Patty Wooten presents ... 
An Interview with Sandy Ritz
From Journal of Nursing Jocularity, Spring 1995, 5(1), pp 46-47.Sandy Ritz, MSN, MPH, NP is a public health doctoral student at the University of Hawaii. Her dissertation research explores how the survivors of disasters use humor. She received her BSN and NP degrees from the University of California at San Francisco in 1975 and her MSN and MPH degrees from University of Hawaii in 1981. She's worked as a nurse manager in a clinic for neck and back pain and as an independent nurse consultant for patients with chronic pain. She is now a legal nurse consultant and owner of MedicoLegal Research Services, which provides consultation and expert witness services for physicians, attorneys and insurance companies. Her interest in humor began with patients suffering from chronic pain. She noticed that humor facilitated their recovery. She is a frequent speaker and presents "Lighten Up Seriously!" for nurses and other caregivers.
Patty Wooten: Sandy, tell me about your research with disaster humor.
Sandy Ritz: My research initially began studying the scope of humor and health as a public health phenomenon. I planned to look at culture and humor. I changed my focus after my experience working in Kauai following hurricane Iniki. As I was helping, I noted that there was a lot of humor going on. So I kept notes on comments, and then I'd draw cartoons to capture the message. I have a year's worth of cartoons recorded.
One broad definition of culture means a shared perception. Disaster survivors create a disaster culture. A disaster is a situation where available resources are overwhelmed and people can no longer cope. Public health efforts, in a disaster situation, attempt to create a supportive environment for people to deal with adverse situations. We're supposed to help the survivors resume independent function by supporting their usual coping mechanisms. My agenda: if the role of health workers is to step in and support usual coping mechanisms, then they need to understand that humor is a coping mechanism for some people and for other people it's not. An understanding of humor can provide an assessment and an educational tool for public health workers.
In all the disaster literature, they talk about normal coping mechanisms, but no one's talking about humor. There's an occasional recommendation to "avoid grim humor" and "laughter's the best medicine." I'm attempting to look at humor as a therapeutic intervention for a community in crisis. I'm looking at the idea of using humor for community healing, bonding and respite. Survivors share the same experience and perception and therefore share the humor. Survivor humor is spontaneous. It is situationally-relevant and actively produced by the survivors as a coping mechanism to laugh with each other and at the situation.
PW: What is the hypothesis for your research project?
SR: My hypothesis is twofold: Certain types of humor are associated with the emotional phases of disaster, and these emotional phases are associated with a type of humor. It goes both ways.
PW: You mean the humor may shift, indicating a change of phases, or that the phase will change and their humor shift will follow?
SR: Don't know yet. When I was helping in Kauai, I wasn't looking at phases. I was just recording humor. Then when I learned about the phases, I went back and looked at the cartoons. I saw that not only are there certain types of humor, but that you could tell what phase the survivors were in by the type of humor they liked. "Oh, he's in the disillusionment phase. He likes George Carlin's humor because he's pissed off." The type of humor the survivor uses or appreciates may be dependent on the phase of emotional recovery he or she is in. The humor used could be a useful indicator in the mental health assessment of the disaster survivor.
PW: Can you explain these phases and what they mean?
SR: Disaster Relief mental health specialists have identified emotional phases that survivors experience following a disaster. Awareness of these phases can assist the public health disaster worker to understand and support the coping style used by survivors as they go through recovery. Different types of humor are used or avoided in each of these phases. Note that these phases are descriptive and not normative. Survivors may move back and forth between phases as circumstances change. An understanding of the humor used in each of these phases will help the worker support the use of humor as a coping strategy.
The Heroic Phase, occurs at the time of the impact and immediately after. At this time, much energy is spent helping others survive and recover, altruism is prominent and, if there is any humor, it is spontaneous and often not considered very funny to an outsider. It is used to relieve tension and overcome fear. For example: Two hikers, caught on the coast trail of Kauai when the hurricane struck, sang the theme song from Gilligan's Island. They kept up their spirits and dispelled their anxiety by reframing the situation in a comical format.
The Honeymoon Phase lasts from one week to six months. It is the phase of recovery optimism, where survivors feel supported by relief efforts, and feel a joy in being alive. They deny any negative emotions or difficulties. The humor is positive and upbeat. It is humor that laughs at the absurdity of the situation without a lot of anger. Examples are T-shirts with, "Landscaped by Iniki" or "House for sale -- best deal of the century."
The Disillusionment Phase lasts from two months to two years, although I believe it can start as early as four days post-disaster. It is a time of grieving and feelings of disappointment, anger and resentment, as agencies and community groups become less involved and survivors rebuild their lives. Survivors feel isolated, angry and pessimistic. The disillusioned survivor is bitter and can easily be offended by attempts at humor. Aggressive humor expresses powerlessness through satire, ridicule and irony aimed at disaster workers and others in power. A T-shirt in Florida after Hurricane Andrew said, "I survived Hurricane Andrew, but FEMA is killing me" (FEMA is the Federal Emergency Maintenance Association.) During this phase, joking from anyone perceived as an outsider, even disaster workers, is not appreciated by survivors and can be easily misinterpreted.
The Reconstruction Phase may last for several years. It is a time of rebuilding and recovery. Humor returns slowly and may reflect a sense of community. It can acknowledge collective fears, goals, problems, acceptance and adaptation to change.
PW: Your research is pioneering a new way of understanding and evaluating disaster recovery.
SR: Yes, no one has looked at humor from these established descriptive phases. We must understand that humor is a very complex communicative tool whose expression could be an assessment cue.
PW: Can you describe your research methodology?
SR: I am using twenty of my cartoons, five for each phase, as measurement tools. I am testing them on health care providers who've just completed a two day training in mental health disaster relief. They are asked to assign each cartoon to one of the phases of disaster recovery. Early testing suggests that those with prior disaster experience can identify the phases more accurately than those who've only learned it in the classroom. Maybe it's because they've already shared the disaster culture. We are testing each cartoon for clarity and to see if it represents the phase I predict.
We're finding certain cartoons are very regional, and some workers don't get the implications. For example, in California, the workers didn't understand the one about the guy who runs for the ice, past all the free food and money. Right after a hurricane, it's so darn hot and there's no electricity, so your main concern is keeping your food and drinks cold. Money doesn't really matter that much yet. So that cartoon is too region-specific. I want my test cartoons to reflect universal, shared survivor humor, no matter what the type of disaster.
Another example: After the fires that destroyed over 500 homes in Santa Barbara, men made up T-shirts that said, "My chimney's bigger than your chimney." After a firestorm only the chimneys are left. People in Hawaii don't have chimneys, so they don't get it. After testing the cartoons, I'll survey experienced disaster mental health specialists to validate the association between the humor in these cartoons and the phases.
PW: Are you going to use these cartoons with the survivors as well as the workers?
SR: I have a real concern with the ethics of doing research on disaster survivors. In the middle of a disaster you need to pull up your sleeves and start helping. Testing these cartoons on survivors could uncover strong emotions. Humor and tears are just too close. The researcher would have the responsibility to provide appropriate and adequate support for the survivors through the expression of those feelings.
PW: We know that survivors use humor and workers use humor. Is there any difference in the types of humor used?
SR: Workers use humor to offset compassion fatigue. They may use a type of humor that survivors would find offensive. At the same time the survivors' humor may be unappreciated by the workers. If they overhear each other, resentment could arise and block the communication and caring aspects of the helping. There are certainly implications for further research in this area.
PW: Why is it important for nurses to understand survivor humor?
SR: Anyone can be confronted with a disaster. Nurses in particular may be called upon to help, work and live in horrendous conditions. We need to develop humor skills as a coping strategy now, including the ability to actively produce spontaneous humor. So, when faced with the adversities of disaster recovery, these skills can be called upon to help relieve tension, manage stress and reframe perspective. Survivor humor in a disaster can help you cope and maintain hope.
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This article was originally published in "Jest for the Health of It", a regular feature in the Journal of Nursing Jocularity.
Feature columnist Patty Wooten, BSN, is also a past President of the American Association for Therapeutic Humor, author of two books related to humor, and a national speaker presenting on the benefits of humor.
