Surprise Liberation Theory
In her book on playful conversations between patients and providers across seven different healthcare settings, du Pre (1998) argued that humor can function as a signal that things are “not so bad” for those involved. She defined humor according to her surprise liberation theory (SLT): When something is interpreted as funny, it’s because we’ve encountered a surprising deviation from our expectations, and because we’ve perceived that deviation as pleasurable and liberating. Du Pre also specified that we possess fluid upper and lower boundaries that define our willingness to see our expectations for different situations and phenomena subverted. If a surprise goes beyond those thresholds and violates an assumption that we cherish (e.g., our loved ones’ safety) or are indifferent to (e.g., being asked for the time by a stranger on the bus), we would consider the surprise too threatening or too trivial to be considered humorous. However, especially when we’re committed to an expectation that something is menacing or restricting, an unexpected event can provide us with a sense of profound relief (du Pre, 2018). But what would bring a doctor or a patient to include humor in a “serious” setting like a hospital room or medical office, and what effect could it have on the rest of their conversation?
Relational Perspective of Communication
Du Pre (1998) argued that medical routines, especially those that are tense and formal, can actually lend themselves more to the use of humor than other less threatening situations. Because even the smallest surprise in cold, distant, sterile, and regimented medical settings can seem unexpected and comical, both patients and healthcare providers can experience humor as a temporary reprieve from their anxiety, and its use can help redirect their conversation going forward (Schöpf et al., 2016). This phenomenon can be explained by the relational perspective of communication (Bateson, 1972), which views communication as a transactional, collaborative process in which both sender and receiver influence and interpret the meaning of a message together.
For example, a message receiver can send feedback that helps determine the ways in which a sender’s initial statement is ultimately interpreted. Du Pre (1998, pp. 95-96) described a humorous exchange that she observed in a breast care center before a patient received a mammogram, which takes x-ray images of a patient’s breast tissue while two flat x-ray decks compress the patient’s breast. As the technician explains to the patient that the machine has “automatic compression” that will prevent it from crushing her breast, the patient delivers an ambiguous statement (“I don’t know that that’s such a good idea!”) that could be interpreted as “I’m actually nervous” or “I’m just joking around.” When the technician chooses to laugh along with the patient rather than seriously explain why that wouldn’t happen, she communicates to the patient that her fear was unreasonable, and the patient laughs off as a joke her initial statement.
When both the patient and the technician treat a potentially serious message as funny following the technician’s feedback, we see that communication is a collaborative process in which meanings are mutually managed, and that humor can be a persuasive guide to interpretation. In fact, du Pre (1998) noted that following the introduction of humor in healthcare exchanges, patients and providers tend to appear more relaxed and casual with one another. The rest of their conversations are often filled with more eye contact, smiles, personal stories, and humor attempts than before. Thus, she argued that humor can help us change the “sense” of a distressful, threatening, embarrassing, impersonal, “uncommonly weird and emotionally charged” (p. 153) situation in a radically different way.