Sick jokes: why medics need gallows humour

Most jobs have their own joke books. If you’re outside the job, you don’t get the joke — and if you do get the joke, you’re on the inside; which is what the jokes are for. (It’s the same with all comedy: some, if not most, of the appeal of Stewart Lee is in being the sort of person who finds Stewart Lee funny.) But some jobs have joke books which, from the outside, are not just unfunny but actually offensive. Usually the most stressful jobs, those that involve the rawest emotions, have a gallows humour that is thought to relieve that stress. If you didn’t laugh, you’d cry. Or have to go to therapy.

It’s been a mixed week for this sort of gallows humour. On the one hand, the final controversy that brought Dame Cressida Dick’s resignation was a report of jokes between officers at Charing Cross police station. The ‘banter’ may well have reduced stress, and been fantastic for morale, but that’s beside the point — it destroyed what confidence Sadiq Khan had in the commissioner. On the other hand, the first episode of Adam Kay’s This Is Going to Hurt, based on his experiences as a junior doctor, aired. The show was disgusting, objectifying, and it destroyed confidence in the profession — and it had more viewers than the Brit awards.

Why do we accept offensive or pitch-black humour from medics in a way we don’t from other equally stressful and important jobs? Partly it’s because there’s a strong tradition of medical comedy in this country. Doctor in the House was the biggest film in Britain in 1954 — it was seen by a third of the population — and four Carry On films were set in a hospital. Based on the Carry On metric, the National Health Service is four times funnier than the police force (or spying or camping or abroad) — although it also has to be factored in that hospital sets are cheap to build and whenever Sid James was recovering from a heart attack he needed a part he could play lying down.

This Is Going to Hurt may seem like a departure from this tradition of medical comedy — Kay himself said that it was the ‘most disgusting’ representation of hospitals in comedy — but the series merely shows what previous representations tell. In Doctor in the House, James Robertson Justice bellows at medical students to faint away from the patient and to keep an eye on the swabs (‘You can cut a patient’s throat under general anaesthetic and nobody’ll mind, leave anything inside and it’ll be in the Sunday papers’); This Is Going to Hurt actually shows what happens if they don’t.

The underlying attitude is the same: doctors view their patients as a collection of symptoms and body parts rather than as people. Kay doesn’t, like James Robertson Justice, say to a patient ‘Don’t worry! This is nothing to do with you!’ while addressing a congregation of medical students. Of course not — instead he turns to the camera and says it directly to us.

Another reason medics can get away with darker humour than, say, policemen or firemen is that we are more familiar with doctors. I haven’t spoken to a policeman since I got too old to drink in town centres on Friday nights; and I haven’t seen a fireman since my son was of an age to insist we visited every fire station open day within a 50-mile radius.

But it’s also because we know that this sort of humour leads to something doctors need — whether we call it objectivity or objectification. I once spoke to the lady from one of the anatomy offices, who arranged the collection of bodies for anatomical examination. She was exactly as practical and straightforward as you would hope. She spoke enthusiastically about how donating your body can help 400 medical students learn to care for a million patients. (A professor of anatomy had done the sums.) I felt almost apologetic when I mentioned that I had known a few medical students and I had heard some stories…

She sighed. This was obviously something that came up regularly. The way I had to look at it, she said, was that doctors needed to learn not just how a body worked, and how to operate on it, but also that they needed to be comfortable acknowledging that bodies were objects. Most of us do not distinguish between cutting a person and cutting through flesh — quite rightly — but doctors can and must. Medics need to be able to disassociate themselves, otherwise they can’t do their job.

The medical context requires them to ignore every other context. The black humour of doctors, in other words, isn’t just banter — it’s a necessity.