A seemingly frivolous tweet about superstorm Sandy drew a sharp rebuke this week from the Michigan Nurses Association.
The offending tweet came from the Detroit News and actually was a retweet of what another Twitter user (a civilian, apparently) said about the storm: “BREAKING: Frankenstorm upgraded to Count Stormula.”
The nurses’ association tweeted back:
— MI Nurses Assoc. (@minurses) October 30, 2012
The organization’s communications director, Dawn Kettinger, then contacted media uberblogger Jim Romenesko to further press home the point. “People are hungry for information and connection right now,” she wrote. “Moments of misjudgment are understandable, but perhaps it is worth another discussion of how media use their resources and power.”
Is it ever OK to use dark humor when confronted with tragedy, whether it’s death, life-threatening illness or injury, or natural disaster?
It’s a little ironic that the “Count Stormula” criticism would come from someone in the health professions, a demographic that’s well known to engage in black humor to cope with the illness, injury, tragedy and stress they encounter on a daily basis.
There’s been little formal research on the use or frequency of black humor among health care professionals. The use of this type of humor seems to be most common in the higher-stress specialties: emergency medicine, critical care and surgery.
A small-scale study several years ago, involving 608 paramedics in New Hampshire and Vermont, as well as members of the National Flight Paramedics Association, found that almost 90 percent used gallows humor as a coping mechanism. In fact, it was their most frequent method of de-stressing, even more than venting with colleagues or spending time with family and friends.
The use of irreverent terms such as “acute lead poisoning” to refer to a gunshot wound or “celestial transfer” to describe patients who have died is so widespread that several online dictionaries have been compiled to list all of them.
Some studies even have found that black humor can benefit clinicians and patients by reducing tension and allowing the clinician to focus on the situation at hand.
But there seems to be a growing consensus that it’s not acceptable to resort to black humor within earshot of patients and families, or to frame the joke at someone else’s expense (and I daresay this applies to the media as well).
A group of Canadian researchers who explored the issue agreed that although laughter is often therapeutic, cynical humor that’s directed toward patients “can be seen as unprofessional, disrespectful and dehumanizing.”
Furthermore, the use of black humor to cope is frequently a learned behavior that medical educators need to address, they wrote:
“There is disturbing but compelling evidence that medical education and acculturation are partly to blame, by tolerating and even fostering a certain detachment and cynicism. Recent moves to encourage the development and evaluation of professionalism in medicine embrace concerns about this issue and the distinction between dark humor about the human condition and the particular observations of those who style themselves as healers.”
At its worst, black humor can stereotype or dehumanize the patient and make it harder to be objective or empathetic, wrote a nurse at Those Emergency Blues, a group blog of Toronto ER nurses. When this happens, doctors and nurses can end up providing poor care, she wrote. “The wisdom is having the insight to understand the sources of black humour in our own relative helplessness, and to recognize it, first, as an inevitable part of our practice, and secondly, as having a time and place.”
Readers, what do you think? When is black humor appropriate and when is it unacceptable?