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Laughter is an age old method which has benefited mankind for centuries. Everybody understands that laughter is beneficial and relaxing. But, it is only recently that the scientific basis of benefits of laughter have been understood. This chapter analyses the scientific principles of the medical benefits of laughter therapy and presents clinical data from some of "Laughter Clubs" in India.

 Laughter as practised by us
Laughter as practised by us is different from laughter therapy practised in the Western world. They have hospital based laughter clinics for individual patients who are made to laugh by reading jokes or viewing comic videos.

Our laughter is Spontaneous, Unprovoked, Group Action Remedy (SUGAR) for positive health.


Laughter as an eustress or stress buster
Hans Selye described laughter as a form of Eustress. It is a positive life enhancing type of stress. Laughter has a built in balancing mechanism that encourages two step action of stimulation and relaxation due to release of chemicals adrenaline and noradrenaline.This produces a feeling of well-being by relieving minor stresses and strains of daily life. Laughter reduces anxiety, tension and depression. Thus, it helps in mitigating several serious diseases such as hypertension, heart disease, diabetes, etc. where anxiety and tension are predisposing factors. Kay Herth (Am. J. of Nursing 1984) has documented reduction of hypertension after laughter therapy. Many of our members have demonstrated the beneficial aspects of laughter in hypertension, heart disease, diabetes, anxiety, insomnia, etc.

Meditation and Relaxation
Laughter Therapy is one of the finest anti-stress measures. It is ideally suited for today's stress ridden lifestyle. It can be compared to any form of meditation or relaxation. To achieve the desired end through meditation, one has to put in a concerted effort to completely detach oneself on mental and emotional levels from one's own feelings and thought process, as well as from the physical world to prevent distractions. On the other hand, while laughing, we do not have any conscious thought process and all our senses naturally and effortlessly combine in a moment of harmony to give joy, peace and relaxation.
In other types of meditation you need to concentrate a lot to take your mind away from distracting thoughts, which is easier said than done. Therefore, Laughter Therapy is the easiest form of meditation, a form which brings you instant relaxation.

High Blood Pressure and Heart Disease
There are a number of causes for high blood pressure and heart disease like hereditary, being overweight, smoking and excessive intake of saturated fats. But stress is one of the most important factors.

Laughter definitely helps to control blood pressure by reducing the release of stress related hormones and bringing relaxation. In experiments it has been proved that there is a drop of 10-20 mm pressure after participating for 10 minutes in a laughter session. It does not mean that those who are taking 2-3 tablets for blood pressure everyday will be completely cured. Maybe, you will require 2 tablets if you are taking 3 or borderline high blood pressure patients may not require any medication.

Similarly, if you are at a high risk of developing heart disease, laughter may be the best preventive medicine. Those who are suffering from heart disease and have stabilized on medication will find that laughter therapy improves the blood circulation and oxygen levels to the heart muscles. Those who have had heart attacks or have undergone bypass surgery can also participate in laughter therapy.

Laughter and Healing
Laughter releases catecholamines together with adrenaline and noradrenaline. This enhances blood flow, reduces inflammation and speeds the healing process and heightens the overall energy level of the body. Thus it would help in mitigating arthritis, spondylitis, myofascitis, and such other inflammatory diseases.

Laughter as analgesic
Laughter releases two neuropeptides viz. Endorphins and Enkephalins. These are opioids which are body's natural pain suppressing agents. The ability of laughter to release muscle tension and to soothe sympathetic nervous system stress also helps to control pain. Increased circulation also helps to minimise pain. Thus, laughter has multipronged approach for the relief of pain, in painful conditions such as arthritis, spondylitis, etc. This is aptly demonstrated by the famous article of Norman Cousins (New England Journal of Medicine, Dec. 1976) where he documents that 10 minutes of laughter had an analgesic effect for 2 hour in his personal problem of severe ankylosing spondylitis. Coganetal (Journal ofBehavioural Medicine 1987) has demonstrated by clinical experiments that discomfort thresholds were higher in subjects after laughter bouts. Some (21 %) of our members with painful orthopaedic conditions had relief.

Laughter and Immunity
Lee S. Berk (Clinical Research 1989) has found that laughter may attenuate some stress related hormones and modify natural killer cell activity resulting in immunomodulation. Labott also supports Berk's findings (Journal of Behavioural Medicine 1990) and concludes that laughter results in improved immunity.

In a study at Canada's University of Waterloo (Well Being Journal), it was well documented that laughter increases the levels of immunoglobulins IgA and IgG. Norman Cousins ('Prevention' March 1988) also states that laughter serves as a blocking agent against disease.

Thus laughter by improving body immunity can mitigate host of chronic diseases such as bronchitis, common cold, rheumatoid arthritis, allergies, etc. By improving immunity it may also be a supplementary measure in control of AIDS. Some (12 .9%) of our members had improvement in such chronic diseases viz. bronchitis, common cold, etc.

Laughter an Aerobic Exercise
Fry states that laughter is a good aerobic exercise. He says that 100 laughs a day is equal to 10 minutes of rowing or jogging . Lloyd (Journal of General Psychology 1938) showed that laughter is a combination of deep inhalation and full exhalation inspiring excellent ventilation, wonderful rest and profound release. Thus laughter increases lung vital capacity and oxygenation. We measured the lung vital capacity (Peak flow rate) of our members using a Spirometer. The peak flow rate was lower than normal (<300 1/m.) in 13%, was normal in 67% (3 00-5001/m.) and high in 20% (>500 1/m.)

This would benefit patients with Lung diseases such as bronchitis, bronchial asthma, bronchiectasis, etc. Some (7.8%) of our members have relief of such lung diseases.

Bronchitis and Asthma
Laughter is one of the best exercises for those suffering from asthma and bronchitis. It improves the lung capacity and oxygen levels in the blood. Doctors recommend chest physiotherapy to bring out mucous (phlegm) from the respiratory passages. Blowing forcefully into an instrument and blowing balloons is one of the common exercises given to asthmatics. Laughter therapy does the same job, more easily and cheaply.

There are many individuals suffering from asthma and bronchitis who participate in laughter clubs. They have reported reduced frequency of their attacks. Laughter therapy may cause some discomfort if you have severe bronchspasm. There is a small percentage of asthma cases who may get a little aggravation by doing any exercise (exercise induced asthma). Such individuals should consult doctors before taking up laughter therapy.

One of the most common causes for frequent attacks of asthma is infection. Laughter therapy increases the antibody levels in the mucous membrane of the respiratory passages, thereby reducing the frequency of chest infections. It also tones up the normal mucous clearing system of the bronchial tubes. Stress is another factor which can bring on an attack of asthma. By reducing stress, it might improve the prognosis of the disease.

Improves Stamina In Athletes
Since breathing capacity is one of the factors which determines stamina in sports, laughter therapy may improve athletic performance.

There is a lot of tension before appearing in a competition. Laughter before any competitive sports activity will increase the relaxation levels and hence, performance. Laughter therapy can be introduced as a regular exercise in any kind of sports activity.

Internal Jogging
There are plenty of exercises available for your body muscles, but laughing provides a good massage to all internal organs. It enhances their blood supply and increases their efficiency. It has been compared to magic fingers which reach into the interior of the abdomen and massage your organs.

Good for Actors and Singers
Laughter therapy can be very beneficial for singers and actors. Increased lung capacity, exercise of the diaphragm and abdominal muscles will help to gain a better control over voice. It may enhance self confidence reduce stage fright.

Makes you Look Younger
People do exercise for all the muscles of the body, but there is no regular exercise designed for facial muscles except in Yoga. Laughter is an excellent exercise for your facial muscles. It tones up the muscles of the face and improves facial expressions.When you laugh, your face becomes red due to an increase in blood supply which nourishes the facial skin and makes it glow.

Laughing people look more cheerful and attractive. By squeezing the tear glands through laughter, it moistens the eyes adding a little sparkle to them. Laughter exercises your abdominal muscles and helps to improve muscle tone of those with pot bellies.

Snoring occurs as a result of lack of tone in the muscles of the soft palate. Laughter therapy is very good for the muscles of the soft palate and throat. Some individuals have reported improvement. We have already started clinical studies on the effects of laughter on snoring.

Interpersonal Relationships
Laughter brings people together and improves interpersonal relationships. All the members of a Laughter Club meet each other with open minds and they care for each other. You will get a chance to interact with a positive frame of mind. Today all, the members of different laughter clubs are like family members. They know each other well, they share their griefs and sorrows. They share their joyful moments by meeting each other, going out for picnics etc. They organize health workshops, yoga camps and naturopathy seminars from time to time. People from various walks of life come together and greet each other with a smiling face. Their attitude towards their family members improves considerably as well as towards their professional colleagues and staff.

World Peace
This is an ideal platform to promote world peace. Laughter has no barrier. Why can we not hold Laughter Contests on international levels to bring fellowship, brotherhood and make this planet a better place for living?

Self Confidence through Laughter
When you are laughing in a group at a public place with your arms up towards the sky, it removes your inhibitions and over a period of time you become a more sociable, unreserved and outgoing person. Admittedly, some people are a bit reluctant to join the laughter group initially, in spite of strong inclinations for it, for fear of appearing absurd to onlookers. However, this is a passing phase and the very decision to join a Laughter Club opens your mind. Gradually, it also adds to your self confidence.

Laughter Therapy for School Children & College Students
At present, a majority of the members of Laughter Clubs are 40 plus or senior citizens. However, we have already begun to initiate and spread this concept amongst students as it has various benefits for them. Its positive and refreshing effect can help them to improve their level of concentration and memory, and equip them to cope with examination related stress. Young people enjoy laughter sessions a lot. Many school teachers have shown interest in introducing laughter therapy in their schools and colleges. India's first school Laughing Club was set up on 27th of October, at Progressive English School in Aurangabad (Maharashtra). Reports indicate that, nearly 250-300 children are laughing for 10 minutes after the morning prayers. It is being conducted by senior teachers of the school. Alternately a laughing session can be incorporated in P.T. classes.

Some of this Therapy's Possible Benefits to Children are :-
1. Laughter therapy will increase the level of relaxation & reduce nervousness and stage fright.
2. It will help children to be more outgoing and develop self confidence.
3. Laughter therapy will increase their stamina and breathing capacity enabling them to excel in sportsactivities
4. Laughter therapy will increase oxygen supply & improve mental functions & academic performance.
5. Cheerful moods will become a way of life & help children to develop a positive altitude towards life, as well as enhance their leadership qualities.
We are approaching educational authorities and Government officials to introduce Laughter Therapy in schools and colleges. Meanwhile, we shall also assist and guide people who wish to start Laughter Clubs in private schools or colleges.

Laughter Therapy in Corporate Houses
In Japan, it is a regular practice to do some physical exercises in office premises in the morning before employees start their work. All the members of the company, from Managing Director to peons, participate.

We believe that introducing Laughter Therapy in corporate houses is a very significant and worthwhile idea. It can help to improve inter-personal relationships at all levels in an organization replacing mutual lack of trust and confidence with a more positive outlook and cooperative attitude towards one's colleagues and subordinates. This should in turn definitely help to improve the prevalent work environment and overall performance of an organization. One such Laughter Club is being conducted at Larsen & Toubro's head office at Ballard Pier.

Laughter Therapy for Blind students and Old Age Homes
In the month of October 1995, a unique experiment was conducted in making blind students laugh at Dadar (Mumbai). There were about 30-40 young girls mostly below 12 years of age along with same senior members of the organization. Initially they were hesitant, but after a live demonstration the little girls were laughing non-stop and they were laughing as if they were starved of this natural gift. We are also approaching institutes for the blind to introduce laughter in the lives of blind students.

It will certainly help them to become more cheerful and cope with depression and frustration that haunts them quite often. We call upon social workers and philanthropists to join hands with us in this mission. Similarly, this nature cure can cheer up residents of old age homes.

Clinical analysis of 516 members of laughter clubs from all over India
A simple proforma prepared by Dr. S.D. Khandwala was sent out to all the Laughter Clubs in India in September 1997. Replies were received from 516 members. An analysis of these 5 16 fonns which was an eve opener was presented at World Congress of Alternative Medicine held in Colombo in November 1997 by Dr. Khandwala. This data is presented here. Most members (71.7%.) were males and in the age group 50 to 70 years (63.5%) and retired or housewives (40.2%) as the male senior citizens are more interested in such activities. However, almost 10% were younger people. It is necessary to target younger people and even students as well as women.

This movement has started only recently and still almost 40% members have been attending for over a year. It is most heartening to note that 93.8% of members are regularly attending indicating the popularity of laughter sessions.

Majority (59.3%) of the elderly members are suffering from some disease as would be expected in this age group and laughter therapy resulted in amelioration of the disease in as many as 83.6%. The amelioration was moderate to substantial degree in 56.1%. It was heartening to note that 44% needed less medication and there was not single case of worsening of the disease.

The holistic benefits of laughter therapy are also well documented and 77.1% had a positive improvement in their general health both mental and physical. The attitude of majority (82.6%) of members towards their family members improved resulting in a harmonious family life. 71.7% of our members reported improved relationship with their colleagues in their profession, business or places of service. The self confidence was increased in 85.7% of members, while 66.7% reported increased concentration.

Almost all (99.6%) stated that they would like to continue laughter session as well as recommend the same to others. Many members reported several additional tangible benefits such as feeling energetic, fresh (32.1%); improved outlook on life (11.2%); improved social behaviour (8.5%); increased stamina (3.9%); increased appetite, improved digestion (3%). All these minor benefits go to improve the quality of life.

Who Should Not Join a Laughter Club ?
People are instructed to laugh forcefully so that all the residual air in the lungs is emptied and is replaced by oxygen-rich fresh air. Forceful laughter involves some physical strain and rise in abdominal pressure. Patients with the following complications are those who should not join in laughter therapy sessions.
Hernia - Hernia is a protrusion of abdominal contents through the muscle wall of the abdominal cavity Those suffering from inguinal (groin) hernia or abdominal incisional (operative scar) hernia should avoid attending laughter sessions. This is because laughter produces additional abdominal pressure and may aggravate the condition. However, if the patient has undergone surgical treatment for hernia, he/she could be assessed by a surgeon for fitness before attending laughter therapy.
Advanced Piles - The condition of patients with long standing piles may worsen with laughter therapy. They should get themselves treated before attending therapy. They should get themselves treated before attending therapy.
Heart Disease with Chest Pain - Heart patients who get chest pain while walking or during routine activity, should not participate. Patients whose condition has stabilized and who can walk for 3045 minutes without difficulty, are fit to join the laughing session. Avoid laughter therapy for three months after a heart attack and for two months following abdominal surgery.
Prolapse - Ligaments supporting the uterus become weak after the age of 40. They may sag and cause prolapse of the uterus. Such women have lower abdominal discomfort and may lose complete control over their urine flow (stress incontinence). They should avoid laughter therapy until they are treated surgically.
Pregnancy - Pregnant women with any complication should avoid attending a laughter session. Even patients without any illness, but who feel uneasy after a laughter session should discontinue their attendance and consult a doctor.
Severe Cold, Flu and any Lung Infection - Those suffering from a viral common cold with running nose along with fever and chest infection should stay away from the group for 2-3 days till the infection and fever settle down.
Glaucoma - Those having Glaucoma should avoid laughter session as the condition may worsen.