There’s an old joke about a man that goes to a doctor. “Doctor, I’m depressed,” he says. “Life is harsh, unforgiving, cruel.” The doctor offers a simple treatment. “The great clown Pagliacci is in town tonight,” the doctor says, “Go and see him! That should sort you out.” The man bursts into tears. “But doctor,” he says, “I am Pagliacci.”

I’ve always appreciated this joke—first recorded in an 1880s story by Ralph Waldo Emerson, but which I stumbled across in Alan Moore’s Watchmen—because of its depiction of the sad loneliness—and a sort of atomised narcissism—that often lurks behind the gregarious personae of our celebrities and entertainers. It also offers sardonic commentary on how ill-prepared most medical professionals are to deal with mental health, which is sadly still relevant over a century and a half later. Most importantly, it illustrates the complex relationship between humour, those who perform it, and mental health, one that goes beyond simplistic aphorisms like “laughter is the best medicine.” 

Over the past ten years, disentangling that relationship on stage has become something of a core mission for contemporary standup comedians. Take one look at your favourite streaming platform and you’ll come across plenty of modern-day Pagliaccis. There’s Maria Bamford, the trailblazing American comedian and actor who transforms her experiences with anxiety, depression and suicidal ideation into brilliantly eccentric, incredibly empathetic standup comedy. There’s Hannah Gadsby, who became an international comedy icon with Nanette, a show about the trauma-for-laughs transactions that fuel much of modern standup. Even baby-faced John Mulaney, his boy-next-door persona in tatters after revelations of serious drug abuse, has turned to exorcising his demons on stage. 

It’s not just an American phenomenon either. Closer home, comedians like Daniel Fernandes, Sumaira Shaikh and Neville Shah have put out well-received sets that explore mental health and personal tragedy, unabashedly moulding their pain into laughter (and hopefully sparking some contemplation and conversation as a bonus). These comedians may be inspired by a cultural zeitgeist that is more welcoming of mental health discourse than at any time in the past—just look at Tumblr—but they’re also tapping into a long tradition of using humour to grapple with emotional turmoil and inner dysfunction.

In the early 1900s, Sigmund Freud called humour a “defensive process”, a way to deal with anxieties and psychic threats by facing up to them and transforming them into “pleasurable affect.” More recent research into standup comedy in specific supports the idea, with a 1975 study published in the American Journal of Psychoanalysis suggesting that comedy allowed comedians a measure of control and agency over their traumas and feelings of powerlessness. Daniel Fernandes—whose 2020 special Shadows revolves around his struggles with anxiety disorder and suicidal ideation—concurs. 

“I have found that if you can laugh at something that scares you, then it doesn’t scare you anymore,” says Fernandes. “When I am on stage talking about mental health or anything uncomfortable, I am actually the farthest away from the real pain of it. It is relaxing for me to be able to release that tension and it’s the same for my audience because together we can get to a point where we feel okay, so it’s not that bad if we can laugh about it.” 

Unlike other forms of entertainment—music, films, books—standup comedy relies on the conceit of a one-to-one conversation with the audience, a discussion between equals. That, along with the ‘say-what-you-want’ atmosphere of a comedy club, encourages the candour required to address trauma and tragedy without the crutches of lyrical allusion or story-telling fiction. If comedy depends on making the audience member feel like your friend, then why not talk about all the things we talk about with friends? Including the stories you hide away in your mind’s deepest, darkest corners? 

Supriya Joshi—who has an hour-long set on heartbreak, and has been quite open about her experiences with online bullying—believes that performance allows her distance from her grief. “Once you do it night after night, it becomes just words you say from muscle memory, so the pain subsides and it becomes a routine,” she says. “And sharing that with my audience makes me feel less alone—it’s almost as if I am speaking to a friend.”

Cognitive behavioural therapy emphasises the importance of vocalising one’s anxieties, and the role of repetition in breaking “the habit” of unhelpful thought patterns. Standup comedy that addresses your fears and anxieties, then, can be a way to do both. That’s the idea behind a number of comedy-based mental health interventions, such as Angie Belcher’s NHS-funded programme Comedy On Referral, a standup comedy course for men at risk of suicide. Working out your issues through humour—and the intimate, introspective process of writing a standup set—can be therapeutic. 

I have found that if you can laugh at something that scares you, then it doesn’t scare you anymore.

Daniel Fernandes

That doesn’t mean standup comedy is, by itself, therapy though (seriously, don’t cancel that therapy appointment for an open-mic slot). A comedy set is still a performance, with the aim to entertain, and the stories that comedians tell us are often curated and edited, even the ones that are grounded in authentic trauma. “A comic only takes to the stage what is palatable for the audience,” says Neville Shah, who has released a viral clip about dealing with condolence calls after his mother’s passing. “You don’t take the most vulnerable, raw and gutted truths with you up on stage so there is a moment of conscious approval and choice every comedian has to make.” 

Nor are comedy audiences trained in psychotherapy. There’s a fine line between comedy that deals in trauma and emotional vulnerability, and straight up trauma-dumping, and it can be hard to walk that tightrope. Sharing such intimate experiences with rooms full of strangers can also bring its own anxiety: you may feel bad when you bomb with a set full of middle-class parenthood jokes, but imagine how it feels to bomb with a set about your bipolar disorder? Or as Sumaira Shaikh—who often performs a darkly funny bit about her brother’s funeral—puts it, “one, my brother is dead and now no one is laughing either.”

So whether this comedy of vulnerability has helped the comedians themselves—without outside therapeutic intervention—remains an open question. A 2016 retrospective study on the life-spans of “top-ranked comedians” found that successful comedians often lived shorter lives than similarly successful actors and other entertainers. Studies and anecdotal experience—collated, for example, on CNN’s Spark of Madness documentary—repeatedly suggest that comedians are more likely to suffer from mental health issues, though the numbers are fuzzy. Comedy may be a form of self-medication, but its efficacy is still up in the air. 

But joking about your trauma does allow comedians to fully own their experiences—the full spectrum of who they are—on stage in a way that’s still fun and engaging to their audience. It allows them to penetrate the social walls we’ve built around issues of mental health, trauma and grief, topics that still carry a major taboo in society. By joking about these experiences on-stage, comedians have brought these supposedly ‘private’ conversations into the public domain, offering up their most vulnerable stories as emotionally-fraught ice-breakers. In the process, they’ve helped transform the public discourse around mental health, giving their audience the tools and lexicon necessary to deal with these issues. 

Maybe it’s time for an update of the old sad-clown joke. I propose we go with this 2011 re-work by the comics creator Eric Collossal: “Doctor, life is unbearable. ‘Go see the great clown Pagliacci, he’ll cheer you up!’ But Doctor… I don’t think you understand depression…”