Laughter is an effective remedy for these trying times
PANDEMIC PROMPTS DOCTORS TO INTEGRATE HUMOUR INTO MAINSTREAM MEDICAL PRACTICE
Some enlightened doctors, nurses and therapists have a prescription for helping all of us to get through this seemingly never- ending pandemic: Try a little laughter. Humour is not just a distraction from the grim reality of the crisis, said Dr. Michael Miller, a cardiologist at the University of Maryland School of Medicine in Baltimore. It’s a winning strategy to stay healthy in the face of it.
“Heightened stress magnifies the risk of cardiovascular events, including heart attacks and strokes,” Miller said. “Having a good sense of humour is an excellent way to relieve stress and anxiety and bring back a sense of normalcy during these turbulent times.”
Laughter releases nitric oxide, a chemical that relaxes blood vessels, reduces blood pressure and decreases clotting, Miller said. An epidemiological study of older men andwomen in Japan confirmed that those who tend to laugh more have a lower risk of major cardiovascular illness. Possessing a healthy sense of humour is also associated with living longer, an epidemiological study from Norway reported.
Jest a while
Armedwith this growing body of research, Miller prescribes “one good belly laugh a day” for his patients. It’s not just going “ha, ha,” he explained, but a “deep physiological laugh that elicits tears of joys and relaxation.”
While the long- term impacts of such a practice remain unknown, Sophie Scott, a neuroscientist at University College London, said that laughter has been shown to reduce the stress hormones cortisol and adrenaline and increases the body’s uptake of the feel- good endorphins.
There also appear to be cognitive benefits. Watching a funny video was tied to improvements in short- term memory in older adults and increased their capacity to learn, research conducted by Dr. Gurinder Singh Bains of Loma Linda University found.
Perhaps most relevant today, possessing a sense of humour also helps people remain resilient in the face of adverse circumstances, said George Bonanno, a professor of clinical psychology at Columbia University.
In one study, Bonanno interviewed young women who had been sexually abused and noted their facial expressions. “Thosewho managed to laugh or smile at moments during their interviewwere more likely to be doing better two years later than those who had not,” he said. “Humour keeps negative emotions in check and gives us a different perspective, allowing us to see some of the bad things that happen to us as a challenge rather than a threat.”
Humour and tragedy may be more intimately connected than onewould think.
“Charlie Chaplin once said ‘ In order to truly laugh you need to be able to take your pain and playwithit,’” saidPaul Osincup, thepresident of the Association for Applied and Therapeutic Humour. “Write down all of the most difficult and annoying things about quarantine,” Osincup recommends. “Play with those. See if you can find any humour in your situation.”
Halloween skeleton
Megan Werner, a psychotherapist in private practice, uses a similar strategy in her work with at- risk youth in Fayetteville, Arkansas. During group therapy sessions, she has the teenage gang members she works with interact with “Irwin,” a life- size Halloween skeleton, to encourage them to confront their dangerous lifestyle head- on. “Most of the time you try to deflate a painful situation,” she said. “Inmy therapywork, it’s more like ‘ let’s blow it up, let’smake it so absurd that we laugh about it.’ This releases anxiety, and we’re able to approach the topics that weren’t approachable initially.” Increasingly humour is being integrated into mainstream medical practice with a similar goal, said Dr. Kari Phillips, a resident physician at the Mayo Clinic in Rochester, Minnesota.
Softening the impact
Phillips observed over 100 clinical encounters and discovered that humour surfaces about twice during a half- hour doctor visit. It is initiated in equal measure by doctors and patients, often to break the ice between them or to help to soften the impact of a difficultmedical conversation. “We found that introducing humour results in better patient satisfaction,” she said. Dr. Peter Viccellio, a professor of emergency medicine at Stony Brook University Hospital on Long Island, has seen many Covid- 19 patients. A touch of playfulness and kindly humour, he said, has helped to ease an enormously painful situation for both his patients andmembers of the overburdened hospital staff.
“If you are empathetic with the person, your humour tends to fit them, it’s not forced. If you are not emotionally connected to them and force a joke it can go verywrong,” he said.
A case in point: “A colleague of mine once said casually to a patient whose medical history he did not know, ‘ Don’tworry about it, at least it’s not cancer,’” Viccellio recalled. “The patient replied, ‘ Actually, Doc, it is.’”
Other kinds of joking that are potentially destructive, he said, are the in- group humour that mocks patients ormembers of the hospital staff.
Programmes in hospitals
Laughter releases nitric oxide, a chemical that relaxes blood vessels, reduces blood pressure and decreases clotting.”
Despite these potential pitfalls, some hospitals have initiated formal humour programmes, making funny books and videos available and inviting clowns in to interact with patients.
Mary Laskin, a nurse case- manager at Kaiser Permanente in San Diego, has been working with chronic pain patients online, teaching themlaughter exercises alongside practices designed to develop positivemental states like gratitude and forgiveness.
“This pandemic is like a tiger creeping toward us, a huge slow- motion stressor that makes the experience of pain worse. Humour helps my patients relax and release their grip on pain,” she said.
Humour can also serve to powerfully reaffirm one’s humanity in the face of illness or disability, said Dr BJ Miller, a palliative care physician in San Francisco who suffered a freak electrical accident in 1990 that cost him two legs and an arm.
After the accident, he said, most people — including medical staff members — viewed him as an object of pity. “There is a solemnity in how people look at you,” he said. “You are essentially walled off from others, they stop treating you as a source of humour.”
The one exception, he recalled, were the men who scrubbed off his burned skin in the hospital. “It’s a terrible job, Imean you are inflicting reams of pain on someone to save their life,” Miller said. “But this ragtag crew, they were freaking hilarious. They were cracking jokes the whole time.”
“It mademe stronger because theywere looking atme and saying this guy can handle the pain and he can also handle a joke — it made me feel like a human being again.”
Dr Michael Miller | Cardiologist