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Is Laughter the Best Medicine?

Laughter yoga, first popularized by Dr. Madan Kataria, has become an international movement.

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Francine Shore, her straight, straw-colored hair reaching down to her shoulders at odd angles, held her hands together like she was about to bow her head in prayer. Instead, she looked up at me, her eyes wide, and she laughed. It was a full-bodied laugh, beginning in her diaphragm and erupting in a series of cackles and ah hah’s — like a detective making a breakthrough — while her head rolled back and forth, hair momentarily obscuring her eyes. Across from her, I sat in the same position, doing exactly the same thing. After a few awkward moments of forced cackles, the laughter became genuine.

That exercise was just a warm-up, an example of a typical greeting that begins the hour-long sessions that Francine leads three times a month in a rented studio overlooking The New Yorker Hotel. Her sessions then transition into dancing, controlled breathing, and improv — anything to get everyone loosened up and giggling. All of the exercises, from using bright and beaded props, to pretending to break an invisible vase, are part of laughter yoga, a two-decades-old therapy from India that attempts to capitalize on the many health benefits of laughing.

“We imitate life. Think of any situation and I can develop a laughter exercise: I’m late for something, so I’m jogging in place,” Francine said, her teal and fuchsia sleeves pumping back and forth by her sides. “I’m pointing to my watch, but I’m late anyway. So then I just let go and laugh.”

In her boyfriend’s Upper West Side apartment, where we met, Francine explained that she dislikes — she prefers not to be hateful — how laughter yoga is portrayed in videos. Short clips of the practice, aired on news segments or uploaded to YouTube, show strangers standing around shaking hands or pouring imaginary buckets of ice on each other. All the while they laugh in a way that could be mistaken for a flock of chickens, clucking in a farmyard. “If you actually watch the videos…it looks like a cult, loons, or something,” admitted Francine. “If you don’t go and see the science behind it, it does look a little crazy.” I promised I would.

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Laughter yoga had its genesis with Norman Cousins, the respected, longtime editor-in-chief of the now defunct magazine Saturday Review. In 1964, doctors diagnosed Cousins with ankylosing spondylitis, a type of arthritis that put him in constant pain. He locked himself in a hotel room and watched funny movies or read humor books in order to make himself laugh, finding his only solace in “10 minutes of genuine belly laughter [that] had an anesthetic effect and would give [him] at least two hours of pain-free sleep,” an observation he reported in his bestselling book Anatomy of an Illness, published in 1979. His acclaimed book ushered forward interest in the beneficial effects of laughter and put into the spotlight the close relationship between the mind and body.

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Norman Cousins, respected author of Anatomy of an Illness

After publishing his book, Cousins wanted to further promote research into laughter, an idea that was met with skepticism from much of the medical community. At the time, Dr. Lee Berk, a researcher in neuroimmunology at Loma Linda University in Southern California, was conducting experiments showing that laughter repressed the production of cortisol, a stress hormone, which lead to a boost in the immune system. Cousins called Berk and they agreed to meet.

Soon after, Norman showed up at Loma Linda University with his wife. “He asked what it would take to show evidence that laughter does something that is inductive to the healing process,” Berk recalled, his now-graying hair combed straight back above thin-framed glasses. “Being young and naive, I said, ‘Maybe $80,000?’ [Cousins] replied by asking, ‘Who do I write the check to?’”

Since that meeting in 1988, Berk has gone on to show or expand evidence that laughter lowers the risk of cardiovascular disease, decreases stress hormones and spurs the immune system. In his latest research, electrodes attached to the skull show evidence that laughter induces gamma waves in the brain. When an individual enters deep, or slow-wave, sleep, their brain waves slow into low-frequency delta waves, which fall at the opposite end of the spectrum from the high frequency, gamma waves Berk observed. These waves are thought to be associated with heightened consciousness, although this topic is debated. When Tibetan Buddhist monks meditate, gamma waves move throughout their brain.

The meditative benefits of laughter didn’t go unnoticed. In the early 1990s, Berk was visited by an Indian physician named Dr. Madan Kataria. Kataria had read about Cousins’ experiences with laughter and was exploring its use in alternative medicine. He didn’t know it yet, but he was conducting research for what would become the basis for laughter yoga, the international movement he’d father in 1995.

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Dr. Lee Berk, researcher at Loma Linda University

Beginning with just five men giggling and telling jokes in a public park, Kataria’s practice has grown to include over a quarter million people participating in over 50 countries, although the informal nature of the sessions make it hard to gauge exact numbers. He spreads laughter through his own courses, by certifying others, like Francine, as laughter yoga leaders, and through his 1999 book Laugh for No Reason. On his YouTube channel, Kataria laughs on stage in front of business leaders, in front of a green screen of waves rolling against a beach or just in his kitchen.

Francine was first introduced to laughter yoga in 2002 at a conference in New York led by Kataria. She came upon a flyer for the conference at a time in her life when she says the light had gone out, when she wasn’t dating and felt stuck. Laughing was something she immediately understood. It built her confidence, helped her to meet others, and forced her to let go of many of the stressors in her life. And laughter yoga takes confidence.

In her laughter yoga class, her teal top traded in for a lively green, Francine took charge. She has to; there’s no other way to break people of their hesitation to laugh for no reason. While she explained the exercises, the class, about 10 of us, circled up. I stood between an actress, now into her 90s but still going to auditions, and a father who came with his son, who has autism. Currently, those that come to laughter yoga do so because they want to break out of their shell, because disability or age keeps them from more active forms of exercise, or because they are looking for something new.

At first we began imitating laughing animals: lions, elephants, clams. Someone suggested a hyena. The specifics didn’t matter — we weren’t even really laughing in the traditional sense. It was all about the breathing. By pushing stale air out of your lungs you’re oxygenating your blood. And, maybe, tricking your brain so it releases laughter-related hormones. But most important, I soon found out, was being ridiculous for the sake of it.

There’s no way to capture the feeling of looking strangers in the eye and fake laughing into their face. It was like a roomful of terrible comedians, all trying to console each other as best they knew how. Each suggestion of a stressor (“Poverty”,”Rejection”,”Pain”) was thrown into the middle by Francine and stomped on by everyone. Each time we began a new exercise, the thought occurred: “this is strange,” followed by another, louder thought: “it’s suppose to be.” It was humbling and tiring and always a little uncomfortable. But I started to feel good.

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Dr. Madan Kataria, founder of laughter yoga

But questions remained. Can this forced laughter elicit the same beneficial response as genuine, mirthful laughter? Does your body know the difference between a comedy club and a laughter yoga studio? The most scientific studies cited to support laughter yoga employ comedy to elicit laughter, not forced laughter: Berk uses a range of comedians and humorous clips in his studies; Dr. Miller from the Maryland Medical Center proved watching the comedy King Pin led to decrease blood pressure and increased blood flow; Dr. Dunbar, an evolutionary psychologist from Oxford, had his test subjects watch The Simpsons, Friends and South Park to increase pain tolerance. To support his practices, Kataria, the laughter yoga founder explains that scientific fact supports that “the body cannot differentiate between fake and real laughter”. However, this fact has not been fully proven.

“They are not one in the same,” said Berk, describing the difference between forced and mirthful laughter. “When one utilizes forced laughter, they’re accessing how they’ve been conditioned…if I start to elicit forced laughter, I can cascade myself into [mirthful laughter].” If you laugh frequently, your body has a learned response to laughter. Forced laughter can be used in a way that Berk associates with genuine laughter, although he’s aware of the ambiguities. “Laughter yoga has grasped the dovetail of the research into mirthful laughter,” he said, although a direct link is not proven, only supported anecdotally. One related study asked participants to complete a stressful task while holding chopsticks in their mouths in a way that made them smile. It found that these “forced” smiles reduced stress more than the control group, who flashed neutral expressions.

While there are many benefits from the connection between the mind and the body, there are also detrimental effects, which are also little researched. One example is takotsubo cardiomyopathy, also known as “broken heart syndrome”, in which an acute episode of stress leads to a weakening of the cardiac muscle and heart failure. Headlines occasionally mention the phenomenon when they report on elderly couples that pass away only days or sometimes hours apart. Similarly, some patients in hospice care will hold on for the holidays or a family visit, only to pass away days later. Berk links this phenomenon to bereavement in the elderly, which can lead to a suppressed immune system. These phenomena go mostly unexplained, because most medical research is devoted to purely somatic problems, rather than psychological ones.

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Francine Shore, leading breathing exercises during a laughter yoga session

This emphasis on studying the biology of the body isolated from the health of the brain goes back to the 17th century, when René Descartes first popularized the split between the mind and the body in a school of thought called dualism. The current dearth of research into the link between the mind and body is a result of this early separation. And in the eyes of the FDA, hard, peer-reviewed evidence is everything. When alternative medicine competes for time and funding with proven pharmacological regimens, it gets pushed aside. “In hospitals, you might only get five to 10 minutes with a doctor, 15 if you’re lucky. So [doctors] use the quickest, most responsive remedy to the problem the patient presents,” said Berk. “For hypertension, high cholesterol, diabetes, [doctors] don’t have time to do extensive lifestyle therapy, but [they] can give them beta blockers, write scripts and then say, ‘See you in a couple of weeks’.”

The best hope for the integration of laughter into traditional hospital practices could come from the expansion of medical reimbursement, Berk said, which President Obama recently signed into law. Currently, where hospitals do provide laughter-based treatments, the approach is offered on a voluntary basis or done in the spare time of the full-time staff. At North Kansas City Hospital, Kelly Jantz, the creator of the PHIL (Positive, Hopeful, Individuals, Laughing) Project, pushes around a rolling, waist-high, lime-green toolbox. In the drawers are magic tricks, jokes, riddles and stuffed animals. Two states away at the Midwestern branch of the Cancer Treatment Centers of America in Illinois, Dr. Katherine Puckett leads laughter sessions alongside western medicine, with some patients participating while they undergo chemotherapy.

Puckett currently serves as Director of Mind-Body Medicine at the Midwestern Regional Medical Center, a position she has held since August 2002. On the suggestion of a patient, she became certified as a laughter yoga instructor in 2004. The next day she implemented the first meeting. “In the middle of this session, this one woman started crying and saying, ‘I’m just so sick of people coming up to me and saying how are you?’ I just happen to have cancer, but it’s defined me,” Puckett said. “Then everyone turned it into a support group. And then we started laughing about it.”

Back in Francine’s studio, as the class wrapped up, after the final breathing exercises and meditation, we all went around and said how we felt before the class, and how we felt after. None in the room knew each other, save for the 90-year-old actress who attended weekly, but we all shared without much hesitation. Everyone, without exception, said they felt stressed before the class and now they felt more relaxed, that everything would be alright. Francine likes to say that laughing takes over; you can’t hold onto worry if you are laughing like a madwoman.

I felt a euphoria and tiredness in my diaphragm from laughing for an hour straight. The moments after we stopped were some of my most relaxed that day. Part of this was the laughing, the activity, the breathing. But it was also due to the fact that 10 people had just let their guard down. It was hard to take anything too seriously when strangers had just shown you how to let go and lose yourself for an hour. I left humbled, knowing that there were people out there willing to laugh with you, even if it meant things got a little weird.

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