Is Laughter Really the Best Medicine?

Screenshot 2014-07-31 19.36.48

Areej Abdel-Fattah, 2nd year, finds out if there is any truth behind the phrase “Laughter is the best medicine”!

As medical students and future doctors, we sure do have more than our fair share of stress in our lives. Rewind to your first ever dissection practical: remember how eerily quiet it was? Remember the apprehension everyone was feeling? You could almost slice through the tension with your scalpel! It is not often you see a cadaver before your eyes, much less be expected to dissect it!

Now, skip ahead to your most recent dissection practical and notice the transformation: the easy atmosphere, the nonchalant attitude we have all adopted. When you have to deal with a traumatic experience such as dissection on a weekly basis, you habituate and learn to cope.

One of the most popular coping mechanisms among people in the medical field is humour. This is mainly because it does not require you to reveal your vulnerable interior; you can mask it behind a facade of bravado instead. Because we tend towards professionalism, it is much easier for us to utilise humour as our main coping mechanism rather than to succumb to a heartfelt conversation about our experiences, which is why humour can be of utmost importance to our wellbeing. It may seem counterintuitive that humour is a rational coping tool, but psychologists concur on its classification as a “mature defense mechanism [sic]” (Lickerman,)Screenshot 2014-07-31 19.42.14

The BMA suggests that out of all occupations, doctors are the most likely to suffer ill mental health. Freud stresses the importance of humour in maintaining one’s sanity “Its (humour) fending off of the possibility of suffering places it among the great series of methods which the human mind has constructed in order to evade the compulsion to suffer – a series which begins with neurosis and culminates in madness and which includes intoxication, self-absorption and ecstasy” (Freud, 1927).

The specific type of humour employed by medical people when dealing with these traumatic circumstances is referred to as Gallows Humour, a type of dark humour which serves to make fun of serious situations.

There is a danger when employing humour as a coping mechanism to pass anything as acceptable. Due to the stressful nature of medicine, even the most distasteful forms of humour can be justified. Since it is usually exchanged behind closed doors, in the absence of the patient (the subject of the joke), an ethical dilemma is posed. This exclusive nature of “backstage humour” causes us to question its morality as a coping mechanism as it raises the matter of ethical erosion. Is joking in the presence of the patient ever considered to be in good reason? As medical students, we are continually advised to be empathetic as well as establish a good rapport with the patient. This enables patients to feel comfortable and enclose their most private matters to us. Channelling humour to the patient has sparked controversy due to the fear that it may appear unprofessional and insensitive. However, following a study, it was found that these fears were simply unfounded, as the majority of  patients were found to be in favour of medical staff making them laugh and considered it neither unprofessional nor insensitive (McGhee, 1999). It is worth noting; however, that medical staff should refrain from laughing at the patient’s expense and tread with caution, as although the intent is to cheer up the patient, this may easily be misinterpreted.

Hundreds of hospitals across the USA have put inplace ‘Hospital Humor Programs [sic]’ whereby staff are encouraged to share a laugh with patients and specialised hospital clowns wheel humour trolleys containing humorous literature and media around the wards. This programme has received resounding success; not only has it improved the patients’ mood but was also found to reduce pain, inflammation, blood pressure as well as decrease the duration of stay in hospital. The positive effects of these programmes did not just stop there, but also spread to the staff, aiding them and relieving their stress. (McGhee, 1999)

There is an endless list to the benefits of laughing; it is the body’s natural response to stress and acts to reduce anxiety and restore calm. A subconscious presentation of this form of coping is nervous laughter; this acts to “redress an imbalance in stress hormones” (Clarke, 2010). These benefits can, of course, be recreated through conscious laughter, meaning humour can revolutionise the way we improve health. The following table contains some of the benefits of laughter:

Screenshot 2014-07-31 19.45.40

Unfortunately, just like everything else, laughter does not come without its disadvantages .In the past, there have been some cases where laughter has had serious consequences. Laughter is known to trigger asthma (ATS, 2005), syncope (Nishida et al., 2008) asphyxiation and cardiac arrest (Brottman, 2012). All these are a result of uncontrolled laughter and are usually secondary to underlying health conditions. Like any other treatment, overdosing on laughter can lead to death. Overall, the advantages outweigh the disadvantages by far.

Screenshot 2014-07-31 19.47.35With a long and stressful career ahead, many of us have adopted “work hard, play harder” as a motto. Humour is definitely one way we all vent our stress, and rightly so, as it is evidently effective. Since humour has such extensive benefits, we should aim to utilise it correctly in order to optimise the health of patients and develop strong working relationships, easing the stressful atmosphere of healthcare settings. In doing so, we should consider the ethical concerns and respect patients – it’s no laughing matter!

REFERENCES

ATS – American Thoracic Society (2005, May 25). Laughter-induced Asthma: It’s No Joke.

BMA. Doctors’ health matters. 2007. http://bma.org.uk/images/HealthMatters_tcm41-146805.pdf.

Brottman, M (2012). Funny Peculiar: Gershon Legman and the Psychopathology of Humor. 2nd ed. New York, USA: Routledge. Ch. 3. Clarke, A (!2010). The Faculty Of Adaptability: Humour’s Contribution To Human Ingenuity. Cumbria, UK: Pyrrhic House. p393. CSA – The Society of Certified Senior Advisors. (2011). Hospitals Prescribed Humor to Patients . Available: http://www.csa.us/

HumorForP!atients.aspx. Last accessed 16/11/2013. Freud, S (1927). Der Humor. Vienna, Austria. Translation by Riviere, J. http://www.scribd.com/doc/34515345/Sigmund-Freud-

Humor-1927 Last accessed 16/11/2013.

Learner, S. (30 March 2011). Doctors and mental health. The British Medical Journal. http://careers.bmj.com/careers/advice/viewarticle.

htm!l?id=20002383#ref1 Last accessed 16/11/2013.

Lickerman, A. (23 January 2011). Why We Laugh. Available: http://www.psychologytoday.com/blog/happiness-in-world/201101/whywe-

laugh L!ast accessed 16/11/2013. McGhee, P. (1999). Humor and Health Course, Part III The Humor-in-Hospitals Movement. Available: http://www.nurseslearning.com/

courses/nr!p/NRPCX-W0009/html/body.humor.page6.htm. Last accessed 16/11/2013. Nishida, K; Hirota, S; Tokeshi, J. (7 June 2008). Laugh syncope as a rare sub-type of the situational

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