Mind if I Laugh?

Mind If I Laugh?
originally published  2007

Following the events of September 11, 2001 and the terrorism that ensued, I continued traveling around the country, addressing groups about the healing power of humor and laughter.  I heard a variety of comments:
“I really want to laugh, but I just can’t bring myself to do it.”
“I can’t bear to watch another news report—it’s sucking the life right out of me.”
“I feel like laughing, but I’m afraid other people will think I’m being inappropriate.  Is it really okay to laugh yet?”

Abraham Lincoln may have said it best: “With the fearful strain that is on me night and day, if I did not laugh I should die.”

Now more than ever, we, as individuals and as a country, need the healing power of humor and laughter to deal with the tragedies we experience.  Reports showed that the country is in poorer health overall than it was prior to September 11th.  Accompanying the levels of higher anxiety and stress are people suffering from a myriad of stress related illnesses and conditions: Headaches, stomachaches, general malaise, fatigue, difficulty sleeping, muscle aches, difficulty concentrating, depression, and the list goes on.

People find many ways to cope with their stress including unhealthy means, such as abuse of drugs, alcohol, food, sex and work among others.  A healthy person needs a variety of coping mechanisms at his disposal, as there is no single coping mechanism that will be right for every situation.  Humor should be one of the many tools one carries in his repertoire, as it is recognized as one of the healthy coping mechanisms we have available at our disposal.

Humor relieves anxiety and tension, serves as outlet for hostility and anger, and provides a healthy escape from reality.  It lightens heaviness related to critical illness, trauma, disfigurement, and death.  It comes as no surprise that many people are utilizing humor to deal with the trying times.  But is the humor timely?  Is it appropriate?

“When tragedy and death cloud our lives, they darken our humor as well.” (Karyn Buxman, This Won’t Hurt A Bit)

Much of the humor that saw after 9/11 is what has been referred to as gallows humor, dark humor or black humor.  In her book, Humor and the Health Professions, nurse researcher Vera Robinson explains, “(Black humor) is a humor that people have always used when they feel hopeless and helpless, when there is nothing we can do to change what has happened.  Black humor is a defense against the horror against whatever it is we fear and is a way to master it, and give us a sense of control by laughing at it.”

The truth is that we all experience tragedy on a variety of levels.  For some of us, it may be on a personal level.  At times, it may be on a community level.  And periodically we experience tragedy on a national or even global level.

On a personal scale
None of us will escape experiencing personal tragedy: Illness, accident, loss of job, divorce, or death in the family.  These painful ordeals can sometimes evoke humor that allows us to ventilate our frustrations about such unfair events in life.

Sometimes when we use humor to cope, others discourage us with comments about the inappropriate nature of the humor.  One patient told me that when making a joke about his cancer his daughter admonished him by saying, “Dad, you must not understand just how sick you are or you wouldn’t be cracking jokes about this.”

Author Allen Klein asked terminally ill patients about the use of humor and laughter during their illnesses.  Over three fourths of those surveyed said they wished their care providers and support persons would use more humor and not discourage them (the patients) from using humor.

On a community scale
Communities experience tragedies such as floods, earthquakes, fire, natural disasters, loss of industry or politicians caught in compromising situations.

1993 marked ‘The Flood of 500 Years’ on the Mississippi River. Communities along the entire river experienced flooding, destruction of property, loss of homes and jobs, and sometimes death.  Yet, humor marked the will of people to keep their spirits afloat, not to be oppressed and depressed by the Muddy Mississippi.  In Iowa the Des Moines Register held a contest, “I’m a Floody Mess,” where contestants tried to one-up one another with descriptions of their misery.  When the local water system failed as a result of the flood, and running water for drinking and bathing was no longer an option, one contestant wrote, “I smell so bad that my Sure deodorant is undecided.”

Following the 2007 fires in San Diego, in which almost half a million people were temporarily displaced and thousands lost their homes, healing and recovery once again were marked by signs of humor—sometimes literally. In front of one home which had been reduced to ashes, the owner posted a sign that said, “Fire Sale! Everything Must Go!”

On a national scale
Unfortunately we will witness events that have national ramifications, such as the Shuttle Challenger explosion, and even global ramifications, such as the loss of the World Trade Center in New York. With the technological advances in mass media, events that might once have been local tragedies now impact people near and far: The shootings at Columbine, the Oklahoma City bombing, Hurricane Katrina:  These events hit home through television, radio and print around an entire nation and beyond.

At times, the humor demonstrated after these events was a ‘hoping humor’, a “let’s hang in there together and we’ll get through this together” kind of humor.  The focus of the humor was more situational and unrelated to the tragedy; the humor was used as a relief mechanism from feelings of sadness and feeling overwhelmed.  One survivor of the Oklahoma City Bombing commented, “I laugh because I’m cried out.”

While we certainly see many examples of ‘hoping humor’ related to the tragedies of recent terrorism, we also see ‘coping humor’ or the humor that is used to express anger in a socially acceptable way.  By targeting humor at the ‘enemy’ or the oppressors, we are able to whittle them down in size and feel more powerful, more superior.

Some of the humor after 9/11 was grotesque, such as computer exercises allowing us to shoot Osama bin Laden in virtual games or blow up terrorists with a keystroke from the comfort of our own computer.  Some humor was less violent, yet still targeting our enemies.  An example is an e-mail forwarded to me:

“The nonviolent solution currently being circulated is to say to the Taliban:  Give us Osama bin Laden or we will take all of “your” women and send them to college.”

The Internet provides opportunities galore to express our frustration and disgust through games, cartoons, websites, jokes, discussion boards, chat rooms and e-mail targeting bin Laden, the Taliban and the like.

The challenge: What is stress relieving for some is stress producing for others.  While some find gallows humor to be a positive means of dealing with their stress, others find these expressions of humor to be salt rubbed into an already irritated wound.  What’s appropriate?  What’s not?  There is no clear-cut answer.  Gallows humor can be a positive means of coping with anxiety, but it helps if certain guidelines are followed:

Establish a bond: Gallows humor is less offensive when there is a bond between the initiator and receiver of the humor.  Often this is a type of ‘inside humor’ that is utilized within certain the boundaries of a certain group of people. There is an almost unspoken agreement: “I’ll not be offended by your sick humor if you agree not to be offended by mine.”

Be aware of the environment: The trick is to keep the humor within the confines of said group.  Once the dark humor escapes the confines of the group, it then may become hurtful.  Anyone who hears, sees or experiences the humor is part of the audience, whether you intended them to be or not.  Think twice before hitting the ‘forward’ key on an e-mail or blurting out a joke you just heard.  Will it be hurtful if unintended audience members intercept?

Be sensitive to the timing:  H. G. Wells once said, “The crisis of today is the joke of tomorrow.”  Generally it takes time for people to see any humor derived from pain or discomfort.  Some people never will.  Every person’s situation is unique and determined by their own set of circumstances and life experiences.

Despite its multiple benefits, humor is always risky business. Try as you may to be politically correct, there will almost always be someone waiting in the wings to be offended.  The humor or laughter provides an excuse for him to ventilate about an unspoken and deeper issue.  That being said, if you choose to use humor to cope with difficult times and are mindful of the feelings of others then, more than likely, most folks won’t mind if you laugh.  Indeed, they may welcome the respite.

Press Release: 10 Tips for Finding Humor in Turbulent Times

I, along with members of The Association for Applied and Therapeutic Humor, put together a list of fun-filled ideas to help you rise above the current economic turmoil.

It is my gift to you.  Happy Holidays!
10 Tips for Finding Humor in Turbulent Times                                                   

The economy is on its wildest ride in decades.  The line waiting for a government bail-out is almost as long as the line waiting to check-out in stores this holiday shopping season.  And, you’re simply at wits end in trying to deal with it all!

Fear not – there’s humor to be found amidst all of this chaos and confusion.  So says Karyn Buxman, Publisher of The Journal of Nursing Jocularity, from San Diego and incoming president of AATH – the Association for Applied and Therapeutic Humor.  The mission of this growing, international community of professionals, founded in 1987, is to study, practice and promote healthy humor and laughter.

“The great thing about humor is it’s FREE and available to everyone,” says Buxman.  “It’s sugar-free, fat-free, salt-free, and tax-free!  It’s available 24-7 and you don’t need a prescription!  There’s no assembly required and you don’t need batteries!  It’s environmentally friendly, and best of all, it’s socially contagious!”

Healthy, therapeutic humor enhances relationships, is non-hostile, sympathetic, benevolent, tolerant, and often philosophical.  AATH is careful to distinguish it from hurtful, harmful humor that is more aggressive, critical, sarcastic, cruel, often based on put-downs, and involves laughing at someone else’s expense.

AATH has generated the following list of 10 tips to help you lighten up and rise above the current economic turmoil and stress of the holiday season:

1.  Adjust Your Attitude – Stop watching the news and start counting your blessings instead of your money!  The blessings will increase, while the money is…well, you know!

2.   Make Someone Else Happy – Send unexpected ‘thank you’ or greeting cards to a mix of people.  Start with those who aren’t expecting it but deserve it. Then, send a couple to people who aren’t expecting and don’t deserve it.  Then, pick a couple names at random out of the phone book that certainly aren’t expecting it and have no idea who you are!

3.  Signs of the Times – Have some mirthful signs or sayings handy.  For example:
- The rules have changed… there are none!
- Walking on water is in my job description!
- Apparently, not all clowns are in the circus!
- Never wrestle with a pig – you both get dirty, but the pig likes it!
- You don’t have to be crazy to work here…but it sure helps!
- If we’re closed, just slide the money under the door!
- I’m not weird… I’m gifted!

4.  Try Some Random Acts of Silliness and Kindness – Wear mismatched gloves or socks… on purpose!  Page yourself over the intercom!  If and when a store clerk, restaurant server or flight attendant asks matter-of-factly “How are you today?” try replies such as, “Well medicated – and you?” or “At least I’m vertical!”  Instead of them always thanking you, thank them first and watch their reaction!

5.  Fun with Food – Put a bag of cookies or marshmallows in your briefcase.  Then, start your meeting by asking, “Dessert, anyone?”  Have a marshmallow stacking competition!  Put a pack of bubble gum in your coat pocket and, in the elevator, offer some to everyone!

6.  Pop Goes Your Worries – Save your bubble wrap!  It’s a great stress reliever.  Pop it with your fingers, knees and toes!  Dance on it!  Pop it with the help of young children!  Pop it, in unison, to the beat of music!

7.  Use Your Imagination – Think of what would happen if certain companies merged.  For example: Fairchild Semiconductor and Honeywell Corporation would become Fairwell Honeychild.  Grey Poupon and Docker Pants would become Poupon Pants.  If FedEx joined UPS, they might become FedUP.

8.  Rename to Keep Sane – Cash Flow: The movement your money makes as it disappears down the toilet.  Broker: What I am today, after taking the advice of my financial planner.  P/E Ratio: The percentage of investors wetting their pants as the market keeps crashing.

9.  Exaggerate – Comedians overstate things to get a laugh.  You can too!  Our family is so poor these days… we took out a second mortgage on our cardboard box.  Our family is so poor these days… to save on milk, we eat our corn flakes with a fork.  Our family is so poor these days… when someone rings the doorbell, I stick my head out the window and yell, “Ding-Dong.”

10.  Let a Smile Be Your Umbrella – This simple choice is yours.  You can frown and be miserable (way too many people readily choose this option), or you can wear a contagious smile.  In your conversations with people, smile and ask to see their smile.  Then say, “I see you’ve been practicing!”

For more information contact AATH and/or Karyn Buxman at 858-456-1874.

Humor, Cancer and Chronic Illness

“I’m not afraid of dying.  I just don’t want to be there when it happens.”  Woody Allen

 
Pat’s hand gripped mine tightly– her eyes glistened with mischief. “I so look forward to your visits. Everyone else around here is so darned serious!  I wish they’d just lighten up a little.”  I looked around the room and she was right. Her 58-year-old husband and 32-year-old daughter sat on the couch, looking as if a smile would shatter their faces into a million pieces.  “Tell me something funny that happened to you this week,” she continued. “What’s that little boy of yours been up to now?”

Pat was one of several patients that I made home visits to as a nurse, following up after her chemo and radiation for a tumor in her neck and jaw. Physically she was doing fine and her outlook was tremendous. However, her family had an attitude that could sink a battle ship. Even though Pat valued laughter, her family felt her condition was much too serious to permit using humor.

 
Despite the tremendous advances in cancer treatment, just the word “cancer” evokes a visceral reaction in many people. This includes family, friends, and even some health care providers. One of my patients shared that when she attempted to make a joke about her condition, her husband reprimanded her: “Honey, you shouldn’t be making jokes.  Don’t you realize how serious your condition is?”  This came as no surprise to me. A survey of terminally ill patients showed that over three fourths of them said they wanted more humor but that their family would not joke with them.

Does humor serve a purpose for those with terminal or chronic conditions?  Absolutely. Humor serves many purposes, including relieving anxiety, managing painful feelings, and releasing anger in a socially acceptable way. Humor is a wonderful coping mechanism that can help by reframing or seeing situations in a new light.

Distraction serves as another useful purpose. Sometimes humor helps to divert our attention, instead of focusing on what’s stressful to us at the moment. Humor can often provide relief, whether it’s from an uncomfortable needle stick or the unpleasant side effects of a medication. Scientists are collecting more evidence every day that humor, laughter, and positive emotions have numerous physical benefits, including a decrease in muscle tension and an enhanced immune system.

 
Where do you find humor? Fortunately it’s all around you. You just have to be looking for it. It’s a mindset, an attitude. It is not the same thing as joke telling, which may come as a relief to some of you. However, if you want to learn to tell jokes, practice telling a joke out loud to yourself seven times before you attempt it with someone else. (Once you blow the punchline, there’s no saving it.) 

Better than jokes are personal experiences or embarrassing moments. Few adults have not locked their keys in their cars, or found their zippers unzipped, or discovered a colorful piece of food stuck between their teeth when trying to impress someone. When sharing these universal events, we share our vulnerabilities and our willingness to trust others.  If you can see any humor in it at all, try sharing an embarrassing moment with a friend or family member.

Schedule some time for play daily. Many folks this frivolous and their lowest priority, but research now indicates that those who are too serious to allow time for play wind up seriously ill. Make a “list of things you find pleasurable and fun to do (some of these ideas should be of little or no cost). Then when you are most in need of lightening up but unable to think of anything fun to do, pull out your list and make an agreement to do at least one thing. You will feel better afterwards.

 
Get out of your rut. Do something out of the ordinary. It can be something as minor as sleeping on the other side of the bed, listening to a different type of music than you’re accustomed to, leaving for work 20 minutes early to take the scenic route, paying for the toll of the guy behind you, sending a cartoon to a coworker, taking a bubble bath by candle light, calling an old friend from high school— just use your imagination!  I once watched in bewilderment as a friend tossed his loose change into the couch in his hotel room.  “What are you doing?!” I exclaimed.  He smiled and said, “Even though I won’t be here to see it, someday someone’s going to have fun discovering the money in this couch.”

No matter what your physical condition, humor can benefit you.  Plan a daily humor break and reap your profits. Make the most of every day– lighten up!

Today’s Nursing Crisis: A Laughing Matter?

Did you hear the one about…?  According to a recent study, one of every three U.S. nurses surveyed under age 30 plans to leave their jobs within the next year. One in five nurses plans to leave the profession within five years because of unsatisfactory working conditions. According to the Bureau of Labor Statistics, 450,000 additional registered nurses will be needed to fill the present demand.  Experts worry about the year 2020, when the registered nurse shortage is projected to reach 500,000 positions, coinciding with the increasing needs of healthcare in an aging U.S. population.
It is obvious that the state of health care today is no joke.  But it may be a laughing matter, if one understands the premise that humor oftentimes is generated by painful circumstances.  There is nothing funny about unlimited resources, job security or a physician who responds quickly and cheerfully to a nurse’s request. The things that make nurses laugh tend to be the very things that drive nurses crazy.

Whether it’s a picky patient, a cranky coworker, or a demanding doctor, nurses frequently have no control over the stressors that arise in their work setting. They do, however, have a choice in how they respond to those pressures.  No single tactic will be appropriate for every situation, so a healthy nurse needs to have a variety of strategies. Numerous means of coping with stress in a healthy manner are available, and one of those ways is with humor.

There are three primary roles of humor in the healthcare setting: psychological, social, and communication. 

Psychological.   As nurses become more anxious and their focus becomes narrower, they become less creative and are more easily upset. Stress may not come from the event, itself, as much as from the nurse’s perception of that event. Humor provides a perceptual flexibility that can increase one’s sense of control. Learning techniques such as catastrophizing the event, where one takes the situation at hand and looks for the absurdity by asking, “How could this be worse?” may help the nurse put the event into its proper perspective.

Social.  As Victor Borge, a well-known comedian, said so eloquently, “Laughter is the shortest distance between two people.” When two or more can share in amusement, there is a commonality experienced among them, thus creating a bond. Some types of shared humor, such as self-effacing humor, reveal one’s own flaws, ‘humanness’ and vulnerability. This ‘revelation’ creates an environment where the listener feels that it’s safe to share, helping to develop rapport and establish or strengthen relationships. For that moment, the humor helps to diminish the perceived hierarchy, such as nurse/patient, doctor/nurse, or teacher/student while all involved participate in the fun.

Communication.  Sometimes a joke is just a joke.  But often, true words are spoken in jest. It may be helpful for the nurse to know that frequently people will present a serious concern in the guise of a joke. A patient may joke about an embarrassing or frightening situation. If her nurse responds in the manner that she had hoped, she has achieved her desired outcome. However, if the nurse doesn’t recognize the serious nature of her comment, then she has the ability to “save face” with the rationale that she was “only joking.” The skill for nurses is in learning to listen beyond the laughter, whether the person addressing them is a peer, patient, family member, or doctor.

 Physiological effect.  In addition to the functions of humor, the physiological effect of humor is identified as a benefit.  Most nurses have experienced at least one negative physiological effect of stress: Muscle tension, cold hands, headaches, gastrointestinal disturbances, among others. While researchers have spent years identifying the negative effects of stress on body systems, they are now looking at the therapeutic effects of humor and laughter on the human body.  These include decreased muscle tension, deeper respirations, and positive increases in the immune system.

As nurses practice to improve their abilities to use and appreciate humor, they also enhance their skills.  “Humor appreciation involves responding to humor produced by others or being a good audience. On the other hand, humor production involves thinking of things on your own to amuse yourself or others,” says Michelle Newman, PhD. When using humor as a coping mechanism, one cannot always count on being able to find an external locus of amusement.  “Of the two, humor production is the more portable skill,” says Newman and adds, “From the standpoint of coping, it seems to me to be less important whether you can amuse other people than whether you can amuse yourself.”  The implication for nurses is that while they may gain benefits from humor when enjoying it passively, there are even more benefits in being active participants by producing a humorous state of mind for themselves. 

Some nurses have shown themselves to be highly creative. One nurse carried a marker to decorate disposable gloves and masks on isolation carts.  A critical care nurse took a couple of adhesive EKG patches, attached them to the bottom of her shoes and “tap danced” her stress away during her break.  At a medical-surgical nurses station, whenever someone would shout “Massage Train!” everyone on hand would line up, put their hands gently on the shoulders of the person in front of them and soothingly massage. Before disbanding, they would switch directions of the line so the person on the end wouldn’t be left out. The whole procedure lasted only a minute or two, but everyone proceeded to their next task with a big smile.

Unfortunately, there is no “one size fits all” list of fun things for nurses to do. Because everyone’s sense of humor is unique, the techniques used to create humor must be highly individualized. The methods need not be flamboyant to be effective. For example, some nurses might be comfortable wearing a small decorative pin with an amusing picture or statement on it, particularly at seasonal times. Colorful clothing with festive accents might be an option if dress codes do not forbid. Some nurses are subtle, wearing Looney Tunes socks or Mickey Mouse jewelry while others walk the halls wearing a red sponge nose or carrying a rubber chicken! Posting cartoons and illustrations can brighten up any nursing unit.  Sharing jokes, stories, or embarrassing moments are other ways to generate laughter.  Humor baskets, carts and humor rooms are means of creating a more humorous environment.

Nurse researcher Vera Robinson once said that a sign of a profession’s maturity is its ability to laugh at itself. The profession of nursing is surely mature enough to be able to laugh at itself, and yet many nurses still refrain from using the skill of humor on the grounds that it is not “professional.”  Humor is not the equivalent of “goofing off.”  Indeed, it is important for nurses to maintain high standards and high expectations on their units and to take their work seriously. It is also important for nurses to be able to take themselves lightly. Sad is the nurse who cannot learn to separate the two– and that is no joke.

Stress Busters

There’s no one coping mechanism that will work for every stressful occasions. People need a variety of skills to stay healthy. These could include deep breathing exercises, progressive muscle relaxation, and meditation just to name a few.  But the benefits of humor and laughter are so plentiful, so convenient, and so cost-effective that people would be foolish to leave these awesome coping tools out of their coping toolbox. 

Here are a few quick stress busters. Try one the next time your energy level drops and your attitude is sagging:
 
Call your own answering machine or voice mail to leave a humorous message that you can enjoy later. Bonus—you get to laugh twice: Once when you leave the message and again when you play it back.  (For example: “Just calling to remind you to be careful when you go by the post office to pick up stamps and be sure to wear clean underwear because you never know when you might be in an accident!”)

Keep a file folder at your desk with clippings, cartoons, and e-mails you find entertaining. Pull it out and refer to it when you’re put on hold or when you feel those shoulders tightening.
 
Keep a book of word games, crossword puzzles, or cards at your desk. Re-spark your creativity and energy by taking a daily 10-minute ‘play break’ and you’ll recognize how important it is not to wait until you feel better to play. Play and then you’ll feel better.
 
Got a problem that’s bugging you?  Practice playing with your pain by asking yourself “how could this be worse?” Exaggerate the situation until you can make it absurd enough to put things in their proper perspective.
 
Smiles and laughs can diminish muscle tension. They’re also contagious. Practice wearing a smile to share with others and notice how their responses make you feel better, too.
 
Gain maximum benefits by proactively seeking humor every day.

What was he thinking?!

Obviously, he wasn’t. Thinking, that is. Michael Richards, better known to the world as Kramer, took his funny and light-hearted image he’d established over his successful career with Seinfeld, and flushed it down the tubes. I can just picture him skidding into Jerry’s apartment, shaking like an electrically charged, over-caffeinated baffoon, uttering “Oooooooooooohhhhhhhhhhhhhhh nooooooooooooooooo!”

“Oh no” is right. Whether you’re dealing with hecklers, irritable coworkers or cranky customers—insulting them is a bad idea. Comediennes anticipate that these things will happen, and they have comebacks that are so practiced that they can appear to be spontaneous—but few professional comics will leave those situations to chance.

There’s something you can learn from Michael Richards’ common sense infarct. We all have times when have to deal with hostility from others. A lot of times, if we’d thought about it, we could have anticipated these episodes.

And when those situations do arise, we have choices. In his book, The Light Touch, Malcolm Kushner suggests:
We can respond seriously to the complaint.
We can refuse to respond.
We can pretend to respond (picture the doctor that overwhelms the other person with medicalese or the lawyer that responds with legalese).
We can respond with humor.

All of these choices, mind you, are appropriate choices at one time or other. But not every one of them will fit every occasion every time. You have to use good judgment (which apparently some people lack).

When responding with humor, the idea is not to derail the other person so you can totally avoid the conflict. You want to unbalance the other person, even momentarily, so that you give yourself a moment to think, regroup, and then respond in the best possible manner to the situation at hand.

Take for instance the waiter who has forgotten your request for water. Twice. When you ask him a third time, an appropriate response for the waiter might be, “I’m sorry. My memory is really very good. It’s just very short.” (pause). “I’ll be right back with your drink.”

The waiter addressed the concern; used a quick one-liner (doesn’t have to be fall-down-funny) that he has thought about ahead of time, and then responded to the need.

In one of my workshops, a manager said that an irritable customer once demanded: “How long have you worked here?”
His humorous response: He looked at his wristwatch, smiling, and asked, “Well, let’s see… What time is it???”
The customer looked surprised and then smiled. From there, they were both able to move forward in a more positive frame of mind.

Anticipate and prepare. Comics do it. Politicians do it. And so should you.

Here’s your homework assignment:
Make a list of the hostile questions you might deal with at work.
Now come up with a list of humorous responses.
Force yourself to come up with at least 10.
The rationale? Because the first ones you come up with are going to be absolutely hysterical—and they’re probably going to get you in trouble! Flippant is funny—but in this case, you need to stretch further to find something that is funny but not offensive. It takes a little more work, but it’s worth it.

Use humor in your workplace proactively and you’re going to find that you have a lot more fun AND a lot more profit!