The best medicine: laughter therapy

Laughter therapy is being dispensed liberally for sick children in hospital, with encouraging results. Annette Rawstrone hears the diagnosis.

By sticking out her tongue and pulling a stupid face, Samantha the life-size puppet can make six-year-old Yasmin laugh so much that the big, bright jester hat balanced on her head falls over her eyes. The laughter remains as Samantha pushes her squashy nose up against Yasmin's cheek and gives her a kiss. But it was no laughing matter six months ago when Yasmin (not her real name) was admitted to Booth Hall Children's Hospital in Manchester with meningitis.

While Yasmin lay critically ill in intensive care with her eyes tight shut, surrounded by tubes and machines, Samantha made her first short visit to her bedside. Through play consultant Frances Binns, Samantha spoke to Yasmin and the following day she sang 'Old Macdonald', which encouraged Yasmin to speak very quietly. The puppet and Yasmin have since become best friends. As Yasmin's dad carried her to the operating theatre the puppet accompanied them on his back, and after Yasmin had both her feet amputated Samantha helped comfort her.

Now, during painful treatments, Samantha and Yasmin both stick their tongues out at the doctors and, with the help of Frances, Samantha creates humorous diversions to take Yasmin's mind off the pain. Yasmin says Samantha is 'silly' as she recalls her funny leg kicking antics during physiotherapy sessions.

'Yasmin's mum commented that she speaks more to Samantha than she does to her parents or grandma,' says Frances. 'The first picture Yasmin drew while in hospital was of Samantha helping cut the dressings for her legs.'

'We were concerned about Yasmin returning to school in her wheelchair - how she would feel and how the other children would react - but she has Samantha, and Samantha has been into school with her a few times. Now that Yasmin is an outpatient she looks forward to seeing her again and Samantha will be here for Yasmin for as long as she needs her.'

Yasmin's school is considering buying a puppet like Samantha, costing 40.95. Puppets are an important part of the healing process for children like Yasmin and an essential tool in Frances' laughter therapy. Instead of a white coat and stethoscope, Frances, who is an NNEB and trained play specialist, wears a colourful Mickey Mouse jacket, dangly troll earrings and a cheerful smile. Along with the life-like puppets, her therapeutic instruments include funny hats adorned with bells, an array of disguises, talking Teletubbies, jokes and giggle balls.

'Once a child is admitted into hospital it is easy to lose normality because the disease has a tendency to take over. But we must remember that our patients are children first with individual identities,' Frances stresses. 'It is easy to be caught up in the medical routine, but what's happened to being civil? It is very important to empower children. Despite being ill, they need to be given information, and the puppets can help guide us.

'Children relate to the puppets straight away. We had a Greek Cypriot boy in the hospital who couldn't speak any English but he still managed to co-operate with them. They have given us another form of communication and let us have a laugh.'

Frances is a firm supporter of humour in healing. 'Laughter therapy is all about having a positive outlook,' she explains. 'It is easy to be miserable, but that also makes you feel tense. Laughing immediately makes you feel happy and brighter. It can contribute to the children getting well - laughter is like a non-pharmaceutical drug.'

Laughter has indeed been found to directly combat pain by releasing endorphins to the brain. It can also lower blood pressure, boost the immune system and exercise the whole body - notice how your stomach aches after a good, long laugh.

Frances' form of therapy also helps to reduce stress for busy staff and worried parents. Just by walking down the hospital corridor she elicits smiles, and a puppet's wave will be immediately rewarded with a large smirk. 'It is positive for the child if we create some fun, but it also brings fun for the families. A mum said to me that it was the first time all day she had laughed, and I was honoured to be called "the wish lady" by one grandma,' Frances recalls. 'Having had fun is especially important if the child dies, because at least the parents can have some positive memories and remember the happy times.'

Each month the hospital is invaded by magicians, musicians, puppeteers and storytellers. The professional entertainers are provided by POD, a charitable trust founded to help sick children feel better by giving shows in hospitals around the country. The name POD was adopted because 'out of a pod come the seeds of fun, laughter and feeling better', as administrator Margaret Munford says. Frances is also hoping to 'bring on the clowns' to the children's bedsides in the form of clown doctors from the Theodora Children's Trust. The clown doctors, used at London's Great Ormond Street Hospital, are trained in medical confidentiality and hygiene rules. Skilled in entertainment, including improvisation and magic, they are also well versed in patience, sensitivity and listening.

Frances, whose personal motto is 'hug me - they're free,' wants to make the children's whole hospital stay as happy as possible. She tries to inject humour into most situations while working toward educating people in the merits of laughter therapy by gradually introducing new ideas. Her team of 33 play staff and eight play assistants go to all the hospital wards, but they are often referred to individual children, such as Yasmin.

Frances is quick to stress that the job is not as easy as it may appear. 'It is important to assess situations first. You can't just go in and be silly, because sometimes it would be inappropriate. But if a child is frightened we can help by making the stress come out.

'People think you're not clever when you're being daft but it is a skill, like the jester in the courts who was an intelligent person. People can say you're mad, and I admit that I've always been mad, but I just say mad stands for "make a difference" -  and it really does.'

Inspired by hospitals in Australia where there are 'laughter rooms' filled with comic books and funny videos, Frances is developing 'laughter trolleys' to take around the wards so children can blow soap bubbles, wear red noses and funny wigs and forget their environment. 'The children do love it and it is exciting for them,' she says. 'It allows them to have free expression and to do something for absolutely no reason.' Frances' ultimate ambition is to transform the hospital building into a 'laughter clinic' full of fun, colour, music and, above all, the healing power of laughter.

Yasmin's life has tragically altered but hopefully the transition has been softened by puppet Samantha's friendship and Frances' gaudy clothing and equally bright vision.   

Contact POD on 01938 810374 or the Theodora Children's Trust at 12 Vicarage House, 58-60 Kensington Church Street, London W8 4DB(0171 937 2100).