Laughter as Medicine: Benefits and Effects on Health

1. Gelotology: the study of laughterDoc Talks-Maui 2017Jacob Schor, ND, FABNO

2. Gelotology Greek gelos, geloto: meaning laugh, laughter, laughing. Gelotology: The study of laughter

3. Norman Cousins ~1976

4. “I made the joyous discovery that ten minutes of genuine belly laughter had an anesthetic effect and would give me at least two hours of pain-free sleep…..When the pain-killing effect of the laughter wore off, we would switch on the motion picture projector again and not infrequently, it would lead to another pain-free interval.” Norman Cousins

5. Hiroshima

6. Why do we laugh?

7. Laughter evolved early

8. Hajime Kimata

9. JAMA. 2001 Feb 14;285(6):738.Effect of humor on allergen-induced wheal reactions.Kimata H. • N=26 • Atopic dermatitis: allergies to dustmites, cedar and cat dander. • 72 hours without medication. • Skin prick tests before and after watching Modern Times. • Size of the skin wheals were measured. • Identical procedure weeks later after watching the weather station. • Watching Charlie Chaplin significantly decreased size of the wheals.

11. Charlie Chaplin studies

12. Watching Mr. Bean decreased allergic reactivity….

13. Emotion with tears decreases allergic responses to latex in atopic eczema patients with latex allergy. PMID: 16813847

14. Effect of viewing a humorous vs. nonhumorous film on bronchial responsiveness in patients with bronchial asthma. PMID: 15178163 • “….. These findings indicate that viewing a humorous film may be useful in the treatment and study of BA.” PMID: 15178163

15. Mozart does the same • Listening to Mozart reduces allergic skin wheal responses and in vitro allergen-specific IgE production in atopic dermatitis patients with latex allergy. 2003. PMID: 14977243 • Laughter counteracts enhancement of plasma neurotrophin levels and allergic skin wheal responses by mobile phone-mediated stress. 2004. PMID: 15369195

16. Viewing humorous film improves nighttime wakening in children with atopic dermatitis. 2007. PMID: 17468523 • INTRODUCTION: Patients with atopic dermatitis suffered from night-time wakening, but the exact mechanism of it was not known. Ghrelin was involved in growth hormone secretion, regulation of appetite, anxiety, night-time wakening and stress. METHODS: Thus salivary ghrelin levels during the night were measured in 40 healthy children or 40 patients with atopic dermatitis with night-time wakening. Salivary ghrelin levels at 02:00 h were markedly elevated in patients with atopic dermatitis compared to those in healthy children. RESULTS: Neither viewing control non-humorous film nor viewing humorous film had any effect on healthy children. In contrast, viewing humorous film improved night-time wakening and reduced elevation of salivary ghrelin levels in patients with atopic dermatitis, while viewing control film failed to do so. CONCLUSION: Viewing humorous film may be useful in the treatment of night-time wakening in patients with atopic dermatitis.

17. Laughter elevates the levels of breast-milk melatonin. 2007. PMID: 15369195 • •Patients with atopic eczema (AE) often complain of sleep disturbance. N= 48 infants. • Half (n=24) of the mothers of these infants were patients with AE, while another 24 mothers were healthy subjects. The mothers viewed either an 87-min humorous DVD (Modern Times, featuring Charlie Chaplin) or an 87-min nonhumorous weather information DVD at 2000 h. After viewing, breast milk was collected and the levels of breast-milk melatonin were measured. In addition, skin wheal responses to HDM and histamine were studied in infants. • •RESULTS: Laughter increased the levels of breast-milk melatonin in both mothers with AE and healthy mothers. In addition, allergic responses to latex and HDM of infants were reduced by feeding with breast milk after laughter of mothers with AE or of healthy mothers.

18. “Donald Trump never laughs.” Al Franken

19. Increase in dermcidin-derived peptides in sweat of patients with atopic eczema caused by a humorous video.2007. PMID: 17188121 • Dermcidin (DCD)-derived peptide is an antimicrobial peptide produced by the sweat glands. However, the levels of DCD-derived peptide in sweat were decreased in patients with atopic eczema Viewing a humorous video increased DCD-derived peptide in sweat of patients with AE, and thus, it may be helpful in the treatment of skin infection of AE.

20. Elevation of testosterone and reduction of transepidermal water loss by viewing a humorous film in elderly patients with atopic dermatitis. 2007. PMID: 18035752. • n=36 men, mean 70 yo • Viewing a humorous film (The Best Bits of Mr. Bean) slightly but significantly (P<0.05), elevated salivary testosterone levels and reduced transepidermal water loss (TEWL) values in healthy men. It markedly elevated salivary testosterone levels and reduced TEWL values in elderly patients with AD • Viewing a control non-humorous weather information had no effect.

21. Erectile dysfunction • 2008. Short-term improvement of erectile dysfunction by viewing humorous films in patients with atopic dermatitis. • PMID: 18266651 • n= 36 ED/AD patients & wives • Watched humorous films on three consecutive days • significantly improved erectile function, orgasmic function, sexual desire, intercourse satisfaction, overall satisfaction in association with increased serum testosterone levels and decreased serum estradiol levels…

22. Short acting • However, this effect was short-term. By day 7, 3 days after finishing the movies, the effects had worn off.

23. Modulation of fecal polyamines by viewing humorous films in patients with atopic dermatitis. 2010. PMID: 19543102 • viewing humorous films on fecal flora and fecal levels of polyamines. 7 days. • n = 24 healthy and 24 patients with atopic dermatitis • In AD pts. viewing humorous films: • (i) increased colonization with lactobacilli and bifidobacterium, • (ii) decreased colonization with S. aureus and Enterobacteria, and • (iii) increased fecal levels of polyamines • nonhumorous films had no affect on AD pts.

24. Atopic dermatitis in children in the United States, 1997-2004: visit trends, patient and provider characteristics, and prescribing patterns. PMID: 17766497 • pediatric atopic is increasing in the United States. • In 1997 there were 620,000 pediatric visits for atopic dermatitis. • In 2003, the number had more than doubled to 1,700,000

25. Violence depicted on TV has increased during this time: • 1993 to 2001, incidents of physical violence increased by 378 % [1] • Between 1998 and 2002 violence displayed on television increased: [2] • 41% increase in depictions of violence during the 8:00 to 9:00 pm Family Hour • 134% increase during the 9:00 to 10:00 pm time slot. • [1]PMID: 19030148 • [2] TV Bloodbath: Violence on Primetime TV. The Parents Television Council. 2002

26. Dysbiosis, etc. • Humor should also be considered in the treatment of : • Low melatonin • Low testosterone • Dry skin • Erectile dysfunction • Dysbiosis • Diabetes, whoops need to add those studies….. • Increasing NK Killer cell activity, etc.

27. The bus driver joke

28. update PMID: 14637240 Kissing reduces allergic skin wheal responses and plasma neurotrophin levels.

29. 2011 • Medical clowning increases pregnancy rates after in vitro fertilization, 36% vs 20%. PMID: 21211796 • four weekly sessions of laughter therapy reduced depression and increased cognitive function and sleep quality in seniors. (n=109)PMID: 21211796

30. 2011 (cont) • laughter decreases post-partum fatigue in Korean women (n=67) PMID: 21804338 • with improved quality of life and resilience in breast cancer survivors (n=37) PMID: 21804337

31. sneaky

32. 2009 . The effect of mirthful laughter on the human cardiovascular system.Miller and Fry PMID: 19477604 Laughter is good for the heart: Increases release of nitric oxide in the endothelium Serves as a counterbalance against mental stress having an opposing effects on endothelial

33. laughter improves short-term memory in older adults • 2014 Loma Linda University • learning ability improved by 38.5% • delayed recall improved by 43.6% salivary cortisol, ….significant and borderline decreases for the humor group • PMID: 26026141

34. Cancer patients undergoing radiation therapy, three hour long laughter sessions significantly reduced mood disturbances (n=62). PMID: 25875938 Middle aged severely depressed Chinese women, it took just ten laughter therapy sessions to significantly increase their serotonin levels and their quality of life measurements.(n=64) PMID: 25947184

35. Australia • Elder Clowns in nursing homes (35) • 9-2 weekly sessions (n=189) • six month period (26 weeks), those who participated in the humor therapy session were measurably less agitated and exhibited longer durations of happiness. PMID: 24814320

36. COPD = contraindication • Sense of humor among patients with COPD is associated with positive psychological functioning and enhanced quality of life, but …. • laughing aloud may cause acute deterioration in pulmonary function secondary to worsened hyperinflation. PMID: 21724041

37. Laughter should be considered a therapeutic tool for patients with allergic conditions • Atopic Dermatitis • Atopic Eczema • Allergic Asthma • Night-waking in allergic infants

38. What makes people laugh? • Holist Nurs Pract. 2009 Nov-Dec;23(6):349-54. Humor theories and the physiological benefits of laughter. Wilkins J, Eisenbraun AJ. • There are 3 main theories used to explain the functions of humor: • (1) the relief theory • (2) the incongruity theory • (3) the superiority theory. • But….

39. It doesn’t really matter • “…these physiological benefits occur regardless of the theory that is used to explain the humor function.” • In other words, the benefits occur whether the joke is ‘polite’ or not. Whatever makes people laugh is useful for our purposes….

40. How to prescribe laughter: • “What movies make you laugh?” • “Watch them daily” • Start with a loading dose…. 1.5 to 2 hours and then a daily maintenance dose, 1/2 to 1 hour

41. Jokes: • Tell them jokes. • Get them to tell jokes. • Make them practice.

42. Other uses for laughter: • We need to talk about painful subjects with our patients. Laughter makes it easier. • Laughter provides a teaching opportunity: patients may hear a message embedded in a joke easier than alone. • What homeopathic remedy is the bus joke about? • Laughter can shift our attitude, our viewpoint.

43. The hunters: funniest American Joke: Two hunters are out in the woods when one of them collapses. He doesn't seem to be breathing and his eyes are glazed. The other guy whips out his phone and calls the emergency services. He gasps, "My friend is dead! What can I do?". The operator says "Calm down. I can help. First, let's make sure he's dead." There is a silence, then a shot is heard. Back on the phone, the guy says "OK, now what?"

44. Another US joke: • A man and a friend are playing golf one day at their local golf course. One of the guys is about to chip onto the green when he sees a long funeral procession on the road next to the course. He stops in mid-swing, takes off his golf cap, closes his eyes, and bows down in prayer. • His friend says: “Wow, that is the most thoughtful and touching thing I have ever seen. You truly are a kind man.” • The man then replies: Yeah, well we were married 35 years.

45. Canada When NASA first started sending up astronauts, they quickly discovered that ballpoint pens would not work in zero gravity. To combat the problem, NASA scientists spent a decade and $12 billion to develop a pen that writes in zero gravity, upside down, underwater, on almost any surface including glass and at temperatures ranging from below freezing to 300ｰC. The Russians used a pencil.

46. Laughter counteracts enhancement of plasma neurotrophin levels and allergic skin wheal responses by mobile phone-mediated stress. Behav Med. 2004 Winter;29(4):149-52. Decreased • Skin wheal responses • Neve growth factor • Neurotrophin-3 • Bean versus Weather info • text messaging made these measures worse • Laughter caused by viewing a comic video (Rowan Atkinson's The Best Bits of Mr. Bean) reduced the plasma nerve growth factor, neurotrophin-3 levels, and allergic skin wheal responses in patients with atopic dermatitis, whereas viewing a nonhumorous video (weather information) failed to do so. In contrast, stress induced by writing mail on a mobile phone enhanced the plasma nerve growth factor, neurotrophin-3 levels, and allergic skin wheal responses. However, previewing the comic video counteracted mobile phone-mediated enhancement of plasma neurotrophins or allergic skin wheal responses, whereas previewing the weather information failed to do so. Taken together, these results suggest that, in patients with atopic dermatitis, writing mail on a mobile phone causes stress and enhances allergic responses with a concomitant increase in plasma neurotrophins that are counteracted by laughter. These results may be useful in the study of pathophysiology and treatment of atopic dermatitis.

47. Text messaging “causes stress and enhances allergic responses with a concomitant increase in plasma neurotrophins that are counteracted by laughter”