Charlie Chaplin reportedly said: “The difference between tragedy and comedy is distance. Up close, things seem tragic. Distance yourself from it, and you get comedy.” And Mel Brooks nailed it: “Tragedy is when I cut my finger. Comedy is when you fall into an open sewer and die!” We inherently know that negative emotions bring with them unpleasant somatic symptoms, and laughing feels good, but is it actually good for you?
Well, here is the headline: yes, laughter is, if not the best, then at the least, very good medicine. Aviators live by checklists that guide us through processes to keep us safe. But adding laughter to the POH can improve your health and safety, and not just in the cockpit. Compelling data demonstrates that laughter has measurable effects on physical and mental health, avoidance of negative outcomes from disease, extending life, and directly affecting your fitness to fly. So, let’s explore the science, starting with an exploration of being miserable.
Numerous studies have shown that negative psychological states such as depression, anxiety, or chronic stress are related to many health problems. Loneliness, for instance, is equivalent to the deleterious effects of smoking ten cigarettes a day, and one study from Harvard correlated social isolation with a 50% increase in mortality. An extensive Norwegian study of 53,000 people by Dr. Svebak demonstrated that those with an underdeveloped sense of humor had markedly higher risks of death from heart disease and infection.
Observations in children living with HIV-AIDS and other serious, life-threatening illnesses could dramatically improve when promised a trip to a favorite theme park or other exciting life event—a phenomenon called psychoneuroimmunology, when good feelings help the immune system to kick into action.
While interesting reading, medical journals do not usually provoke guffaws, but a paper in The Lancet by Professor Andrew Steptoe concluded that a happy outlook independently predicts health outcomes, having controlled for other risk factors such as smoking or obesity. So, eating fruits and veggies and hitting the gym help, but so does watching a Mel Brooks or Charlie Chaplin movie. And being happy seems to change the disease trajectory of those conditions most likely to lead to pilots losing their medical. And without a medical, no flying. And no flying? Unhappy pilots!
But it goes further than this; while it may not be Mad magazine, a 15-year study in Psychosomatic Medicine found that older adults with a strong sense of humor had a 48% lower risk of death from all causes, and a 73% lower risk of death from heart disease. When one laughs, feel-good chemicals (enkephalins, endorphins, endomorphins, dynorphins, and nociception/orphaninendorphins) are released, and like keys opening a lock, they open pathways that promote a sense of euphoria. This is the same pathway by which drugs like heroin have their effects, but these internally generated substances do no harm; in fact, it is an evolutionary effect to reward “good behavior.” Additionally, cortisol, the hormone associated with chronic stress, drops with merriment. Laughing causes heart rate to increase, muscles to relax, and blood vessel function to improve, all resulting in reduced blood pressure, and in turn, burns calories, so chortling is akin to a mini workout.
As a surgeon, I have always thought about the small, incremental things that can improve outcomes. Turns out that humor helps, and patients with a positive outlook tend to recover faster. And the research backs it up. At UCLA, James Rotton and Mark Shats established that patients maintaining a good sense of humor after surgery needed less postoperative pain medication and achieved earlier discharge than those who couldn’t see the funny side.
Flying imposes the ability to multitask, to make rapid and important decisions while maintaining situational awareness, all requiring superior cognitive function. And hilarity helps. Most MRI scans are performed to characterize a structural abnormality, but MRI can also be used to evaluate brain function, cleverly called fMRI! Studies with this modality have shown that titters and chortles activate areas of the brain such as the pre-frontal cortex, which is involved in complex decision-making. It also helps the brain remain plastic, a state in which it is better suited to learning and problem solving. A study of older adults from Korea ascertained that regular laughter was associated with improved memory and fewer symptoms of depression. However, there are differences between types of laughter; the effects above seem to be stimulated by joyous laughter rather than a consequence of being taunted or tickled.
In flight, we know that crew resource management (CRM) training helps ensure safety, and an environment commensurate with humor helps diffuse tension. We have all experienced the rare ATC employee whose stress levels lead them to be snippy, and know the negative emotion that invokes. Conversely, a kind word or gentle pun over the airwaves makes us feel good about life; once, when flying high over the Midwest, a Center controller, on hearing my English accent, asked if I could “pass the Grey Poupon” before handing me off.
There are sex differences with laughter, and it plays a big role in relationships. Men are more likely to initiate humorous outbursts and women rate a sense of humor as a top three desirable trait. Similarly, men find women who laugh at their jokes more desirable. The phenomenon of “infectious” laughter is fascinating and has evolved to promote social bonds, or as William Makepeace Thackeray would have it, “A good laugh is sunshine in the house.”
He was right, couples who laugh together have higher quality relationships—and better relationships equate to better health.
Laughter can be therapeutic, but it is not a panacea, and if you, or someone you care about or know, seem to have a persistent low mood and inability to laugh at even your most risible anecdote, please seek help, as this might indicate depression or another serious medical condition which, untreated, can jeopardize flight status and personal safety. And that’s no laughing matter. With help, these conditions can be treated and do not automatically mean losing your wings—mental health treatment and flying are not mutually exclusive.
Together with two colleagues I have just written the first volume in a new book series demystifying medicine for the public. This book addresses diverticulosis and diverticulitis, the subject of a prior AOPA article entitled “Diplomatic Pouches,” and while it is a serious topic, we have injected humor to make the book easier to digest (the pun is deliberate) and help messages sink in.
Our aviation ancestors, the Wright brothers, had a dream, determination, and bravery. But history suggests they also had a sense of humor with Wilbur once quipping that their bicycle business gave them “experience in crashing gracefully.” Please take a minute to digest the message of this article, take time to laugh, and take time to laugh with others because comedy is about timing—and so is life. Fly well!
You can purchase a copy of Some Important Medical Sh*t: Diverticulosis and Diverticulitis here and for each copy sold we are donating to a medical charity.
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You can send your questions and comments to Dr. Sackier via email: [email protected]
