Holistic Humor: Coping With Breast Cancer

About the Author

Kathryn Bouskill holds both a  BA and MA in Anthropology from Notre Dame and Emory respectively. She is currently  completing a Ph.D. in Anthropology and a M.P.H. in Epidemiology at Emory. She maintains an interest in the topic of breast cancer though her current focus has shifted from ethnographic research on coping mechanisms to the globalization of typically American breast cancer awareness campaigns and their social implications in new contexts, specifically in Austria.

The Author, Kathryn Bouskill
The Author, Kathryn Bouskill

The Big Idea

Kathryn Bouskill decided to take a slightly different look at humor and illness. Traditional interest centers around humor as therapy, the idea that laughter can be a form of medicine, and/or the physiological implications of humor. However, Bouskill preferred to explore how humor was utilized in order to cognitively augment a sociocultural reality through social connection and understanding among survivors. While the fear was an unavoidable constant, by focusing on the comedic aspects of the non-lethal aspects of breast cancer sufferers were able to regain a sense of control while navigating their new role. This presented as true across age, race, and SES.

Neuroanthropology:  Joining Humor and Coping

Discovering the presence of breast cancer is a polarizing moment. Life is almost immediately divided in two categories: life before cancer and life with cancer.  Once a lump is discovered the acceleration into the world of cancer is almost exponential. In an exceptionally short amount of time  a woman loses her health and, for many, most of  her defining feminine features. The experience is not only characterized by sickness but by loss of identity, both personal and social.  Any coping mechanism is defined as managing stressors by the cognitive consideration of the situation within the context of the individuals’ life, i.e. their sociocultural  context. Both humor and coping are rooted within such a context, as responding to humor requires social aptitude and understanding. Bouskill notes that humor is instinctual and is a topic that has lacked popularity through the evolutionary-adaptionist lens as it doesn’t have a necessarily affect fitness one way or another. In all actuality the study of  humor presents difficulty through almost any lens, the most glaringly obvious reason being that it is difficult to find in the lab setting.  Humor study has long been a key topic in enthnography as a means of both as a means of social bonding and deviance. Though there is still much to explore what is known it that it creates a discernible distance between an individual and their suffering.

Breast Cancer in the United States: Politics And Pink Ribbons

The U.S breast cancer awareness movement was prompted in response to the shocking stigmatization and victim-blaming that formerly characterized the disease. Breast cancer is now a common concept as noted by how commonplace it is to see anything and everything bedecked in pink ribbon. While these are great strides forward, the disease has also become feminized and all-encompassing. Most male sufferers are overlooked and the attitude towards the disease serves to further define the diagnosed as a cancer suffer before they are seen as anything else

“We Laughed for Hours!”

The interest in this topic was prompted when an inaugural breast cancer support group meeting had an unexpected affect on the participants. Rather than the tales of hardship and frustration, the organizer was met with three hours of laughter. Most of the ethnographic information was taken from the Midwestern support center that hosted that very meeting. Every participant said that they used humor, as defined by each of the survivors, to cope.

Transitioning to “Cancer World”

The transition to the cancer world is as literal as it is metaphoric. It means coming to grips with the realities of suffering from breast cancer, dealing with each and every physical and emotional facet. Survivors from the center and associated biomedical clinic formed deep connections to other sufferers and staff, often communicating outside of scheduled meetings. “Cancer World” becomes a social haven though it continues to be a physical hell. The solidarity is an earmark of their world.  The support center becomes a place where they are no longer required to be the valiant survivor, they can feel their feeling and express them any way they choose. Typically this turns out to be a form of humor that could be considered to the layperson to be morbid, but is simply an expression of their reality. Time also plays a role in the transition, as most sufferers will not be wise cracking about shaving their heads at their first chemotherapy appointment. It is a fluid process of acceptance.

Dealing with “Cancer World”

The psychological stress that accompanies the diagnosis of cancer arises in many forms.  Where does one turn to deal with such an outpouring of change and emotion? Having an outlet along with locale and label assist in modulating such stress responses. Social support leads to lower cortisol levels and overall better quality of life. Humor cultivates the social bonds that lead to these marked physiological and psychological changes. The participants noted that humor allowed them to take their minds off of the negative aspects of the disease, whereas dwelling and complaining only seemed to give is power over their minds in addition to their bodies

Language, Humor, and Meaning

Linguistically, humor alters meaning.  It allows people to joke about the serious as well as the inherently humorous. Within this support center is acted as a mode of changing the minds of those who suffered to a frame of mind that allowed them to accept and cope with their situation. Humor does not remove their stress but it does serve to lessen their anxiety. Though metaphor and idiomatic reference, their orient themselves within their own world as well as the one outside.

Recess and Reward: The Positive  Effects of Humor

Physiologically humor does actually provide physical advantages.  If is looked at as a reward then is can be linked to the  mesolimbic  dipaminergic reward system . It also activates the medial ventral prefrontal cortex,  as seen through fMRI data. Women are seen to experience  greater reward response from the language processing centers than their male counterparts. Additionally coping via humor seems to lower the systolic blood pressure in women. Humor, however, is too complex to be looked at in a purely neurological manner. Activation of neural reward centers is dependent upon social interactions and context. It cannot simply be chalked up to neural reward, as that explanation is far to simplistic.

Conclusion

Humor allows breast cancer suffers a cognitive coping mechanism in three ways: 1.  It is a form of optimism that forces acceptance but also allows mental distance from stress 2. Allows a fluid transition to coping and finally 3. It taps into the human suite of traits that allow for stress relief and social group bonding through its instigation and laughter response.

All three of the above reasons are also challenges to how breast cancer and coping was previously assumed to be understood.

14 thoughts on “Holistic Humor: Coping With Breast Cancer”

  1. After reading this blog, I never really thought about the role of the “pink ribbon” and it being a clear label to becoming a breast cancer sufferer or survivor. The presence of the pink ribbon could be adding stress and anxiety to that individual’s life. It’s a reminder of the pain they have, or, had to endure. Do you think the presence of the pink ribbon does more harm than good?

  2. I find this all very interesting. I had never thought about humor and laughter in these ways. It makes sense to me to think that these things would help in some way with coping with breast cancer, as well as with other cancers and diseases. I think that this is a very interesting study to apply to today’s world because the cancer rates have gone up significantly. As they say, “laughter is the best medicine.”

  3. Great review- As I read this I wondered if the author was also a cancer patient. She really seems to have captured the emic perspective and was accepted into the support group. I also thought this was a great use of ethnography, and supports the use and value of participant observation.

  4. While the pink ribbon may just be a way to commercialize breast cancer and allow people to feel good about themselves for “helping the cause,” the cultural view toward breast cancer has come a long way. The idea that women in the past were blamed for having breast cancer and unable to seek treatment is simply horrifying. In my opinion, it is much better to have the stigma that follows the pink ribbon versus the stigma that follows the taboo.

  5. Dr. Bouskill mentions a couple times how humor and laughter changes survivor’s sense of external reality and self. I wonder if we could see such changes on a neurological level, like in connections in the motor cortex or cerebellum.

  6. I thought the “Holistic Humor” chapter by Kathryn Bouskill was a fun read. It was simply written and very on point. In fact, today kicks off national breast cancer awareness month. What I think is most interesting about this article is that it highlights transformations both in how breast cancer is seen at large and how this relates to how people experience it on an individual scale. I think the article would have been stronger if there was more cultural theory. I would have liked to have seen some elaboration on cultural play and/or Turner’s liminality but this might have drowned out the neurological aspects of the article. My only question is as follows: how influential is the transition from stigmatization to valorization in terms of creating space for humor groups to develop and how widespread are these groups?

    The Chiao et al. (2012) article had a better sense of balance between cultural and neurological factors. Previous research by others indicated that there is cultural specificity and cultural variation in the expression and recognition of fear. What does this mean neurologically? The authors were specifically interested in how culture affects neural responses when exposed to a fear stimuli. I wish they had explained why they chose their two independent samples. Are there extreme differences between native Japanese people’s expression of fear and that of Americans? I would assume this to be the case. If there were no neurological differences to be seen when cultural differences are high, then their hypothesis would likely be more strongly rejected than if cultural differences had been minuscule. However, I did find it helpful that the authors were very explicit about the dimensions of these individual samples. They certainly made an effort to control for confounding variables. Still, I was unsure of why they tossed two Japanese participants for “excessive head movement.” Is that not a fear response? I also wondered why they tossed the first 6 images in each run when completing testing with the MRI.

    Similarly, I read a 2013 article by Carmelo m. Vicario and Anica Newman titled “Emotions affect the recognition of hand gestures” in which facial expressions (happy, angry, neutral) and hand postures (open, closed, and neutral). Right-handed participants, 13 in total, were pulled from the University of Queensland in Australia. Four of these participants were male and the average age was about 23 years old. Participants were given a ready signal (100 msec), followed by a reference stimulus (100 msec), an emotional prime (500 msec), and finally a test stimulus. The participant must then push a button indicating whether they believe that the test stimulus was the same as the reference stimulus or not. It turns out that emotional primers (facial expressions) do have an effect on response time in recognizing hand postures. They can decrease the time it takes to recognize hand postures that are not socially connected to the facial primer. For example, happy faces decrease recognition of closed (anti-social) hand posture whereas angry faces decrease recognition of open (pro-social) hand posture. Vicario and Newman conclude that there is a conceptual connection between emotions (as expressed by face) and gestures (as expressed by hands) that is socially mediated.

    1. Looking back at the Chiao et al. (2012) article, I could not help thinking about the racial tensions tearing this country apart. I wonder how much the cultural specificity and cultural variation in the expression and recognition of fear plays a part in race relations during times of danger, perceived or real. The exploration of stigma in Bouskill’s chapter on “Holistic Humor” could also be used to understand the racial divide plaguing our country. Do white police officers shoot and kill innocent black men because they panic? Many argue that the stigma surrounding black men, that they are all dangerous criminals, is preventing our police force from acting fairly. I would be curious to see if a reproduction of Chiao et al.’s study using black and white Americans could provide scientific evidence of this stigma. With this point proven, we could all turn our time and efforts to learning how to switch the stigma from a negative one to a positive one, like the way in which breast cancer survivors overcame the morally flawed stigma and created a new fighter/hero stigma.

  7. As someone who has had four (!!!) close friends lose parents between the ages of 10 and 18, two of those to cancer, and with a mother currently battling cancer, this article really hit home for me. Watching my best friend lose her father, a second father to me, when we were only 13 was one of the roughest things I had to face as a youth. I still see the effects of her loss reflected in her life almost every time I see her. Though I know she is struggling to go through life with a dead dad, a now-alcoholic and bankrupted mother, and fully self-supportive, the best medicine has always been laughter. Once my mother was diagnosed, I felt a bit entitled to laugh with her. Now that she’s terminal, we laugh together all the time. I called her up and asked, “Hey, just wanted to let you know of my intentions to pledge the Dead Parent’s Society in a year or too!” Sam replied, “Oh darling, I’d rather you not — our colors don’t match your skin tone.” It was nice to laugh as choked back the tears that would eventually spill over. Once over a dinner with my close friends at UA, we told a story: “Our friend Claire’s father works on skyscrapers in Chicago. We were all walking together and she said, ‘Sometimes I walk through the city, look up to the sky, and yell, ‘Hey, Dad!!!’ Sam, without missing a beat, said, ‘Yeah, me too!'” Sam and I both find this story hilarious, and upon the blank stares explained, “It’s funny because her dad is dead. He’s in heaven, you know?” Blank stares turned to cringes. We feel they have no real right to cringe — it’s her tragedy, and if she finds little moments like that funny, then it’s funny.
    There was a lot of set-up and background to this article, and at times it felt a bit repetitive, but I appreciate her commitment to understanding humor holistically rather than just on a neurological level (though that is interesting to me, as well). It’s crazy to consider that emotions “evolve” and that humor has been “selected for” as a “protective buffer.” It’s not something I’ve thought about, but I like it, and I’d like to read more about it.

  8. After reading this article and discussing it in class, I realized that I had my own form of “cancer world” humor. While I have never had cancer and so cannot fully understand the mental and emotional states of cancer survivor, I have used humor in a social setting as a form of coping. During the summer, I worked with one of my friends, Ricky, in a research lab. Work is an understatement. Both of us were worked to the point of breaking, sometimes working 16+ hour days, working on the weekends, and seeing no visible results. While both of us enjoyed what we were doing, we started making jokes that we were slave labor, chained to our lab benches. We would joke that we would start using meth or coke. It got to the point where we would joke that we would drink toxic chemicals, throw our research away, and jump off a building. Besides these general jokes, we would joke about whatever failures we currently had, from specific situations where I was panicking because my computers failed in the middle of a timed trial to how I fell asleep during one of my trials due to exhaustion. In the setting of my lab, all of these jokes seemed normal and even necessary to survive. We were working so much that we were often each other’s only social interaction. However, what made me realize that there is a parallel here to the cancer jokes is that I noticed that other students became uncomfortable by our jokes. Just like how healthy people were uncomfortable when cancer survivors joked about their hair loss, students were actually troubled by what gave us endless amusement. I can directly see how our research experience correlates to the coping mechanism of humor. It distanced us from our stress, gave us a way to express our frustration, and allowed greater social bonding.

  9. After our class discussion, I now have a completely different view on this subject. I think that using humour in this way is extremely important to the overall health and well being of a cancer patient. As a person who has watched someone suffer from colon cancer and eventually pass away from something related to their cancer, I have seen firsthand how exactly laughter can work to help those suffering with a disease that makes them feel powerless. The family member that I watched struggle with his cancer was always joking and laughing about it and was never seen without a smile on his face in general, and I think this helped him to live longer than he would have without the release that laughter gave him.

    I also think that laughter is a tool for healing in all kinds of ways, emotional and physical. I know that I have frequently felt better after a good laugh and am able to joke about whatever has got me down. I think that more studies into this phenomenon of laughter will reveal that it can help people heal in a myriad of ways.

  10. Peter Gray talks about the uses of humor in a Hunter-Gatherer Governance in his article, Play as a Foundation for Hunter-Gatherer Social Existence. According to Gray, anthropologists have pointed out that hunter-gathers use humor for another purpose, to correct or punish those who are in some way disrupting the peace or violating a rule. In Gray’s article, he states that Elizabeth Thomas, who used to live among the Ju/’hoansi, claims that they would not criticize people directly but would do so through humor. Thomas then gives an example of two women who would not stop fighting, so others in the tribe made songs about them and would sing it when the arguments started. After hearing the songs, the two woman felt shamed and fell silent and the community prevailed without mentioning the problem directly, Anthropologists call the use of humor “humility-enforcing” or leveling’ devices to keep people in line, according to Gary.

  11. For some reason, I thought that I had already commented on this post. When I went back through to check, it didn’t come up. Anyways, I digress.

    I’ve never had cancer, and I have never had a close friend suffer from cancer. However, my best friend recently lost her father to cancer. I can tell you first hand that humor was simply not an option of handling it. At first, when the family was still in shock about his diagnosis (he was in his late 50’s, went in to the doctor for heart burn, found out he had stomach and colon cancer), perhaps they cracked a few jokes. However, after months of chemotherapy the humor abruptly ended. Laughing the situation off, for their family, was just not something that they were emotionally capable of at the time. They thought that he had beat cancer, and the doctors told him he was in full remission. A mere two weeks later, he started having seizures and they discovered it had spread throughout his nervous system and was put on hospice that evening. Although I highly disagree with the marketing events to anthropomorphize cancer and make tons of profits in fun runs and events, I do believe that these events raise awareness. Events provide a community for people whose lives have been affected by cancer. However, if a coping mechanism is healthy and works, go for it.

  12. Looking back at this article, humor as a coping mechanism appears to be like a really great things in some cases. I agree that it can serve to break the ice that such chilling situations provide, but I think that it does have a time and place. Although the humor may be a good coping strategy for the patient, it might not match up well with the coping strategies of the patient’s loved ones. Such discord doesn’t seem very helpful in any way. Nonetheless, it would be interesting to see how shamanistic cultures deal with laughter as a coping mechanism and compare the way allopathic societies view it. It might be good to consider how other forms of stress relief go hand in hand.

  13. This chapter really made me more interested in how people experience cancer, attending chronic health condition support groups, and humor in health. One of things I learned was that besides the financial and stressful burden of having cancer many people become socially isolated. Depending on where people live they may have to seek treatment away from family or friends and have frequent stays away from loved ones. The experience it self may disconnect them from their family. A social support system like the one outlined in the chapter could be invaluable to patients. However, the medical system is not currently set up to consider patients social situations or potential isolation during the duration of their illness. The humor is the other aspect that can only really develop among patients who understand the experience. It would be difficult for family members to find humor in the illness of a loved one even if they were available.

Leave a Reply

Your email address will not be published. Required fields are marked *