Laughter: Is It Really the Best Medicine?

by David Spero, RN

Did you hear the one about the 26 Japanese women with rheumatoid arthritis (RA) who went to the hospital in Tokyo? They had their blood drawn, but then, instead of receiving medical treatment, they were ushered into a small theater. There they watched a performance of rakugo, traditional Japanese comic storytelling.

But in this study, published in 1996, the joke was on them. After the perfor­mance, the women reported that their pain levels were much reduced. Not only that, their blood levels of cortisol and epinephrine had dropped, suggesting a reduction in stress. And their levels of interleukin-6 and interferon gamma, indicators of inflammation, had also dropped.

We have all heard that “laughter is the best medicine,” but now there is some evidence to support the old saying. Though research into laughter and its effects is far from conclusive (and some critics believe that much of it has not been done well), several small studies have found a connection between laughter and improved cardiovascular and immune system health. Add these effects to those everyone knows about — reduced stress and improved mood — and laughter may indeed be good for us.

The history of laughter

If laughter is good for us, why didn’t we know about its benefits before? Actually, people have known about the benefits of laughter for ages. An old Irish proverb states “A good laugh and a long sleep are the best cures in the doctor’s book.” And as early as the 1300’s, Henri de Mondeville, a French professor of surgery wrote: “Let the surgeon take care to regulate the whole regimen of the patient’s life for joy and happiness, allowing his relatives and special friends to cheer him, and by having someone tell him jokes. The surgeon must remind the patient that the body grows fat from joy and thin from sadness.” (This was in the days when fat was good.)

Interest in laughter increased in modern times when journalist and author Norman Cousins wrote in the 1960’s about his recovery from ankylosing spondylitis, a sometimes-severe form of arthritis that can fuse the vertebrae of the spine. Cousins believed that negative emotions had a negative impact on his health, and he thought that positive emotions might have a healthful effect. So with doctors putting the odds for his recovery at 500 to 1, Cousins checked himself out of the hospital and into a hotel room, bringing with him videos of Candid Camera, the Marx Brothers, and Laurel and Hardy, humorous books, and anything else that might make him laugh. After a while, he found that 10 minutes of hearty laughter gave him 2 hours of pain-free sleep. He treated himself by eating healthy food, taking vitamin C, and laughing as much he could. Cousins amazed doctors by eventually recovering.

Many studies have been performed to test Cousins’s claims. For example, in one study, Dr. Margaret Stuber at the Jonsson Comprehensive Cancer Center at UCLA had children watch funny videos before, during, and after putting their hands in ice cold water. The kids were able to better tolerate the water when they laughed. Studies such as this built a preliminary case for laughter’s therapeutic effects.

The effects of laughter

In addition to the study discussed at the beginning of this article, several other Japanese studies have explored the benefits of laughter for people with RA. One, published in 2005, showed that laughter causes the blood level of growth hormone, usually elevated in people with RA, to drop significantly after a period of mirthful laughter (again induced by rakugo). Growth hormone is thought to contribute to joint pain and swelling. Another study, published in 2006, found that blood levels of interleukin-6 (an inflammation-causing molecule) decreased in people with RA after a period of laughter. In the same study, levels of TNF-alpha, another inflammation-causing molecule that plays a major role in RA, also decreased after laughter, but only in people whose RA was easily controlled. These studies suggest that laughter has at least a temporary effect on several molecules involved in RA.

Many studies have focused on other benefits of laughter. Lee Berk, DrPH, has been at the forefront of the study of laughter for many years, examining whether laughter has the power to bring about a wide variety of health benefits. In a study published in 1989, he reported that laughter brought about reduced blood levels of cortisol and other hormones associated with stress. In a study published in 2001, Berk and his colleagues found an increase in natural killer cells and other immune-system cells in the blood of people who watched a funny video. Stress is known to decrease the levels of these cells.

Two studies from the University of Maryland have helped clarify laughter’s effect on the cardiovascular system. In a 2001 study, 150 people who had had heart attacks or bypass surgery were compared with 150 controls, who had not had heart problems. The study found that people without heart problems were more likely to have a humorous perspective on life, finding greater comedy in everyday events. In other words, it’s possible that laughter protects heart health. In a 2006 study, healthy volunteers were shown either a scene from a funny movie or one from a tense movie. Measures of blood flow were taken before and after these viewings. In all, people’s blood flow increased 22% during laughter and decreased 35% during mental stress brought on by the tense film.

There isn’t enough evidence about laughter’s effect on health to have doctors start handing out laughter prescriptions. Furthermore, researchers are not sure what causes laughter’s benefit. But at the very least, laughter is aerobic exercise — according to a study published in 2007, genuine laughter causes a 10% to 20% increase in energy expenditure and heart rate over resting levels. And no one can argue against laughter’s effect on our emotions. Some researchers believe this is its greatest contribution to good health. Laughter acts as a positive emotional force, distracting your mind from pain and negative emotions such as anger and guilt. Laughter can also give you feelings of power and hope, allowing you to keep or regain control of a difficult situation. By turning you from these negative feelings, laughter helps to reduce stress. And stress reduction is a good thing. Stress has been shown in numerous studies to raise blood pressure and decrease immune system functioning, and people with arthritis sometimes find that their symptoms grow worse when they are under stress.

Laughter has a social benefit too. It helps to bring people together — reducing stress even more in the process. As cultural anthropologist Mahadev Apte writes, “Laughter occurs when people are comfortable with one another, when they feel open and free. And the more laughter, the more bonding occurs within the group.”

So how do we get some?

Laughter is cheap, but it can be hard to come by. When we’re weighed down with grief, sadness, frustration, and anxiety, how do we find the humor in life? Well, it turns out that humor is actually all over, if we can learn to see it. Here are some strategies for putting more laughter in your day:

  • Watch or listen to funny TV shows, movies, and radio programs. There are lots of comedies out there, at the theater, on video, and right on your TV or radio. Find something that is truly hilarious — it’s an easy way to start laughing more. You can also read humorous books or comic books. Ask friends to suggest their favorite laugh riots.
  • Get social. A study published in 1989 showed that people are 30 times more likely to laugh in social settings than when they are alone. Going to a movie or comedy club with friends is a great way to get more laughter in your life. Just having other people around may mean you’ll laugh more than you otherwise would. Dinner parties, game nights, and other social events are more ways to help you laugh a little more.
  • Look for the humor in your life. By looking for the humor in everyday experiences, even the frustrating ones, you may find yourself being more lighthearted and silly, giving yourself and those around you more to laugh about.
  • Spend more time with children. Children are natural comics. They laugh easily, and laughter is contagious. Of course, their behavior is often unintentionally funny, too. If you don’t have children in your family to visit with, perhaps you can volunteer at a preschool or playground. Kittens and puppies are a laugh-promoting alternative to children.
  • Fake it. Even if your laughter is not totally genuine, you may still be able to get health benefits from it. And sometimes pretending to laugh can progress to real laughter. This principle lies behind a practice called “yogic laughter” or “laughing meditation,” which was developed by a physician in India, Dr. Madan Kataria. He started a number of “laughing clubs” throughout India. There are now 5,000 laughing clubs in over 40 countries, probably including one near you.
    Laughter clubs are organized by two groups: the World Laughter Tour and Laughter Yoga. The clubs are led by people who have been trained in making laughter experiences helpful, safe, and enjoyable. In the San Francisco Bay area where I live, Bev Bender leads one such club. Bender might start by having her group say “Ho, ho, ha, ha, ha” or some other laughing sounds. They add in other types of laughs and may include making silly faces at each other. Pretty soon, everyone is laughing as hard as they ever have.

It may feel strange to laugh by yourself, but if others are laughing, it’s easy. One person laughing can make a lot of others laugh with them. So if you’re worried about what other people will think if you’re laughing, don’t worry. They’ll be laughing too. You’ll be helping yourself and the people around you at the same time.

Last Reviewed February 24, 2013

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David Spero is a nurse/educator and author of The Art of Getting Well: Maximizing Health When You Have a Chronic Illness (Hunter House, Alameda, California, 2002). You can visit his Web site at

Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.

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