What to Make of Laughter at Illness or Disability?

[smallcleanrat]

I've been musing over my collective academic experience taking courses, TAing, and attending seminars which concern various neurological, neurodevelopmental or psychological disorders. I have often noticed a great deal of laughter when videos of patient cases are presented. I find this unsettling, but have never heard a professor or presenter comment on this.

Examples:

• A man with brain damage and severe memory impairment as a result of a viral infection. Apparently, the fact that he kept repeating himself to the interviewer was hilarious, despite the confused and unsettled expression on the man's face when told he had already said the same thing a few moments ago (his reaction got another laugh).
• A child with narcolepsy collapsing to the floor mid-interview.
• A child with epilepsy grimacing during a seizure.
• A teenager with autism stimming by tongue-clicking and arm-flapping.
• A man with a severe phobia of dogs reduced to trembling and tears when presented with a 3-month old puppy as part of exposure therapy.
• A woman with an odd gait due to traumatic brain injury.
• A woman with schizophrenia speaking incoherently (comprehensible words, incomprehensible sentences) in response to an interviewer's questions.

I could go on, but I think this gives the gist. I know there are people living with debilitating conditions who find the humor in them, and are able to laugh and joke about it. But that seems quite different from having other people laugh at you. And in many of these conditions, the person is cognitively compromised, which somehow makes the laughter seem even more inappropriate to me. Some people's lives are severely affected by these conditions. Some end up in an early grave. What's so funny?

I have noticed that this seems to happen more with undergrads (often pre-meds) than with grad students (often interested in research careers in the biomedical sciences), and more with grad students than with full-fledged professionals in the field (clinicians and researchers). Although, I did know a post-doc who, when discussing a research program attempting to identify risk factors for PTSD, said, "I hope this works out. Then we can finally weed the candy-asses out of the military."

Is it immaturity? A nervous response to seeing a person in distress? A lack of empathy or sensitivity? Or something completely harmless and nothing to worry about?

I wonder if this happens when the illness in question is not related to brain or behavior. Do people laugh at heart disease patients collapsing? Do they laugh at conditions causing incontinence or vomiting or diarrhea (often a source of crude comedy in entertainment media)? Would they laugh at the puffy face of someone with kidney dysfunction? Or the way a person with an amputated limb has to adapt their movements to perform daily tasks? I know there are people who do laugh, but I would hope they are not future medical practitioners or anyone else who may have a hand in how patients are treated.

Does anyone here have related thoughts or experiences?

[marshwiggle]

I've been musing over my collective academic experience taking courses, TAing, and attending seminars which concern various neurological, neurodevelopmental or psychological disorders. I have often noticed a great deal of laughter when videos of patient cases are presented. I find this unsettling, but have never heard a professor or presenter comment on this.





Does anyone here have related thoughts or experiences?

Just to clarify; this was laughter by people watching videos of the patients in question, not laughing in the presence of those patients. Is that correct? That's an important distinction.

[smallcleanrat]

I've been musing over my collective academic experience taking courses, TAing, and attending seminars which concern various neurological, neurodevelopmental or psychological disorders. I have often noticed a great deal of laughter when videos of patient cases are presented. I find this unsettling, but have never heard a professor or presenter comment on this.





Does anyone here have related thoughts or experiences?

Just to clarify; this was laughter by people watching videos of the patients in question, not laughing in the presence of those patients. Is that correct? That's an important distinction.

Yes; watching videos. When patients are actually present, people do have the decency to keep quiet.

[Wahoo Redux]

Many years ago when I was still in college I got a summer job working for a sheriff's department.  I didn't do the hard policing but I got a pretty good luck at the working conditions of police.  I appreciated police officers after that summer.

One of the first things I noticed was the terrible dark humor of cops.  These were men and women who honestly cared and helped the public and would literally put their lives on the line or deal with the terrible effects of high speed traffic accidents, brawls, domestic disturbances, etc.  Laughter and dark humor are release mechanisms.  They are methods of coping and distancing oneself from situations that would absolutely plunge one into rage or despair or horror. 

As long as the care is given, I wouldn't worry too much about it.  Unprofessional and inappropriate maybe, but humans were not initially designed to be professional.

[Puget]

Its probably some combination of the factors you list, though I'd hope it is mostly not knowing what to do with their own discomfort. What bothers me most is your statement that the instructors never addressed this-- if this was to happen in one of my classes, I would immediately stop the video and have a discussion with them about it.

I do cover various developmental disabilities and psychopathology in my courses and can't say I've ever had this happen though. Our students tend to be very cognizant of issues around neurodiversity and mental health stigma. So you may just have a different type of student there that needs some more education about how to handle these things appropriately and professionally. Especially pre-med students!

[mamselle]

I recognize that laughter can be a release for anxiety, etc., but it's also a values judgement....per one of my teachers, who wrote in c. 1970 about M. Ficino's collection of ribald jokes as indicative of societal norms in terms of negative or exceptional evidence....the underlying contrast or cognitive dissonance causing the sense of humor reflected a reversal of "what ought to be"....basically a sign of unwillingness to accept abnormal actions or ideas as acceptable.

So, no....I would use the first instance in which laughter erupted as a teaching moment.

I'd stop the film, wait for quiet, and then calmly say something like, "I realize this scene may be difficult or embarrassing to watch, but this is the life, or some of the conditions of life, for another human being who may be suffering, in pain, or already aware they are going to always be this way, are dying, or are terminally ill.

"Your mercy and your awareness of their humanity despite apparent otherness can be an important part of their healing, whether they ever "get well," or get better...or not. I understand that tension may be relieved by an occasional moment of gallows humor, but you will never know if the child's parent is just behind you to ask a question, or their spouse is trying hard to understand what their life together will look like from now on...or if the patient themselves is being wheeled around behind you for an X-ray.

"You don't want to cultivate a climate of mockery for the sake of your own morale, either.

"So, let's return to this film and have a little more respect. That stuttering, slobbering person could someday be you, or a loved one. Or they may be alone in the world and are only holding on by a thread of self-respect. Always think of them in those terms."

M.

(Posted just after Puget, with whom I agree.)

[apl68]

I strongly agree with mamselle and puget about the need to deal with the issue.

While it would be comforting to put this sort of thing down mainly to nervousness and immaturity, unfortunately the huge popularity of point-and-laugh videos online suggests that there's an awful lot of lack of empathy/sensitivity out there.

[hungry_ghost]

A request for clarification: when you've noticed this, are you the instructor of record, or a TA, or a student or audience member? Do you have the authority to stop the presentation and comment?
What you describe is disturbing behavior. It shows lack of empathy. The idea that such people might someday become MDs is terrifying. (but, a lot of pre-meds are sort of terrifying).

You asked about similar experiences. I teach a course in which we read material from another era that makes mocking, belittling comments about women, including joking about violence against women and rape. In the material we read, such attitudes are seen as normal and not wrong. My students are disgusted. They acknowledge that there are people even today who might make similar comments and find them humorous, but they see it as wrong. The similarity is in the original material we're reading and its mockery of human suffering, not in my students' reactions.

Which brings me to my point: I wonder how students would react to a video of people laughing at someone with a neurological disability, or even a video of others watching a video of such and laughing at it?
Somehow I imagine the response would be quite different.

[kaysixteen]

Welcome to 2020 America, where we've a president who publicly mocked the disabled.

[mahagonny]

Welcome to 2020 America, where we've a president who publicly mocked the disabled.

Yeah, imagine what it takes to 'handle' bone spurs. But there are comedians who've been doing this for some time. There was a shift at some point. The old school comedians considered it part of their job to make you like them. No more. Gilbert Gottfried had a routine about Groucho Marx talking with Dick Caveat after having a stroke. Then there was a guy who said about Katharine Hepburn 'you gotta take dramamine to watch that chick work.'

Many years ago when I was still in college I got a summer job working for a sheriff's department.  I didn't do the hard policing but I got a pretty good luck at the working conditions of police.  I appreciated police officers after that summer.

One of the first things I noticed was the terrible dark humor of cops.  These were men and women who honestly cared and helped the public and would literally put their lives on the line or deal with the terrible effects of high speed traffic accidents, brawls, domestic disturbances, etc.  Laughter and dark humor are release mechanisms.  They are methods of coping and distancing oneself from situations that would absolutely plunge one into rage or despair or horror. 

As long as the care is given, I wouldn't worry too much about it.  Unprofessional and inappropriate maybe, but humans were not initially designed to be professional.

Yet this is true too. A friend of mine was a health care professional who worked with things like conjoined twins who were about to be surgically treated, and they told sick jokes. But she did a job I couldn't do, God bless her.

[fishbrains]

I would go with Mamselle's approach. I remember our high school class getting a similar speech when we laughed at the gruesome driver's education videos they use to show back in the 80's.

Sometimes being suddenly confronted with difficult images evokes oddball responses from people--especially unseasoned people. I don't think it means you have a bunch of sociopaths in the room. 

[Myword]

This is emotional immaturity and unacceptable insensitivity among some youth even through the forties. Seniors would not laugh because of their longer life experiences and they know that this could happen to anyone. There but through the Grace of God go I. They have probably suffered or know someone who did. If you have never had surgery or major illness at all, some find pleasure in others misfortunes and others do not know how to react. They want to break the stressful "ice" and heard that humor helps relax tension. But the thing is that humor at the wrong time and place is hurtful and stupid. I have seen this myself face to face many many times. A cardiologist laughed at a comment I made. Not funny! A girl laughed when told her I broke my tooth. A colleague laughed loudly when I told him that a neighbor was killed by a bus. A real riot. Another laughed when her father said he had hearing loss! Rude to the extreme and they don't know it--or care. Then again some people will literally laugh at anything. The xerox machine isn't working. Big laugh. Don't know how to respond to bad news. So it isn't just med students. I think it is stupid idiocy.

Black humor is very popular throughout the culture, maybe thats a reason. Movies, TV, Halloween, digs at males, etc. Used to be called sick humor and was considered very weird. Now it is the prevalent form of humor.

[sonoamused]

Fishbrains hit it on the head when he said  - people react oddly when they see difficult images; but that doesn't mean that they will react that way in person at all.   

For example:  I was working at a busy research library when I had a student approach me that (I after the fact guessed and it was later confirmed) was in the middle of schizophrenic episode.  He was very frustrated nobody could understand him and he first had approached some student workers.

No one - and especially not the other students - were laughing at him.  They were too worried trying to figure out how to understand what he wanted, and what was going on - and why no one could understand each other.  Their first reaction when confronted with the unknown was concern!

[smallcleanrat]

...
Laughter and dark humor are release mechanisms.  They are methods of coping and distancing oneself from situations that would absolutely plunge one into rage or despair or horror.

I would be more inclined to think this is the explanation if it weren't the students not the actual professionals in the field who were more inclined to laugh. I have rarely noticed this reaction from the people who actually have frequent interaction with patients.

As long as the care is given, I wouldn't worry too much about it.  Unprofessional and inappropriate maybe, but humans were not initially designed to be professional.

But I wonder if the person who finds this sort of thing a source of humor is more likely to behave less professionally when it comes to patients. And a lot of dark humor isn't necessarily of the "point and laugh" (as apl68 put it) variety, directly making fun of an individual patient's affliction. A lot depends on context and the specific content of the humor. It reminds me a bit of the controversies surrounding racist jokes being swapped among police officers. Some say it's harmless tension-relieving humor and that it is no indication that any racist behavior carries over when they are doing their jobs. Others would say, "Are you sure?"

A piece of personal anecdata (an anecdatum?): In a neuropsych unit, I observed several members of staff surrounding a security monitor laughing and whooping at live footage of a woman experiencing a psychotic break being forcibly restrained. "Hah! Look at her struggle!" Before she started to struggle they had been betting on whether or not she would; when she did struggle, the ones who had bet on it let out a shout of triumph. I also observed some of these staff members mocking another patient's labored speech behind her back, and pointing and snickering at another patient who was crying hysterically. These also seemed to be the staff members most likely to speak brusquely to patients, roll their eyes at patients attempting to ask them questions, and say "hey, you!" to address a patient rather than using names.

Its probably some combination of the factors you list, though I'd hope it is mostly not knowing what to do with their own discomfort. What bothers me most is your statement that the instructors never addressed this-- if this was to happen in one of my classes, I would immediately stop the video and have a discussion with them about it.

I do cover various developmental disabilities and psychopathology in my courses and can't say I've ever had this happen though. Our students tend to be very cognizant of issues around neurodiversity and mental health stigma. So you may just have a different type of student there that needs some more education about how to handle these things appropriately and professionally. Especially pre-med students!

Puget, I'm curious. How would you address this if it did happen in one of your classes? Also, how do you suppose your students came to be cognizant of such issues? Do you think they picked it up in previous college courses, the general increase in activism for combating stigma, or some other source?

I recognize that laughter can be a release for anxiety, etc., but it's also a values judgement....per one of my teachers, who wrote in c. 1970 about M. Ficino's collection of ribald jokes as indicative of societal norms in terms of negative or exceptional evidence....the underlying contrast or cognitive dissonance causing the sense of humor reflected a reversal of "what ought to be"....basically a sign of unwillingness to accept abnormal actions or ideas as acceptable.

So, no....I would use the first instance in which laughter erupted as a teaching moment.

I'd stop the film, wait for quiet, and then calmly say something like, ...

mamselle, thanks for making this point and for your eloquent hypothetical teaching moment speech. I think you make an important to point: you never know who else is listening. Even though the subject of ridicule may not be harmed if the laughter is out of their hearing, people who do hear can still be hurt. They may have a loved one with the same condition, or they may be another patient who, already feeling vulnerable by their illness, will now have additional worries that the doctors they are meant to trust are laughing at them behind their backs.

A request for clarification: when you've noticed this, are you the instructor of record, or a TA, or a student or audience member? Do you have the authority to stop the presentation and comment?
What you describe is disturbing behavior. It shows lack of empathy. The idea that such people might someday become MDs is terrifying. (but, a lot of pre-meds are sort of terrifying).
...

I've either been TA, student, or audience member. Someday I may be the instructor with the authority to stop and comment. It might be a good idea to have some specific comments in the metaphorical back pocket just in case.

Fishbrains hit it on the head when he said  - people react oddly when they see difficult images; but that doesn't mean that they will react that way in person at all.   

For example:  I was working at a busy research library when I had a student approach me that (I after the fact guessed and it was later confirmed) was in the middle of schizophrenic episode.  He was very frustrated nobody could understand him and he first had approached some student workers.

No one - and especially not the other students - were laughing at him.  They were too worried trying to figure out how to understand what he wanted, and what was going on - and why no one could understand each other.  Their first reaction when confronted with the unknown was concern!

It's good to hear that his fellow students felt concern for him. I do know that people can react quite differently to watching something on film and seeing it in real life. But their real life reactions can also be context-dependent. Someone who would never think of laughing at a peer may still have no compunctions snickering at the homeless person standing on the sidewalk arguing with thin air. I'm seen some otherwise very compassionate people do things like this: an ill coworker deserves sympathy, but a "crazy homeless guy" is fair game.

[Puget]

Its probably some combination of the factors you list, though I'd hope it is mostly not knowing what to do with their own discomfort. What bothers me most is your statement that the instructors never addressed this-- if this was to happen in one of my classes, I would immediately stop the video and have a discussion with them about it.

I do cover various developmental disabilities and psychopathology in my courses and can't say I've ever had this happen though. Our students tend to be very cognizant of issues around neurodiversity and mental health stigma. So you may just have a different type of student there that needs some more education about how to handle these things appropriately and professionally. Especially pre-med students!

Puget, I'm curious. How would you address this if it did happen in one of your classes? Also, how do you suppose your students came to be cognizant of such issues? Do you think they picked it up in previous college courses, the general increase in activism for combating stigma, or some other source?

I like to teach by asking questions that guide students to think through issues on their own, so I would stop and ask them what just happened and why they think it happened-- what were they thinking and feeling that made some of them laugh? What did that laughter signify? I'd use their responses to guide a discussion on how laughter can be a response to a discomfort (e.g., middle school health class), and it's OK to feel those feelings (like all feelings), but they need to learn not to express them in ways that hurt or stigmatize other people. 

As to why our students tend to be good at this, I don't know that we can take that much credit-- we tend to attract and select students who already hold these values. I'd like to think we foster it further with our campus culture and teaching, but I think they learn the most from each other (we know for sure peers have the strongest influence at that age).