Copyright © 2000, Lawrence Erlbaum Associates, Inc.
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FAMILY CAREGIVERS' USE OF HUMOR IN CONVEYING INFORMATION ABOUT CARING FOR DEPENDENT OLDER ADULTS
Lisa Sparks BETHEA, Shirley S. TRAVIS, Loretta PECCHIONI (USA)
Twenty-three family caregivers were interviewed using a semistructured interview format to explore their experiences managing medication administration and providing long-term care to frail elderly family members. Content analysis of the transcripts utilized the arousal-relief theory of humor (Berlyne, 1969) to understand the frequent use of humorous anecdotes found throughout the interviews. For example, caregivers of individuals experiencing dementia often included smiles, jokes, and "punch lines" in their stories of behavioral problems that complicated medication administration schedules. Adult children frequently used humor to describe their role reversal with aged parents and the parents' forgetfulness, incontinence, or inability to dress without assistance. These accounts were placed in a taxonomy of humor response patterns that included categories for cognitive, affective, and behavioral responses. Second-level analysis created subcategories to reflect the function (relief or coping) that the humor served in the interview situation. It appears that humor is a useful communication tool for family caregivers that releases nervous energy about the interview process and the recall of difficult caregiving events. It is the responsibility of the interviewer to recognize the problems and issues embedded in the interview data and follow up humorous anecdotes with appropriate probes for additional information. Based on the results, a meta-humorous interaction theory is offered as an extension of the arousal-relief theory of humor.
Humor in conversation often reveals what people find most disconcerting (du Pre, 1998). In the case of studies of long-term caregiving, family caregivers are frequently asked to talk about topics such as bowel movements, loneliness, personal safety, and intimate care. Such socially taboo and sensitive topics can cause family caregivers to experience periods of awkwardness and embarrassment. When caregivers must convey this information to others, which may also expose their own personal fears and shortcomings in the caregiver role, humor may be one mechanism available to help them manage face-threatening situations. The problem is that in interview situations, it can be difficult for the interviewer to know whether to laugh or smile when respondents are offering information that is conveyed in a humorous fashion, yet is obviously laden with other nonhumorous emotions (Beck & Ragan, 1992; Ragan, 1990; Robinson, 1975). Clearly, it is important to understand the caregiver's intersubjective sense of appropriateness during the humorous interaction. But, because conversations such as these tend to occur rapidly, it is not always easy for the interviewer to grasp the relevance of the humor. It may be the case that information cues about problems or concerns that should be followed up with additional questions or probes are being missed.
There is no research that explains variations in humor responses or the specific function a humorous response or anecdote may be serving in the conveyance of information. A better understanding of the use of humor would be instructive to interviewers who need to be ready to make appropriate follow-up inquiries about the conditions and situations underlying the humor. Therefore, the purposes of this article are to: (a) utilize the arousal-relief theory of humor to understand the use of humorous responses and anecdotes used by family caregivers to describe their caregiving experiences and relationships with care-recipients, and (b) explore the most common caregiving problems or issues that were shrouded in humor by a group of long-term caregivers.
REVIEW OF THE LITERATURE
The majority of older adults who need long-term care live in the community and receive most or all of their care from informal networks made up of family, friends, and neighbors (Dwyer, 1995; Scanlon, 1988). Unfortunately, the competing demands placed on contemporary families often create high levels of stress in the caregiving situation (Pasquali, 1991).
Humor is widely recognized as one highly effective coping strategy among patients and health care professionals in a variety of settings (Bellert, 1989; Buffum & Brod, 1998; Collins, 1988; Davidhizar & Shearer, 1996; Simon, 1990; Sparks, 1994; Tennet, 1990; Weisberg & Haberman, 1992). It is also known to be extremely useful among caregivers of individuals with Alzheimer's disease who must deal with a constellation of problems over the long term (Haley, Levine, Brown, & Bartolucci, 1987). Less well understood is the purpose humor serves in interview situations in which a caregiver is reporting or "making meaning" out of the caregiving situation for a listener-interviewer, who as an active listener (Holstein & Gubrium, 1995) is also making meaning out of the stories being told.
Conceptual Foundations of This Study
In a variety of cultures, humor is used to create relationships, vent emotions, and exert social control (du Pre, 1998). Arousal-relief theory posits that laughter is also a method of venting nervous energy. Berlyne's (1969) approach holds that emotional arousal is generally pleasurable and laughter provoking. This relief or venting is necessary either when someone enters a situation with nervous energy ready to be released, or when laughing causes the buildup of nervous energy, as well as the need for its release (Morreall, 1983). Berlyne (1969) postulated an inverted-Urelation between physiological arousal and the experience of enjoyment. For example, a joke induces arousal beyond its optimal level of pleasure, followed by a punch line that rapidly decreases the arousal. The relief component of this theory further suggests that a resolution or reduction in arousal should produce a more pleasurable level of mirth. In our study, it was not known whether the caregivers' humorous moments of conversation regarding caregiving situations would result in relief, as the theory would suggest, or whether humor simply conveyed a difficult story void of pleasurable effects. Understanding the situation, issue, or concern underlying the humorous anecdote and understanding the type and nature of the humor response utilized seem to be important parts of the communication that have not been examined in the past.
In addition to arousal-relief orientations of humor, the relational communication perspective is used in this study as the basic foundation regarding the nature of conversation or talk. Bateson (1972) argued that communication involves more than simple message translation. Indeed, from the viewpoint of relational communication, humorous message translation is far from simple. Consequently, Bateson (1972) suggested that researchers and interactants attend to and offer clues that reduce ambiguity to a manageable level. This can be accomplished not only by communicating with others but also by communicating about the communication. In other words, each interactant, in a conversation, often plants cues to suggest how a message should be interpreted. It is on the relational or metacommunicative level in which the conversational puzzle must be interpreted and understood. To use Bateson's terminology, these relational or metacommunicative cues contribute to the context or the "frame" of the conversation to make understanding possible. For example, it is informative to watch for the ways in which a caregiver conveys when an action or utterance is humorous or serious. Further, du Pre (1998) suggested the presence and significance of these cues is particularly interesting considering that the participants themselves are often unaware of them and seem to effortlessly attend to and present cues in their talk.
In the data presented, evidence of a sophisticated system of metacommunicative "humor cues" consists of exaggerated facial expressions, altered vocal inflections, and idiosyncratic word choice, to name a few. As we discuss in the analysis section, using metacommunicative cues and evidence of relief or nonrelief (coping) following a humorous anecdote allowed us to create a new humor response taxonomy that builds on previous applications of these theoretical frameworks.
METHODS AND PROCEDURES
In this study, we investigated the function and communicative use of humor in sensitive interview situations. The larger exploratory study from which these data are drawn used caregiver questionnaires and semistructured, face-to-face interviews to gather information about background and demographic characteristics, caregiving histories, and caregiving issues from family caregivers of dependent older adults who were attending adult day care service programs. In addition, researcher field notes provided supplemental information about the long-term care settings and observations about the interactions of the caregiving triads (formal providers, family caregivers, and care recipients).
Two adult day care centers in the greater Oklahoma City area participated in the project. Center A, the larger of the two centers, provides care to approximately 65 adults per day. Center B, located in the far eastern corner of the metropolitan area, is a smaller center with an average daily census of 20 participants. The center also serves a large rural area. With the assistance of center staff, 23 family caregivers were recruited for the study. Their care recipients met the following inclusion criteria: (a) 65 years of age or older, (b) taking medication daily, (c) dependent on the informal provider to manage and oversee the medication regimens, and (d) attended adult day care at least 3 days a week for the 3 months preceding the interview. Caregivers who were themselves frail or impaired and who depended on others for assistance were not eligible to participate in the study.
The sample was constructed using a multistep process designed for the centers to protect the privacy of their day care participants and their families. First, center staff identified all families who met the inclusion criteria and sent the primary caregiver of record a letter, developed by the research team, describing the purpose of the study and inviting the caregiver to participate. A form was attached to the letter giving the center staff permission to release the name, address, and phone number of the primary caregiver of record to the research team. Onreceiving the caregiver form from the adultdaycare centers, the project principal investigator contacted each caregiver by telephone to personally invite him or her to participate in the study and to answer any questions about the project. The project team members then scheduled the face-to-face interviews at times and locations convenient to the caregivers. Because of this multistep process, and based on earlier experiences of the principal investigator with the process, all caregivers who gave permission to have their names released to the project team agreed to face-to-face interviews (100% response rate). Eight caregivers from Center Band 15 caregivers from Center A agreed to be interviewed. In addition, one male caregiver from Center B who volunteered to be interviewed, but who did not meet the inclusion criteria for the study because his wife attended the day care center 2 days a week, served as the pilot interview for the project. His data are not included in the study.
Following completion of the caregiver questionnaire, a semistructured, taped interview was conducted using a set of generative questions and the data from the caregiver's questionnaire was used to guide the interview. The entire process took between 1 and 2. hr. All procedures were approved by the University of Oklahoma Health Sciences Center Institutional Review Board prior to beginning the project.
Slightly more than half of the respondents were interviewed at their respective adult day care centers, at their request. Both adult day care centers provided a private space for the interviews. All other interviews were in respondents' homes. With the permission of the respondent, an oral consent to participate in the study was tape recorded at the onset of the data collection session. The tapes were turned off while the questionnaire was being filled out and restarted for the interviews.
Caregiver questionnaires. Descriptive statistics were used to summarize the characteristics of the caregivers (age, gender, marital status, relationship to care recipient, employment status, living arrangements), their care recipients (age, gender, functional status, current medications, principle medical diagnoses), and elements of their caregiving histories (such as length of time caregiving, services used at the present time and in the past, reasons for selecting adult day care, satisfaction with current long-term care arrangements, and length of time in day care). The caregiver questionnaire also included a significant amount of information pertaining to medication administration issues and long-term caregiving. This information is not included in this article; however, it can be obtained by writing to Shirley S. Travis.
Interview data. Content analysis of the transcribed interviews was facilitated by the use of HyperRESEARCH (1991), a software program for qualitative analysis. In the initial review of the humor passages, it became apparent that three distinct response patterns were being used by the caregivers. Therefore, consistent with classic conceptualizations of human functioning in interaction, we created a taxonomy to separate the humorous accounts into cognitive, affective, and behavioral response categories. These categories have been utilized in prior research on humorous interaction and seemed to fit our study well (Sparks, 1994). In this taxonomy, humorous accounts that included pragmatic, rational, or intellectual processing of events or circumstances were labeled cognitive patterns. In contrast, accounts that were more emotional in content or included insights into caregiver attitudes or values were labeled affective. Finally, action-oriented anecdotes were labeled behavioral.
Passages were then reviewed within each of the three major groups (cognitive, affective, and behavioral) to identify what function or purpose the humor served. This level of analysis resulted in the identification of passages that suggested either the traditional relief function, as described by the arousal-relief theory, or a second function of nonrelief, which we labeled coping. For example, a caregiver whose humorous account resulted in relief would conclude the account with a phrase that indicated closure and a sense of pleasure from conveying the story. In contrast, the anecdote or response resulting in nonrelief (coping) would be more open-ended and leave both listener and respondent with an inability to enjoy or lack satisfaction from the story. A coping anecdote might end with the notion of "just having to deal with" something about the caregiving situation.
A third level of analysis became necessary when we realized that the relief functions in the cognitive domain were not all of the same type. On close examination, cognitive relief actually represented either a positive relief outcome or a painful relief outcome in which some residual pain or discomfort coexisted with the humor relief closure.
To enhance coding reliability, a random set of transcript pages was coded separately by two of the authors. This step resulted in 80% agreement on the assigned humor taxonomy codes. Following discussion of the "missed" codes, the humor response codes were slightly modified (the third level of analysis previously described), and the transcripts were recoded. The revised coding scheme resulted in 100% agreement among the authors of the assigned codes.
In all, the caregivers used 108 humorous accounts to convey some of the most sensitive information about their caregiving situations. Almost all of the caregivers (86%) utilized humor at some time during the interview process. In each of the following sections, we describe cognitive, affective, and behavioral response patterns in greater detail. Included in these results are frequencies for each response pattern and humor function (relief or coping) in the taxonomy. Table 1 provides a summary of the taxonomy and the frequencies and percentages for each response category.
Caregiver respondents ranged in age from 33 to 77 years (M= 59.9). Their care recipients were 66 to 94 years of age (M = 80.5). The overwhelming majority of the caregiving dyads were spousal (52%) or parent-child arrangements (35%).
Taxonomy of Humor Responses and Functionsa
Humor Response n %
Cognitive 60 56
Coping 43 40
Relief: Painful 14 13
Relief: Positive 3 3
Affective 25 23
Coping 7 6
Relief 18 17
Behavioral 23 21
Coping 13 12
Relief 10 9
aN = 108 accounts.
Despite efforts to recruit male respondents, only one eligible male caregiver volunteered to be interviewed (4%). About two thirds of the respondents (61%) did not work outside the home. Caregivers had been in their roles between 7 and 188 months (M=54 months). The caregivers were generally well educated. Most (83%) reported at least a high school education, and 21% reported having received college or graduate degrees. Consistent with the utilization rates of community-based, long-term care programs across the state (Travis & Duer, 1998), only one of the respondents was African American.
Cognitive Response Patterns
An array of cognitive humor response patterns reflected rational, intellectual, and critical thinking in constructing humorous anecdotes about such issues as the functional and cognitive decline of the care recipients, the constant demands of caregiving, and changes in interaction and conversational styles with the care recipients. In addition to coping and relief functions, humorous anecdotes in the cognitive domain were further subdivided into either positive or painful relief functions. This is the only dimension in which relief functions were so clearly different that they were divided in this way.
Cognitive relief: Positive. Consistent with Berlyne's (1969) notion of humor relief, a few of the caregivers' anecdotes (n = 3, 3%) included cognitive humor to achieve positive relief in the telling of their caregiving stories. One respondent said with a subtle smile and chuckle It gives me a good feeling, I know that she feels good living with us. It's a little hard in that you do have to make plans. You can't just run to the grocery store, or uh, do things without prior planning. [sarcastic emphasis] And it does restrict you, however, we do go on vacations. We hire somebody to come in and stay with her, and it seems to work out well. Cognitive relief: Pain. This category of responses included evidence that the caregiver experienced relief in the telling of the anecdote, yet, the relief was associated with some residual discomfort or pain. Approximately13%of the anecdotes (n =14) were in this category .Thesituations described in the anecdotes were often conveyed as absurd or ridiculous, and they were always atypical of "normal" behavior. The following respondent laughingly shared a difficult account of her demented mother's bedtime behavior. Here we noted the rational way she approached the losses of mental functioning and the solid closure of the story. The residual pain is evident in the daughter's inability to pinpoint why this behavior is happening (hallucinating or dreaming) and the mention of her deceased father. The daughter said
And then she goes to bed and sometimes she'll lay in there and talk to herself, and…she'll talk about everything and she'll see things and she'll talk to my father, he's at the foot of her bed, and you know, she's…I don't know if she's hallucinating or if she's dreaming.
And then she'll…if I happen to go in there, she'll ask me about something that's happened 30 years ago, and wanna know where the…we're from Maryland and we have Maryland crabs. And she's always asking me, "Did you get the crabs?" [Laughter]. No, I haven't been back to Maryland to get any crabs! And then she'll sleep all night.
A similar story of painful cognitive relief can be seen in an account by a caregiver whose husband was experiencing hearing loss. She laughed throughout the following story of nighttime awakenings from her husband's television. Her anecdote was provided in response to a question about the couple's bedtime routine. The humorous account did have closure; however, residual discomfort was noted. She said
Well, just, his … the television is in his bedroom, and it's up where he can watch it. And he has pillows that he can lean back on that cushion him and he is, you know, in an upright position. And I remove them at night when he goes to bed for the evening. When I go to bed for the evening, I remove his pillows [Laughter]. And so he has a hearing aid, and sometimes he takes his hearing aid out and then he turns up the television too loud! [Laughter]. And, it's all right until the middle of the night about 2:00 in the morning, all the sudden you're blasted out because he woke up and turns it on!
Cognitive coping. Cognitive coping was one of the most frequently utilized communicative tools for the caregivers. In all, 40% (n = 43) of the humorous accounts fit this category. One of the defining characteristics of this group of anecdotes was the rambling nature of the stories about various caregiving responsibilities and difficulties. Contrary to the relief function of humorassociated with resolution or reduction in arousal, these anecdotes demonstrate the open-ended qualities of caregiver coping. For example, a respondent who accepted the caregiver role for her 94-year-old mother-in-law after her husband (the care recipient's son) died, said
It's just, sometimes you just say, you know, Do I have to keep doin' this? [Laughter]. No, I guess I get to. You know, it's not all bad. They are a blessing, but it's just, I guess I've had so much that it's just like, one more sick person, or one more person that's gonna die on me! [Laughter]. I'm just gonna …they are gonna be sick or gonna die. I guess that's…I know the frustration with these older people, I know they're not gonna be here, but you know, when my husband was dying of cancer here he said, "Well, God may take me but God's givin' you an old lady that's gonna live forever [Laughter]."
Similarly, another respondent described her psychological adjustment to the loss of everyday conversation with her increasingly demented husband, as well as his physical decline. The phrase "…all the time he keeps me upset" embedded in this humorous anecdote about popcorn and the caregiver's closing remark combined to suggest to us that this anecdote belonged in the cognitive coping category. The caregiver reported
I leave home and try to do things. In his mind he thinks he can do them, but he can't do them. He comes home … a lot of time when I come home, he has spilled food, he's just like a bad child. And he keeps me upset, I mean, all the time he keeps me upset. Like last night I made popcorn. Gave him a bowl of popcorn and I was watching something on one TV and he was watching a game. I heard this noise, I came, I said, "What in the world happened?" "Nuthin"…And there was all this popcorn on the floor with a bowl on, upside…" Nuthin'." [Laughter]. He's just like a bad child. So he keeps me on my toes all the time.
Affective Response Patterns
Affective humor response patterns reflected emotional expressions, attitudes, values, and feelings in constructing humorous anecdotes. Caregivers talked the most about others in the relational network and their ability to help deal with the care recipients.
Affective relief. About 17% (n = 18) of the humorous accounts included evidence of emotional relief following the anecdote. In the following anecdote, the respondent was conveying her satisfaction with her mother's adult day care service program and the socialization her mother received at the center. Consistent with humor relief, the anecdote, which ends with laughter, offers closure of the account accompanied by feelings of pleasurable release at the end of the story. The respondent said, "They sing for about an hour in the afternoon, they're still singing when she leaves, and she enjoys that. So she'd rather stay for all the singing instead of coming home … " [Laughter].
Another example of the sort of closure one would expect with relief was associated with an anecdote intended to describe the personal care a spouse provided for her husband and the antics of the family dog in their daily routine. The respondent reported
The dog has to have his, uh, treat while my husband has his breakfast. He expects it on the tray with my husband's breakfast. He gets up on the bed with him and has his treat while he has his breakfast! [Laughter]. Then I help him [the spouse] get dressed, and the dog barks at me all the time I'm helping dress him! [Laughter]. The dog lays across his chest and says, "Over my dead body will you hurt him!" [Laughter]. And since he's a Pomeranian, I'm really scared!
Affective coping. This group of seven anecdotes (6%) conveyed stories about difficult situations or relationships with the care recipient in which the story ended in the somewhat unsettled, open-ended fashion we have labeled coping. In the following excerpt, a respondent described what her life is like as the primary caregiver for her demented husband. She relayed this story with an enormous smile on her face, although the frequent mention of stress conveyed the more powerful message. She said
From the time he opens his eyes until he shuts them at night, it's just very stressful. Like on the way out here, things may happen, he's trying to say "car," it just doesn't come out. Oh, and talking about road rage, when a person will cut the…in front of us, he has a tendency to curse and stick his finger, and I have told him, "Don't do that!" Talk about stress! It's a constant stress with [husband]. Okay, and when he's trying to tell me something, if it's a lady, he will point to me. And I will ask, "Is it in my family?" "No." "Is it at church?" "No. "We go all around the world until we finally figure what a young or an old lady, what…it's like, uh, and that is quite stressful. Then he becomes frustrated if I don't get it within a certain length of time, but he still won't stop. I've got to sit there and try and to figure out what he's try in' to say. That's when I get a headache. I don't care what it is he's try in' to tell me, he will not stop.
Another respondent used humor to explain the difficulty she experienced trying to deal with her mother's memory loss and family relationships. Her final comment with an emphasis on "sometimes" caught our attention and led us to classify this anecdote as a coping function. She said
"She doesn't know, you know, her grandkids' names sometimes. She knows all mine…she gets the twins mixed up because [the names are so similar]. She'll just say Hi…she's talking to the wrong one, and she'll correct herself, but my … my sister's family, she doesn't know the names of them or my brother's family. She doesn't remember my husband's name. I mean, she just forgot a lot. She says she was never married. I know she was! [Laughter]. I mean, it's funny sometimes.
Behavioral Response Patterns
Behavioral response patterns reflected an action orientation in constructing the humorous anecdote. For example, the anecdotes in this domain included descriptions of a particular skill or specific task associated with the care giving experience. Figuring out how to administer medication to an uncooperative care recipient or managing daily care giving routines are examples of action-oriented anecdotes that were placed in the behavioral category. Behavioral relief. Approximately 9% (n = 10) of the humorous accounts were labeled behavioral relief. As before, these anecdotes had the now-familiar element of closure (relief) following the humorous account of an action-oriented theme. In the following short response, the respondent was asked to summarize her advice to new caregivers. She smiled when the question was asked and emphatically said with laughter, "Get help right away! [Laughter]. You can't do it…I've tried it before, 24 hours a day by myself, and it doesn't work."
Another respondent used humor to describe the action she had to take when she had difficulty getting information from the doctor or pharmacist about her care recipient's medications. In the following exchange, the respondent used word emphasis and facial expressions in humorous ways, and the interviewer, who at this point in the interview had an understanding of the assertive nature of the caregiver, responded with laughter. The humorous exchange ends with a sense of closure (relief; R is respondent; I is interviewer):
R: You just have to be insistent. Sometimes when I can't talk to the druggist on the phone, I get in the car and go there.
I: [Laughter]. You're gonna get your answer aren't you?
R: And, uh, well you have to know. If things are not going right, you have to find somebody that knows the answers. And, uh, if my druggist wouldn't get … I would call another druggist and ask them.
Behavioral coping. About 12% of the anecdotes (n = 13) were placed in this category of behavioral coping. As with other coping categories in the taxonomy, these anecdotes have an open-ended quality that offers little satisfaction or pleasure from the use of humor to convey the information. A spousal caregiver describing the action (piano playing) she takes to relieve her stress said
Every night I go to bed with a headache. Not one night, every night. There's just no relief. My doctor keeps tell in' me I need to get some rest. There's no way. And I'm not supposed to let him [care recipient] know my true feelings because he would worry about me and that would cause him to become sick. So I've got to hold all this in until he's out here [at the day care center]. Then I get on the piano and take it out on the piano! [Laughter].
Another respondent who was constantly vigilant to adverse drug reactions, because her husband had severe idiosyncratic responses to most medications, conveyed the following information with a smile that did not fit the severity of her story. She said
Well, the worst part for me is with new medication…is will he react to it or not! This is a…you always dread that new medication when it comes along. Other than that … I wish he would take his [medication] more willingly sometimes!
Problems, Issues, and Concerns Conveyed by Humor
Once the taxonomy of humor response patterns was complete, we were able to take a closer look at the most common caregiving problems that were shrouded in humor. This step is important because interviewers must be able to recognize humor as a signal that the interview is nearing an important topic and anticipate the need for appropriate probes into caregiver issues.
In our review of the cognitive response patterns, the most common stories being conveyed related to caregiving logistics, safety concerns, and loss associated with functional and cognitive decline of the care recipient. Follow-up questions to cognitive responses capitalized on the rational, critical thinking that was being used by the caregivers and included such questions as "How did you decide what to do?"
The affective response patterns dealt primarily with stress in the caregiving arrangement, embarrassing social situations caused by the care recipient, and relationship problems in the caregiving social support network. Follow-up questions to affective responses included "How does that make you feel?"
Finally, the behavioral response patterns typically included concerns about how to safely administer medication (a focus of the larger study from which the data are drawn), strategies to keep daily routines under control, and skill in monitoring for medical emergencies or other adverse responses to care. We found that knowledge-related questions about the type or amount of caregiver training or asking about the approaches that the caregiver used to provide direct care were appropriate follow-up probes to anecdotes in the behavioral domain.
As we learned in this study, humorous anecdotes shared during interview sessions are more than "funny stories" about caregiving. In fact, when talking to others about their experiences, humor appears to serve several communicative functions for long-term caregivers. First, humor is a comfortable way to share personal and often sensitive information with the interviewer. Second, humor can give caregivers a face-saving vehicle to explain how or why they thought, felt, or acted in a certain way. Third, the coping function of humor provides an important communication signal that the area being discussed may be an area of unresolved caregiving conflict or concern, without the caregiver actually having to state that he or she is having difficulty. It is this last point that we believe has important practical and theoretical implications for the future.
Practical Implications of the Findings
In the real world of health care, most providers do not have the luxury of spending an hour or more interviewing a family caregiver or taking the time to decipher and categorize humorous anecdotes. Nevertheless, we feel strongly about the need to educate health care providers to be more aware of communicative cues such as humor when discussing treatment-caregiving issues with family members and the manner in which humorous anecdotes are constructed by the caregivers. These cues may be highly suggestive of the caregiver's need for additional education, training, and caregiving assistance, especially when cognitive (rational, intellectual, critical thinking) or behavioral (action-oriented) response patterns are being used by the caregiver to construct humorous anecdotes about their caregiving situations. Anecdotes that are serving a coping function (i.e., those that by definition do not convey an "end of story message") may be among the most important cues for the interviewer to pursue to maximize the effectiveness of a treatment plan, relieve caregiver distress and burden, and neutralize future problems.
Because in the interview situation humorous anecdotes and responses probably offer a protective and socially acceptable shroud for caregivers, it is also important for practitioners to understand that this protection must be carefully removed during the interview to find the messages within, and that caregivers may resist its removal. In our experiences, humor can be a very distracting communication device that has the potential to enhance understanding of the caregiver's situation or to exacerbate communication breakdown during the interview.
It is also worth noting that three of our caregiver respondents never used humor to convey their caregiving stories. Although this is a very small subset of respondents, it may be the case that the absence of any humorous anecdotes is as equally an important communicative cue as the use of humor. More research is needed to understand when and why some caregivers do not find humor a useful mechanism to convey information about caregiving experience, and what, if anything, the absence of humor says about their caregiving situations and arrangements. In summary, there is strong evidence that humor in sensitive interview situations is a complex response process by respondents that calls for equally complex interviewing responses by health care providers, researchers, and others who interview family caregivers. By recognizing that myriad humor response patterns and relief or coping functions exist, interviewers should be better able to craft appropriate and timely interview probes, focus more directly on the problems and issues embedded in the interview data, and develop more accurate interpretations of the caregivers' situations.
Theoretical Implications and the Need for Additional Research
Berlyne's (1969) arousal-relief theory of humor combined with a relational communicative approach appears to offer a superior approach to understanding the ways in which long-term family caregivers convey their caregiving experiences to others. Because of the absence of any comparable work in the literature, further development of the humor response taxonomy developed from this project is needed to better understand the function of humor in interaction, in general, and humor in the caregiver interview situation, in particular. Although there are several existing theories of humor, none fully capture the function of humor in this interview context. Arousal-relief theory is useful for predicting pleasurable aspects of humor; however, it falls short of anything beyond the function of humor as delightful or gratifying. It is time to move beyond the stimulus-response approaches to humorous interaction (e.g., arousal-relief theory) and to embrace a relational or process-oriented approach-or what we have come to call meta-humorous interaction theory (MetaHIT).
Our initial effort at a MetaHIT taxonomy extends arousal-relief theory by recognizing coping and relief functions of humor while incorporating important relational elements in the interview process. In other words, the use of humor by the caregiver often is used as a cue that something of deeper meaning is going on in the caregiving situation. Humor in this context is not always funny; stems from a choice of cognitive, affective, or behavioral responses to the interviewer's request for information; and has either relief or coping results from the telling of the story.
Additional work is needed to validate MetaHIT with other caregiver groups, such as parents of a chronically ill child, and in a variety of other family situations that might be reported during an interview with a professional person, such as individuals going through divorce or retirement from paid employment. Understanding more about how humor serves as a communication vehicle for conveying diverse sensitive information to a professional interviewer will have important implications for how interviewing skills are taught in health professions programs in the future.
On a methodological note, we strongly recommend that additional research on this topic include video as well as audio tapings of the interviews so that researchers can observe the more subtle communication patterns that can be missed in field notes or lost in the recall of the interview situations. We also recommend additional efforts to refine probes that interviewers can use for the three (cognitive, affective, or behavioral) humor response patterns. Once a response pattern is recognized, it is essential that the interviewer be prepared to follow up with appropriate probes. As we listened to our interview tapes, we found missed opportunities for follow-up probes, in large part because we were still defining the taxonomy of humor responses and learning to recognize the cues that the caregivers were giving us. As others use the taxonomy, it is likely that a menu of probes will be developed that are humor-response-pattern specific and that will result in more effective and fruitful interviewing experiences.
In conclusion, humor is a useful communication tool for family caregivers who need to convey sensitive and personal information to health care providers. Unfortunately, families have learned to use complex humor response patterns better than professionals have learned to interpret the function of humor in the interview situation. Important theoretical development and practical applications of this area of inquiry remain.
Project supported by a grant from the Nursing Research Program, Clinical Applications Research, Glaxo Wellcome, Inc.
This article was presented as a poster session, Annual Meeting of the Gerontological Society of America, Philadelphia, PA, November 1998.
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About the authors:
Lisa Sparks BETHEA
Department of Communication
George Mason University
Shirley S. TRAVIS
College of Nursing and Health Professions
University of North Carolina at Charlotte
Department of Speech Communication
Louisiana State University
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