How humour can help – or hurt – your heart disease recovery

by Carolyn Thomas  ♥ @HeartSisters

“My hubby is stuck with me for another 15 years as long as I keep following doctor’s orders.”

“I told my family that I now had a pig valve in my heart – but I was disappointed when the doctor told me I couldn’t keep the bacon.”

“I am determined to outlive my husband – because I want to clean out his garage!”

Heart patients often use humour like this to distract themselves from the high levels of stress and fear often associated with a life-altering diagnosis like heart disease – such as upcoming surgery, diagnostic tests, or even the ongoing awareness of significantly increased risk of future cardiac events. So reports Nicholas Lockwood, whose research focused on how heart patients use humour to help them cope with such a frightening condition – but ended up showing some surprising results. 

Nicholas is not just your average garden-variety researcher. Here’s how he explained his personal experience to me recently:

“My mother’s own heart attack a few years ago was the primary attraction to this thesis subject. Aside from the prescribed medical treatments, my mother’s use of humour about her condition has comforted family members, fellow patients, her cardiologist, and most importantly, herself.

Nicholas said he was also interested to discover that this phenomenon was not unique to just his mother.  After her cardiac event, he joined the organization called Mended Hearts in Montana, and his observations of other heart patients there led him to choose humour in enhancing recovery for his University of Montana graduate thesis.

He knew that research already suggests that humour has a wide range of health benefits. These benefits tend to lie within three interrelated main categories:

• physiological
• psychological
•  social

We know, for example, that humour may increase the pain tolerance of a patient (physiological), which then in turn can influence the attitude of the patient (psychological).

1.  Why are heart patients using humour?

2.  What types of humour can potentially enhance recovery and relationships with others?

He interviewed members of both Mended Hearts and WomenHeart: The National Coalition For Women With Heart Disease who volunteered for his study.

His findings show that self-oriented humour (used to alleviate negative affective states – e.g. “Saturday has a morning?”) can indeed benefit a heart patient’s psychological and social health.

But other-oriented humour (used to distance the patient from companions – e.g. “After I die, you’ll be glad to have the remote control all to yourself!”) seem to negatively predict health.

The self-oriented antidotal function of humour allows the patient to escape the role of the patient (Scholl & Ragan, 2003), so the patient no longer identifies as a victim of the disease, but instead identifies as a “normal” healthy individual.

Additionally, antidotal humour functions as a coping mechanism, associated with reducing stress, tension, and instilling relief to an overwhelming situation.

But when humour disturbs the relationship between the patient and their companions, the patient suffers a psychological and social health decline.

The explanation of emotional labour in this thesis is particularly compelling.

Originally identified by researchers in 1983, this concept is described as the suppression of feelings to provide a welcoming outward appearance.  (Sound familiar, heart sisters?) This is widely experienced by heart patients who tell me they often feel compelled to put on their best ‘game face’ so as not to worry their families or friends.

When patients exhibit this emotional labour, explains Nicholas, the outward expression of emotion is not always genuinely felt – even though this outward expression serves to make other people feel comfortable.

And it’s not limited only to patients. For example, previous research has found that cardiac rehabilitation nurses exhibit emotional labour when speaking to their heart patients (Barrett et al, 2005). Nurses note that they outwardly express care and compassion while they are internally focused on the more instrumental tasks at hand. This emotional dissonance can evoke psychological stress.

And when patients exhibit this emotional labour (meaning that they feel one way, but act another), this can result in more stress, frustration, and even impaired health.

Patients may feel the need to put on a happy face when in fact they actually feel psychologically distressed about their cardiac condition. Nicholas explains:

“This masking of genuine emotions not only increases psychological stress, but it can decrease relationship satisfaction. Whether a person uses humour to entertain their companion, start a conversation, or even enhance their likability, heart patients can be attempting to express a positive, pro-social emotion which is not genuinely felt.”

Hiding this psychological distress can have far-reaching negative outcomes, he adds.  For example, heart patients who perceive poor health can experience grief and depression much like those suffering from bereavement. In fact, grieving widows and heart patients have been found to share similar negative psychological impacts including fear, anxiety, loneliness, and anger (The American Heart Association, 2010).

“The most surprising finding is that not all humour is created equal. The effects of negative humour appear to be more potent than positive humour. As such, it could take five positive humorous messages to counteract the health effects of one negative humour message.

“So humour can possibly harm you more than help you if not used in a positive manner.”

Nicholas also found that the introduction of taboo topics through humour might be one possible explanation as to why pro-social humour in heart patients can negatively predict relationship satisfaction. Other researchers had previously found that topics become taboo when partners perceive they can harm the relationship, and are typically avoided because they are seen as risky, inefficient, or futile for the relationship.

But a cardiovascular event is a compelling reason to introduce conversations about taboo topics such as fears, death, and the state of the relationship itself. Humour can serve to introduce difficult topics, but re-introducing topics that have become more serious are not related to positive relationship outcomes. In fact, humour has been found to be inappropriate when it involves discussion about medical diagnoses, treatment procedures, and illness outcomes.

So humour can function as a social lubricant to introduce taboo topics, which Nicholas explains are, by their very presence, negative weights upon relationship satisfaction.

Heart patients clearly use humour to fulfill multiple functions, he adds – not all of which are necessarily positive.

In the context of recovery following a cardiac event, for example, patients use humour:

• to cope with the medical event
• to socialize with their companion
• to distance themselves from their companion

For instance, a patient joking about funeral arrangements, the medical procedure, or his/her companion’s lifestyle following the patient’s death, negatively predicted relationship satisfaction, which also negatively predicted health.

You can read Nicholas Lockwood’s entire thesis entitled “The Heart of the Matter: The Functional and Relational Effects of Humor for Cardiovascular Patients”.  Or find out more information about the organizations Mended Hearts and WomenHeart: The National Coalition for Women With Heart Disease.

See also:

• It’s Hard to Feel Like a Victim When You’re Laughing 
• Women Laugh Their Way to Better Heart Health