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Wednesday, April 13, 2011

'Appropriate' affect", "Inappropriate affect" - is humor a bad thing?

I fell this past Monday. Splat, right on my face. My nose was bleeding profusely, turning all sorts of colors it is not supposed to be.

Strangely I was not in pain. I had some aches here and there but nothing spectacular. Mostly I felt perplexed, how did I do that? and embarrassed.

The more uncomfortable I feel the more I smile and joke around.

Ambulance attendant: "We think you may have broken your nose."
Me: "That's okay. I could use a nose job."

Ambulance attendant: "I found your mirror but it is all broken."
Me: "Uh Oh. 7 years more bad luck."

He and I laughed and joked some more. Then I arrived at the hospital. No one really stayed around long enough for me to joke with them. I wondered though. Is it in the records that my affect was off because I was joking around?

I grew up being told, when punished, "You get into your bedroom and do not come out until you are smiling. I don't care how you feel, I expect a smile."

It was a lesson I learned well. The joking was an offshoot of the sometimes inappropriate smile.

I remember being in the hospital being evaluated for the pain. As often occurs with chronic pain patients I was seen by a psychiatrist.

Psychiatrist:"Your pain cannot be as bad as you say. You are always smiling."
Me: "The more I hurt the more I smile. It's something I learned in childhood."

His chart note read 'smiles inappropriately.' He ignored my explanation, something a psychiatrist should have attended to. Instead he concluded that maybe my pain was not as bad or disabling as I said.

I can understand that. Your pain is horrific and your response is to look happy? Something cannot be right.

The only problem is I have found the opposite to be true as well.

People who are in pain tell me their doctors say they are malingerers or faking it because they cry too much or talk about it too much. Research has shown women, for instance, are less believed then men, when they come to the doctor complaining of chronic pain. If they look well they are disbelieved and if they look disheveled they are believed to be depressed rather than in pain.

Pain being subjective is a problem when it comes to being believed. It is made worse when doctors jump to conclusions without asking us: Why do you laugh? Why do you cry?


  1. Inappropriate affect. First, don't take it personally. It's clinical jargon that just means you laughed when most people might have cried. I agree that professionals often use the term "inappropriately." But let that be their problem.

  2. Ah I try to preview for post, always forget to double check the title. ((*_*))