Humor in Health and Illness 2 - What Didn't Make It into the Previous Part and Something Else

Motto: The most difficult part of studying articles about humor is deciding whether the authors are serious or just joking.

Encouraged by the motto of this contribution, we offer a perspective by Joseph Palladino and Mitchell Handelsman on Humor-Impaired Personality Disorder (insufficient, possibly reduced and possibly damaged humor). The key features of this disorder are: inability to smile or laugh, lack of understanding or appreciation of many or all forms of humor, rigidity. Direct diagnostic tests assessing the presence of symptoms (e.g., questionnaires) are unusable because these individuals lack insight. Therefore, information is collected from significant others.

For a diagnosis to be determined, an individual must exhibit 3 of the following criteria within 6 months.

• Attempted and failed while telling a joke and resorted to the phrase: "You had to be there!".
• At least 3 times said the sentence: "Couldn't you be serious just once?".
• Cannot wait to get home from work or school to watch the weather forecast.
• Never smiles. (If this symptom is present, the criteria require only one additional symptom for diagnosis.)
• Unusual beliefs are present (e.g., that smiling or laughing is equivalent to passing (bodily) gas in public).
• Such beliefs are not interpreted by others as a weak attempt at a joke.
• Reads the Psychological Bulletin just for entertainment.
• Is unable to understand the concept of a comedy club.
• If a faculty member or student: attends all work meetings and enthusiastically offers to read and correct manuscripts.
• If a faculty member: considers faculty meetings the highlight of the week. Becomes visibly angry if a meeting ends without setting the date and time of the next meeting.
• If a student: underlines or highlights more than 55% of the textbook in any subject.

Regarding the treatment of this disorder, no cure is currently known. Several attempts have been made aimed at slowing and mitigating its progression. One approach is structuring the environment of these individuals so that they cannot infect others. The authors (Palladino, Handelsman, 1996) conclude their contribution about people with Humor-Impaired Personality Disorder with a note that these people lead productive lives, being, for example, deans of faculties, editors, or chairs of psychological associations.

People with Humor-Impaired Personality Disorder are unable to smile and understand humor. However, most people are able to laugh and are said to have a "sense of humor."

Sense of Humor

Steve Wilson (1996) compares the sense of humor to gravity, a force that we cannot directly observe with our five senses, but whose effects are constant and undeniable. We cannot see, taste, touch, smell, or hear a sense of humor, but we can certainly feel its effects. The same author elsewhere (Wilson, 2009) speaks not of a "sense of humor" but of "senses of humor." Several examples of senses of humor: abstract, bizarre, burlesque, cynical, childish, diabolical, witty, farcical, clownish, grotesque, hysterical, intelligent, uninhibited, unconventional, morbid, lewd, parodic, boisterous, exuberant, sardonic, sarcastic, satirical, self-deprecating, rustic, dry, jester-like, roguish, wacky, audacious, unique, amusing, malicious, jovial. The author further adds that if we learned to appreciate the differences in senses of humor, we could increase tolerance and reduce hostility in the world (Wilson, 2009).

Humor is a serious matter and requires a rigorous, professional approach. The study of humor is conducted through gelotology (from the Greek gelos – laughter). This discipline deals with the study of humor and laughter and their physiological and psychological effects on the human body.

The Healing Power of Humor

Research has shown that humor and laughter promote many physiological changes: they stabilize blood pressure, massage internal organs, stimulate circulation, facilitate digestion, increase oxygen supply to muscles, reduce muscle tension, and promote an overall sense of well-being (Seaward, 1992). The positive effect of humor and laughter on the immune system has also been confirmed (Wilson, 1996; McGuire, 1999; Berk, Felten, Tan, Bitman, Westengard, 2001; Bennett, Lengacher, 2007). During laughter, the number of NK cells (NK stands for natural killer) increases, which destroy tumor or infection-affected cells, and the number of T-lymphocytes, which attack infectious agents, also increases (Wooten, 1996; Nešpor, 2002).

It is important to know about the positive effects of humor and laughter on the human body, but for a psychologist it is more interesting to focus on humor in relation to psychotherapy. Carbelo and Jáuregui (2006) point out that humor can be used to facilitate contact between patient and therapist; for example, humor can help in establishing communication between them, to strengthen the therapeutic relationship, or to reduce potential hostility or anxiety. The authors further note that analyzing how a patient uses humor can aid in diagnosis. Important themes of the patient's mental life appear in the jokes they tell. Carbelo and Jáuregui (2006), drawing on the work of Kubie and other authors, point out that the use of humor in therapy can also have its contraindications. Humor can be used to avoid communication about painful feelings, which can result in inhibition or stagnation of therapeutic progress. If a patient interprets the therapist's humor as sarcastic or disrespectful toward them, their family, or their social group, the patient may perceive it as an attack, which can lead to conflict or hostility (Carbelo and Jáuregui, 2006).

You might ask: "How to use humor in the therapy (treatment) of people?" We will present two specific approaches. The first approach is humor drama. One of the basic characteristics of us humans is that we like to laugh at other people, to mock other people. However, we do not like it when others laugh at us or mock us. Some people have a pathological fear of ridicule, which is called gelotophobia. Titze (2007) uses humor drama to help people with gelotophobia, which is a variation of psychodrama, and its two basic tools are clown reduction and playful absurdity. Both techniques are developed to eliminate the perfectionistic approach of individuals who want to avoid situations in which they might appear ridiculous. In humor drama, people with gelotophobia can joyfully share many playful and uninhibited activities that may appear ridiculous or embarrassing from the perspective of a perfectionistic adult.

Another approach to the use of humor is shown by David Granirer (2005(a)) through his project Stand Up For Mental Health. Stand-up comedy is a specific format of humor. It is the fastest and most effective way to elicit laughter. The comedian's goal is to make people laugh as often as possible during their performance (measured by the number of laughs per minute). This requires brevity and a good punchline. David Granirer teaches people with mental illnesses how stand-up comedy is done. His goal is to increase the self-esteem of these people and also to fight public stigma. As he says: "There is something incredibly healing about telling a roomful of people who you are and having fun with them. It leads to kicking shame to the curb. And to the thought: Hey, I'm not so bad after all." (Granirer, 2005(a)).

Work – Humor – Stress

"Work is a serious matter that has nothing to do with humor!"; "Work is only worthwhile if you suffer at it!"; "I promise you nothing but blood, sweat, and tears (Winston Churchill)!" We often hear such or similar sentences from the mouths of superiors (bosses). However, we are slowly beginning to realize that work is killing us. The Japanese in the 1980s and 1990s experienced such high levels of stress that they introduced a new term "karoshi," which means "sudden death from overwork" (Wilson, 1995; McGhee, 2009). McGhee (2009) estimates that 20% to 50% of the average American worker's workday is lost due to stress, boredom, and general dissatisfaction with work.

The aforementioned author lists the following 4 constant sources of stress in every job:

• Keeping up with change – workers have learned to hate changes because they are endless. By the time we manage to learn something, something even newer is already here.
• Doing more with less – downsizing means two things – those who remain fear the same fate awaits them, and a reduced number of employees means an increased workload for those who stayed. Conclusion: fearful employees have to learn new things and take on new responsibilities at the same time.
• Doing things faster – as soon as one project is completed, another is already waiting for immediate attention.
• Information overload – the Internet and emails do not allow us even a day off, just think of the mountain of messages waiting for us after the weekend (McGhee, 2009).

Wilson (1998) refers to Fred Pryor when he says that healthy and happy employees work, while unhappy ones tend to call in sick. It is good for an employee to be healthy and happy, which is also advantageous for the employer. So what can be done to make employees happy, healthy, and satisfied? Wilson (2009) suggests establishing Uh-Oh squads. We are in an "Uh-Oh" situation when we feel something in our stomach and a voice in our head says: "Uh-Oh." These are signals of impending stress. Squad members should have red clown noses on hand; when someone is in an "Uh-Oh" situation, they should surround them and parodically sing "Uh-Oh! Uh-Oh! Uh-Oh! Uh-Oh!" four times. It only takes 30 seconds (Wilson, 2009).

For those who still need more, let them learn from the following thoughts presented by Baum (1996) that can help bring a bit of humor into personal or work life:

• Strive to add humor to everyday activities. You don't have to reserve it only for special occasions.
• Do something that pleasantly surprises coworkers and family members.
• Focus on positive forms of humor. Sarcasm, ridicule, and other negative forms of humor usually serve to create bad emotions.
• Appreciate naturally occurring humor at home and at work. People do strange and funny things – sometimes intentionally, often by accident. Try to appreciate these moments.
• Experiment with positive and appropriate jokes. Try them first at home and then at work.
• Smile and laugh more often. Practice "humorobics." Laughter aids the production of endorphins – a biochemical substance that leads to good feelings.
• Be sensitive to what colleagues or family members find funny and what they do not. Do not let something funny for you turn into a bad experience for someone else.
• Relax. Do not let yourself get stressed by events that are not important.
• Try to separate work (professional life) from personal life. Plan fun activities with family during free time.
• Realize that the only thing constant, whether at work or at home, is change. Try to be as flexible as possible so that you can change when needed.
• Observe stressful and negative situations so you can decide what you can control and what you cannot.
• Try not to worry about what people think. Try to be a little wacky, wild, and strange – you might learn to like it (Baum, 1998).

For those who still need more, let them check out 71 tried ways to bring humor into work activities (Wilson, 2009). Of course, I will not list them all; truth be told, I will not list even one, because it would tire every reader and last but not least me the writer (meaning the author of this contribution).

University lectures or conference contributions (presentations) should not be tiring and boring either. On the website www.write-out-loud.com, in the article "How to Use Humor Effectively (A Good Joke Is Very Good. A Bad One Can Be Disastrous)," we can read, among other things, that humor breaks barriers, humor relaxes the audience, alerts them to listen, to pay attention, humor adds "juice" to the presentation, humor releases tension, humor connects people.

David Granirer (2005(b)) says that a joke should contain at least one of these two elements – exaggeration or surprise (it is worth verifying this). A joke further consists of two components – setup (introduction of the situation) and punchline. The setup is a brief introduction of the topic (20–30 seconds), which should not be meant jokingly, because then the second part of the joke – the punchline – has nothing to contrast with. The punchline should therefore contain an unexpected twist. So far these were David Granirer's thoughts; now follows our example: A joke does not need to have a punchline (setup). Although it does not hurt if it has one (punchline).

Instead of a Conclusion

If you were expecting something else, don't stop waiting! Hang in there! You might get it in my next contribution concerning the psychology of humor. If you really cannot wait, consult your doctor (psychologist, psychiatrist) about whether you are neurotic, or let yourself be inspired by the list of websites that you will find after the reference list. Oscar Wilde once said: "Life is too important to be taken seriously." And I add: "If you still want to take life seriously, take it with humor!"

Róbert Ďurka, Centrum pedagogicko-psychologického poradenstva a prevencie, Michalovce

The contribution was published in the conference proceedings "Psychológia zdravia - Zdravie a múdrosť. Psychológia zdravia a syndróm vyhorenia. Rodové rozdiely v zdraví". The conference took place in 2009. Editors: PhDr. Dušan Selko, CSc., MPH, Mgr. Róbert Ďurka, PhD. Proceedings published with financial contribution from Národného ústavu srdcových a cievnych chorôb, a. s., Bratislava Publisher: Národný ústav srdcových a cievnych chorôb, a. s., Bratislava through Vydavateľstvo MAURO Slovakia s.r.o., Bratislava 2010, ISBN 978-80-968092-6-4