Is Laughter Really the Best Medicine? Reflecting on a Mental Health Initiative Using Pragmatic Collaborative Autoethnography

Research Design

We use ICAE, a type of pragmatic autoethnography (Gonot-Schoupinsky 2022). This subjective narrative qualitative methodology encourages researchers to narrate their story by connecting the autobiographical with the sociocultural and scientific to share “the experiential process of generating actionable knowledge” (Gonot-Schoupinsky et al. 2023).

ICAE specifically “invites” nonacademics into a collaborative autoethnography. Collaborative autoethnography is used in academia to support multivocal, relational, and democratic research (Hernandez, Chang, and Ngunjiri 2017), important factors in promoting public-science communication relating to mental health. ICAE responds to calls to “include others . . . whose perspectives need to be studied and documented” (Chang 2016:120). ICAE may be viewed by the invitee as “I Can Add Experience.” In fact, early autoethnographic narrative was that of “outsiders” (Gonot-Schoupinsky et al. 2023).

Procedure

Initial e-mail contact to Merv was made in April 2022. We agreed to meet and explore ways to gain insight from the Laughie Challenge and considered a collaborative relationship, or an interview, as potential modes of discourse. To help us decide, and ensure we had access to the same terminology, links to literature on autoethnography and ethnography were exchanged. Jerome organized a Zoom call for us to meet on May 21, 2022. At that time, we agreed to use ICAE to build rapport and reflect on drawing insight from the Laughie Challenge.

Ethical Approval

The Research and Graduate School of the University of Bolton provided ethical approval for this research (Certificate Number: MANUAP0067).

Getting to Know Each Other

Freda: My PhD research topic is laughter prescription. However, I didn’t intend to become a gelotologist (someone who studies laughter). The accessibility of laughter and its potential to increase well-being drew me in. I returned to academia, after degrees in precomputer days, to study health psychology. Having recently lost my 85-year-old father to complications following a fall, my focus was healthy aging and the oldest-old (Gonot-Schoupinsky, Garip, and Sheffield 2022). A lady in her 90s confided that reduced mobility and social contact meant she hardly ever laughed. She lit up when talking of laughter. This led to my interest in laughter, both socially, but perhaps even more the therapeutic potential of laughing alone as a health and well-being exercise. My Personal Development Theory of Laughter and Humor (Gonot-Schoupinsky et al. 2020) highlights laughter’s versatility to benefit us in multiple ways.

With this in mind, I developed the Laughie as a practical tool for the medical community to prescribe laughter. It can be used alone or with others. Users record 1 minute of their laughter, in audio, or video, on their smartphone and laugh with their recording, which acts as a prompt and timer, as prescribed. We have known for some time that 1 minute of laughter can boost mood (Foley, Matheis, and Schaefer 2002). We all have 1 minute available to exercise, and laughing for 1 minute is exercise! The Laughie can boost well-being in healthy adults (Gonot-Schoupinsky and Garip 2019). On hearing the Laughie was the focus of a community mental health initiative in Australia, I was keen to understand its “real-world” impact.

Merv: I didn’t find laughter. It found me. Back in 2002 I was diagnosed with a very serious bone marrow and blood disease and started to laugh. The health professionals were mystified. “What do you find so funny” they asked? “I have no idea” was my reply. But I continued to laugh even though everyone thought I was going mad and (maybe) lost my mind. Regardless, the more I laughed the better I felt, and the better I felt the more I laughed.

Fast forward to 2019 when I was invited onto a national health-related TV show called “Medicine or Myth,” I was interviewed by Dr Charlie Teo who is one of our most famous brain surgeons here in Australia. He diagnosed me on national TV and suggested that I was (maybe) having mini strokes and bleeding into the center of my brain, the hypothalamus. When this occurs, people can start to laugh uncontrollably. It’s a condition called pathological laughter. All of a sudden, the pieces started to fall into place.

Rewind to 2002. It took 8 months before I was deemed to be totally cured (as determined by conventional medical standards), and I knew that laughter played a major part in my recovery. The Indian doctor who was looking after me agreed. He explained what had happened and how (maybe) the laughter had helped to heal my very serious condition. I had just experienced first-hand why they say that laughter is the best medicine.

Having been given a second chance in life, I went on a quest to find out more about the impact that laughter can have on our body, mind, and spirit. I found Laughter Yoga. I traveled to India in 2005 to meet another Indian doctor who had popularized this idea of this long-standing concept called Laughter Yoga and attended their International Laughter Conference in Mumbai. I reluctantly got involved in their laughter competition, won the Best Laughing Man in the World Award, and my life has never been the same since then.

The next step was to become a professional speaker, so I could share with people what I’d learnt. I joined the National Speakers Association of Australia, graduated from their Speakers Academy, won their Mentor of the Year award, and promoted myself to Speakers Bureaus. But there was a missing link. I had a story to tell but no real evidence or proof. I needed to conduct a research study. I contacted Professor Bob Cummings who was the head of Psychology at Deakin University and a Happiness Researcher (his words and not mine) and arranged a meeting. He and I had just appeared on an episode of the TV program 60 minutes, which was called “In Pursuit of Happiness,” and I guess that is why he took my phone call. By the time we had finished lunch, he agreed to arrange a study on the impact that laughter can have on staff (around 200) from two Melbourne businesses. He even paid for lunch!

The results were a game changer. We measured what I call “the positives” of general life satisfaction, personal well-being indicators, mood, self-esteem, optimism, control, and workplace well-being. We also measured “the negatives” of stress, anxiety, and depression. After just one session the positives went up and the negatives went down. This showed laughter can act instantly and provide a balance for whatever you need at that point in time. As the program progressed, they continued to increase and decrease. You can’t have too much laughter in your life. At the end when the laughter sessions ceased, the positive measures decreased and the negative measures increased, but they never returned to where they began. Regular laughter can change you permanently over time, even if you cease the stimulus. And finally, our gold nugget that we uncovered was the continued increase in workplace well-being well after the program ceased. When we went back to ask them why, they all said that they now felt so connected to the people they had been laughing with. Workplace well-being is about connecting through laughter with those you work with. Everything else flows from that.

I have done three other studies since then. The one with people undergoing kidney dialysis (Bennett et al. 2015) made me a medically published author. I started to get invitations to talk at health-related conferences. Pretty cool hey, ha ha ha.

Apart from my research studies, I conduct laughter training, run laughter workshops, am a Conference Keynote speaker, organize the Annual Australian Laughter Wellbeing Conference, which is the longest consecutively running laughter conference in the world (this year will be our 17th), have created and am developing the Laughter Quotient, where we can analyze visually through sound wave graphs, the length, repetition, loudness, and pitch of a laugh, to measure the effectiveness of people’s laughter to help their illness, and just recently, the Laughie Challenge Australia.

In summary, I could confidently say that my background and relationship with laughter are extensive, exciting, curious, and a life journey that have only just begun. I’m Australia’s leading laughter expert and “serious about laughter.”

Jerome: This was a completely new adventure for me. My background was as a clinical psychologist in the British National Health Service (NHS). I spent thousands of hours listening to peoples’ problems. There was very little to laugh about. In fact, working with patients who are chronically depressed can be a very draining experience. J.K. Rowling, the author of the Harry Potter books, is said to have invented the concept of the dementors as a metaphor for what depression does to people. Dementors drain the souls from people. I took early retirement from the NHS at the age of 54 and after a year sitting at home unsuccessfully trying to establish a “portfolio career,” I was fortunate to obtain a professorial post at the University of Bolton.

My two main interests in psychology are recovery from mental health problems and positive psychology. The latter has been one of the major developments in contemporary psychology and has been led by Professor Martin Seligman (2018). Positive psychology focuses on building what’s strong in people, not fixing what’s wrong (Carr, 2019). I became aware of this new approach around 2006. Soon after taking up the post at Bolton in 2012, Dr Chathurika Kannangara and myself set up the first MSc in Positive Psychology in the North of England. One of the main tenets of positive psychology is “strengths building” (Peterson and Seligman 2004). There are 24 universal strengths that fit into six virtues (You can discover your own personal strengths by going to www.viacharacter.org). I was amazed to discover from Freda that humor was one of the 24 strengths, as I have seldom heard it mentioned. Examining the Oxford Handbook of Positive Psychology, which has 64 chapters, not one mentions humor, and indeed it is not even in the index (Lopez and Snyder 2009)! I checked the leading journal, The Journal of Positive Psychology, and could only find four references to humor and none to laughter. Professionally, humor and laughter are topics that I rarely come across. Being the oldest member of this trio, I remember my grandmother’s copies of “The Reader’s Digest,” which I read as a child. This popular American magazine had a feature, “Laughter is the best medicine.” It was not a message I ever came across in my professional career, with the exception of some personal detective work into the story of Dr Patch Adams, who was played on screen by Robin Williams in the movie of his life.

As this is autoethnography, I need to report on my own personal relationship with humor and laughter. I chair the Board of Studies for Higher Research Degrees at the University. I always try and bring some humor into that role. During lockdown, I remember sharing especially humorous sessions with a mature student and also a PhD student. These tended to be about a third party and their reaction to either the student or a colleague. They were about situations that were only funny to the pair of us. Telling an anecdote about the laughter later to another colleague never really led to significant laughter with them. There is no doubt that the shared laughter was a wonderful joint experience and deepened our relationship, but it was not “a laughie” in the strict definition of the term.

Highlighting the Laughie Challenge

Freda: Merv’s challenge for over two million Australians to record a Laughie caught my eye. Even if the challenge resulted in 200 Laughies it would extend our knowledge. My research involved 21 participants who were prescribed to laugh with their Laughie three times a day for a week (Gonot-Schoupinsky and Garip 2019). I know how much time and encouragement it can take to record a Laughie. Many people are not used to the idea of laughing for 1 minute. The four Laughie techniques “Enjoy it your way,” “Natural is best,” “Train to gain,” and “Laugh for a reason,” for example, for health or happiness can help. And once achieved it is a mastery experience that can promote self-efficacy, or our belief in our own ability (Bandura 1995).

With Merv’s long-standing professional laughter experience, he can expertly and comfortably demonstrate how to record a new Laughie each day. Merv is exploring new ways of using the Laughie and records Laughies in different settings, to enhance visual communication. I wanted to hear more about Merv’s ideas.

Merv: When I work as a laughter therapist it’s usually for mental health (illness) and can be challenging and hard work for both parties to achieve a result. As CEO of Laughter Yoga Australia, we have always had a commitment to health and well-being. This is not just the absence of illness. For this reason, we are always looking for ways to get this message out to people. With any marketing idea the quirkier the better, as it gets people’s attention. When I heard about a Laughie it certainly grabbed my attention. Upon investigation I thought to myself that it was a nice idea but couldn’t see any potential on a large scale at the time, so smiled and let it go. I had overlooked that when you’re building a rocket ship you still need an ignition to launch it from the pad. The Laughie was to provide that spark for us.

People in Australia have been struggling with mental health for some time now. Numbers had been steadily increasing, and services were overwhelmed and not able to keep up. Such was the situation that a Royal Commission was held here in Victoria to determine just how bad the situation was, and the outcomes didn’t make for good reading. Action was required immediately to fix this “crisis.” And then along came COVID.

Our 2010 Australian of the Year and mental health campaigner Patrick McGorry started to talk in the media about a shadow pandemic. This was the mental health pandemic associated with any major event such as floods, bushfires, and earthquakes to name a few. One of my memorable times was when I was asked to do work in New Zealand for a business group just after the second earthquake in Christchurch in 2011. COVID was all these events put together times ten. Laughter Yoga Australia went into mental health overdrive. We put daily free laughter services online and coined the marketing tag line. Your Laughline for Mental Wealth for 2021. This is a play on words from a suicide prevention organization here in Australia called Lifeline. Patrick McGorry has since reported in the media that mental health issues had increased by 25 percent during COVID.

At the start of 2022, having endured the longest number of days in lockdown than any other city in the world here in Melbourne, and starting to have COVID restrictions lifted, it was time for our new Mental Health strategy. Our monthly meeting think tank determined that we needed something new and quirky and fun that would have a positive impact on people’s mental health quickly. The Laughie was mentioned as an example, which quickly became an option. Most people have a mobile device, are used to the idea of taking a selfie, and are time poor, but who doesn’t have a minute to spare. The ideas started to flow, and the pieces were coming together.

The 2nd of February, or 2/02/22, was looming. So we had the idea of 2,022,022 videos, or Web site hits, or Facebook posts, or social media likes and shares. We went with 2,022,022 people. The Laughie was the foundation to everything else that followed.

There was a popular online activity in 2014 called The Ice Bucket Challenge. This involved tipping a bucket of ice onto someone, and then posting the video on social media. So, why not the Laughie Challenge Australia? The similarities to the (ice bucket) process. Do it, post it to social media, and challenge someone else to do it. We also have a cause which is to improve the mental health of a nation. The differences are that we are not asking for money, it is fun, and we have kept it local to Australia. There is something about COVID that has made us all a little more “local.” If someone from another country then wants to replicate it elsewhere, then please feel free to do so for your “local tribe.”

In summary, possibly the biggest challenge was to go to our contacts and friends and ask people to participate and laugh for a whole minute, without making funny noises, or pulling funny faces, all by yourself. This epitomizes the long-held belief that to be able to laugh with others, you first have to be able (and prepared) to laugh at yourself and post it on social media with the call sign #thelaughiechallengeoz. I record a Laughie each day to demonstrate how to do it. (Neal 2022a). And here I’m demonstrating how you laugh with it (Neal 2022b).

Jerome: One of the differences between positive psychology and positive thinking is that the former is said to be based on science. Positive psychologists collect evidence that their interventions work. Yet some of these interventions have been surprisingly low key. “Write down three good things,” “use your signature strengths in a new way,” and take part in a “gratitude visit” (Seligman et al. 2005). One of the classic studies on gratitude had participants write down three things they were grateful for (Emmons and McCullough 2003). The “Laughie Challenge” is no more or less sophisticated than these. However, it will need robust evidence to show that it leads to demonstrable benefits in well-being and to be acceptable to “hard-nosed” positive psychologists. An anonymous skeptical scientist once said, “The plural of anecdote is not data.” Yet, how often do you have to see the benefit of what you have been doing as Merv has, without feeling that the stories of positive change are as real as the data gathered from questionnaires used in randomized controlled trials? Stories are often how we communicate with each other and are more memorable than tables of data, or statistics with p values, effect sizes, and power calculations. As a social scientist I spend my life advising students on their quantitative and qualitative research projects, but I also know the value of narrative and autoethnographic accounts (Hopkinson, Voyce, and Carson 2021; Hurst and Carson 2021; Hurst et al. 2022; Voyce and Carson 2020).

Sharing Thoughts on Community-Science Communication

Freda: When Jerome, my PhD supervisor, shared his work using autoethnography I was keen to explore adapting it as a pragmatic discourse mode. I felt that an autoethnographic approach could be helpful to communicate the Laughie Challenge to a wide audience, and a collaborative approach could stimulate science-community cooperation. This led to developing ICAE as a pragmatic solution to invite Merv to join us using a qualitative approach that is usually reserved for academics. Merv clearly likes challenges, but may not have anticipated an “invited collaborative autoethnographic challenge.” Because he was so receptive it meant we could share our experiences and ideas, as collaborators.

Merv: One of my business mentors said to me one day “If you want to go fast then go alone; if you want to go far then go with others.” Since then, I have always looked for alliances, partnerships, and significant others who can provide synergy instead of a service or product. When I was contacted by Freda and Jerome and they shared their ideas I was very excited to pursue this further. It’s not every day that you get contacted by people with titles before their names and letters after them, who want to work with someone who failed secondary school.

It’s already been mentioned that I like a challenge and the first one was to understand the concept of ICAE. I’d never heard of this before, and the terminology sounded daunting. I sensed I was out of my depth before we even began. Then I saw another acronym from Freda that said ICAE “I Can Add Experience.” I then realized that my 20 years of devotion to laughter could certainly do that. After several e-mail exchanges we finally met via Zoom. It was then that I truly realized that there was no hierarchy or egos involved in this concept but a true collaboration to deliver an outcome which could bring together the two mindsets of public and academic that will talk to many instead of a few.

The big breakthrough with laughter and its therapeutic and wellness value will come when we provide more evidence to say to people “laughing is good for you and here’s why.” Many of the groups that I present to are nonacademic just like me. So, the fact that I have been involved in, and can present and cite academic evidence to them that this laughing works and here’s why, helps me to convince them that this is something worth trying. Their own personal experience then becomes their belief. Using the Laughie daily will lead you to have a healthier and happier life. If people adopt such a simple and fun way to use it this way, then we may then move from success to significance.

Jerome: One of my PhD students talking about his experiences in the asylum system commented that if we didn’t write down our reflections of what happened then, the stories would be lost forever (Green 2021). As I have aged and by the time this paper is published I will be 66, I have become more conscious of the importance of recording personal experiences that I have had throughout my career (Stevenson and Carson 1995). My career has brought me into personal contact with many of the legends in the field of psychology and psychiatry, psychologists such as Professor Hans Eysenck, Professor Jeffrey Gray, and Professor Martin Seligman and psychiatrists such as Professor Sir David Goldberg, Professor Sir Graham Thornicroft, and Professor Anthony Clare. I remember my encounters with all these great figures, interestingly all men, and my encounters with them have illuminated many of my presentations over the years. Yet, these conversations and memories are seldom recorded. To my mind, this is the greatest strength of autoethnography. It is using our experiences to tell powerful and memorable stories, which otherwise would never be told. A single example will illustrate this. Andrew Voyce and I both attended the University of Reading in the 1970s. We both ended up in psychiatry. He became a “revolving door” patient, going in and out of mental hospitals over a 20-year period. In contrast, I worked in the NHS as a clinical psychologist on the “other side of the fence.” We used our contrasting perspectives to construct a powerful collaborative autoethnography (Voyce and Carson 2020). This paper has brought together three individuals with completely contrasting backgrounds from three different countries and cultures, to share in an ICAE and to offer contrasting but illuminating dialogue on the power of laughter.

Views on Conducting Citizen Ethnography

Freda: With the focus of the Laughie Challenge on promoting mental health over 1 year, I was keen to see if we could draw out findings in a more formal way. With no mechanism in place to gather information, we cannot analyze outcomes or disseminate findings. Citizen science tends to be initiated by scientists; however, “forms of citizen science exist that grow out of community initiatives” (Kasperowski and Kullenberg 2019). We thus discussed citizen ethnography (Badami and Goodman 2021) as a way to gather data on the Laughie challenge.

Merv is well placed to observe the Challenge, as its initiator, a laughter professional, and someone with an inside track on the potential benefits of laughter for health. Jerome and I can support from afar and advise on the use of ethnographic methods and ethical implications. We shared ideas as to why, what, and how to gather insight from the Challenge using ethnographic data-gathering methods. We wanted to gather insight on Laughie usage behavior, and perceived user needs, benefits, and effects. We were keen to understand the impact of intentional laughter practice, and the potential to promote it as a regular behavior.

Merv: I present laughter to many and diverse groups of people and have been introducing them to the Laughie Challenge as part of that experience. This simple idea has opened the door as to how easy it could be to engage people and then collect specific data from them.

Many businesses, as a part of their Workplace Wellbeing Program, are always looking for activities that can have measures attached to them. First, having teams working together as a part of a competition, like number of steps per week, and second, to measure whether the activity is providing a business outcome such as improvement in morale. As I’m new to citizen ethnography I believe that the latter fits this perfectly if they then share this information with me.

Many local government agencies here in Australia (we call them Councils) have a well-being component to them, and we have been promoting anything to do with laughter as a “Community Health and Wellbeing Initiative” focusing specifically on promoting mental health, or a new terminology that’s being used is mental fitness. Any sort of fitness requires a level of regularity. Using a Laughie provides that regularity on a daily basis, even if only for a minute. There is a quote that I’ve seen that says, “The more you laugh, the more you find reasons to laugh.” This is about a sense of humor, or as I call it, a sense for humor. When you laugh on a regular basis you start to see the world through a different and more positive lens. Doing a Laughie daily reminds you to laugh and creates a new habit or to become a part of your daily routine. “A day without laughter is a day wasted” (Charlie Chaplin). As laughter is contagious, we may be able to observe the difference of effectiveness between doing the Laughie Challenge alone and with others.

The Laughie Challenge is free. It’s also a conditioning and habit-forming process. This is no different to doing your 10,000 steps per day, yet this one only takes a minute to do and it’s fun. I have been incorporating it into my Social Laughter Club, as well as my sessions that I do with organizations such as councils and the like. By combining the concept of Laughter Yoga where we laugh for up to 30 minutes in a session, and the 1-minute Laughie daily, it provides a more holistic exercise program where significant health benefits can be obtained. The thing they like about it is that it’s fun and free and easy. What’s not to like about that?

And the final benefit is to observe others laughing. By stimulating the mirror neurons in the brain, it’s hard to watch someone laughing and smiling and not join in as it’s contagious.

So, what are the next steps for the Laughie Challenge? If we are to lay claim to it being beneficial for people’s mental health, then how can we provide evidence for this?

For more than 20 years I have been involved with laughter I have seen and heard many stories of how laughter has been of benefit to people. This is what I believe to be anecdotal evidence. We can start to get some stories from people doing the Laughie Challenge.

There is also the opportunity to get some practice-based evidence. I have done this in the past but only for people attending a weekly Laughter Club and not daily as we have never had a method available until now. As a seasoned businessman for more than 51 years I enjoy qualitative feedback but always focus on quantitative. I love numbers as they don’t lie and can tell a tale of trends.

In the short term some social media data could be useful to see the take up of people getting involved. Video posting and sharing are simple ways to track this. This is about “going viral” to gain exposure.

In the medium term we need to get feedback from those who are committing voluntarily to doing a daily Laughie as a part of the challenge. With the assistance of smart devices such as phones and watches, we can get some measures of better sleep and reduced breathing and heart rates to indicate reduced stress levels. These and heart rate variability (and increased exercise levels are just a few that spring to mind.

And in the long term the number of people who have this referred to them by health professionals such as general practitioners, doctors, psychiatrists, and surgeons as a Social Prescription, and a part of their health treatment plan.

Jerome: If I have one hope arising out of this paper, it is that our shared experiences might encourage others to think of collaborative partnerships that might offer different insights into the nature of this business of health and well-being. The recovery movement in mental health brought mental health professionals and people with lived experience together, to learn from each other (McManus and Carson 2012). In a similar vein I have been learning from some of my younger students (Hurst and Carson 2021). We may be still worlds apart (Allen et al. 2020), yet we have so much to learn from each other. As a University educator, our greatest loss of resource is that the vast majority of excellent and publishable work produced by our students sits dormant on electronic databases, never to see the light of day and never to inform others. Likewise, in the health sector. How often do we learn from our patients about their lived experience? We are experts by training and profession, yet unless you have ever experienced some of the distressing conditions seen in mental health services, your knowledge is incomplete. ICAE allows these different voices to be heard and enables us to learn from each other. Academics inhabit different worlds, often referred to as “Ivory Towers.” Occasionally, we appreciate the reality of life for our students. This was brought home vividly to me one day when a student failed to attend for her appointment with me. “Why didn’t you come then?” I asked. “I couldn’t afford the £6 bus fare,” she replied. Worlds apart.