Saturday, June 11, 2005

Psychiatrists and humor

Dr. Maurice Bernstein has been posting about the use of humor in the doctor-patient relationship. He sends this e-mail:
What I am interested in is whether, in your opinion, psych patients should be treated differently when either giving or receiving humor compared with patients who are not in a psychiatrist's office. Is there a similar role for humor in a psychiatrist's office as in the office of an internist? Your views would be valuable in my thinking out my presentation to the students. ...Maurice.
What a difficult question! Both patients and psychiatrists can find benefits in humor, but there are risks. Humor can be constructive or destructive, as Dr. Bernstein points out. Humor can be used to approach or avoid difficult topics. The wrong tone can humiliate a patient (or a doctor), and sabotage treatment.

So I am posting this little poll (scroll down, please):





Free polls from Pollhost.com
How should psychiatrists use humor with their patients?

They shouldn't.  Patients' problems are not funny.
Very carefully and very selectively.
When a joke might be instructive or illustrate a point.
When a joke might defuse tension or show compassion.
Is humor being used as a defense?  What's causing the anxiety?
Try not to laugh so hard that you disturb patients in the waiting area.

  




Comments welcome!

Update: here's Dr. Howard J. Bennett, MD, on Humor in Medicine, via Medscape.

12 Comments:

Blogger Dreaming again said...

If my psychiatrist never used humor with me, I'd probably have never returned. Humor is a major part of who I am and how I communicate. I do need it to break tension at times or to illustrate a point at times that I am not getting otherwise.

If it ever humiliated me, I would obviously feel differently ...but used to help break down my walls ...it is quite useful and to be perfectly honest is probably the only way they were able to make a chink in my very high, very thick wall of a 20+ year long eating disorder. (started at 14, 36 before I sought therapy for the first time)

8:43 PM  
Anonymous Mr. Pseudo Nym said...

Write-in poll option: Like the dentist in Little Shop of Horrors (the one with the nitrous oxide backpack).

9:00 PM  
Blogger Lisa said...

Holy cow, comments on a Shrinkette post! I'm gonna come on down here in Commentland and have a little party! Very exciting.

I don't think humor is bad in a therapeutic relationship as long as it's not being used by either party to deflect serious conversation about serious issues.

As far as the humiliation aspect goes, all humans should strive not to be asshats -- in or out of therapy.

Also, did you know that there had been a study about this by Carl Marci of MGH? See here for a link to an article on it.

9:05 PM  
Blogger BotanicalGirl said...

I think humor can be used in psychiatry/psychology, but with care. Humor works very well to relieve tension and it also strengthens the bond between doctor and patient.

8:48 AM  
Blogger DrTony said...

I have an advantage. As an ER doc, I can use the same, finely-tuned jokes over and over again and they are (usually) new to the patients. However, I have gotten some complaints from the nurses who hear them time and time again in the patient rooms.

9:46 AM  
Blogger shrinkette said...

I've read about a psychiatrist who tells tearful patients, as he's handing them the tissues, "At Christmas we use green Kleenex." I thought that sounded...unempathic.

Dr. Bernstein also asks about receiving humor from patients. Some hypomanic patients can say extremely amusing things, and it can be infectious for the unwary. And we're taught to ask why a patient might want to make us laugh sometimes...what's the patient's agenda?

(Sometimes patients say and do things that strike us as...very funny. We do our best to maintain professional deportment, but sometimes it's a struggle...)

1:06 PM  
Blogger Dreaming again said...

Ok in all fairness ... I'll admit, I will crack a joke with any one of my eating disorder treatment team when my therapist or my psychiatrist ..or ESPECIALLY when my nutritionist get too close to a point and I think they are going to make me cry.

I'm not sure how many of the 3 of them have that figured out.

While they can use humor to help me easier, I can also use humor to hold them at a distance easier. So, it might be a catch 22 situation?

9:20 PM  
Blogger blondzila said...

My pdoc is about as funny as an abcessed tooth. He thinks he's the East Indian version of Jerry Seinfeld, full of anecdotal observations that should be hilarious and clever. They aren't, and I find his interjection of these anecdotes rather narcissistic: pay attention to how smart and clever I am, Miss Patient of Mine, and once you've duly chuckled at my lame jokes, then perhaps we might discuss you. If there's time. But then again, I think the guy's an ass to begin with so I might be biased. Humour is important. But the potentially mental and emotional fragility of patients should have doctors treading carefully. With most doctors I am full of jokes. Because I dislike my pdoc so intensely, all he gets from me are non-committal grunts, which I suppose would be funny to a caveman. Enough outta me...

5:58 AM  
Anonymous Anonymous said...

Humor can be a useful thing, from the patient's perspective.
It can be a sign of intelligence (in the doctor), since it's another cognitive layer in addition to whatever medical/psych issues are involved. It can also reveal what we might call "real" empathy in the doctor, since it requires a lot of judgment about appropriateness, and "is this visit about you, or is it all really about ME."
Problems come up when it intrudes into the relationship -- is the patient laughing because the doc's funny or in order to please the doc?
And unfortunately, the doc has a "captive" audience. Would you go to a comedy club if they locked the doors while you were there?
Personally, I don't think I could practice medicine (neurology, in my case) if I couldn't poke fun or make jokes, but you have to be intelligent about it, never make fun of the patient, pay attention to the "audience", and always know where the exit is.
I do some neurorehabilitation, and I used to have an informal "Humor Scale" to assess patients with (0-5) based on the patient's reaction to my causal jokes on rounds. I think it's a function of integrity of the frontal lobes (factoring in that some people have a sense of humor and some don't). Frontal lobe dysfunction will frequently affect the patient's appreciation of humor, and you can see this improve as the patient recovers. Occasionally, there would be someone who would laugh at everything I said, even, "How are you doing today?" -- that's a 6 on the 0-5 scale!

6:27 AM  
Anonymous Dr. Lisa said...

As a psychologist, I use humor all the time with my clients. For many I could not have forged a therapeutic bond without it.

Change is hard. Bringing certain issues to a client's attention without having them dig their heels in can be even harder. When I have to "confront," I almost always do it with humor if I can.

Also, being cracked up by a client is a very genuine way of showing that I like and value them.

If a client is using humor to keep issues (or me) at arm's length, it's not long before I throw the proverbial nerfball at their head.

8:09 PM  
Blogger Candice said...

I'm an anthropologist I posted a couple times in other blogs about humor cross-culturally, so I'm not going to do it again.

My shrink is a riot. I love to entertain him. But we are dealing with meds and not doing therapy.

I had a therapist/psychiatrist who laughed when I told him about the sexual side effects of the antidepressants I was taking. I don't know what was so funny, but it really messed up my therapy from there forward. It was clear that I couldn't talk to him about sexuality. Therapists should be careful what they think is funny.

4:38 PM  
Anonymous Anonymous said...

I say it is fine but they should be careful... I had one who laughed at evrything I said or ended it with a smirk and chukle. I thought it was funnt but rude at times... They should use some humor though it does help make things seem so much better and at times build bonds but they really do need to WATCH WHAT THEY DO AND SAY!

6:07 PM  

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