A spoonful of the right laughter… Andrew Orenstein

“I have an idea!” I said to the 6-year-old girl. She leaned forward excitedly. She was brought to see me by her mother. She had shown a severe regression in toileting. My formulation was that the regression was due to dysfunctional power struggles between the mother and her.

On a whim I had invented ‘the secret weeing game.’ The idea behind it was that the game could shift the power struggles, whilst potentially being fun for the girl. In the game she was required to go to the toilet without anyone else in the family ever knowing that she had gone. When I told her the idea she giggled uncontrollably. The sort of giggle that suggested she enjoyed the subversive nature of the game. Was this laughter as medicine? As with most cases in psychology, it can be difficult to determine what, of the multitude of interpersonal dynamics, gets shifted by one’s intervention. Often, different stakeholders interpret the intervention in different ways. In this case, the toileting regression completely ceased. The girl functioned better at school. Some, but not all, of the relationships with her family members improved.

I am a clinical psychologist, working mainly with children and adolescents. I have found humour, and therefore laughter, to be of huge importance in my work. However, before writing this article, I had not considered how understanding laughter could be so complex.

In September 2008, I was in a remote delta region of Myanmar. Cyclone Nargis (potentially the second deadliest cyclone in recorded history) had hit Myanmar in May. Between 130,000-300,000 people had died or gone missing (depending on whether one believes the official figures from the Myanmar government or figures from aid organisations). I was there on a short-term trip to train local Christian leaders in a trauma program called ‘Tree of Life’, a program designed to help children process traumatic events without being retraumatised. I sat a table with two 70-year-old men. They had both survived the storm but had lost most of their family members. These men had been friends since they were children and were sharing stories about the mischief they got up to when they were young. Despite the significant loss they had experienced, they were roaring with laughter. The sort of laughter that is rich in history and love.

Indeed, there are many different types of laughter: inclusive, exclusive, canned (think sitcom laughter on the television), authentic, taunting, joyful, tickling, and anxious laughs to name a few. Which ones are the best medicine? Is all laughter good for us, or can some laughter have a negative effect? Klages and Worth (2014) found that exclusive laughter (used to exclude others) increased participants social pain and perception that they were being ostracised. It also produced lower mood, worse relational evaluation, and increased temptation to aggress. As psychologists, we see many people who have been bullied. A lot of this occurs as exclusive laughter from cruel jokes. When the bullied person gets upset, the defence is invariably, “It was only a joke.” This is laughter as poison rather than medicine.

I have been working as a psychologist since 2010, mainly with children and adolescents. One of the reasons I found myself drawn to working in this area was the enjoyment I got from seeing children transition seamlessly between discussing serious problems and laughing. This suited my personality and outlook. I have noticed an interesting phenomenon in this time. Often, when I finish a session with a child or adolescent, upon walking back into the waiting room, the parent might say, “Well it sounded like you guys were having a good time,” referring to the laughter they could hear, in a tone suggesting criticism rather than encouragement. It may seem foreign to them that a room with laughter can also be a room where we discuss psychological distress. In my opinion, laughter is crucial to this process.

Experimenters have found that willingness to disclose personal information increased after laughter. Interestingly, the effect was only found in participants rating another person’s willingness to disclose rather than their own willingness to disclose. The experimenters concluded that laughter increased everyone’s willingness to disclose personal information but that people were not always aware that it was doing so (Gray, Parkinson, & Dunbar. 2015). Also, laughter can occur alone but more commonly occurs within social contexts. Kurtz and Algoe (2017) found that shared moments of laughter can improve the quality of a relationship by increasing the perception of similarity between two people.

There is a boy I see who is at risk of homelessness. He has bounced from service to service. Most professionals have found him impossible to engage, one service even suggesting he was a psychopath. I also found it difficult to engage him. There are times when sitting in a counselling room just does not work with teenage boys. In those situations, I kick a footy or go for a walk with them. On one such occasion, about eighteen months into our work and with me feeling as though we were getting nowhere, we walked past an old beat up car. I said to him “I bet that’s your car!” He scoffed/snorted/laughed. The sort of noise that leaves the body involuntarily. “Whatever.  It’s yours!” he retorted. So started a game that continues to this day. What was in his laugh? Was it the joke that was hilarious? Or was it that I had the gall to say such a thing? In any case, he accepted me in that moment and we were able to join in something together.

“It may seem foreign to [others] that a room with laughter can also be a room where we discuss psychological distress”

Psychologists and GPs are alike in that the relationship between the professional and the patient has been found to significantly impact the health outcomes of that particular patient. Laughter can play a crucial role here. The impact of laughter on a relationship has implications for GPs. It has been clearly demonstrated that a good relationship between a patient and a GP can increase compliance to treatment, increase patient satisfaction, decrease the chance of litigation due to malpractice, and improve health and psychiatric outcomes (Francis et. al 1969; Levinson et. al 1997; Ong et. al 1995).

How do you treat PTSD in children when the trauma results from the east coast low storms that hit the Hunter region most summers? There are a number of evidence-based theories with structured tasks and homework that help people overcome the PTSD symptoms. However, the delivery of these treatments can feel quite dry (excuse the pun) and compliance with such treatments can be inconsistent. This is when psychology becomes an art as well as a science. I see a girl with this type of PTSD. Each member of her family has a wild sense of humour. When discussing treatment options, it became clear that humour was going to be an important component. Despite being only 11 years old, she loves listening to loud music. It became obvious. The treatment needed to include “Thunderstruck” by AC/DC (her favourite band) blaring loudly next time a storm rolled through. As we told her parents that this was their homework, their laughter was loud and in stereo.

Laughter can increase pain tolerance according to Dunbar et. al (2014). More specifically, relaxed, shared laughter can increase a person’s level of pain tolerance. Their study measured physical, rather than psychological, pain. They suggested that the mechanism was possibly an endorphin-mediated opiate effect and concluded it was due to the laughter itself rather than another confounding factor.

Is it enough to say that laughter is the best medicine? Not quite. From a theological perspective, laughter is like any good thing God created. Used in the wrong way (e.g. exclusive laughing) it can cause severe pain and psychological damage. However, shared, inclusive laughter is an effective way of increasing perceived similarities, increasing pain thresholds, improving interpersonal connections, and improving the therapeutic alliance. This can lead to increased patient satisfaction, improved treatment compliance and improved health outcomes.

Laughter – the best medicine? More specifically: it might be that a spoonful of the right laughter helps the medicine go down.

pic-aorensteinAndrew Orenstein

Andrew is a clinical psychologist who works mostly with children and adolescents from his own practice called Redstone Psychology in Wallsend, Newcastle. He is the father of two young boys who give him much laughter and joy.

References

  1. Dunbar RI1Baron RFrangou APearce Evan Leeuwen EJStow JPartridge GMacDonald IBarra Vvan Vugt M. (2011) Social laughter is correlated with an elevated pain threshold.  Proc Biol Sci. 2012 Mar 22;279 (1731):1161-7. doi: 10.1098/rspb.2011.1373.
  2. Francis, V., Korsch, B. M., & Morris, M. J. (1969). Gaps in doctor-patient communication: Patients’ response to medical advice. The New England Journal of Medicine, 280(10), 535-540. doi: 10.1056/nejm196903062801004
  3. Gray, Alan WParkinson, BrianDunbar, Robin. (2015). Laughter’s Influence on the Intimacy of Self-Disclosure. Iournal of Human Nature : An Interdisciplinary Biosocial Perspective; Vol. 26, Iss. 1, : 28-43. DOI:10.1007/s12110-015-9225-8
  4. Kurtz, Laura EAlgoe, Sara B. (2017). When Sharing a Laugh Means Sharing More: Testing the Role of Shared Laughter on Short-Term Interpersonal Consequences. Journal of Nonverbal Behavior.  Vol. 41, Iss. 1,  45-65.DOI:10.1007/s10919-016-0245-9
  5. Levinson, W., Roter, D. L., Mullooly, J. P., Dull, V. T., & Frankel, R. M. (1997). Physician-patient communication. Jama, 277(7), 553-559.
  6. Ong, L. M. L., de Haes, J. C. J. M., Hoos, A. M., & Lammes, F. B. (1995). Doctor-patient communication: A review of the literature. Social Science & Medicine, 40(7), 903-918. doi: http://dx.doi.org/10.1016/0277-9536(94)00155-M
  7. Platow, Michael JHaslam, S AlexanderBoth, AmandaChew, Ivanneet al. (2005). “It’s not funny if they’re laughing”: Self-categorization, social influence, and responses to canned laughter. Journal of Experimental Social Psychology. Vol. 41, Iss. 5,  (Sep 2005): 542-550.

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