Part IV (continued)
Humor and Mental Health: Using Humor to
How Does Humor Help You Cope and Boost the Quality of Your Care?
What is it about humor's effect on you that enables you to cope better with the stress that automatically goes with being a nurse, and that helps you provide better care in the midst of that stress?
1) Muscle Relaxation
Stress causes you to get upset or anxious, and these feelings increase muscle tension. This increased muscle tension can, in turn, help sustain or even increase your anger or anxiety. So a vicious cycle is created in which your upset feeds on itself. Since relaxing the body has long been known to produce calmer thoughts and emotions, muscle relaxation has become the main goal of all stress management techniques.
We have already seen in Part I that muscle relaxation is a natural by-product of laughter (it is not known whether humor in the absence of laughter also produces muscle relaxation). So when it is appropriate to share humor with a patient, or fellow healthcare professional, you automatically receive the main benefit that all stress management techniques are trying to produce. As noted in Part V, a judgment always has to be made about whether any form of laughter is appropriate under the circumstances.
Of course, there are always some risks associated with this relaxation effect of laughter. Muscles may relax that you don't want to relax. If you've ever had a good belly laugh after a couple of glasses of wine or beer, you know what I mean.
2) Emotional Release
Have you ever noticed how your emotions gradually (or sometimes sharply) escalate on a typical high stress day? You can feel the tension, anger or upset increase as the day goes on. The upset may reflect a few key events, or an accumulated effect of having unexpected problems develop, too many patients to see, too much paper work, etc.--and with too little time to do it in. The longer this goes on, the greater the build up of emotional tension within you. If you have no way of releasing this tension, you soon feel that you're going to explode. As this feeling escalates the quality of your care often go down.
This is precisely why nurses have come to attach so much value to humor and laughter on the job. With a good belly laugh, you can immediately feel the release of emotional tension. You feel as if a tremendous weight has been removed from your shoulders. And this is precisely the case-- except it's an emotional weight, not a physical weight. It's hard to hang onto your anger and anxiety when you're laughing. That's why both nurses and their patients say they just feel better after a good laugh.
The available evidence suggests that humor is effective in reducing feelings of both anger133 and anxiety134, although there is some evidence that it may be less effective in reducing anxiety.135 Other research, however, has shown that humor is just as effective as progressive relaxation procedures in reducing anxiety.136
While most hospital humor is spontaneous, here's an example of a joke nurses often tell to keep their stress levels in check. The reason nurses love this joke, is that they feel it pretty much sums up their job.
Three nurses died and went to hell. When they got there, the devil gave them a choice of the room in which they would spend eternity. All the rooms were bad, but one was much less bad than the others. It was a room in which people were standing in sewage up to their knees. So they all three chose this room. As they were walking away, the devil said, "OK, coffee break's over. Back on your heads!"
Laughing at this joke or any other event that occurs in your work provides a cathartic release of the negative emotions accumulating within you, allowing you to leave the source of upset in the past for the moment--instead of carrying it up front in a way that interferes with your ability to communicate, identify potential problems, and provide quality care.
You may give a patient a cathartic to induce a bowel movement. This purges the system, removing poisons from the body. Laughter does the same thing, emotionally. Unexpressed negative emotions build up and become poisonous if you allow them to build up. They sour your attitude toward your job and your life generally. They can gradually kill your ability to experience joy, spontaneity, aliveness and fun. So think of laughter as an "emotional movement." And just as you need a good BM every day to stay healthy, you also need a good EM.
"If I had no sense of humor, I should long ago have committed suicide."
(Mohandas K. Gandhi)
3) The Law of Psychological Gravity
I finally realized a few years ago that there's a Law of Psychological Gravity that sums up the effect that accumulated stress has upon us. The Law of Psychological Gravity says that if you're already angry, anxious or depressed, then any new anger-arousing, anxiety-arousing or depressing event that occurs will have much more impact because you're already in a negative emotional state. The new event will seem heavier than it would if you were starting in a happy state.
When you have one bad day after another, you can feel yourself start to drag emotionally. You become emotionally heavy. For some, this emotional heaviness takes the form of depression. You get so depressed that you feel like you're scraping the floor as you drag yourself lifelessly from one place to another. You have less energy; it's as if your body weighs five times as much as it used to, and it drains you to just move yourself around. Everyday tasks that are usually done without much effort and thought become a burden, and it's hard to call forth the energy you need to do them. So you increasingly just stay home--and get heavier and heavier.
As already noted, anger and anxiety can build up over time, it you don't have skills to let go of them. If you're upset about something, and don't talk about it or take steps to resolve the problem that's making you upset, the anger increases until you either explode or start developing health problems. Accumulated anger, anxiety, depression and sadness all become so emotionally heavy that they soon begin to interfere with our relationships and our jobs. We have arguments, lose our ability to concentrate, and make more and more mistakes--both at work and at home. When these mistakes involve your patients, the potential for disaster is clear.
The wonderful thing about your sense of humor is that it is very effective at getting rid of this emotional weight. We are all familiar with a wide range of weight-loss techniques when it comes to physical weight, but how many techniques do you know that work for emotional or psychological weight loss? Talking about your problems, of course, is always helpful in removing some emotional weight. You should use every opportunity to do this, even if you already have a well-developed sense of humor and are a great laugher. Unfortunately, however, we don't always have access to a good listener when we need one, so it would be great if we had some simple technique, which would allow us to quickly "let go" of unwanted emotional pounds. This is precisely what a good belly laugh provides.
I witnessed the anti-gravity power of humor several years ago while visiting my parents. My father was in his mid-80s at the time, and had a number of health problems (including cancer of the pancreas, which he successfully overcame) and physical limitations. The way he usually put it was, "My day is full of misery; you just don't know what it's like. My job is to just put in my 24 hours and get through the day." I often heard him say, "I just ain't any good any more." He said it was hard to keep his spirits up, because he had nothing to look forward to, nothing to hope for. He knew things would never get better; they could only get worse.
But a funny thing happened when the in-home care lady who had been helping my mother was replaced. The new caregiver had a good sense of humor, and often engaged my father in playful banter and good-natured ribbing. The impact on his mood was immediately apparent. He became emotionally lighter and began to have better days. You can imagine how wonderful it was to see a playful grin come over his face when she began talking about how the two of them had "a thing" going, and that she hoped my mother wouldn't be too jealous.
He even started telling jokes and funny stories. One day on a Christmas visit, he asked me, "Did you hear about the fellow who bowled 301?" "301? That's impossible!", I said. He couldn't keep from grinning as he added, "Well, did you ever see anybody who bowled 300 and lost?" (The ambiguity here only works orally.) Since he had rarely told jokes before, I saw this as a direct effect of the new caregiver's ability to bring out his own playfulness. She had used her own sense of humor to remove a tremendous amount of emotional weight from his daily life. This had obviously improved the quality of his life.
On the same trip, I had some animal noses and a silly-looking "Smile on a Stick" sitting around the house. I took a few photos of him and my mother wearing these fun props (making silly faces at the same time). From that point on, whenever friends or relatives came over, he would grab the Smile on a Stick and suddenly turn toward the guest, holding it under his nose with his eyebrows sharply raised. Or he would hand them the nose photos hidden in a bunch of "regular" photos, and watch for their reaction.
These simple little props and the new caregiver's playful style of interaction brought many moments of joy to his difficult, dreary days, and you have the same power to elevate your own patients' spirits. The humor you bring to your patients may not add years to their life, but it will certainly add life to their years.
"When down in the mouth, remember Jonah. He came out OK."
4) Increased Energy / Reduced Burnout
Anger and anxiety are energy-sapping emotions. If your job causes you stress day after day, week after week, the anger, anxiety, and depression you live with drains the energy you need to provide quality care. It also lowers your morale and job satisfaction, and sets you up for burnout.
As you learn to lighten up on the job, you'll have more energy and experience less burnout. Laughter recharges your batteries. It fights burnout by giving you back the energy you're supposed to have, and by making your work more enjoyable. It restores energy by cutting though energy-sapping emotions and replacing them with energizing ones. In short, it revitalizes you. Nurses who are able to maintain their competence and professionalism, but still incorporate humor and fun into their job look forward to going to work, and are more effective when they get there. This alone reduces job stress.
"I've developed a new philosophy . . . I only dread one day at a time."
This energizing effect of humor is most noticeable when you actively find humor in a situation yourself, but even listening to others' humor causes most people to feel more vigorous and less fatigued.137
5) Maintenance of Perspective
One of the most important ways in which humor helps you cope, is that it helps keep the minor problems and everyday hassles in perspective. Most people have some kind of conflicts or problem to deal with every day. As Roseanne Roseanna Danna (Gilda Radner), of Saturday Night Live fame, used to say, "It's always something! If it's not one thing, it's another!" You discover that your car battery is dead as you leave for work. The photocopy machine is jammed! You're out of coffee! Someone cut in front of you in the line! Your suit or dress is not ready when it's supposed to be! You got in the shortest line, and the long line is moving faster!
As you learn to lighten up in life, you realize that these problems are just not worth the emotional toll taken by getting bent out of shape by them. Finding a light side of these situations enables you to take an emotional step back from them; and from this more distant vantage point, they lose their emotional control over you, leaving you in a better position to take effective action to deal with them.
Dr. Robert Elliott, former Director of the National Center of Preventive and Stress Medicine, said in 1983 that we all need to develop some means of maintaining a broader perspective on our problems. Your sense of humor is one of the best tools you'll find for doing this. As you get better at learning to lighten up, you automatically become adept at keeping your focus on the big picture as you see your daily hassles for what they really are--problems to be dealt with in the most effective way possible.
6) Substitution of a Positive Mood for a Negative One
Anything that helps you maintain a more positive, upbeat, optimistic mood our outlook on life (and especially your job) puts you in a better position to cope with that stress of being a nurse, and provide the quality of care you want to provide. But extended periods of stress can cause you to fall into a negative mood. This adds further to your stress by making you less efficient in dealing with the cause of it. But if you can find humor in the situation, it helps prevent this mood disturbance from occurring.138 The emotional state that results from genuine humor and laughter are simply incompatible with anger and upsets.
Negative moods (especially depression) also weaken your motivation to take action. You feel that there's no point, since you're likely to fail anyway. You're more likely to feel powerless and decide that things are hopeless. The improved mood that humor creates stimulates hope and motivates you to take action.
Even if you're not very good at using your sense of humor to cope, but you do enjoy humor and often find a light side of things when you're not under stress, these two aspects of your sense of humor are enough to help keep you in a more upbeat, positive mood.139
For many, a bad mood from stress shows up as depression. The power of humor to counter depression was evident in a hospital patient who told me that she was given only limited chances of surviving her illness. One day a clown visited the hospital and gave her several good laughs. The clown raised her spirits to the point that she decided then and there that "They're going to take me out of here in a wheel chair, not in a box." To this day, she continues to avoid the box, and loves life.
"[Humor] does put you in a good mood . . . Usually when people are sick, or have something wrong, they get depressed. They can't do this, they can't do that . . . But if you start to laugh, it'll change your mood. It's a feeling of 'I can, I can,' instead of 'I can't.' Because depression is 'I can't,' and laughing is 'I can.'" 140
Again, research has documented that humor is an effective means of staving off, and of bringing you out of, mild (non-clinical) levels of depression.141 And it is precisely when you're under stress that finding humor in the situation helps keep you from getting depressed.142 This is why you'll want to actually make the effort to improve your humor skills using the guidelines provided in Part VI.
In one innovative study, young women in different phases of their menstrual cycle were asked to select from among comedy, drama and game show programs for an evening of television viewing. Premenstrual and menstrual women preferred comedy over the other choices to a greater extend than did women mid-way through their menstrual cycle.143 The researchers conducting the study concluded that this choice was due to "a desire to overcome the hormonally-mediated noxious mood states that are characteristically associated with premenstrual and menstrual phases of the cycle."
"Most folks are about as happy as they makeup their minds to be."
Finally, among a group of 35 patients in a rehabilitation hospital, 91% said that laughter puts them in a good mood.144 If laughter can improve the mood of patients with brain or spinal cord injuries, severe arthritis, neurological disorders, and amputations, it can also improve your mood and help sustain a high quality of care.
7) Increased Sense of Control
A perceived lack of control, or sense of helplessness, is probably the most important single cause of stress. An unwanted event occurs, but you feel powerless to change it--sometimes because several problems have developed at the same time (a common experience for nurses). Finding something to laugh at in the mist of these problems helps you feel more in control, because you really are taking a form of control over the situation. You're taking control over your emotional state, as described above. Rather than allowing the circumstances to generate feelings of anger, anxiety or depression within you, you create a positive mood--which supports your ability to deal with the problem.
A recovering alcoholic put it this way halfway through the 8-Step Humor Skills Program:
"I take control by looking in the mirror and having a good laugh before I walk out the door in the morning. I leave with the intent of passing on a smile to whomever I meet. It changes everything . . . A good laugh helps me take charge of the things that used to upset me. I can get through the nuttiest traffic situation now, and it doesn't bother me. I just let them be who they are, and I go on my way. Before, every little thing that happened on the road upset me. But if I can manage to find a bit of humor in things, it keeps me in a good mood. By the time I get home, I may be tired, but I'm not beaten, depressed or angry. And it's all under my control."
A long-standing theory of humor argues that we laugh at situations, events and jokes, which make us, feel superior in some way. This is one reason some people love put-down jokes. You feel superior to the person who is the butt of the joke. This same idea can be extended to stressful situations. When you find something to laugh at in the midst of difficult circumstances, you can notice a change in yourself. You feel like you've beaten it, like you've risen above it.
In support of this view, researchers conducted a study of Israeli soldiers in war-like conditions. Soldiers who joked, told funny stories, or clowned around more were judged by both their peers and commanders to be coping better with the highly stressful conditions of combat training.145 The researchers concluded that the humor initiated by the soldiers increased their feeling that they were in control of whatever situations came up, and that this enabled them to perform at a higher level. As you improve your own ability to use your sense of humor on the tough days, you will discover this same feeling of being more in control over your emotional reactions to the stressors you have to deal with.
Consistent with this idea, a humor-training workshop has been shown to strengthen the general belief that important events in our lives are under our own control, rather than a result of outside forces or luck.146