“I need someone well versed in the art of torture— do ... · “I need someone well versed in...
Transcript of “I need someone well versed in the art of torture— do ... · “I need someone well versed in...
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“I need someone well versed in the art of torture—
do you know PowerPoint?”
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The Laugh’s on Us Lessons from 85 Years
of Cartoon Psychiatry*
*Rated PG-13 for violence, adult situations,
and brief nudity. Viewer discretion advised.
James Morrison, M. D.
Affiliate Professor of Psychiatry, OHSU
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OMG, 40 min of jokes?
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OMG, 40 min of jokes?
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Medical & Psychiatrist Cartoons
Compared with Total
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NonPsychiatrist MDs Psychiatrists
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“It could be one of those things that crawl into your ear and lay
eggs, and the eggs hatch and burrow into your—nope. It looks fine.”
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1925-1944 1945-2009
perc
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couch
no couch
Use of Couch in Psychiatrist Cartoons
2 (Yates) = 73.7, p<.0001 (two-tailed)
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Gender of Psychiatric Patients for Two Time Periods
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1925-1954 1955-2009
perc
en
t o
f p
ati
en
ts
female
male
2 (Yates) = 32.1, p<.0001 (two-tailed)
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“Your problems make my fee seem insignificant.”
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“Don‟t you think it‟s time we talked about Operation Doug?”
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“Lately I‟ve had uncontrollable cravings for venison.”
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“Face it, Porky. You‟ll always be Looney Tunes.”
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“Every now and then I get the
overpowering urge to wear a cowbell.”
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“I think we‟ve made real progress today.”
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“They think they‟re accidents.”
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“You are a very sick rabbit.”
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“We could reshape your nose with conventional surgery,
but I‟m going to suggest something radical.”
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“Actually, I divorced him right after I fired him.
God, it makes me feel better to talk this through.”
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“Oh, my husband‟s fine in bed
as long as he stays on his side.”
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“Next week we‟ll try sitting in a chair.”
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Why Do We Laugh?
Historically, 3 theories:
• Superiority (Plato, Hobbes)
• Relief (Freud)
• Incongruity (Kant)
Slightly more recent idea:
• Connect the Dots (Morrison, unpublished)
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Why Do We Laugh?
Historically, 3 theories:
• Superiority (Plato, Hobbes)
• Relief (Freud)
• Incongruity (Kant)
Slightly more recent idea:
• Connect the Dots (Morrison, unpublished)
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“…laughter is nothing else but sudden
glory arising from [the] sudden
conception of some eminency in
ourselves, by comparison with the
infirmities of others, or with our own
formerly.” — Thos. Hobbes
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“I‟m terribly sorry, Mrs. Crummett, but all at
once I‟ve had it up to here with psychiatry.”
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“Sober, Mrs. Thompkins is the personification of virtue.”
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Why Do We Laugh?
Historically, 3 theories:
• Superiority (Plato, Hobbes)
• Relief (Freud)
• Incongruity (Kant)
Slightly more recent idea:
• Connect the Dots (Morrison, unpublished)
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“Bad sex! Bad, bad, bad sex!”
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“Well, you have three hundred miles and
two more waterfalls to get in the mood.”
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“I can‟t understand a word you‟re saying.
Have you got a gun in your mouth?”
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Why Do We Laugh?
Historically, 3 theories:
• Superiority (Plato, Hobbes)
• Relief (Freud)
• Incongruity (Kant)
Slightly more recent idea:
• Connect the Dots (Morrison, unpublished)
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Humor arises “…from the suddenly vanishing
transformation of a tense expectation.” — I. Kant
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“…what is essential to humor is the mingling of two
ideas which are felt to be utterly disparate. The
neatness of the joke will depend on two things: the
degree of contrast between the two elements, and
the completeness with which they are made to
fuse.” — DH Monro
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“First off, you‟re not a nut. You‟re a legume.”
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Why Do We Laugh?
Historically, 3 theories:
• Superiority (Plato, Hobbes)
• Relief (Freud)
• Incongruity (Kant)
Slightly more recent idea:
• Connect the Dots (Morrison, unpublished)
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“I‟m not hopping mad, I‟m just hopping disappointed.”
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“I‟m right there in the room, and no one even acknowledges me.”
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Boundary Violations
• Sexual issues: impropriety, transgression, violation
• Dual relationships (financial, friendships)
• Gifts, services (e.g., babysitting)
• Timing, duration of appointments
• Language (erotic terms, pet names, other
expressions that might cause discomfort)
• Self-disclosure
• Physical exam that is inappropriate in context
• Other physical contact Gabbard, Nadelson. JAMA 1995;217:1445
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Boundary Issues in Cartoons and Film
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Cartoons Film*
pe
rce
nt
of
clin
icia
ns
% sexual % other
*Gharaibeh NM. Acta Psychiatr Scand. 2005; 111:316-9
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0
5
10
15
20
25
Cartoon Psychiatry California Psychiatry* xxx
perc
en
t
Psychiatrists’ Sexual Boundary Violations
*Morrison J, Morrison T. Am J Psychiatry 2001; 158:474-478
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Boundary Violations by Category
0
1
2
3
4
5
6
7
Sex
ual
Dua
l
Gifts/
Ser
vice
s
Time
Lang
uage
Sel
f Disclosu
re
Phy
sica
l Con
tact
perc
en
t
1925-1964 1965-2009
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“Then again, we are what we eat.”
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“Are you uncomfortable discussing this because
I‟m a man or because I‟m your husband?”
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“Think of it, Madam. I was only 16 at the time.”
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“Well, right now I‟m feeling a little uncomfortable.”
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“You‟ve done me a world of good, Doctor,
but you know too much.”
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Target of the Joke (where discernable)
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
1925-
1934
1935-
1944
1945-
1954
1955-
1964
1965-
1974
1975-
1984
1985-
1994
1995-
2004
2005-
2009
pe
rce
nt
Patients Clinicians
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“Shouldn‟t you be writing some of this down?”
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“Have you ever tried buying lots of stuff?”
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“He‟s still in therapy.”
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“I think what Polly really want is approval.”
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“I medicate first and ask questions later.”
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“Could we up the dosage? I still have feelings.”
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“Our psychopharmacologist is a genius.”
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“How many verses of „Froggie Went A-Courting‟
are there, Jay, before your pill kicks in?”
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“It would have been an open casket, but he overdosed on Viagra.”
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“Your eggs will be ready in a minute.
Meanwhile, take a mood stabilizer.”
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“Would you care to try some of my
handmade artisanal antidepressants?”
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“Discouraging data on the antidepressant.”
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“We had an argument and now
he‟s trying to make me feel bad.”
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“You know, Doctor, I've been toying
with the idea of killing myself.”
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“Hold it! Where‟s Toomey?”
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Suicide as percent of mental health cartoons
0
2
4
6
8
10
12
14
16
18
1925-
1934
1935-
1944
1945-
1954
1955-
1964
1965-
1974
1975-
1984
1985-
1994
1995-
2004
2005-
2009
perc
en
t
meanc
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“Looks like broker assisted suicide.”
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“It was assisted suicide, but he was
too pig-headed to ask for it.”
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“Yes, Oregon‟s lovely, but we‟re just here for the suicide.”
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“Lieutenant, he left a suicide sticky.”
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Method of Suicide
0
10
20
30
40
50
60
70
80
Firearms Hanging Poisons Leaping, Falls Other + Multiple
perc
ent
Cartoon 1925-1964 Cartoon 1965-2009 Actual US 2001
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“If you‟re not going to come back inside,
at least put on a sweater.”
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Of 1600 mental health cartoons:
45% are related to substance use.
Of these, 93% concern alcohol.
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“Do you know what you‟re looking at, Pal?
You‟re looking at a drunken psychoanalyst.”
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Substance Use as % of All Mental Health Cartoons
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
1925-
1934
1935-
1944
1945-
1954
1955-
1964
1965-
1974
1975-
1984
1985-
1994
1995-
2004
2005-
2009
All Years
pe
rce
nt
Patient Intoxicated No Intoxication Shown
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“Actually, right now I‟m in retox.”
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“Would you like to buy some Girl Scout crack?”
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“At this point, we know it‟s addictive.”
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Non-Substance Diagnoses
0
5
10
15
20
25
30
35
40
Anx
iety
Moo
d
Sle
ep Sex
Psy
chos
is
Impu
lse
Som
atofo
rm
Per
sona
lity
Disso
ciatio
n
pe
rce
nt
1925-1964 1965-2009
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“Of course your Daddy loves you.
He‟s on Prozac. He loves everybody.”
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“Perhaps your performance anxiety wouldn‟t be
so bad if you performed better.”
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“I finally saw a shrink today.”
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“After tonight, you‟re going to need a prescription.”
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“I was able to get in one last lecture about diet and exercise.”
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“His final wish was that all his medical bills be paid promptly.”
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“He‟s going to be O.K., but he wants you to remarry anyway.”
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“Lots more interesting stuff under the table.”
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“You have irritable spouse syndrome.”
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“Alternatively, your mother could have a cooking disorder.”
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Points to Ponder
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• Increased interest in medicine and psychiatry
Points to Ponder
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• Increased interest in medicine and psychiatry
• Publicize: We also use medication
Points to Ponder
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• Increased interest in medicine and psychiatry
• Publicize: We also use medication
• Publicize: Half of psychiatrists are women
Points to Ponder
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• Increased interest in medicine and psychiatry
• Publicize: We also use medication
• Publicize: Half of psychiatrists are women
• Why are most ’toon patients men?
Points to Ponder
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• Increased interest in medicine and psychiatry
• Publicize: We also use medication
• Publicize: Half of psychiatrists are women
• Why are most ’toon patients men?
• Watch for boundaries (patients might not)
Points to Ponder
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• Increased interest in medicine and psychiatry
• Publicize: We also use medication
• Publicize: Half of psychiatrists are women
• Why are most ’toon patients men?
• Watch for boundaries (patients might not)
• Substances change; use is increasing
Points to Ponder
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• Increased interest in medicine and psychiatry
• Publicize: We also use medication
• Publicize: Half of psychiatrists are women
• Why are most ’toon patients men?
• Watch for boundaries (patients might not)
• Substances change; use is increasing
• Suicide is by pills and guns, not leaping
Points to Ponder
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• Increased interest in medicine and psychiatry
• Publicize: We also use medication
• Publicize: Half of psychiatrists are women
• Why are most ’toon patients men?
• Watch for boundaries (patients might not)
• Substances change; use is increasing
• Suicide is by pills and guns, not leaping
• Caregivers are a legitimate target of humor
Points to Ponder
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• Increased interest in medicine and psychiatry
• Publicize: We also use medication
• Publicize: Half of psychiatrists are women
• Why are most ’toon patients men?
• Watch for boundaries (patients might not)
• Substances change; use is increasing
• Suicide is by pills and guns, not leaping
• Caregivers are a legitimate target of humor
Points to Ponder
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“Please! One at a time.”
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“And then she said, „And that goes double for
that fatheaded, conceited analyst of yours.‟”
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“You needn‟t feel guilty. You earned the fortune you inherited by
giving her great happiness while she was alive.”
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“My father—who the hell do you think named me
Edward the Lesser?”
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“Does this make me your bitch?”
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“You left your demons here last week.”
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“You‟ve got to want to connect the dots, Mr. Michaelson.”
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"Going to be long over there, Mr. Happy? I
need to get my casserole in."
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“First, we‟ll look for repressed memories of malpractice suits.”
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“After-psychotherapy mint?”
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