Folklorist Lisa Gabbert’s newest book, The Medical Carnivalesque: Folklore among Physicians, is an admirable work of scholarship. Twenty-plus years in the making, Gabbert’s work on this topic addresses several core aspects of United States medical culture and takes us much deeper than its title might at first glance suggest.
Her point of entry is physicians’ occupational folklore, with a particular focus on types and uses of a strictly in-group body of humor. But this insightful volume is not an itemized collection (though it includes a great many informative examples) and is much more than a utilitarian compendium of specialized knowledge. It is well-researched in a range of both academic and popular literatures and media sources, together with the particular access afforded by personal experience (at the time this interest began to emerge, her husband was in medical training, facilitating “insider” access and mediated introductions).
Gabbert employs the lens of literary theorist/critic and philosopher Mikhail Bakhtin’s theory of the carnivalesque (formulated in his analysis of Rabelais’s tales of the grotesque and disgusting father-son giants Gargantua and Pantagruel) to her analysis of medical humor. She does not suggest that this is an emic view within the medical profession and its institutions. Rather, she applies this approach as a tool for thinking about what else is going on in medicine, a milieu whose public face is professional, expert, capable, emotionally controlled, authoritative, of respectful demeanor and even occasional heroism. Alongside the endless activities of containment and amelioration, the demanding everyday activities and punishing schedules of physicians are shot through with doubt, distress, uncertainty, anxiety, stress, and existential pain. These tribulations are leavened somewhat by strictly out-of-the-public-domain exchanges of humorous and insulting stories, joshing banter of self- and other-deprecation, jokes about and parody of colleagues and bosses, and jokes and wry assertions about patients that would be considered wildly inappropriate if uttered publicly.
Bakhtin defines carnivalesque as a temporary or occasional domain of thought and behavior that, like street carnival, is rule-breaking, transgressive of normative social and cultural values, scatological, absurd, inversive of rank and roles, grotesque in its portrayals of human bodies and their functions, yet liberating in promoting radical freedom of expression, producing laughter, and fostering group-identity formation. Gabbert proposes that these qualities can be applied to illuminating the forms and functions of “backstage” medical “occupational shoptalk” (3) and its humor, explicating her theory in a well-argued introduction.
The topically focused chapters of the book start, appropriately, at the beginning of medical training and induction into the world of medicine. Chapter 1, “Like Drinking from a Firehose,” is a detailed factual description of the organization and progression of medical training in the US. For any folklorist with an interest in work involving “official” or conventional medicine, I would consider it an indispensable guide to the field setting. As a folklorist who made a career in medical education starting in the late 1980s, I wish this chapter had been available to me before I entered the medical realm as a non-clinician outsider. (I’d suggest this chapter as well to any would-be physician when considering her/his professional future. Indeed, any with a tolerance for the humanities would benefit from reading the entire book.)
The following chapter carries the satirical title “Living the Dream,” an ironic statement physicians (mostly residents) use to reference the “burdensome, unpleasant, or even intolerable” (54) aspects of their working lives. I have heard senior attending physicians who have been practicing for years ask their residents in the hospital some version of this: “How’s it going? Living the dream?”, usually to an exhausted trainee coming off a long shift with a lot of challenging, complex patients and an immense amount of related paperwork. This question is typically met with a dramatic eyeroll or a sarcastic “Oh, yeah.”
In this chapter, Gabbert introduces the heart of the book: physician suffering, and an eloquent plea for its recognition and remediation. She observes that “suffering is a cultural feature of medicine, not merely a clinical one” (54) and drives home the point that it is not only patients who suffer in hospitals. The causes of physician suffering are legion, and its effects are compounded by the myths and expectations of physician heroism and toughness that pervade a professional culture that simultaneously creates and “ignores the suffering of physicians” (68). It is certainly a bizarre way to raise and encourage merciful healers. Physician suicide rates are among the highest of all occupations, a fact that—despite fairly frequent publications that reference it—remains as obscured to the public as the out-of-earshot occupational humor that Gabbert explores.
In the following two chapters, “Death, Life, and Other Absurdities” and “Bodies of Humor,” Gabbert builds on the suffering inherent in medical practice as foundational to the carnivalesque nature of its insider humor. Her detailed arguments are persuasive: physicians must tolerate the excreta, effluvia, and unanticipated eruptions of human bodies, and sometimes even be their targets—definitely grotesque. Commonplace social taboos are routinely violated in handling and penetrating the bodies of strangers, causing fear and pain, reacting dispassionately to dreadful conditions and wounds and death; joking and making fun of patients’ bodies and their circumstances—certainly transgressive. The “toughening-up” assault on the sensibilities of medical trainees begins in the first year of medical school, in the gross anatomy lab. There students who may not yet have experienced a death in their families or seen a dead person even in a funeral home are presented with their cadavers, which they will steadily disassemble throughout their first term (think “desecration of a corpse”—a social taboo of sufficient power to be legally encoded as a crime).
In her fifth and final chapter, Gabbert focuses on some of the less grotesque, more festive aspects of the carnivalesque in addressing the fun poked at self and others in the profession by satirizing “spurious and expert knowledge” (140), such as characterizing differing medical specialties by mocking stereotypes in sayings, songs, online blogs, and virtually any other format by which humor can be shared. Here she also gives us a more straightforwardly folkloristic review of forms and functions of humor, including the common medieval public performances and shows in which doctors were figures of fun or of derision and abuse lobbed by outsiders to the profession. (Oddly, British Isles mummers’ plays, in which a quack doctor is a stock character, are mentioned only in a footnote to this chapter.)
One form of carnivalesque medical humor not mentioned, but I believe very common in the residency years of medical training, is end-of-residency (graduation) follies, a festive performance in which lower-ranking residents make fun of those about to graduate, and often of faculty members as well. These more open performances of humor (parents and family members, for example, are typically present at the occasion) are nevertheless very in-group focused in their referents, and outsider audience members may not grasp the jokes—but they are still risky and transgressive in inverting status, cross-dressing, exaggerated behaviors, and their frequently scatological content. In the residency in which I worked, it was considered by most faculty members to be a badge of honor to be identifiably roasted, and the intern (first-year resident) who had the courage to lampoon the highest-ranking faculty member with the most fearsome reputation merited serious admiration from peers.
In her clear and concise conclusion, Gabbert mentions other productive theoretical approaches to humor, summarizes her main themes and her choice of the carnivalesque as a frame, and concludes with a straightforward “plea for society to take better care of its doctors, care that would necessarily involve systematic and institutional change” (175). Such a transformation must begin “with a recognition that suffering is part and parcel of doctoring” (176). This is a very tall societal order, but also an extremely worthy goal. All of us will be patients at one time or another, and we—as much as our physician caregivers—would greatly benefit from such deeply needed reform.
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[Review length: 1319 words • Review posted on April 9, 2025]