Hospitals are not fun for any of us. But imagine being trapped in a hospital bed as a young child, perhaps with a serious condition that requires multiple extended visits. Staff on children’s wards do their best to entertain their patients but their first priority, of course, is always medical.
This is where “giggle doctors” come in. These professional entertainers are trained and paid to go round hospitals to cheer up children with music and laughter. As a researcher interested in the benefits of laughter, I am fascinated by the work giggle doctors do and how it might make a difference to sick and disabled children. But as a scientist I am also challenged as to how we might measure these effects.
Every year there are around 1m hospital admissions of children under 15, many of them serious and extended. With their tiny team of just 25 giggle doctors, Theodora Children’s Charity is able to visit 33,000 of these children each year. Each visit has the potential to make a difference. As one parent told the charity, thanks to a giggle doctor, her daughter “actually looks forward to coming to hospital for chemotherapy”.
In a typical visit a giggle doctor may see 25 children, spending about ten minutes with each one. In a year one giggle doctor will visit over 1,000 children. They are not medical professionals but the charity provides them with training in how to interact with poorly and disabled children and how to work best with doctors and nurses.
They currently visit 21 hospitals, three hospices and two specialist care centres throughout England and feedback shows that hospitals believe that they improve children’s experience of hospital. But so far there has not been any systematic research to assess how they help children. The charity do keep good records of their teams work but they have not got systematic data. Part of the reason is that the benefits are intangible.
Giggle doctors are actors, entertainers, musicians and magicians. Laughter is important, but there is more to it than that. Every other interaction with an adult in a hospital is transactional. Giggle doctors do not using humour to distract from some unpleasant procedure; they are an escape and a respite. The emphasis is on connection and attention.
Clare Parry Jones, known to children as Dr Ding Dong, has been a giggle doctor for 18 years. Interviewed by the BBC she said: “I have learned to celebrate the time I have with each child … It’s a gift to be able to go in able to spend time with people and not care about anything else except for them.”
What’s the science say?
I’m not a giggle doctor, but a child psychologist. I know children with serious medical conditions do not stop being children, and as a laughter researcher I know that the secret of any good performance is to know your audience and be able to connect with them. Which is why Dr Ding Dong’s repertoire includes lots of jokes about poo.
But scientific research on the health benefits of laughter has been surprisingly thin on the ground. There is evidence of laughter’s physiological benefits. Robin Dunbar and colleagues showed in 2011 that laughter can increase our pain threshold and recent research has show that this is because laughter stimulates the release of the endogenous opioids, the body’s own painkillers. Other research with adults suggests laughter can improve vascular function and increase serotonin levels.
The closest fit in the research literature are two small pilot studies. Margaret Stuber, a child psychiatrist based at UCLA, has worked with US charity programme Rx Laughter™, which aims to promote comedy in a therapeutic setting. In 2007 they asked children to watch funny videos before, during or after putting their hand in very cold water. The amount of laughter didn’t change their pain tolerance, but children did keep their hand in the water longer while distracted by the video. Only 18 children were tested however and Stuber herself describes it as a pilot study.
Meanwhile, in 2011, a group at Holland Bloorview Kids Rehabilitation Hospital in Toronto, Canada, saw how 13 children with disabilities responded to two therapeutic clowns as compared to a control of watching television. The study measured physiological and emotional responses, but the results were a bit of a mess. Children’s moods certainly improved but the physiological data showed no clear patterns and again the sample size was tiny.
None of this research directly addresses the effectiveness of the giggle doctors or gets at the holistic benefits their visits seem to bring. But the many thousands of visits they make offer a tremendous opportunity for research. It’s not clear, however, how we might conduct a gold-standard randomised control trial on the work of the giggle doctors. Do we send in control performers who are trained not to be funny? Finding funding is also challenging for studies that are seemingly a frivolous luxury.
But should laughter be considered a frivolous luxury? Feedback from parents suggests the visits reduced stress and anxiety, and measuring the impact of such programmes will be important for their expansion. Although perhaps the real benefits are more intangible: found in those magic moments.