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).