Ha! (23 page)

It was about this time that Cousins decided that, instead of trusting the doctors, he would laugh.

First, he left the depressing surroundings of the hospital and checked into a hotel, which was not only more cheerful but cost only a third as much. Then he got to thinking: What could he do to help himself? Since traditional medicine wasn't going to cure him, what other approaches could he take? It was then that Cousins began to consider the effect of stress on medical recovery. Stress likely contributed to his illness, as well as hindered his treatment, so it seemed reasonable to question whether the effect worked in both directions. “If negative emotions produce negative chemical changes in the body, wouldn't the positive emotions produce positive chemical changes?” he asked. “Is it possible that love, hope, faith, laughter, confidence, and the will to live have therapeutic value? Do chemical changes occur only on the downside?”

One way to find out was to put himself in a good mood—and to do that, Cousins began a systematic plan for laughing. He started with films of the old practical-joke program
Candid Camera
(similar to
Punk'd,
but without Ashton Kutcher). This wasn't easy, since DVDs and Blu-rays hadn't yet been invented and the only way to watch these shows was to use a motion-picture projector. But he was able to borrow one from a friend, along with several Marx Brothers films, and anything that made him laugh became part of his treatment.

Cousins watched the films regularly, every day, and despite being in pain he discovered that he was still able to laugh. Not only that, but
the laughter was more effective in combating the pain than aspirin or any of his other analgesics. “Ten minutes of genuine belly laughter . . . would give me at least two hours of pain-free sleep,” he wrote.

Amazingly, after a little over a week of rest and laughing, Cousins was able to move his thumbs again, something his doctors previously thought impossible. After several months, he could grab books from atop bookshelves, and as more time passed he even hit tennis balls and played some golf. His disease hadn't disappeared—one shoulder and both knees were still causing him occasional trouble—but given his initial prognosis, his recovery was incredible. Cousins went on to live twenty-six more years.

Cousins's recovery was uplifting and positive, yet also rather troubling. His rejection of doctors, hospitals, and the newest drugs in favor of a more holistic approach probably saved his life. But if you were in the same situation, would you have had the strength to make the same choice?

We've all seen medical “cures” that are far from scientific. However, while it's easy to blame modern medicine for being impersonal, it's wrong to think of doctors as closed-minded people. It's the rare doctor who wouldn't do anything humanly possible to help a patient. Alternative-medicine approaches, such as laughing, are alternative for a reason—they have yet to be proven as beneficial. They haven't been ignored. Quite the opposite, as we'll see in this chapter, laughter as a medical treatment has been studied quite extensively. Doctors just don't prescribe it to their patients for the same reason they don't recommend other alternative medicines, such as acupuncture or large doses of vitamin C. Research results have been mixed.

This chapter takes a holistic view of humor and its effects on the human body. So far we've seen that our brains use conflict like our muscles use oxygen, or cars use gasoline. Humor empowers us to make decisions and take pleasure in a complex world. But the benefits don't end there. Humor is also a form of exercise, keeping our minds healthy the same way that physical exertion helps our bodies. But like
jogging in a smog-filled tunnel, humor used improperly can do more harm than good.

T
HE
D
OCTOR
I
NSIDE

“Each patient carries his own doctor inside him.”

This is the claim that best describes Cousins's philosophy, one taken directly from his book,
Anatomy of an Illness.
In his recounting, Cousins describes both his laughing treatment and the responses he received from doctors, relatives, and friends after they heard news of his recovery. Everybody seemed to have an opinion about what had caused his ankylosing spondylitis to remit. Some thought Cousins had simply willed the disease away through positive thinking. Others argued that his recovery was an anomaly—one that randomly occurs in only one in a million patients and shouldn't be interpreted as a blueprint for future success. Still others simply congratulated Cousins for having the courage to control his own medical destiny.

At one point in his book Cousins equates laughter with internal jogging—a great analogy. We know that laughter benefits the body because it's an aerobic exercise. Highly controlled measurements have shown that laughter expends between 40 and 170 kilocalories per hour. Lots of work had equated that to other forms of exercise, with the most common being that a hundred laughs are roughly equivalent to ten to fifteen minutes on an exercise bike. How you measure number of laughs I have no idea, but it still sounds like a good time to me.

One way jogging improves our health is by pushing our hearts to work harder, and laughter relies on the same mechanism. As researchers have shown, both systolic and diastolic blood pressure rise during exercise. The same thing happens during laughter. Sometimes these changes last no longer than a single heart beat, and sometimes they last much longer, but that elevation is critical because the more we work our heart, the lower our resting blood pressure—and the less our hearts have to work the rest of the time.

This benefit can be long lasting, too. Two measures of blood flow—carotid arterial compliance and brachial artery flow mediated dilation—can remain elevated for up to twenty-four hours after viewing a laughter-inducing comedy.

One scientist who knows a lot about the benefits of laughter is Michael Miller from the University of Maryland. His specialty is vasodilation, which refers to the widening of blood vessels. The reason elevated blood pressure during exercise is healthy is that it helps our blood vessels stay flexible. Healthy vessels relax or constrict depending on our level of activity, but unhealthy ones remain stiff and tight, restricting blood flow at the times when we most need it.

Two of the greatest threats to our health are vasoconstriction and reduced vasoreactivity. Often caused by stress, these conditions lead to narrower blood vessels, reduced blood flow, and a decreased ability to vary the amount of blood delivered throughout the body. In many people they also lead to coronary disease and stroke. Doctors recommend frequent exercise because aerobic activity loosens up the blood vessels, making them more pliable. And so does laughter, according to Michael Miller, who presented his findings on vasoreactivity to the American College of Cardiology in 2005. Specifically, laughter decreases stiffness and increases vascular reactivity, thereby increasing blood flow to the areas of the body that need it.

Miller's study examined twenty men and women, all with roughly the same level of heart health when the study began. Subjects watched the opening scene of either a stressful movie such as
Saving Private Ryan
or a comedy such as
Kingpin.
Before and after each movie, measures of vasodilation were taken, assessed by tightening and then releasing a blood pressure cuff on the arm. By aiming ultrasound devices at subjects' arteries, Miller also measured how well the arteries “rebounded” after the cuff's constriction, thereby letting him know how flexible or unresponsive they were. He expected the stressful movie to lead to less responsive blood flow, as had been seen in numerous previous studies. The question was whether humor would have the opposite effect, and low long it might last.

Miller found that fourteen of the twenty subjects experienced reduced artery size following the stressful viewing, leading to reduced blood flow. Even more impressive, however, was the change seen in the humor-watching group. Among those subjects, all but one showed
increased
artery size, with an improvement in blood flow of more than 20 percent. This change lasted long after the movies concluded.

It has always fascinated me that our bodies don't get stronger through rest but by exertion. Muscles increase in mass first by breaking down, then rebuilding. Blood flow is improved when blood pressure is first increased through exercise, then allowed to return to a lower state, the blood vessels more relaxed than if they hadn't been worked. Laughter has the same effect, and that makes us stronger and more capable of dealing with challenges later on.

Our hearts aren't the only things benefited by laughter, either. Research shows that laughter suppresses glucose levels in diabetics, helping to prevent diabetic neuropathy. It also improves immune system function, reduces chemicals associated with joint swelling in arthritis patients, and even helps allergy sufferers combat dermatitis. In short, the mirth associated with laughter leads to positive physiological changes throughout the body.

A big challenge for psychologists and doctors is identifying how cognitive states, like mirth, lead to physical changes in the body. We know, for instance, that exercise puts us in a good mood because it leads to the release of dopamine, which gives us pleasure. That's a physical act leading to psychological change. But does cause and effect work in both directions? Can improved state of mind lead to physiological change?

Fortunately, it can. Consider, for example, immunoglobulin A. This antibody is one of our immune system's first lines of defense against invading organisms such as bacteria, viruses, and even cancer cells. Though our bodies produce several different kinds of such antibodies, they all work the same way—first, by identifying and targeting the foreign body and, then, by either neutralizing it or tagging it for attack by other defense mechanisms. Studies show that watching funny movies and listening to stand-up comedy significantly increase
immunoglobulatory response—and so does being in a humorous mood. A similar effect has also been associated with natural killer cells, which, in addition to having a very impressive name, help stave off diseases like cancer and HIV. Watching movies like
Bill Cosby: Himself
or
Robin Williams, Live at the Met
has been shown to increase killer cell counts by up to 60 percent.

By now, you might think that laughter is the best thing you could do for your body. It improves cardiovascular health, boosts immune response, and even activates cells that attack invaders like teams of highly trained Navy Seals. For Norman Cousins, it helped overcome the rheumatic disease ankylosing spondylitis. If humor does all these things, what's to keep us from laughing our way to immortality?

It's a good question. And the answer is—humor doesn't actually help us live any longer. In fact, it does just the reverse.

I was surprised when I first learned this interesting fact, and you probably are too, given the findings discussed above. Laughter certainly has its benefits, but these don't necessarily ensure a longer life. It's a disappointing fact, but it's important to recognize because laughing isn't a panacea. It's an activity much like jogging or jumping rope. Used responsibly in the right circumstances, it can be a great protector. But if used without good judgment it can be as dangerous as running a marathon barefoot.

Let's look at two studies to see why. The first involved nearly the entire population of the Norwegian city of Nord-Trøndelag—more than sixty-five thousand people in all—agreeing to take three tests in the name of science. One measured their sense of humor, with questions like “Do you consider yourself to be a mirthful person?” A second test assessed their bodily complaints. Essentially a psychological survey of health, it asked respondents questions about common complaints such as heartburn, nausea, even constipation, rating the frequency of each on a three-point scale. The third test involved a blood pressure reading and a measurement of body mass index.

As expected, the researchers found a significant relationship between overall health satisfaction and sense of humor. It wasn't huge,
only a correlation of 0.12, but it was positive, suggesting that the more subjects appreciated humor, the happier they were about their health. However, sense of humor had no benefit on actual measures of health such as blood pressure or weight. Though older individuals tended to have higher blood pressure and reduced sense of humor, when the factor of age was controlled, humor showed no relationship with heart health.

That's a disappointing finding, of course, but there's a lot more to health than blood pressure. Perhaps the important question isn't how much humor helps our bodies but how much longer it allows us to live. Longevity is really the best measure of health, so shouldn't we measure that?

I believe we should, and that's why I also present this study by psychologist Howard Friedman of the University of California at Riverside. It took over sixty years to conduct because Friedman didn't just give people surveys or blood pressure readings. Instead he enlisted more than fifteen hundred children, all roughly eleven years of age when the study began in 1921, and waited for them to die. Actually, that's a rather morbid description, because his true goal was to follow these middle-class schoolchildren over the course of their lives to monitor changes in their health. He wanted to see if there were any connections between their personality traits and their longevity, and also if this longitudinal approach could uncover relationships that weren't observable using simple physiological measures. Fortunately, though some children disappeared over the years, more than 90 percent of his sample checked in with him regularly throughout the years.