key: cord-0050397-srkgg0ll
authors: Fessell, David
title: Murmurs of Mirth: Ruling in Levity and Lightness
date: 2020-09-21
journal: J Am Coll Radiol
DOI: 10.1016/j.jacr.2020.09.016
sha: 1aaa1f7f62257cce23cb01f0f8b618deaa61900a
doc_id: 50397
cord_uid: srkgg0ll

nan

I have seen what a laugh can do. It can transform almost unbearable tears into something bearable, even hopeful.

-Bob Hope [1] As coronavirus continues to stimulate stress, many have experienced the relief humor can bring. Of course, it's not that pain and suffering are funny, but rather that levity can be a welcome coping strategy. Perhaps you're starting to think of your favorite coronavirus jokes or memes right now. As we mask up and work day and night to "rule out" lifethreatening disease and pathology, let's be sure to "rule in" at least a bit of humor and its benefits. There's good news to report on this front: humor is a skill we can cultivate and spread [1] .

It's no coincidence that humor has been described in all cultures across the globe [2] . It can bring relief, ease, and social connection. Of course, humor can be used in unhealthy or inappropriate ways, as denial or avoidance, or as a weapon. However, when used artfully, and with empathy, humor can be expansive and hopeful. This style is known as empathic humor [3] . Bring this flavor, and you'll be a source of lightness and ease-for yourself, and those around you.

Think about the last time you laughed until tears flowed. Likely you noticed an emotional shift for the better, yes? It's highly probable you were not alone, and not the only one shedding happy tears. Usually laughter occurs in the company of others [2] . It's often co-created, one person riffing off another, one joke building on the last-a generative thread that keeps on giving. Sharing these kinds of emotions also fosters a sense of belonging and brings benefits to our physical health [4] . And laughter is contagious, too-the good kind of contagion [2] .

So how can we get, and keep, the humor train rolling? Humor mentors can help, and they're always at your fingertips [1] . What fun would the Seinfeld crew-Jerry, Elaine, and George-make of coronavirus? Or Tina Fey? Give yourself a minihumor staycation as you ponder how Robin Williams might stretch a mask all over his body, voicing a cacophony of characters as he cracks us up [5] . Just how might Gilda Radner and Steven Martin spoof quarantining and social distancing? Pick your favorite generation of mirth makers-what would Carl Reiner, Carol Burnett, or Johnny Carson make of it all? No doubt they would mine the pain and find some gold. For good reason-it helps us cope.

Make it a habit-a humor habitto bring a joke, cartoon, or some empathic humor to share with colleagues, family, and perhaps even patients as appropriate. Robust research indicates the simple act of writing down three humorous things from our day helps build our humor skills and increases our well-being [5] . Looking for humor, and bringing it, is a form of active coping. But beware: there can be side effects-including resilience and hope [2] .

Like other forms of art, a cartoon or joke can bring awareness of an emotion that might not be fully conscious. Perhaps it's easier to share a cartoon and some laughs than to say, "I'm feeling really anxious and not sleeping well." By gently and playfully raising our awareness, humor can help us navigate difficult emotions, and perhaps even name them. By naming an emotion, one's brain activity shifts from the amygdala to the prefrontal cortex, where creativity, insight, and higher order thinking happen [6] . A healthy bit of separation occurs, and one is no longer "fused" with the feeling. Humor can help us name it, feel it, and laugh or cry about it. As we do so, the emotions flow through us [7] . This is a place of selfconnection and healing and fertile ground for new possibilities.

When we laugh, especially with others, it indicates a level of shared understanding and belonging. Seeing a cartoon or hearing a joke can help us realize, "Ahh, someone else feels this way. I'm not alone." Simpatico! Sharing laughs can also generate feelings of exhilaration and energyperhaps even the feeling of being a bit more in control [2] . When we laugh at a challenge or difficulty, it does not rule us. It has not beaten us. Done artfully, humor can be a gentle form of hope and empowerment.

Just as humor can bring relief and resiliency, it can also expand our perspective. By helping us see, and perhaps even momentarily try on a different perspective, a cartoon or joke can stimulate new connections both inside and outside our brain. "Humor is a kind of double vision," notes Bob Mankoff, a cartoonist and former cartoon editor of the New Yorker (personal communication). This is worlds away from the tunnel vision of "fight or flight." It's a relaxed and expansive parasympathetic state in which we can think at a high level, care deeply, and live more fully. It's well established that humor, done artfully and with empathy, can aid learning [8] . Perhaps that's another thing we can use a bit more of-and with a big dose of humor. Laughter, social connections, positive emotions, and learning-these are the elements of upward emotional spirals [4] . You just might know someone who could use one of those right now.

Although humor may stimulate some "happiness" hormones and and natural pain killers, it's definitely not a "cure-all" [2] . "It's not a substitute for medical care-or for bleach," quips Mankoff. It can, however, be an icing of ease on the unpalatable events of life. Pediatric wards know this; some use clowns to reduce stress and anxiety for kids, and for their parents too. When done well, humor in clinical settings can bring warmth and ease-for patients and staff members-and for physicians too.

So, bring some empathic humor to work, and outside of work. You'll reap the benefits, and others will too. Share the lightness and levity-we need it now more than ever. Consult with your favorite humor mentors. Bring the props and jokes, keep a humor journal-whatever works for you. By sharing laughs, you cultivate resilience-and spread hope. Sometimes the magic of humor unfolds in a spectacularly spontaneous way. But we don't have to wait for those lucky moments. It's much too important to leave to chance.

Humor as survival training for a stressed-out world: the 7 humor habits program

The psychology of humor: an integrative approach

Toward a theoretical framework for the study of humor in literature and the other arts

How positive emotions build physical health: perceived positive social connections account for the upward spiral between positive emotions and vagal tone

Laughter leaves me lighter: coping with COVID-19

Putting feelings into words: affect labeling disrupts amygdala activity in response to affective stimuli

Humor, laughter, learning, and health! A brief review

Dr Fessell is an employee