The humanities and the literature of the world, from the time of the ancient Greeks to the present, have been concerned with the nature of comedy and laughter. Comedy reveals people’s imperfections, gives them courage to face life, and leaves them more tolerant. Tragedy is idealistic and expresses “the pity of it,” while comedy tends to be more skeptical and expresses “the absurdity of it.”³

Early philosophers were concerned with the nature of humor in relation to the issues of good and evil and the nature of humans. Both Plato and Aristotle felt that laughter arose from enjoyment of the misfortunes of others and that comedy was an imitation of people at their worst. Other philosophers viewed laughter as a valuable asset in correcting the minor follies of society.

According to the psychoanalytic view of humor set forth by Sigmund Freud, civilization has led to repression of many basic impulses, and joking is a socially acceptable way of satisfying these repressed needs. Freud described four major types of jokes: the sexual joke, the aggressive and hostile joke, the blasphemous joke, and the skeptical joke. This joking activity serves to preserve psychic energy. Freud differentiated between wit, the comic effect, and humor. The pleasure of wit comes from an economy of inhibition; the pleasure of the comic, from an economy of thought; and the pleasure of humor, from an economy of feelings.⁴

Psychologists go beyond Freud’s interpretation to assert that humor is not simply determined by the present stimulus situation but also depends on recollections of the past and anticipation of the future. A collective process is important in generating the pleasure of humor. Humor is cognitively based and involves information-processing and problem-solving abilities. Psychologist Harvey Mindess proposed the liberation theory of humor. He views humor and laughter as the agents of psychological liberation. They free us from the constraints and restrictive forces of daily living and, in doing so, make us joyful.⁵

Anthropologists have described the use of humor within various cultures or ethnic groups. They have identified a joking relationship that is a kind of “permitted disrespect,” in which one person is required to tease or make fun of another, who is in turn required to take no offense. This kind of social relationship is widespread in different societies and provides a basis for comparative studies of social structures.⁶ One of the first cross-cultural studies of humor found that humor is the result of cultural perceptions, both individual and collective; it is a cognitive experience that must have a cultural niche and cannot occur in a vacuum.⁷ Humor is universal, but the culture, society, or ethnic group in which it occurs influences the style and content of humor and the situations in which humor is used and is considered appropriate.

Many sociological studies have explored exactly how humor is used within society. Humor is a social relationship and occurs in a social environment. Research has shown that it promotes group cohesion, initiates relationships, relieves tension during social conflict, and can be a means of expressing approval or disapproval of social action. Joking relationships within organizations serve to minimize stress and release antagonism.⁸,⁹,¹⁰

The three major theories of humor are (1) the superiority theory, (2) the incongruity theory, and (3) the release theory. The superiority theory asserts that people laugh at the inferiority, stupidity, or misfortunes of others so that they may feel superior to them. This type of laughter can be cruel and scornful or can reflect warmth and empathy. For example, people watch the foolish actions of beloved comics such as Lucille Ball or Charlie Chaplin and feel smart and dignified compared to them. Essentially, people are laughing at themselves, at their own imperfections. For the moment, they feel superior. What they are laughing at did not happen to them, but it could have. This type of comedy demonstrates that “man is durable, even though he may be weak, stupid, and undignified.”¹¹ In the superiority theory, humor can be viewed as a continuum: from laughing at no one (nonsense jokes), to laughing at a specific person or group (jokes about morons or ethnic groups), to laughing with others in general at people’s foibles (Charlie Chaplin’s humor), to laughing at oneself, the most therapeutic of all.

The incongruity theory of humor holds that a sudden shock or unexpectedness, an incongruity, ambivalence, or conflict of ideas or emotions, is necessary to produce the absurdity provoking a burst of laughter.

The relief or release theory of humor proposes that humor and laughter provide a release of tension. The relief can be cognitive—an escape from reality, from seriousness, from reason. The relief can be an emotional release of anxiety, fear, anger, or embarrassment from social conflict. It also can be a release of nervous energy and physical tension.

Many of these theories and perspectives on humor obviously overlap. Some describe the nature of humor, while others describe the function of humor. However, this diversity of perspectives shows that humor, laughter, and play are very complex phenomena that serve people in many ways. The possibilities for the study of humor are endless. The importance and influence of humor have been examined from the perspectives of anthropology, psychology, literature, sociology, linguistics, religion, and so on. More information about the influence of humor in people’s lives can be obtained from the International Society for Humor Studies. A discussion of the therapeutic value of humor and its beneficial influence on the body, mind, and spirit follows.

Modern dictionaries define humor as the quality of being laughable or comical, or as a state of mind, mood, and spirit. Our sense of humor gives us the ability to find delight and experience joy even when facing adversity. Humor, then, is a flowing energy, involving and connecting the body, mind, and spirit.

Humor can take many forms: jokes, cartoons, amusing stories, outrageous sight gags, funny songs, whimsical signs, bloopers, “daffynitions,” and physical slapstick antics. These humorous techniques stimulate the auditory, visual, or kinesthetic senses.

Therapeutic humor can be divided into three basic categories: hoping humor, coping humor, and gallows humor. Hoping humor gives the individual the courage to face challenges. Coping humor offers a release for physical and emotional tension. Gallows humor provides protection from the emotional impact of witnessing tragedy, death, and disfigurement. Sharing humor and laughter with clients and colleagues can have profound healing potential. Finding a humorous perspective on one’s problems, or experiencing the relaxing effects of laughter, can be an effective stress management technique that helps one stay healthy.

The term to heal comes from the Anglo-Saxon word haelen, which means to bring together and make whole. Bringing together the body, mind, and spirit can be healing. Humor, laughter, and the resulting emotion, mirth, unite the body, mind, and spirit. Humor is a cognitive activity engaging the mind. Laughter is a physical activity involving the body. Mirth is an emotional state that lifts the spirit.¹²

The ability to hope for something better enables human beings to cope with difficult situations. Hoping humor laughs in spite of the overwhelming circumstances.¹³ It reflects an acceptance of life with all its dichotomies, contradictions, and incongruities. This type of humor is usually warm and gentle and accepts the reality of the situation. Consider the following example of hoping humor.

Janet Henry had breast cancer. After her mastectomy, she received chemotherapy. First she lost her breast, and then she lost her hair, but Janet never lost her sense of humor. She wrote a little poem to describe her ritual as she prepared for bed each night.

With whimsy and gratitude, Janet remembered the blessings in her life despite her losses.¹⁴

Hoping humor can also be used to sustain the spirit during the shock and trauma of natural disasters. People create humor to literally laugh in the face of their loss. Both disaster victims and those who offer professional assistance use humor to provide hope and courage as they deal with the overwhelming task of recovery. As Charlie Chaplin once noted, “To truly laugh, you must be able to take your pain and play with it.”¹⁵,¹⁶,¹⁷

Sandy Ritz, a nurse from Hawaii, completed her doctoral thesis in public health on the topic of humor and disaster recovery.¹⁸ Her research showed how humor changed as the stages of recovery progressed. After the devastating floods in the Midwest during 1997, a large billboard announced: “Concerned about the weather? Call 1-800-NOAH.” After a tornado destroyed a house in Texas, the family moved across town to live with relatives. They placed a sign on their front lawn: “Gone with the wind.” After an earthquake in Los Angeles, one house that had completely collapsed had this sign in front: “House for Rent. Some assembly required.”

Nurses and other professional caregivers use hoping humor to acknowledge their own reality and to laugh in spite of the pressure and demands. For example:

Illness and trauma cause stress and suffering. They disrupt our ability to function smoothly and present many challenges. Coping describes what people do to minimize this disruption and attempt to regain some control. To cope effectively, people must change how they think and how they behave. Humor often is used as a coping tool to change perspective, release tension, and regain a sense of control. As Freud noted, “Humor has a liberating element, it is the triumph of narcissism. It is the ego’s victorious assertion of its invulnerability. It refuses to suffer the slings and arrows of reality.”⁴ Clients use coping humor to laugh about uncomfortable and embarrassing moments. Although they may not always be able to control their external reality, they can use humor to control how they perceive their situation and use their ability to laugh about it to provide some sense of empowerment,²⁰,²¹,²² as shown by the following example.

Barbara used humor to redefine her uncomfortable situation, took control of her perceptual process, and changed her attitude about the event.²³

Coping humor often expresses anxiety or frustration about things that are out of one’s control. Consider the following:

Caregivers also create humor to help release feelings of hostility or frustration created by patients or other professionals.²⁵ Sometimes nurses enjoy making jokes about physicians. For example:

Sometimes, caring for patients who are noncompliant, combative, demanding, or ungrateful can be frustrating. These patients are sometimes referred to as gomers, an acronym created by Samuel Shem, a physician writing about his internship experience. GOMER stands for Get Out of My Emergency Room. Over the years, several versions and additions to the gomer criteria list have evolved.

You know your patient is a gomer if:

Coping humor is a socially acceptable form of expressing hostility, but it should be used with caution. It can be viewed as disrespectful and hurtful if overheard by someone who either identifies with the person being laughed at or feels that this type of humor is offensive and inappropriate for health professionals. Sharing any form of humor is always a risky venture because people vary greatly in what they find funny and which topics they consider too serious to laugh about. What is funny to one person may be viewed as offensive by another.²⁶,²⁷ Exhibit 15-1 shows guidelines for appropriate use of humor.

Gallows humor often is used by professionals who work in situations that are horrifying or tragic. Every day these people cope with the reality and horror of illness, suffering, and death. In this group are doctors, nurses, police officers, newspaper journalists, social workers, hospice workers, and many others. These professionals, because of their caring and compassion, are more likely to feel the impact of the suffering they witness. Caregivers often use humor as a means of maintaining some distance from the suffering to protect themselves from empathic pain.²⁸,²⁹ Gallows humor acknowledges the disgusting or intolerable aspects of a situation and then attempts to transform it into something lighthearted and amusing. People’s ability to laugh in this type of situation provides them with a momentary release from the intensity of what might otherwise be overwhelming. They are able to maintain their balance and professional composure so that they may continue to offer their therapeutic skills.

Consider the following example: One night, in the emergency room at a county hospital, an ambulance brought in a homeless person who had been found unconscious in an alley. The man was filthy, his breath reeked of alcohol, and he had lice crawling on his body. It took two nurses more than an hour just to clean the man up enough for admission. It was difficult work, and the nurses’ senses were overwhelmed with unpleasant sights and smells. One of the nurses read the intern’s admission note on the way up in the elevator. It said, “Patient carried into emergency room by army of body lice, who were chanting, ‘Save our host. Save our host.’” The nurse laughed heartily at this amusing picture. Suddenly the struggles of the last hours were put into a humorous perspective, and she felt a lot less anger and a lot more compassion.

One study of the use of humor among hospital staff in emergency rooms and critical care units described how gallows humor was used as a coping tool:

It is important to note that gallows humor, so therapeutic for staff, may not be appreciated by clients or their families. One group of nurses hung the following sign in the visitor waiting room to reassure visitors that the staff’s use of humor actually helped them provide better care for their loved ones:

Laughter is a smile that engages the entire body. At first, the corners of the mouth turn up slightly. Then, the muscles around the eyes engage and a twinkling can be seen in the eyes. Next the person begins to make noises, ranging from controlled snickers, escaped chortles, and spontaneous giggles to ridiculous cackles, noisy hoots, and uproarious guffaws. The chest and abdominal muscles become activated. As the noises get louder, the person begins to bend the body back and forth, sometimes slapping the knees, stomping the feet on the floor, or elbowing another person nearby. As laughter reaches its peak, tears flow freely. All of this continues until the person feels so weak and exhausted that he or she must sit down or fall down. Very strange behavior!

Of course, not everyone experiences such intense laughter every time they are amused. For example, people may struggle to contain themselves if they are concerned about how others might judge this behavior; if they are concerned with maintaining a dignified image; if they feel others might be offended by their robust laughter; or if the culture places strong taboos on such behavior.

If we listen to the sound of someone laughing, we hear that the laughter has different tones and rhythms, almost as if the laughter were coming from different parts of the body. These sounds can give us a clue as to why the person is laughing. A “tee hee” laugh is often a high-pitched titter that seems to come from the top of the head. This laugh arises when a person is very nervous and tries to disguise his or her anxiety with laughter. Like the valve atop a pressure cooker, this laughter acts as a safety valve and allows the person to release a little steam before he or she explodes from built-up pressure. A “heh heh” laugh is a shallow, almost hollow sound that comes from the throat area. This laugh occurs when a person feels socially obligated to laugh at a joke that is not really considered funny. A “ha ha” laugh emanates from the heart space with a warm resonance and palpable sincerity. This laugh occurs when someone is truly amused or delighted by the humorous stimuli. It is also the kind of laugh that occurs during deep insight or peaceful, joy-filled moments, such as during meditation. A “ho ho” laugh is the deep belly laugh, the kind in which a person really begins to let go of control and surrender to the experience of deep joy and amusement. The whole body is engaged in movement, which usually continues until exhaustion. The person must put down whatever is being held and must sit down to avoid falling down. Sometimes the laughter is so deep and so prolonged that the person is left gasping for air and exhausted from the activity. After the laughter, as the person becomes quiet, a warm glow fills his or her body. The person feels lighter, almost buoyant, and his or her mind is clear of worry, fear, and anger. His or her body feels energized yet relaxed. Usually, the person is no longer aware of any pain that was previously felt. If this laughter was shared with others, the person feels a sense of connection and trust. During these moments one’s problems do not feel oppressive; one feels safe and at peace with the world. The body is listening to this emotional weather report and making subtle, or sometimes profound, changes at a molecular level. These changes have a powerful impact on the immune system and can enhance the ability to heal. As Barry Sultanoff, a holistic physician, explained: