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Humour in
Emergency Work

The Australasian Journal of Disaster
and Trauma Studies
Volume : 1997-3


An Evaluation of Humour in Emergency Work


Carmen Moran and Margaret Massam, School of Social Work, University of New South Wales, Sydney, NSW 2052, Australia. Correspondence to Dr C Moran - Email: C.Moran@unsw.edu.au
Keywords: emergency work, coping, humour, communication

Carmen Moran and Margaret Massam

School of Social Work, University of New South Wales,
Sydney, NSW 2052
Australia


Abstract

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.


An Evaluation of Humour in Emergency Work


Introduction

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.


Coping and emergency workers

Alexander and Wells (1991) point out the stereotype remains of the emergency worker as someone of infinite resourcefulness who is impervious to the impact of trauma. We reject this stereotype and acknowledge the vulnerability of emergency workers. At the same time we recognise that many people survive traumatic exposures and remain in emergency work.

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.


Theories of humour

The theories of humour come from a variety of perspectives, such as linguistic, sociological, psychological, anthropological and theatrical. Haig (1986) notes there are over a hundred such theories. To narrow our task, we have taken the advice of Coser who argues the meaning of humour is to be detected primarily in the common concerns of the group (Coser, 1960). Because we are interested in emergency workers, we will focus on concerns related to the emergency environment, although we recognise that workers who use humour do not confine themselves to using it only in the work environment.

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).


Humour as cognitive reframing

Given that humour can lead to a reduction of tension and a reinterpretation or reframing of distressing events, it very neatly reflects the aims of many stress management programs, particularly cognitive-behavioural ones (Moran, 1996). Even when not incorporated as therapy, sense of humour appears to mitigate the effects of stress (Berk et al, 1988; Martin & Dobbin, 1988; Lefcourt, Davidson-Katz & Kueneman, 1990). Studies suggest that people with a high sense of humour do not experience less stress, but they are able to generate humour to cope with the stress (Martin & Lefcourt, 1983; Nevo, Keinan & Teshimovsky-Arditi, 1993; Nezu, Nezu & Blissett, 1988). The tendency to use humour to reframe events is captured in the often quoted phrase "things can't be that bad if I can still laugh", but humour may also serve more specific functions such as challenging self-defeating or harmful thoughts. In more extreme circumstances, humour may be used to protect the self by distancing the individual from the stressor (Dixon, 1980). In the emergency context circumstances may be horrible or sad, particularly on the scene, so reframing may not be as relevant as distancing.

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 physiology of humour

Many claims have been made for the health enhancing effects of humour, and in particular laughter. Although these claims sometimes exceed our knowledge of the changes brought about by laughter, the results of research are generally encouraging. Research into the health enhancing effects of humour were given a boost by the writings of Norman Cousins in which he documented his own recovery from pain and illness as a result of humorous films and a couple of hours of "belly laughter" (1979).

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, language and communication

Successful teamwork is an essential part of emergency work and requires effective communication. An emphasis on teamwork has been shown to be effective with police officers who work with body handling after a disaster (Alexander & Wells, 1991). Shimizu et al (1986) in their study of laughing as one among many emotional expressions, state that laughing is one of the most important means of communication. Although the use of jargon can have unpleasant consequences at times, it is understood that it often serves a protective function for those who use it (Coombs & Goldman, 1973, Maslach & Pines, 1979). Medical slang involves creating a sense of belonging, a unique identity, and a private means of communication. The use of slang by paramedics has been documented by Palmer (1983) Terms such as a "crispy critter" for someone who is severely and fatally burned, or a "greenie" for someone who has been dead for some time and is in various stages of decomposition have an obvious humorous component, going beyond mere technical language.

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).


Humour in the emergency context

The emergency scene can be charged with tension, with an environment reflecting incongruity in terms of the unexpected, the exaggerated and the extreme. Although not necessarily commonly displayed at the scene, there may be aggression towards those thought to be contributing to a problem or impeding rescue and recovery. As of this writing Australia has experienced a landslide at a snow resort in Thredbo, New South Wales. Due to the precarious nature of the terrain volunteer and emergency workers were called off the site on many occasions, causing confusion amongst distressed families of survivors, local inhabitants and the workers themselves. The very slow progress made towards searching for survivors and later for bodies, caused much anguish and discontent. In such a situation there is considerable scope for aggression towards emergency workers.

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.


Cautions regarding humour

Not everyone agrees that humour is healthy, whether within a stressful context or when trying to deal with problems associated with past stressors. Kubie (1971) expressed concern that humour prevents a person dealing with anxiety, believing it was more important to face the anxiety than suppress it with humour. Even if humour has a positive side, such as defusing an intense situation, it still may be regarded suspiciously, for example Robinson (1991) speculated that humour might be used to curry favour with other workers. Robinson goes on to warn that humour should not be used deliberately to shock or hurt, needs to be used prudently, and that those lacking in humour should not be seen as abnormal. We would add that whereas lack of humour may be just part of the normal variation of human characteristics, loss of humour can be a predictor of poor coping or symptomatic of other conditions such as depression.

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).


Conclusion

More research on how humour is used in the emergency context and the level of functioning of people who use it will help us better understand the role of humour in emergency work. Humour may help emergency workers manage their cognitions and stress reactions in their emergency work and thus provide conditions which facilitate performance at an emergency scene. As humour is a communication tool it may facilitate performance directly and because effective communication increases the opportunity for peer support, may also decrease anxiety indirectly. While not suggesting that the humour of emergency workers is limited to black humour, it is useful to consider a description of black humour by Janoff (1974, 303). "Black humor cannot be described as being pessimistic or simply lacking an affirmative moral voice. Rather, it lives outside these limits in a terrain of terrifying candor concerning the most extreme situations."

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 distress.


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Carmen Moran & Margaret Massam © 1997. The author assign to the Australasian Journal of Disaster and Trauma Studies at Massey University a non-exclusive licence to use this document for personal use and in courses of instruction provided that the article is used in full and this copyright statement is reproduced. The authors also grant a non-exclusive licence to Massey University to publish this document in full on the World Wide Web and for the document to be published on mirrors on the World Wide Web. Any other usage is prohibited without the express permission of the author.


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