Laughing with our patients 

Journal of Psychiatry Reform vol 12 #7, April 29, 2025

Caroline Giroux, MD, FRCPC

Author information:

Professor of Psychiatry, Psychiatrist, University of California, Davis Medical Center, Department of Psychiatry and Behavioral Sciences, Sacramento, California, USA. [email protected]

A few weeks ago, a patient I have known for a few years now, tried various pharmacological agents to deal with her paranoid beliefs. Like many people, she has noted an unfortunate weight gain likely as the result of that class of medication. During the visit, she seemed, if not embarrassed, quite disconcerted as she processed her struggles and walked me through her food selection. “And then, I get one of those ice cream cones at Dairy Queen”. How not feel that this was a relatable scenario ? I had such empathy for that. So I immediately replied, with a complicitous smile, “Oooooh …aren’t these good ?” And her face lit up with a smile. This shared “guilty pleasure” created a respite bubble of solidarity in the chronic heaviness of her symptoms and ruminations. Once again, I realized how powerful sharing laughter with another human being can be. It is an unquantifiable, yet effective therapeutic tool at anyone’s disposal, as long as we pay attention and feel that there is a good alliance with a patient. It might even indicate that the therapeutic relationship has progressed to a stronger level of trust and emotional intimacy. 

Months prior to that visit, she was bringing up the recurrent fear of her ex. She thought he was “messing” with her through her phone. She often expresses the fear that he will harm her. Spontaneously, I said, “wait, do you even know whether he is still alive ?” I will always remember how refreshing her laughter felt right after my comment made her pause and realize I had a point. “Well, I’d rather figure that out then !”, and this made us both laugh. 

Laughter is such an awesome display of positive emotion while having some mysterious inner workings, especially when it occurs unexpectedly. According to Wikipedia, laughter is a pleasant physical reaction and emotion consisting usually of rhythmical, usually audible contractions of the diaphragm and other parts of the respiratory system. It is a response to certain external or internal stimuli [1]. Being mindful about the experience makes us more able to appreciate the nuances of laughing too. I have come to detect when laughter is forced or rehearsed as opposed to candid, genuine, just by the subtle differences in intonation, tempo or accompanying facial expressions.  

A meta-analysis concluded that laughter-inducing interventions can have beneficial effects on a variety of health-related outcomes including mental health, physical health, and physiological parameters [2]. Another one revealed that laughter and humour interventions are effective in relieving depression, anxiety, and improve sleep quality in adults [3]. 

These findings are not surprising. And it is helpful to review the available literature on the subject as a reminder. The more I share laughter with a patient during a session, the more it reminds me of other such encounters with other people, putting an even bigger smile on my face and creating a soothing chain of gratitude for all these moments. 

As such, another memorable encounter was when a patient who had some addictive tendencies said his contemplative stage of quitting reminded him of a scene from the movie Airplane. Having watched that movie many times as a child, I remembered exactly what he was talking about and I started chuckling. This created a bridge and this togetherness in humor was healing even for me to think about during times of stress after that exchange. 

For many years, I saw in therapy a patient who was quite jocular and who liked to make me laugh because he felt he had a positive impact on people in general and it gave him a sense of purpose. Patients need to know they can have an impact on us as well. Like Irvin Yalom wrote in his wonderful book “the Gift of Therapy” [4], we must let patients matter to us. For me, accepting their offering of a humorous moment or gentle teasing is a way to restore their dignity and sense of confidence in their social skills.  

More recently, I was validating a patient’s comment about the use of dark humor as one of the ways to cope these days. I emphasized that learning to not take oneself too seriously was freeing and often, the only control we had over a situation. Later during the session, he asked about his diagnosis of attention deficit disorder (ADD), still asking my opinion whether such a diagnosis he had received many years ago would justify a claim for disability. I told him I would be cautious with diagnostic labels, as they can be weaponized by people who have no knowledge of mental imbalances and used against them. I told him that my conceptualization was that it is simply part of neurodiversity, that it is a phenotype and a specific way the brain is wired. Such a brain wiring also comes with gifts that can be expressed once the person is in the right environment. As such, people with ADD are often creative, out-of-the-box thinkers who appear under performant in an industrial mentality asking them to be productive 8 am until 5 pm. It resonated with him, and he mentioned the recent NYT article on the subject of ADD and stimulants. I told him that I had also read it, “but I didn’t finish it, it was too long, and I have ADD !” His laughter upon hearing my comment came directly from the heart, like my own. We laughed wholeheartedly for several seconds after that. I concluded the psychotherapy session by commenting that we had good laughter therapy today ! 

There is something so divine about humor that is used with discernment, not rehearsed or calculated, as a gentle teasing that happens in the moment. Whenever this happens, I feel in awe of the mini miracle of bondedness that takes place. Then, I realize I am simply receptive, and I therefore become a conduit for that transformation of the absurd or the painful into something comical. I don’t have to force anything. Authentic laughter is a mindful quality, just like gratitude, joy, kindness, compassion, acceptance and letting go. I am more and more able to participate and co-create these moments of connection with patients because I have done a better job at being de-attached from the outcome and letting myself be “energized” by the here-and-now, also a theme from Yalom’s book. 

In conclusion, humor should be cultivated more in our clinical settings. It brings us closer as human beings and makes us see each other’s authenticity. Laughing from the soul is transcending and I can even feel the benefits for a while after the interaction as I relive the vocal exclamation and it puts a smile on my face. I certainly hope patients walk away with a sense of lightness and relief after laughing together. 

I think being taken by good surprise from laughter is a portal to our spiritual dimension that sees the good in all people and just wants the best for them, including a good laugh. Like so many pure habits we find universally in healthy children (even babies), “rire de bon coeur” as we say in French, or laughing heartily brings us back in the moment and allows us to live mindfully, yet another foundational part of healthy, balanced and resilient living. 

References: 

1. https://en.wikipedia.org/wiki/Laughter 
2. Stiwi K, Rosendahl J. Efficacy of laughter-inducing interventions in patients with somatic or mental health problems: A systematic review and meta-analysis of randomized-controlled trials. Complementary therapies in clinical practice. 2022 May 1;47:101552. 
3. Zhao J, Yin H, Zhang G, Li G, Shang B, Wang C, Chen L. A meta‐analysis of randomized controlled trials of laughter and humour interventions on depression, anxiety and sleep quality in adults. Journal of advanced nursing. 2019 Nov;75(11):2435-48. 
4. Yalom ID, HarperCollins MD. The gift of therapy: An Open Letter to a New Generation of Therapists and their patients. Prim Care Companion J Clin Psychiatry. 2006;8(3).