Laughter

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Tonight, I watched television news.   Gloom and doom, anger, frustration and layers of judgement.   Where was the good news?  Where was laughter and joy?  The spring cherry blossom, a philanthropic donation, or a free art exhibit?  Downplayed for sure, nothing much to make me laugh.
 
It made me ask the question “is laughter the best medicine?” I looked into it.
 
Laughter is defined as the sound of mirthfulness, an expression of merriment or amusement.  It has several synonyms, including chuckle, giggle, snicker and guffaw.
 
Laughter as a drug is an interesting concept.   It doesn’t come as a liquid, pill, injection or vape.  It can originate from a circumstance, the written or spoken word.   Certain specialists prescribe laughter (comedians), and almost no one objects to it (maybe funeral parlour directors and high court judges).   It can be contagious, but nothing we vaccinate against.  It is usually free, and does not respect race/religious/sexual boundaries. In fact, these boundaries are often flash points from which laughter originates (stand-up comedy).
 
Robinson et al (1) highlight the benefits of laughter on the immune system, pain axis and stress response.  More commonly observed in children, it can have benefits long into adulthood. In addition to physical benefits, it can defuse conflict, enhance teamwork and promote group bonding. Creating opportunities to laugh include ‘seeking out funny people, share a joke, make time for fun activities and play with a pet’.  And don’t take yourself too seriously!
 
Now, when the Mayo Clinic weight in, you have to take it seriously. (2) “It’s just what the doctor ordered” (or didn’t).  Sure, it stimulates vascular health and releases endorphins, but do we actually prescribe it?   Maybe we need to rethink prescription pads: one for exercise, one for diet, one for pills, and one…  with a joke on it.

 
Seriously, given the epidemic levels of stress, isolation and anxiety we see in our elderly population, it may well be that a red nose and a funny hat could do more for our patients than the latest biologic agent, or heart failure drug.  A squawk from a rubber duck might dent my patient’s confidence, but I have yet to regret making a patient smile with a little humour now and then.  I am no Patch Adams.  But I usually tell them the main risk factor for heart disease is ‘age-over-60: that’s when the warranty runs out.’  It works both ways.  I used to look after a very elderly priest who treated episodic dyspnoea with a small cylinder of sports-oxygen (i.e. acute heart failure).   Eventually, he gave the device to me - citing avoidance-of-destiny, for him, might be a conflict of interest.  Ha, Ha!
 
Of course, I have to mention ‘laughing gas’, first popularised by Humphrey Davy in 1799: Laughing Gas Parties were all the rage in the UK and US.  In 1844, the American dentist Horace Wells noted that a participant (Samuel Cooley) was covered with bruises the next day (from falling over), without feeling any pain. Wells used nitrous oxide to good effect when extracting a tooth from John Riggs, but it was not very effective for surgical anaesthesia, especially in obese alcoholics. When a previous dental associate, Dr William Morton, tried ether instead - the practice of Anaesthesia was born (1846).(5) 
 
There are times when laughter may be inappropriate:
At the roadside.  “Well, officer, I thought a speed zone meant something altogether different…. Ha ha!”
At the graveside.  “Uncle Mario had a good life, he was a fair-and-honest cryptocurrency banker in Miami….. giggle, giggle, ha, ha!”
In the ER. “Yes, looks like acute renal failure to me!  Ha, ha!”
In court.  “So, your honor, just 4-months in prison for my break-and-enter?  Ha, ha!”
On the phone with the taxman.  “You’ll never find my retirement stash!  Ha, ha!”
 
David DiSalvo (3) emphasises the potent endorphin release properties of laughter (‘homegrown feel-good chemicals), mimicking the euphoria one sees with narcotics.  Social bonding, increased brain-region connectivity, strengthening of conjugal relationships, and short-term neurotransmitter release (c.f. antidepressants) add to the known cardiovascular and anti-inflammatory benefits.  
 
Let me ask the obvious question: “are humour and positivity taught in medical school, and has a randomised controlled study showing proven benefit?”  The answer is YES (4) - at least in China, where 87% of student and teacher respondents agreed with the use of humour in the didactic setting.  Presumably, the 13% who said ‘no’ became pathologists.  
 
I have to agree with one instruction, ‘don’t dwell on the negative.’ But how do I avoid negative interactions when everyday people bring me their problems and complaints?  Well, I sure do celebrate success, a balancing measure in any medical practice.
 
Some people might not have the gift – but we all have a ‘funny bone’ somewhere…  Funny and happy people are remembered, miserable and serious ones are not.  So, make someone smile today…. Ha, ha!
 
References:

Laughter is the best medicine
Robinson et al, HelpGuide.org 28Feb2023
https://www.helpguide.org/articles/mental-health/laughter-is-the-best-medicine.htm
 
Stress relief from laughter? Its no joke.
Mayo Clinic July 2021
https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth-stress-relief/art-20044456

Six Science-Based Reasons Why Laughter Is The Best Medicine
DiSalvo, D
Forbes June 2017 
https://www.forbes.com/sites/daviddisalvo/2017/06/05/six-science-based-reasons-why-laughter-is-the-best-medicine/?sh=4e61465d7f04

Use of humour in medical education: a survey of students and teachers at a medical school in China                                                                                                       
Yan-Ping Liu et al
BMJ Open. 2017; 7(11): e018853.
Published online 2017 Nov 28.
doi: 10.1136/bmjopen-2017-018853
 
Further reading:
The laughing gas parties of the 1700s – and how they sparked a medical breakthrough
ABC News 19Feb2019
https://www.abc.net.au/news/2019-02-20/laughing-gas-parties-discovery-of-anaesthesia/10811060