Harsh humour: a therapeutic discourse

Abstract

Humour research in healthcare has tended to focus on rehearsed as opposed to spontaneous humour. This paper reports an empirical example of spontaneous humour in healthcare interactions: a negative case analysis from a constructivist grounded theory study. Twenty Clinical Nurse Specialist (CNS)-patient interactions and CNS pre- and postinteraction audio diaries provided the baseline data corpus. Follow-up interviews, field notes, focus groups and observations serviced theory generation with a constant comparison approach to data collection and analyses. Interpretative and illustrative frameworks incorporating humour theories, non-laughter humour support, discursive features and prosodical features of speech were applied to all data. This paper is based upon the negative case comprising a 90-minute follow-up interview and 10 hours of field note observations. The negative case - a CNS working with female drug users' sexual and reproductive health needs - contradicted emerging findings from the baseline data corpus. First, the negative case had greater awareness of humour, deliberately initiated humour and recognised parameters and exclusion zones. Second, a good patient personal was evident in the baseline data corpus but the negative case worked with 'bad' patients. Accordingly, a specific type of humour - harsh humour - was evident in the negative case. Harsh humour used areas of potential discord (e.g. drug use) as a focus of humour creation and maintenance. The deliberate initiation of harsh humour enabled the negative case and her colleagues to achieve their aims by engaging effectively with unpredictable, reluctant and recalcitrant patients. The negative case demonstrates how humour can be used to therapeutically enhance healthcare interactions with disenfranchised individuals. Humour is not superficial but integral to the accomplishment of key aspects of interactions. Health and social care workers should consider the potential for therapeutic humour to engage and maintain all patients - disenfranchised or otherwise - in healthcare interactions.

Humour in health‐care interactions: a risk worth taking

“…Humour might be a risk, but, according to patients, it is a risk worth taking . Indeed, there may even be therapeutic potential in nurses initiating humour 33 . It is therefore important to consider which nurses are more likely to initiate humour use and why.…”

“…However, a key finding – both observed and reported (by patients and CNSs) – was that patients were much more likely to initiate and reciprocate humour than the CNS . There being only one exception to this; a negative case of a CNS in sexual and reproductive health working with female drug users 33 . CNSs were generally unaware of when patients were using humour unless it was structured more like a joke (e.g.…”

Let me grow old and senile in peace: Norwegian newspaper accounts of voice and agency with dementia

“…The most important aspect here is the symmetry of humour. If the laughter is mutual it can bring some release, but if it is one-sided it can function as a therapeutic tool – joking about one's own situation may function as a protection against abuse or public ridiculing (McCreaddie 2010). This seems also to be the case here.…”

Laughter and Humor Therapy in Dialysis

“…The scientific support for using laughter therapy and the evidence to support positive effects is still equivocal . Furthermore, there are suggestions that excessive laughter may indeed be harmful with potential lung hyperinflation in chronic obstructive pulmonary disease and the disenfranchising of specific groups of patients . A further limitation to many of these studies is the nonseparation of laughter and humor, and thus a cautious approach to laughter and humor should be taken .…”