The Development of Humor

Let's go back to Matrim laughing.
Now, I'm not what anyone would describe as "baby crazy," however, I am fascinated with human development. I am also, because of my 'night job' inherently interested in the idea of a sense of humor, and what makes things funny. The anatomy of a laugh.

To me, a baby laughing in response to a non physical stimulus is the most interesting thing a baby can do because it's a sign of the development of thought process as well as a sign of a developing sense of humor.

To break it down developmentally, Matrim is 15 months old which puts him in the Sensory Motor cognitive stage of development. He is not just a little adult. His brain works differently than mine or yours. He achieves all of his learning through his senses and his developing physical relationship with the world.

By four to eight months infants engage in repetitive behavior to produce interesting effects, such as batting at a mobile to make it move. Or, in the case of Matrim's YouTube video, dropping a toy to produce a noise/make his uncle pick up the toy again.
By the time an infant is fifteen months these repetitive behaviors increase and take on even more intention, as the effects can be predicted by the baby.

When you want to start talking about the beginning of the Development of a Sense of Humor you're beginning to talk about Social Development.

Babies smile in recognition of their mother or father's face or voice when they are only two months old in some cases. They laugh by the age of four months, usually in response to tickling or facial recognition. It's not until months and months later that laughter is elicited by engaging in games like "Peek a Boo." The reason is that only by then has the baby gained the cognitive concept of "object permanence." When Mom's face disappears Baby knows she's behind her hands, but there is some very tense time waiting for her to return. When she does return, with a noise and an abrupt motion Baby laughs, the same way we jump and laugh at the sudden loud noises in scary movies.

But by the time an infant is Matrim's age he is actually finding humor in noises or events. He might laugh if Mom or Dad pretends to eat his food. Or if they make funny faces. This in and of itself is fascinating to me. I have spent many a day in Baystate Children's Hospital trying to make an infant laugh. And most babies past 8 months have already developed enough sense of taste to know what's funny and what's just not. Think about that for a second.

But THEN, even more amazing, the infant learns how to make other people laugh. The same way physical cause and effect was once established, social cause and effect begins to set in when he begins to process which actions or events are positively reinforced by the laughter of those around him.

Matrim, although he is unable to stand on one leg or talk in complete sentence, can make a joke. He is intentionally repeating an action that he knows will be funny, and he thinks it's funny too.

Someday he will move on to more sophisticated humor: first, intentionally garbled words in otherwise familiar songs, moving on quickly to non sequitors, and graduating eventually to puns and knock knock jokes by the time he's nine*. The rule of three comes later. Scatological jokes though, as far as I can tell, are forever.

If the kid is smart, no matter what he'll keep playing to his audience as well as he does now.
And then we'll go on tour.
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* Uncles automatically revert back to this stage once they become Uncles.

scapel, clamp, sponge, farts

I love my stethoscope. It's a simple classic Littmann, and was a gift from my college roommate Jen for getting into the School of Nursing. I love the new RN computerized charting system. Oh! And I am a huge fan of the mini portable 02 sat reader because it's so handy to bring into patient rooms. But my favorite thing at work right now is The Fart Machine.

One of the nurse practitioners set up in the work room one day last week. She kept hitting the remote and amazingly realistic noises began to fill the air. She let me borrow the fart machine to use all day on the floor. The results were amazing. I made grumpy co workers smile. I made friends with a respite aide who I work with often but rarely speak to, and I got laughs from housekeeping staff who don't speak the same language as I do. Just as in Tokyo, some humor doesn't need language. Like fart humor.

Clinically speaking the results were even more significant. I used the machine wisely. For example, I didn't use it when I was with my patient with extreme paranoid schizophrenia because I know it would have agitated her quite badly. But I made the most out of every appropriate opportunity.

For example, I worked with a new admission who hated needles but needed a flu shot because she's so high risk. As I prepped the injection she was very jumpy, unable to sit still. I took my time as I got everything ready and hit the button in my pocket as I approached her. She made eye contact with the NP in the room, who shrugged at her. I hit the button again and her jaw dropped but she recovered quickly. As I swabbed her arm with the alochol pad I hit it a third time, and she couldn't be polite any longer and asked, "Are you farting?" I responded by saying, "sorry, rough breakfast," and letting out five more honks, which sent her over the edge. I showed her the button she was so amused and distracted that when I said, "here we go," she held out her arm and I stuck her with no problems at all.

I made a ton of patients laugh the first day with the machine, but my favorite was this woman who has a terminal diagnosis and is here for some real respite care. She is in almost constant pain despite her long list of pain medications, and rarely leaves her bed. I bent over in her room to pick up a cup and hit the button. She jumped. I excused myself, and she told me it was alright. It happened again and I grabbed onto the bed and she asked if I was ok. But then I just kept pushing the button, contorting my face each time until she was screaming with laughter. Tears rolled down her face, and she got out of bed and followed me down the hallway telling people, "listen, my nurse has broccoli for breakfast! Listen!" She told me I made her day.

And that is why The Fart Machine is my favorite new clinical tool.