Why a laugh a day keeps the doctor—and the cardiologist and the psychiatrist—away.
Mary Desmond Pinkowish | August 2009 issue
The teacher gathers his laughter yoga students from the corners of this tiny studio on the second floor of a downtown Manhattan building. Most of us have never met and from the looks on some faces, aren’t quite sure what to expect. “Ha-ha-ha,” our laughter sensei begins, clapping along with the cadence. “Ha-ha-ha,” we respond, also clapping. “Hee-hee-hee,” he continues; we “hee-hee-hee” in obedient reply. Then we begin to meander around the room, clapping and continuing with different variations of the ha-ha-ha, hee-hee-hee chant. When we come face-to-face with someone, we have the option of patty-cake clapping with that person.
I’m a bit distracted from the intermittent comments of Sebastien Gendry, our teacher, because I’m trying to figure out some of the other students. One man is trying very hard; I think he’s participated in these workshops before. He knows the drill, but his efforts seem forced. I get the feeling that if he stopped laughing, he’d cry. I want to hug him. While I’m trying to figure him out, an older woman actually begins to cry. She regains her composure quickly, but she says all the laughter is causing other, less felicitous emotions to emerge.
Emotions? That’s the curious thing about my first exposure to laughter yoga. I’m not feeling funny. Am I supposed to? Have I failed to enter into the spirit of the proceedings? Or does laughter yoga not require the union of laughter and mirth?
Laughter yoga is a form of exercise based on the principle that you can—and probably should—laugh independently of your state of mind or mood, and that this laughter has health benefits. Its proponents are quick to explain that laughter yoga is playful, not silly, and that participants shouldn’t try to look or be funny. You don’t even have to be happy.
As Gendry writes on the website for the American School of Laughter Yoga he founded, laughteryoga.us, “Yoga is a body-mind approach to laughter, not something mind-body. The distinction is very important. … Laughter yoga invites you to ‘fake it’ until it becomes real.” In fact, Gendry, who’s the founder and director of the American School of Laughter Yoga, discourages the use of jokes and comedy routines, which make it more difficult to get ego, power struggles, conflict and judgment out of the way of plain, simple laughter. Laughter yoga’s link to more familiar forms of yoga is that the laughter is used as a form of breath work, and, like yoga, its goals are harmony and balance. Laughter yoga is the outgrowth of research on the health benefits of laughter conducted by Madan Kataria, a family physician based in Mumbai, India, who developed the technique in conjunction with his yoga-instructor wife, Madhuri, in 1995.
Perplexed by my experience with laughter yoga, I decide to try it out the next morning with a group of teenage boys in my high school writing seminar. We start the clapping and ha-ha-ha-ing. They start to wake up, startled out of their grogginess by their teacher’s early-morning idiocy. This is fun and it’s probably healthier than coffee. Is the old saw from Proverbs true? “A merry heart doeth good like a medicine, but a broken spirit drieth the bones.”
Solomon—or whoever wrote Proverbs—was clearly onto something. In the past decade or two, scientists have gathered evidence of laughter’s perks. Laughter blunts stress and pain; hearty chuckling increases levels of the “happy” brain chemicals known as endorphins. Laughter staves off black moods, which can damage heart health and increase the risk of stroke. It reduces levels of cortisol, the stress hormone that’s tied to several health problems, including deposition of fat in the abdominal area, the most dangerous place for it. Laughter can ease anxiety disorders, while the breast milk of mothers who laugh hard contains higher levels of melatonin, which can reduce the chances of eczema in newborns. Laughter may also mitigate the damaging effects of inflammation, a process linked to heart attacks, arthritis, allergies and other conditions. The progress of diabetic kidney disease may be stymied by laughter, and laughter is linked to better respiratory function in those with chronic lung disease. Best of all, you burn more calories when you laugh. (This might be a good time to let go. Go ahead—take a moment or two for a big, fake guffaw.)
“If you increase your humor quotient, it will change your life,” says Steven Sultanoff, professor of psychology in the Graduate School of Education and Psychology at Pepperdine University in Malibu, California, and an authority on the therapeutic uses of humor. “Laughter is a physical response to humor,” says Sultanoff. “Muscles contract, blood flow increases, breathing rate speeds up and circulation increases.” For most people, the alternating contraction and relaxation of muscles feels good. This is, in fact, a standard tense-release technique used in many forms of relaxation therapy—minus the laughter. Laughter even increases pain tolerance. Sultanoff says he listens to tapes of comedian Robin Williams on his way to the dentist. But is laughter just a feel-good bandage for occasional tough times?
The strongest evidence for the health benefits of laughter comes from psychiatric research. Evidence has been accumulating for years that people who suffer with chronic anxiety, anger and depression have multiple physiological problems. Anger and depression have been linked to heart disease, while gastrointestinal troubles are said to result from uncontrolled anxiety. The American Heart Association (AHA) warns people who’ve had heart attacks that depression can slow their recovery and increase their risk of future cardiac calamities. The AHA also urges its cardiologist members to get psychiatric help for heart attack patients who show signs of depression. What does this have to do with laughter? “We know that in the human condition, you cannot experience emotional distress and emotional uplift at the same time,” Sultanoff says. “When you’re experiencing mirth, you are not experiencing depression, anxiety or anger.” Mirth reduces the negative impact of anger and other distressing emotions.
Gendry, the Manhattan laughter yoga instructor largely responsible for introducing the technique in the U.S., told our class essentially the same thing: “This will not change your life. You will not be happy all the time from laughter yoga. I myself am not happy all the time. Sometimes I am disturbed or unhappy. But the laughing helps me cope with the stress.” His corporate presentations of laughter yoga, Gendry says, help employees deal with stress, increase productivity and creativity, and improve communication and teamwork.
In his late 1970s classic Anatomy of an Illness, Norman Cousins described how the Marx Brothers helped his recovery from a painful illness that was never satisfactorily diagnosed. Their movies gave him hours of pain-free sleep, and he eventually recovered. Some mainstream medicos were dismissive of Cousins, but today, approximately 20 percent of National Cancer Institute-designated treatment centers in the U.S. offer laughter or humor therapy—not because it will cure cancer, but because it helps patients cope.
Could laughter kill cancer cells, too? Mary Payne Bennett, director of the Western Kentucky University School of Nursing, has evidence that it does, at least in the test tube. She and her colleagues conducted experiments to assess the activity of natural killer cells before and after volunteers watched a so-called “humor stimulus” (in lay terms: something funny). It’s the business of natural killer, or NK, cells to kill cancer cells, among other chores. The strength of this anti-cancer response can be assessed by placing NK cells in a container with cancer cells and measuring cancer cell death after four hours.
In Bennett’s study, blood was drawn from the volunteers before they watched a funny video and again afterward. Bennett found some of her volunteers laughed out loud, while others simply looked amused during the video. Both sets of NK cells were tested against the cancer cells. Although both groups reported decreases in psychological stress, NK cells from the laughers were more active against the cancer cells after the funny video. “We can say for sure that mirthful laughter causes reductions in self-reported psychological stress, and it is also associated with decreases in the stress hormone cortisol, which is evidence of a reduction in physiological stress,” Bennett says. “Laughter is a good thing, with no major harmful side effects. This is a longstanding component of major belief systems around the world, but now we’re documenting it.”
A prevalent stereotype suggests humorless, angry people have more heart attacks than happy ones. That’s obviously grossly overstated, as most of us have known jollity-bringers who’ve dropped dead of heart attacks and sour people who’ve lived to be 100. Nonetheless, Michael Miller, director of the Center for Preventive Cardiology at the University of Maryland Medical Center in Baltimore, investigated the link between humor and heart health in 2005. Miller enrolled 300 people in his study, 150 of whom had a history of heart attacks or bypass surgery. The others, of the same age and gender, were healthy. The volunteers completed a humor survey to determine how much individuals laughed in certain situations and to assess anger and hostility. Not surprisingly, people with a history of heart disease weren’t as good as healthy people at recognizing or acknowledging humor in everyday situations. Even in positive situations, they were more likely to demonstrate anger or hostility.
Miller says mental stress is associated with damage to the endothelium, the inner lining of blood vessels. Eventually this damage encourages inflammation and plaque buildup on the endothelium, which, with the resulting arterial stiffening, can lead to a heart attack.
“Our studies found a direct effect of laughter on the endothelium, and recent studies in Athens found improvements in arterial stiffness following laughter,” Miller says. The studies, performed at Athens Medical School and Hippokration Hospital and published last May in the journal Psychosomatic Medicine, confirmed the detrimental effects of stress and beneficial effects of laughter on arterial stiffness in a group of volunteers who alternately watched upsetting and funny videos. Unlike more elastic arteries, stiff-walled arteries increase the risk of stroke and heart attack. “Laughing 15 minutes daily, or more, may be another important therapeutic lifestyle measure for maintaining vibrant heart health,” Miller says.
Other studies have given tantalizing clues about laughter’s health benefits. Evidence from Japanese investigators shows that laughing may help people with diabetes stabilize their blood sugar levels, especially the spikes that commonly occur after meals. The scientists, from the Foundation for the Advancement of International Science in Ibaraki and the Diabetes Center at Tenri Yorozu-sodansho Hospital in Nara, demonstrated that genes related to NK cells, which may also help regulate blood sugar levels, were turned on after patients with type 2 diabetes (the most common kind) watched comic videos, but not after they were compelled to listen to lectures about diabetes. Further, their post-meal blood sugar levels were much improved after the funny videos.
I call the laughter yoga phone conference line—(712) 432-3900, access code 6071292#—a service staffed by volunteers who offer their laughter-leader services for people who are unable to attend a live session. It’s Saturday morning. I’m alone in the house—no kids or husband to inhibit me. I’ll give it my all. A woman, the apparent leader, comes on the line in a minute or two and starts laughing. No introduction, no pleasantries—we just jump into it. She starts chuckling, and I follow her lead. Soon we begin to laugh really hard. I realize that my belly hurts. It could be the crunches I just did at the gym, but I don’t think so. About 10 minutes into the exercise, another voice joins the call, muttering, “Uh, hi?” We ignore her and keep laughing. Soon she’s laughing too.
I’m sitting here on the phone in front of my computer. I decide to multitask with some online shopping during this yoga laughter call. Strangely, the laughter, which has no mirth or cognitive component, has induced a state of heightened concentration or flow. I can’t shop. What size? What color? I’m laughing too hard to know, and I close the browser lest I order something two sizes and two decades wrong for me. In the past, I’ve successfully online-shopped with a crying baby on my lap and during calls with clients. But apparently, I cannot shop and laugh at the same time.
Then as abruptly as it started, the session ends. “Thank you,” the leader says. “Have a good day.” Click.
I feel good, refreshed. Will it work this afternoon during my 3 o’clock lull? I miss several other sessions during the day, and it bugs me; I really want to do this again. When I finally connect with a yoga laughter leader that evening, I’m happy even though she can only stay on the line for a few minutes. This is good stuff, and it’s free—except for the cost of ringing Iowa, where the conference call initiates.
Conventional psychological theory states that expressions of anger and sadness signal a healthy adjustment to grief, while expression of positive emotions are evidence of denial that will prolong and worsen the grieving process. In Born to Be Good: The Science of a Meaningful Life, Dacher Keltner, professor of psychology at the University of California, Berkeley, describes research that he and George Bonanno, professor of education and psychology at Columbia University in New York City, conducted to answer the question, “What allows people to adjust to life-altering traumas?” They interviewed 45 adults who had watched their spouses die six months earlier. Keltner and Bonanno wanted to determine which emotions predicted a healthy adjustment to loss in these survivors. They assessed anxiety, depression and protracted grief in the months and years following the loss. As Keltner describes in his book, he and Bonanno found the widows and widowers who smiled and laughed when they talked about their deceased spouses during the initial interviews experienced less grief six, 14 and 25 months later.
Specifically, people who displayed Duchenne laughter—the most genuine type, recognizable because it makes your eyes crinkle—when they reminisced about their spouses experienced less anxiety and depression and were more engaged in life. In contrast, people who expressed angrier emotions continued to experience more anxiety and depression and had more difficulty getting back into their daily rhythms. Keltner and Bonanno were able to rule out financial difficulties, the suddenness of death and pre-existing anger and personality problems as causes for the differences between the groups.
Keltner and Bonanno also checked for a correlation with elevated heart rates, a sign of emotional arousal, in their grieving subjects during interviews about their dead spouses. Both laughers and non-laughers had higher heart rates. The non-laughers, though, also displayed increased emotional distress, while the laughers’ heart rate elevations weren’t linked to emotional distress. This led Keltner and Bonanno to conclude that laughter gave these people a brief “vacation” from mourning, helping them separate the emotional and physiological components of grief. “What it’s telling us,” says Keltner, “is that laughter is this little trap door that allows you to escape from the toxic stress.”
Laughter is clearly a complicated business—one shouldn’t try to be funny during a laughter yoga session, but laughing about one’s dead spouse seems to be good for you. Is laughter in the absence of something funny the same as laughter triggered by something amusing?
“It’s hard to separate laughter from the other two therapeutic areas linked to humor—mirth and the cognitive response to mirth,” says Pepperdine University’s Sultanoff, past president of the Association for Applied and Therapeutic Humor. “Humor also stimulates mirth, which is the emotional response to a humorous stimulus. If you hear a joke, you feel joy and pleasure on the inside. It’s an emotional experience as opposed to a physical one.” It’s possible, he says, to laugh without mirth and feel mirth without laughing. In addition, humor includes a cognitive response, which Sultanoff calls wit. “It may not make you laugh out loud or feel tickled,” he says, “but you ‘get it’ intellectually.”
Comedian Chris Rock has a routine that goes something like this: “Marriage is tough. It’s so tough that even Nelson Mandela got a divorce. He survived 27 years in a South African prison enduring beatings, torture and hard labor in the hot sun. Twenty-seven years. He comes home, spends six months with his wife and he gets a divorce. Marriage is tough.”
If this makes you giggle—or smile ruefully—you’ve gotten the cognitive component to humor. The funniness lies in what this story says about marriage. This kind of wit may be the source of much of the psychological benefit of humor. “Humor triggers wit, and wit shifts belief systems and thinking patterns and prompts changes in attitude,” says Sultanoff.
Our son, a 20-year-old computer science major, has left for a 12-week internship that has taken him 3,000 miles from home. We miss him very much. Sitting gloomily at breakfast one morning the week after his departure, I see a cartoon by Mike Luckovich. On one panel, an astronaut with a laptop is spacewalking near the Hubble Space Telescope, saying “Installed new software. Still can’t get it to upload photos onto computer. Please advise.” In the next panel, a young kid is sitting at home at his computer, speaking into his cell phone: “C’mon, Dad. It’s simple.”
I push the page across to my husband. We look at each other and laugh. Sultanoff would say laughter shifted my perspective. It occurs to me that he’s incredibly lucky to have landed this internship—especially now, when jobs are scarce. Also, I make a smug mental note that he’s much better looking than the kid in the cartoon. I’m not as sad as I was when I started breakfast, and it’s the beginning of an upward trend.
Some of the upside derived from the cognitive aspects of humor may relate to the pleasure of sharing wit with others, as I shared the cartoon with my husband. “It’s an added benefit,” says Sultanoff. “My original experience with the cartoon is reactivated in my memory and also in the pleasure of connecting with you.” The cartoon wouldn’t have been half as funny if my husband hadn’t been there to share it.
Not everyone is convinced of laughter’s advantages. “There is no scientific evidence that laughter has health benefits,” says biological psychiatrist Ilona Papousek of Karl-Franzens University in Graz, Austria. Papousek does, however, endorse a sunny attitude toward life. “Cheerfulness as a stable personality characteristic and a positive, serene attitude to life can have health benefits,” she says. “Studies have demonstrated this for the prevention of cardiovascular disorders and longer independence later in life.” In fact, Papousek says cheerfulness and a positive attitude are as protective against cardiovascular disorders as controlling body weight, quitting smoking and getting more exercise.
Keltner, of the University of California, Berkeley, may be able to bridge this apparent gap between cheerfulness and laughter with his work on smiles and smiling. As part of a larger project on the lives of women, he found correlations between the absence or presence of Duchenne smiles in the yearbook photos of 110 women who graduated from Mills College in Oakland, California, in 1959 and 1960 and the subsequent course of their lives over the next 30 years. Compared to women with non-Duchenne smiles, those who displayed this warm, inviting grin were less likely to report anxiety, fear, despair, sadness and pain during the entire 30-year period. Keltner postulates that smiling effects “stress-related cardiovascular arousal.” Further, he says warm smiles promote trust and intimacy with others—another positive health trait.
Sometimes shifting the balance is easier than you’d think. Sultanoff tells the story of a depressed patient who was dedicated to her distress, although she constantly affirmed her desire to get better. Several years into therapy, Sultanoff started some mild teasing during sessions. The patient asked him to stop, but Sultanoff repeated this for several weeks over her continued protest. Then one day, she arrived for a session and announced, “This humor thing really works.” She said that after their last session, she’d rented a Woody Allen movie and felt much better when it was over. The woman still struggles with depression periodically, but she recently told Sultanoff that only her own religious beliefs and practices were more significant to her than her use of humor. People with severe anxiety problems “are more often willing to integrate humor in their therapy and lives, because it gives them an immediate benefit,” Sultanoff says.
It’s 3 o’clock in the morning. I’m awake and worrying about several things, not the least of which is the deadline for this article. I must stop ruminating and get back to sleep. I wonder about one last thing: Is it true that smiling can change a person’s mood? I’ll try. I’ll stop tossing and start smiling in the dark. A huge grin. I sleep.
Mary Desmond Pinkowish exhorts you not to call the laughter yoga phone line while you’re driving—or shopping.