After my first week as a resident on a palliative care rotation, three patients for whom I had cared died within hours of one another. A staff member on the palliative care unit nodded knowingly, saying, “Death always comes in threes.” While I have been unable to find peer-reviewed evidence supporting this phenomenon, it does seem to be a widely-held belief; perhaps an urban myth due to humanity’s innate desire for pattern recognition, and our propensity to be swayed by confirmation bias. In that, once one is aware of this superstition, given a flexible timeframe, any set of 3 misfortunes can be shoehorned into a triad.(1)
Veracity of tripartite tragedy notwithstanding, the concept did remind me of another general rule: The Rule of Threes in writing.(2) Three is a satisfying number. It is at once a synecdochal way of saying a lot (“three’s a crowd”), or saying a little (the well-known phrase, “Three is less than infinity”). Throughout story-telling history, three has weaselled its way into society’s consciousness as a Good Amount For Things To Be. Whether they be Billy Goats Gruff, Little Pigs, Weird Sisters, Musketeers, Stooges, dimensional characters, Wise Monkeys, Laws of Robotics, or even (albeit scripturally-unsupported) Messiah-visiting magi, those who have told stories throughout the ages return (and return often) to Three.
In a similar vein, Three is also a stalwart in comedy and joke-telling. Classic joke structure is dictated by Rule of Threes, seen in “An Englishman, an Irishman and a Scotsman walk into a bar…”, or “A blonde, a brunette and a redhead walk into a barre…”. The first two characters will establish a pattern – building tension. The third character will invariably subvert the pattern in a punchline – bringing release. This nicely helps us to understand how a particular theory, known as the ‘incongruity-resolution model of humour’, plays out.(3)
In order to appreciate humour, one must connect the surprise of the punchline with the pattern established by the first examples in the set-up. Resolving the incongruous punchline is a problem-solving exercise which involves frontal lobe activity. As with all physiology, this can dysfunction with certain frontal lobe strokes, and lead to an ‘up the garden’ pathology known as Witzelsucht.(4) This translates as “joking addiction”, and results in an inappropriate jocular affect, where sufferers of Witzelsucht cannot refrain from constant punning and the perpetual construction of jokes, even at inopportune times.(5)
The tension that builds into a dark cloud as one is forced to ponder difficult thoughts of increasing frailty and approaching death, is silver-lined; punch-lined with a cloudburst of mirth – bringing release.
At first glance, Witzelsucht would appear homologous with humour in the palliative care setting; a time when patients and their families come inescapably face-to-face with mortality: an elderly couple coming to grips with the fact that she cannot support his needs at home and must start to confront the idea of a residential facility; a man with metastatic cancer who is coming to realise he may never again be without pain; a previously fiercely independent woman who can no longer walk herself to the bathroom and is mourning the loss of autonomy.
In this environment, where patients are processing such massive themes every day, joking would appear to be inappropriate – even disrespectful. However, just as Three can represent large or small numbers, so too can seemingly small flashes of humour impact the burden of pondering these large concepts. The husband still makes his wife laugh by exaggeratedly checking his wallet and, finding it empty, accuses her of cleaning him out. The man with cancer regales with hilarious tales of how he got his nickname. The lady who struggles to mobilise to the bathroom confides with a wink that her plan for the evening involves nipping down to the disco.
The tension that builds into a dark cloud as one is forced to ponder difficult thoughts of increasing frailty and approaching death, is silver-lined; punch-lined with a cloudburst of mirth – bringing release. Regardless of whether death comes in threes, laughter comes, and frees.
BIO: Dr Tim Wiles is a resident at Bendigo Hospital in Bendigo. He attends Bendigo Baptist Church. In fact, if the venue is prefixed with Bendigo, he might be there. Often called Ned Kelly, he is unsure yet whether this is due to his pattern of ruddy hirsutism or his tendency to stage highway robberies. He is interested in the intersection of faith, work and humour.
- Allen, J. Why Do We Believe That Catastrophes Come in Threes? ABC News, 5th July 2009. https://abcnews.go.com/Technology/WhosCounting/story?id=7988416&page=1
- Clark, B. How to Use the ‘Rule of Three’ to Create Engaging Content. Copyblogger, 10th September 2015. https://www.copyblogger.com/rule-of-three/
- Buijzen, M., & Valkenburg, P. M. (2004). “Developing a Typology of Humor in Audiovisual Media. Media Psychology. 6(2): 147-167
- Shammi, P., & Stuss, D. T. (1999). Humour appreciation: a role of the right frontal lobe. Brain, 122(4), 657-666.
- Granadillo, E., & Mendez, M.F. (2016). Pathological Joking or Witzelsucht Revisited. Journal of Neuropsychiatry and Clinical Neuroscience, 28(3):162-167.
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