Humor and sympathy in medical practice

While a potent example, it is not the only one. There are many examples of this, such as surgeons making jokes about unconscious or sedated female patients during their surgeries (Tomlinson 2015). There is also the story of the Virginia colonoscopy patient who had his phone on to record post-surgery instruction, only to accidentally record his surgeons mocking him during the surgery (Abbott 2014). Based on the reports from medical professionals, these occurrences are not uncommon.

It would be an added bonus if this paper also helped to change the public opinion of everyday patients—that is, those that are not medical professionals—but that would go beyond the scope of this paper. I do think that developing a method for changing public opinion of this may be beneficial, but that will be a project for another time or for someone else to pursue.

As Hodson and MacInnis note, “exposure to sexist jokes led to more tolerance of the discriminatory behavior. But original levels of hostile sexism moderated the effect: only those high in hostile sexism reacted to sexist jokes with greater tolerance toward a discriminatory act” (Hodson and MacInnis 2016, p. 66).

Sometimes, this method is even used to see if someone has the right audience for their actual beliefs and judgements. In this sense, they make a joke that is a little sexist or racist, then if the audience does not react in a positive way, the joke-teller merely has to say that he or she was “just kidding” to lessen the moral blame from the audience (Saucier et al. 2016, p. 77).

While it would be more accurate and complete to discuss humor as an affect in general with specific emotional dimensions, I am here choosing to focus on only these emotional dimensions of humor. This is both for the sake of simplicity and for conciseness.

Examples include law enforcement and the military.

Humor can serve as a stress-reducer, and as a way to improve one’s resilience and recovery concerning challenges (Cheng and Wang 2015, p. 761). Other noted health benefits include lowered blood pressure and anxiety, improved cognitive functioning, and improved immunity (Granek-Catarivas et al. 2005; Oczkowski 2015; Robbins 2015). For physicians, humor helps narrow interpersonal and cultural gaps, communicate difficult messages, and express frustration and anger (Granek-Catarivas et al. 2005). Though, there are those who argue that the research done on the medical benefits of humor is poorly conducted and does not sufficiently support the conclusion that it is beneficial” (Bennett 2003).

I want to be careful here, because I do not want to make such a strong claim that we never experience humor when we are alone. On the other hand, while I can experience humor when alone, it is either still directed at others or it is experienced very differently than humor with others. What I mean is that it often lacks expression, making the experience of humor weaker. This difference in experience is supported by research that shows we are less likely to express humor when alone. While humor can be experienced alone, it is more often (and primarily) an intersubjective experience (Barber 2015). We are less likely to laugh if there are no others around. Some have argued that this is because humor acts as “a form of communication—[which] could be positive (for example ‘breaking the ice’ in a difficult and very serious situation, relaxing the atmosphere) or negative (involuntary or intended sarcasm, mockery, demonstration of superiority)” (Stefanova 2012, p. 67). We use humor to convey information about ourselves and our opinions of others in a relatively safe way. As a form of communication, humor is experienced in a weaker state if there is no one else around to continue the humor-dialogue.

For instance, I can feel happy or sad in relation to merely myself or something happening in the world, but intersubjective emotions, like empathy, require there to be someone else with whom I empathize. The same goes for sympathy, guilt, love, and so on.

Whether we are talking about superiority theory, incongruity theory, or relief theory, others are an important part of humor. For incongruity, it is others that tell us jokes or humorous stories, creating instances in which we will find incongruity. For superiority, it is over others that jokes make us feel superior.

As Wu et al. say, “the lack of a sense of humor might be one of the reasons that people with autism frustrated in social interaction” (Wu et al. 2016, p. 25). Though, it is worth noting that individuals with autism responded to nonsense jokes a lot more normally than incongruity jokes (Wu et al. 2016, p. 26). The authors note that this difficulty partly stems from “deficits in theory of mind” (Wu et al. 2016, p. 290), or a difficulty understanding the mental states of others, such as the intentions of their jokes.

I could also talk here about the difference between sympathy and a feeling of oneness—or true emotional identification (Scheler 1954, p. 18). It is “the act of identifying one’s own self with that of another… it is not only the separate process of feeling in another that is unconsciously taken as one’s own, but his self (in all its basic attitudes), that is identified with one’s own self” (Scheler 1954, p. 18). As Bornemark explains it, Einsfühlung is “an act where a unity between oneself and the other is experienced. It is a rare experience where the other is identified with what is one’s own in a pre-conscious and unconditional way” (Bornemark 2014, p. 363). All of the other’s basic attitudes—all of the other’s intentions and desires, emotions and feelings, and so on—are identified with my own. In this sense, Scheler calls emotional identification a “limiting case” of emotional contagion, since the latter only involves the other’s feeling being taken as one’s own, but not identification between selves (Scheler 1954, p. 18). What he means here is that I take more than merely the other’s emotions as being associated with my own (Scheler 1954, p. 18). In emotional contagion, the other’s emotion is adopted as if it were my own. In emotional identification, the other’s entire self is involuntarily taken as being identified with my own. Emotional identification can be distinguished from sympathy due to the distance that sympathy allows between the self and other (Scheler 1954, p. 23). Emotional identification is not an emotional reaction to the other’s emotional reaction, since this would mean that my identification with the other is completely separate from the other. In sympathy, I can feel a wide variety of emotions towards others, but this doesn’t mean that I truly identify myself with them.

Scheler also argues that it is not necessary that another person be in the emotional state that I have caught (Scheler 1954, p. 15). In other words, it is not necessary that I catch the emotion from another person. Scheler explicitly notes that one can catch an emotion from objects or the environment, “such as the serenity of a spring landscape, the melancholy of a rainy day, the wretchedness of a room” (Scheler 1954, p. 15). In these examples, we adopt the emotion from the environment in the same way we catch it from others, even if we do not explicitly attribute that emotion to the landscape and we think that the emotion is entirely our own.

In his work, “Ordo Amoris”, Scheler even claims that if we can understand the ordo amoris—or, the order of love—of another person, then we understand the person (Scheler 1973, p. 100). This is because we would be able to see through the other person’s eyes and understand the way that they person values the world based on the things that he or she loves, as well as how they are being loved.

I would also argue that this applies to more than just the relationship between humor and sympathy. In general, the use of humor needs to be carefully balanced with other emotions. We don’t want our medical professionals to merely laugh off all conflicts and difficulties. Likewise, we also want medical professional to train themselves experience other emotions at the right time and place, including care, guilt, anger, and even pride. All of these emotions have an important place in the morality medical practice.