laughter and tears: best medicine for stress

Laughter and Tears: Best Medicine for Stress

by Daniel 0. Dugan

Laughter and tears are natural resources that are often neglected in managing personal and professional stress. Facilitating patients’ and families’ laughter and tears is an important skill in providing emotional support, which is central to the caring role of nursing. Social stigmas, the medical model, and stressful hospital environments can distract nurses from employing these resources and other catharses in managing stress and supporting patients and families. Nurses can learn to integrate laughter and tears practically and appropriately into nursing care, thereby increasing work satisfaction and facilitating emotional healing.

“The best doctors in the world are Dr. Diet, Dr.

- Jonathan Swift Quiet, and Dr. Merryman.”

‘A person can’t stay well if she’s not happy.” The patient, an 83-year-old woman with a back injury, made this statement very

perfunctorily in a conversation about whether she would go from the hospital to a nursing home or back to a retirement living center where she had been living for seven years. She was considering the consequences of leaving her network of friends, most of whom would be unable to visit her in a nursing home.

This woman, of course, is not the first person to observe the correlation of happiness with wellness - and the corollary, the correlation of unhappiness with

Daniel A . Dugan, PhD, is director, Human Support D epa r tm e n t , E 1 Cam in o Hosp i ta I, Mountain View, CA.

illness. Popular wisdom in many cultures has pointed to the same link: “Laughter is the best medicine.” “You’ll worry yourself sick.”

This correlation has been recognized as well in the history and practice of Western medicine. Galen, the well-known Greek physician in ancient Rome, observed that depressed women are more susceptible to breast cancer, referring to the correlation between unhappiness and illness (Simonton, Simonton & Creighton, 1978). The 18th-century dictum, “The arrival of a single clown has a more healthful impact on the health of a village than that of twenty asses laden with medications,” expresses the positive aspect of the same idea, that happiness and wellness are linked.

Against this background, it is not surprising that many workshops, seminars, and writings emphasize the importance of laughter, play, and humor in the healing process. They also urge health professionals to integrate these activities into their work with patients and their relationships with one another.

Tears are important, too. “My roommate and I kept ourselves together

18 NURSING FORUM, Vol. XXIV, No. 1, 1989

all through the tests and diagnosis,” explained the 45-year-old man. “When we learned that I had AIDS, we struggled hard to control our emotions and make realistic decisions in the hospital. Then it hit us. I was lying in bed when he walked into my hospital room. I thought, ‘I’m going to lose you,’ and I started weeping. He sobbed then, too. We had our first really good cry then. For me, it was very productive. It helped us release the tremendous tension we had built up during the most devastating time in our lives. We felt our closeness again.”

Laughter and tears are important therapeutic resources for nurses in today’s hospital setting for at least three reasons. One, as mechanisms that

Tranquilizers and muscle relaxants help patients to achieve physiological relaxation. Physicians and nurses use these medicat ions extensively to facilitate physical healing and health. Laughter and tears often achieve the same beneficial results as these medicat ions, chief ly a physiological relaxation response. Actually, laughter and tears, in many instances, are preferable to tranquilizing medications in at least three respects: They do not appear on itemized hospital bills; they have no deleterious side effects; and, unlike tranquilizers -which dull sensations of discomfort, tension, and pain - laughter and tears provide a genuine discharge and consequent reduction of stressful tension.

Laughter and tears are beneficial in stress management in at least four important respects

* they release release stress- Laughter and tears often -

achieve the same beneficial results and tranquilizers and

related tension and pain, they facilitate patients’ physical healing and well-

nursing burnout.

muscle relaxants. Actually, laughter and tears, in many

being and reduce

Two, skills in instances are preferable to tranquilizing medications. . . . facilitating laughter

and tears increase the nurse’s effectiveness in providing emotional support to patients and families. Three, laughter and tears are effective humanizing antidotes to the dehumanizing effects of health care industrialization on nursing practice. These effects include sicker patient populations, shorter patient stays, leaner staffing patterns, increased nursing staff turnover rates, a growing prominence of mechanization (e.g., computerized technology), and fiscal pressures on medical and nursing practice.

Benefits of Laughter and Tears

Laughter and tears are among the most effective human resources for stress management. Stress- related disorders cause, or significantly contribute to, a high percentage of the problems that patients bring to their physicians and into hospitals (Roberts, 1 9 8 7 ) . Ac c u m u 1 ate d , “pent - up ” , s t r e s s - re 1 ate d tension is a risk factor in heart disease, diabetes, arthritis, migraine headache, and ulcerative colitis. Scheduled surgeries may be postponed because of anxious patients’ excessive tension levels.

emotional tension; * they reduce social and emotional distance between people, generating the c o m p a s s i o n a t e human contact that helps to reduce stress; * they assist i n

resolving interpersonal conflicts; and * they help to create a mental outlook oriented to constructive problem solving.

Release Emotional Tension

The biological function of laughter and tears is to effect biochemical change - to discharge the tension that accompanies the painful emotions of fear, anger, and loss. Tears and nasal secretions, which are excreted during laughter and weeping, contain hormones, steroids, and toxins that accumulate in the body during stress (Mazer, 1982). Both laughter and tears initially stimulate production of increased catecholamine levels i n the blood. This contracts arte,rial and venal musculature, which, in turn, increases heart rate and elevates blood pressure. The contraction phase (sympathetic arousal) is followed by a relaxation phase (parasympathetic response) that generates a state of systemic relaxation in the organism. In other words, people usually feel “pleasantly drained” after a good, long laugh or cry. Laughter and sobbing facilitate respiratory relaxation by provoking diaphragmatic breathing patterns, which are the opposite of the

NURSING FORUM, Vol. XXlV, No. 1, 1989 19

Emotion

Sadness

Fear

Anger

Response

Sighing Tears Words

Shaking Perspiring Laughter Words

Ranting/raving Hitting Laughter Words

Result

Healing

Relief

Release

Table 1 Therapeutic Effects of Emotions

Adapted from a lecture by Annette Goodheart, 1983.

tension-produced and tension-producing thoracic analgesic properties; that is, laughter can reduce breathing pattern associated with the fight-flight perceived pain levels, as children have shown for response. centuries. Cousins recommends laughter to hospitalized

Moreover, according to John Diamond, MD (1 979), patients experiencing pain in some circumstances. The laughter contracts the zygomaticus major muscle in the underlying physiological pathways of this effect of face (the ‘‘smile’’ muscle), which, in turn, stimulates the laughter have not yet been demonstrated. One popular thymus gland to secrete hypothes is is that laughter thymosin. The thymus, the SO- stimulates the secretion of beta- called “master gland” of the endorphines in the brain, thus immune system, regulates the affecting pain receptor sites on production of T-cell f unc t ion t o discharge the nerve cells and reducing pain

sensations. No author, it seems, has

lymphocytes. Def ic i t s in immune system functioning following stressful events, both the d w m i c a l s accompanying the represented the ana lges ic in animals and humans, have pain fu l emotions of f e a r , anger, proper t ies of c ry ing as been noted in epidemiological articulately as Dr. Cousins has and biophysical research and sadness . Tra n q u i 1 i z ed represented those of laughter. studies. Immune sys tems pat ien ts cannot laugh or cry. The common phrase, “a good

cry,” suggests what any child knows from experience, that

become depressed when people become depressed, as Galen observed (Locke , 1980). activate the tension-release weeping often helps one “feel Stress-related tension, mechanisms of laughter and better.” Like laughter, crying according to Dr. Diamond, tears can reduce perceived pain impairs the thymus gland by crying. levels and e l ic i t pleasant the way of the hypothalamus, sensations. Should hospitals which modulates the fight-fl ight response in the provide “crying sessions” (grief-support groups) and autonomic nervous system. “laughter sessions” for patients, families, and staff!

Norman Cousins (1979) maintains that laughter has It is perhaps easier to see crying as releasing painful

Laughter and tears are ca tharses , mechanisms that

p h y s i c a 1 t ens i o n a n d re b a 1 a n c e

One must experience tension to


emotional tensions than to see laughter as doing the appropriate catharsis mechanisms. same thing. The philosopher William James makes the In 1960 Eric Lindemann published his classic study point pithily: “We do not laugh because we are happy,” of the grief reactions of relatives of those who died in he says. “We are happy because we laugh.” Yet laughter the Coconut Grove fire in 1947. Since that time the may come from tension and painful emotion, not just medical community has acknowledged unresolved grief from joy or mirth. Laughter as a potential source of mental and tears are ca tharses , Laughter and tears can be and physical disorders. The

painful emot ion of sadness naturally seeks expression in

mechanisms that function to discharge the physical tension and rebalance the chemicals crying, in tears. If those tears

a re “choked off” for any accompanying the Painful burnout.” . . . Burnout is a emotions of fear, anger, and reason , the tension is not sadness. Tranquilized patients released nor a re the waste cannot laugh or cry. One must chemicals excreted in the tears.

Resultant disorders can include the spectrum of stress-related

experience tension to activate the tension-release mechanisms of laughter and crying. o r psychosomatic sympto-

As the charts (Tables 1 and 2) show, laughter and matology: fatigue, contraction and migraine headaches, weeping are emotion-specific. Laughter releases the hypertension, bruxism, low-back pa in , as thma, physical tension (“charge”) accompanying fear and increased susceptibility to colds and flu, anxiety and anger. Tears discharge the tension that accompanies depression disorders. sadness. Annette Goodheart has lectured extensively on loss,

Table 1 represents healthful functioning. Table 2 laughter, and tears. She has estimated that effectively represents the emotional and physical pathology resolving the loss of a loved pet requires a minimum of mediated by stress chemicals and cumulative tension, 20 hours of crying tears; and that the loss of a spouse, which may be caused or potentiated by non-usage of parent, child, or close friend requires 200-300 hours of

therapeutic resources f o r nurses, f o r they are antidotes to “helper

syndrome consisting of three phases: tedium, negativity, and disgust.

Emotion (becomes) Result Sadness Fear Anger

Depression Anxiety Hostility/resentment

When emotions and tension are held within, signs of stress develop:

Physical Signs Emotional Signs Mental Signs

Hypertension Muscle tension Headaches Bruxism Lower resistance Colds Cold sores Stomach acidity Stomach tightness Fatigue

Irritability Pessimism Exhaustion Less concentration Boredom Pickiness Anxiety Tunnel vision Depression Mental errors Withdrawal Forgetfulness Helplessness Insomnia Lethargy

Table 2. Non-therapeutic Effects of Withholding Emotions

Adapted from a lecture by Annette Goodheart, 1983.

NURSING FORUM, Vol. XXIV, No. 1, 1989 21

crying. If one does not cry tears during or following emotional investment in the work, either leaving the job significant losses, healing does not occur. Unresolved or doing “just enough to get by.” Psychosomatic grief consists of uncried tears. Unreleased tension, held symptoms of escalating severity often accompany these within, turns sadness into depression, both emotional stages . and physiological (immune system) depression. The Burnout therapists recommend a multi-faceted tears must flow, even years later, if the loss is to be therapeutic response to burnout, both for cure and resolved. prophylaxis. Recommendations include exercise

It is interesting to note that women in all societies programs, re laxa t ion techniques , so l i tude , cry more than men. This well-known phenomenon is intimacy, t ime-management strategies, regular based not only on cultural stereotypes (“boys don’t vaca t ions , f requent t imes of play and fun , cry”), but also on the biological fact that post-pubescent compartmentalization of work and personal life, females secrete approximately 30 times more of the and worksite support groups. hormone prolactin than do post-pubescent males. The purpose of worksite support groups is to Prolactin is instrumental in the biochemistry of both discharge emotional tension and pain with colleagues. milk and lachrymal secretions. Women cry more, at Laughter, crying, raging, and verbalizing are permissible least in part, because of higher prolactin levels. in such group meetings. Participants help each other in

relieving stress and maintaining realistic expectations of Reduce Social and Emotional Distance themselves.

Support groups are wonderful in theory. In reality, the hospital staff often does not have or does not make

to reduce social and emotional the time available to meet distance among people and regularly before or after work. groups. In social settings such Bringing more laughter into the as banquets, speakers routinely j s work itself, i n therapeutic open their presentations with ways, helps to maintain and humorous stories or statements. s o c i a l l y a c c e p t a b l e . A c k n o w - develop social support- Shared laughter “breaks the l ed 8 i n 8 e m o t i o n a 1 u p s e t o r nurturing systems.

Laughter and tears are useful in stress management

Admitting physical pa in , within re a s 0 n a b 1 e b 0 u n d a r i e s ,

- - By “therapeutic ways” of

increasing laughter, I mean its “compassionate usage.”

asking f o r emotional support can ice,” facilitating emotional contact with the audience. In health care settings, where f e e l like Confessing a Sin, a Sin Of access to emotionally weakness. supportive human contact is a major resource in stress management (Matthews-Simonton, 1984), shared laughter and tears can have the same effect, even among strangers.

Sharing emotional pain makes friends out of strangers and soulmates out of friends. Concealing or repressing emotional pain erodes closeness in relationships. When holding one’s emotional pain inside, one’s relationships with others remain or become superficial.

Laughter and tears can be therapeutic resources for nurses, for they are antidotes to “helper burnout.’’ The phenomenon of burnout in health care professions has been widely discussed (Freudenberger & Richelson, 1980; Jaffe & Scott, 1984).

Burnout is a syndrome consisting of three phases: tedium, negativity, and disgust. In the tedium stage the helper feels fatigue, boredom, and frustration with routines. In the negativity stage, the helper also feels increasingly critical of patients, colleagues, and self. In the disgust stage the helper withdraws his or her

Specifically, I mean educating staff, patients, and families to perceive laughter

as a means of releasing emotional stress; and refraining from laughter at the expense of individuals (e.g., teasing) and groups (e.g., ethnic humor).

It is therapeutic to laugh wi th but not at colleagues, patients, and families. It is therapeutic to join a patient who is “laughing out” his pain. It is not therapeutic to laugh at another’s pain before he does. Laughing at patients and families who are experiencing emotional pain is insensitive behavior that divides and distances people rather than fostering closeness. It increases stressful tension instead of reducing it. This seems to be the case whether the laughter occurs in their presence or “behind their backs.”

Resolve Interpersonal Conflicts

Laughter and tears can be effective methods of facilitating interpersonal conflict resolution. By discharging anger- and fear-generated tensions, they can


create the conditions for constructive action planning. The patient, a 69-year-old woman with rheumatoid arthritis, had been pushing the call button all morning, then trying t o engage her nurse in small talk. After several hours of this, the nurse, smiling, asked the patient, “Have you heard the story of the little boy who cried ‘wolf’?’’ The patient nodded, “Well,” said the nurse, “I have the feeling that we are in that story. And if you are in the mood to change fairy tales, I’m game.” they laughed together. Two minutes later the nurse emerged from the room with a verbal contract with her patient, and relished the reduction in calls from her patient.

Laughter and tears may be used a s “weapons” dur ing conflict a s well , of course. Laughter can convey ridicule. Tears can serve a

driving home, he burst into laughter so intense that he was forced to stop his car at the side of the road, tears streaming down his face. “He burped! I was feeling utterly dejected, alone, devoid of hope .... and he burped!” Slowly a sense that “life goes on” began to pervade him. Perhaps his problems were not so paralyzing after all . He discontinued therapy, thanking his therapist for his supreme assistance.

Role of Laughter and Tears in Emotional Support

Emotional pain carries a social stigma in American public life. Many Americans internalize this stigma as they grow into adulthood. Admitting physical pain, within reasonable boundaries, is socially acceptable. Acknowledging emotional upset or asking for emotional support can feel like confessing a sin, a sin of weakness.

Hospitals can sometimes m a n i p u l a t i v e , seem schizophrenic in their controlling intent. “ I know how y o f i s a officially sanctioned responses Such uses are non- to emotional pain. On the one in f lammatory and unsuppor t i ve therapeutic for all response t o a pa t i en t or f a m i l y hand, they are places of parties involved , treatment and healing, birthing and may increase member w h o is exper i enc ing and dying: events that turn frustration, tension, em o t io na 1 upset . and interpersonal alienation.

Affect Mental Outlook

Laughter and crying have the capacity to “clear the head” and alter mental perspective. They facilitate a transformation of feelings of helplessness and negative expectancy into feelings of motivation to make choices and solve problems. Hopelessness, in part at least, is a matter of mental perspective. Narrow mindedness or tunnel-vision restricts perception of one’s range of options. Psychosclerosis, a “hardening of the attitudes,” is a potent cause of stress-related pathology. Laughter, in particular, can alter perspective, uncover options, and help to restore a sense of motivation in the process.

The 31-one-year-old man began his weekly one-hour session with his therapist by describing his lack of motivation and his abiding conviction of hopelessness about the future. Having recently completed his lunch, the therapist burped gently as his client talked, and continued to listen. The client continued in the same vein for an hour, haunted by the therapist’s burp. While

~.

people’s lives upside down and inside out. Medical and psychiatric staff provide patient

care according to the medical model. This is the prevalent form of the physician-patient relationship in scientific medicine, according to which trained and licensed experts provide “treatments” (e.g., drugs, surgery).

Yet, intense painful emotions inevitably accompany serious physical and mental illnesses. When the tension that accompanies these emotions is not released, as we have seen, the results include stress-related organic symptomatology, emotional and social isolation, interpersonal conf l ic t s arising f rom poor communications, and diminished perspectives of perceived options for choice. All these, of course, undermine hospitals’ efforts to achieve their basic goals of healing and treatment in a cost-effective and timely fashion. So hospitals need to recognize and address the emotional pain of patients, families, and staff in healthful ways.

On the other hand, social standards and the medical model encourage patients, families, and nursing staff to repress emot iona l pain. Outs ide of acceptable boundaries (which vary according to gender, from institution to institution, and from nursing unit to

NURSING FORUM, Vol. XXlV, No. 1, 1989 23

nursing unit within individual institutions), painful emotions and their cathartic release-mechanism behaviors are sometimes perceived as a “problem” to be “treated” with drugs.

In practice, patients and their families are allowed to release their painful emotional tensions within

and accepted, not criticized, rationally evaluated, fixed, changed, or otherwise negated. Emotions are not rational. Reasoning with emotions is usually a waste of time. It often increases frustration.

Moreover, emotions are contagious by nature. Expressions of fear, anger, and sadness elicit these

acceptable (as institutionally defined) boundaries. If they become “too” upset, though, they risk eliciting escalating degrees of restraint behaviors from hospital personnel. These restraints can range from gentle counsel and warning through tranquilizing medications to leather restraints and squads of strong- armed males. The medical staff is permitted to emote within “professional” boundaries. Physicians can explode or rant and rave, nurses can cry-but not “too” much. Physicians and nurses who exceed their professional boundaries are sub.iect to

A s nurses f ind ways to develop the natural resources of laughter and tears into their work with patients and fami l ies , they will experience further benefits in stress management and emotional support. In the process, they act as role models in healthful emotional pain management, increasing the f l o w of compassion that heals and sustains human beings in t imes of trouble.

emotions and their accompanying tensions in everyone in the vicinity. Care givers may, therefore, feel their own emotional control mechanisms threatened by the catharses of pat ients and families. Resulting fears of losing emotional control give rise to helplessness , “no t knowing what to say.” When a nurse is struggling to restore his or her own emotional control , that nurse is most l ikely to make the tactical mistake of negating or trying to tranquilize the patient’s painful emotions. The nurse’s desire to maintain “professional status’’ may reinforce motivation to

social and even formal institutional sanctions. Providing emotional support to patients, families, and

one another in such a setting is a major challenge to nursing. Add the factors of time and budget restraints, paperwork, and pressures for ongoing skill development, and the challenge for nursing to provide caring to patients and families seems even more formidable.

Managing Emotional Pain

The nurse’s own style of managing emotional pain, is a key to providing the caring that has traditionally been at the core of nursing as a profession. How does the nurse “treat” his or her painful emotions?

Supportive. Supporting painful emotions promotes physical, emotional, and mental health, providing “care of the whole person,” which has been found to be a potent ingredient in healing (Lynch, 1977). Supportive emotional pain management is the essence of the practice of compassion in nursing. Allowing patients and families to laugh and weep is one of the most potent resources available to nurses in providing effective and supportive emotional care to patients, families, and one another.

Supporting painful emotions is primarily a matter of several aspects. First, accepting their reality and expressions. Painful emotions want to be acknowledged

employ emotional pain negation strategies with patients and families. A rule of supportive emotional pain management is, “Do not resist painful emotions or try to change them. Accept and acknowledge them.”

Second, conveying a genuine interest in understanding the concerns behind the painful emotions. “I know how y o u feel” is an inflammatory and unsupportive response to a patient or family member who is experiencing emotional upset. The intent, though, is valid. It is supportive, when one experiences painful emotional upset, to release it cathartically and verbally in the presence of someone who conveys a sense of understanding. Conveying one’s understanding in emotional matters is most often accomplished, though, through nonverbal communications such as eye contact, nods of the head, and appropriate touching. The most tangible evidence of such understanding is listening without interrupting, changing the subject, giving advice or pep talks. Only one who truly knows how it feels to experience and release fear, anger, and sadness knows how to listen long enough to allow another to experience some measure of release.

Third, acknowledging the validity of coping mechanisms. Patients and families have the right to “handle” their emotional pain in their own ways. Defense mechanisms, emotional controls that anesthetize sensations of emotional pain and safeguard


func t ion ing , a re activated au tomat ica l ly and unconsciously in the human psyche when ego-stability i s threatened . Denial , ration a 1 i za t i o n , project ion, avoidance, reaction-formation, and joking behaviors are examples of such are self-protective mechanisms. These mechanisms are most effective and may usually be trusted to work effectively. Caregivers may, therefore, refrain from protective strategies aiming to shield patients and families from emotional pain. Accepting the coping styles and mechanisms of patients and families, moreover, creates an atmosphere of safety in which the defenses may be lowered naturally and automatically. A rule here is “trust the self-protective wisdom of the patient’s own psyche.”

Fourth, conveying acceptance, interest, and acknow- ledgment in a natural, genuine way. Natural responses by the nurse are an important part of a repertoire of supportive emotional pain management skil ls . Withholding one’s responses (e.g., briefly listening, then nodding and leaving) is non-supportive because it leaves a patient in the powerless, vulnerable role of wondering if he or she is mentally unbalanced or even crazy. Purely “professional” responses reinforce a “powerful care giver-powerless patient” dynamic. People who need compassion need human responses. They do not need canned lines (“I hear you”), authoritative professional prescriptions for feeling better, or paternalistic replies (“We certainly are upset, aren’t we?”).

All this suggests that nurses are most effective in providing supportive emotional pain management when they facilitate emotional self-acceptance and release in

patients. By helping patients to experience, accept, and release their painful emotions, the nurse provides a more valuable service than when he or she provides tranquilizers, advice, or pep talks, attempting emotional rescue.

Unsupportive. The nurse who ignores painful emotions or “treats” them (in self and in patients and families) as “problems to be eliminated” blocks the flow of caring. Such a nurse seems uninvolved, busy, task- oriented, over-professional - in a word, “uncaring” - to patients and family members.

“You shouldn’t feel that way” is the essence of unsupportive emotional care, whether the message is conveyed verbally or nonverbally. Verbal versions of this message include reassurances (“everything will be fine”), comparisons (“others have it worse”), advice (“think of something positive”), pep talks (“get a hold of yourself’), and guilt trips (“think of your family”). Nonverbal versions of this message include pretending not to hear, busying oneself with tasks, requesting and order ing increased amoun t s of t ranqui l iz ing medications, and avoidance behaviors.

Laughter and tears are Mother Nature’s most efficacious methods of releasing the tension that accompanies the painful emotions of fear, anger, and sadness. Sharing a I0-minute laugh or a good cry is often more beneficial to and supportive of an emotionally upset patient or family member than an hour’s lecture on proper ways of feeling and coping.

Laughing and weeping are more time efficient than words a s well. Listening t o patient or family verbalizations of emot iona l pain is emotionally

Laughter

Putting Laughter and Tears to Work

. You can laugh “for no reason.” You do not need humor or a “sense of humor” in order to laugh. Laughter is not reasonable.

. Laughing with patients can be therapeutic, as long as the patient laughs first. Finding ways to l augh ou t your o w n e m o t i o n a l t ens ion i s healthful for you and can be therapeutic for your patients.

. Accumulate laughter resources on your units: cartoons, toys, games, comedy tapes and books.

Tears

. Maintain adequate supplies of facial tissue. Respond to patients’ and families’ tears with facial tissue and a few moments of permissive presence. If you don’t have the time, offer external resources (e.g., pastoral counseling workers, social workers, nursing supervisor, human support staff).

. Be ready to interpret your laughter to patients and families as a way of releasing tension, not as a sign of feeling “happy” or “indifferent.”

. Allow patients and families to laugh without asking for explanations. supportive bond.

. It is therapeutic to cry with your patients, as long as the patient cries first. Only remember that your tears are relieving your emotional pain. That is, you are experiencing your own emotional pain, not the patient’s. Crying together can create a valuable,

NURSING FORUM, Vol. XXIV, No. 1, 1989 25

supportive. Yet the deep layers of tension that accompany fear, anger, and sadness may be catharted only through laughter, raging, and weeping. Words cannot take care of those deep levels of feeling and discomfort. So, ultimately, patients are the best sources of their own emotional support.

The patient, a 76-year-old woman, was recovering from a deliberate drug-overdose incident. She had left a note for her husband, then ingested a lethal dose of Valium. For two days, since her transfer from critical care to a medical floor, she had been wincing, groaning, and writhing. She slept fitfully and lacked all appetite for food. Suddenly the sitter rushed out to the desk and yelled to the charge nurse, “She’s throwing things and trying to yank out her IV lines.” The charge nurse entered the room. “Call the doctor! Get some tranquilizers! ” screamed the sitter. The nurse approached the patient, picked up the plastic water pitcher from the floor, and handed it to her. “Here,” she said. “Throw it again.” The pitcher crashed into the wall. The nurse retrieved it, and gave her two pillows. Again the patient threw the pitcher, along with one of the pillows. She then smashed her fist into the other pillow repeatedly, cursing all the while. After 10 minutes she lay back, sighed, and began to cry. The nurse sat on her bed, took her hand, pushed back some hair that had fallen over the patient’s eyes, and supplied the tissue. “I know you’re hurting,” she said, simply. One hour later, after a nap, the patient was halfway through her lunch. “I haven’t lost my temper for 40 years,” she told the nurse, “ever since I almost killed one of my children. I know that I really need help.”

This nurse “provided” high-quality emotional support to her patient, and did so by “doing” very little. She “utilized” her patient’s own cathartic release mechanisms of raging and weeping. It is impossible for caregivers to respond in this way to the emotional pain of patients without being open to and accepting of their own emotional pain, and without being willing to place the art of caring above social stigmas and the “medical model.” Thankfully, despite many formidable obstacles in the acute care setting, i t can be and is done.

So, providing emotional support often does not mean “comforting” others, tranquilizing them, or trying to make them feel better. It does mean accepting their emotional stress, tension, pain, and their mechanisms

for coping and release. It means, in a sense, helping others to feel “bad,” to experience their painful emotions so that they may experience the benefits of the healing that comes with releasing their tensions.

Conclusion

Laughter and tears are time-effective and cost- effective resources for health-promotion. Increasing economic constraints on acute care hospital-based nursing practice call for further developing such resources.

As nurses find ways to integrate the natural resources of laughter and tears into their work with patients and families, they will experience further benefits in stress management and emotional support. In the process, they act as role models in healthful emotional pain management, increasing the flow of compassion that heals and sustains human beings in t imes of trouble. Healthful emotional pain management practices in nursing care give substance to the hope to keep hospitals human places despite social st igmas, medical models, and fiscal constraints.

References

Cousins, N. (1979). The Anatomy of an Illness. New York: Norton.

Diamond, J. (1979). Your Body Doesn’t Lie. New York: Warner.

Freudenberger, H., & Richelson, G . (1980). Burnout: The High Cost of High Achievement. New York: Bantam.

Jaffe, D., & Scott, C. (1984). From Burnout to Balance. New York: McGraw-Hill.

Lindemann, E. (1960). Symptomatology and management of acute grief. American Journal of Psychiatry, 101, 141-148.

Lynch, J. (1960). The Broken Heart: The Medical Consequences of Loneliness. New York: Basic

Locke, S . (1980). Stress, adaptation, and immunity: Studies in humans. General Hospital Psychiatry,

Mazer, E. (1982). 10 sure-fire stress releasers.

Roberts, A. (March 13, 1987). American Medical

Simonton, C., Simonton, S. & Creighton, J. (1978).

Matthews-Simonton, S. (1984). The Healing Family.

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laughter and tears: best medicine for stress

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