Monday, November 15, 2010

Guest Blogger Dr. Darell on Not Being Funny in Psychotherapy

A while back, I put up a YouTube video that I thought was funny. A commenter didn't like it and felt it promoted stigma. So I took a vote, and while most people were fine with it, a number did not like it, and I took the post down. We received this note, and I thought it was substantial enough to be it's own guest post (with permission, of course).

Hi. I am a practicing psychiatrist based in New York City. I find your blog interesting, informative, and, at times, funny. Now, can you guess which entry I'd like to comment on?
Mel Brooks once said, (paraphrased), that if you slip on a banana peel and land on your butt, it's comedy. If I fall down a flight of stairs, it's tragedy.
I've had a long-term interest in humor, and a brief career as an unpaid stand-up comic in L.A. (Brief because my bombing to "killing" ratio was about 15 to one.)
With respect to my experience as a therapist, I now occasionally utilize humor in my treatment, but only extremely judiciously, once I have gotten to know my client.
I learned my lesson early. At the beginning of my residency training, during my second session with a client, I commented that perhaps he felt like Groucho Marx when Groucho said that he wouldn't want to be a member of any club with standards low enough to accept him. I sat back, feeling as if I had made the interpretation of the century, and waited for a reaction. I got one. The client stormed out of my office and never returned. My supervisor later told me that, as I suspected, I had screwed up royally.
This memory resonates with Dinah's statement that it's the recipient's reaction to a joke or a comment that counts. So know thy audience, and know thyself. You're obviously on much safer ground if you make a joke about a community or an ethnic group that you belong to. We do, however, live in an era of enhanced sensitivities and political correctness, and need to be extra careful not to anger or offend.
With respect to the Youtube audio, I, like a number of your readers, have heard other versions and have become desensitized to it. Ironically, I read about a version of it being told by a psychiatrist moonlighting as a standup comic years ago. My immediate reaction was, "Keep your day job, doc!"
Since "Psychiatry Hotline" is available to a large and varied audience, including people suffering from mental illness, I would not personally have posted it. Although it appears comparatively innocuous, I voted for it as offensive from a psychiatrist's point of view because it trivializes mental illness and is potentially hurtful to many.
Warmest regards,
Edward W. Darell, M.D.
Blog: ShrinqueRap (on Wordpad). Very soon to be updated. Please do not sue me. I registered the domain name before hearing of your blog, and my pockets are extremely shallow. (just short of being inside-out).

And while we're on the subject of humor---- a nice break before I start writing about In Treatment tonight--- Sarebear sent us a link on A Proposal to Classify Happiness as a Psychiatric Disorder.'s a joke, right?
And don't worry, Dr. Darell, we're not going to sue you, but do keep your day job.


Roy said...

Great comments, Edward. We also later found out we weren't the first "Shrink Rap." There are at least a dozen of us, so welcome to the club (forgive the painful Groucho reference).

Sarebear said...

Nice guest post, and thanks for the mention of me, too!

OH, if you have never discovered andertoons, he has some great, funny psych cartoons . . . some are awesome, some you might debate does it stigmatize, but many don't . . . so many are laugh out loud funny.

you can even get them made into shirts, I think, there's one or two I'd wear on a shirt! NO affiliation. If you see enough to debate the humor in some, of course it may need it's own post, or debate in this thread, but like I say some are just laugh out loud funny like the Freudian Pink Slip. Nothing stigmatizing there . . . and the twitter bird, having the whale dream again, heh. Of course, those who don't do twitter won't get the joke, but those who do, will . . .

Sarebear said...

Ok. I just looked through all 124, and some of them are no-stigma/neutral, fairly obvious, like the two I cite above, but then there's definitely ones that are, and then there's some that fall in between . . . some also that probably aren't, too. There's one, I think 6050, about how psychiatrists joke, that's hilarious and definitely neutral/no stigma.

Anyway, have fun looking through and making up your own minds about what you like, and what's stigmatizing and what's not. To my mind there were only about 15% that were STRONGLY stigmatizing, with a larger percentage that was mildly to moderately so. at least 30% of em fall into the neutral or nearly so camp though, and it's nice to find some psych humor like that! That's my opinion, anyway.

Retriever said...

Liked your post. it probably sounds quaint in this day and age of quickie CBT and meds checks, but I tend to think that humor is probably safe after about the second year in therapy (assuming the person is feeling a LOT better and the shrink has built up a reserve of gratitude sufficient to balance any annoyance if the joke/story inadvertently offends.

Everyone has different tastes in humor. I think the Groucho Marx remark is hilarious, and have often told it on myself.

I also think that in this PC age, we often underestimate the degree of cross cultural miscommunication and enrichment that goes on in therapy. In other words, a person may be and feel better understood by a therapist from the same ethnic, religious and political tribe as themself (and it might be less risky using humor when one has a lot culturally in common), but one also can learn a lot from someone totally different (tho humor is probably less likely to be useful, as it is more of an effort to understand each other at all).

On the other hand, when it comes to child psychiatry, I would say that humor is a prerequisite. Not to be an entertainer or a friend, but just to help ease the kid and the parents' anxiety. But, ironically, given the shortage of child psychiatrists, more and more seriously ill kids are getting their psychiatric care from foreign doctors whose native language is not English, and who don't understand American culture and values yet. It's a bit hard to use humor effectively under these circumstances.

Tho a kid I am close to with Aspergers liked one of his doctors who was a Russian trained at an Ivy, who was super smart and who was funny in a geeky way he could appreciate. But that was unusual.

Sarebear said...

One example of humor that stands out for me is when I was filling out paperwork to try to get financial consideration to reduce the double MRI bill for my hip MRI's from a year ago that was well because of the way the dr had ordered em it was ended up being on my head financially instead of being paid by ins it was a nightmare but anyway, i was having probs with the letter I needed to write so brought it to therapy to get help with it, and whilst talking about all the bills we had, and asking, so what do I write, my psychologist jokingly said, "We're screwed!". After I'd said, so far I've got, Dear U of U Medical, ok now what . . . and he said, "We're screwed!" referring to all the bills I'd just been talking about, and he said it deadpan, and I burst out laughing, it SO relieved the tension I was feeling, which was probably part of the point, or all of the point . . . . we'd also kind of run towards the end of the appt anyway, but . . . later I thought, that was risky to say, cause what if I end up feeling, hey, I AM screwed on this bill (THAT bill and the upcoming 2nd knee surgery led me to my first suicidal bout this year). Eventually they wrote 99% of the bill off, proving it woulda been a stupid reason to do that.

Anyway, the humor. It was funny, and still makes me smile, but to say something like that, you gotta KNOW your patient, and after five years, he does, or I don't think he'dve said it.

Anonymous said...

Happiness already is a psychiatric disorder. It is called "hypomania";>) (at least my version of it feels like joy and intense happiness...each of which my life could use alot more)

Alison Cummins said...

"We do, however, live in an era of enhanced sensitivities and political correctness, and need to be extra careful not to anger or offend."

What does "political correctness" mean? Courtesy? Open-mindedness? Awareness of the complexity of social status and class in a country that is supposed to be classless? Reluctance to enforce the social order through bullying and ridicule?

If that's not what you mean, what is?

If you live in a homogeneous community, it might be safe to ridicule people outside it and everyone might know the occasions it's safe to make fun of people inside it. That doesn't necessarily make it ok, it might still mean that you are a thoughtless jerk, it just means that even if you are, you won't be excluded from your community for it.

Few of us live in homogenous communities any more. When we are being thoughtless jerks we are more likely to be called on it. That's not a bad thing.

If "enhanced sensitivities" means that in the past white people could use racial slurs and other white people didn't mind - only the targeted groups did - I'm not sure it's a bad thing that white people do mind these days.

*** *** ***

Regarding use of humour by people in power when addressing people without power: yeah, you have to be careful. Patients are not in the best shape. They feel vulnerable. They are talking to someone who has their s**t together: a doctor, someone who is there to tell them how they are supposed to think.

A psychiatric patient knows they aren't thinking right. Throwing humour with multiple levels of meaning at them can feel like a challenge. The psychiatrist knows what they mean by it; now the patient has to decipher the layers of meaning and figure out what the appropriate response is. It can actually worsen the balance of power.

If you're going to use humour, you need to be sure that the patient can handle multiple levels of meaning without feeling overloaded. Manic and hypomanic patients are likely to be just fine with it.

Even something as simple as exclaiming "Ouch! That must have hurt!" instead of a solemn "Oh dear, that must have hurt" might cause the patient to think you're sounding awfully cheery and check to see if you're making fun of them.

That's not to say you shouldn't use humour. Just that the reasons it's difficult are real.

Alison Cummins said...

Oh, and I voted that the Mental Health Help Line was funny - an oldie but goodie.

Also RE racial slurs being (relatively) newly offensive to white people as well as to their targets. See also Ree-Tard and That's So Gay.

There are lots of ways to use gentle humour without singling out any group as deserving of ridicule.

Sunny CA said...

Thanks. I liked your guest posting. My psychiatrist has an excellent sense of humor and generally (when not too depressed) so do I. It has not hurt my psychotherapy at all to joke about the difficult and impossible situations I have encountered with my shrink. I think it is too bad you got such a negative reaction to the Groucho Marx joke. It is a joke I know and have always found very funny, and I would not have walked out of your office, I'd have chuckled if I was not too depressed and even if I were I'd have appreciated the comedic irony in bringing Groucho into psych therapy. I don't think my psychiatrist joked until he knew me pretty well, though he could have as far as I was concerned. Since I was afraid of him for at least a year (not his fault), it might have eased the situation for me.

Anonymous said...

The Mel Brooks line is bang on. I recall a shrink making a joke about my bipolar diagnosis after it was confirmed by a few different specialists. (2nd and 3rd opinions, after which I gave up expecting a different answer). This following years of other diagnoses that did not really fit. I was pretty devastated at the time and not ready to accept the diagnosis. The joke was a huge blow and all I could think of was that the shrink would not have found it so funny had it been one of their kids or the child of a friend. of course, I know I am not part of shrink's life but I felt the joke to be so insensitive. Time has gone by, changed shrinks, am able to accept the diagnosis and even joke about it with people close to me and yes, sometimes current shrink will say something funny in response to me when I am going high, but doesn't when I am really sick. There is a line somewhere and if you have a condition you get to make jokes about it if you want to. If you don't have it, but know someone who does, follow their lead. It is less about being PC and more about being mindful of other people around you.

Anonymous said...

I see a sourpuss for med checks. She reads questions off a paper, barely looks at me, and never smiles. (Unless you count that one time she said, "See you in six months!" as I walked out the door. She seemed really happy then.) I get the feeling she's not interested in me at all. She seems bored. Among her many certificates is one about her training in electroshock. I'm not knocking ECT: Not what I need, but I've heard that it saves lives and all. But considered with everything else I gotta say, my doc is creepy, spooky even. I keep trying, but I don't feel connected to her at all. I have doubts about how well she "gets" me. I for one would greatly appreciate having a little humor and humanity inserted into the process.

A long time ago I had a doc who did have sense of humor. Not in a jokey way, but often she had an amusing way of phrasing things. I adored her. She seemed like a real person not some automaton. Had I needed to I would gladly have trusted her with my life. Sourpuss? Not so much.

BTW I voted that I liked the hotline post. What I consider my primary diagnosis wasn't in it, and I keep trying to think what number I'd be supposed to dial.