The question caught me off guard for a moment, then its meaning sunk in. She was really saying, “Cancer is serious stuff, my breast has been cut on and radiated, and you’ve given me cancer fighting poisons in my veins. My hair has fallen out, food tastes funny, and I’m on a first name basis with the muzak at my insurance company. I’ve done my crying, but is it appropriate to laugh at it all?”
I remembered back to an intimidating nurse critiquing a tape of my very first patient interview during my second month of medical school. Her eyes were sharp and piercing and her brow furrowed as she watched the tape. Half way through she stopped it, turned it off, and said, “You are flippant…. I don’t much care for it.” My heart sank, and then she continued without a smile, but with a twinkle in her eyes, “but it works for you, so don’t mind me and keep on doing it.”
I believe that humor is therapeutic. Of course, that is not a new idea. The saying, “laughter is the best medicine” did not originate with Readers Digest. The biblical record states, “A merry heart does good like medicine, but a broken spirit drieth bones” (Proverbs 17:22). I don’t know that a merry heart will add time to a cancer patient’s life, but I know that it will add life to the time that they have.
We don’t know a lot about the physiological effects of humor. It does promote an array of changes in our complex mind-body feedback mechanism that has lead to speculation that amusement decreases physical wear and tear and promotes improved immunity. It is fairly clear that laughter does reduce psychological stress and increases pain thresholds. What has been abundantly demonstrated is that the antithesis of genuine humor, depression, can have devastatingly negative effects on our health.
It’s awfully hard to do a blind, randomized and controlled trial involving humor. Imagine taking a couple hundred cancer patients and telling each one, “Heads you use humor and tails you don’t - oh and by the way, we won’t tell you which treatment you have been assigned to.” It just won’t work. For another thing, until you can put laughter in a pill, no drug company is going to fund the research, though a UCLA study to see if funny videos can promote healing, was funded by the Cable TV network, Comedy Central.
Most of us use humor to cope. The diversion that it provides can be essential when the emotions of dealing with cancer become overwhelming. However, consistently using humor to hide or ignore cancer is maladaptive. The real power of humor comes when it is used to pull oneself through the anger, fear, and grief that inevitably confront someone struggling with a disease from which they might die.
In the same vein, not all humor necessarily reduces stress. Being able to make light of ones self and predicament is certainly healthy, but sarcasm may deepen one's sense of anger and futility instead of promoting acceptance and adaptation.
As caregivers we use humor to break the ice, reassure, deflect anger and to demonstrate our humanity. I’ve learned from experience how much trust is engendered when I take the time to share a joke or an amusing story with a patient or family. It seems to say that I can take their cancer seriously and yet take myself lightly.
Cancer isn’t funny. But the happiest people I know are those who have met tragedy and overcome the grief that comes with it. They know how to smile and they know how to laugh and we hold them in awe. Carol Burnett, a breast cancer patient willing to use her personal tragedy on stage says, “Comedy is tragedy plus time.”
It is okay to laugh.
