Humor as Used in the Doctor-Patient Relationship: Constructive and Destructive(2)
I wondered whether humor in psychiatric practice was a useful tool in the psychiatrist-patient relationship or whether there were special concerns with its use as compared with the use in general medical practice.
Psychiatrist Shrinkette covers this issue on her blog and has responses from some visitors on how they look at humor in psychiatric consultations. In addition, Shrinkette wrote me e-mail stating, in part, her view:
"...what's different about psychiatry is that the relationship between psychiatrist and patient becomes fodder for understanding the patient's life and symptoms. People respond to us as they've responded to other important figures in their past (it's called transference). So humor becomes one more variable to interpret.
Another difference is that sometimes patient's symptoms can include
extreme humor (manic patients, for example). We're supposed to model
appropriate behavior, and that means not cracking up at their stream of
manic jokes (if the whole session consists of the patient joking and me
laughing, that's not therapy!) But sometimes we can soften an
important message to a patient with a little joking (at least we hope
so)."
Thanks Shrinkette. ..Maurice.
posted by Maurice Bernstein, M.D. @ 8:43:00 PM
6 comments
6 Comments:
JS commenting on humor in psychiatry in Mr Sun! blog, also reminds us of a resource site for journal articles on humor in psychiatry.
As a praticing psychologist, I was interested in JS's comments about humor. Her comments were primarily addressing the interpretation of the patient's humor. These were interesting but, I believe, just scratch the surface. Humor can be a very powerful interventional style when used artfully as it can lend more objectivity to the issue (by standing back and seeing the humor of a situation despite the frustration) and can address issues metaphorically and indirectly when direct methods aren't working. One need only read some of Mark Twain's satire (to name one writer) to understand how satire/humor can address an issue that the reciever might otherwise not be receptive to addressing. Natually, this needs to be done with the same sensitivity and artfulness of any psychotherapeutic intervention.
I believe Phil was referring to Shrinkette's comments above and not JS writing on Mr. Sun! Blog. In any event, Dr. Phil is correct that there is the issue of the psychiatrist initiating humor into the attempt to attain a therapeutic relationship. I would think that the psychiatrist must be more cautious in this process than a physician in a general medicine relationship. I haven't read the series of papers on the topic in the PubMed resource link I included in my previous comment. However, it looks as though psychiatry and humor has been a studied topic.
Phil, could you relate what kind of humor you have, in practice, personally used and to what patient pathology would you feel would be the most appropriate for such use? ..Maurice.
I am a cultural anthropologist with research experience in Africa. To the anthropologist, "joking behavior" is seen as a way to "dramatize" tensions in the society and diffuse otherwise tense relationships. Those relationships, for example, may be between a woman and her brother-in-law -- relatively close relationships where sexuality is out of the question. The Trobriand Islanders, as another example, use sexual inuendo to put down the opposing side in a cricket game. When I came to understand humor in a rural village, I knew that I had reached some level of understanding in the society. Things that struck us (my African friends an I) were as simple as a calf leaping across a road, my boy getting a good kick (although harmless) in the abdomen by another calf, and my son popping out of a hedge. It is impossible to explain why these things were funny cross-culturally.
Candice Bradley
anthromom@gmail.com
Candice, have you observed joking used by the islanders in medical situations? ..Maurice.
That's an interesting question. My experience overseas (in Africa) is that medicine is not viewed with any humor. I have not been to the Trobriand Islands. Here is a website which cites an article that apparently has some info about humor in the Trobriand Islands:
http://www.anthrosource.net/doi/abs/10.1525/eth.1998.26.1.73
This is about linguistics and psychology, in an anthropology journal called Ethos (I used to get this at one point, no longer).
Hope this helps.
Visit my blog(s).
Candice
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