Part II (continued)

Psychoneuroimmunology and Humor

Symptoms

It is not surprising that the grief you feel after the death of a loved one can damage your own health. But even the commonplace bad moods and negative attitudes we all suffer can set us up for poorer health--if they occur day after day, month after month.  This is difficult to document in research, but the herpes simplex virus (responsible for small ulcers, fever blisters, and cold sores around the mouth) provides a good way to demonstrate it.  This virus, carried by about 1/3 of the U.S. population, normally remains latent, but persistent negative emotions can trigger an outbreak.⁷⁹ Pessimistic students, who can be expected to generally have more negative moods than optimistic students, have even been shown to develop more symptoms than optimistic students around exam time.⁸⁰ Pessimistic students also show more symptoms of illness over time than do optimistic students in the general population (i.e., regardless of their herpes simplex status), even when both groups start out equally healthy.⁸¹

In 1991, an article in the New England Journal of Medicine finally established that stress makes you more vulnerable to the common cold. However, your mood and coping skills also influence susceptibility to colds and the flu.⁸² One study showed that those with low morale, and who cope less well with stress, are three times more likely to catch the flu during a flu epidemic.⁸³

In the case of more severe illnesses, increased stress levels among coronary heart disease patients have been shown to increase the level of angina pectoris experienced.⁸⁴

Multiple Sclerosis is a good example of a disease known to incur exacerbations or worsening symptoms in the presence of negative emotional states. Anything MS patients can do to sustain a positive frame of mind on a day-to-day basis helps keep these exacerbations from occurring.  One man who had difficulty controlling his shaking hand told me, "MS also has its good points; I never have to worry about stirring my coffee anymore."

In summarizing the entire field of research in this area, Blair Justice concluded in his book, Who Gets Sick, that while there are many exceptions, the general rule is that "Those who get sick the most seem to view the world and their lives as unmanageable."⁸⁵ What better reason could there be to learn to manage the stress in your own life more effectively?  Your sense of humor makes life more manageable at the same time that it adds more joy and fun.

People who are chronically prone to depression, anger, or anxiety over the course of their lives have a greater risk of disease.⁸⁶ There is a growing conviction among many researchers that this increased susceptibility to disease is at least partly a result of the suppressive effects of negative emotions upon the immune system, although the disease that appears depends on specific vulnerabilities, health-related habits, and family history.

Generally speaking, you're most likely to become ill in response to stress if your immune system is already compromised.  For example, since the immune system becomes weaker as you get older, senior citizens are more vulnerable to stress-related illness.  Clearly, any tools which these individuals can acquire to help manage negative emotions should also help protect them against disease.

Finally, there is now ample evidence that mental factors influence the mechanisms, which mediate pain.  Many patients say that their pain is worsened when they feel depressed or when things seem hopeless.  It is reduced, on the other hand, when they're distracted or doing something enjoyable. One researcher concluded that "thoughts and emotions can directly influence physiological responses--including muscle tension, blood flow, and levels of brain chemicals--that play important roles in the production of pain . . . Psychological factors can also indirectly influence pain by affecting the way you cope with it."⁸⁷ New techniques for managing pain are designed to help reduce the occurrence of stress-increasing thoughts, emotions, and behaviors, because this serves to reduce the pain experienced.  One of these techniques--the most enjoyable one--is humor and laughter.

Positive Health Influences

Survival

On the positive side, one important study showed that among a group of individuals 65 and older, those who were optimistic about their health, in spite of lab tests that showed them to be in poor health, had lower death rates over the next six years than those who were pessimistic about their health, in spite of health records which documented that they were in good health.⁸⁸ Optimism, in this case, became a self-fulfilling prophecy, leading individuals in relatively poor health to fare better than their healthier, but pessimistic peers.

 The most dramatic evidence of the impact of a positive attitude on health comes from studies of survival rates of cancer patients.  For example, among patients with metastatic (spreading) cancers, those who expressed greater hope at the time of their diagnosis survived longer.⁸⁹ In another study, over 400 reports of spontaneous remission of cancer were reviewed and analyzed.  The patients themselves attributed their cure to a broad range of causes, but only one factor was common to all cases--a shift toward greater hope and a more positive attitude.⁹⁰

One clinician traced unexpected tumor shrinkage to favorable changes in the psychosocial situation of the patient. Examples of such changes include "a sudden fortunate marriage; the experience of having one's entire order of clergy engage in an intercessory prayer; sudden, lasting reconciliation with a long-hated mother; unexpected and enthusiastic praise and encouragement from an expert in one's field; and the fortunate death of a decompensated alcoholic and addicted husband who stood in the way of a satisfying career."⁹¹

Norman Cousins described the preliminary findings of a national survey of oncologists, completed during his stay at the UCLA Medical School.  Of the 649 who offered their opinions on the importance of various psychosocial factors in fighting cancer, "More than 90% of the physicians said they attached the highest value to the attitudes of hope and optimism."⁹²

All of these findings are consistent with the findings of a recent study showing that method actors asked to generate the emotion of joy within themselves showed an increase in the number of natural killer cells circulating in the blood stream within 20 minutes.⁹³ Once they got themselves out of this positive state, their levels of natural killer cells quickly dropped again.

There have always been doctors who have emphasized the importance of a "will to live" in fighting serious diseases.  Most recently, this banner has been carried nobly by Dr. Bernie Siegel, who emphasizes the importance of hope, determinism, optimism, and a "fighting spirit" among patients who are battling cancer.  Research now supports this view, so it is important that doctors, nurses, and family members associated with people who are ill make an effort to support the development and maintenance of a positive outlook in the patient.

Evidence of the importance of a fighting spirit was obtained in another study of cancer survivors.⁹⁴ Cancer patients with a fighting spirit were most likely to be long-term survivors, and have no relapses. Short-term survivors were more likely to show a "stoic, stiff upper lip attitude," and to continue their lives either as if nothing were different, or with a sense of helplessness or hopelessness.

   "If I'd known I was going to live this long, I'd have taken better care of myself."

AIDS patients with a more optimistic outlook have also been shown to survive longer,⁹⁵ as have men suffering heart attacks.⁹⁶ In describing preliminary findings from a study of AIDS survivors completed at the UCLA Medical School, Cousins reported that "the refusal to accept the verdict of grim inevitability" is one of the traits that characterizes AIDS patients who live long past the time predicted for them.⁹⁷ All of these findings clearly support the idea that positive beliefs, attitudes, and emotions contribute to your survival. And your sense of humor helps maintain this positive focus on a day-to-day basis.

Symptoms

A generally positive and optimistic attitude also reduces the severity and frequency of occurrence of symptoms.  For example, college students with a more optimistic outlook on life were found to be in better physical health (as determined by their physicians) than their more pessimistic peers two decades later.⁹⁸ More optimistic students also had fewer sick days (e.g., due to colds and flu) in the month after optimism levels were determined and fewer visits to the doctor during the following year (even when initial health status and level of depression were controlled for).⁹⁹

Attitudinal and emotional factors have even been linked to wound healing.  For example, more optimistic patients showed the most rapid healing following an operation for a detached retina.¹⁰⁰ Consistent with this finding, one investigator concluded, following a thorough review of research in psychoneuroimmunology, that positive emotions facilitate the healing of wounds.¹⁰¹ He felt that they did this by disrupting the production of neurotransmitters, hormones, and other substances which interfere with certain steps of the healing process.

Evidence is also emerging to show that hope, like optimism, contributes to improvement of symptoms. For example, among spinal injury patients with comparable injuries, those who expressed greater hope for improvement became more mobile and coped better emotionally than those who saw their situation as hopeless.¹⁰²

In a study of men with HIV infection, meetings were arranged twice a week to practice relaxation methods and talk about coping with the problems confronting them. Early results showed that these procedures delayed the onset of more serious AIDS symptoms, strengthened the immune system, and boosted the men's emotional resilience.¹⁰³

Apart from love, there is no better tool for maintaining a positive, optimistic frame of mind in the midst of serious illness than your sense of humor. That is one reason why many hospitals now make an effort to build humor into the health care setting (see discussion below). The problem, of course, is that it is impossible to have access to your sense of humor when you are ill if you haven't cultivated it when you're healthy and in good spirits. If you begin building your humor coping skills now, you'll have them when you really need them.

Do People with a Good Sense of Humor Get Sick Less Often?

We have seen that humor and laughter positively influence our body in ways that should sustain health, but little research has been done on whether a better sense of humor actually helps keep you from getting sick. However, since people with a better sense of humor have higher IgA levels, and those with higher levels of salivary IgA are less likely to get colds ¹⁰⁴ or be infected with Streptococcus,¹⁰⁵ humor should reduce the frequency of colds.

The only study to directly examine this question found that the impact of one's sense of humor upon colds depends on the kind of sense of humor you have.¹⁰⁶ It was only individuals whose sense of humor took the form of seeking out and appreciating humor who had fewer and less severe colds/flu than their low humor counterparts. Surprisingly, those whose sense of humor took the form of initiating humor more often did not have fewer or less severe colds/flu. The researchers argued that being a person who likes to tell jokes or otherwise initiate humor takes them into more frequent contact with other people, which serves to expose them to infectious agents more often, robbing them of the advantage that a more active sense of humor otherwise offers.  Obviously, more research is required to clear up this confusing picture.

The importance of active use of one's sense of humor in producing humor's health benefits was confirmed in another study in an unusual way. It found that among a group of mothers with newborn infants, those who actively used humor to cope with the stress in their lives had fewer upper respiratory infections--and their infants also had fewer infections.¹⁰⁷ This seemed to be because these mothers had higher levels of immunoglobulin A in their breast milk.  Consistent with this finding, another study showed that mothers with low levels of IgA at the time of birth had babies who showed more illnesses in the first six weeks postpartum.¹⁰⁸ So breast-feeding mothers now have all the more reason to build plenty of laughter in their life every day.

Among adults, if we look at bodily symptoms alone, independent of any diagnosed illness, there is some evidence that individuals who have more negative reactions to humor (finding a lot of different types of humor aversive or objectionable) report more bodily symptoms and complaints.¹⁰⁹ Students complaining of cardiovascular symptoms and gastroenterological symptoms also have been shown to have this more negative reaction to humor.¹¹⁰

Coronary heart disease (CHD) has long been linked to the so-called Type A personality. One pair of researchers observed over 25 years ago that only type B individuals use humor as a coping tool in dealing with stress and hostile feelings.¹¹¹ Hostile humor has also been found to be the main kind of humor enjoyed by Type A patients, while Type B patients enjoy non-hostile as well as hostile humor.¹¹² This is consistent with the findings showing a close relationship between hostility and heart disease. While laughter at hostile humor must provide some of the benefits described above for CHD-prone individuals, those benefits are clearly not enough to offset the bodily effects caused by hostility to begin with.  Developing non-hostile aspects of one's sense of humor to counteract this effect is essential for Type A individuals.