Monday, July 30, 2007

Mirror Neurons and Laughter

Browse any college's library and you're sure to find several books on the use of humor in psychology. Many of these books are very serious in tone and explain humor using technical jargon and psychological terms many are unfamiliar with, and reading this material it becomes clear that often talking about why something is funny is a surefire way to slowly kill the joy in conversation. I am very wary of this, but am also endlessly fascinated by new research that explains how and why people build connections through humor. With this idea in mind, it is interesting to consider a discovery of something in the brain called mirror neurons, something renowned neuroscientist V.S. Ramachandran says "will do for psychology what the discovery of DNA did for Biology." This is an extraordinary claim, and one that needs further clarification.

What mirror neurons essentially are is a group of neurons first observed in monkeys that "fire" not from the animals own behavior, but through watching the behavior of another animal. Mirror neurons in humans were also found in the interior frontal and interior parietal regions of the brain, and this discovery has potentially enormous implications for understanding and observing human behavior.

So why is this important and what does it have to do with laughter? The implications of mirror neurons begin with the idea that people tend to mimic each other and also feel pain when others around them feel pain. This idea was confirmed by an experiment that showed when people watch someone else get poked with a pin, their pain neurons fire exactly like the person being poked. These neurons came to be known as "Dalai Lama" neurons and showed how empathy works on a cellular level.

With this in mind I decided to conduct an experiment of my own to see the affects laughter had on mirror neurons. Although I didn't have magnetic imaging equipment or a fully equipped laboratory at my disposal, I did have the ability to measure hand temperature which is a standard technique used in biofeedback. I took 30 people ranging in age from 20 to 41 years old who suffered from headaches, and explained a little bit about mirror neurons and an interesting conversation ensued. Because these patients all had headaches and were all staying in close proximity to each other, someone suggested that perhaps their headaches were affecting those around them, which was exactly where I hoped the conversation would go.

A word about this. A common complaint from the hospital staff I know that works with headaches patients is that they commonly leave work with a headache. Although there are a couple plausible reasons for this such as the power of suggestion, I also believe that mirror neurons may provide an excellent explanation. With the thought in mind that mirror neurons may affect headaches, I wanted to see the effect a positive event such as laughter would have on headache patients, and with this in mind designed a simple experiment.

I first had the patients measure their hand temperatures under normal conditions and then measured the results. The scores ranged from 74 degrees to 93 degrees which is a fairly normal range for headache patients who are on a wide variety of medications that affect their temperatures a great deal. The idea is that the colder a person's hand temperature is, the worse their headache may be, as blood rushes to the head and away from the extremities during a headache. If a person can warm their hands up using biofeedback, they therefore can often reduce the physiological mechanisms of the headache. In my small experiment, the mean temperature at the beginning of the experiment was 83 degrees. The mode of the scores was 84 degrees, which 7 of the patients recorded.

The variable in the experiment was the movie Office Space, in my opinion one of the funniest movies to come out in the last 15 years. I had everyone gather in the common area to watch the movie, and, as I expected soon everyone was laughing heartily including myself. Beyond the fact that the movie itself was so funny, everyone also seemed to be enjoying each other's company.

At the end of the film I again had everyone measure their hand temperature, and this time the results were extremely interesting. Following the movie, the scores ranged from 79 to 92 degrees, but the mean score was now 87 degrees which was 4 degrees higher than at the beginning of the experiment, indicating that the laughter had significantly increased the relaxation response in the patients. More interesting was the mode of the scores. Following the movie 15 of the 30 patients recorded a score of 86 degrees. In effect half of the patients now had the exact same score following two hours of laughter. So not only did the laughter relax everyone, but it also relaxed half of the people in the room in so much the same way that their bodies were responding in an identical manner. This phenomena was also represented by the decrease in the range of scores, which was 19 degrees at the beginning of the experiment, and only 13 degrees following the movie.

So, although from a statistical standpoint my study wasn't big enough to make waves, I still became all the more convinced of the power laughter has on people's physical bodies and health. Beyond the measurements, people were also genuinely happy at the end of the film, and laughing together had provided some much needed pain relief for several of the participants. The positive energy in the room was clearly contagious, and much like the laughter clubs I visited, the act of laughter was all the more powerful when experienced communally. Although the study of mirror neurons on a molecular level is being done by much smarter people than me, I'm convinced of their power, and learning and studying about this discovery only strengthens my faith in the healing power of laughter.

Saturday, July 28, 2007

Stumbling on Happiness

Tomorrow, and tomorrow, and tomorrow
Creeps in this petty pace from day to day,
To the last syllable of recorded time;
And all our yesterdays have lighted fools
The way to dusty death

Life is what happens to you while you're busy
making other plans.
John Lennon


One of the most interesting books I've read in the last couple of months is Daniel Gilbert's
Stumbling on Happiness
Gilbert's premise is that we often make decisions in our present with the idea that these things will benefit us at some future time. We deny ourselves things and save our money thinking that our future selves will enjoy and appreciate these sacrifices, only to arrive in the future full of regret about our past decisions. How can this be? Gilbert makes the point that we are often very poor at predicting what will make us happy in the future, and that we often arrive in the future baffled by the decisions we made in the past.

So what is the lesson here? I took this lesson as a kind of "Carpe diem" (Seize the Day) message, and that because our future selves are often so disappointed with us, perhaps the idea is to indulge in and appreciate the precious present.

I recently came to appreciate this lesson when I used a service called "future me." The purpose of this site is to allow people to send themselves an email at some designated point in the future and then reflect back on how they were thinking at the time they wrote this letter. I recently received one from myself I had written two years ago and it was filled with angst, unrequited love, anxiety about unpaid bills, as well as a glimmer of hope for the future. At the time I had never published a book, was pining away for some girl who I now barely remember, and was worried sick about some financial concern that I now see was ridiculous. Why was this guy so stressed out? I wanted to go back and tell him that everything was going to be fine, and that things were going to work out pretty well for him if he would just hang in there. I was also sad to see how little I was enjoying life at that moment, and how the things I was ruminating about at the time turned out to be virtually meaningless in the future.

So, although I was disappointed in seeing the lack of joy in my past self's life, I also learned a valuable lesson about how the things we worry and obsess about rarely come to fruition. I now do things with little thought for the future me, as I realize he is a very harsh judge and difficult to please. I try to constantly live in and find pleasure in the moment, and, although I now may error on the side of hedonism, I find that this is certainly the best recipe for finding humor in everyday situations.

The dangers of mortgaging the present to pay for the future was also demonstrated to me again and again when I worked in a couple of different Nursing Homes. Most of the patients I interacted with had experienced the depression, and this experience indelibly stamped the idea that money should be saved. Again and again I saw people who were struck with Alzheimer's right as they were getting ready to enjoy their "golden years" and it never failed to break my heart. I heard many stories of how people denied themselves everything during the first 65 years of life so they could finally travel and see the world when they got older, only to arrive at retirement to be struck by a debilitating illness. It wasn't uncommon for a couple to have saved as much as a million dollars for their retirement, only to see this entire amount disappear in a couple of years as the health care industry slowly ate away at their savings. This may in fact be the rule rather than the exception, and this is I hope a cautionary tale for anyone who continually denies themselves things in the present. Life is uncertain, but what is a virtual certainty is that as medical science continues to expand the ability to keep people alive, now roughly 80 percent of people will eventually die in a hospital, and this number continues to get bigger. This virtually guarantees a drain on people's savings, and my advice is to spend your money enjoying things now, as the medical system will find a way to get a lot of it before it all said and done.

So am I advocating not saving at all? No, but there is a lesson here about living in the present, and there is an even greater lesson here about the futility of ruminating about the future.
Most of what awaits us is simply unknown, and as we continue to worry about the future precious opportunities to experience joy in the present continue to pass us by. This is where the relationship between mindfulness and humor becomes essential. Every moment in life can become a wonderful learning opportunity if we stay in the here and now. Many people will tell you humor is about "timing", and when we use our time to obsess about some future or past event, the joy of the moment has past. This is the lesson of Gilbert's book, and it speaks directly to the power of mindfulness in alerting us to the comic possibilities around us.

Friday, July 27, 2007

Albert Ellis-Rest In Peace You Magnificent Bastard

Albert Ellis died today, arguably as one of the most widely disliked psychologists of all time. He was 93 years old and to his dying day espoused the principles of Cognitive-Behavioral Therapy he had created over the last 50 years. He will undoubtedly be remembered as one of the most influential psychologists of all time.

I had a chance to see Albert Ellis talk around the turn of the century when he was in his 80's and I was still very new to the field of psychology. I saw a picture of this little man with Harry Carrey glasses and wondered what the big deal was about this little guy; until he opened his mouth. In the first 30 seconds of his speech this nearly 90 year old man let out a stream of obscenities that would make a truck driver blush, and this was before he was even done with his introduction. I knew I liked this man immediately.

Albert Ellis used humor in therapy like no other therapist had before and likely ever will again. A favorite tactic was blowing up someones anxiety to comical proportions so they could see the absurdity of their faulty thinking. Ellis was not afraid to openly mock his client's thinking in a therapy session, careful to explain that he wasn't mocking the client but instead their way of thinking. He believed that by aligning with the client against their self-defeating behavior, he could create a situation where people could begin to get some perspective on how the way they thought about the world was responsible for much of their problems. Ellis created dozens of funny songs over the years about the absurdity of faulty thinking, and he passionately stuck by his principles despite being openly dismissed as irrelevant by most of the psychological establishment.

A 1982 survey listed Albert Ellis as the second most influential psychologist in history. Despite upsetting the powers that be in psychology for over half a century, his contributions eventually prevailed, and Cognitive-Behavioral therapy is now arguably the most widely practiced branch of psychology today. Although many disagreed with Ellis' particularly harsh brand of humor, he was undeniably one of the most influential pioneers of using humor as a way to cope with the world. He was also personally a very funny man, and his especially unique use of humor in the therapeutic situation will be analyzed and discussed for many years to come. As someone who was personally very much influenced by his emphasis on taking personal responsibility for one's actions, I am deeply saddened by this loss, but also know that his contributions will live on. Rest in peace you magnificent bastard.

Thursday, July 26, 2007

The HA HA HA Prescription for Wellness

Ask nearly anyone you meet on the street to tell you a story about health care, and there's a good chance they'll tell you about their interactions with a particular doctor. Many of these stories will be negative. In my own case I checked into a hospital a couple of years ago after experiencing the most intense pain of my life. Sure I was dying, I waited for 3 hours in the emergency room before the nurse called my name, and, after a few short examinations and an X-Ray, I heard the two words no man ever wants to hear; Kidney Stone.

Ever seen one of those pictures of a snake that has swallowed a huge animal? That huge animal is the kidney stone in your urethra. It was not pleasant. When I finally saw a doctor 5 hours after I arrived he spoke to me for 10 seconds, prescribed some Vicodin, and sent me on my way. A week later I got a bill for 500 dollars.

All things considered, this is a minor story that pales in comparison to most people's misfortune. The point is, more than any other time in the history of the profession, doctors have lost the trust of their patients.

That being said, there are doctors like Clifford Kuhn who walk among us that truly represent the idea that a doctor is a "healer." Not Surprisingly, Kuhn believes laughter is one of the most powerful forces that stimulates this healing.

Kuhn is one of many cutting edge doctors who have come to understand the relationship between the body and the mind, and the role a person's attitude plays in their recovery. What is especially interesting in Kuhn's case, is, although he was prescribing laughter as a mechanism of recovery to the patients he was working with, those same patients told him, in a nutshell, that he wasn't following his own prescription. He had turned into a drip, and hearing this Dr. Kuhn decided to do something about it. Kuhn began hanging around comedians and observing how they worked, came up with material, and interacted with their audience. Soon he was doing stand-up himself, and he left his position at the hospital and began touring around the country as a stand-up comedian, hoping what he learned on the road would ultimately help him become a better doctor.

Kuhn's time on the road helped him create his HA HA HA prescription for laughter. His first "HA" is what he calls Humor Attitude. Humor attitude is a way of looking at the world and recognizing humor in everyday situations. Kuhn explains that many people are afraid to laugh at traditionally serious places like work or school, but that adopting an openness to seeing humor everywhere can lead to a major change in one's way of seeing the world. Kuhn emphasizes humor attitude is not about being funny but instead about having fun. Some people are more comfortable being in the audience than "working the room" and Kuhn emphasizes this is perfectly fine. Sometimes it is the people in the audience that ultimately have the most fun.

The second "HA" is what Kuhn refers to as Humor Aptitude. Kuhn emphasizes that as babies we are born smiling, and become especially delighted when we recognize a familiar face, but that somewhere along the way we lose this joy of simply being with others. He emphasizes that the simple act of smiling is itself contagious and leads to laughter, and that this one thing can help us take ourselves much less seriously.

The third and final "HA" is what Kuhn refers to as Humor Action. Kuhn describes how listening carefully is the key to humor action, as through truly listening as opposed to simply waiting for our turns to talk we can focus our attention on others, create stronger interpersonal connections, which ultimately establishes the trust necessary to share real laughter with another human being.

Finally Kuhn has come up with a list of "fun commandments" which he feels provide a recipe for a successful life,
Dr. Kuhn's Fun Commandments
  1. Always Go the Extra Smile
    Of all my Fun Commandments, this one provides you with the most energy. It is the one strategy most effective for increasing the fun in your life. Smiling is a way to open your heart and at the same time touch the hearts of others. We have measured decreased stress, improved immunity, increased tolerance for pain and frustration, and higher levels of creativity - even from a "fake" smile!
  2. Tell the Truth
    Of all my Fun Commandments, this one helps you keep an inventory of yourself. Our humor natures are open windows to the truth; therefore, if you want your sense of humor to be strong and available, you must make the effort to be true to yourself. This Commandment promotes trust in yourself and keeps you on a steady, forward pace since you will be much more cognizant of what is working in your life and what isn't.
  3. Laugh With Yourself First
    Of all my Fun Commandments, this one helps you take yourself less seriously. When you make a mistake, laughing with yourself keeps you from beating up on yourself. It is a boost to your self-esteem because it is a vote of confidence in yourself. This Commandment sends a clear message to you that you are okay. You know that your foibles do not form links in an unbreakable chain, because you are learning from them and becoming more effective.
  4. Welcome Your Mistakes
    Of all my Fun Commandments, this one allows you to stop being so hard on yourself. Jerry Lewis once told me that he is always nervous before he goes on stage, but "the trick is to harness the fear and make it your ally." In other words, don't be afraid of your mistakes - welcome them! In fact, your mistakes can be so helpful to you that I suggest making them on purpose. You're going to make mistakes anyway. Making them on purpose helps you turn your fear into fun.
  5. Listen Very Carefully
    Of all my Fun Commandments, this one keeps you from being too self-centered. Successful comedians will tell you that the capacity to listen is their number one creative tool. Yet listening is an often overlooked and under taught skill and most of us are very poor at it, preferring to form our next phrases rather than hear what is being said to us. To really listen we must turn the volume down on our own internal chatter and this allows us to communicate from our hearts rather than our heads.
  6. Let Go Frequently
    Of all my Fun Commandments, this one provides you with serenity. If you've ever learned to juggle you quickly discovered that we all have a tendency to hold on to objects for too long. The same phenomenon occurs in life and, since we are all jugglers - juggling our family, our work, our community responsibilities, and our own care, letting go is a vital skill that will prevent stress and give peace of mind.
  7. Challenge Your Assumptions
    Of all my Fun Commandments, this one keeps you open minded and learning. It is also an effective way to bring humor into your life. We make assumptions because it saves us time and energy in our busy lives, but assumptions can keep us from growing and changing if we are not capable or willing to see new perspectives. Get in the habit of seeing things around you in a different way and your sense of humor will become supercharged.
  8. Stay Focused, Yet Flexible
    Of all my Fun Commandments, this one eases you through changes and transitions. This strategy is about keeping your priorities clear, but keeping your options open. You can't help but become an inspired opportunist when you develop a trait for seeing the victories inherent in what you used to call defeats. As you'll come to find out, this trait is shared by all successful people.
  9. Act and Interact with People
    Of all my Fun Commandments, this one gives you a constant and reliable source of amusement. Reaching out and touching someone is often a learned skill, but it pays big dividends. Realize that taking chances means you will make mistakes, but they will happen less often if you are willing to learn from them. You'll also find that a failed action is much more valuable to your health and success than a failure to act.
  10. Practice Wanting What You Have, Rather Than Getting What You Want
    Of all my Fun Commandments, this one helps you attract, and hold on to, abundance. One of the great paradoxes of life is that, as long as you try to fill your inner void with things outside yourself, your void only gets bigger. Learning to love what we have and who we are - right now - opens us up to receive so much more, because we want things for the right reason. We're no longer trying to "fix" ourselves.
  11. Choose to Motivate Yourself With Fun Rather Than Fear
    Of all my Fun Commandments, this one teaches you how to set goals and achieve them. You really only have the choices of fun or fear when it comes to motivation and they both work well. The problem, however, with choosing fear is that it is impossible to sustain the motivation without harming ourselves through burn-out and stress. Choosing fun to motivate ourselves is the simple difference of striving toward positive goals, rather than escaping negative ones.
  12. Celebrate Everything
    Of all my Fun Commandments, this one provides you with abundant joy every day. If you make a practice of celebrating events you normally treated as mundane, you will be filled with an energy and spirit that you haven't felt since childhood. Left to choose between feeling like a jaded pessimist or a naive optimist (of course, I'm using two extremes as examples), why wouldn't you choose the latter? Either way, your life will still unfold around you - but you will see it as a gift.

Reading about Dr. Kuhn's life and work, I reconsidered my attitude towards doctors and better understood that despite the reputation many doctors have, there are those like Dr. Kuhn who really do "get it." Perhaps the lesson here is that, much like Dr. Kuhn's patients called him out on his own hypocrisy regarding humor many years ago, we as consumers can demand more from our own doctors. All too often I see the patients I work with cede all control to the all-knowing doctor, when they themselves are often their best diagnostic tool. Don't be afraid to tell your doctor to lighten up a little, and if they give you trouble I can supply you with a great deal of research about how the quality of the relationship between the patient and doctor is integral. Ultimately medicine is a business, and as the consumer you have the right and responsibility to demand more if you feel your concerns are not being heard. More importantly listen closely to see if your doctor has a sense of humor. Dr. Kuhn feels this is the single most important trait a healthcare leader can have, and if your doctor is missing this it may be a cause for concern.

Wednesday, July 25, 2007

The Rain Man, Reclaiming Joy, & There’s Something About Mary

One of the pivotal scenes in the movie Rain Man occurs when Raymond, who has been repetitively repeating the "Who's on First" monologue from Abbot and Costello throughout the movie, finally comes to understand that the routine has no answer and is in fact a joke. Being autistic, Raymond didn't find funny what most people did, but finally understands when he bonds with his brother. He expresses this realization through humor, and it is a beautiful moment and a beautiful lesson.

This Rain Man analogy can also be applied to many people who seek psychological services, as they too have lost the ability to recognize the opportunity to appreciate humor in their lives. Often they come in bewildered that others "get" something about life that they don't, and that somewhere there is a parade passing them by that no one bothered to extend them an invitation to.

The beauty of the scene in the Rain Man  was that it wasn't that Raymond out of nowhere suddenly understood comedy, but his laughter was instead a reflection of the fact that he had built a relationship. This relationship with his brother was difficult, painful, and occasionally exploitative, but in the end it was something that dramatically changed and improved his quality of life. Friendships are sometimes like this. Although we may at times feel friends are a drain on our time and our emotional resources, it is ultimately our relationships with others that determines our happiness in life. 

The wonderful psychologist Alfred Adler suggested that all problems are ultimately social problems, and this is especially true with the amount of laughter we have in our lives. My experience teaches me that people who aren't laughing enough have almost always found a way to physically or emotionally isolate themselves from others. This is the rub. Often people who experience alienation feel that no one could possibly understand the world the way they do, and you know what? They're right!!!! The way we all individually process the world is so different that it is a wonder that we are able to make connections. But somehow we do, and in understanding why this is, I want to share a personal anecdote about my own road back from alienation.

The year was 1998 and I had been in Chicago for a couple of years. I moved to the city thinking I would be whisked away to Saturday Night Live within a couple of months in the city, but in reality I was often performing more for the busboys I worked with than the American Public, and I sank into a deep depression as my dream seemed to move further and further away. Alienation set in. I felt like I was the only one in the world who had a dream that didn't quite work out, and I stopped returning phone calls as I continued to wallow in my own pity. One day a friend came in to the bar I worked with and told me there was a movie I absolutely must see. It was called There's Something About Mary and, although I hadn't been out socially in months, I pulled myself together and went to the show.

Arriving at the movie, I took a seat in the back and settled in. Soon, although I was sure the movie wouldn't be that great, I began to laugh, and then I began to really, really laugh. In my laughter I looked around and saw that people were in near hysterics from watching the movie. Monitoring my own laughter and looking around and seeing people go so crazy, I soon got caught up in the hysterics and, for the first time in months, laughed so hard that my stomach hurt.

The next day I returned, but this time instead of watching the movie, I found myself watching the people watching the movie, and it filled me with a sense of pure, unadulterated joy. Seeing others happy made me happy, and for the first time in quite some time I felt that I was a member of the parade again. On my third day watching the film, Albert Camus' statement "In the midst of winter, I finally found there was within me an invincible summer" rushed into my head, and this became a mantra that would get me through the next several months of my life.Looking back on those days, I now understand that it was the laughter that brought me back from the brink. Much like the Rain Man I had found a way to connect to others, and this connection reawakened me to the possibility of joy in my life. It was truly a magical transformation, and one I'll never forget as I work with people who have lost the sense of joy in their own lives.

Tuesday, July 24, 2007

Becoming attached to suffering

Much of the work I currently do is with headache patients, who many psychologists feel are one of the most difficult populations to work with. In many cases with a headache patient their symptoms don't show up on an X-ray or any other physical measurement of illness, yet they describe excruciating, debilitating pain that renders them unable to work and attend to their families, and often results in hospitalization.

Because many of their physical symptoms don’t register on medical radar, it is often suggested that these patients are faking or exaggerating their symptoms, and this then becomes a very difficult pain to treat effectively. Is the answer to provide them with large doses of pain medication? This has certainly been the most common approach to the problem, but it is also rife with difficulty. 

These medications are highly addictive, and become a crutch which may imprison the headache patient for the rest of their days. The fact is that pain medications often simply block the pain signal from going where it wants to go, without remotely addressing the source of the pain itself. The drugs in effect become a very expensive band-aid that one can easily become dependent on, and this creates the kind of “repeat” customer that returns to the hospital again and again and again.

Regarding this dependence on drugs, it is important to remember that everything a drug can do, THE BODY CAN DO BY ITSELF!!! This is why drugs work. They mimic the body’s own natural painkillers such as endorphins which are as powerful as any pain medications we have ever and likely will ever create.
So how do we access these endorphins? Many runners will tell you that the “runners high” that they experience during exercise is as pleasurable as anything they have ever experienced. This explains why exercise can become addictive as people want to duplicate this wonderful feeling as often as possible. A psychiatrist named William Glasser wrote a book about this very thing called Positive Addictions (1976), and his work has influenced an entire generation of people to replace unhealthy behavior with more adaptive ones such as exercise.

But what does all this have to do with laughter? The fact is laughter can activate these very same endorphins. According to Dr. Lee Berk ,
who has done a great deal of research on the study, laughter provides
“An increase in the number and activity level of natural killer cells that attack viral infected cells and some types of cancer and tumor cells.
An increase in activated T cells (T lymphocytes). There are many T cells that await activation. Laughter appears to tell the immune system to "turn it up a notch."
An increase in the antibody IgA (immunoglobulin A), which fights upper respiratory tract insults and infections.
An increase in gamma interferon, which tells various components of the immune system to "turn on."
An increase in IgB, the immunoglobulin produced in the greatest quantity in body, as well as an increase in Complement 3, which helps antibodies to pierce dysfunctional or infected cells. The increase in both substances was not only present while subjects watched a humor video; there also was a lingering effect that continued to show increased levels the next day.”
Pretty convincing stuff, yet still a lesson many people understand philosophically but still chose not to implement in their own lives. The single most common personality trait I notice in the patients I work with is a state of anhedonia, or lack of joy, that permeates everything in their lives and eventually presents itself as a painful headache. I don’t doubt their suffering when I see this, but also understand that there is a solution which has worked for thousands of years. As Nietzsche said it, “man alone suffers so excruciatingly in the world that he was compelled to invent laughter." Laughter and joy are the road back to life, and with these tools our pain can become manageable, and as the Buddha admonished, we can accept suffering yet still find joy in the simple act of being in the world.

Monday, July 23, 2007

Radical Honesty, Freedom, & Laughter

Brad Blanton believes in telling it like it is. His book Radical Honesty written in 1996 hypothesizes that much our personal unhappiness comes about as a result of the lies we tell to ourselves, and lies about ourselves we tell to others. He writes that we can become so obsessed with managing other's impression of us, that we eventually destroy our physical and mental health trying to keep this house of cards we have constructed from falling down. Blanton believes that by being totally honest in our lives we may liberate these bonds that constrain us, and in doing so find a way back to lives full of joy and new possibilities.

Is he right? Reading his book I was struck again and again of his discussion of honesty as a kind of liberation, and in reading this I thought back on my own life and how good it felt getting a particularly cumbersome weight of dishonesty off my shoulders. So what does this have to do with laughter? My thoughts are that much of the dishonest communication that occurs between people does in fact have to do with impression management, and that perhaps laughter can be the bridge across our obsession with what other may think about us. The people I like the most in my own life all have the same kind of self-deprecating humility that consistently comes out in their communications with others. Their willingness to laugh at their own limitations never fails to ingratiate them to the people they are around, and seeing them at work I've learned that it is often the people who are the most humble that I end up admiring the most.

So is there a relationship between humor and honesty? It has been my experience that the answer to this is unquestionably yes. The funniest things are often those observations that reflect pure honesty about the human condition back to us in a way that utterly convinces us of our shared absurdity. Rather than reject this absurdity as meaningless, we may find comfort in the fact that we are all going through this together. As Elvis Costello put in so eloquently in his song The Angels wannna wear my red shoes "I used to be disgusted, now I try to be amused." Good advice about the kind of passive volition that fuels the fire of wisdom.

One closing thought about honesty and laughter in relationships. Think about the people in your life you have shared a true, hysterical, rolling on the floor, out of breath, fit of laughter with. What did they all have in common? My guess is these people are nearly always those we have the most trust and honesty with in our personal relationships. It is these people who know everything about us, and have seen us at our best and our worst that we are able to really let ourselves go with, and it is personal honesty that likely makes this possible. These moments of true and unequivocal laughter with another human represent the most powerful kind of human connection we can find, and in these moments we are utterly and totally free of modesty, vanity, and fear. Dropping these pretensions makes this possible, and speaks volumes about the power and relationship of laughter and honesty in creating human connections.

Sunday, July 22, 2007

Patch Adams-The Patron Saint of Laughter

"The creative individual cannot grow up because he keeps growing."
-Eric Hoffel

If Norman Cousins was the Lazarus of laughter, then Saint Paul would have to be Patch Adams, who has spread the word about the healing power of laughter into some of the darkest places on the globe. Many people are familiar with the movie about this wonderful man, but many may not know he also travels to places ripped apart by war and ethnic cleansing like Bosnia where he continues to spread the word. Patch and his clowns have worked with Aids patients in Africa, refugees in Afghanistan, as well as with children in Haiti and El Salvador, and have found that laughter can reach people even in the utter depths of despair.

What Patch also found was that beyond medical attention, what many people needed was stimulation and to reconnect with their fellow human beings. He found that many "medical" conditions were in fact a symptom of a loss of connection with life that manifested itself in a person's biological conditions. This was often the case with the elderly people I worked with in my own life, as the decline in their physical health often coincided with their loss of connection with the outside world. By providing stimulation and laughter we were able to provide a kind of reconnection, and this often had positive implications for their physical health that made even the most skeptical medical practitioners take pause.

In Patch's own words, "we found that the vast majority of our adult population does not have a day to day vitality for life (which we would define as good health). The idea that a person was healthy because of normal lab values and clear x-rays had no relationship to who the person was. Good health was much more deeply related to close friendships, meaningful work, a lived spirituality of any kind, an opportunity for loving service and an engaging relationship to nature, the arts, wonder, curiosity, passion and hope. All of these are time-consuming, impractical needs. When we don't meet these needs, the business of high-tech medicine diagnoses mental illness and treats with pills."

These are very wise words that got me thinking about the idea of loss as it relates to physical health. As Mental Health practitioners understanding what a person has lost in their life often reveals important clues as to what brings a person in to see us. Have they lost their job? Their marriage? A close friend? Their looks? Their youth? Asking these questions offers important clues as to the origins of a person's problem, and the answer to these questions may be a prescription for all of the things Patch Adams describes above as a "road back" to life. The key to this road back begins with laughter, as through laughing we can begin to filter life's losses through the wisdom and humor of our shared humanity. By learning to laugh at our own misfortunes we may develop a deep kinship with our fellow travelers as we take solace in our common fallibility. This creates connections, and these connections help us build relationships, and laughter is the glue that may bond these relationships together. Patch Adams has spent a lifetime demonstrating the power of this simple yet elegant principle, and his life has been an example of the power of this idea.

Friday, July 20, 2007

How the Marx Brothers brought Norman Cousins back to life.

Of all the research I’ve done on the healing power of laughter; none has failed to top the amazing story of Norman Cousins, as his life truly speaks to the incredible power of laughter. Having read several varying legends about Cousin’s actual story, I decided to read his book Anatomy of an Illness and get to the source of the legend of the man who claimed to have literally laughed his way back to health.

His story began in 1964, where doctors found that the connective tissue in his spine was deteriorating, which a condition is known as Ankylosing Spondylitis. The doctors, one of whom was a close friend of Cousins, speculated that his chance of survival was approximately 1 in 500.
Faced with the real prospect of his impending death, Cousins thought long and hard about what role, if any, he could play in his own recovery, and eventually did three things utterly contrary to medical opinion.

First he began his own research on all of the various drugs he was on. He discovered that his condition was depleting his body of Vitamin C and, based primarily on Cousins’ personal research, doctors agreed to take him off several of the drugs he was on and inject him with extremely large doses of this supplement, as Cousins felt this may be his last hope.

Secondly, Cousins made a decision to check himself out  of the hospital and into a hotel room. Cousin’s had concluded that hospitals, with their haphazard hygiene practices, culture of overmedication, general feelings of negativity, and routines that disrupted basic sleep patterns, all contributed to his feeling that, in his words a hospital was “no place for a person who is seriously ill.”

The third thing Cousin’s did was procure a movie projector and a large supply of funny films, including numerous Candid Camera tapes and several old prints of Marx Brother’s movies. On his first night in the hotel Cousins found that he laughed so hard at the films that he was able to stimulate chemicals in his body that allowed him several hours of pain free sleep. When the pain would return he would simply turn the projector back on and the laughter would reinduce sleep, and he was able to measure the changes in his body by measuring his blood sedimentation rate, a key measurement of inflammation and infection in the blood, and found that this rate dropped by at least 5 points each time he watched one of these videos.

Now off everything except Vitamin C and laughter, Cousins described being in a state of euphoria over the next week as he continued to laugh himself back to health. Within a few weeks the beloved editor was back to work at the Saturday Review, and, although he still had some minor physical difficulties, his body continued to recover as he continued with his self- directed wellness program.

How in the world did this happen? In exploring this question it is interesting to consider Cousin’s own state of mind, and how much his personal will to live as well as his personal attitudes contributed to his miraculous recovery. While in the hospital Cousins hypothesized that if negative emotions such as anger and frustration could contribute to poor health, why couldn’t positive emotions such as joy and laughter have the opposite effect? Cousins soon embraced this idea, and this contributed to an optimistic attitude that may very well have saved his life.

So could Cousin’s recovery be considered a mechanism of the placebo effect? In answering this question Cousins himself spoke to famous endocrinologist Ana Aslan who posited that creativity was the central trigger of the placebo effect, as it sets up a chain of events in the body’s systems that eventually restores homeostasis and feelings of wellness, The implications of this assertion are potentially enormous, and certainly deserves further study.

In analyzing the potential placebo affect in his own case, Cousins attributed much of his own success to the close personal friendship and relationship he had with his doctor who fully supported his contributions to his own recovery and encouraged his highly experimental approach despite it not fitting with his preconceived medical model. This idea once again speaks to the power of the relationship between doctor and patient, which is now nearly universally accepted and statistically verified as the single most important predictor of positive outcomes in talk therapy. But could this also be true for physicians and patients in the world of medicine? A great deal of research seems to suggest that it is, and Cousin’s case certainly speaks to this idea.

Most fascinating about Cousin’s story though is the laughter. Despite intense pain and discomfort, Cousin’s made a point of laughing so hard his stomach hurt during the early stages of his Marx brother’s intervention, and this “unquenchable” laughter never failed to produce a strong reduction in his feelings of pain. Cousins goes on to mention many prominent thinkers throughout the ages who knew about the healing power of laughter, and this list includes Sir Frances Bacon, Immanuel Kant, Sigmund Freud, as well as the great Albert Schweitzer. This list could be much longer, and Cousins own story has given rise to many knew ways of thinking that helped contribute to the rise of phenomena such as the laughter club. Ultimately laughter may represent the rapture of the human spirit, and in finding this rapture we also find our way back to health. Norman Cousins certainly thought so, and his journey back to life through laughter is an inspiration to us all.

Thursday, July 19, 2007

Learned Humor Styles

Although Dr. Kataria, the creator of laughter Yoga and others like him have shown that the act of laughter itself is therapeutic, it is also useful to explore the different kinds of humor styles and how these styles affect our interactions with others.

Through my work in the schools I learned that, although kids love to laugh, there can also an element of this laughter that is at the expense of smaller and weaker children. This idea has certainly been around long before I myself was getting wedgies from other children, and bullying is in fact one of the most destructive forces in the educational system.

At the root of bullying may be the intense need to belong, which psychologists like Alfred Adler thought was one of our most primal and powerful instincts. Kids quickly learn that the class clowns receive more attention than other children, and this sends a powerful and conflicting message. Somewhere in our early socialization we find that, although we are trained to respect and listen to the teacher, there is one of them who doesn't look and talk much like we do, and 30 people about our size whose opinions of us quickly becomes much more powerful than the lone teacher.

So we quickly learn to use laughter to become closer to the rest of these people we suddenly find ourselves together with. Often this laughter gets directed at the kids that are the most different, and laughter becomes a powerful tool of conformity that may be used to distance ourselves from those that don't belong.

So how do we teach healthy laughter then becomes the question. It has been my observation that laughter becomes a kind of wisdom when we learn to make a joke at our expense as part of a larger pattern of laughing at the absurdity of the human condition. Pretty heady stuff to teach a second grader grader, but within this idea there lies a powerful understanding of the world. Communal laughter implies thoughtful realization, that I like you, have things happen that are out of my control. Laughter involves choosing to view these things with a kind of passive volition that implies an understanding of how chaotic this shared voyage we are on can really be, and when we come to realize this we have turned a significant corner in our own growth and maturity.

The idea of humor styles has also been written about by Louise Dobson (2006) who contributed a wonderful piece to Psychology Today on this very subject. Dobson begins by talking about how humor was initially thought to be an indication of aggression. This idea fits well with the kind of humor that is often used in bullying, and this kind of humor intersects when people have found a way to combine their anger and their need to belong in a way that uses humor to build themselves up while tearing others down. Dobson talks about how someone like Ann Coulter represents someone who often uses this kind of humor, and hearing her mock presidential candidate John Edward's deceased son, this certainly seems to be the case. People like herself and Rush Limbaugh have built their entire reputations from mocking and taunting others, and one can make a guess that these behaviors may be a compensation for maladaptive behaviors regarding humor they learned early on in life.

Another category Dobson refers to as "self-hating" humor, and she lists Chris Farley and John Belushi, as examples of this kind of humor, a subject I wrote about at length in my book The Tragic Clowns
This kind of humor is also closely related to patterns developed in childhood, as kids who are picked on learn to make fun of themselves before others have a chance to. Many of the world's great comedians in fact honed their comedy skills through this socialization pattern, as they became so adroit and entertaining others through mocking themselves that they eventually became famous for it. Farley was the classic example of this, and this pattern eventually permeated every other phase of his life to the point where he completely self-destructed.

The next category Dobson refers to as "Bonding Humor" and this is the kind of healthy humor I earlier referred to as "communal" which implies a shared understanding of the comedy of our shared humanity. This kind of humor is also at the root of the power of the laughter clubs, as they provide a place to leave worries at the door and participate in a moment of unconditional, shared joy with their fellow human beings. So how do we "teach" this kind of humor, and is this lesson worthwhile? I believe and contend that communal laughter is something people deeply desire to be a part of from the very beginning of life. Returning to the idea of the power of "belonging," perhaps if we emphasized the power of laughter that promotes belonging before the powers of socialization preverts the use of humor in our schools, we could prevent bullying before it has a chance to begin. That was my experience working with kids, and seeing this transformation was truly inspiring. Despite abuse, neglect, and isolation, I found that children ultimately craved the chance to laugh along with others in the same situation. When they reached this place the bullying disappeared, and this humor lesson taught me at least as much as I taught the children.

Saturday, July 14, 2007

Children and the Healing Power of Laughter

The Fiddler of Dooney
By William Butler Yeats

The Fiddler of Dooney

WHEN I play on my fiddle in Dooney,
Folk dance like a wave of the sea;
My cousin is priest in Kilvarnet,
My brother in Moharabuiee.

I passed my brother and cousin:
They read in their books of prayer;
I read in my book of songs
I bought at the Sligo fair.

When we come at the end of time,
To Peter sitting in state,
He will smile on the three old spirits,
But call me first through the gate;

For the good are always the merry,
Save by an evil chance,
And the merry love the fiddle
And the merry love to dance:

And when the folk there spy me,
They will all come up to me,
With ‘Here is the fiddler of Dooney!’
And dance like a wave of the sea.

Eventually I stopped working with seniors as I returned to school full time to become a psychologist. I had thoroughly enjoyed working in a service capacity, and my time with the elderly energized me to want to do more. Wanting to learn more about the healing power of laughter, I enrolled in a doctoral program where I soon found some very somber people. I soon learned that many psychologists are fixated on arguing the merits of a particular psychological orientation, and many in fact spend a lifetime arguing minor differences in approaches to psychotherapy that eventually swallows up their entire academic career. I was determined not to fall into this trap, and found refuge in a few very funny professors, (of which there are many) who seemed to grasp that psychology can and should have an element of playfulness, fun, and even joy.

During this early period of my academic career I took a job as a tutor in a very bad neighborhood in Chicago, hoping that I could bring some of the same approaches to working with the elderly to another difficult population. The first week there they ate me alive, but gradually I earned their trust. Many of these kids came from homes where abuse and neglect was rampant, and these repeated betrayals by people in authority had left them with very little respect for people in positions of power. As is probably the case with many teachers, the ones that misbehaved the most were immediately my favorites, and I found myself amused with their antics while also understanding i was supposed to be the one in charge. I was told to "show them whose boss" by my supervisor, who was a firm believer in the power of discipline, but somehow I couldn't bring myself to take this approach.

By the second week I had made some progress, but still had a difficult time keeping everyone focused. The kids loved to run around, chase each other, and generally be moving all the time, and I realized that to come up with some kind of effective lesson I would have to incorporate all of these things into my program. We began a "tell a funny story" exercise that was immediately a big hit. The kids would tell a story about going to the zoo or Wrigley Field, or to Navy Pier, and soon these became little history lessons where we snuck in a little learning as we were sharing stories. As we got to know each other better, even the most reticent children were now joining in on the fun, and soon the entire group was laughing and talking, and once again I witnessed the contagious power of laughter.

My supervisor was less then thrilled at my approach, as our program was part of a "No Child Left Behind" program with a strict curriculum that she felt needed to be followed. From my experiences working with these kids, it was apparent that despite any math or reading we could teach them, in their relationships with others,and in life, they were truly being left behind. Somehow in the midst of focusing on grades and progress we had forgotten we were raising human beings, some of who were in intense pain from years of abuse.

A surprising fact about psychology is that it is not in fact a psychologist's theoretical orientation or their years of experience that is the most powerful predictor of psychological growth in therapy, but instead the quality of the relationship formed between the client and the therapist. Could this same thing be true for children in a classroom? I certainly thought so, and soon I became very close to a number of my students as we continued to share our stories. Eventually the big day came for the students to take their test to determine if they complied with the standards set by "No child left Behind." My supervisor, who was responsible for three other classes besides mine, was especially worried that my class had made no progress over the three months we had been together, and let me know it on every occasion she could find.

When the results finally came back, I was surprised as anyone to see that my kids had raised their pre and post test scores higher than any of the other classes at the school. Although we had not followed the curriculum, I had constantly encouraged them, laughed with them, and made them feel like they were important to me, and building this relationship had awakened something inside of them. The famous Adlerian psychologist Rudolph Dreikurs once remarked that "children need encouragement like plants need water" and I saw firsthand how true this lesson really was. Once again I had seen how the power of laughter and encouragement could change lives, and I was now more convinced than ever that this lesson needed to be talked about even more.

Having now experienced this powerful lesson of how laughter heals a second time, I felt it was time to do some further research into who else knew this wonderful approach. One excellent article I found early on was called "Laugh, Teacher, Laugh" by Glen Walter, and this article confirmed for me what I eventually discovered many teachers already knew, that, as Walters put it, "Education is too important to be taken seriously."

Walter's article talked in detail about the chemical changes in the body that occur as a result of laughter, some of which include lower blood pressure, a boost to the endocrine and immune systems, and a release of endorphins which are the body's wonderful natural pain killers usually associated with the "runner's high" experienced by people who exercise.The following are a list of Walter's recommendations for using laughter in the classroom,

1. Share humorous events from your own experience.
2. Learn to appreciate class clowns. They are your greatest ally when it comes to laughter and can brighten even the grayest of days.
3. Obtain humorous books from your library and read them to your class.
4. Talk about funny shows or movies you have enjoyed.
5. Have your students find humorous stories and pictures in newspapers and magazines.
6. Have students write and act out a funny class story or play.
7. Laugh at your own mistakes instead of making an excuse or covering up.
8. Wear a funny hat, clown's nose, two different kinds of shoes, or colored socks to school, anything to break the routine.
9. Finally, commit yourself to developing a humorous outlook on life. Take yourself, life, and school less seriously. Laugh at the stressors of the days. Your laughter will help eliminate the dreaded tunnel vision and may even help you say, "School is too important to take seriously."

The simplicity yet brilliance of this advice has served me well, and I hope others will see it and pass it on.

Friday, July 13, 2007

My history with the healing power of laughter.

In the midst of winter, I finally found there was within me an invincible summer-Albert Camus

In 1996 I moved to Chicago to fulfill a lifelong dream to perform as a comedian. With this in mind, I enrolled in classes at the world famous Second City, and within a few months had performed in a couple of shows around the city, it was the least funny time in my life. What I hadn't counted on was the "business" side of comedy that eventually reared its ugly head, and soon, in the midst of this environment, I found a great deal of the joy and enthusiasm I had for making people laugh had slowly disappeared. Still I soldiered on, and along the way met some very funny people, who, like myself, were also deeply flawed. It was during this period of my life when I truly began to understand the relationship between comedy and pain as I continued to observe my fellow performers, along with hearing anecdotes about former Second City stars like John Belushi and Chris Farley. This relationship between comedy and pain would eventually be the basis of my first book

Eventually I left this little world in Chicago, and took a job working as an entertainer in a nursing home where I was quickly assigned to the Alzheimer's unit. I was making 8 dollars an hour, driving a shitty car, and living in an apartment without hot water, it was the happiest time of my life.

Working with seniors and making them laugh in the last days of their lives was an incredibly powerful experience, and soon the joy that originated from the power of laughter was back in my life. Although the job was often very difficult, the little moments throughout the day where I was able to bring someone back from the brink of despair with some silly gesture made it all worthwhile. It was while working this job that I came to an amazing conclusion; laughter can save lives.

Now I understand this is an extraordinary claim, and my own personal evidence was to this point based primarily on a few observations, but I knew I has witnessed something very powerful. Suddenly people who hadn't spoken in years were laughing and singing and dancing, and people who otherwise laid in bed all day were now eagerly getting up in the morning.

Lest I take full credit for getting these people out of bed, I want to make clear that it was not my jokes that were creating these changes, but simply the act of laughing itself. Although these people's memories had in many ways failed them, the stimulation they received from the physical act of laughing created changes that were clearly visible. The communal act of getting people together and simply laughing is utterly contagious, and despite their cognitive deficits, it was my experience that they still had a deep rooted desire to share in the laughter. Soon we were spending afternoons sitting in a circle sharing stories, and inevitably someone would begin laughing, often when it was at an utterly inappropriate point in the conversation. Soon the stories would end, and the laughter would spread throughout the room like a virus. During my first few weeks nurses would often come running into the room, sure that something was horribly wrong. I had disrupted their peace and quiet and also challenged their idea that these patients were "too far gone" to experience joy. Soon they were also on board however, unable to resist the contagiousness of unbridled silliness.

Eventually I would write a book about my experiences working with Alzheimer's patients
and looking back this was the happiest time of my life. Although I had come to Chicago to work as a comedian, I had found something infinitely more valuable through using the power of laughter to serve other people. This experience set me on a path to discover just what it was about laughter that was so powerful, and this is a journey I will continue to follow for the rest of my life. In conducting this research I have heard some truly amazing stories, and have also continued to conduct my own experiences in some highly unusual places. These stories and my continuing research will be the basis of this blog, and I hope these stories will inspire others to share their own stories about the healing power of laughter.

Laughter Clubs

The idea of laughter clubs began in India in 1995 when a doctor named Madan Kataria went down to his local park and began laughing. Soon a few others joined him, and within a couple of days 50 people had begun laughing along within him. Kataria had read hundreds of articles about the healing powers of humor, and set out to explore the question if there was any real difference in the body between laughing at things people found naturally funny, and simply laughing for the sake of laughing. Kataria's research and his own experiences soon convinced him that the body's immune system was unable to distinguish between the two. Kataria's wife, a yoga teacher, soon added to her husband's discovery, and added Yoga and breathing exercises to her husband's laughter exercises, and their collaboration would pave the way for the creation of laughter clubs, which now number more than 5,000 around the world.

So it was with great eagerness that I attended my first laughter club in a cozy little setting not far from my home, but even still I was very nervous as I wondered if I would be able to just laugh for no reason without something actually being funny. I thought back to my days working as an activity director at a nursing home where the things I said while trying to be funny were often met with blank stares, and how the things I said in seriousness often resulted in gales of laughter from my audience. This thought alone got me laughing at myself, and when I met the director of the club Alex, I knew I would immediately find something to laugh about.
Alex was one of those guys whose very presence makes people laugh. He is one of those people who look like they are on the verge of laughing at all times, and being in his presence was a contagious force that I was quickly taken with. After a few minutes of good-natured bantering he introduced me around, and I was a little taken aback when people would burst out laughing simply from me introducing myself, and couldn't help but wonder if they were all in on some joke that at my expense. Soon I discovered their secret however, and it was one I had experienced often in my own life, and that is, simply, that laughter begets laughter. Much like how seeing someone yawn often spreads an epidemic of yawning, laughing had the same effect, and soon I was in the middle of this wonderful crowd right in the heart of the action. Often in my life my jokes are met with polite courtesy laughs and then people politely excusing themselves, but in this room I cold do no wrong. Seeing how easily these people burst into real deep down belly laughs was inspiring, and at the end of the hour, I felt more energized than I had in quite some time.

What had happened to me? Although I enjoy laughing very much, I had a hard time remembering how many times in my life I could truly remembering laughing at something so hard that I literally couldn't stop, but the times I did remember were some of the happiest of my life. Yet these people seemed to turn it on and off so naturally and I was baffled at how they did this so easily. After the session was over I spoke with Alex and heard some amazing stories. Many of the people in attendance that day were cancer survivors, some had experienced horrible childhood trauma, while still others had recently been through a divorce or some other major recent loss. I thought surely when I looked around that I was the most messed up person there, but after hearing Alex talk I reconsidered. The main point I took away from our conversation that day was that it was not what had happened to them in their lives, but how they chose to live afterwards that mattered, which is something I had of course heard during my academic studies but had rarely seen any real life examples of.

I left that day a true believer in the power of the laughter club, and plan to return often whenever I feel I am in need of an energizing workout, as the exercise I got that day was more than I had gotten in months. That whole next week I thought about what I had seen and done that day, and often found myself chuckling for no reason at all thinking of some silly little thing I had remembered. My experience that day had left me wanting more, and I was now reawakened to the everyday silliness of life that exists everywhere if we just take a little time to recognize it. I promised myself I would never again be "too busy" to see it, and penciled in the time slot at the laughter club as a new weekly activity.

Here is a link where you can find a laughter club in your neighborhood, enjoy!!!