Mary Harris: I’m Mary Harris, this is Only Human. And today’s show is for skeptics… like me. And like the guy sitting across from me.
Kurt Andersen: Who is me, Kurt Andersen.
MH: Kurt's the host of a great show called Studio 360, right down the hall from us. It's about arts and culture and this week, you roped me into something kind of crazy.
KA: That sounds more interesting than perhaps it is, but yes I did rope you into something kind of crazy, which is this class in laughter yoga, the premise of which is that laughing by itself can make you healthier.
MH: Yeah, a bunch of people get into a room for 30 minutes,and they laugh at each other basically.
KA: Exactly. And with each other. Now, I was skeptical of going into a small room with strangers and forcing myself to laugh, yes. Might it have health benefits? I was open to that possibility.
MH: So we took this class to try to figure out whether laughter really can make us healthier, for real.
[Walking into class]
KA: This is like fancier.
MH: Oh, here we are!
KA: So this laughter yoga class was like no yoga class I've ever been to. It wasn't in a fancy studio. There were no mats. There were not a lot of young, limber, beautiful people around me. It was in this sort of nondescript, high-rise basement in Time Square.
MH: This is sort of like the dentists'.
KA: Uh, yeah.
MH: It was actually a chiropractor’s office that set aside this little space. There were some weight machines in the corner. And there were like a dozen people, most of them over the age of 70, probably.
KA: Yes, even I was on the younger age of the spectrum, and you were like the child.
MH: So some of them have been coming here for years.
Participant: I’ve been doing it for two-and-a-half years.
Participant: I have been doing this for a couple years.
Participant: I have been doing it for 6 years.
Participant: I've lost track of how many years I've been doing this.
Participant: I feel more centered and calmer in my life.
Participant: So it sort of blocks out everything else.
Participant: I had severe back pain that I would say to people, "Hug me virtually." And not only did the back pain leave, but the memory of the back pain left.
Participant: I have a doctorate of geriatric studies, and it’s really great for your immune system. I do not get sick.
Jonathan Applefield: Okay folks, let's all get together.
MH: So just to set the scene here, a little bit, these were people sort of standing around in their street clothes. And they gathered around in a circle, and then they started laughing.
JA: I first want to say that there’s no wrong way to laugh.
MH: That was Jonathan Applefield, he’s the guy who lead our laughter yoga class.
JA: So if you don’t feel like it, we fake it. We fake it till we make it. So we’re just going to start with ho ho ha ha. (Ho ho hahahs FADE UNDER)
MH: Okay, before we take you through the rest of the class…before we even stepped into the room, I was just like, where did this idea co me from? And it turns out it comes from this really interesting place. It didn't start as yoga at all. The inspiration for laughter yoga came from a famous writer and magazine editor named Norman Cousins. In the 1960s, he got this mysterious illness. He was in pain and he was bedridden. He had nodules that were like gravel under his skin.
So he gets this grim diagnosis from a doctor, but decides to check out of the hospital and into a hotel room. He did this because he thought the hospital wasn’t particularly clean - and the food wasn’t very good either. He’d read about the connection between stress and health problems. And he became a little bit obsessed with the idea that the inverse must be true, too - that positive emotions could heal him.
And the most positive emotion of all - is laughter. So he stopped taking his medication, and he set up a film projector, and starts watching movies, like the Marx Brothers.
[Marx Brothers clip]
Norman Cousins: And I made the very interesting discovery that ten minutes of good belly laughter would give me two hours of pain free sleep.
MH: This is a recording of Cousins from 1974.
NC: I got rid of the painkillers, the codeine, the sleeping pills. And as I discovered that laughter did produce a natural body anesthesia.
MH: This kind of sounds like magical thinking to me. But studies have reproduced this effect. Laughing does increase the pain threshold. Cousins wrote a whole book about his experience, called “Anatomy of an Illness,” and it became a big bestseller. And one copy ended up in the hands of a doctor halfway around the world.
Dr. Madan Kataria: The reason we call it laughter yoga is because we combine laughter exercises with deep breathing techniques from yoga.
MH: This is the inventor of laughter yoga. He’s a guy named Dr. Madan Kataria. He invented it in Mumbai in 1995. He cites Norman Cousins as his inspiration. Now, thousands of people practice it all over the world.
MK: That brings more oxygen to our body and brain and makes us feel more healthy and more energetic.
KA: So the subjective experience of feeling better after laughter, while you're laughing--I have no doubt about that. What I wondered about, is there some measurable, physical effect of laughter. So I went to an actual expert, a neuroscientist named Robert Provine at the University of Maryland, and he says that to start understanding how laughter works, we have to look at why humans starting laughing in the first place.
[Provine imitates chimp laughter]
KA: And that's actually Professor Provine.
Robert Provine: Being one of the three species of chimpanzees, I’m qualified to give you a sample of chimp laughter. The human "ha ha" had its origin in the chimpanzee "pant pant" sound.
MH: Chimps laugh?
KA: Chimps do laugh! And in fact, the other thing I discovered--and of course they're primates, we're primates--that is not so crazy. But also rats laugh, they told me.
KA: Rats laugh!
MH: No. Does it sound like anything? All I want to know about is a rat's laughing now.
K: Meeh meeh.
[clip of rats laughing]
RP: Well laughter is a signal we send to other people to change their behavior. It's the sign that this is about play. I'm not attacking you. In fact, laughter is literally the sound of ritualized, heavy breathing of rough and tumble play.
KA: What Dr. Provine and his team does is go out into public places and eavesdrop and watch people as they talk and as they occasionally chuckle and laugh during their conversations and write down how often they laugh, what makes them laugh.
MH: He’s the Kinsey of Laughter.
KA: There you go. And what he's found isn't exactly what you would think.
RP: What most people said before laughter occurred wasn’t anything that was remotely jokey. Perhaps only 10 to 15 percent of all pre-laugh comments are remotely jokey. They’re like “Hey where you have you been! Ha! Ha! Ha!” or “Where’d you get that shirt,” or “I’ve got to go now!” Not very good sitcom material there.
MH: OK so we tend to laugh more to just kind of make other people feel good. And I have to say when we started talking about this, I do this all the time.
KA: So I've now discovered that people aren't laughing at my jokes, but they're laughing to make me feel wanted and loved and liked. And there is a term for this in the literature--and in the science--it’s called “social laughter” versus “spontaneous laughter.” You and I might call it fake laughter versus real laughter but most laughter is social laughter.
MH: You talked to another expert about this.
KA: Yes, I did indeed. Another neuroscientist -- Sophie Scott at University College, London, who has scanned people’s brains to see what happens when they and we hear other people laughing.
Sophie Scott: What we see in the brain is actually more response to social laughter than there is to spontaneous laughter. There's lots of activation to spontaneous laughter and it strongly associated with auditory processing probably because you hear sounds you never hear in any other context. But when you listen to social laughter and this is a situation where we didn't tell people what to do they just they just hearing sounds and some of them are laughs and some of the authentic and some of them social. You get all these activations in brain areas associated with thinking about what other people think.
When you hear somebody going "Ahahahaha," you know that is a fake laugh at some level (KA: right) and you are trying to work out why that person is producing that behavior. (KA: How interesting). There is an intention behind it. You know maybe they're in pain. Maybe they're trying to cover up being embarrassed. Maybe they're trying to make somebody like them. Maybe they're trying to get out of a problem. You know all this different stuff that sort of stuff we do with social laughter. I think this is just a sign that you just keep coming back to with laughter is that it's never neutral.
SS: It's always meaningful and we're trying to work out what that meaning is.
KA: Uh Mary, you were a big pot smoker in your time I have no doubt, right?
MH: Oh yeah, I look it, right? [laughs]
KA: Well you don't not look it. Anyhow, I'm sure you know that smoking marijuana often causes people to laugh uncontrollably. And I asked Professor Scott if she knew why that was. And she had a really interesting answer.
SS: I suspect that the main basis for it is actually that a lot of what's going on day to day minute to minute in your brain is trying to stop you from laughing. Because there are many situations where it would not be appropriate to get completely hilariously giggly. You are actually suppressing it.
KA: So it just disinhibits this thing we would be doing all the time if we could.
SS: Probably, yes.[laughs]
KA: I love that idea that we're just, we’re just laughing animals and we're just keeping it tapped down all the time.
SS: Yeah, I suspect so! [laughs]
MH: So “laughing animals” is appropriate, cuz back in our yoga class-- we’re going back there--we were standing there and doing this really over the top fake laughter.
GROUP: Ho ho hahahaha ho ho hahahaha ho ho hahaha
KA: And this is before we were actually told to be animals, wasn't it?
MH: Oh no, it's coming.
JA: Well, no laughter yoga would be complete without the lion of all laughters…so let's do the lion laughter. What does a lion have? Claws. Let's hear claws.
MH: Yes, that is Kurt and me roaring like lions.
KA: And I can still do it. RRRAR!
MH: You’re kind of into it.
KA: I was, and I am!
MH: We felt kind of ridiculous but everyone around us was having a great time.
KA: They were. And they--almost all of them had been there before with each other, so there was more of a familiarity. And maybe they really are--apropos Professor Scott--just unleashing this natural laugh-all-the-time animalistic impulse.
MH: They're just letting it all hang out.
KA: That's the idea.
MH: And there was this comedown…like when you're at the end of yoga class, you know how you all sit there and shivasana.
KA: The best part of yoga.
MH: Yeah, exactly. This had its own version of that.
Jonathan: We’re going to return back to the room. If a neuroscientist were here they may say we’re in a high state of relaxation, perhaps the highest state of relaxation. So if you feel so inclined, go around and give each other an embrace. Ahahahaha!
MH: We did it.
KA: I’m having a terrible laughter yoga flashback.
MH: I think that’s technically called PTSD.
KA: Well, light anyway. It was slightly awkward, especially hugging strangers as you’re faking laughter. Two awkward things combined into one.
MH: But there was this one person there who totally had our number.
Lisa: My name is Lisa and I heard you say this is terrifying
KA: Well at first it was...
L: Well I have to say that I sat there for the whole first session, going I thought everybody could see the flashing light cause all I was thinking was this is so stupid. This is so stupid. And then when we all went around and talked and I said this was the stupidest thing I ever did. And three weeks later I came back. [laughs]
MH: What made you come back?
L: When I left here I went on youtube and I started listening to a lot of things. I got a better sense of the conceptual underpinnings of it, and I did notice that I felt better. And it stayed forced for a really long time. So here I see you guys and I’m like they’re going to think we’re so stupid, and you say this is terrifying, and then I got hysterical laughing watching you two. [laughs]
KA: Your laughter at us seemed pretty authentic.
MH: The thing about Lisa is she knows we think she looks completely nuts and she just doesn’t care because it makes her feel better.
KA: Absolutely. And it was the moment in the talkback period, where I thought like, okay, I get this. Over time maybe I’d be able to join her.
MH: And I kind of thought it was a little bit of the placebo effect. She thinks it makes her feel better, so it makes her feel better.
KA: And of course, placebo effects happen all the time, and we're no longer supposed to consider them bogus. But in fact, Sophie Scott, the neuroscientist, I asked her about this, and she said the effects of laughter are more than just a placebo.
SS: It certainly gives you measurable changes in your body's physiology which does relate to mood. You get a measurable change in pain thresholds when you're laughing. That seems to be not specific to laughter -- that's probably because you're doing quite a lot of exercise, within reason, when you're laughing. You also get, and this seems to be more specific to laughter, you get a reduction in adrenaline, and a longer-term reduction in cortisol. And those are both hormones associated with stress.
MH: To me, that was a huge deal. The fact that laughter actually can influence your cortisol levels and your adrenaline because those are real hormones in your body that are associated with big changes, like how your brain functions and how much belly fat you have. So maybe they're right. Maybe laughter does have a real, physical effect.
SS: What we don't know is, is that the laughter, or the fact that pretty much always the laughter is being elicited in a social context. So was I feeling great because I'd been laughing all afternoon, or was it actually because I'd been laughing with two friends all afternoon? And it's very hard to start separating that, because if I hadn't been with my friends, I wouldn't have laughed that much.
KA: Oh the chicken and the eggs there… laughter makes us feel better, but maybe it’s because we do it most of the time with people we like and like being around.
MH: Yeah, but I think we both felt kinda good after that laughter yoga class…
KA: We did. I admit that. We did indeed.
MH: And after roaring like a lion with Kurt Andersen, like I feel bonded.
KA: Well Simba, as your Mufasa, I'm happy to make you feel that way. And we will always have our laughter yoga to return to in memory.
MH: They can't take it away from us.
KA: They won't.
MH: Thank you Kurt for doing this with me. Kurt Andersen is the host of Studio 360. You can hear more about the science of laughter on their full show. Check it out at Studio360.org.
MH: So … if the jury’s still out on laughter as medicine… what do people laugh at in medicine?
Doctor humor. After the break.
MH: Hey guys, do you remember the Presidential Fitness Test from back in elementary school? I do. The pull ups, the push ups, sit ups, and then you had to run a mile. Okay, this is your chance to redeem yourself. If you are going to be in New York City this weekend, we are having a meetup in Prospect Park in Brooklyn on Saturday, you can join me and the Only Human crew while we try to see if we’re fitter than our fifth grade selves…. And the best part is that after we sweat it out, there’s a free concert! We have 10 VIP tickets to see Femi Kuti at the bandshell as part of Celebrate Brooklyn.
That’s Saturday, July 23rd at 5 o’clock. Get details and sign up at OnlyHuman.org.
KA: This is Only Human, I’m Mary Harris.
MH: So at the top, I said this show was for skeptics. And I think the ultimate skeptics are doctors -- They have to keep calm while dealing with so many taboos. So when is it okay for doctors to laugh about their patients? Is it EVER okay? Amanda Aronczyk went to try to find out.
Amanda Aronczyk: Two healthcare workers are performing in one of those exercises taken from improvth theater. Here's the scene: there are Santa’s elves and they're standing side by side, and they're sifting through mail at the North Pole.
Improv Scene: You know, I have problems with ah.. Ah… deep vein thrombosis and these striped tights are just killing me!
AA: Turns out Santa's workshop is a brutal place to work.
Improv Scene: These letters, have you ever read any of these? I want a pony? Well you know what, I don’t get health insurance! [laughs] So cry me a river, Sally!! Shift right! Shift right!
AA: The group included a dental student, an OB-GYN, a physical therapist. There were 35 people in total who came to Chicago to attend Medical Improv.
[Rehearsal with Katie Watson]: Many of you don’t have improv experience and it’s amazing...
AA: The four-day workshop is the brainchild of Katie Watson, a professor of medical bioethics at Northwestern University. In her slightly less academic life, she teaches improv and sketch comedy at Second City. She‘s merged these worlds here: teaching improv techniques to improve communication in the medical field.
KW: I think medical encounters are often unsuccessful when one person, typically the clinician, tries to impose a script on a patient before they’ve even walked into the room.
AA: She says that's the value of medical improv. It’s not comedy camp for doctors. But about learning to walk into situations without pre-judging. To be open and honest. To listen deeply.
KW: Every medical encounter is to some degree improvised, because you have two human beings who arrive hopefully without too much of a script… and they have to develop a shared story.
AA: And develop rapport, quickly. Which often does involve humor. And gets back to the question that brought me here: how are people in healthcare supposed to figure out when humor is appropriate… When the workshop finished for the day, I asked the group: what was absolutely not funny?
Lucy: I’m Lucy, I’m an emergency physician and I think what’s not funny is when stories are shared outside of the workplace.
Improv Student: What’s not funny, is denying or dismissing anyone’s humanity.
Improv Student: Absolutely not funny is doing harm.
Improv Student: Abuse.
Improv Student: Picking on the vulnerable.
Improv Student: Making fun of patients.
Improv Student: Jokes that have to do with race.
Improv Student: Violence of any kind is not funny.
AA: So clearly when it came to joking around, there were a lot of off limit topics.
AA: It’s a long, long list. Right? It's a long list. So I guess what I’d be curious to know is there anything that is absolutely always funny?
AA: This was a harder question to answer.
AA: I want something that’s like always fine, like clowns, always fine.
AA: As a group they couldn’t even agree if farting was always funny. Maybe I was asking the wrong question?
KW: Sometimes we use “that’s not funny” as a proxy for “that’s not okay.”
AA: And Watson said those are not the same thing. So I wanted to try an example with her. This is from a doctor named John. And John didn’t want me to use his last name.
AA: So you’re John, what kind of doctor, can I say that?
John: I’m a urologist.
AA: Okay, urologist. Tell me, what does a urologist do?
J: Urinary tract and genital tract…
AA: So helping someone who is having trouble peeing, or has an issue with their sexual organs…
J: If you really took yourself seriously you’d probably want to tell people you’re a neurosurgeon, or you know, a cardiac surgeon or something like that. If you say you’re a urologist often times people will approach that with, oh really?
AA: But he loves what he does. And he wants to help people. He also knows his work can lead to some absurd and humorous moments.
J: I had this kid come in and he said I think I have a piece of plastic in my bladder.
AA: The kid’s about 16 years old…
J: I said, well what makes you think there’s a piece of plastic in your bladder? And he said, I was taking a nap and there was a piece of plastic on my windowsill and when I woke up it was gone.
AA: The piece of plastic was lost. So John asks the kid…
J: What made you think your bladder is the first place it would be? And he, I don’t know I’m just sure it’s up there, okay? So I look up in the kid’s bladder and sure enough there’s a piece of plastic up there.
J: That he’s shoved up there.
AA: Up his penis?
AA: Oh boy.
J: Yeah. So I left the room and just said in passing to a nurse, boy I hope he doesn’t lose his cat. [laughs]
AA: The doctor says he used a little grasper, and he pulled the plastic out. The kid was fine. But is this story funny?
KW: Well, you’re asking me if it’s funny?
AA: Yes, did you think it was funny?
KW: Yes, kudos. I laughed. [laughs]
AA: Good. [laughs]
AA: Katie Watson said I was asking the wrong question – “is it funny?” - that depends on your taste in humor. She said this is a better question:
AA: Was it appropriate?
KW: I would say yes, I don’t have a problem with it, because the doctor didn’t say it to the patient, said it in the hallway. To me, that’s his way of just commenting, like, that was absurd and then moving on.
AA: And it wasn’t meant to be heard by the patient.
KW: To say that you can never make a joke outside of earshot, I think just goes too far.
AA: Watson describes this story as being “backstage” humor. Between a doctor and a nurse.
KW: Backstage is where patients are not, and front stage is where they are.
AA: Many professions have jokes that there share between just themselves – teachers, journalists, soldiers – but sometimes the line that divides backstage from front stage gets blurry. Take this story out of Virginia from last year: A man goes to the doctor for a colonoscopy.
[Recording]: Sorry I have so many questions, I just, it’s the first time I’m doing anything like this…
AA: He said, “Sorry I have so many questions, it’s the first time I’m doing anything like this…” Then he goes under. Later, in the car ride home, he gets out his phone and realizes he had unintentionally recorded the entire procedure.
[Recording]: After five minutes in pre-op I wanted to punch you in the face and man you up a bit.
AA: The doctors made fun of his anxieties… and that he didn’t like watching the needle go in his arm...
[Recording]: Why are you looking then retard?
KW: That person is naked and unconscious. They’re as vulnerable as they will ever be.
AA: This situation also presents a dilemma:
KW: Are you backstage or are you front stage?
AA: The patient had accidentally transgressed what the doctors thought was a safe space. But Watson says that’s not the problem. The doctors weren’t joking about last night’s episode of Broad City. Or a panda video. They were joking about the patient.
KW: The patient was unconscious, but they’re still present and the doctor’s in the midst of his or her work. And I think that still counts as front stage.
AA: So how are people who work in healthcare supposed to navigate this … fraught territory? I went back to the improv students. They said humor is really important in their line of work.
Improv Student: It makes all of the difficulties tolerable.
Improv Student: I think humor is the thing that can be the light in the darkness.
Improv Student: Sometimes if you don’t laugh, you cry.
AA: Lauren, a social worker from Chicago, said humor is inherent in the kind of work she does.
Lauren: Yeah, I think humor and laughter it’s, it’s coping. And I work with people with dementia, and their families and in our encounters everyone’s like oh, that’s real… And it is. But in every encounter there’s a moment of laughter, there’s a moment of the you know the surreal that is occurring – it helps cope, it helps connect, and it helps deal with what’s happening.
AA: That was the point. Whether it’s appropriate or not, humor in medicine is inevitable.
[Improv scene]: Oh here’s one for you: yeah, read it. I want a new kitty cat. You know what a wish? I wish I didn’t have heart murmurs, that’s what I wish! Shift left! No kidding!
MH: That was our reporter Amanda Aronczyk.
Thank you to Studio 360 for co-producing this episode with us. You guys are awesome… you can check out their show at Studio360.org. Only Human is a production of WNYC Studios. Our team includes Amanda Aronczyk, Elaine Chen, Paige Cowett, Julia Longoria, Kenny Malone, Fred Mogul, Lisa Rapaport and Jillian Weinberger. Our technical director is Cayce Means. Our executive producer is Leital Molad. Thanks to Danielle Fox and Stephanie Daniel. Jim Schachter is the Vice President of news for WNYC. I’m Mary Harris. Talk to you next week.