GLOBAL: Therapeutic laughter in higher education

In 2000 a report came out of the University of California, Los Angeles, indicating that students feel more overwhelmed and stressed than just 15 years ago. The following year an American College Health Association survey suggested that 33% of students felt hopeless, with 22% suffering severe depression at least three times within the previous year.

Nor does the situation seem to be improving. Just last year, the director of campus student health services at Washington University in St Louis stated that "depression and suicide are the largest health issues facing students at this time".

In response to such dire findings, while an assistant professor at Oakland University, 64 kilometres north of Detroit, I submitted a proposal for a course in 'therapeutic laughter'. Its purpose was to use a novel approach to teach students lifelong stress management skills. Support for such a course was strengthened by the increased attention researchers were giving to the subject at such diverse universities as Indiana State, Raleigh Dickinson and Loma Linda.

Interest in laughter's therapeutic value stems from 1979 when Norman Cousins published a personal testimony, An Anatomy of an Illness as Perceived by the Patient. While editor-in-chief of the Saturday Review, Cousins contracted ankylosing spondylitis, a crippling inflammation of the vertebral column. This left him virtually immobile and in extreme pain with a one in 500 chance of recovery.

Finding limited relief from prescribed allopathic treatments, Cousins persuaded his personal physician to allow him to experiment with a steady diet of humorous comedic videos. To his great joy he soon discovered that "10 minutes of genuine belly laughter had an anaesthetic effect and gave me at least two hours of pain-free sleep".

Upon Cousins' almost complete recovery, researchers became inquisitive as to both the physiological and psychological effects that bouts of robust laughter have on the body.

An exhaustive account of their findings can be found in the recently published work of Paul McGhee, Humour: The lighter path to resilience and health. Multiple benefits include decreased pain, reduced production of stress hormones, enhanced immune system functioning, a lowering of resting blood pressure, muscle relaxation, reduction in allergic responses, mood elevation and, from a student perspective, improved self-esteem with decreased bouts of depression.

I was able to introduce 'Laughter as Therapeutic Modality' into Oakland University's general education curriculum during Winter 2005. The four-credit hour course met twice weekly with one period devoted to the theoretical and didactic aspects of laughter and the other designed as a lab focused on developing the Seven Humour Habits (7HH) which include: 1) Surrounding oneself with humour, 2) Cultivating a playful attitude, 3) Laughing more often and more heartily, 4) Creating one's own verbal humour, 5) Looking for humour in everyday life, 6) Learning to laugh at oneself, and 7) Finding humour in the midst of stress.

Critical to skills development were the weekly 'Mirth Diary' assignments in which students engaged in activities designed to help them develop proficiency in each of the seven skills detailed above. These skills are progressive, starting with those more readily achievable to the more challenging ones such as learning to laugh at oneself and utilising humour to combat stressful events.

Additional outside reading requirements included books such as Cousins' Anatomy of an Illness and Vicktor Frankl's Man's Search for Meaning, an expose of survival under the most inhumane conditions in Nazi concentration camps during World War II.

The work of Martin Seligman in Learned Optimism was also heavily relied upon. Baseline questionnaires disclosed that many students leaned towards a pessimistic explanatory style. Since pessimists tend to become more easily depressed when confronted by a hostile environment, they actually have the most to gain from therapeutic laughter courses. Our data supported Seligman's thesis that by practising cognitive restructuring individuals can adopt a more optimistic approach to life and thus be better able to cope with life's stressors.

The future for 'therapeutic laughter' courses in academia appears bright. Personal communication with my former programme director at Oakland University indicates that the therapeutic laughter classes continue to reach capacity every term.

In my current position at La Sierra University, I am frequently approached by students inquiring when the next offering will be. Recently an unpublished doctoral dissertation at James Cook University in Australia demonstrated large decreases in subjects classified as clinically depressed after the completion of the 7HH programme.

Still, there are many questions that remain to be answered. For example, is there a long-term carry over effect, or once the term ends do students neglect to keep working on improving their humour skills? Is there reliability between outcomes of the Seligman explanatory style questionnaires and the Positive-Negative Mood state categories on McGhee's questionnaire? Do humour interventions prior to taking an exam improve outcomes on those exams?

Whatever future research may reveal, one thing is certain: laughter is good medicine and no prescription is required for its utilisation. Gatherings such as the World Universities Forum held in Hong Kong in January this year could be a catalyst for inspiring universities around the globe to incorporate such courses into their curricula.

In doing so they would align their pedagogy with the philosophy of King Solomon who thousands of years ago wrote: "A merry heart does good like a medicine."

* Professor William C Andress is at La Sierra University in California, US. This is a synopsis of a paper presented at the Fourth World Universities Forum in January.

As someone who has had Ankylosing Spondylitis for over 25 years, I really get annoyed that people still are using that d*mn Norman Cousins book as a reference in articles. Cousins did not have AS, and Ankylosing Spondylitis is not a disease that is cured by laughter and high doses of vitamin C. It is a serious, chronic degenerative disease, for which there is no known cure. It strikes young men and women between the ages of 17 and 35, and can be debilitating, often fusing the neck and spine and other joints.

The fact is, even the websites devoted to perserving the memory of Norman Cousins have stepped back from saying he had AS; they now say he had some vague inflammatory disease. But for some reason, this notion that he cured himself of AS will not die, it is mentioned whenever someone wants to write an article about the therapeutic effects of humour, and frankly, it makes my blood boil.

Laughter does have healing properties, and it is good for the soul. No argument there. Heck, I've run a website devoted to making people with AS laugh for over 15 years. It is Cousins' insistence on taking the theory one step further, into the realm of complete fiction, that is so maddening. People assume that if you are criticising Cousins you don't believe humour has a place in the healing process, and that is not true. Humour can heal the soul. It can alter your mindset. It can change your outlook. But it can't stop bones from fusing.

If misinforming the general public about the nature of AS wasn't bad enough, think of all the false hope and later, the despair, that has been created in people with AS over the years, who, like me, try Cousins' approach, only to have their AS keep progressing.

Please stop using this discredited piece of fiction as a reference source.

Michael Smith