotions are put in the background so that people are able to experience happier emotions," says Hamilton, 52.
Janet Entine sure does. For more than six weeks, Entine has been confined to a hospital room at Duke while recovering from intensive chemotherapy treatments for leukemia. A former nurse from Cary who once traveled the state attending stress-reduction seminars in her free time, Entine knows all about the therapeutic effects of humor.
"I absolutely have always believed that good humor is essential," says Entine, who on this day has stepped out into the hallway for her biweekly humor checkup. Meeting her, it's easy to see the physical toll the treatments have taken. She has a slight cough, her head is bald, and after weeks in bed or propped up in a chair, her gait is unsteady. But her spirits remain high.
"It really does a lot for the psyche," Entine says as Hamilton plasters her with a sticker that says "URAQT" and passes a giant pair of plastic red scissors in front of her while asking what she would like to cut out of her life. "Cancer cells," Entine replies, grabbing a water pistol and squirting one of the nurses.
"It's been a long haul," Entine says. "Surely humor is important for all patients. But when you are just here and here and here, it really helps."
Down the hall, melanoma patient Bruce Wells, 69, is awaiting his "humor tune-up." Hamilton begins the session by dusting the stress off of his body with a feather duster. Then she hands him a rubber "Mr. Chicken" to whom he quips: "What happened to your feathers?" The chicken doesn't answer, so Wells scavenges the cart for another gadget and emerges with a pair of furry-browed eyeglasses and a yo-yo. "I can walk the dog and everything else," he says, swinging the stringed oval into all sorts of motions.
After days of being cooped up in his room for treatments, it's clear that he welcomes the diversion of the Laugh Mobile. "This is really nice," he tells Hamilton and volunteer Wendy Harp. "People on this hall don't feel good, and they're run down, and there is just no laughter. But this really helps to give you a little pick-me-up if people are willing to get involved."
Not everyone is, says Hamilton. And that's OK.
"If people don't want to laugh, we certainly don't force them to," she says. "We are there to support their sense of humor. And they know we can always come back if they want us to."
You don't have to be sick to benefit from laughter. Hamilton also gives humor and stress-relief seminars in the workplace.
"Most everybody has got a sense of humor," she says, noting that she recently hauled a humor first aid kit into a marketing conference for executives at Nortel. She says the use of humor in the workplace helps to build morale, reduce stress, increase creativity and process information better.
The great thing about humor, she says, is that "you can only be young once, but you can be immature indefinitely."
Laughing All the Way
Humor increases the body's flow of beneficial compounds, many of them with disease-preventing properties. Here is a summary of what some studies on laughter have shown:
Laughing is aerobic, providing a workout for the diaphragm and increasing the body's ability to use oxygen.
Laughter raises immunity to infection by instantly increasing a flood of disease fighting cells and proteins into the blood.
Brain wave activity changes when we catch the punch line of a joke.
Frequent laughter helps control pain, lower blood pressure and relieve stress.
If you are interested in learning more about the positive effects of humor or are interested in becoming a certified humor presenter, you may want to consider attending:
"Finding the Funny Side of Life," a seminar aimed at exploring and teaching humor techniques. The seminar will be Nov. 6-7 at the Center for Creative Self-Discovery in Durham. Interested participants can also learn about becoming certified humor presenters, as well as receive information about volunteering for Duke University Medical Center's Laugh Mobile program. To register, call 846-5739.
Humor and Healing Symposium will be held Nov. 10 from 6 to 8:30 p.m. at the Center for Documentary Studies in Durham. The dinner and program are free, but seating is limited. For more information call 933-1739.
Resources
Carolina Health and Humor Association (Carolina Ha Ha): 846-5739.
American Association for Therapeutic Humor:(314) 863-6232.
© The News & Observer
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