"Research has shown..."

How many times have you read that in an article, or heard someone quoting 'research' without actually being able to back it up?

Well, I decided that some evidence was needed on this site in order to relate theory to practice.

I have STACKS of articles at home that can do this, unfortunately, I cannot display them here without having permission first - copyright and all that caper don't y' know!

So, as and when I do get permission to reproduce an article, I'll display it here.

Hope you find all this useful!

The Power of Laughter
By Enda Junkins, LMSW, LMFT
Sunday, 20th May 2007

Laughter and therapy are not generally paired in the minds of clinicians nor in the minds of the general public.

Therapy is a serious business and is viewed and approached with a proper amount of ponderous gravity. After all, people enter therapy for serious reasons, often at critical times in their lives. How, then, can laughter be a vital part of the therapy process when the subject matter is so serious?

Laughter, a birthright of all human beings, is actually misunderstood and undervalued as a healing, cathartic process. Heavily identified with humor, laughter is generally deemed appropriate only for lighter, more frivolous concerns and things that are funny.

Certainly humor is one trigger for laughter but not the only one. If one entertains the idea that laughter is a physical process which releases emotional pain, then other, more serious triggers like stress, anxiety, and tension will make sense. According to psychologist William James, “We don’t laugh because we’re happy. We’re happy because we laugh.” If we put laughter into a pain framework, all kinds of laughter in all kinds of painful situations begin to make sense.

Cathartic psychotherapy emphasizes and utilizes laughter as one of the major cathartic processes healing emotional pain. It is specific to the release of light anger, light fear, and boredom. When people laugh, if uncomplicated by medications which may interfere with the physical catharsis, they are releasing painful feeling which is gone for all time. The exact amount of pain is immeasurable but the body will keep discharging pain cathartically until there is no longer a need. The only thwarting influences are the controls artfully imposed in childhood. Human beings are taught the value of control from an early age. The loss of control cathartically through laughter, crying, or anger makes us uncomfortable to say the least. What we don’t realize is that when we lose control of our feelings cathartically, we actually gain “control of our lives in flexible, intelligent, creative, and caring ways.” (Goodheart, 1994, p. 36)

Our cultural preference for processing feelings cognitively instead of feeling them in our bodies tends to maintain and prolong emotional distress. Nevertheless, some part of us instinctively knows that pain is driving us unconsciously. This may be viewed as the innate drive toward health which carries us toward the help we need. Clients from families where feelings are not allowed, may have squelched their ability to laugh, cry, and get angry. As clinicians, we can offer assistance in regaining these cathartic processes. This will enable our clients to release emotions deeply held which may be thwarting their happiness.

Only now has research begun to validate the belief that emotions are stored in the body, not the mind. Cathartic techniques allow clinicians to help clients access their stored emotions and release them. The more catharsis the client experiences, the faster he moves through the healing process. Laughter, which is possibly the most powerful cathartic process and the least threatening in many respects, leads the way in easing controls on emotion and often opens the door to crying and deep anger.

What causes the mental health community to be so slow in accepting laughter as a healing tool? It’s not comfortable. “Like any expression of the true self, laughter is radical and revolutionary, and it upsets conformity.” (Steinem, 1992, p. 175) In order to offer clients the power of laughter, clinicians must be willing to break loose from traditional therapeutic constraints, regain their own laughter, and learn the techniques to facilitate laughter in their clients.

The fact that laughter is often viewed with suspicion in adulthood as silly, inappropriate, and trivializing must be challenged by clinicians. Otherwise clients will turn away from the healing power of their laughter, fearful that others will see them as minimizing both themselves and their problems. Only the irrepressible few will laugh, hurling conventional behavior to the winds.

Traditionally, mental health practitioners have viewed laughter as hiding painful emotion. In contrast, cathartic psychotherapy believes that laughter is releasing emotion.  It is the physical process which powers out certain kinds of pain. Psychiatrist Raymond Moody believes that through laughter, people’s feelings and emotions erupt from inside them into the outside world. (Moody,1978, p. 10) Therefore, if one curtails or quenches laughter as inappropriate, the release of pain is quenched as well.

If people deny their emotions, they tend to become increasingly rigid and less able to change their patterns of behavior. They become more re-active than active and tend to repeat behaviors that are increasingly unsuccessful. If, however, they are able to release their feelings cathartically, they will automatically rethink situations. The clearer thinking made possible by catharsis enables them to take sensible, more appropriate action. (Goodheart,1994, p.97)

The laughter catharsis does not change the facts, but it does change the way one relates to the facts. It allows a person to see things from a bird’s-eye view where horrendous misfortune seems much more bearable. This allows people to remember, to feel, and to explore without fearing that they will   be trapped by circumstances beyond their control. Life’s most tragic and bizarre occurrences contain things which may strike one as personally absurd if one is able to look for them and the absurd is often a trigger point for laughter. Underneath the layers of unresolved pain, there is the child who possesses a strong biological drive toward joy and with the capacity for it, even with the capacity to generate it for itself. (Montagu, 1989, p.153) All that prevents a person from being joyful once again is the release of the pain layered on top. Laughter provides that release in a pleasurable way. It peels away the pain, allowing one to feel the joy beneath.

Emotionally, laughter takes care of several painful feelings. It releases fear which is often the root cause of emotional distress. Created biologically to protect humans from danger, it only becomes a liability if not heeded and released. This is sometimes complicated today because our fears are subtle and not always easy to identify. Much fear masquerades as stress.

When paired with trembling which releases deep fear, laughter takes care of anxiety which untended, often becomes disabling panic attacks or all consuming phobias. The frame of mind created by laughter is one of safety and clear thinking. It allows one to reframe a specific threat or stress, so that it becomes less overwhelming. As people laugh at things which threaten their safety and well-being, they release their anxiety and their discomfort decreases. For example, many people who are faced with life threatening illness find that laughter enables them to face the possibility of death directly while still enjoying and even enhancing the quality of their lives. When their fear is released by laughter, they relate more fully, think more clearly, and bond more with others.

In addition to fear, laughter releases light anger. It also works to release deeper anger indirectly. It does so by allowing one to shed the lighter aspects of fear and anger which can then open access to deep rage. Laughter is often a more acceptable way to approach one’s angry feelings. So much anger has been repressed by fear, that laughter actually serves the dual purpose of first releasing the fear of anger and then the anger itself.

Anger, which is the emotional response to the invasion of one’s boundaries, is not allowed in many families. When childhood boundaries are ignored, and instinctive angry responses are not permitted by adults, they must be redirected or repressed by the child. The lesson learned is that anger is unacceptable. To access their anger, many clients must overcome the defenses of their own childhood. Laughter allows this. With encouragement by a therapist, a client might be able to say “I feel angry” with a smile, the incongruity of which allows him to laugh. For many clients, laughter is a much more gentle way to address anger. It is less threatening than a direct expression of anger.

Finally, laughter releases boredom, the emotion related to changing the amount of stimulus in our environment. Boredom ranges from the simple type which is acutely distressing until the cause is removed, to hyperboredom which is comparable to an agonizing, chronically painful disease which in some cases ends in death. (Healy, 1984, p. 28) When we have too much or too little of something, we get bored, and we to take action. Failing that, we need to laugh. Boredom is a numbing, demoralizing emotion, undermining one’s sense of purpose.

Clinicians may facilitate their clients’ laughter by helping them play with their pain. According to Max Eastman, “…We come into the world endowed with an instinctive tendency to laugh and have this feeling in response to pains presented playfully. (Eastman, 1937, p. 45) Psychologist Annette Goodheart presents this concept as a formula—Pain + Play = Laughter. (Goodheart, 1994) Although laughter is often triggered by things that are funny, it is not about “funny.” Laughter is about the release of pain and therefore highly appropriate for all the things in life which are not in the least amusing.  When a client can play with pain, the result is laughter. It is essential that clinicians understand that they are not to play with the client’s pain for them nor give free rein to their own sense of humor. Doing so can result in a feeling of ridicule by the client and do unintentional harm. The therapist’s role is to help the client find ways to play with his pain that work for him and to assist him in keeping the process moving.

There are many ways to play with emotional pain. Some people do so instinctively and come for therapy already laughing and crying. Others need a little help in finding ways to play with their painful issues. For example, playfully looking at the “good things” about depression can help clients feel that they will be able to cope after all. Their depression becomes a little less consuming, allowing them to take positive action. The resulting laughter allows the client to feel the associated pain and move on. People who are able to see the things they care about the most with an outrageous sense of freedom, can play with their pain. There are no rules. Everyone’s pain is his own. If he chooses to play with it, it’s not only okay, it’s healthy. A client who can laugh about pain is able to feel it and heal more quickly. The laughter also allows it to become manageable.

For those reluctant to let go of their “serious” view of pain, it may be helpful to explore seriousness just a little. As adults, we are fairly obsessed with the idea that life must have meaning. As we superimpose meaning onto life, “we intellectualize it and distance ourselves from it….Distanced from life, we become isolated, alienated, and serious.” (Goodheart, 1994, p.25) Being serious about important things tends to lock us down in the pain. In order to stay serious, we have to maintain control. In maintaining control, we turn away from catharsis and the necessary release of emotion.

Upon entering adulthood and learning to distinguish importance from unimportance, we need to maintain our ability to take things playfully. Once we have learned to care about things, it is important to balance that concern in a way that eases the intensity. It isn’t terribly difficult to reverse our seriousness, once we understand the importance of doing so. It only requires reversing our early brainwashing and tapping into play which is “a socio-physiological state or posture of instinctive life. It is not only something that we do but something we are while we do it.” (Eastman, 1937, p. 16)

Inviting and facilitating laughter in therapy is not the same as developing and using humor to make the client laugh. Although not always true, making others laugh can be an issue of control and often dangerous. It can translate into ridicule without that being the intent. Humor is not necessary to have laughter. Adults can laugh without it as do infants. The greater our inhibitions and restraint, the more we need release of some kind. Our spirits will so desperately crave relaxation, that even the weakest stimuli will trigger the laughter response. (Mindess, 1971, p.245) In other words, we laugh to release emotion if our controls are off. Humor, though not a requirement, can be a cause for laughter, but clients must feel free to use it in their own way with their own issues. It is a good rule of thumb to beware of using humor with someone else’s pain because the result can be hurtful to them. Help them do it themselves instead.

Laughter in therapy enables clients to move closer to the core of their patterns of survival. Since these patterns developed in order to help the child survive, any attempt to alter them raises the client’s anxiety. The “child within,” whose feelings are protected by the pattern, fears that it will die if it is altered in any way. Laughter provides a means of changing things that feels safer. When clients laugh, their total selves move with energy. They will not be stymied by their pain. Their thoughts, made more spontaneous by laughter, create greater flexibility. As they laugh more and more readily, they regain self confidence. (Goodheart, 1994, p.120) They fear change less. Eased by their laughter, clients are more willing to find out who they really are.

As therapist and client approach the client’s pain playfully together, they are actually engaged in what may seem like a kind of joint, playful regression. Depending on the level of a person’s withdrawal or emotional lock down, it is helpful to begin at his level and retrieve him through laughter. It’s somewhat similar to saying to the client, “If you cannot or will not come out of your numbed shell, then I will go into it with you and lead you back out.” (Moody, 1978, p. 111) In enabling clients to laugh at any aspect of their pain, for that moment clinicians enable them to stand above it, acknowledge it, but treat it lightly in the awareness that they are touched but not contained by it. (Mindess,1971, p. 123) Clients are empowered by gaining perspective and find it easier to step out of the sense of victimization.  Surprisingly, they find that their greatest place of power is in lightness.

There are many ways to help clients play with their pain. First and foremost, however, it is important to have a firm understanding of cathartic theory as the springboard for leading clients into laughter. Doing so without knowledge can result in harm however well intentioned therapists may be. People have different degrees of willingness and different capacities for creating playful approaches to their issues and their feelings. It is important that the therapist follow the client’s lead, approaching catharsis with the deep respect it deserves.

Laughter in therapy is not a paradox. The two belong together in the quest for healing. It is the wisdom of nature that equipped us to provide our own spoonful of laughter as a medicine for life. “Laughter and pain”, so perfectly paired, we even overlook the connection.

References

Eastman, M. (1937). Enjoyment of Laughter. New York: Simon and Schuster.
Goodheart, A. (1994). Laughter Therapy. Santa Barbara: Less Stress Press.
Healy, S. D. (1984). Boredom, Self, and Culture. Cranbury, N. J.:Associated University Presses.
Montagu, A. (1989). Growing Young. New York: Bergin and Garvey Publishers.
Mindess, H. (1971). Laughter and Liberation. Los Angeles: Nash Publishing.
Moody, R. (1978). Laugh After Laugh. Jacksonville: Headwaters Press.
Steinem, G. (1992). Revolution From Within: A Book of Self Esteem. Boston: Little, Brown and Company.

Reproduced by kind permission of the author © Enda Junkins LMSW, LMFT

Enda Junkins, MSW, LCSW is a rare commodity. Known as the Laughing Psychotherapist, she stimulates audiences to laugh more both nationally and internationally. She shares her unique, practical, memorable tools for creating laughter to enthusiastic audience response. A national expert on laughter, she speaks with wit and wisdom regarding the use of laughter in countless different settings. Her presentations are effective for businesses, organizations, and individuals.  Enda’s laughter expertise developed over more than 30 years as a practicing psychotherapist using laughter to heal serious issues. Her presentations on laughter are entertaining, uplifting and informative. She is the author of two books and three videos on laughter. Enda is a member of the National Speakers Association.

www.laughtertherapy.com

By Sylvia Mauger

Stress News July 2001 Vol.13 No.3

There is no doubt that any form of counselling, be it psychotherapy, stress management or anything else, is a very serious business. We read so many serious texts and go to so many serious meetings and classes that it is easy to get into a mode of solemn gravity. And, of course, this is largely because we are committed to treating our clients with respect. But in this paper I would like to suggest that respect can include humour and that laughter during a counselling session can be very therapeutic.

The Oxford Concise Dictionary defines humour as 'the quality of being amusing or comic; the ability to perceive or express humour or take a joke', but this is not particularly helpful in therapeutic terms. What is amusing or comic to one person may not be to another and, of course, we are not in the business of entertaining our clients as comics. So if humour is not necessarily about telling a joke, then what is it and how can it have beneficial effects in stress management counselling?

Windy Dryden, writing in Brief Rational Emotive Therapy, quotes Albert Ellis saying 'that one way of conceptualising psychological disturbance is that it is the tendency of humans to take themselves, other people and life conditions TOO seriously.' He goes on to describe how, in order to change, negative events need to be taken seriously, but that if they are taken too seriously, emotional disturbance may follow and action for change can be impaired. Indeed, as the whole model of stress management as conceived in Rational Emotive Behaviour Therapy and Cognitive Behavioural Therapy is based on the idea that people suffer emotional dysfunction when their thinking is irrational, humour can be seen as one of the many ways of 'untwisting' a client's cognitive distortions.

Of course, this does not imply that every stress management counsellor can laugh and joke their way through every session with every client, but it does mean that if a counsellor is sensitive to the mood of the client, a little humour can go a long way. If the therapeutic bond is comfortable, it will be clear to the client that the therapist is not laughing at the client but at the irrationality of her/his ideas. Laughing with people is compassionate, laughing at them is immoral and unethical. Indeed, it can often be the case that laughing together can act, not only as a tool of communication, but can strengthen the bond between the two people concerned. As Victor Borge, the American entertainer, once wrote, 'Laughter is the shortest distance between two people'. (quoted by Robert Holden, ISMA)

It is well known that stress causes physiological changes that are dangerous when prolonged Cortisol levels and blood pressure are elevated and the heart rate is increased amongst a host of other stress triggered responses. There is now considerable research that suggests that laughter lowers cortisol levels and stimulates the immune system, off-setting the immunosuppresive effects of stress. (Patty Wooton, Humour: An Antidote for Stress).

This research was preceded in 1979 by Norman Cousins who had, through his personal experience, attracted the attention of the medical profession to the possible therapeutic effects of humour. He contracted ankylosing spondylitis in 1964 and decided that the hospital regime of strong medication, dull food and the institutional regime was so depressing that any benefits he was gaining could be maximised outside the conventional regime. So, based on his own research, he developed a programme of therapy consisting of megadoses of a mix of vitamin C combined with regular doses of laughter stimulated by re-runs of the Marx Brothers films and Candid Camera. These treatments of belly laughs appeared to relieve his pain considerably and, indeed, when his levels of inflammation were tested, they were found to have decreased. Cousins also asserted that the increased release of endorphins caused by laughter eased the pain.

The beneficial effects of humour

A patient of mine suffering from a combination of physical and psychological stresses, not the least of which was a severely deteriorating irreversible eye condition, stated emphatically at one point that she would like a magic wand to cure all her ills. As it happened I had been given a gift of a joke wand and I promised her we would try out its properties at the next session. I duly brought it in and waved a shower of tinkling sparkles at her. She laughed delightedly although she could not have seen much apart from the basic shape and the sparkling effect. When I added my regrets that although I had a wand, I did not know the spells to go with it, she laughed even more and agreed that CBT would have to do instead. As I joined in her laughter, I felt that this shared experience had brought us closer, and indeed, she referred to it on several occasions afterwards. In her case it seemed that the laughter - particularly at something so absurd - had mitigated her stress by providing a coping mechanism. And when we had finished laughing, we seemed able to return to the serious matters at hand with renewed application. This is supported by Robert Holden, Stress Consultant, in his description of an

This sort of experience supports the concept of the counsellor as 'authentic chameleon' (Lazarus 1993). The key to this theory is that, in order for the client to achieve maximum benefit, the counsellor needs to be as flexible as possible to meet the client's needs. Some clients will prefer a formal mode of interaction and the counsellor may choose to match this with more formal clothes and body language than are used with other clients and to use an empathic but business like dialogue. This sort of client may well be bewildered by the use of laughter. At the other end of the scale, there are clients who are most comfortable with a very casual style of communication. Clearly the therapist is unlikely to change clothes for every client but, provided they are sensitive to their clients' individual backgrounds and personalities, they will try to adapt their body language and style of address. This adaptability also includes making a judgement as to the appropriateness of the use of humour.

When I used my magic wand, I sensed that my client felt supported by the counsellor joining her at The same level. Assuming that the humour is appropriate and genuine, not merely a gesture to please the other person, then the ideal of unconditional positive regard can be reinforced. To some extent it can be assumed that many clients feel they are talking to 'an expert' implying that they themselves are 'lesser beings'. The employment of humour can be useful in reducing this distance and bringing about parity between client and therapist. And it does not always have to be the case that it is the counsellor who introduces the element of humour. In a recent session with a client who was experiencing difficulties in his relationship and who confessed to being a poor listener, I was discussing ways in which people show they are listening. The two-way discussion soon turned into my monologue as he stopped talking and just sat looking at me thoughtfully with the odd 'hmm' thrown in. There followed a pause and I asked him what was going through his mind. He beamed at me silently, then explained that he was listening in an appropriate manner, and we both roared with laughter. I was delighted that he was comfortable enough to be able to laugh at our situation.

My magic wand was used in a fairly light situation, but humour seems to have beneficial effects on a pretty extensive continuum of situations. Charles Rubin, in his book for parents of drug addicts, says:

Humour can often be used to reinterpret or re-frame distressing events. As laughter distances the individual from the stressor, a feeling of perspective and safety is created. This certainly appeared to be the case for an elderly agoraphobic client whose homework had progressed to travelling two floors in a lift. In the event, being a person of extremes, she decided to visit a friend who lived on the twelfth floor. She went up in the lift for four floors - a triumph in itself - but when she left her friend, was too embarrassed to let him see her walk down the stairs, so took the lift all the way down the twelve floors. This client smiled broadly as she walked into the session, told me I'd never believe what she had to tell me, then laughed uproariously as she described the situation, realising that embarrassment was more important to her than her fear of lifts. The laughter encompassed relief that she had survived such a feat and also understanding of the absurdity of the incongruity of the situation. I felt it helped her to see her fears in a slightly different light and provided some reinforcement in her belief that she had some control over the situation.

Appropriate humour never belittles or criticises. It is based on caring and empathy. An invitation to laugh is an invitation to share and, as such, it is supportive and so builds confidence between two people. This can be as true in a group situation as that of one-to-one counselling. A group of part- time women trainees, for example, who had known each other for only two weeks, began a very brief course of stress management with me. They were a little reticent to begin with as can be expected in a situation where trust has not yet been established. Within the first 20 minutes it emerged that one of them felt she had a problem with her adult daughter who still lived with her and for whom she did all the washing, cleaning, cooking and ironing. She laughed in an embarrassed fashion as she told us about this, but soon the entire group was laughing uproariously with her as they predicted what she would be doing for her daughter before and after she was married. The raucous details can be imagined. The laughter proved to be a bonding experience as it showed her that everyone there identified with and shared her feelings. Thus a basis of trust was established within which it became possible for the group to take seriously the issues of why she behaved in this way and what she could do to change.

Laughter with a client about himself or herself can serve to reinforce their understanding of globalising and perfectionism. If, for example, a client has appreciated the irrationality of dismissing anything positive about themselves or the world but has not yet developed a firm counteracting belief, a little mockery of this negative perspective can help them to accept the irrationality of the core belief. The feeling that 'things can't be that bad if I can still laugh' can be a considerable relief as well as having a distancing effect on the problem.

As stated at the beginning of this paper, there is no suggestion here that a counsellor can laugh all the way to a successful therapeutic conclusion for every client. And, indeed, it would be extremely foolish to laugh at all unless the client has indicated that they feel safe, supported and able to see a funny side to the issues that they bring to the sessions. Counsellors must however always be alert to the dangers of using humour for drawing attention to their own cleverness. There must also be a constant sensitivity to the client's cultural background: an inappropriate laugh can do untold damage to the therapeutic relationship.

Nevertheless, the notion that humour can have beneficial effects is demonstrated by the current plethora of related web sites. In this country, one of the best known is Robert Holden's Oxford- based Happiness Project. This was set up after he launched the UK's first laughter clinics in 1991 with NHS funding. Holden runs workshops and also runs eight-week Happiness Programmes targeted, amongst others, at health professionals and also top level managers of some of the country's largest companies.

Another 'laughter practitioner' is Dr. Brian Kaplan, a medically qualified doctor who claims that as soon as you start to laugh at a problem, 'the problem is completely disempowered'. Further afield, the American, Cathy Ripplinger Fenwick, fronts an 'Online Laughter Therapy Centre' which advises on ways to 'put more laughter into your life'. There are also panic/anxiety disorders web sites which advise readers to 'laugh yourself calm, and papers on humour in emergency work (Moran and Massam).

Some of these web sites may be questionable in that they imply that self-help through humour is easy, but there is no doubt that the current trend is to take the funny side of things seriously and to appreciate the psychological benefits that humour can bring.

In this paper I have tried to cover the main benefits of the uses of humour in stress management counselling. There appears to be both anecdotal and scientific evidence that humour and laughter can act as antidotes to stress. Humour can:

• act as a communication tool as well as provide an emotional bonding and a demonstration of supportiveness and acceptance

• enhance the therapeutic alliance by confirming parity between client and counsellor

• help to reinterpret a distressing event and to distance the individual from the stressor thus providing a more realistic perspective on the problem

• serve to reinforce belief in new adaptive ways of thinking

• improve the physiological state

There remains one more area to be addressed and that is the use of humour to the counsellor. If we take ourselves too seriously we may become too concerned with our own thought processes and so risk losing sight of the clients' issues. To be able to laugh at ourselves, acknowledging that we are fallible human beings, is an effective tool that enables us to see things in perspective. It is quite often the case that a good laugh in the middle of a serious discussion can provide the relief from tension that is needed to carry on with the seriousness of the deliberations.

Adams, M. Humour in the Psychotherapeutic Relationship, Counselling, Volume 11 No. 3

Dryden, W. Brief Rational Emotional Behaviour Therapy. Wiley, 1995 3

Ellis, A. A New Guide to Rational Living Robert Harper 1975

Fenwick, C. An Online Laughter Therapy Centre, (undated)

Lazarus, A. The Practice of Multimodal Therapy: John Hopkins 1989

Massam, Margaret & Moran, Carmen: An Evaluation of Humour in Emergency Work. The Australasian Journal of Disaster and Trauma Studies: volume 1997-3

Rubin, C. Don't Let Your Kids Kill You. Element Books 1996

Trower, Casey and Dryden. Cognitive-Behavioural Counselling in Action. Sage Publications, 1988

Wooton, P. Humour: an Antidote for Stress. Anti-stress.htm undated

Sylvia Mauger works as a Stress Management Counsellor in the NHS and in private practice in South London. She also delivers Personal Effectiveness training in a Further Education setting. Sylvia is a member of ISMA (International Stress Management Association).

Reproduced by kind permission of the author © Sylvia Mauger.

The following is an excerpt taken from Chapter 3: Humor and Healing, or Why We're Building a Silly Hospital of Gesundheit!: Bringing Good Health To You, The Medical System, And Society Through Physician Service, Complementary Therapies, Humor And Joy.

Thank you to Patch Adams for kindly giving me permission to reproduce the said excerpt.

The arrival of a good clown exercises more beneficial influence upon the health of a town than of twenty asses laden with drugs.Dr. Thomas Sydenham,

seventeenth-century physician

Humor is an antidote to all ills. I believe that fun is as important as love. The bottom line, when you ask people what they like about life, is the fun they have, whether it’s racing cars, dancing, gardening, golf, or writing books. Philosophically speaking, I’m surprised that anyone is ever serious. Life is such a miracle and it’s so good to be alive that I wonder why anybody ever wastes a minute!

Anyone who has picked up a copy of Reader’s Digest in the last forty years knows that laughter is the best medicine. In spite of the empirical nature of this truth, the mainstream medical literature hasn’t refuted it, as far as I know. The late Norman Cousins wrote eloquently about having laughed himself back to health after suffering from a serious chronic disease. The experience had such an impact that he changed careers late in life to help bring this information to the health care profession. Jokes seemed so important to Sigmund Freud that he wrote a book on the subject. But we don’t need professionals to tell us about the magnetism of laughter. With great insight, we call a funny person “the life of the party.”

Humor has been strongly promoted as health-giving throughout medical history, from Hippocrates to Sir William Osler. As science became dominant in medicine, subjective therapies like love, faith, and humor took a backseat because of the difficult task of objectively investigating their value. I am astounded that anybody feels the need to prove something so obvious. When individuals and groups are asked what is most important for good health, humor invariably heads the list even over love and faith, which many people feel have failed them. Few people deny that a good sense of humor is essential for a successful marriage. All public speakers recognize that humor is essential in drawing attention to what they are saying.

People crave laughter as if it were an essential amino acid. When the woes of existence beset us, we urgently seek comic relief. The more emotions we invest in a subject, the greater its potential for guffaws. Sex, marriage, prejudice, and politics provide a bottomless well of ideas; yet, humor is often denied in the adult world. Almost universally in the business, religious, medical, and academic worlds, humor is denigrated and even condemned, except in speeches and anecdotes. The stress is on seriousness, with the implication that humor is inappropriate. Health education does little to develop the skills of levity. On the contrary, hospitals are notorious for their somber atmosphere. Although hospital staff members may enjoy camaraderie among themselves, with patients their goal seems to be to fight suffering with suffering. What little humor there is occurs during visiting hours.

The focus on humor in medicine at Gesundheit Institute has often been declared a major deterrent to our getting funds. Still, I insist that humor and fun (which is humor in action) are equal partners with love as key ingredients for a healthy life.

Although humor itself is difficult to evaluate, the response to humor-laughter-can be studied quite readily. Research has shown that laughter increases the secretion of the natural chemicals, catecholamines and endorphins, that make people feel so peppy and good. It also decreases cortisol secretion and lowers the sedimentation rate, which implies a stimulated immune response. Oxygenation of the blood increases, and residual air in the lungs decreases. Heart rate initially speeds up and blood pressure rises; then the arteries relax, causing heart rate and blood pressure to lower. Skin temperature rises as a result of increased peripheral circulation. Thus, laughter appears to have a positive effect on many cardiovascular and respiratory problems. In addition, laughter has superb muscle relaxant qualities. Muscle physiologists have shown that anxiety and muscle relaxation cannot occur at the same time and that the relaxation response after a hearty laugh can last up to forty-five minutes.

Psychologically, humor forms the foundation of good mental health. Certainly the lack of a good sense of humor indicates underlying problems like depression or alienation. Humor is an excellent antidote to stress and an effective social lubricant. Since loving human relationships are so mentally healthy, it behooves one to develop a humorous side.

I have reached the conclusion that humor is vital in healing the problems of individuals, communities, and societies. I have been a street clown for thirty years and have tried to make my own life silly, not as that word is currently used, but in terms of its original meaning. “Silly” originally meant good, happy, blessed, fortunate, kind, and cheerful in many different languages. No other attribute has been more important. Wearing a rubber nose wherever I go has changed my life. Dullness and boredom melt away. Humor has made my life joyous and fun. It can do the same for you. Wearing underwear on the outside of your clothes can turn a tedious trip to the store for a forgotten carton of milk into an amusement park romp. People so unabashedly thank you for entertaining them.

Being funny is a powerful magnet for friendship, life’s most important treasure. Nothing attracts or maintains friendship like being a jolly soul. I know that humor has been at the core of preventing burnout in my life. Finally, as a nonviolent person, I feel that humor has often protected me by deflecting potentially violent situations.

In the twelve years we saw patients during the pilot phase of Gesundheit Institute, we had many opportunities to explore the relationship between humor and medicine. Although we greatly appreciated casual humor, it seemed imperative that we deliberately incorporate it into our day-to-day lives to prevent an atmosphere of agony and despair. Some of this humor came from a stream of jokes that patients and staff brought with them. However, jokes die quickly, and we found that for an atmosphere of humor to thrive, we had to live funny.

We learned to first develop an air of trust and love, because spontaneous humor can be offensive, and we wanted it to be taken in the spirit of trying. (Cautious people are rarely funny.) It soon became clear that silliness was a potent force in keeping the staff together as friends. And I, as a physician, began to see the potent medicinal effect of humor on diseases of all kinds.

Humor is important, too, for the health of a community, whether a neighborhood, church, club, or circle of friends. It has helped me live communally for more than twenty years. The first twelve years we used our home as a free hospital, surrounded by patients who had great mental and physical suffering. The staff stayed many years without pay or privacy because it was so much fun. As physicians, we also discovered that humor was a major medicine. Humor, maybe even more than love, made our pioneering project work; it would have been impossible without this great social glue.

We live in a troubled world. Many aspects of society are unhealthy or even deadly, and large segments of the population live on the edge. If we are to doctor society we must rely heavily on humor. Often in public a parent and child are at odds, and the frustrated parent is ready to strike out at the child. If I put on my rubber nose and act goofy, most of the time the situation is defused and neither parent nor child has a win/lose feeling.

How can one inject more humor into a medical setting? First, it must be a joint decision by administration and staff. The most important elements of bedside manner are not medical knowledge or skill but the qualities inherent in fun and love. Once the medical establishment has agreed to accept more humor, people at all levels of employment will be willing to take steps in this direction. It is easiest to be funny when people are familiar with one another. Spend time together learning your limits and practicing being funny. Invite patients and visitors to participate. Be open to experimentation and escalate slowly. Expect many experiments to fail and even to cause some pain. Avoid racist and sexist humor. Strive for goofiness and fun, not an infinite string of jokes.

Some hospitals have begun the process already. At Duke University Hospital, humor carts deliver videos, cartoon and humor books, juggling equipment, toys, and games. DeKalb Hospital, near Atlanta, has created a Lively Room for romping. The clowns of the Big Apple Circus in New York City have created Clown Care Units, which visit children’s hospitals on a regular basis to bring joy and assist with patient care. The Association of Therapeutic Humor is creating a clearinghouse with information about humor and about people who practice it as therapy. Finally, we at Gesundheit Institute are building the first silly hospital, where the entire context will be geared to fun and play.

There are many avenues to explore. I think hospitals need to give patients a choice between a goofy ward or a “straight,” solemn ward. In lectures all over the United States, I ask medical groups which ward they would choose, and more than 90 percent always choose the goofy ward. In any hospital, “fun” rooms could be designated as playful environments for all to enjoy. This could attract many of the community’s creative people, forge closer bonds between hospital and community, and diminish the hierarchical nature of current medical practice.

For all levels of staff, I suggest classes, intimate gatherings, picnics, and even slumber parties to cultivate the closeness needed to ensure more humor and joy in the workplace. I suggest creating humor support groups and maybe a place where people come just to laugh. Many hospitals have realized the importance of faith and have included ministers and priests on the staff. The same could be done with humor: hire clowns and playful people. Many large communities have performers and artists who could be invited to bring their specialties to the hospital. Some hospitals might even consider creating space for them, including a well-stocked costume and prop room.

The practice of medicine is hurting at many levels. Patient discontent is so great that many are resorting to lawsuits. Many health care professionals are so dissatisfied that they are quitting or even killing themselves. Few if any happy hospitals exist. Most people hate going to a hospital and have traumatic experiences when they do. Yet, it doesn’t have to be this way if we make great efforts to change it. Service to people in times of pain and suffering should - and can - bring rich fulfillment. Let us call on humor to lend a hand and make medicine fun.

Adams P with Mylander M (1998) Gesundheit!: Bringing Good Health To You, The Medical System, And Society Through Physician Service, Complementary Therapies, Humor And Joy Rochester: Healing Arts Press

Laughter Provides Emotional and Physiological Benefits To Patients and Care Givers Alike

by Brian Luke Seaward, PhD

In the past three decades the medical world has begun to take more serious notice of the healing power of humor and the positive emotions associated with it. Humor and laughter are currently being employed by psychotherapists and other care givers as tools to promote and maintain health, as well as intervention and rehabilitation tools for a host of maladies and illnesses related to stress and life-style.

Although this empirical medical approach is relatively new, the study of humor has revealed a complex psychological phenomenon. Senses of humor have been categorized in types associated with personality. Humor has many styles and can be found in almost any situation, on any occasion. Theories of humor include the superiority theory, the incongruity theory, the release/relief theory, and the divinity theory.

Laughter has many clinical benefits, promoting beneficial physiological changes and an overall sense of well-being. Humor even has long-term effects that strengthen the effectiveness of the immune system.

In healthcare, humor therapy can help relieve stress associated with disease and illness. It serves as a diversionary tactic, a therapeutic tool for disorders such as depression, and a coping mechanism. It also is a natural healing component for care givers trying to cope with the stress and personal demands of their occupations.

Feelings are chemical, they can kill or cure.

--Bernie Siegel, MD1

For centuries people have said that laughter is the best medicine, but until recently this fact remained scientifically unproven. However, since 1964, when Norman Cousins incorporated humor therapy in his treatment of ankylosing spondylitis,² the medical world has begun to take more serious notice of the healing power of humor and the positive emotions associated with it.

The relationship between stress (negative emotions) and disease and illness has proven to be profound, with approximately 70 percent to 90 percent of disease and illness strongly associated with stress.³ Cousins’s premise and subsequent health philosophy was this: "If negative thoughts can have negative physiological repercussions, can positive thoughts produce positive effects throughout the body?"⁴ This hypothesis planted seeds for the development of a new medical discipline, psychoneuroimmunology, the study of the mind-body relationship.

Humor and laughter are currently being employed as tools to promote and maintain health everywhere, from the classroom to the boardroom.⁵ In addition to its use in preventive medicine, humor also has a role as an intervention and rehabilitation tool in the clinical setting for a host of maladies and illnesses related to stress and life-style. Although alone it is no replacement for clinical medicine, humor’s supplementary use is now recognized as a powerful aid for both patients and healthcare professionals.

Many a truth be told in jest.

--Geoffrey Chaucer6

Even in the biblical days, humor was considered a tool of therapeutic medicine: "A merry heart does good like medicine, but a broken spirit drieth bones" (Prv 17:22). Greeks included shades of humor in their dramas, with comedy balancing the theatrical scale with tragedy.

The Latin origin of the word "humor" means fluid or moisture. According to medieval physiology, the body hosted four primary humors, each associated with a mood: choler, anger; bile, melancholy; blood, confidence; and phlegm, apathy. An excess of any one of these humors brought on poor health and often ridicule, whereas a correct balance was indicative of "good humor," or health.

Some cultures used humor and laughter to lift spirits and promote health, employing individuals like the European court jesters or Native American shamans. However, humor was not always thought of as good for one’s health. Some cultures associated laughter with the work of the devil. In Puritan times, laughter was considered a moral sin, regardless of the occasion, and even smiling was prohibited.

A smile is the shortest distance between two people.

--Victor Borge7

Although this empirical medical approach is relatively new, the study of humor has revealed a complex psychological phenomenon. Like love, humor has proven difficult to define, with no consensus among scholars. Suffice it to say, humor is the quality of being funny or appreciating funny thoughts or acts, manifesting in smiling or laughter.

With rare exceptions, everyone has and demonstrates a sense of humor. In fact, senses of humor have been categorized into types associated with personality, including "good sport" (laughter at one’s own expense), conventional (eye-to-eye humor, where two or more people laugh at the same thing), creative (imaginative wit), and "life of the party" (an extrovert who makes people laugh).⁸

People have always been curious about what causes laughter, from the incongruous to the ironic. Moreover, humor has many styles, including slapstick, black (gallows) humor, parody, satire, and the lowest form of humor, sarcasm (which literally means to tear flesh). Humor, it seems, can be found in almost any situation, on any occasion. For example, Bernie Siegel writes that once, while performing surgery for a cancerous tumor, he heard Frank Sinatra’s voice on the radio crooning, "Why Not Take All of Me?"⁹

Paralleling the four components of wellness--mind, body, spirit, and emotions--are four theories of humor, suggesting that humor is an important factor in the integrity of the wellness paradigm. The oldest theory of why people laugh is the "superiority theory," an emotion-based theory credited to Plato. It suggests that laughter is a socially acceptable outlet for aggression, where laughter at someone else’s expense elevates one’s own self-esteem (e.g., Dan Quayle jokes).

A more recent theory is the incongruity theory, a cognition-based theory that laughter is triggered by the connection of two or more concepts that seem absurd or incongruous--for example, years ago Charlie Chaplin entered a Charlie Chaplin look-alike contest and got third place. Research indicates that stroke victims with right-sided brain damage are unable to laugh at cognitive-based jokes, supporting the theory that humor is a right-brain cognitive function.¹⁰

Sigmund Freud, in his study of laughter, suggested the release/relief theory, explaining that laughter is a physical manifestation of repressed thoughts of taboos such as sex and death.¹¹ This theory may account for the continued popularity of sexual jokes.

Finally, the newest theory on humor is the so-called divinity theory. It suggests that humor has the ability to make order out of chaos, promote unity and connectedness through shared laughter, uncover the naked truth of a situation, and lift one’s spirit. In essence, the theory goes, humor is a gift from God.¹²

Although humor is classified as a perception rather than an emotion, it can produce many positive emotions, including joy, mirth, hope, confidence, and an overall sense of well-being. It is this expression of emotions which has healing potential. Humor can serve as a positive coping strategy, often used to diffuse feelings of anger or impatience by acknowledging the absurdity of the threat to the ego. Likewise, humor can be used to dispel fear, including fear of the unknown, fear of death, and fear of failure, by providing a wider perspective and clearer focus on the situation. Humor is often used to communicate these feelings to oneself and others by diminishing the stress in an acceptable way. In many ways, humor is a universal language.

Laughter, like a virus, is contagious.

--Art Buchwald13

Physiological research in the field of humor and laughter has uncovered amazing results, suggesting that, indeed, laughter has many clinical benefits. In the short term, laughter promotes many physiological changes; most notably, it stabilizes blood pressure, massages inner organs, stimulates circulation, facilitates digestion, increases oxygen supply to muscles, decreases muscle tension, and promotes an overall sense of well-being.¹⁴ In fact, laughter produces similar, if not identical, responses to those associated with progressive muscular relaxation, a widely recognized relaxation technique used to reduce muscle tension.

In addition, tears produced by laughter differ from those produced by sadness and depression in that they contain toxins the body tries to release through the laughter response.¹⁵ The most remarkable effect laughter may produce is the release of neuropeptides, including the beta endorphine, which act as pain reducers.¹⁶ Cousins, in his now famous testimony, said that ten minutes of laughter gave him two hours of pain-free sleep during his recovery.¹⁷

Perhaps most interesting are the long-term effects of laughter and the positive emotions that accompany it. Current evidence indicates that cells associated with the immune system (the lymphatic system) are activated through a complex mind-body feedback mechanism. Stress-produced emotions trigger the release of cortisol and aldosterone, which in substantial amounts may actually decrease the T-lymphocyte cell count, thereby impairing the immune response. Conversely, positive thoughts and feelings increase the effectiveness of the T-cells and, hence, strengthen the ability of the immune system to operate against illnesses from common colds to cancer.¹⁸ Thus laughter and positive emotions, including joy, love, faith, hope, confidence, and will, contribute to the strength and integrity of the immune system. Although researchers have yet to identify an intensity-frequency-duration formula for the exposure to laughter as with physical exercise, conventional wisdom suggests that daily encounters with humor are beneficial to total well-being.

Humor is mankind’s greatest blessing.

--Mark Twain19

Comic relief, now widely viewed as a viable preventive technique for coping with stress, is also being used in many clinical settings as a supplemental tool in the healing and recovery process for everyone from alcoholics to cancer patients.²⁰

The difference between clinical medicine and humor therapy is most notably found in their application. Whereas clinical medicine is prescribed by a physician and administered by healthcare givers, the use of humor therapy is often more subtle and much less formal. Comic relief arises from the ironies and incongruities acknowledged in everyday life, experiences in which inhibitions are suppressed, allowing a natural flow of emotions. Healthcare givers must be extremely sensitive to the patient’s needs and moods and not force this mode of therapy. Instead, they should take advantage of opportunities initiated by patients to help relieve stress associated with disease and illness.

Humor provides several ways in which it can help patients in healthcare facilities or clinical therapy.

Humor as a Diversionary Tactic
In many ways the hospital setting is the antithesis of the home environment. Illness and death often cast a shadow of intense seriousness, interfering with the expression of the full range of emotions. Experts suggest that on average a person laughs approximately 15 times a day.²¹ In the hospital, however, this number can drop to zero.

Several hospitals across the country, particularly those with oncology wards, are developing humor programs for their patients. These offer rooms with videocassette recorders and compact disc players, in-house humor cable channels, library shelves filled with humorous books, and movable humor carts with a host of resources to promote laughter.²² Clinical staff note that the primary benefit of humor therapy is it serves as a diversionary tactic, taking patients’ minds off their illness and related moods of depression, thus promoting a balanced expression of emotions.

Humor as a Therapeutic Tool
Psychotherapists have discovered humor as an aid in the treatment of several clinical disorders, most notably depression. Although opinions are divided on this issue, humor has been reported to strengthen the bond between client and therapist in the treatment process, increasing the progress toward recovery. Currently, humor is used as both an assessment tool, to help the therapist learn what topics the client wishes to discuss, and as a therapeutic tool, to help dissolve psychological defenses inhibiting recovery.²³

Humor as a Coping Mechanism
Both anger and fear surface in the fight against life-threatening illnesses such as cancer, and care givers can use humor to help patients control these emotions rather than becoming the victim of them, as described by comedian Gilda Radner during her visits to the wellness community.²⁴ Similarly, in the rehabilitation of persons recovering from substance addictions, humor can help them express negative emotions in a positive light, thus relieving feelings of despair and helplessness. Many addictions are related to low self-esteem. Although humor does not necessarily build self-esteem, the ability to laugh at oneself can be a crucial transition in the basic stages of recovery.

Humor therapy in this context is generated by the patient, not the therapist. It is important to distinguish between laughing with a patient and laughing at a patient. Care givers also need to be cautious about--or even refrain from--using sarcasm, since it may be a direct reflection of latent anger. Sarcasm is an inappropriate form of humor in healthcare because it may promote stress rather than reduce it. On the other hand, positive humor can provide ammunition to deal with stress and the emotions surrounding it: anger and fear.

Healing for the Care Giver
Comic relief is a natural healing component not only for patients, but also for care givers. In her book Humor and the Health Professional, Vera Robinson cites the need for healthcare professionals to incorporate humor into their lives to cope with the stress and personal demands of their occupations.²⁵ Humor helps balance the scale of emotions in a hospital setting where morbidity and mortality often cast a dark shadow. Although professionalism is expected in the healthcare industry, an absence of humor is now viewed as unprofessional, supporting the trend to take one’s job seriously, but oneself lightly.

The use of humor therapy on the oncology ward of Shady Grove Adventist Hospital, Rockville, MD, resulted in a significant decrease in employee burnout and attrition for nurses in that ward over a two-year period.²⁶

Professionals can integrate humor into their life-style by making a point to find one humorous thing a day, laughing at themselves, recognizing moments of fallibility, exaggerating events to the point of ridiculousness, looking for life’s ironies, and starting a "tickler notebook"--a collection of cartoons and jokes.²⁷ This is particularly important for the healthcare professional working with AIDS patients or others facing death, as physicians and nurses often transfer their somber emotions to their patients. It is important to balance the workday with supplemental activities that add joy to life.

It’s never too late to have a happy childhood.

--Tom Robbins28

Science is beginning to prove what many people have known all along: that, indeed, laughter is good medicine. Humor and laughter enhance positive feelings and emotions to balance the preponderance of negative emotions that surface during stressful times. Humor and laughter appear to have many healing qualities. The introduction of humor therapy and comic relief programs in many clinical settings as a rehabilitation tool, and in work settings as a prevention tool, reveals the strong mind-body connection associated with humor, which can promote well-being for patients and care givers alike.

For more information about humor therapy, contact the Humor Project, 110 Spring St., Sarasota Springs, NY 12866, 518-587-8770.

NOTES
1. Bernie Siegel, Peace, Love and Healing, Walker & Co., New York City, 1990, p. 17.
2. Norman Cousins, Anatomy of an Illness, W. W. Norton, New York City, 1976.
3. Roger Allen, Human Stress: Its Nature and Control, 2d ed., Burgess Press, Minneapolis, 1992.
4. Cousins, Anatomy of an Illness.
5. Barbara Mackoff, "The Business of Laughter," New Woman, October 1991, pp. 74-75.
16. Geoffrey Chaucer, Prologue to The Monk’s Tale, 1386.
17. Victor Borge, "International Humor Treasure," Humor Matters, vol. 7, no. 4, 1991, pp. 127-139.
8. Ramond Moody, Laugh after Laugh, Headquarters Press, Jacksonville, FL, 1987.
9. Bernie Siegel, Love, Medicine and Miracles, Perennial Library, New York City, 1986.
10. Vera Robinson, "Humor and Health," in P. McGhee and J. Goldstein, eds., Handbook of Humor Research Vol. II, Springer-Verlag, New York City, 1983.
11. Sigmund Freud, "Humor," International Journal of Psychoanalysis, vol. 9, 1928, pp. 1-16.
12. Tal Bonham, Humor: God’s Gift, Broadman Press, Nashville, TN, 1988.
13. Art Buchwald, "The Healing Power of Humor," keynote address for "Humor and Health," American University, Washington, DC, November 27, 1990.
14. William Fry and Waleed Salameh, Handbook of Humor and Psychotherapy: Advances in the Clinical Use of Humorm, Professional Resource Exchange, Sarasota, FL, 1987.
15. Allen Klien, The Healing Power of Humor, Tarcher Press, Los Angeles, 1989.
16. Siegel, Peace, Love and Healing.
17. Cousins, Anatomy of an Illness.
18. Siegel, Peace, Love and Healing.
19. Alex Ayres, The Wit and Wisdom of Mark Twain, Harper & Row, New York City, 1987, p. 109.
20. Erma Bombeck, I Want to Grow Hair, I Want to Grow Up, I Want to Go to Boise: Children Surviving Cancer, Harper Paperback Books, New York City, 1989.
21. James Hassett and John Houlihan, "Different Jokes for Different Folks," Psychology Today, January 1979, pp. 64-71.
22. Norman Cousins, Head First: The Biology of Hope and the Healing Power of the Human Spirit, Penguin, New York City, 1990.
23. Fry and Salameh.
24. Gilda Radner, It’s Always Something, Simon & Schuster, New York City, 1989.
25. Vera Robinson, Humor and the Health Care Professional, Charles B. Slack, Thorofare, NJ, 1977.
26. Christine Flannigan, "Humor as a Coping Strategy for Cancer Patients at Shady Grove Adventist Hospital, Rockville, MD," keynote address for "Humor and Health," American University, Washington, DC, November 13, 1990.
27. Joel Goodman, "How to Get More Smilage Out of Your Life: Making Sense of Humor and Then Serving It," in McGhee and Goldstein.
28. Tom Robbins, Still Life with Woodpecker, Bantam, New York City, 1980, p. 277.

Dr. Seaward is assistant professor, Department of Health and Fitness, American University, Washington, DC.

Laughter guaranteed to lift spirits

By LARA HASTINGS

Life has been a bit of a roller coaster for me lately, with a major lifestyle change, a new job, family members getting sick, getting hurt and dying - not to mention serving two weeks as acting managing editor, recent relationship drama and other personal internal squabbles.

It is enough to seek therapy.

According to the American Psychological Association, about 50 percent of American households have had someone in the family see a mental health professional. I, however, have never made a visit to my local shrink.

Don't get me wrong. I'm no Tom Cruise.

I fully believe in the power of seeking mental health. In fact, most of the people I know, including family members and close friends have seen some sort of counselor or therapist to help them cope when life gets rough.

But I have my own therapy regime that I follow which includes: Working out until I fall over, dancing, writing letters that may or may not ever get sent, going shopping and spending way too much money and of course, having a chat with Mom.

Being with friends also helps me, but the right kind of friends can help me out of the deepest pits of stress and sorrow. These are the people that you may not see everyday, but they know you well and make you feel good about yourself. They help you remember the person you really are underneath - the layers of doubt, negativity and sadness that certain people and events in your life pile on top of you.

To me, these friends are the best kind of therapy.

After a particularly stressful Monday night, my friend Alyse knew I needed some good company, so Tuesday night she invited me out for just that. Our friend, Evan, from college was in town from Wisconsin and I told my friend, Zac, from high school to join us as well.

As soon as I walked in the door of the popular pub we were meeting at, I immediately felt a bit of the weight from the last couple of weeks lift off of me. Alyse and Evan sat at a table smiling at me as I walked towards them.

"What took you so long?" Alyse exclaimed.

Evan sat there with a very "Evan" look on his face, with his hair grown out into an unruly mop.

Zac got there a bit later with his usual spiky, dyed-blonde hair and interesting choice of clothing. I hadn't seen him in years, but he is still the same guy I remembered.

The four of us discussed the finer things in life.

Zac and I told stories about our unique relationship in high school. It was a miracle we ever passed chemistry because we were too busy sitting in the back passing notes about nonsense, making fun of the uptight teacher and doing all the usual disruptive things that teenagers do. We tried to explain the sheer hilarity of Zac's impression of "goat boy" and how everybody in the school knew we were coming down the hallway because of all the noise bouncing off the walls. Just for good measure, Zac demonstrated his talents for the entire bar and we all laughed.

It wasn't any ordinary laugh. It was the kind of laugh where you don't breathe for the first few seconds, then you practically fall out of your chair, tears start streaming down your face and your stomach muscles start to ache worse than the time you over did it at the gym.

It was a true-to-life-that-was-the-funniest-thing-I-ever-heard kind of a laugh.

And the laughter continued throughout the rest of the night.

We laughed when Evan mixed up his credit cards and tried to explain why he couldn't talk to any other women besides Alyse and me. We laughed when the biggest drunk in the place came up to us and we couldn't figure out a word he was saying and we laughed when Evan and Alyse got into a debate over what kind of pizza they should get.

Their advice about certain situations in my life helped me, but the stories, the laughing and the company were the real therapy.

Life hands you a lot of difficult things to deal with, but it helps me to remember that everybody goes through it. Even when you think your problems and tragedies are bigger and worse than everyone else's, somebody in the world has already lived through it and made it out just fine.

Like the saying goes, "S... Happens."

As sad as it is, I can never bring back lost loved ones, I cannot go back to the way life was in college and that certain someone may never call me again, but what I can do is be thankful for what I do have and go on living my life as I see fit - with the help of a little therapy of course and a whole lot of laughs.

Lara Hastings is a reporter for The Kansan City Kansan. If you would like to email her, the address is: lara@kansascitykansan.com

They certainly did, and not only did yours truly get to appear on page three (not topless, so don't panic folks!) he also got this  photo on the front page:

Here is the article in full. Many thanks to the Wigan Evening Post and to the article's author, Rob Calderbank.

Not Feeling well? Just Have a laugh.

Trainee nurse Neil Baxter may not look a happy chappy.
But don't let the 32-year-old from Springfield's glum demeanour – and inability to smile – fool you.

Neil, who is training to become a mental health nurse, is a comedy connoisseur who has launched a website to investigate whether having a laugh has therapeutic value.

Tuesday 20 July 2004.