I’ve been thinking about what Apps I’ll need to acquire for my new smartphone, when I get it. That reminded me of a poster presentation on that very topic at the Academy of Psychosomatic Medicine (APM) Annual Meeting last week. After all, with the title “Appreciating Apps Apropos to Psychosomatic Medicine,” how could you go wrong.
It turns out you could go very wrong. According to these enterprising medical students (who else could I count on but the young experts?), the utility of these products has not yet been established (click to enlarge image).
The message is short and sweet, or not so sweet depending on your point of view.
This reminds me of yet another APM session, this one “Humor as a Potent Tool for the Consultation Psychiatrist,” presented on November 12, 2015. I remember one of the presenters, Dr. Jordan Matus, MD, quoting (or misquoting if you’re a purist) E.B. White:
“Analyzing humor is like dissecting a frog. Few people are interested, and the frog dies.”—E.B. White
The quote, in this paraphrased form, is short and funny, at least in my opinion. However, the full quote actually goes like this:
“Humor can be dissected, as a frog can, but the thing dies in the process and the innards are discouraging to any but the pure scientific mind.” (“Some Remarks on Humor,” in Essays of E. B. White [New York: Harper & Row, 1977], 243.). This was originally published in “Some Remarks on Humor,” preface to A Subtreasury of American Humor (1941).
You may argue with me (and that’s OK, because I can’t hear you anyway), but the latter version seems to lack the terse vitality, the pith and punch of the former–that’s probably because White didn’t write it. Don’t get me wrong; E.B. White is one of my favorite writers. But hunting for a short, pithy quote from him is sometimes like trying to pull just one shirt from a whole load of wet clothes out of the washing machine.
You can’t seem to do anything but drag out almost the entire load.
Anyway, the presentation on humor was one of the many bright spots of the meeting for me, and the speakers were actually funny. I couldn’t decide at first whether these were scientists trying to be funny or funny persons impersonating scientists. White had something to say about that too, though I’ll be damned if I can easily find a quote in the same essay from which the dissected frog jumped–or limped.
In fact, I dare anybody to find a quote directly from White in that essay about it. He has to quote somebody else, Frank Moore Colby, who I will not even pretend to know anything about:
“False-humor worship is the deadliest of social sins and one of the commonest.”–Frank Moore Colby.
Doctors may pretend to be clowns. Clowns may pretend to be doctors. This charade is all around us. On the other hand, I think the speakers actually had bona fide funny bones.
Douglas J. Opler, MD
Assistant Professor, Rutgers New Jersey Medical School, Newark, New Jersey
Jordan Matus, MD
Director, Psychosomatic Medicine Service, Montefiore Medical Center-Wakefield Division, Bronx, New York
Stephen E. Nicolson, MD, FAPM
Director, Psychosomatic Medicine Fellowship, Vanderbilt University Medical Center, Nashville, Tennessee
Mary Alice O’Dowd, MD, DFAPA
Director, Psychosomatic Medicine, Montefiore Medical Center, New York, New York
James Levenson, MD, FAPM
Professor of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
The abstract for the symposium: Humor is one of the most complex forms of communication. Freud proposed that jokes allow us deal with difficult emotions and threats such as shame and death. The joke lets us release psychic tension through laughter. Vaillant classified humor a mature defense mechanism. Humor can serve many positive functions, including discharge of emotional stress, strengthening affiliations, bridging socio-cultural gaps, relieving situational tension, and providing relaxation.
While far from definitive, there is robust literature for humor’s place in the medical center. Watching funny videos led to lower pain ratings and less use of pain medications in post-operative orthopedic patients. Doctors who had never been sued used more humor during their patient encounters than physicians who had been sued. Nurses who use humor more report greater sense of coping and more job satisfaction. Humor fosters better relationships and overall medical team morale.
However, there are certainly pitfalls to the use of humor in the hospital. Jokes can humiliate and entrench hierarchy. “Gallows humor,” the use of satire to deal with painful or life-threatening situations can sound degrading and cruel if overheard by patients or family. Some patients may be offended by physicians’ attempts at humor. Students may panic if they feel they are the object of ridicule.
Appropriate use of humor gives the consultation psychiatrist a potent (and often fun!) communication tool. This symposium will address the power of humor as a form of communication, including types of humor, its neurobiological underpinnings, and its appropriate place in the hospital.
“Types of humor”
What is humor? Dr Opler discussed the varieties of humor. He gave examples of the incongruity, social, and relief theories of humor that educated us and were funny.
“Neuroanatomy of humor and physiology of laughter “
Dr Matus tried to point out the location of humor in the brain and endeavored to help us understand if laughter can be considered a form of exercise. He also described the Duchenne smile, named after the 19th century French neurologist who first described it as compared to what used to be called the Pan Am smile, the usual polite smile. The former activates muscles around the mouth and eyes, the latter just around the mouth.
Humor in the medical center can both relieve and cause tension. Dr Nicolson discussed the ways in which humor can benefit patients and health care workers and offered practical tips on identifying situations when humor should be avoided.
“Humor and diagnosis”
Can a patient’s sense of humor (or lack thereof) help the psychiatric consultant make a diagnosis? Dr O’Dowd discussed how humor, resiliency, and personality traits can intersect in the context of medical illness.
“Humor in the General Hospital: Ethical Considerations”
How ethical is it to joke about patients? Dr Levenson used medical ethics as the basis for evaluating medical humor.
Watson: Gallows humor in medicine. The Hastings Center Report 2011; 41(5):37-45
Bennett: Humor in medicine. Southern Medical Journal 2003; 96(12):1257-61
Wild, et al: Humor and smiling: Cortical regions selective for cognitive, affective, and volitional components. Neurology 2006; 66(6): 887-893
I use humor a fair amount, though sparingly with patients. And this is as close as I could come to dragging just one shirt out of the washer; E.B. White says this about humor:
“It plays close to the big hot fire which is Truth, and sometimes the reader feels the heat.”
Agent K in Men in Black, “No, ma’am. We at the FBI do not have a sense of humor we’re aware of.”