Gallows Humor and the Physician's Psyche
“Life does not cease to be funny when people die any more than it ceases to be serious when people laugh.”
-George Bernard Shaw, The Doctor’s Dilemma
Laughing at Death, Part 1
by James Belarde
If you’re reading this article, you’re going to die. That’s not to say, hopefully, that this piece is so bad it will kill you.
Nor is it a cursed essay like the video in The Ring, a horror film I still refuse to watch on principle (the principle being that I’m scared). What I mean is that dying is an inevitable experience for all who live, a topic each of us has thought about. And like all widely relatable things, death is fertile ground for comedy. But does humor born from death, an event usually consumed with sadness and pain, serve a deeper purpose than producing nervous chuckles?
The technical term for this comedy is gallows humor, and while it can be used to describe jokes on any threatening or frightful topic, it is most often associated with death and dying. Hence how it came to be named for the gallows, an old device for hanging criminals. One (likely apocryphal) anecdote illustrating this connection comes from the execution of infamous poisoner and physician William Palmer in 1856. When examining the trapdoor he was to stand on for the hanging, he reportedly asked the executioner “Are you sure it’s safe?”
It’s important to note that gallows humor is distinct from offensive humor, which often derives from topics termed “blue material” in the comedy industry. (Quick historical aside: the term “blue material” comes from the vaudeville theater days of the early 20thcentury. Theater managers had to approve an act before the performance. Anything deemed inappropriate would be sent backstage to the performers in a blue envelope, which they were then required to leave out of the show.2) Offensive humor obtains its effect by shocking and creating discomfort with little concern for whom the joke might be bullying. Gallows humor, on the other hand, is typically more nuanced. While it can be shocking and uncomfortable, it isn’t necessarily seeking to do this, and certainly not at anyone’s expense.
Though an analysis of a joke often kills anything fun about it, I’ll offer up one of my own on the sacrificial altar of comic theory to more concretely pin down an idea of gallows humor. For years I’ve performed a joke based on annoyance with belated birthday cards and an industry creating a product to capitalize on a social faux pas (forgetting someone’s birthday). This, of course, as opposed to being satisfied with people sending regular birthday cards late, perhaps with a scribbled apology. After setting up this premise and reaching the conclusion there should be similar cards for other mistakes if we’re going to condone the belated birthday, I reach the main punchline: “The next funeral I go to, I want to bring a belated get well soon card.”
In this joke, as in many that fit the gallows humor label, death is used to highlight the absurdity in and poke fun at a common phenomenon: the commercial condoning of careless behavior. Forgetting someone’s birthday is exaggerated to forgetting their illness until too late (and buying a card that says as much in both cases). And while this joke tends to get a good response on stage, I learned over several iterations it requires a specific presentation. The punchline always works better when it’s kept as hypothetical as possible. Wanting to bring this card to a vaguely defined future funeral gets more laughs than pretending I did bring such a card to a recent one. Ambiguity creates a psychological distance, allowing an audience to feel more comfortable laughing at a macabre joke, silly as it may be.
This mental detachment from the topic is a common quality of gallows humor that sets it apart from offensive comedy. It suggests a concern for the listeners’ sensitivities that more cruel humor actively seeks to upset. The distancing can also come in many forms, from ambiguity to depersonalization to sheer unbelievability (yet another thing working in my favor in the greeting card joke, as few can imagine such an offensive product realistically being made and utilized). And the comedy world knows well the power of this tool in mining humor from deadly subject matter. As Mel Brooks said in character as the 2000-year-old man, “Tragedy is when I cut my finger. Comedy is when you fall into an open sewer and die.” This exaggerated comment illustrates how much funnier something morbid can be the further removed it is from an observer’s experience.
In part 2, I’ll seek to examine the role gallows humor might serve for suffering patients or those near death. But I would like to conclude this article with a brief look at the benefit it might have for physicians. To start, I want to suggest that not only does space make a joke on death funnier, but attempting to participate in gallows humor can itself serve the function of psychologically dissociating the participant from these uncomfortable topics. Thus, distance can create comedy, but comedy can also create distance.
The tragedy of death constantly assaults physicians as they tend to the ill and their families. If this vicarious pain is felt too personally, it can place an overwhelming burden on doctors’ psyches and hinder their ability to provide optimal care to those who need it. Participating in gallows humor with colleagues behind the scenes, especially that not founded in deriding patients but rather based in highlighting the absurdity of death, can help depersonalize the losses and shield doctors from incapacitating grief.
Of course, treading the line between this kind of humor and jokes that are more malicious is difficult. But it’s important to address. After all, if gallows humor can provide a psychological benefit to doctors, I would hesitate to suggest they should abstain entirely from these jokes. But even as a coping mechanism, its use should remain within reason. It’s an ethical debate with no clear answer and not one I can do justice to here. But in a fascinating article on this topic by ethicist and comedy instructor Katie Watson (which I strongly encourage reading), Watson asserts the use of gallows humor by physicians is worth a critical eye and not something we should dismiss lightly. After all, as she puts so well in the article, “Surely we can advocate for the humanity of patients without denying the humanity of those who treat them.”