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Part IV Humor and Mental Health: Using Humor to
Freud pointed out a century ago that humor offers us a healthy means of coping with life stress. George Vaillant, in his book, Adaptation to Life, reported that in-depth interviews revealed that humor was a very effective coping mechanism used by many professional men under stress. Gail Sheehy reported the same thing for both men and women in her book, Pathfinders. A key idea emerging in both of these books is that you need to actively use your sense of humor in dealing with the hassles and stresses in your life to get the coping benefits. You can have a good sense of humor, but still have your sense of humor abandon you when things begin to go wrong. On your good mood days, you can have quick and easy access to a playful attitude, be the one who comes up with clever quips or finds a funny side to things that happen, and be able to poke fun at yourself. But this won't help you in managing the stress in your life unless you can do the same thing on the tough days. "If it weren't for the brief respite we give the world with our foolishness, the world would see mass suicide in numbers that compare favorably with the death rate of lemmings." (Groucho Marx) This view was supported by a Canadian study that found that even if you're someone who finds a lot of humor in everyday life, it doesn't help you cope with stress unless you also make an effort to actively use humor to deal with that stress.126 So even though you have a great sense of humor when all is well, you'll be just as stressed out as the next person on your bad days. People who have access to their sense of humor in the midst of stress are much more resilient than the rest of us. They are emotionally more flexible, and can bend without breaking in the midst of the most difficult circumstances. If you're lucky, and have parents who showed a good sense of humor in the midst of stress, chances are you've already got some of those qualities within yourself. You just need to refine and strengthen them. One study showed that even a 5-session humor workshop was enough to improve adults' use of humor to cope with life stress.127 It's important to know that it's never too late to improve your humor skills--even if you're past retirement age. One recent study showed that going through my 8-Step Humor Skills Program (see the last section of this course) had a significant positive impact on seniors' ability to cope with the stress in their lives.128 The study used seniors living in different retirement centers. One group spent 8 weeks focusing on the Homeplay (activities designed to build the humor skills associated with each step) provided for my 8-Step Program, while a second group simply got together weekly to watch comedy films (from the 40s and 50s). So the first group made an active effort to improve their humor skills, while the second group was passively engaged in humor without trying to improve their sense of humor. While the two groups showed similar coping abilities at the beginning of the study, the group going through the Humor Skills Program scored significantly higher on two different measures of coping at the end of eight weeks. The findings showed that they were not only coping better with the stress in their lives; they were also actively using humor as a coping tool more than they had before the program started. So you're never too old to learn to use humor to cope with stress. Whether you're 25, 50, or 75 years old, you can learn to lighten up. Remember, a good sense of humor prevents hardening of the attitudes.
Hospital Humor What's the difference between humor and aroma? My apologies for the crude and inappropriate nature of the above humor, but this is the best way to draw attention to the kind of humor that is most common in every hospital in this country (as well as in other countries). In the keynotes I do for nurses and doctors, I always ask them to describe their sense of humor in a single word. Ninety per cent of the time, the word that is shouted out from all over the room is "sick." ("Macabre" and "black" are also common descriptions.) Most nurses and doctors have this sick sense of humor. They share humor that the average person would consider insensitive or inappropriate. (Policemen, firemen and EMS professionals also have this kind of sense of humor, as we will see later.) Why do hospital staff have such a crude and macabre sense of humor? Doctors and nurses confront life-threatening tragedy every day. So if humor does help cope with extreme emotional stress, you would expect it to show up in hospitals, where staff are exposed to serious illness and injury, death and dying every day. Working in a hospital is tremendously stressful, and staff have no choice but to develop effective tools to help them cope. Most doctors and nurses soon learn that humor is an especially powerful tool in letting go of the difficult emotions that accompany every day's work. And where in the hospital would you guess that such humor is most common and most extreme? Try to answer this question from your own experience before you read further. Where should the need for the benefits humor offers be most extreme? In those areas where the illness or injury is the greatest, and where the threat and actual occurrence of death is most common: the emergency room, operating room and critical care units. Every time I speak to a hospital group, I ask them where in their hospital the black or sick humor is most extreme. The answer is always the same: ER, New staff members who are initially put off by crude hospital humor gradually learn to enjoy it--or try to work elsewhere. Most realize that this kind of humor helps them live with the terrible things they must confront every day. It helps fight off burnout and do their job effectively. The following letter demonstrates doctors' and nurses' awareness of the importance that humor and laughter play in helping them cope with the constant stress of their jobs. It was written by the anesthetist present during the surgery on a man who died during the surgery. "You saw me laugh after your father died. I was splashing water on my face at a sink midway between the emergency room lobby and the far green room where his body lay. Someone told a feeble joke and I brayed laughter like a jackass, decorum forgotten until I met your glance . . . your eyes streaming with tears . . . My laugh was inappropriate, and for that I apologize. But it was a necessity. I laughed, nominally, at a corny joke. It's no secret that hospital people seem to enjoy warped humor . . . we're often too morbid: burned patients become crispy critters; Vietnam casualties were Jungle-Burgers. It's not pleasant. Neither is hospital work, at times . . . While we may appear emotionless behind our various masks, please understand: Much of the stress that health care workers suffer comes about because we do care. We cared about your father . . . That day you saw me laugh, I knew that another patient was waiting who needed my care and full attention in surgery. As I stood at that sink and washed sweat and vomitus from my face and arms, my laugh was no less cleansing for me than were your tears for you." 130 If you're the next patient to go under the knife with this surgery team after they've lost a patient, you want their full attention. You don't want them thinking about the last patient, whether there was anything they missed, should have done, etc. You want them to have a good belly laugh. The laughter helps them let go of any tension and upset that could prevent them from giving you their best effort during your own surgery. If you're a doctor or nurse, you will always laugh at things others find cold, morbid, and unfeeling. But this laughter is essential to fighting burnout and keeping yourself focused--prepared to deal with the next crisis situation that could come at any moment, possibly with someone's life on the line. If you work in a hospital, you know that healthcare staff also laugh at more benign forms of humor, including things that patients say. For example, after completing his examination of a young woman, a male gynecologist told her that she had acute vaginitis. Her response was, "Why thank you." Another woman was concerned about the dangers of tampons. She asked her doctor if she was at risk for toxic waste syndrome.
Using Humor to Cope with Cancer "Live each day as if it were the last day of your life; some day you will be right." (Anonymous) The first Sunday of every June is National Cancer Survivors Day. At a program in Utah several years ago, I came across a woman who had had a double mastectomy because of breast cancer. Several weeks after her surgery, she went out to her front porch early one morning to get her newspaper. As she bent over to pick it up, one of her breasts popped out. The family dog, thinking this was just a new toy, grabbed it and started running around the yard with it. She ran after it, shouting "You come back here with my breast! You bring my breast back!" When she realized what she was saying, she stopped and looked around to see if anyone had heard her. To her great relief, no one else was up that early. But when she started thinking about what the neighbors would have thought had they heard her, she started laughing, and couldn't stop. She was laughing so hard that tears were coming out of her eyes. When she finally stopped laughing, she realized that was what had been missing from her life. She could not remember laughing since her diagnosis of cancer. And she was determined to never let another day go by without having some laughter in her life. She realized that she needed to laugh, even when she didn't feel like laughing. The laughter itself boosted her spirits and made it easier to face the tough days. I now tell this story to all the cancer groups I speak to, because I think her experience applies to everyone learning to live with cancer--or any other serious illness. You need to be sure that you have some joy in your life every day, and humor and laughter provide you with a powerful means of creating joy. If you can't find anything to laugh at, laugh on credit! The resulting impact on your mood will help you find things that are honestly funny to you. Most cancer patients say they know that it's important to keep a positive attitude, and to try to keep some humor and laughter in their life. But they simply can't generate a mood or frame of mind that allows them to find anything to laugh at. Their sense of humor abandons them right when they need it the most! That's why several future columns will be devoted to how to develop your humor skills--so that you can use your sense of humor to cope with the tough days. The fact that people like Gilda Radner, of Saturday Night Live fame, die from cancer shows that while your sense of humor strengthens your immune system, it's not a magic bullet guaranteed to cure your cancer. What it does do is strengthen some of the body's basic health and healing mechanisms. Humor and laughter help assure that your mind and emotions are working in favor of good health, and not interfering with it. While humor did not save Gilda's life, she made it very clear that it helped her cope with the disease and improved the quality of her life as she fought the battle. She knew she was winning the battle to cope with her illness, even as her body was losing it's battle. In her book, It's Always Something, she says, "The important thing is that the days you've had, you will have lived. What I can control is whether I'm going to live a day in depression and panic, or whether I'm going to attack the day and make it as wonderful a day as I can." Gilda knew that when you're living with cancer, there'll always be something to deal with every day. But she also knew that her sense of humor was her strongest ally in living her days fully. It can also be yours.
Humor in Emergency and Disaster Situations "Life does not cease to be funny when people die any more than it ceases to be serious when people laugh." (George Bernard Shaw) Further evidence of the power of humor in helping you cope comes from other types of employment that involve frequent contact with death, illness, injury or suffering. Employees in these areas consistently show the same pattern of joking and humor we have found to occur among hospital staff. Paramedics and emergency medical technicians (EMTs), for example, are constantly being exposed to serious injury/illness (and occasional deaths)--often under physically and emotionally trying conditions. Humor has been shown to be one of the main tools they use to cope with their own emotional reactions to these situations.131 Police officers also must learn to deal with frequent exposure to sudden death in traffic accidents, suicides, homicides, and the taking of lives themselves. They, too, commonly use humor as a means of coping with stress and relieving tension.132 All three of these emergency response professionals laugh at things most of us would consider to be in bad taste. But they have all learned that they need to laugh, because it helps them adapt to the terrible things they are exposed to. They need the release that humor and laughter provide. The laughter is emotionally cleansing, and helps them counter the psychological gravity they experience every day on their jobs. Firemen, EMS workers, ambulance drivers, and policemen often talk about "crispy critters" after fires, or "road pizza" after traffic accidents. Following major disasters, such as hurricane Andrew, the World Trade Center bombing, the California brush fires of 1993, the Los Angeles earthquake of 1994, or the Oklahoma City bombing, there is always a critique among the emergency response team concerning how well they handled the situation. There's often a great deal of humor in these discussions, as emergency workers let go of the incredible tension and strain that builds up throughout the response to the disaster. I have done numerous keynote addresses for FEMA (Federal Emergency Management Agency), state emergency response conferences, and police conferences, and they consistently tell me "If we didn't learn to laugh at some of the things that happen, we'd never survive on this job." They learn not to share their humor with others who do not do their kind of work, because it's seen as inappropriate and insensitive, but they know that it's one of their most important tools for getting through some of the difficult days. The following examples will give you a taste of their sense of humor. After responding to a call in which a man had committed suicide by jumping in front of a train, a member of the response team said to his buddy, "Hey, give me a hand, will ya?" (The body was dismembered.) After a plane crash, in which the emergency response team spent the morning putting bodies in bags, someone said "The bag lunches are here." Delta Airlines suffered three crashes within a 2-3 year period in the 1980's. Firemen and police could be heard following the last crash sharing some of the following jokes: At Delta, we now offer three classes of service: smoking, non-smoking and burned beyond recognition. Delta now offers you free drinks if you present your dental records when purchasing your ticket. These jokes may seem insensitive to people not in the field of emergency response, but they are crucial in helping emergency response professionals sustain the frame of mind they need to save lives. Just as this humor helps them cope with the tragedies of others' lives, it can help you manage the tragedies that arise in your own life. While emergency response professionals know from experience that humor helps them remain effective on their job, they sometimes feel a twinge of guilt about laughing at such things. This is especially the case for newcomers, who feel that it's somehow inappropriate to laugh in the midst of others' misfortune. The key thing to remember if your own humor takes this direction is that you are not really laughing at others and their misfortunes; you are laughing at the situations and unpredictable events that arise in the midst of those misfortunes. You are seizing the opportunity (and sometimes creating it) to let go of the difficult emotions that inevitably accumulate with your work. In addition to helping you let go of already accumulated anger, frustration or tension, humor initiated in the midst of a disaster can also help prevent these negative emotions from building up inside you to begin with. As one EMS employee told me, "Humor is an emotional condom." It helps keep negative emotions that might interfere with the quality of emergency response from accumulating to the point that they do interfere. Emergency workers' humor generally shows up after the emergency situation has been handled. One ambulance driver explained to me that a woman he was about to take to the hospital kept saying that she had "brain farts." She repeated it over and over, as if she thought it were really important. He restrained his laughter until she was safely delivered to the hospital, and then let his laughter loose as he shared the story with his buddies, realizing all the while that she had meant to say that she had brain "infarcts" (dead brain tissue). During the long-lasting flood of the Mississippi river in 1993, there were endless jokes among emergency workers about the flood. The joke at the beginning of this article was told to me by a member of the state emergency response team in a program I did for the Missouri Department of Emergency Management in 1994. Another joke circulating at the time was that Des Moines, Iowa had changed its zip code to 50H20. Again, the purpose of reviewing all of these examples of humor in emergency situations is to remind you that humor can also help you in coping with your own personal and professional crises--helping you provide a higher quality of care in the process.
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OR, CCU. The very same conditions that generate this kind of humor in the book and TV series M.A.S.H. are operating in these areas of the hospital, and the black humor predictably emerges. Humor has also been found to be the most common coping mechanism of staff members in a psychiatric emergency room.129 I've learned not to share their humor with non-hospital staff, since the reaction is invariable one of disbelief that healthcare professionals laugh at such things.
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