Is Humor Possible in Psychiatry?

I just have a few moments before heading off to my (perpetually solemn) work, but at the risk of seeming to protest too much, I thought I'd dash off a few thoughts on humor and its hazards in psychiatry as raised by the last post.

The theory of humor is famously unfunny, but it seems to me that amusement can arise from: our common vulnerability to physical circumstance (slapstick), the humbling of the high and mighty and the pretentious (satire), and the sheer delight of ambiguity (puns).

The general humor of medicine, such as it is, owes most to satire inasmuch as doctors are viewed as (and really are) self-important. However, psychiatry is more subject to smirking precisely because of the ambiguity of its practices. Thus the myriad on-the-couch cartoons of The New Yorker are funny precisely because psychoanalysis is an ambiguous endeavor (this humor is also safe inasmuch as the patients there are viewed as well-to-do worried well). However, from the point of view of stigma, one could argue that psychoanalysis is in desperate straits as a profession; can it afford such lampooning?

There are a number of problems that are not funny because they are both serious and unequivocal: schizophrenia, dementia, mental retardation, severe depression, etc. However, when, as yesterday, when I see a new patient who has diagnosed himself with adult ADHD, I smile wryly to myself not because ADHD is not a real and serious condition, but because it has become so faddish and so ambiguous. Senility used to be faintly amusing until it became better appreciated how devastating dementia really is. Similarly, drunkenness is becoming less amusing over time as the gravity of alcoholism is better appreciated.

Arguably bipolar disorder is in a class by itself in this respect inasmuch as, in its severe forms, it is an appalling and potentially fatal disease, but it continues to defy proper understanding, as reflected in the ongoing controversies over its diagnosis and treatment. If I sometimes roll my eyes at bipolar disorder, I am doing so not due to its sufferers, but due to my and our own incomprehension of what is really going on. I will grant that, given the epistemological quagmire, humor may be best avoided, but prudence does not always prevail.

So in my humble opinion the Onion piece was funny on multiple layers. It was a kind of behavioral pun, in which Obama's roller coaster ride in politics and public opinion was suddenly cast in the absurd new light of a mood disorder. It was absurd, and therefore funny, precisely because we know that Obama doesn't have bipolar disorder (if he suddenly did, it would cease being funny). And given Obama's lofty status ("The One"), there is a pleasure in puncturing the pretension, even for one of his supporters.

So as a politically-interested psychiatrist, I was naturally amused not because the piece somehow made fun of bipolar patients, but because it showed the fallibility of our own diagnostic practices in a political context. I can well understand, of course, that someone with clear-cut bipolar disorder might view the Onion piece rather differently. After all this analysis, it ceases being funny, but that fact in itself is mildly amusing.

Bipolar Barack

Some time ago I wrote a post that questioned the practical feasibility of electing a U.S. president with openly diagnosed bipolar disorder. I caught some flak for that, but I have changed my point of view only today, thanks to this mind-blowing story by The Onion. This changes everything. Vice-President Biden is helpfully diagnosed as well at the end of the first clip. If President Obama starts to put on a lot of weight, we'll know why. (No, this is not a cheap shot at bipolar disorder; it's merely hilarious).

Story and Schizophrenia

This year marks the bicentennial not only of Darwin and Lincoln, and of Edgar Allan Poe, but also of Nikolai Gogol (1809-1853), who will fittingly turn 200 on April Fools Day. In addition to his comic masterpieces "The Nose" and The Inspector General, he is remembered for his short story "The Overcoat" as well as the novels Taras Bulba and Dead Souls. And in "The Diary of a Madman" (1834) he produced an early description of what may be schizophrenia.

Compared to psychoses related to substances or to depression or mania, which are relatively common in historical and fictional accounts over many centuries, schizophrenia is relatively scarcely documented in past records before the 19th century. This has led some historians of psychiatry to argue that schizophrenia could in fact be a relatively novel disease, related perhaps to an as yet undiscovered virus or to modern society itself (a number of studies, although not all, have suggested the urban environment as a risk factor for schizophrenia). Or schizophrenia may just have had a lower profile because its unremitting, less forgiving course has afforded less historical opportunity for articulation in memoirs and literary works.

A summary of "The Diary of a Madman," as well as the historical speculations about schizophrenia, may be found here. The story is notable for being Gogol's only work written in the first person, as the remarkable account of the clerk Poprishchin, who hopelessly admires the daughter of the office director, comes to overhear the conversations of dogs in the street, and ends up convinced he is the King of Spain.

The story is an interesting amalgam, on the one hand a whimsical parody of the hapless functionary oppressed by the system, yet on the other a poignant treatment of a deteriorating mind. It ends as follows (trans. Pevear and Volkhonsky):

No I no longer have the strength to endure. God! what they're doing to me! They pour cold water on my head! They do not heed, do not see, do not listen to me. What have I done to them? Why do they torment me? What do they want from poor me? What can I give them? I have nothing. It's beyond my strength, I cannot endure all their torments, my head is burning, and everything is whirling before me. Save me! take me! give me a troika of steeds swift as the wind! Take the reins, my driver, ring out, my bells, soar aloft, steeds, and carry me out of this world! Farther, farther, so that there's nothing to be seen, nothing. Here is the sky billowing before me; a little star shines in the distance; a forest races by with dark trees and a crescent moon; blue mist spreads under my feet; a string twangs in the mist; on one side the sea, on the other Italy; and there I see some Russian huts. Is that my house blue in the distance? Is that my mother sitting at the window? Dear mother, save your poor son! shed a tear on his sick head! see how they torment him! press the poor orphan to your breast! there's no place for him in the world! they're driving him out! Dear mother! pity your sick child!...And do you know that the Dey of Algiers has a bump just under his nose?

It is telling that Gogol ended this harrowing passage with the grotesquely comic note at the end. It brought to mind the way that well-meaning folks outside of psychiatry, curious about the inscrutable, want to hear about the flamboyant absurdities of the truly around-the-bend, and end up disappointed that these are far outnumbered by sordid banalities. In the interest of understanding stigma, why is craziness so often found to be laughable, in life and in popular culture?

Three possibilities occur to me. One is the theory of humor as incongruity, as the sight of animate persons behaving as things or automata (thus slapstick and, potentially, psychosis; but it's not funny if someone really gets hurt, which is why real schizophrenia is not amusing).

Second is the theory of humor as a way to take down the powerful or pretentious. Oddly, all paranoia can be seen as massively self-centered or grandiose--in a clinical and not a moralistic sense--inasmuch as the target is implied to be sufficiently important as to mobilize intricate schemes of surveillance or hostility. Paranoia is not self-abnegating--quite the opposite. Pathologically this may be unconscious over-compensation for what is in fact the disintegration of the self, but to observers it may appear as self-aggrandizing, which may in turn inspire humor as a way to deflate the paranoia.

Third is the possibility that madness provokes massive anxiety of the there-but-for-the-grace-of-God-go-I variety, and humor is the way we manage this discomfiture.

The Funny Book

"And yet you are sad. I had rather have a fool to make me merry than experience to make me sad; and to travel for it too!"


Rosalind



When I splurged on the luxuriant two-volume Complete Far Side five years ago, my then five-year old took an interest for some reason. She was accustomed to seeing me reading (a lot), but the sight of my laughing out loud at a tome nearly as large as her was irresistible I suppose. So we developed a regular habit of reading "the funny book," as she always called it. We enjoyed it on two levels--I enjoyed her company and Gary Larson's sublime sense of the absurd, while she enjoyed all of the funny-looking animals and people. She always tried to get me to explain the joke, and it was a good reminder of all the cultural foundation beneath a simple witticism.


The other night we retrieved the book for the first time in a long while. She is ten now, but dry wit, like puberty I guess, is still (fortunately) for her a ways off. Analysis of humor is notoriously unfunny, and none of my explanations leads to hilarity--I'm sure Larson could have done a great panel on some solemn-looking kid cramming to become a comedian or a cartoonist (and it probably would have involved a duck somehow).


The sight of any Far Side cartoon takes me instantly back a quarter century. Larson's strip ran from 1980 to 1995, but it was pre-eminently a creature of the 1980's; tellingly, he took a year-long sabbatical in 1989, and the last five years of the series seemed tired and plodding in comparison to its heyday. Even genius runs its course. To me The Far Side is one of the very few great cultural products from that benighted time; before Seinfeld was the "show about nothing" in the following decade, Larson's work was the cartoon strip about nothing--except raw wit and the unabashed depiction of ludicrous but pitiable humanity.


I like my humor in lightning flashes: the devastating turn of phrase or sight gag. The best visual humor, whether in the old-fashioned pen and paper cartoon or in a digital concoction on The Daily Show, bursts upon us in an instant. I always liked Larson's style because it was so simple, even archaic; its visual directness contrasted with its extreme semantic shrewdness.


Far Side kids were always chubby, naive, and incredibly dorky--they were wide-eyed in a crazy world. The men tended to be of two types, either nerdy and vulnerable (and therefore paired with a strong-minded woman), or oafish and slovenly, but in a complacent, bachelor, devil-may-care sort of way. The women were matronly and, it must be said, homely in the extreme.


Of course the strip was dominated by animals, but they, like all the clowns, scientists, aliens, and cavemen, were really ways of accentuating our own very peculiar propensities in an unfamiliar host (witness the praying mantis kids having breakfast: "Mom, Edgar's making that clicking sound again!"). I have no idea what Larson's views on animals is, but his cartoons often implied the mayhem that humans are continually creating in the natural world (one of my favorites shows a suburban dude's consternation as some bears direct their sewage pipeline into his living room).


Looking back now, nuclear holocaust was a surprisingly frequent theme (it's not easy explaining to a ten-year old how that's funny), as are scientists shown as careless and as clueless as the rest of us. Compared to, say, New Yorker cartoons, shrinks were a rare subject (although one of his best shows a hapless "Mr. Fenton" perching in the office coatrack); Larson was writing for a less thoroughly therapized readership. But I can't imagine any cartoonist having more fun with hell (nerds in hell ("Hot enough for ya?"), distributing accordions in hell, video racks full of nothing but Ishtar in hell, pizzas being delivered to hell).


Far Side humor is frequently satirical of course, but never witheringly so. The animals were counterpoised to people as if to remind us that we, too, are animals, with our own limited needs, visions and repertoires. People are more often greedy, selfish, and short-sighted than truly malicious (yes, that's a compliment). And if Larson took aim at the most self-important among us (as groups, that is, and without naming names), that is as it should be. An artist in the deepest sense, he delighted and instructed, showing us how contingent, ridiculous, and yes, cruel and unjust human and non-human worlds can be, and doing so while being, well, funny as hell.