The rise and fall of black humor in medical slang

Via Steve Sailer, here is a very long list of black humor medical slang, such as "TF BUNDY" -- totally fucked, but unfortunately not dead yet -- or "Double whopper with cheese" -- obese female with genital thrush.

All forms of slang, in fact oral culture generally has been declining from sometime in the '90s onward, after their re-birth in the '60s and peak in the '80s. (An earlier cycle saw a peak in the '20s, and a lull during the mid-century.) Medical slang must fit that pattern too, and sure enough it does. Here's how common the spelling variants on "medical slang" have been in the American books in Google's digitized library (Ngram):

Considering all three variants, it looks like it reliably gets going during the '60s. The main growth is the '70s, '80s, and first half of the '90s, and a decline afterward. As for specific slang terms, the only one that appears to show up in Google's library is "get out of my emergency room" ("GOMER"):

That one got going during the late '70s and fell during the early '90s. It's unusual for any word to stay at a nearly constant level, the way this one does after 1990, so I'm guessing it's being kept on life-support, as it were, by new works referring to slang no longer in use (medical TV dramas perform the same function). The term was popularized by a 1978 satirical novel, The House of God.

The NYT has only four articles in its entire history with the phrase "medical slang" -- from 1968, 1973, 1991, and 2009. However, the last one is a retrospective on The House of God, not an article that casually uses contemporary medical slang, with a parenthetical remark like "that's medical slang for..."

Many of the entries in the list can be dated, at least what they're referring to, although the term referring to it may not have started right away. Still, people try to be somewhat topical in their pop culture references. Here are the ones I could date from the A-D entries (there are too many to look through the whole list right now):

4H -- AIDS ref from the '80s.
404 moment -- mid/late '90s internet ref.
Airwolf -- mid-'80s TV ref.
AOB -- mid/late '80s, after the "Baby On Board" fad.
APD -- Prozac ref, from '90s or after.
Blinky the Fish -- early '90s Simpsons ref.
Bunny Boiler -- late '80s ref to Fatal Attraction.
Captain Kangaroo -- mid-'50s through mid-'80s TV ref.
Caveman -- mid-2000s ref to Geico ad.
CCFCCP -- '80s or '90s? Ref to Cocoa Puffs slogan.
Code Pink -- sounds '80s or early '90s, pre-Tom Hanks in Philadelphia.
Crackerjack referral -- mid-'50s to mid-'80s TV ref.
Crispy Critter -- '60s or late '80s cereal ref.
Death Star -- late '70s or '80s Star Wars ref.
DILF -- late '90s / early 2000s ref to "MILF."
Disco biscuit -- '80s drug ref, recycled in early 2000s.
DPS -- late '90s / 2000s Viagra ref.

Again the '80s and first half of the '90s seem to be the peak, confirming the Ngram and NYT results. Other major hints that this list reflects older usage are all the swear words, whereas younger people these days (who are the most likely to coin words) prefer "gosh" to "god," "effing" or "fricking" to "fucking," and so on. And of course all of the politically incorrect terms like "HONDA" -- hypertensive, obese, non-compliant diabetic African-American -- and "HMS" -- hysterical Mexican syndrome.

The decline of medical slang has been written about for some time now. Adam Fox, a British doctor, wrote an academic article about it back in 2003, which I have not read. In that year his views also made it into a BBC article, and later still in a 2011 Daily Mail article.

What accounts for the rise and fall? Once again we see the rising-crime vs. falling-crime pattern -- no pervasive use of black humor medical slang during the mid-century, followed by a rise from the '60s through the early or mid 1990s, and a decline since then. That's also the pattern for black humor in movies, really beginning with Dr. Strangelove, going through Network, and peaking with Heathers and Total Recall.

Falling-crime times are also periods of social isolation, and elements of oral culture such as slang require frequent face-to-face interaction, especially in unsupervised and unmanaged settings. If doctors used to see each other as peers who they could joke around with, they now see each other more as co-workers who need to maintain an appropriate social distance in the workplace. Rising-crime times reverse this, with a greater desire to connect with others, and more jocular peer interactions.

Perhaps rising-crime times also increase our need for ways to cope with a topsy-turvy world. Doctors are probably like the rest of us these days in not seeing a bigger picture behind everyday violence and death, even though they're exposed to it more than we are. But back when the crime rate was a lot higher, they must've felt like something strange was affecting the whole society, just like we did.

Black humor helps most when it seems like there's nothing we can do in a waving-the-magic-wand kind of way. Hence the term "gallows humor." Falling-crime times give us a sense of greater and greater safety, so violence, gore, and death are seen as unfortunate, but not as harbingers of a possible apocalypse. Not being very portentous, they don't require black humor to help doctors cope with them.

It's not that falling-crime times deliver fewer victims of violence to doctors. If it were only that, medical slang would be qualitatively the same, only less frequently spoken. From all signs, though, the change is not that doctors don't have occasion to make use of those terms as much as they used to. It's that the whole tradition is CTD -- circling the drain.

But I have hope that when the crime rate begins rising again, and people start interacting more face-to-face and as trusted equals, the oral culture will revive like it did starting in the '60s, black humor and medical slang along with the rest of it.