Banter!

The phrase ‘laughter is the best medicine’ is a common one and something I believe in strongly. I use humour a lot in my work, on social media, on my courses, and in my life in general. But unfortunately, humour is generally lacking in many aspects of healthcare including physiotherapy and when it is used it is often criticised by some uptight pearl clutching clinicians and academics who think it’s unprofessional.

I think humour is an essential yet poorly used ingredient within all healthcare, including physiotherapy, and I believe if more physios had better ‘banter’ and were encouraged to use it more, we would see improvements not only in patient outcomes but also in our profession as a whole.

The power of laughter as a medicine has been known throughout the ages with one of the first references to it being found in the Old Testament in Proverbs 17;22

A merry heart is like a medicine, but a broken spirit dries the bones

There is quite a lot of science behind laughter being a medicine with some research showing it can stimulate multiple physiological systems that can decrease levels of stress hormones such as cortisol, and increase the production of rewarding hormones such as dopamine (ref).

Laugh away the pain!

Laughter has also been shown to be an anti-depressant (ref) lower blood pressure (ref) and even have anti-inflammatory properties (ref). Laughter can also be a bloody good painkiller (ref). In this study, researchers test subjects pain thresholds and then exposed them to either a control or a laugh-inducing test, and retest pain thresholds afterwards.

Because laughter is a social activity they tested laughing in both group and isolated settings, and found that all the participants’ ability to tolerate pain jumped significantly after laughing but laughing with someone else is best. On average, watching about 15 minutes of comedy increased pain thresholds by around 10%, with those laughing alone having slightly smaller increases than those laughing in groups.

The theory behind laughing as a pain killer is that the long series of exhalations that accompany it create a physical stimulus of the abdominal muscles that in turn trigger the central nervous system to release Endorphins usually released during physical activity, proving that a good ‘belly laugh’ really is good for your health.

This research has also been reproduced using colour PET scans showing laughter triggers the endogenous opioid receptors in the frontal cortex of the brain just as exercise does (ref).

Now physios often try to reduce pain in their patients sometimes using some questionable and usually ineffective treatments. The common justification for these silly treatments is that by reducing pain it can open the ‘window of opportunity’ allowing patients to move better, and I have discussed my thoughts on this before.

Whenever I hear a physio saying they use a treatment because it opens a window of opportunity, I have to fight back the very strong and very impulsive urge of shouting ‘SO WHAT…’

Many things reduce pain a little bit, for a short period of time, such as swearing, wearing woolly underpants, and now laughing. For me reducing pain although nice is often not necessary for many that I see, the bigger issue is do patients understand their pain, do they have a strategy to deal with it themselves, and can they tolerate it?

More physios and healthcare professionals need to realise that reducing pain isn’t the only way to measure success. The sooner more physios move away from constantly trying to reduce or remove pain in those that they see the better. Personally, I feel more physios need to shift their focus to helping patients develop resilience and tolerance to pain, not removing it.

Laugh away the arguments!

But before I go completely off-piste again taking about physios acting like bandages or hot packs, let’s get back to the topic at hand, laughter as a medicine.

Not only can humour help us physiologically it can also help us psychologically. Laughing has been shown to help develop social bonds (ref) and learn better (ref), and it is these two key properties I think we could use humour more effectively.

We have all at some time or other been in a disagreement with a friend, a colleague or been involved in an online disagreement, me more than most. How these situations get handled is very different but one way I find useful is to try and inject a little humour and levity into the disagreement to chill everyone out, me included.

If more of the social media flame wars had a little more banter, a bit more leg pulling, a touch of piss-taking, I’m sure we would all get along better, tolerate our differences more, and actually learn more from each other.

Humour in disagreements can break the tension in a way that doesn’t threaten anybody’s position and can create more open communication. Humour can also put everyone on a more even playing field and help break down the many hierarchical barriers that still exist in our profession that can limit open discussion.

I disagree with many, many people from peers to Phd’s and I have had many ‘blow ups’ with them all, both face to face and behind the keyboard. Over the years I have learnt that some humour, satire, and irony can and does build bridges with most, it can make criticism tolerable, the disagreeable agreeable.

I know this first hand, because when someone is criticising me, which tends to occur a lot these days, if they do it with some humour and some piss taking, I acknowledge and accept it better, and I am more likely listen to them more.

Learning from my own experiences I use humour as much as possible to cross the divide of a difference of opinion. But, I have learnt that this is not always easy to do and not everyone responds well to it, in fact, some can react quite adversely to it. As soon as I notice the other party has no interest in acknowledging or engaging in some banter or feels it is inappropriate, childish, or even worse offensive I often find I am not going to gain much more from continuing the discussion and tend to leave it there!

I find I often learn a lot from those I disagree with, but who I can also laugh with. People like Greg Lehman, Sandy Hilton, Sarah Haag, Liz Prokopowicz, Tom Goom, Ben Cormack, Jason Silvernail, Scot Morrison etc… all these individuals often challenge my thinking yet often do it with a touch of humour, which is surprising seeing as most of them are Americans!!! (that’s a joke BTW)

In my experience, if you want to challenge someone’s opinion or thinking, do it with some humour, there is nothing like a bit of banter to disarm someone’s cognitive defences. Evidence also suggests that humour can boost others perceptions of competence and status, making funny people appear knowledgeable and influential (ref).

Humour also gets people to listen, helping to communicate messages and is a powerful tool that many successful leaders use to enhance group cohesiveness and organisational culture (ref). Some research also suggests the more fun we have at work the more productive we are, and the less likely we are to suffer burn-out (ref).

Dangers of laughing?

There are, however, some pitfalls with using humour both personally and professionally. One of the most common ones I see is ‘spotlighting’ which is the focusing or directing of the humour at the expense of one person.

This kind of humour works well for stand up comedians, but not so much in our discussions or disagreements. Ok some leg pulling and a bit of micky taking can be fine, but you do need to have a good relationship with the person first before you can do this and ensure that they recognise it as friendly banter and not snide snarky sarcasm.

I do however find spotlighting yourself a good way to use humour. Self-deprecating humour, making yourself the butt of the joke tends to be a good way to break the tension and disarm aggressors in many disagreements, but yet again, some don’t appreciate this or find it immature, and these are most definitely the gold plated fuck knuckles I tend not to have anything to with any further.

Another pitfall of humour is that some are just really bad at it. Really, really bad at it. There is nothing worse than having to endure an embarrassing head in the hands moment when someone is trying to be funny but failing desperately. Being funny is a skill, and does take practice but there is also a natural ability to it and this is easier for some than others for many reasons.

The most naturally funny people I know are often the most intelligent people I know, and research supports this (ref). Studies have found that those who are good at ‘dark humour’ have higher IQ’s than their less funny peers, due to it taking more cognitive and emotional ability to process and produce humour.

My good mate Erik Meira who is a moderately funny guy (and an American again) discusses in one of his blogs how humour is also closely linked with critical thinking ability (ref).

So considering these points it does surprise me that I tend to find those who have the least humour and who are the worst in using it, or tolerating it, are often the so-called intelligent academics and expert manual therapy teachers! I guess this goes to prove the age-old truth that education is easy, comedy is hard.

That’s a wrap!

So there you go, my light-hearted look into the world of humour, banter, jest, piss taking in physiotherapy and healthcare. Of course, there is a time and place for humour and not all situations can be or should be approached with jokes or japes.

However, I think humour needs to be used more in physio despite many thinking otherwise. I can not count the number of times I have found humour has helped me connect with a patient, developed some trust and rapport that I wouldn’t have been able to achieve any other way.

One recent example was a gentleman I was seeing a few weeks ago with some hip OA who was telling me that one of his biggest problems was that he couldn’t get cross his legs anymore when he wanted to tie his shoelaces. I said that it must be terrible not being able to get his leg over, which he found funny but then went on to tell me that he was having difficulty getting his ‘leg over’ with his partner but didn’t feel like he could mention it. Without a bit of humour, I don’t think I would have got this information from him and been able to help him with some more ‘functional’ bedroom leg over exercise.

So in summary, not only do I think humour can help us clinically, I think it can help us get along, learn, and tolerate each other better. We don’t all have to agree, in fact, I couldn’t think of anything worse if we did, and we don’t all have to be best of friends, but this doesn’t mean we can’t try and have a laugh as we are disagreeing and arguing the toss over the many things we like to argue over. So please don’t stop disagreeing just try to up your banter a bit when you do. 

As always thanks for reading
Adam