Humor and the Therapeutic Alliance

Article excerpt

The ability to understand and create humor is a high-order cognitive function that might elude some patients with mental illness. However, several studies have shown that very often, psychiatric patients are able to detect and appreciate humor.

In one study, patients with schizophrenia were no different from controls in appreciating humor by identifying funny moments in four silent slapstick comedy film clips. However, the investigators did find that the patients were less sensitive than controls in detecting humor (Psychol. Med. 2008;38:801-10). Another study found that patients with bipolar disorder were able to find humor in captionless cartoons while they were in remission (J. Nerv. Ment. Dis. 2007;195:773-5).

Given the ability of psychiatric patients to discern and appreciate humor, can it be used to help advance their treatment?

This month, CLINICAL PSYCHIATRY NEWS speaks with Dr. William B. Hunter about the value of humor on the unit. Dr. Hunter is an attending psychiatrist on the inpatient psychiatric service at Wood-hull Medical Center in Brooklyn, N.Y., and was the featured psychiatrist for an Inpatient Practice column published 2 years ago on using Suboxone (CLINICAL PSYCHIATRY NEWS, January 2007, p. 54).

Clinical Psychiatry News: Is there a place for humor in the care of psychiatric inpatients?

Dr. Hunter: As in religion, humor in medicine is a delicate matter, often better partly ignored, if not left alone altogether. However, humor also forms and defines many things human, and working with all things human is the essence of good medical practice.

CPN: Are you suggesting that psychiatrists should be prepared to kid around with patients? Is it possible that establishing this kind of rapport could prove counterproductive to treatment?

Dr. Hunter: It really depends upon the patient. In a recent essay that appeared in the health section of the New York Times (Nov. 18, 2008; p. D5), Dr. Benjamin Brody, a psychiatry intern, raised the question of whether to laugh at a patient's joke. Whether to laugh appears to be more a function of the physician's level of comfort in an emotionally charged situation than a matter of what is right or wrong. A solid foundation of self-knowledge will allow the physician an immediate grasp of the source of the patient's humor, and the physician's response--whether to laugh or not--can be supportive and therapeutic. This sort of empathy should be the essence of every physician-patient transaction, and I believe all physicians strive for such empathy.

CPN: How can humor be used to help the psychiatrist advance the treatment?

Dr. Hunter: Psychiatry (and probably medicine in general) is moving more and more toward checklists. This is certainly true of inpatient psychiatry, where checklists may account for the entirety of the psychiatric diagnostic work-up of each patient. …