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Emergency work can be distressful, but in recent years there has also been a growing number of publications which recognise the positive aspects experienced by emergency workers. This paper identifies humour as a coping strategy which contributes to emergency workers' adjustment to difficult, arduous and exhausting situations. We argue that humour enhances communication, facilitates cognitive reframing and social support, and has possible physical benefits. The authors believe an important delineation needs to be made between a healthy use of humour and humour that is used to mask feelings in a way that will cause later distress. Abstract
In the last two decades there has been wide discussion of the nature of stressors
experienced by emergency workers, in particular extreme stressors that occur during
what are commonly called critical incidents. There is no doubt that emergency work
can lead to distress, but in recent years there has also been a growing number of
publications which recognise there are positive aspects to emergency work (eg
Andersen, Christensen & Petersen, 1991; Hytten & Hasle 1989; Micheels 1989;
Moran & Colless, 1995). This view in no way intends to negate the often arduous,
perilous and fatiguing situations in which emergency staff work. Paralleling the study
of stressors have been studies of coping mechanisms employed by workers to reduce
their stress. Humour has been one such personal (and group) coping strategy
receiving attention as a possible positive contribution to individual adjustment. To
further address this research we intend to consider the use of humour by emergency
workers and its relationship to their short and long-term wellbeing.
Knowing what emergency workers do to cope and survive extreme incidents may help
us understand and assist those who are more at risk of traumatic reactions. Positive
coping strategies need to be discussed with caution and this is particularly the case
with humour. For example, in popular media, but also some health related journals
there has been a burgeoning view that humour can help unreservedly. On the other
hand, the term humour is seldom found in stress journals or monographs, let alone
those that deal with traumatic stress. Of course, not all theories of humour regard it
as a coping strategy, let alone an effective one. It is not surprising there are
discrepant views of humour because the phenomenon is broad and the ways to study
humour numerous.
Across many theories of humour it is accepted that humour can provide some form
of tension release, and can facilitate a reinterpretation of a given situation or event
(Koestler, 1964; Martin & Lefcourt, 1983). Tension release occurs as a type of
rebound effect following the increase in arousal that accompanies much humour, such
as during the build up of a joke. Reinterpretation occurs as a result of an incongruity
within the humour stimulus. Incongruity refers to that unexpected association of two
normally unrelated or even conflicting contexts or circumstances. Koestler (1964)
referred to this as bisociation and as a fundamental characteristic of humour.
Although incongruity might be expected to increase stress, in the humour context it
adds to the pleasure. Nerhardt (1970) showed that it was possible to increase the
proportion of persons laughing in a situation simply by introducing or increasing the
experiencing of incongruity.
A third aspect of humour theories is that humour provides a release for aggression
although there is uncertainty about whether aggression is reduced or increased by the
more overtly aggressive humour. If aggressive humour occurs in emergency work
it may be more likely to be directed at an organisation rather than an emergency
situation. Indeed, humour in most organisational contexts commonly reflects an
aggressive component at least some of the time.
Humour does not lend itself readily to definition, in part because there are various
aspects to humour. At times we may be talking about sense of humour, appreciation
of humour or generation of humour (Bizi, Keinan, & Beit-Hallahmi, 1988; Martin &
Lefcourt, 1983; O'Connell, 1969). Sense of humour is seen as a characteristic of an
individual, and in some cases is measured as a propensity to laugh at certain things
or oneself. Appreciation of humour refers to the ability to see humour in the
environment, whereas generation of humour is the tendency to make humorous
comments or act in a humorous manner in a situation. Research suggests that
generating humour is more psychologically protective than simply appreciating humour.
Overholser's 1993 study of 96 college students found that generating humour is
correlated more strongly with psychological adjustment and it has been suggested that
the element of spontaneity is a primary requirement of therapeutic humour (Kuhlman,
1988). Guiding people towards generating humour has been found to be
therapeutically beneficial (Prerost, 1989).
A compilation of amusing situations in an emergency department by Nelson (1992)
illustrates that humour helps relieve the distress of medical training and emergency
department work. Humour is not the only reframing technique used by the workers.
Taylor and Frazer (1982) found some workers involved with body recovery from a
plane crash imagined that the bodily remains were not of human beings and those
doing so showed less distress afterwards. In both humour and non-humorous
reframing, the uninformed might see these ways of dealing with extreme
circumstances as either callous or baseless. Many workers from the field, however,
recognise the functions they serve.
The physical effects of humour appear similar to those of exercise including increased
muscle tension, heart rate, respiration rate all of which are followed by a rebound
reduction or relaxation effect. The effects also extend to the immune system and
laughter can be accompanied by changes to IgA, an immune enhancer related
particularly to the respiratory system. There are speculations that laughter also
releases endorphins. Whether these effects have longer term consequences is
unclear despite numerous studies (Berk et al, 1988; Berk et al 1989; Lefcourt,
Davidson-Katz & Kueneman, 1990; Martin & Dobbin, 1988). These physical effects
may not have direct relevance to the immediate emergency context, but they indicate
that humour and laughter are considered important contributors to our wellbeing and
thus add to our contention that humour in the emergency environment deserves
serious study .
Humour can act as a communication tool as well as provide an emotional bonding.
Kuhlman (1988) describes humour among staff in a maximum security forensic unit
as an emotional language. Humour may well serve more than one function. People
may use humour to help them put negative thoughts out of mind, and also profit from
the social benefits it provides. Overholser (1992) found that students who reported
using humour to cope were also less depressed, less lonely and report higher levels
of self-esteem.
Many of the studies regarding the physiological and psychological benefits of humour
are set in a university environment. This does not negate the possibility that humour
has beneficial effects for emergency workers. These benefits may be that humour
helps provide socialisation and support, but it is likely the effects are broader.
Kuhlman (1988) notes that certain medical work environments provide little or no
sense of accomplishment for staff and therefore staff must rely on each other for this.
We can compare this with the broader emergency situation, where if the event is
particularly unpleasant and the media or other workers emphasise how devastating
it is, this may take away a sense of achievement from those who have put in effort at
the scene.
There is increasing evidence that humour can enhance creativity, problem solving and
memory. Johnson (1990) suggests using humour as an innovative method for
teaching sensitive topics such as aging, death, dying, grieving and suicide. She
proposes that humour used in educational settings increases comprehension,
enhances memory retention, and improves faculty ratings. There is no direct evidence
yet that humour has a direct performance enhancing effect in emergency work, but
emergency workers say it helps them focus on the task at hand rather than focussing
on their emotions or the awful nature of certain events (Moran, 1990).
There are circumstances peculiar to each emergency organisation and context that
will contribute to the type of humour used, if it is used at all. Pogrebin and Poole
(1988) list four types of humour noted in police work. 1. jocular aggression, 2.
audience degradation, 3. diffusion of danger or tragedy, and 4. normative
neutralisation. They suggest that jocular aggression among police officers "provides
a means by which subordinates can express dissatisfaction with superiors or with the
organisation itself" (Pogrebin & Poole, 1988, 194). A study of staff working in a
psychiatric hospital has made a similar point - that humour can be used by those in
subordinate positions to cope with feelings of aggression which cannot be expressed
(Coser, 1960).
Researching humour use in emergency contexts let alone distinguishing between
types of humour can be difficult because even in chronic situations some humour is
ephemeral. Moran (1990) asked emergency workers to describe the use of humour
in emergency work but participants had great difficulty describing what was funny
some time after the event. In all but one of 15 cases, the humour appeared to arise
spontaneously rather than as a conscious attempt at coping. In a spontaneous
situation, someone may add a funny comment or the group response becomes part
of the humour stimulus. In one example in this study, a participant reported laughter
at the sooty and startled appearance of a colleague emerging from a building, and the
group laughter then caused even more laughter. But even in this simple example, the
humour was not just a reaction to a visual stimulus or the contagion effect of laughter.
As the participant who reported this example noted, the knowledge that the colleague
was safe contributed to the tension relief that accompanied the laughter. The
participant was not able to relate any comments from this scene, but it seems
probable that at least one person would have come up with a witty comment that
would have added to the humour at the scene, or even served as a sign that it was
permissible to laugh.
A particular type of humour which applies in the critical incident situation is often called
black or gallows. Gallows humour takes its name from the genre of jokes about the
condemned man or the hopeless victim and is often generated by the victims
themselves (Freud, 1905). Although the term referred initially to a specific situation
it has come to be used for humour in chronic or ongoing situations including work
environments. It is seen to be a mechanism for coping with life in harsh settings so
that negative feelings can be developed into positive acceptance (Maier, 1989). It is
found in situations where people have to persist in working even though the nature of
the work is incongruous: "It proposes an illogical, even psychotic, response to
irresolvable dilemmas and offers a way of being sane in an insane place" (Kuhlman,
1988, 1085).
One of the debates about black humour is whether it reflects a heightened or reduced
sensitivity to circumstances. It is worth noting here that many writers regard black
humour as reflecting a grim ability to see things rather than deny them. Perhaps
people who use black humour have an even darker vision than most and as Janoff (1974)
notes, they may present this through a unique mixture of comedy and despair.
There is considerable scope for humour to act as a positive, healthy coping
strategy in emergency work. Group norms will have a strong influence on the
acceptance of humour in any context, and in the emergency context these norms
may be accompanied by implicit rules about the humour. For example,
emergency workers restrict their humour to when they are out of the range of
the public (McCarroll, 1993). Herrman (1989) in his discussion of police officers
indicates that humour, whilst a primary release for many officers, would not be
understood nor appreciated by the public. Alexander and Wells (1991) in their
study of police officers working on the Piper Alpha disaster reported that the
police officers used humour to cope with their feelings but were aware that a
joke or wisecrack quoted out of context would be adjudged tasteless and offensive.
In her investigation comparing inexperienced and experienced emergency workers
Rosenberg (1991) found that most inexperienced participants believed they would
readily share the humour of their work with family and friends. In contrast,
experienced paramedics did not think humour used at work could be shared with
family and friends because it was spontaneous, situation specific and because "other
people would not appreciate it or get the point, they would think you were sick"
(Rosenberg, 1991, 199).
There appears to be no formal organisational attitude to the appropriateness of humour, but acceptance is probably passed on informally through various aspects of the organisation, such as during training programs, group meetings and with the influence of certain personalities. This proposition is borne out by Rosenberg who found that trainees picked up occupational humour informally from more experienced emergency personnel. She quotes one participant: "It becomes easier to make a joke and see the lighter side of things - you can more easily adapt to a situation. During the training experience, riding with other paramedics, humor is handed on like a trait: it is learned" (Rosenberg, 1991, 199).
Rosenberg (1991) also lists how humour use among paramedic trainees was
influenced by five factors: 1. the subject's previous experience in critical care, 2.
previous use of humour as a coping strategy, 3. clinical exposure during training, 4.
the humour environment and models present in current clinical placement, and 5. the
subject's own receptivity to acknowledging and participating in the humour present in
the emergency environment.
Use of humour may be predicted by experience, exposure and acceptance of humour
in the emergency context, as well as a personal appreciation or tendency to use
humour. Thompson and Solomon (1991) in their work with police volunteers found
that they were an extroverted, well-knit team with many jokes and friendly banter
between the officers. As Coser (1960) notes, humour can be a means of socialisation,
including the affirmation of common values, of teaching and learning, of asking for and
giving support. Humour, therefore, can be both a means and a consequence of
socialisation in the emergency context.
We must then wonder what happens if people work in an environment with little use
of humour. In such cases use will probably be determined more by individual
differences than group norms but if individuals are then using it in isolation they may
end up feeling guilty or isolated.
A cautionary note as to the efficacy of humour as a therapeutic tool is highlighted by
a number of researchers. Some studies report humour reduces distress, but there are
still concerns as to whether this effect is meaningful. Even if there are physiological
changes this does not necessarily mean the psychological impact and consequences
of humour are beneficial. In their study with students, White and Camarna (1989)
found laughter reduced physiological measures of stress but had much less effect in
reducing psychological stress. Thomson (1990) suggests that inappropriate use of
humour may create an imbalance in the therapeutic relationship and block effective
communication. Murgatroyd (1987) stresses that any use of humour in therapy
depends upon the reason for therapy. Haig (1986) believes that the overuse of
humour is a form of denial used to avoid dealing with problems and a similar stance
is taken by Mulkay (1989) who views humour as a method of inaction and withdrawal.
Joyce, a police sergeant and psychologist, has argued that police officers use humour
to hide their feelings from their companions (Joyce, 1989), which could reflect a social
concern rather than concern for the feelings themselves. This generating of humour
may be more of a "macho" coping mechanism which would equate with Thorson's and
Powell's (1993) tentative finding that males generate humour more than females.
They suggest people who frequently generate humour may have a need for
dominance as McCarroll notes with examples of supervisors laughing at subordinates
(1993). Conversely it may be a mechanism to move away from a "macho" attitude as
proposed by Kuhlman (1988) in his discussion of gallows humour. Of course,
generating humour in the emergency context may be influenced by factors different
from those in other contexts. Kuhlman notes that humour is essential to survival in
a maximum security unit, and humour is used in an attempt to have a good time so
that working is not so depressing and staff play with the patients as much as work with
them. Steele, an ambulance worker, has also argued against the view of "macho",
observing that humour frequently was used to prevent intense feelings overwhelming
a worker: "crying does not seem to help us do (our job) better whereas laughter does"
(Steele, 1989, 488).
As Mitchell has noted, an excessive use of humour can be a tell-tale sign of distress
(Mitchell, 1988). Humour may also be inappropriate in certain situations. Rosenberg
(1991, 208) listed these as: 1. when humour is used without regard to the situation,
timing or individuals present 2. when it becomes annoying and tiresome 3. when
humour interferes with job performance and 4. when there is an over-reliance on
humour for stress relief, excluding other strategies. The second point is particularly
relevant in an emergency group context, where the person who uses humour badly
not only fails to relieve stress but becomes a source of stress to others. Overholser
(1992, 803) calls this overuse of humour "the Uncle Joe syndrome" which causes a
person to lose their social attractiveness. Davidhizar and Bowen (1992) have
emphasised the importance of the timing and context of humour in the nursing setting.
Others' reactions may not be the only consideration as McCarroll has noted, some
people might be frightened by their own humour thinking they have gone too far over
the edge (McCarroll, 1993).
Those who use humour in emergency work may be signalling to others they recognise
the horrors of their tasks. It is necessary to investigate whether humour in emergency
work is a general cognitive style that affects the way information is processed or a
coping strategy to deal with the specific difficulties of the work. For the use of humour
to be truly therapeutic, an important delineation needs to be made between a healthy
use of humour and humour that is used to mask feelings in a way that will cause later
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