There may not be much humour in medicine but there is some medicine in humour. Doctors are acknowledging the therapeutic benefits of having a good laugh.

When Payal Khemani was hospitalised for leukaemia two years ago, she realised the cure wasn't going to be any less painful than the disease. But a few weeks into treatment, she found an unlikely solace. "A nurse walked in wearing a radiant smile and kicked off our conversation with a joke, " recalls the 46-year-old Mumbai banker. "Before I knew, she'd become essential to my existence. " What was endearing about the nurse was her ability to enliven an otherwise despondent setting with humour. This took Khemani's mind off her agony for a while. "To me and my family, laughter was inconceivable in my situation, " says Khemani. "But my responding to humour seemed to suggest I was finally beginning to accept my diagnosis, which doctors said was the first step to recovery. "

Relentless work and travel schedules left Karthik Ramasamy, 32, with chronic fatigue last year. The pain relief he was prescribed provided succour, but no motivation to slow down. For the Bangalore-based IT professional, popping painkillers soon became an everyday way to keep going. "Coping with exhaustion and irritability was a constant battle, " he says. When his father chanced upon his stash of analgesics, he forced Karthik to seek help. "I couldn't believe it when the doctor said I was addicted to painkillers. " On his doctor's advice, Karthik tried out something that he can't stop raving about: "Whenever I feel the urge, I watch comedies on TV, DVD or the internet, depending on where I am. It is an amazing distraction and helps keep my withdrawal symptoms at bay. "

Humour, it turns out, is not just an antonym of distress, but also its antidote. It is now also known to aid healing, especially in conditions exacerbated by stress, humour holds promise as a complementary therapy too. In the West, clowns, humour carts, and special rooms devoted to funny movies and books are gradually gaining ground across hospitals. A beginning has been made in India with brightly dressed and bulbous-nosed clowns prancing and playing through paediatric wards in certain hospitals in Bangalore and Chandigarh. "In Bangalore, we have worked across four hospitals, " says Mili Jalan, a therapeutic clown who, along with Sanjay Balsavar, heads Docteur Clown India. "The real challenge is to draw and retain volunteers. "

Therapeutic humour, says the Association for Applied and Therapeutic Humour, is any intervention that promotes health and healing - physical, emotional, cognitive, social or spiritual - by stimulating a playful discovery, expression or appreciation of the absurdity or incongruity of life's situations.

By releasing mood-enhancing hormones such as serotonin and noradrenaline, humour contributes to feelings of well-being and happiness. It enables greater sense of control over life's situations, helps release fears and anger, and encourages relaxation. That can be immensely therapeutic even in life-threatening conditions such as cancer. "Where cancer patients who do well differ from those who don't is their ability to put cancer in the background, " says oncologist Dr Navin Manjesh.

A recent Australian study of older people with dementia shows that humour has the effect of anti-psychotic medication in enhancing positive behaviours and reducing agitation. Researchers at the University of Maryland Medical Centre say that watching a funny movie improves the functioning of blood vessels, much like aerobic exercise or statin does. As American humourist Henry Wheeler Shaw (aka Josh Billings) said, "There ain't much fun in medicine, but there's a heck of a lot of medicine in fun. "

"In therapy, " says Dr Adarsh Tripathi, assistant professor and consulting psychiatrist at King George's Medical University, Lucknow, "humour narrows interpersonal gaps, communicates a caring attitude, and relieves anxiety associated with medical care, allowing clients to open up. " Senior consultant psychiatrist, Dr Sanjay Chugh seconds that: "A statement with a ring of humour can sometimes force the client to look at the situation from an alternative perspective, reducing the psychological weight of the situation, " he says.

At the Mumbai clinic of veteran dentist Dr Suchetan Pradhan, comedy shows on TVs, coupled with his self-directed humour, help patients get in a happy frame of mind. "Pain is often heightened by the anticipation of its arrival and having patients concentrate elsewhere lowers their pain perception, " he says. "Employing humour is about evoking and transferring empathy to make the medical process easier and effective. "

Tripathi cites the example of 13-year-old Ananya brought to him by her mother for being cripplingly shy. She had nearly no friends and shunned school. The mother was worried that if Ananya once felt uncomfortable in clinic, she wouldn't come again. Tripathi chose to meet her at an outside location and began by befriending her with humorous stories. To everyone's surprise, Ananya not only attended all subsequent sessions, but is also making steady progress today. "She couldn't have been helped by conventional ways of dealing with clients, " Tripathi says.

Bangalore-based writer Nazneen Tonse also wears the hat of a therapeutic clown. She works independently with senior citizens today, but was earlier associated with Docteur Clown India - an offshoot of the French NGO Docteur Clown - and regularly visited sick children in paediatric wards. "One of the benefits of humour is that children cooperate better in medical procedures, " she says. When a three-year-old boy suffering from chest infection was too scared to use a nebuliser, his first time with a device meant for inhaling mist-like medication into the lungs, Tonse went up to him and joked, "Look at this, such a small boy and he's already smoking!" The trick worked: The boy smiled and began imitating Tonse's deep inhalation and exhalation. Tonse avers that it is adults more than children who need clowns. "Children can use their imagination and play, but as adults, we have forgotten to use our imagination. "

When it comes to using humour in medical situations, caution and sensitivity are the buzzwords. "Humour must be timed correctly and must not be personal or offensive, " warns Chugh. "The application of humour is more of an art than a science, " avers Tripathi. "Humour cannot be at somebody's expense, " says Pradhan. "Not all patients appreciate humour. Humour should not be forced to a point where it becomes counterproductive, " says S Menaka, a Chennai-based counsellor.

While formal humour therapy has yet to come into its own in India, it doesn't help either that doctors often have trouble lightening up. "Most doctors equate a serious disposition with a sense of power. Besides, we, as a people, have a rather plastic sense of humour, " says Pradhan. Adds Chugh, "It must be remembered that using humour does not mean being less serious about work. " Indeed, for humour in itself is serious work.


Some names have been changed on request.