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ANA CRISTINA TORRESLAUGHING YOUR WAY BACK TO A HEALTHIER LIFETSTYLEDiseases are something most of us don’t like to think about. Maybe because they gross us out or bring us bad memories. From the time that I was a little girl, the diseases that scare me the most were cancer and Alzheimer. I don’t remember when was the first time I heard of them or who explain them to me but I was always terrified about them. What I don’t like about them is that it can happen to anyone (they aren’t like a cold that you can prevent), and because they have no cure. So what can patients do when they are facing a terminal disease? Sure there are medicines and surgeries to make the process less painful, but is that all? A lot of people say that the medical treatment is the most important thing, but someone with any illness will face not only physiological but also psychological damage. It is very common that people suffering a terminal disease alienate themselves from family and friends, thinking they don’t understand what they are going through. That is why therapy is an essential part in the treatment of any disease. Humor therapy is one option that is becoming very well known and accepted around the world. When we are sick humor is the last thing we think about, but the lack of laughter can be harmful for our health. In a time of sickness humor is needed not only by the patient but the persons around him. Humor therapy improves the course of the patient sickness and shouldn’t be taken as a joke.Humor is defined by The Oxford English Dictionary as “that quality of action, speech, or writing which excites amusement; oddity, jocularity, facetiousness, comicality, fun” (Simpson & Weiner, 1989). It has been considered a tool of therapeutic medicine since biblical days, but it wasn’t until the past three decades that the medical world has taken a new interest in the healing power that humor and laughter posses. Since then many individuals had help spread around the world humor therapy, by proving that it can reduce pain Norman Cousin, give cardiovascular benefits Dr William Fry, reduce the % of recurrent heart attacks Dr lee Berk, creating therapeutic hospitals organizations Dr. Hunter (Patch) Adams. Now a day a session of humor therapy has as main objective to make the patient laugh, for this therapists have to create an environment of calmness and trust so that the patients feel comfortable enough to perform in all of the exercises. Each session is usually compose of 20 or 15 patients and 1 or 2 therapists, by working in groups the patient can empathize with their partners. But humor therapy is much more complex than a simple group meeting where you laugh. To have a better understanding of how humor therapy works, we have to know how laughter affect us: 1)Psychologically 2)Physiologically; and also how humor can be use in healthcare as a : 1)Therapeutic tool 2)Coping mechanism 3)Diversionary tactic 4)Healing for the caregiver.Physiological changes made by laughter:For many years it was believe that laughter (known as a universal language) was only a characteristic of humans, however, it was discovered that we are not the only species to laugh; when tickled, some primates, including apes, gorillas, orangutans, and chimpanzees, will giggle, hoot, and scrunch their faces (resembling a smile).Yet scientists have no evidence that these other primates have a sense of humor. The notion that laughter has helpful properties is a very old one, dating at least to the biblical proverb that "a merry heart doeth good like a medicine" (Proverbs 17:22; King James Bible). The first results on the body while laughing will include relaxation of muscles, improved respiration, enhanced circulation, and increased production of endorphins. The results are very similar to the effect that exercising has on our bodies. This may make us wonder the next question: If laughing has the same effects of exercising, wouldn’t it be harmful for a sick person to laugh? Aren’t sick person suppose to rest? Well after many studies mainly done by Dr Frey and Dr Berck(Berk, 1989; Pelletier & Herzing, 1989); it was proven that while laughter does have similar effects as exercising it also has properties that increased pain tolerance, enhance immunity, and undo cardiovascular consequence of negative emotions. There have been some studies made by neurologist trying to figure out what properties of laughter make this happen, and they concluded that when we laugh we release certain neurotransmitters that increase the number of antibody-producing cells and enhance the effectiveness of T cells. The following excerpt is from a much more recent popular book on complementary approaches to medicine by Zand, Spreen, and LaValle (2000):Even more important, research shows that laughter stimulates an increase in the activity of defensive immune cells, including T-cells, that attack and kill tumor cells and viruses. It also boosts the activity of the antibodies that defend the body against harmful organisms, and it steps up the production of interferon, a hormone that fights viruses and regulates cell growth. These solidly documented findings are being taken so seriously that there is a software program in the- works designed to help doctors create "laughter prescriptions" tailored to specific individuals.” (pp. 600-601). As we can see Laughter therapy not only creates beneficial changes in musculoskeletal, cardiovascular, endocrine, and neural systems; it also increases the count of natural killer cells which is an important component of the immune system and helps to overcome and destroy cancer cells. A second beneficial mechanism of humor laughter is that it works as a stress-moderator. There are daily reports of partial or total cure of most stress-related illnesses like hypertension, heart disease, depression, asthma, arthritis, allergies, stiff muscles and more. While this may sounds unrealistic, it all makes perfect sense, there is considerable evidence that stressful life experiences can have harmful effects on many aspects of health; laughter is nature’s best cure for stress. Most illnesses today are stress related and chronic stress attacks the immune system and makes us vulnerable to infections, virus attack and cancer.?Psychological changes made by laughter:Psychology has always been one of the disciplines that contribute most of our knowledge of humor. However, there have been relatively few studies dedicated to humor (compared to anger, anxiety or depression). Humor and laughter are something hard to define. From a psychological perspective, humor is a rather broad and multifaceted concept, which can be defined in a number of ways. Freud defines humor as “the activity that involves the bringing together of two normally disparate ideas in a surprising or unexpected manner” (Freud 1960: 224), he also affirmed that by laughing out loud one frees negative emotions. Even though the cause of humor is still a mystery, it is clear that on a psychological level laughter and humor proves to be a way of producing emotions such as joy, mirth, hope, confidence, and sense of well being. This is one of the reasons humor can be used as a coping system using it to reduce feelings of anger, impatience, and fear emotions that are very present on a patient facing a terminal disease.It is well know that hospitals aren’t the most homely environments. The food is usually bland and not very appealing, illness and death are an imminent shadow of the place, and silence more often than not rules the place. Several hospitals around the world with humor therapy, particularly those with oncology wards , try to develop different ways to prevent patients to suffer their stays in the hospital. Humor can be use in healthcare as a: Therapeutic tool:A major causal factor of many illnesses is a person's inability to express their feelings and emotions. People are afraid of conflict. As a result they suppress and hold their emotions which eventually affect their immune system leading to a variety of very serious sicknesses. Laughter can be a cathartic exercise which will help people release their blocked emotions in a non-violent way and makes them emotionally balanced.?Patients should use humor to communicate their feelings of fear, doubt, loss, and isolation; so that they can acquire a clearer perspective of the situation they are. Humor has been reported to strengthen the bond between patient and therapist in the treatments process, this is incredibly important because the patient has to trust on his or her doctor completely. The nurses at the hospital, in my doctors' offices and who came to my home cared for me physically as well as psychologically and spiritually...I could not have made it through my journey without that care. These nurses became a part of my family.Diane Wilkins, Germantown, MDBreast Cancer?Patient (Cancer Patient Stories)I received great care at a great hospital. I love my doctors; they have been advocates for me throughout my treatment. I think it is key that the doctors really get to know you, and that they know each other and work together as a team.Gretchen Fitzpatrick, Gaithersburg, MDBreast Cancer?Patient (Cancer Patient Stories)Coping mechanism:While fighting an illness, such as cancer or a substance addiction, negative emotions will always come to surface. Humor therapy can also help patients express these negative emotions (fear, anger, despair, helplessness). For the caregiver:All caregivers have to face to various difficult situations of stress and other powerful emotions. Humor helps them find a balance of those emotions in a place such as a hospital that sickness and death is a day to day event. Professionalism is expected in the healthcare community, nevertheless it is important to implement to the workday different experience that add calming and liberating activities. “Humor is an important piece of my survival skills. Over time, if a took home the weight of everything that goes on every day here, I wouldn’t be able to get out of bed in the morning” Physician OncologistHumor therapy appears to be a treatment full of benefits and no negative effects, and that has proven to be true only when the caregiver is cautious enough to follow a number of rules; if he doesn’t humor laughter can become an unstable and controversial type of treatment. The rules are the following: It is important to distinguish between laughing with a patient and laughing at a patient, sarcasm should never be used because it can promote stress rather than reduce it, serious news should never be delivered using any kind of humor. When a doctor delivers bad news, he has to transmit to the patient a feeling of trust and hope but also make sure that the patient understands the gravity of his or her condition. To achieve this humor is not a viable option, the doctor has to look the patient in the eye and clearly explain the situation. These rules are so easily broken that many doctors and nurses do not initiate humor without a clear lead from the patient. Trying to solve this problem Dr. Keith Huber, on June of 2012, presented an article in which he proposes a model that clinicians can follow to introduce humor to their patients and successfully address all of the benefits mention above. The model follows the mnemonic of SMILESS- Smile M- Make eye contact. I- Intuition and imagination (an inappropriate comment can cause hurt feelings, anxiety, hostility, and embarrassment). L- Look for, listen to and leap at the opportunity: listen and pick up on things they joke about, avoid sarcasm. E- Elephants never forget: remember things personal things the patient tells you, the patient will appreciate the effort. S- Sensitive to the situationThe mnemonic has received a lot of positive reviews by several member of the health community.Conclusion While it is clear and has been proven that humor therapy is extremely beneficial to everyone, it still hasn’t be proven helpful enough to be use as an only treatment for serious illnesses such as cancer. While the caregivers are careful and use humor therapy only on the situations that is required, it can be a great complement to the treatment earlier prescribed by their doctors. Humor is a way to normalize the abnormal; it can be a way for the health giver to reach out to the patient and remind them that the fight isn’t over, and the ability of doctors to take a moment to detach themselves from medicine is something that is certainly appreciated by patients. In Mexico humor therapy started to gain popularity in the year 1999 when the organization “Risoterapia” started organizing group therapies on several hospitals around the country. Today “Risoterapia” not only gives therapies to the sick but also gives classes for people that are interested in becoming “doctors of laughter”, they have more than 800 active volunteers in 25 cities, visit 52 hospitals and 12 indigenous communities, and help around 6,728 families each month. Thanks to their success in the last 10 years there have been created many other humor therapy organizations (Riendo Mexico, Casa de la Amistad,…) As it was mention above Humor Therapy is a great activity for everyone involve, because the therapist can be volunteers that learn to help people in need.As the American essayist Frank Moore Colby observed, "Men will confess to treason, murder, arson, false teeth, or a wig. How many of them will own up to a lack of humor?" (cited in Andrews 1993:431).Words quoted:Berk, L. (1989) Neuroendocrine and stress hormone changes during mirthful laughter.American Journal of Medical Sciences,?298(6), 390—396.Dr. Keith Huber, SMILES-Toward a Better Laughter Life: A Model for Introducing humor in the Palliative Care Setting., June 26, 2012, The Grey Nuns Palliative Care unit by.Borod, M. Journal of Cancer Education. 2006; 21:30-34.Freud, Sigmund. El humor. Obras completas. Tomo II biblioteca nueva 1968Fry, W. (1979). Mirth and the human cardiovascular system. In H. Mindess & J. Turek (Eds.),?The study of humor?(pp. 56—61). Antioch University PressFry, W. (1977). The respiratory components of mirthful laughter.?Journal of Biological Psychology, 19(2),?39—50.Hernández Aguilar Eduardo Daniel Espinosa Chávez Mariana, Villa Hernández Irma Cristina, Risoterapia, , XXI CONGRESO CUAM ACMor, Colegio Anglo Mexicano de Coyoacán.Norman Cousin, “Anatomy of an Illness”, New England Journal of Medicine, 1976Penson, Richard (department of medicine, division of hematology-oncology, Massachusetts), Laughter: The Best Medicine? , The Oncologist Shwartz Center Rounds, 2005:651-660 Zand, Spreen, and LaValle, Smart Medicine for Healthier Living : Practical A-Z Reference to Natural and Conventional Treatments (1999)Bibliography Ariniello L. Brain Briefings. Humor, Laughter and the Brain. Washington: Society for Neuroscience, 2001 Cancer treatments centers of America September 27, 2012Erdman Lynn, Laughter Therapy for Patients with Cancer, Journal of Psychosocial Oncology, pages 55-67Joshua AM, Cotroneo A, Clarke S. Humor and oncology, J Clin Oncol 2005; 23: 645-648 Penson, Richard (department of medicine, division of hematology-oncology, Massachusetts), Laughter: The Best Medicine? , The Oncologist Shwartz Center Rounds, 2005:651-660 Wild B, Rodden FA, Grodd W et al. Neutral correlates of laughter and humor. Brain 2003; 126: 2121-2138 ................
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