Laughter as a Modality in Cancer Care
Just when I couldn’t write anything else about nutrition it came to me.
“Hidden within every problem lies an opportunity so powerful that it literally dwarfs the problem.”
Why a paper about laughter? It is natural, it is fun, and when done in appropriate way at an appropriate time within treatment of the cancer patient this can be enormously helpful in the treatment of the whole patient. What is more natural than laughter? It touches on so many of our basic Naturopathic tenants. It incorporates so much of the body, mind, spirit component that we claim to treat. Humor and laughter although similar are not the same. One can experience one without the other and vise versa. Gelotology is the study of laughter and the psychological and physiological effects of laughter. This paper is the starting point for my humor files beginning with some general contraindications of humor in the doctor patient relationship. A brief timeline of humor in medicine, physiological benefits of laughter including studies done world-wide on laughter in medicine and a review of patient (and some physician) sources for humor as related to oncology.
Determining when it is appropriate to use humor in the doctor-patient relationship can be challenging for some humor is used to ease an uncomfortable situation and therefore may be inappropriately to ease the physicians discomfort and not for the patient’s benefit. The use of humor may be inappropriate at that time. In an article titled Laughter: The best medicine, there is a discussion of the beneficial impact of humor in the therapeutic relationship with a firm caution on the appropriateness of timing. Some of the advice given, to avoid the pitfalls of the use of humor are:
- Don’t use humor when giving bad news
- Don’t use a lot of humor during the first visit- assessing boundaries
- Assess how “raw” a patient’s emotions are. Some people are fragile in terms of what they can handle.
- Allow the patient to set the stage for humor
- The 3 situations in hospitals where humor is never used: when patients are threatening not to cooperate with staff, when patients are extremely upset and when interacting with friends and family of dying patients.
“The art of medicine consists of keeping the patient amused while nature heals the disease.” – Voltaire
Here is a very brief history of laughter in medicine just to illustrate how far this theme dates back.
Laughter in medicine goes back as far as the Bible: “A merry heart doeth like a medicine; but a broken spirit drieth the bones.” (Proverbs 17:79)
Herbert Spencer wrote the Physiology of Laughter, which was first published in Macmillan’s Magazine in 1960. He remarks that laughter is a result of the perception of incongruity like when we see a child put a man’s hat on or how someone cannot keep his or her foot still when it is being tickled.
Norman Cousins was the editor of The Saturday Review for many years and was diagnosed with a fatal disease. He had always known that laughter had improved his life he checked himself out of the hospital moved into a hotel and obtained all the comedies he could. He found that after 10 minutes of laughter he was able to sleep for 2 hours without pain. This was a time prior to TV where he had to obtain film reels and a slide projector to watch Charlie Chaplain films. He later recovered from his terminal illness and lived for two decades after this illness. He then wrote Anatomy of an Illness as Perceived by the Patient.
Patch Adams from the Gesundheit Institute, note to self- see the movie again.
Laughter has benefits that go beyond the physical into the psychological and social. Some of the things that research has proven laughter to do: reduce blood pressure, improve respiratory capacity, decrease cortisol, increase immune cells, act as a mild aerobic activity, improve sleep, mood and sense of well being, and increase quality of relationships between people. I don’t really need a double blind placebo controlled study to tell me that laughter is a good thing when used appropriately. However, some researchers are trying to do this and running into the pitfalls faced by those who try measure a multi-factorial concept like laughter or humor with the standard evidence based medicine theories.
“Analyzing humor is like dissecting a frog. Few people are interested and the frog dies of It.” –E. B. White
At the Prince Mahavajiralongkorn Cancer Center, in Thailand, researchers are gaining insight on how humor affects patients overall well being as a non-invasive therapy for pain management. Patients were randomized into two groups control or humor therapy. The patients in this study are in an inpatient cancer care program that aids the medically underserved. Due to a lack of resource there are no psychological or emotional therapies for these patients. The humor therapy group improved in the areas of pain and satisfaction and comfort.
“Life does not cease to be funny when people die any more than it ceases to be serious when people laugh.” – George Bernard Shaw
10 Ways You Know That Your Doctor is an Oncologist
– Emily Hollenberg, Cancer Survivor
10. Even though he/she is wearing a white lab coat and not a military uniform, words like battle, fight, war and weapons are frequently used in the conversation.
9. You know that your doctor is an oncologist at a medical center when he/she uses “oma” words like carcinoma, lymphoma and melanoma instead of cancer.
8. He/she tries to explain to you why a low grade is better than a high grade on your path report. (I could have used that approach explaining my grades to my parents.)
7. He/she wants you to be excited when your tests come back negative not positive, of course this does not fit with most life experiences when you know it is better to be positive than negative.
6. He/she talks a lot about trials and as far as you know is not a lawyer or a judge.
5. When shaking hands with you at your initial appointment, you have a feeling that your veins are being checked out.
4. Asks you if you want a port and you know that this is not an invitation to have a drink.
3. Tells you that you will get a series of treatments and you keep wondering where the “treat” part comes in.
2. Tells you that you are on a protocol and it doesn’t seem to fit with the dictionary definition. Protocol: form of ceremony and etiquette observed by diplomats and heads of state.
1. Has you sign a consent form for treatment that is more intimidating than the diagnosis.
Bennet, Mary Payne and Cecile A. Lengancher. Humor and Laughter may influence Health. I. History and Background. ECAM 2006:3(1) 61-63.
Bennet, Mary Payne and Cecile A. Lengancher. Humor and Laughter Many Influence Health: II. Complementary Therapies in Humor in a Clinical Population. ECAM; 3(2) 187-190.
Bennet, Mary Payne and Cecile A. Lengancher. Humor and Laughter May Influence Health: III. Laughter and Health Outcomes. ECAM 2007.
Bhosai, Satasuk Joy and Saki Miwa. Rx Laughter and Prince Mahavajiralongkorn Cancer Center. Understanding the effects of humor therapy on patient’s self-reports of pain, comfort and anxiety. Jan 2006-2007.
Joshua, Anthony M, Angela Cotroneo and Stephen Clark. Humor and Oncology. Journal of Clinical Oncology. Vol. 23 No. 3 Jan 20 2005.
Polimeni, Joseph. The First Joke: Exploring the Evolutionary Origins of Humor. Evolutionary Psychology. 2006. 4: 347-366.
Spencer, Herbert. The Physiology of Laughter. Macmillan’s Magazine. March 1860.
Penson, Richard, Rosamund A. Partridge, Pandora Rudd et al. Laughter: The Best Medicine. The Oncologist. Vol 10 No. 8 651-660, Sept 05.