James Belarde

“My wallpaper and I are fighting a duel to the death. One of us has got to go.” -Oscar Wilde, shortly before succumbing to illness

In Mumbai, India, a kind-looking elderly woman sits on a stool behind a microphone and calmly quips “Life is like that TV journalist Arnab Goswami. Never take it seriously.” In response to her playful dig at the Indian news anchor, peals of laughter break out from the audience around her. The 65-year old is performing stand-up comedy at The Cuckoo Club, a theater in Mumbai. She also has a terminal illness, as do the other three amateur performers on the bill.

The Indian Association of Palliative Care (IAPC) organized this show in early 2017 with the goal of fighting the taboo in India surrounding open discussions of dying and death.1 In doing so the IAPC hopes to raise awareness about the importance of palliative care, a branch of medicine primarily concerned with minimizing pain and suffering, often in the final months of life. For the performance, they recruited four terminally ill patients receiving palliative care who wanted to share their thoughts on life and death in a fun way. The patients wrote stand-up sets under the tutelage of professional Indian comedians and performed them in front of friends, families, and caretakers.

As seen in the video clips, the performances are a combination of humor and touching reflection on the process of dying. (They also occasionally display a skill beyond that expected of first-time comics. When one performer sees an audience member walking in late, she greets him and hilariously teases, “If you came five minutes later, not only would the show have finished, but so would I.”) The show is a wonderful testament to the role palliative medicine plays in preparing patients for death, making them comfortable enough to joke about it onstage. But I also found it a concrete example of what gallows humor can do for dying patients.

In last month’s article, I described gallows humor as any comedy that primarily deals with subject matter related to death.2 I ended that post by suggesting a role such humor might have for healthcare workers in providing a coping mechanism against the emotional onslaught that comes with losing patients. But the dying also frequently partake in such humor themselves. This month I would like to briefly explore this complementary usage of gallows humor.

To help answer the question of why terminally ill patients are drawn to joke about death, and more importantly the benefit it may hold for them, I will turn to one of the first extensive analyses of humor and psychology: The Joke and Its Relation to the Unconscious by Sigmund Freud. This work frequently suffers from logical flaws and poorly backed claims (not to mention upsetting misogyny in some of the sampled jokes) resulting from Freud’s attempt to force joke analysis into a framework identical to the groundbreaking dream analysis he had proposed years prior. However, despite its many shortcomings, he puts forth intriguing thoughts in the more convincingly argued sections of the book.

Sigmund Freud, 1921 (portrait by Max Halberstadt). Wikimedia Commons

In his view, Freud unhelpfully divides comedy into three arbitrary categories: jokes, the comic, and humor. Rather than try to define these divisions with his confusing logic that still leaves me dizzy, I will simply state that as far as Freud’s model is concerned, there seem to be two probable sources of gallows humor in the mind of the patient facing death. The first is a veiled feeling of aggression that resides in the unconscious mind. These feelings give rise to what Freud calls “tendentious jokes,” or jokes that have a tendency for some purpose rather than a joke solely for pleasure’s sake.

Originating in the unconscious, these hostile feelings are not always apparent to the sufferer, but they can still influence joke formation. Freud stresses that while this type of aggression-born joke can be directed at a specific person, it is frequently aimed at institutions and abstract concepts. Furthermore, the targets of such jokes are usually perceived as being in a position of incontestable power or authority. It would seem to me one such abstract concept that appears to hold an incontestable power over all our lives is death. This then could be a fitting target for one’s hostility and an opportunity for the terminally ill patient to create a joke which “represents a rebellion against such authority, a liberation from the oppression it imposes.”3 The joke allows one to momentarily defeat an undefeatable foe.

The second likely source for gallows humor, according to Freud’s theory of the comic, is the super-ego. The super-ego is a sort of conscience that encourages good behavior and seeks to protect the mind from unnecessary suffering. It was in this latter function that Freud found a possible genesis for humor in an article written years after his treatise on jokes. Using his own example of gallows humor (a criminal being hung on a Monday notes, “Well, this is a good beginning to the week”), Freud suggests that for someone confronted with such fear, the super-ego takes charge and allows the mind to assert “its own invulnerability. It insists that it is impervious to wounds dealt by the outside world…that these are merely occasions for affording it pleasure.”4 In this case, rather than strike out at an all-powerful foe like the hostile joke allows, the trivializing humor encouraged by the super-ego inverts the power dynamic, allowing one to feel superior to, and less fearful of, death.

Regardless of whether gallows humor stems from a struggle against the oppression of death or a complete inversion of its place of superiority to one of inferiority, the result is the same. The dying patient rejects a feeling of powerlessness and asserts her continued existence with a joke. It facilitates the revelation that a death sentence is not death. The sufferer is still an active participant in life and can be invested in it. A dying Oscar Wilde can be frustrated by distasteful wallpaper. The terminally ill Indian comedian can still be playfully annoyed with the tardy audience member. And this is precisely what the practice of palliative medicine stresses: the acknowledgement that a terminal illness still leaves life to care for and suffering to minimize, both physically and mentally. And when this ideal end-of-life care is realized, death doesn’t have to be so torturous. After all, as the late Robin Williams said, “death is nature’s way of saying ‘Your table is ready.’”

Featured Image

Avhell, CC BY-SA 3.0, via Wikimedia Commons


  1. “#LaughAtDeath.” Indian Association of Palliative Care, 29 Mar. 2017, http://www.endoflifecareindia.com/. Accessed 30 Mar. 2018.
  2. Belarde, James. “Laughing at Death: Gallows Humor and the Physician’s Psyche.” Medical and Health Humanities, 3 Mar. 2018, https://medicalhealthhumanities.com/2018/03/03/laughing-at-death-gallows-humor-and-the-physicians-psyche/. Accessed 27 Mar. 2018.
  3. Freud, Sigmund. The Joke and Its Relation to the Unconscious. Penguin Classics, 2003, 100.
  4. Freud, Sigmund. Humour. International Journal of Psycho-Analysis. 1928;9:1–6. Accessed online 23 Mar. 2018.

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