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Humor and Health
Guest Editorial
Humor and Health Patch Adams, MO* Studying humor is like dissecting a frog-you may know a lot but end up with a dead frog. Mark Twain
I
N THE LAST TWO DECADES, humor has been gaining respect as a very important component of good health and even possibly as a therapeutic tool. The otherwise very serious medical profession is inviting humor into the hospital; at Duke University they bring "humor carts" to the patient's side. Throughout the ages humor has been strongly promoted as good for your health by physicians from Hippocrates to Osler. As scientific medicine began to dominate practice, the subjective therapies, such as love, faith, and humor, began to take a back seat because of the very difficult task of investigating any scientific basis for their value. I am astounded that anyone feels they need proof for something so obvious. In many years of asking individuals and groups what things are most important for good health, humor invariably heads the list, even over love and faith, because many feel these things "failed them." Few deny that a good sense of humor tops the list of attributes of a successful marriage. Few things so powerful as humor are ever so heatedly denied in the adult world. Almost universally in the business, religious, medical, and academic worlds, humor is denigrated-even condemned, except in speeches and anecdotes-and replaced by a call for seriousness. The implication is very strong: humor is inappropriate. It has been declared many times that Gesund*oirector, Gesundheit Institute, Arlington, VA. Address correspondence and reprint requests to Patch Adams, Mo, Gesundheit Institute, 2630 Robert Walker PI, Arlington, VA 22207. © 1991 by the National Kidney Foundation, Inc.
1051-2276/91/0103-0001 $03.00/0
116
heit's focus on humor in medicine and life is probably a major deterrent in our obtaining funding. I believe that humor (or fun, which is humor in action) is equal to love as the two key ingredients to a healthy life. The scientific investigation of humor has done much to strengthen its validity as strong medicine. Although humor itself is very difficult to evaluate, the response to humor, laughter, can be studied quite easily. Research has shown laughter to increase secretion of catecholamines and endorphins, which helps explain why laughter makes one feel so good and peppy. Cortisol secretions also decrease, implying a stimulated immune response, which I have found in my family practice to be reflected as a general decrease in jolly people of being sick, or a diminished response to illness. This may partly explain a lowering of the sedimentation rate as a response to laughter. There is increased oxygenation of the blood and increased residual air exchange in the lungs. The heart rate initially increases with a transitory increase in blood pressure followed by arterial relaxation; the overall effect is one of decreased blood pressure. Skin temperature increases as a result of an increase in peripheral circulation. The last three observations imply that laughter may have a very positive effect on many cardiovascularrespiratory problems. Laughter has superb muscle relaxant qualities. Muscle physiologists have shown that anxiety and muscle relaxation cannot occurr at the same time, and that the relaxation response after a good hearty laugh can last up to 45 minutes.
Journal of Renal Nutrition, Vol 1, No 3 (July), 1991: pp 116-118
HUMOR AND HEALTH
Psychologically, humor is at the heart of good mental health. A lack of a good sense of humor is a very good indicator of mental status. Certainly, humor remains central to most any effective catharsis for stress. Since loving human relationships are so necessary for good mental health, and since humor is probably the most effective social grease, it certainly behooves one to develop his or her humorous side. Humor is so important in communication that all speakers recognize it as the most essential ingredient in their talk to draw attention to what they are saying. I believe humor to be very important in healing the problems of individuals, communities, and societies, and would like to give personal examples of each. I have been a street clown for 30 years. I have tried to make my life a silly life. None of my attributes has been more important. First, selfishly, it has made my life extremely joyous and fun. Silliness can turn a tedious trip to the store for a forgotten carton of milk into an amusement park romp just by wearing your underwear on the outside of your clothes. People so nakedly give their thanks for entertaining them. To wear a rubber nose daily (and nightly) for a week everywhere you go can change your life. Dullness and boredom atrophy. Being fun has been a very powerful magnet for friendship, which I hold to be one of life's most important gifts. Nothing draws friendship to you or maintains it like being a jolly soul. This is as true for my marriage (still fun after 20 years) as for the chance encounter on a plane. I know humor has been responsible for preventing any burnout in my life. Finally, as a nonviolent person, I feel that humor has prevented me from being hurt many times by deflecting the potentially violent situation. Humor is important for the health of a community, whether it be a neighborhood, church, club, or a circle of friends. I have lived communally for 20 years. The first 12 years we used our home as a free hospital. Twenty adults and our children lived in a large house where 100 to 1,000 people came each month and there were 1 to 50 overnight guests every night. There was
117
never any private life and many who came had great mental and physical suffering. Humor, maybe even more than love, made it work. The staff stayed many years (making no money and having no private life) because it was so much fun. As physicians, we found that humor was also an important form of medicine. This romantic project would have been impossible without humor, the great social glue and relaxant. We live in a very troubled world. So many aspects of our society are unhealthy, even fatal. So much of our population lives "on edge." If we are to heal this society, we must bring humor to social change. Following is an example on the microcosmic level. So often in public a child and parent 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 diffused and neither the parent nor the child end up with a "win-lose" feeling. Globally, I feel humor has a place for easing tension and pain. Every year since 1985, I have gone to the Soviet Union as a clown to do nasal diplomacy. I am amazed at humor's power to break down barriers. I have gone up to Soviet police, removed their hats, and put rubber noses on their faces; we have been surrounded with mirth on these occasions. The last three years, I have focused on taking clowns to visit children in hospitals and orphanages. These experiences have been some of the most fulfilling ones of my life. What can one do to put more humor into a medical setting? First, a value has to be placed on it both by the administration and the staff; this has to be a conscious decision. The main ingredients of bedside manner do not include medical knowledge or skill, but the qualities of fun and love. Once the members of the medical setting have agreed to engage in more humor, then find those people at all levels of employment willing to initiate steps. Spend much time with any interested staff members practicing being funny. It is easiest to be funny when people are familiar with each other. Draw patients and visitors to the facility into dialogue, even participation. Be open to vast experimentation via slow escalation.
118
Be willing to accept that many things may bomb, or at tim'es may even bring out some pain. I suggest avoiding racist and sexist humor. I think you want to strive for a fun, goofy context, not an infinite string of jokes. Some hospitals have begun the process already. Ruth Hamilton created hospital humor carts for Duke University Hospital that include videos, cartoon and other humorous books, juggling equipment, toys, and games. DeKalb Hospital near Atlanta created a Lively Room for some hospital romping. The clowns of the Big Apple Circus in New York City have created Clown Care Units. The job of these clowns is to go into children's hospitals on a regular basis to bring joy, even aid, in the care of the children. The Association of Therapeutic Humor is creating a clearing house of information and people involved in humor 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 so many avenues to pursue. I think hospitals are ready to develop fun, goofy wings to give patients a choice between joyfulness and serious gloom. I lecture allover the United States to medical groups and ask the audiences which of the two wards they would choose; more than 90% always choose the fun and goofy ward. Consider setting aside a few rooms in the hospital called "fun rooms." This would be a room anyone could design, a playful environment for all to enjoy until the next one was created. This could be an area that would attract many of the community's creative people thus creating closer bonds with the community. The administration of the hospital could reward joy and fun in some way to help stimulate their growth. There is a great need to diminish the
PATCH ADAMS
hierarchical nature of current medical practice and humor can help pave the way. To develop the closeness required to bring more humor into a setting, I would suggest many fun events for all levels of staff such as classes, intimate gatherings, picnics, and slumber parties. I think other side effects would be more joy in the workplace, less burnout, less malpractice, and greater ties with the community. Humor support groups could be fun; perhaps an area in the facility could be designated where folks could come at a certain time and just laugh. Once hospitals realized the importance of faith in a hospital setting, some put priests on the staff. The same could be done with humor-hire clowns and playful people. In fact, most large communities have many kinds of performers and artists that would add greatly to the healing process. One needs simply to provide some space into which they can bring their creativity. Over time, the hospital might consider creating a well-stocked costume and prop room. The practice of medicine is hurting on many levels. Patient and staff unhappiness are so great that many patients consider lawsuits when they are dissatisfied with treatment; many health professionals are quitting or even killing themselves. There are few, if any, happy hospitals. Most people hate going to hospitals and have bad experiences when they do. Let us consider that it does not have to be this way and put great effort forward to change it. The serving of people in times of pain and suffering should bring rich fulfillment. There can be a health professional-patient relationship indistinguishable from a friendship full of warmth, and joy, and laughter. Let us call on humor to lend us a hand and make medicine fun.
Humor and Health Patch Adams, MO* Studying humor is like dissecting a frog-you may know a lot but end up with a dead frog. Mark Twain
I
N THE LAST TWO DECADES, humor has been gaining respect as a very important component of good health and even possibly as a therapeutic tool. The otherwise very serious medical profession is inviting humor into the hospital; at Duke University they bring "humor carts" to the patient's side. Throughout the ages humor has been strongly promoted as good for your health by physicians from Hippocrates to Osler. As scientific medicine began to dominate practice, the subjective therapies, such as love, faith, and humor, began to take a back seat because of the very difficult task of investigating any scientific basis for their value. I am astounded that anyone feels they need proof for something so obvious. In many years of asking individuals and groups what things are most important for good health, humor invariably heads the list, even over love and faith, because many feel these things "failed them." Few deny that a good sense of humor tops the list of attributes of a successful marriage. Few things so powerful as humor are ever so heatedly denied in the adult world. Almost universally in the business, religious, medical, and academic worlds, humor is denigrated-even condemned, except in speeches and anecdotes-and replaced by a call for seriousness. The implication is very strong: humor is inappropriate. It has been declared many times that Gesund*oirector, Gesundheit Institute, Arlington, VA. Address correspondence and reprint requests to Patch Adams, Mo, Gesundheit Institute, 2630 Robert Walker PI, Arlington, VA 22207. © 1991 by the National Kidney Foundation, Inc.
1051-2276/91/0103-0001 $03.00/0
116
heit's focus on humor in medicine and life is probably a major deterrent in our obtaining funding. I believe that humor (or fun, which is humor in action) is equal to love as the two key ingredients to a healthy life. The scientific investigation of humor has done much to strengthen its validity as strong medicine. Although humor itself is very difficult to evaluate, the response to humor, laughter, can be studied quite easily. Research has shown laughter to increase secretion of catecholamines and endorphins, which helps explain why laughter makes one feel so good and peppy. Cortisol secretions also decrease, implying a stimulated immune response, which I have found in my family practice to be reflected as a general decrease in jolly people of being sick, or a diminished response to illness. This may partly explain a lowering of the sedimentation rate as a response to laughter. There is increased oxygenation of the blood and increased residual air exchange in the lungs. The heart rate initially increases with a transitory increase in blood pressure followed by arterial relaxation; the overall effect is one of decreased blood pressure. Skin temperature increases as a result of an increase in peripheral circulation. The last three observations imply that laughter may have a very positive effect on many cardiovascularrespiratory problems. Laughter has superb muscle relaxant qualities. Muscle physiologists have shown that anxiety and muscle relaxation cannot occurr at the same time, and that the relaxation response after a good hearty laugh can last up to 45 minutes.
Journal of Renal Nutrition, Vol 1, No 3 (July), 1991: pp 116-118
HUMOR AND HEALTH
Psychologically, humor is at the heart of good mental health. A lack of a good sense of humor is a very good indicator of mental status. Certainly, humor remains central to most any effective catharsis for stress. Since loving human relationships are so necessary for good mental health, and since humor is probably the most effective social grease, it certainly behooves one to develop his or her humorous side. Humor is so important in communication that all speakers recognize it as the most essential ingredient in their talk to draw attention to what they are saying. I believe humor to be very important in healing the problems of individuals, communities, and societies, and would like to give personal examples of each. I have been a street clown for 30 years. I have tried to make my life a silly life. None of my attributes has been more important. First, selfishly, it has made my life extremely joyous and fun. Silliness can turn a tedious trip to the store for a forgotten carton of milk into an amusement park romp just by wearing your underwear on the outside of your clothes. People so nakedly give their thanks for entertaining them. To wear a rubber nose daily (and nightly) for a week everywhere you go can change your life. Dullness and boredom atrophy. Being fun has been a very powerful magnet for friendship, which I hold to be one of life's most important gifts. Nothing draws friendship to you or maintains it like being a jolly soul. This is as true for my marriage (still fun after 20 years) as for the chance encounter on a plane. I know humor has been responsible for preventing any burnout in my life. Finally, as a nonviolent person, I feel that humor has prevented me from being hurt many times by deflecting the potentially violent situation. Humor is important for the health of a community, whether it be a neighborhood, church, club, or a circle of friends. I have lived communally for 20 years. The first 12 years we used our home as a free hospital. Twenty adults and our children lived in a large house where 100 to 1,000 people came each month and there were 1 to 50 overnight guests every night. There was
117
never any private life and many who came had great mental and physical suffering. Humor, maybe even more than love, made it work. The staff stayed many years (making no money and having no private life) because it was so much fun. As physicians, we found that humor was also an important form of medicine. This romantic project would have been impossible without humor, the great social glue and relaxant. We live in a very troubled world. So many aspects of our society are unhealthy, even fatal. So much of our population lives "on edge." If we are to heal this society, we must bring humor to social change. Following is an example on the microcosmic level. So often in public a child and parent 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 diffused and neither the parent nor the child end up with a "win-lose" feeling. Globally, I feel humor has a place for easing tension and pain. Every year since 1985, I have gone to the Soviet Union as a clown to do nasal diplomacy. I am amazed at humor's power to break down barriers. I have gone up to Soviet police, removed their hats, and put rubber noses on their faces; we have been surrounded with mirth on these occasions. The last three years, I have focused on taking clowns to visit children in hospitals and orphanages. These experiences have been some of the most fulfilling ones of my life. What can one do to put more humor into a medical setting? First, a value has to be placed on it both by the administration and the staff; this has to be a conscious decision. The main ingredients of bedside manner do not include medical knowledge or skill, but the qualities of fun and love. Once the members of the medical setting have agreed to engage in more humor, then find those people at all levels of employment willing to initiate steps. Spend much time with any interested staff members practicing being funny. It is easiest to be funny when people are familiar with each other. Draw patients and visitors to the facility into dialogue, even participation. Be open to vast experimentation via slow escalation.
118
Be willing to accept that many things may bomb, or at tim'es may even bring out some pain. I suggest avoiding racist and sexist humor. I think you want to strive for a fun, goofy context, not an infinite string of jokes. Some hospitals have begun the process already. Ruth Hamilton created hospital humor carts for Duke University Hospital that include videos, cartoon and other humorous books, juggling equipment, toys, and games. DeKalb Hospital near Atlanta created a Lively Room for some hospital romping. The clowns of the Big Apple Circus in New York City have created Clown Care Units. The job of these clowns is to go into children's hospitals on a regular basis to bring joy, even aid, in the care of the children. The Association of Therapeutic Humor is creating a clearing house of information and people involved in humor 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 so many avenues to pursue. I think hospitals are ready to develop fun, goofy wings to give patients a choice between joyfulness and serious gloom. I lecture allover the United States to medical groups and ask the audiences which of the two wards they would choose; more than 90% always choose the fun and goofy ward. Consider setting aside a few rooms in the hospital called "fun rooms." This would be a room anyone could design, a playful environment for all to enjoy until the next one was created. This could be an area that would attract many of the community's creative people thus creating closer bonds with the community. The administration of the hospital could reward joy and fun in some way to help stimulate their growth. There is a great need to diminish the
PATCH ADAMS
hierarchical nature of current medical practice and humor can help pave the way. To develop the closeness required to bring more humor into a setting, I would suggest many fun events for all levels of staff such as classes, intimate gatherings, picnics, and slumber parties. I think other side effects would be more joy in the workplace, less burnout, less malpractice, and greater ties with the community. Humor support groups could be fun; perhaps an area in the facility could be designated where folks could come at a certain time and just laugh. Once hospitals realized the importance of faith in a hospital setting, some put priests on the staff. The same could be done with humor-hire clowns and playful people. In fact, most large communities have many kinds of performers and artists that would add greatly to the healing process. One needs simply to provide some space into which they can bring their creativity. Over time, the hospital might consider creating a well-stocked costume and prop room. The practice of medicine is hurting on many levels. Patient and staff unhappiness are so great that many patients consider lawsuits when they are dissatisfied with treatment; many health professionals are quitting or even killing themselves. There are few, if any, happy hospitals. Most people hate going to hospitals and have bad experiences when they do. Let us consider that it does not have to be this way and put great effort forward to change it. The serving of people in times of pain and suffering should bring rich fulfillment. There can be a health professional-patient relationship indistinguishable from a friendship full of warmth, and joy, and laughter. Let us call on humor to lend us a hand and make medicine fun.