A clown is like an aspirin, only he works twice as fast. - Groucho Marx

Medical studies indicate that laughter boosts levels of endorphins, the body's natural painkillers, and suppresses levels of epinephrine, the stress hormone. Norman Cousins, whose book Anatomy of an Illness tells how watching comedic movies helped him recover from an illness that was predicted to be fatal, is generally credited with starting the scientific study of the effect of humor on physical wellness some 20 years ago.

Laughter may or may not activate the endorphins or enhance respiration, as some medical researchers contend. What seems clear, however, is that laughter is an antidote to apprehension and panic.
- Norman Cousins

Science may consider this a new field, but spiritual teachers, some physicians and most comedians have known for centuries that laughing can take some of the power away from a disease.

I've been doing comedy for 13 and 1/2 years and I know I'm healthier because I've done this. Something happens inside my body. I can't say it regenerates, but it certainly holds steady the progress, slows it down for the night.
- Brett Leake, comedian with muscular dystrophy

Studies have shown the following physiological effects of laughter in the immune system alone: increase in the number and activity of T cells and natural killer cells, which attack viruses, foreign cells and cancer cells; increase in gamma interferon, a blood chemical that transmits messages in the nervous system and stimulates the immune system; a rise in immunoglobulin A, an antibody that fights upper respiratory tract infections (stress, particularly depression, has been shown to lower Ig A levels); and more immunoglobulins G and M, which help fight other infections.

Mirthful laughter has also been shown to exercise the cardiovascular system by raising and lowering the heart rate and blood pressure; improve coordination of brain functions, thereby enhancing alertness and memory; lift depression; reduce stress; bring pain relief; aid ventilation and clear mucus in the respiratory system; increase blood oxygen by bringing in fresh air; and strengthen internal muscles by tightening and releasing them. One doctor says that 20 seconds of guffawing gives the heart the same workout as three minutes of hard rowing.

Healthcare workers who exercise their humor muscles also benefit from reduced stress, greater empathy and a better ability to relate to their patient's emotions. However, the hospital experience itself is still great fodder for humor.

Once person is admitted into a hospital, he is no longer a person, but a patient. After this metaphysical transformation, he loses all dignity and grace, going from bashful to dopey.
- Jeff Charlebois, comedian and writer with spinal cord injury, author of Medical Secrets Revealed, 1994, LeBois Productions.

Hospitals today officially encourage patients to laugh. Many have instituted humor rooms, comedy carts full of costumes and gag props, closed-circuit comedy television channels and visits from clowns.

The abbreviation PT, by which physical therapy is widely known, originated from both Latin and Greek roots, the Latin being "paineoneous" and "torturellia," meaning pain and torture. And the Greek being "punishamento" and "tormentia," meaning punishment and torment.
- Jeff Charlebois

People who work in medical settings learn that humor, as healing as it may be, isn't always appropriate. Each person reaches acceptance of crisis at his own pace.

Patty Wooten, owner of Jest for the Health of It!, a consulting business that helps health and social service professionals develop therapeutic humor programs, has spent much of her nursing career in intensive care units.

"How you use humor depends on the patient," she says. After making clear her professional competency, she tests patients by showing them a cartoon or wearing a funny button. Then she watches for facial changes such as "glistening of the eyes and flushing of the cheeks." If the patient seems to like the gag, "Then I'd get a little bit bigger with my humor. At first I always direct it at myself before I would turn it on them."

Humor is tragedy plus time.
- Carol Burnett

In their study of humor and disability, Lefcourt and Martin observed that the people who laughed at disability-related cartoons had already come to terms with their disabilities and were able to see references to disability with less sensitivity. If less than three years had passed since a disability or diagnosis, the person was less likely to see humor in the situation.

Wooten helps professionals communicate to people dealing with a new disease or disability an understanding that They're facing a difficult challenge and that sadness and a sense of loss are inevitable. She adds, "What they're going to have to look a little closer for is the joyful moments, the playful moments. I encourage them to believe that it's still possible to laugh."

By listening to what others say and watching for situations that are appropriate for humorous comment, friends and family can know when it's time to administer a dose of laughter.

One of the gifts you can give your child is a willingness to be playful, to laugh with your child, because if you're serious and somber, the child picks up that that's what's expected.
- Patty Wooten

Humor can be uplifting to all family members. Cousins recounts the story of a 23-year-old woman who was losing the use of her legs because of an illness. Her doctor feared that the entire family "was becoming unhinged by worry and despair."

Cousins encouraged the family to look for humorous material at the library and share anecdotes and jokes with each other. The family found new ways to connect with the patient, and all felt more hopeful.

What's significant about the laughter was not just the fact that it provides internal exercise for a person flat on his or her back - a form of jogging for the innards - but that it creates a mood in which the other positive emotions can be put to work, too.
- Norman Cousins