Therapeutic Humor:A Coping Tool for Cancer Patients and Nurses
Therapeutic Humor:A Coping Tool for Cancer Patients and Nurses
By Karen M. Sherman, RN, MS, HNC
One’s sense of humor is constantly modified by life experiences. Humor is an essential tool that guides people through dark, difficult storms of life, enhancing quality of life. A sense of humor also can help people choose emotional responses to serious illness, balance emotions, and bring about relaxation, confidence, and a feeling of control.
A nurse’s ability to use humor in the caring process is a challenge in today’s health care environment. Medical technology has threatened the caring role of nursing. By learning to laugh at ourselves, we can begin receiving humor’s many benefits. Our patients will also benefit from human caring, which is transmitted with gentleness, a light heart, and compassion. Florence Nightingale believed that "painful expressions are far better dismissed by a real laugh."1
The Mind-Body Connection
Positive emotions expressed through a positive sense of humor can create neurochemical changes that buffer the immunosuppressive effects of stress and illness.2 Laughter can provide comic relief and can stimulate the release of toxic chemicals such as cortisol,3,4 which purifies the emotions and releases tension. Norman Cousins said it best: "Laughter accomplishes one very essential purpose. It tends to block deep feelings of apprehension and panic that all too frequently accompany serious illness. It helps free the body of the negative emotions that in turn may impair the healing system."5-7
Scientific evidence supports Cousins’ claim that humor can cure disease. Berk demonstrated that the experience of laughter lowers serum cortisol levels, increases the number and activity of natural killer cells, and increases the number of T cells that have helper/suppressor receptors.8 In other words, laughter stimulates the immune system by diminishing the immunosuppressive effects of stress.
In a study by Stone, subjects showed higher salivary immunoglobulin A response levels on days of positive mood.9 Salivary immunoglobulin A is the first line of defense against infection through the respiratory tract. This finding has been confirmed by other studies.10,11
Until recently, medical science mostly regarded the mind as a complicated, poorly understood entity that involved thoughts, emotions, and attitudes that interfered with controlled clinical studies. Pert’s discovery of opiate receptors and many other peptide receptors in the brain and body has led to a new understanding of the chemicals that travel between the mind and the body.12 The presence of neuropeptides on immune cells suggests an interactive network of information flow between the brain and the immune system in which direct control of emotions may have immunological consequences.
Parse also demonstrated that laughing and health are interconnected.13 The study of the lived experience of laughing and health is different from other studies using the Parse method. An understanding of the laughter-health connection was gained through a study of 20 men and women over 65 years of age. During part of the study, participants talked about their experiences and connected health with feeling good and considered laughing as something that prompted this good feeling.14
Humor and Cancer
Humor can be a very powerful coping tool for cancer patients. Humor neutralizes emotionally charged situations and provides hope. When a sense of humor is used to disclose sensitive personal issues, it helps remove the seriousness from the situation. The person learns to take his disease seriously but himself lightly. Introducing humor helps patients to step back and laugh at the absurdity of the moment. Humor has the power to unlock a person’s creative potential and to assist in finding new ways to solve problems.
Support groups may choose humor to block the therapeutic process. Clowning, scapegoating, and joke-telling are ways to avoid serious or sad issues facing some members. However, nurses who facilitate groups need to be aware of the potential misuse of humor. A maladaptive pattern may be formed as the group decides to sidestep issues like death and dying with "fun" respite breaks.
Selye clarified that a person’s interpretation of stress not only depends on the stressor or the stressful event, but also the perception of the event and the meaning attached to it.15 Different people respond differently to cancer. It is also true that some people cope with cancer better than others. Kobassa has defined three hardiness factors that can increase a person’s resilience to stress: commitment, control, and challenge.16 People who have a strong commitment to getting better, believe that they have control and choices in their lives, and see change as a challenge are more likely to be stress hardy. A sense of powerlessness is a major part of the cancer experience; humor can impart a sense of empowerment. Humor gives a different perspective by detaching emotions from the problem; patients gain a sense of control and are protected from harmful stress, which weakens the immune system.
Humor for Nurses
Sense of humor is made up of attitudes cultivated over a lifetime. These attitudes allow us to appreciate the incongruous, absurd, ridiculous, and bizarre things that occur in the real and imaginary world. Without humor, we also lose a powerful coping tool with which to face life’s harsh challenges.
Job stress and burnout are two major challenges that nurses face. To survive and even prosper in a high-stress work environment, one must learn to function well under stress. The ability to laugh provides a momentary release from the intensity of what otherwise might be overwhelming.17 A good sense of humor is a stress reducer for all health care professionals. Humor promotes bonds and breaks down barriers, creating a team atmosphere.
Humor also improves communication by providing a means to discuss serious or emotionally strained issues. It can be helpful in managing difficult situations including conflict. Making work more fun improves morale and job satisfaction. Opportunities to experience humor and enjoy playfulness on the job actually help people perform better. Humor stimulates creativity and can help make employees more effective and better able to develop solutions to difficult problems.
A sense of humor can help adults rediscover a child’s sense of joy and playfulness and live more fully in the moment. It also increases the chances for personal happiness because humor and laughter have a positive effect on health and well-being.
You may wish to keep a special group of stories, jokes, and anecdotes that you can use on the job. As you become more relaxed with your own sense of humor, your own humorous ideas will begin to flow. This kind of exercise sharpens the mind and stimulates creative thinking. This is the basis of empowerment for any practicing nurse.
Conclusion
Some of us have forgotten how to laugh and have fun. By being more light-hearted and playful on the job, we can enhance the quality of our own lives and the lives of our patients. But first we must re-examine our own lives to see if our sense of humor is still alive and well. Like everything else in life, we have to cultivate it to keep it fresh.
Ms. Sherman is a licensed psychotherapist and holistic oncology nurse at the HOPE Community Cancer Center in Marmora, NJ.
References
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2. Moran C. Does the use of humor as a coping strategy affect stresses associated with emergency work? Int J Mass Emergencies Disasters 1990;8:361-377.
3. Cotman CW, et al, eds. The Neuroimmune Endocrine Connection. New York: Raven Press; 1987.
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5. Cousins N. Head First: The Biology of Hope and the Healing Power of the Human Spirit. New York: Penguin Books; 1990.
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8. Berk LS, Tan SA. Humor associated laughter decreases cortisol and increases spontaneous lymphocyte blastogenesis. Clin Res 1988;36:4-35.
9. Stone S, et al. Evidence that secretory IgA antibody is associated with daily mood. J Pers Soc Psychol 1987;52:988-993.
10. Dillon K, et al. Positive emotional states and enhancement of the immune system. Int J Psychiatry Med 1985-1986;5:13-18.
11. Lefcourt H, Martin, RA. Humor and immune system function. Int J Humor Res 1990;3:305-321.
12. Pert CB. The wisdom of the receptors: Neuropeptides, the emotions, and bodymind. Advances 1986;3:8-16.
13. Parse RR. The experience of laughter: A phenomenological study. Nursing Sci Q 1993;6:39-43.
14. Parse RR. Laughing and health: A study using Parse’s research method. Nursing Sci Q 1994;7:55-64.
15. Selye H. The Stress of Life. New York: McGraw-Hill; 1978.
16. Kobassa SC. Personality and social resources in stress resistance. J Pers Soc Psychol 1983;45:839-850.
17. Wooten P. Compassionate Laughter: Jest for Your Health! Salt Lake City, UT; Commune-A-Key Publishing; 1996.
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