Jul 14, 2020 in Health

Gallows Humor

Health professionals are notorious for joking in a crude, cynical manner because they deal with life and death situations on a daily basis and need it as a method of coping with stress. In the article “Gallows Humor in Medicine,” Katie Watson suggests a more nuanced and complex understanding on the reasons underlying this phenomenon. The author argues that black humor, or gallows humor, aims to show medical workers’ belonging to a group, reveal an ugly truth when it is difficult to vocalize it, and help coping with doctors’ helplessness in terminally ill cases. Although for an outsider some cases of medical humor can seem rude and insensitive, I find it instrumental for medical workers to deal with high levels of stress and despair and believe it is justified within their group. 

Humor in medicine often refers to serious issues such as grave illnesses, terminally ill patients, and death. It has a special name for it – “gallows humor” which means “humor that treats serious, frightening, or painful subject matter in a light or satirical way”. Not all people find this type of humor funny and light-hearted and some are outright offended by it. However, even though gallows humor is a version of adult jokes about important matters, it does not necessarily imply derogatory treatment of patients, even if they are a butt of the joke. Humor is a multifaceted and multidimensional phenomenon studied by the great minds of humanity such as Ancient Greeks and modern philosophers and psychologists. Therefore, one should not automatically conclude that joking about somebody is a sign of disrespect.

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Humor performs many functions and, referring to medical and health specialists, coping with stress is one of them. Doctors and nurses daily deal with life and death situations and come across medical cases they can do nothing about, so they need an outlet and some way of handling the pressure. Sigmund Freud argued that “through laughter” humor helps people “release psychotic tension” from “death … and other anxiety-provoking topics like sex, excrement, race, and religion”. Viktor Frankl, a famous psychologist and a WW2 survivor, also said that humor had helped him and his friends survive cruel treatment in the concentration camp as it gave “an aloofness and an ability to rise above any situation, even if only for a few seconds”. 

Health care providers can often be exhausted mentally and physically and it contributes to their proclivity to joke darkly. An important aspect of why gallows humor thrives among health professionals is their working conditions, namely a habitual lack of sleep. I personally know a few physicians like surgeons and psychiatrists and I know their night shifts can be very grueling. I do not know about all doctors but doctors of these specializations have a very dark sense of humor and their friends have no problems with it. When an individual’s physical body is weak, defense mechanisms get weaker and people become less compassionate. Additionally, young physicians are more susceptive to emotional stress because they deal with a larger number of people such as their supervisors, patients and their relatives, whereas their senior colleagues do not have as much ‘vertical pressure.’ Thus, for interns and young doctors humor becomes “tension relief” more frequently than for their older colleagues. 

Additionally, people’s reaction to humor often stems from how they see power play. If they think doctors are powerful gods, they perceive doctors’ jokes as a jab at patients’ vulnerability and weaker position. Bullies can use humor to humiliate and denigrate their peers and by association people might think that doctors act as bullies when they joke about their patients’ conditions. However, if people can see doctors’ despair at difficult cases, they can understand that a feeling of one’s powerlessness sometimes results in gallows humor.

Therefore, one should be careful not to confuse power play with tension relief. In her article, Watson gives an example of obese patients and their doctors who joke at them and explains that it is more nuanced than it seems. When doctors  utter darkly humorous comments it is not necessarily ‘the healthy making fun of the sick’ because some cases of obesity are beyond recovery and doctors’ jokes are more cheering themselves up and trying to compensate for the blame they feel for not being able to cure them. Doctors are not omnipotent, even if they want to be so. So gallows jokes that seem too cynical and even degrading of patients are often a response to doctors’ feeling of helplessness.

Another function of humor is creating a sense of connection. In case of gallows humor, it refers to situations when a backstage joke is intended only for colleagues and sometimes only for a very narrow group of colleagues. Watson writes in the article that doctors admit that they believe some types of jokes are appropriate only for senior colleagues who, so to say, ‘earned’ their right to make fun of their jobs, so they frown upon younger physicians treading on the ‘wrong’ territory. Philosopher Ted Cohed also confirms that connection is one of the functions of humor aimed to emphasize people’s likeness in something. ‘Connecting’ jokes can be exchanged between physicians who want to establish closer relations between their colleagues and themselves. Also, it can be patient-doctor jokes which remove the distance between the doctor and his or her patient and thus humanize patients and remind doctors that their sense of humor is alike and they can be alike in other ways too.  

Finally, Watson admits that some gallows jokes are funny simply because people react to linguistic and behavioral absurdities.  In some cases, it is not disrespectful to laugh at a particularly dark medical joke; it is a reaction at linguistic incongruity. Watson gives an example of this type of a joke: “‘Funniest beeper pages in the middle of the night’ [is,] for example, ‘Doctor, your patient is on fire’”. In this case, clinicians do not make fun of a particular patient or of any patient. Rather they laugh at incongruity in this situation on many levels: the content is absurd as “people do not usually catch on fire, especially in hospitals”; linguistically it is difficult to imagine that someone has time to send a message if a patient has caught fire somehow; metaphorically it may mean that a patient urgently needs to see the doctor and demands it in a very emotional manner. All these together make a joke funny and without any disrespect to patients. 

For me all these functions of humor justify its use in medical circles. I agree with Watson when she concludes that to check a medical joke for appropriateness one should ask several questions and see whether the joke truly makes patients targets or it is more a coping mechanism, whether it prevents practitioners from fulfilling their obligations thoroughly, whether it is told in an appropriate place because the joke can be fine for doctors but sound insensitive to relatives. I do not think doctors should not allow themselves gallows humor but it should be done with care and consideration. Humor is one of the distinctive features humans have in contrast to animals. Inasmuch as humor has many functions, it is highly advisable as one of the coping mechanism for medical specialists.

Medical professions deal with hard life situations on a daily basis. Therefore medical humor is primarily one of coping mechanisms. Helplessness that doctors feel transforms incongruity and absurdity of life situations and meaningful illnesses into a positive force that sustains human life. It should be noted, however, that a range of coping mechanisms is not limited to jokes about difficult life situations only. Straightforward communication about difficulties and absurdities in work and verbal expression of difficult emotions became more wid spread as a coping mechanism. However, jokes still have the right to exist and should be treated with consideration.

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