Humor and HOPE
Charles Atkins, MD
First Published In American Medical News June 26, 2000
I do a lot of public speaking and consultation—often on topics of stress reduction, humor and healing, and how our thoughts influence our emotions and our health. It’s basic stuff, but invariably I’ll be asked why it’s not more a part of the generally held notion of health.
It’s good to laugh, yet hospitals don’t encourage this. When I talk with groups of nurses, I’ll be asked about the appropriateness of humor when people are suffering. My response is that there’s no better time. Humor is adaptive; it allows emotional distance from pain, and gives a sense of control.
The psychologist Victor Frankl in his book Man’s Search for Meaning reflected on his experiences in a Nazi concentration camp. What he observed was that two groups of prisoners seemed to do best: those who could hold on to a sense of purpose and those who could laugh.
Last week I was sitting with a woman who told me a heartbreaking story; it was a modern retelling of The Book of Job--only this was her life. Throughout the telling she laughed and told jokes. I commented how I thought it was great that she still had her sense of humor. Her reply: "I can either laugh or cry, and I’d rather laugh."
A friend of mine who’s in her 80’s discussed her recent hospital stay. She was comparing her two doctors, both of whom are well-qualified and competent practitioners. Dr. A would come in, chat, tell a joke, listen to her heart and lungs and leave her with a generally positive feeling. Dr. B—whom she’s nicknamed Doom and Gloom—will enter her room and tell her how ill she is. He’ll discuss her heart failure and atrial fibrillation. He’ll warn her about her increased risk of stroke—her greatest fear. As he puts stethoscope to flesh, he makes tsking noises as he hears fluid crackling at the bases of her lungs.
After he’s gone, she’ll mull over his words, both spoken and implied, thinking about the catastrophic scenarios he’s hinted at.
If I have a stroke who will look after my cat? Am I going to be left a vegetable? I’d rather be dead than go into a nursing home. Can I even afford a nursing home?
For the next few hours she’ll stew in a miasma of "what ifs".
Laughing to sleep
It’s just words, isn’t it?
When Norman Cousins, who was suffering with ankylosing spondylitis, wrote Anatomy of an Illness as Told by a Patient, he told how 10 minutes of forced belly laughter gave him two hours of pain-free sleep. Since then, we’ve come to understand how aerobic exercise—such as his marathon of laughter, causes the release of endorphins and enkephalins, natural painkillers that may well explain the analgesia he experienced.
Similarly, we know that anxious thoughts cause elevations in stress hormones such as cortisol and adrenaline with the physiologic changes that come with these substances. Just remember the last time you slammed on the breaks to avoid an accident and how for the next minute or two you felt the effects of adrenaline as your heart raced and your body prepared itself for fight or flight. That stress response—which is highly adaptive and keeps us from getting killed—can also go haywire. It’s what happens to people who have panic attacks, and in a lesser and more chronic way, it’s what we find in the persistently anxiety-ridden.
When Hans Selye researched the stress response and sliced open his experimentally stressed-out rats, he consistently found enlarged adrenal glands, elevated cholesterol, coronary artery disease, ulcers and strokes. The take home point was that it didn't matter how you stressed the animal, but that the effects of protracted stress led to common end points.
I believe most physicians are acquainted with these principles. What’s often missing is the next step. If we know that chronic stress is bad, both emotionally and physically, how do we harness the power of thought and emotion in the healing process? Is a negative bedside manner correlated with poorer outcome? It’s a study I’d love to see.
Hope as therapy
Compassion, empathy, humor and the instilling of hope are powerful therapeutic agents. They’re also undervalued. I think it’s actually the advances in technological wizardry that will eventually bring these back into importance. As we view the brain with real-time PET and SPECT imagery and look at the effects of emotions and stress on neurotransmitters, maybe we’ll be satisfied that indeed our thoughts and our feelings alter our physiology.
At a recent seminar, a participant made the following comment: "When doctors made house calls, you were left with the feeling that everything was going to be OK. Now it seems they’re more concerned in giving you a legal discussion of the relative risks and benefits with ‘10% of this and 20% of that.’"
I knew what she meant, and I thought about my own attention to laying out options to patients and the need to discuss risks and benefits. But even there, it’s all in the telling.
I’ll often personalize the discussion as I map out my treatment choices. I’ll look at my patient and imagine, what if they were a family member? If you were my sister/mother/brother/father this is what I’d recommend.
I’ll be certain to let them know that there are options, and if treatment A doesn’t work, then we’ll move on to treatment B, while mentioning treatment C that's waiting if needed. If hopelessness and despair are expressed, I’ll listen and let them know how normal it is to feel that way, but that there is hope and that the reason I like to do what I do, is that people get better.
It’s all words, but in the emotionally charged reality of having an illness, humor and empathy are powerful tools that can allay fear, lessen pain and restore hope.