To troll or be trolled?

Laughing at others conceals a terror of being laughed at ourselves.

Roger Bretherton

Roger Bretherton is Associate Professor of Psychology, at the University of Lincoln. He is a UK accredited Clinical Psychologist.

Donald Trump gestures with his hands while someone holds a mic in front of him,

Politics and satire belong together, they deserve each other. Humour has been part of politics ever since the first jester dared jingle a bell in the face of a king. Those who get their kicks from bursting the bubbles of the pompous are drawn to the corridors of power like moths to a flame. But in recent weeks laughter has hit the headlines again. A couple of weeks ago, when Democratic presidential candidate Kamela Harris chose her running mate Tim Walz, the only thing most of us knew about him was that he was the one who had called Trump ‘weird’. A few minutes of furious googling later we knew much more, but the suspicion lingered that he had been picked for having finally answered the question that had plagued the Democrats for nearly a decade: how do you deal with Donald Trump?

As a psychologist who works with leaders I have been asked this question numerous times. How do you go up against someone with the magnificent trolling skills of Trump? Is it possible to win against a person so adept at humiliating those who oppose him? And I think Walz is on to something. He hasn’t called Trump a threat to democracy or labelled his supporters a basket of deplorables. No. He has called Trump weird, and his supporters good dinner guests. Why is Trump weird? Because, says Walz, he has never seen him laugh.

Trump is not the only one accused of being humourless. Our own former Prime Minister, Liz Truss, was equally unamused at becoming the butt of the joke, when a banner reading ‘I Crashed the Economy’ next to a googly eyed lettuce quietly descended behind her during an onstage interview. She left the stage abruptly and was quick to respond on X that what had happened was not funny. Most people thought it was funny and that she – like Trump – was slightly weird not to laugh it off, at least a little bit. As the political prankster Noël Godin once said: there is no better way to judge a person’s character than by how they behave when hit by a custard pie.

We spend our lives subtly and unconsciously evading the slightest whiff of humiliation.

There is however a deep psychology behind all this hilarity, or lack of it. For decades now psychologists have conducted numerous studies on the phenomenon of Gelotophobia. Not the fear of ice-cream, as one might initially think. Gelotophobes you’ll be pleased to know are perfectly capable of holding it together in the presence of a knickerbocker glory. What they fear is being laughed at, and as always this sounds infinitely more sophisticated translated into Greek (gelos/laughter, phobos/fear). Much of the gelotophobia literature is a heartbreaking tale of young people crippled by the fear that others will laugh at their weight, or their acne, or target them for bullying. Sticks and stones may break our bones, but mocking words it seems can leave us socially terrified for the remainder of our adult life. In its most debilitating forms gelotophobia is a cause for clinical intervention.

But the study of gelotophobia goes further than treating the clinically distressed. Lurking among the samples and statistics is a wisdom that helps us understand why Trump and Truss are the people they are, and more importantly teaches us something about ourselves. Because most of us in some mild sub-clinical way are gelotophobes. We spend our lives subtly and unconsciously evading the slightest whiff of humiliation. Margaret Atwood was no doubt right to say that men are afraid that women will laugh at them, and women are afraid that men will kill them. But many people would rather die than be laughed at.

Could it be that our love of laughing at others conceals a terror of being laughed at ourselves?

One of the primary findings about gelotophobia, is that those who are most scared of being laughed at are also scared to laugh. To say of Trump or Truss that they lack humour is equally to say that the last thing on earth they want is to be the object of laughter. Most gelotophobes were once victimised, ostracised or bullied, and humour was the chief instrument of their humiliation. They were forged by the cruel conditioning of mockery. As a result, they view laughter-eliciting situations negatively. In facial coding studies they show less joy and more contempt when presented with smiling joyful people. The inner freedom to join others in laughter has been quashed by the suspicion that the laughter of others is a threat. Some compensate for this by making sure they always have the upper-hand, always the troll never the trolled. Which speaks to another finding, more applicable to Trump than to Truss, that derisive humour is the way narcissists conceal their vulnerability. Behind every grandiose expression of superiority, lies a shame and inferiority that can be defended by attacking others.

Gelotophobia ultimately is a subtype of our fear of being disliked, and if the bestseller lists are anything to go by, this is clearly a pressing concern for many people. Fumitake Koga and Ichiro Kishmi brought the wisdom of Japan to the question in The Courage to be Disliked, and Ryan Holiday did the same from a Stoic perspective in Courage is Calling. How to live in a world that shapes us through the threat of ridicule has been pondered for thousands of years. It even turns up in the New Testament of the Bible. When the disciples of Jesus stepped out to deliver their first public discourses, they were accused of being drunk, stupid and presumptuous. The word used to describe them in the historical sources is parrēsia, usually translated bold, but perhaps more accurately rendered the freedom to say anything (pas- all; rheō- to utter). For them freedom of speech was not a societal given but a virtue they enacted in spite of their society.

In the ancient world the term parrēsia was more often used to describe the counter-cultural courage of the Stoic philosophers. But the disciples were not Stoics. They weren’t schooled in the rigours of Greek philosophy, but rather apprenticed to the Hebrew prophetic tradition. A tradition which equally appreciated the inevitable opprobrium befalling those who presume to critique and rejuvenate a stale culture. They were simply following the teaching of the master who pointed to ridicule, scorn and gossip not as PR disasters to be managed, but as prophetic honours to be celebrated. Or, as Marty Babcock once claimed, ‘Jesus promised his disciples only three things: they would be absurdly happy, entirely fearless, and always in trouble.’

We should be cautious then laughing too much at the embarrassments that befall our political class, and perhaps more attentive to what our schadenfreude might point to within us. Could it be that our love of laughing at others conceals a terror of being laughed at ourselves? Even worse, what if vindictively celebrating their misfortunes is itself a symptom of the inner helplessness, inertia and unfreedom we claim to oppose? Or, to give the same question a more positive inflection: what would we be doing or saying differently if we were genuinely and entirely free of the fear of being ridiculed?

Blessed are those who do not fear the laughter of others for they may change the world.

Article

Assisted dying

Care

Culture

Death & life

13 November 2024

8 min read

The deceptive appeal of assisted dying changes medical practice

In Canada the moral ethos of medicine has shifted dramatically.

Ewan Goligher

Ewan is a physician practising in Toronto, Canada.

a doctor consults a tablet against the backdrop of a Canadian flag.

Once again, the UK parliament is set to debate the question of legalizing euthanasia (a traditional term for physician-assisted death). Political conditions appear to be conducive to the legalization of this technological approach to managing death. The case for assisted death appears deceptively simple—it’s about compassion, respect, empowerment, freedom from suffering. Who can oppose such positive goals? Yet, writing from Canada, I can only warn of the ways in which the embrace of physician-assisted death will fundamentally change the practice of medicine. Reflecting on the last 10 years of our experience, two themes stick out to me—pressure, and self-deception.

I still remember quite distinctly the day that it dawned on me that the moral ethos of medicine in Canada was shifting dramatically. Traditionally, respect for the sacredness of the patient’s life and a corresponding absolute prohibition on deliberately causing the death of a patient were widely seen as essential hallmarks of a virtuous physician. Suddenly, in a 180 degree ethical turn, a willingness to intentionally cause the death of a patient was now seen as the hallmark of patient-centered doctor. A willingness to cause the patient’s death was a sign of compassion and even purported self-sacrifice in that one would put the patient’s desires and values ahead of their own. Those of us who continued to insist on the wrongness of deliberately causing death would now be seen as moral outliers, barriers to the well-being and dignity of our patients. We were tolerated to some extent, and mainly out of a sense of collegiality. But we were also a source of slight embarrassment. Nobody really wanted to debate the question with us; the question was settled without debate.

Yet there was no denying the way that pressure was brought to bear, in ways subtle and overt, to participate in the new assisted death regime. We humans are unavoidably moral creatures, and when we come to believe that something is good, we see ourselves and others as having an obligation to support it. We have a hard time accepting those who refuse to join us. Such was the case with assisted death. With the loudest and most strident voices in the Canadian medical profession embracing assisted death as a high and unquestioned moral good, refusal to participate in assisted death could not be fully tolerated.

We deceive ourselves if we think that doctors have fully accepted that euthanasia is ethical when only very few are actually willing to administer it.

Regulators in Ontario and Nova Scotia (two Canadian provinces) stipulated that physicians who were unwilling to perform the death procedure must make an effective referral to a willing “provider”. Although the Supreme Court decision made it clear in their decision to strike down the criminal prohibition against physician-assisted death that no particular physician was under any obligation to provide the procedure, the regulators chose to enforce participation by way of this effective referral requirement. After all, this was the only way to normalize this new practice. Doctors don't ordinarily refuse to refer their patients for medically necessary procedures; if assisted death was understood to be a medically necessary good, then an unwillingness to make such referral could not be tolerated.

And this form of pressure brings us to the pattern of deception. First, it is deceptive to suggest that an effective referral to a willing provider confers no moral culpability on the referring physician for the death of the patient. Those of us who objected to referring the patient were told that like Pilate, we could wash our hands of the patient’s death by passing them along to someone else who had the courage to do the deed. Yet the same regulators clearly prohibited referral for female genital mutilation. They therefore seemed to understand the moral responsibility attached to an effective referral. Such glaring inconsistencies about the moral significance of a referral suggests that when they claimed that a referral avoided culpability for death by euthanasia, they were deceiving themselves and us.

The very need for a referral system signifies another self-deception. Doctors normally make referrals only when an assessment or procedure lies outside their technical expertise. In the case of assisted death, every physician has the requisite technical expertise to cause death. There is nothing at all complicated or difficult or specialized about assessing euthanasia eligibility criteria or the sequential administration of toxic doses of midazolam, propofol, rocuronium, and lidocaine. The fact that the vast majority of physicians are unwilling to perform this procedure entails that moral objection to participation in assisted death remains widespread in the medical profession. The referral mechanism is for physicians who are “uncomfortable” in performing the procedure; they can send the patient to someone else more comfortable. But to be comfortable in this case is to be “morally comfortable”, not “technically comfortable”. We deceive ourselves if we think that doctors have fully accepted that euthanasia is ethical when only very few are actually willing to administer it.

We deceived ourselves into thinking that assisted death is a medical therapy for a medical problem, when in fact it is an existential therapy for a spiritual problem.

There is also self-deception with respect to the cause of death. In Canada, when a patient dies by doctor-assisted death, the person completing the death certificate is required to record the cause of death as the reason that the patient requested euthanasia, not the act of euthanasia per se. This must lead to all sorts of moments of absurdity for physicians completing death certificates—do patients really die from advanced osteoarthritis? (one of the many reasons patients have sought and obtained euthanasia). I suspect that this practice is intended to shield those who perform euthanasia from any long-term legal liability should the law be reversed. But if medicine, medical progress, and medical safety are predicated on an honest acknowledgment about causes of death, then this form of self-deception should not be countenanced. We need to be honest with ourselves about why our patients die.

There has also been self-deception about whether physician-assisted death is a form of suicide. Some proponents of assisted death contend that assisted death is not an act of deliberate self-killing, but rather merely a choice over the manner and timing of one's death. It's not clear why one would try to distort language this way and deny that “physician-assisted suicide” is suicide, except perhaps to assuage conscience and minimize stigma. Perhaps we all know that suicide is never really a form of self-respect. To sustain our moral and social affirmation of physician-assisted death, we have to deny what this practice actually represents.

There has been self-deception about the possibility of putting limits around the practice of assisted death. Early on, advocates insisted that euthanasia would be available only to those for whom death was reasonably foreseeable (to use the Canadian legal parlance). But once death comes to be viewed as a therapeutic option, the therapeutic possibilities become nearly limitless. Death was soon viewed as a therapy for severe disability or for health-related consequences of poverty and loneliness (though often poverty and loneliness are the consequence of the health issues). Soon we were talking about death as a therapy for mental illness. If beauty is in the eye of the beholder, then so is grievous and irremediable suffering. Death inevitably becomes therapeutic option for any form of suffering. Efforts to limit the practice to certain populations (e.g. those with disabilities) are inevitably seen as paternalistic and discriminatory.

There has been self-deception about the reasons justifying legalization of assisted death. Before legalization, advocates decry the uncontrolled physical suffering associated with the dying process and claim that prohibiting assisted death dehumanizes patients and leaves them in agony. Once legalized, it rapidly becomes clear that this therapy is not for physical suffering but rather for existential suffering: the loss of autonomy, the sense of being a burden, the despair of seeing any point in going on with life. The desire for death reflects a crisis of meaning. We deceived ourselves into thinking that assisted death is a medical therapy for a medical problem, when in fact it is an existential therapy for a spiritual problem.

We have also deceived ourselves by claiming to know whether some patients are better off dead, when in fact we have no idea what it's like to be dead. The utilitarian calculus underpinning the logic of assisted death relies on the presumption that we know what it is like before we die in comparison to what it is like after we die. In general, the unstated assumption is that there is nothing after death. This is perhaps why the practice is generally promoted by atheists and opposed by theists. But in my experience, it is very rare for people to address this question explicitly. They prefer to let the question of existence beyond death lie dormant, untouched. To think that physicians qua physicians have any expertise on or authority on the question of what it’s like to be dead, or that such medicine can at all comport with a scientific evidence-based approach to medical decision-making, is a profound self-deception.

Finally, we deceive ourselves when we pretend that ending people’s lives at their voluntary request is all about respecting personal autonomy. People seek death when they can see no other way forward with life—they are subject to the constraints of their circumstances, finances, support networks, and even internal spiritual resources. We are not nearly so autonomous as we wish to think. And in the end, the patient does not choose whether to die; the doctor chooses whether the patient should die. The patient requests, the doctor decides. Recent new stories have made clear the challenges for practitioners of euthanasia to pick and choose who should die among their patients. In Canada, you can have death, but only if your doctor agrees that your life is not worth living. However much these doctors might purport to act from compassion, one cannot help see a connection to Nazi physicians labelling the unwanted as “Lebensunwortes leben”—life unworthy of life. In adopting assisted death, we cannot avoid dehumanizing ourselves. Death with dignity is a deception.

These many acts of self-deception in relation to physician-assisted death should not surprise us, for the practice is intrinsically self-deceptive. It claims to be motivated by the value of the patient; it claims to promote the dignity of the patient; it claims to respect the autonomy of the patient. In fact, it directly contravenes all three of those goods.

It degrades the value of the patient by accepting that it doesn't matter whether or not the patient exists.

It denies the dignity of the patient by treating the patient as a mere means to an end—the sufferer is ended in order to end the suffering.

It destroys the autonomy of the patient because it takes away autonomy. The patient might autonomously express a desire for death, but the act of rendering someone dead does not enhance their autonomy; it obliterates it.

Yet the need for self-deception represents the fatal weakness of this practice. In time, truth will win over falsehood, light over darkness, wisdom over folly. So let us ever cling to the truth, and faithfully continue to speak the truth in love to the dying and the living. Truth overcomes pressure. The truth will set us free.