Paul McGhee, PhD
The Impact of Hospital Humor Programs on Patient Outcomes
In last month's article, we discussed the ways in which hospitals around the world are bringing the therapeutic benefits of humor to their patients. The main purpose of these programs is to provide a positive emotional counter-weight to the negative circumstances that have brought patients to the hospital. While there is considerable evidence, as we have seen, that humor and laughter boost some of the body's health sustaining systems, does the addition of a humor program help heal patients or boost wellness? In the current climate of rising healthcare costs, it's an important practical question whether humor has any effect on recovery rate or other measures of improvement of one's condition.
In spite of the large number of hospitals around the world which have adopted clown visits or other types of therapeutic humor programs for patients, there has been little attempt to document their impact on such measures as speed of recovery, postoperative pain or wound healing. Hospitals have simply adopted humor programs because they can see from their own experience that these programs work in helping patients cope. If it saved the hospital money, that would simply be icing on the cake.
As indicated in an earlier article, Dr. James Walsh noted 70 years ago that laughter appears to promote wound healing. Recent research in psychoneuroimmunology has confirmed this finding for positive emotion in general. One researcher has suggested that it may not be so much what positive emotion does that is the key, but what it prevents.1 He feels that the effect may be due to the disruption of production of neurotransmitters, hormones and other substances (associated with stress and negative emotion) which interfere with the healing process.
Humor's power to speed up wound healing may be due to its capacity to lower blood levels of cortisol (see section on stress hormones), which can suppress natural killer cell and lymphocyte activity and suppress the production of antibodies. This possibility is supported by a study in which surgical patients were given training in guided imagery and relaxation. It showed that these patients had more rapid wound healing than a control group, and also had
lower post-surgical levels of cortisol.2
Several studies (discussed above) have documented humor's ability to reduce pain in many patients. In one study, patients were shown either comedy or serious movies (one in the morning and one in the afternoon) on two consecutive days following orthopedic surgery. In comparison with the serious movie, those who watched the comedies requested 61% less "minor" pain medication (aspirin and mild tranquilizers) over the next two days.3
Surprisingly, among those who watched the comedy films, the amount of major pain medication requested depended on whether patients were able to choose the funny movie they watched. Those who were able to choose movies that were funny to them requested less major pain medication than those who were presented a movie to watch without choosing. According to the researchers, "This unanticipated result is probably due to the fact that humor preferences are idiosyncratic, and few things are as irritating as being exposed to material that fails in its attempt to be funny. From an applied standpoint, our results suggest that care should be taken to determine a patients' humor preferences before humor is introduced into a hospital setting."
Among a group of elderly residents who suffered chronic pain in a long-term care facility, watching a 20-minute comedy program 3 days a week for 6 weeks significantly reduced the amount of pain medication requested during this period.4 This reduction was, not surprisingly, accompanied by a more positive mood.
Given the strong (and growing) interest in the therapeutic benefits of humor in healthcare settings around the world, it is surprising that more has not been done to determine humor's impact on patient outcomes. There are signs, however, that this is changing. For example, a promising study is now under way at the University of California at Berkeley. For information regarding this study, see www.RxLaughter.org or www.mentalhealth.ucla.edu.
[Excerpt from Dr. McGhee's book, Health, Healing and the Amuse System: Humor as Survival Training. Published by Kendall/Hunt, 1999. To order a copy by e-mail, see www.kendallhunt.com. Click on orders. ISBN number is 7872-5797-4.]
Pun Fun
1. Did you hear about the (fill in the name of anyone you want to put down) who took his wife to a Pizza place when she went into labor? He heard they had ______________.
CLUE: What do some pizza restaurants do if you prefer to eat your pizza at home?
2. What's the best gift for the person who has everything? _______________.
CLUE: Find another interpretation for "has everything." In this case, having everything is not good.
EXTRA CLUE: He's ill.
3. Why wouldn't the skeleton cross the road? He didn't have the __________.
CLUE: A familiar phrase meaning "didn't have the courage."
4. How can a baseball player win the game without every throwing a ball? By ________________________.
CLUE: He really does throw a ball . . . and yet he doesn't.
EXTRA CLUE: What does the umpire call it?
References
1. Melnechuk, T. Emotions, brain, immunity and health: A review. In M. Clynes & J. Panksepp (Eds.), Emotions and Psychopathology. New York: Plenum, 1988, 181-247.
2. Holden-Lund, C. Effects of relaxation with guided imagery on surgical stress and wound healing. Research in Nursing and Health, 1988, 11, 235-244.
3. Rotton, J. & Shats, M. Effects of state humor, expectancies and choice on post-surgical mood and self-medication: A field experiment. Journal of Applied Social Psychology, 1996, 26, 1775-1794.
4. Adams, E.R. & McGuire, F.A. Is laughter the best medicine? A study of the effects of humor on perceived pain and affect. Activities, Adaptation, and Aging, 1986, 8, 157-175.
Adams & McGuire, 1986.
Answers to Pun Fun
1. free delivery
2. antibiotics (or a good doctor, etc.)
3. guts
4. throwing only strikes
