Summary of the impact

Written and performed by Oliver Double, the stand-up comedy performance Saint Pancreas uses the medium of comedy to enhance public understanding of type 1 diabetes, and to challenge prevailing assumptions about the condition within and beyond the community of patients and their families. As a live performance and on DVD, the work has had impact on:

• diabetes sufferers
• diabetes organisations in the UK and the US
• charity and healthcare professionals

Furthermore, within the field of stand-up comedy itself, it has contributed to challenging and broadening the aesthetic possibilities of the form.

Underpinning research

Premiered live in 2006 and released on DVD in 2007, the 90-minute stand-up comedy show Saint Pancreas focuses on the experience of parenting children with type 1 diabetes [2]. It thereby extends in a practical form Double's research on the issue of emotion and intense personal experience in comedy, which was investigated in his book Getting the Joke [1]. In this work Double draws on comic theory, interviews and analysis of stand-up performances to investigate how the need to elicit laughter from an audience, which defines the form of stand-up comedy, has been conventionally perceived as a barrier for addressing certain kinds of intense personal experience, such as that related to illness. Such topics might provoke ostensibly non-humorous responses from an audience, such as empathy and pathos. Contemporary comedians Jimmy Carr and Lucy Greeves express a widespread assumption about stand-up comedy when they suggest that `emotional pain' is one of the `still unacceptable taboos', (Jimmy Carr & Lucy Greeves, The Naked Jape: Uncovering the Hidden World of Jokes, London: Michael Joseph, 2006, p.188). From a theoretical perspective, certain strands within comic theory suggest that emotion and laughter are even inherently incompatible. Henri Bergson, for example, argues that laughing requires a `momentary anaesthesia of the heart', (Henri Bergson, `Laughter' in Wylie Sypher (ed.), Comedy, Garden City, NY: Doubleday, 1956, pp.63-64).

Double's academic research has concentrated on influential work by a number of stand-up comedians (such as Richard Pryor, Andre Vincent and Mark Thomas) who deal precisely with such material deemed unsuitable, even unspeakable, tackling traumatic, confessional or disturbing topics. Double argued that this work both extended the emotional range of the medium and suggested new ways of developing rapport, empathy and solidarity between comic performers and their audiences, as well as suggesting new ways of negotiating the risks of working with emotionally intense personal material.

Saint Pancreas tested these arguments in the form of a stand-up performance that drew on Double's own experience of being the parent of two children with type 1 diabetes. St Pancreas thereby extended the original scholarly research in the form of a practice-as-research project, which involved analysing the performance and reception of the performance in relation to comic theory and the work of the other comics that had been the focus of the scholarly research. The show includes material that deals directly with intense personal emotional experiences, for instance with Double's younger son falling into a coma in a paediatric intensive care unit. The central focus of this practice-based strand of Double's research was to further investigate the effect of emotion on the basic performance dynamics of stand-up. It explored three central issues:

i. the effect of the nature of the material on the way it was performed

ii. changes in the performer-audience relationship

iii. most importantly, the question of humour: would it actually be funny?

In so doing, the research sought to expand and enrich the aesthetic and imaginative possibilities of this popular performance genre, `Recalling traumatic experiences in a way that was funny without suppressing the horror' of them [3]. Audience members who were interviewed directly after the show testified to the success of the experiment. One said, `You're still aware of how horrible things are, but there's nothing wrong with it, it doesn't detract from the terrible situation, just because you're laughing' [2].

A central part of the investigation was the idea of sharing intense personal experience, one of three key concepts that emerged from Double's research; the others being emotion and empathy [4, 5]. As part of this sharing of experience, the show then also explained various aspects of diabetes to its audience, including its physiological causes, its treatment, and the impact it has on families. It also tackled some of the popular misconceptions surrounding the condition. The research was undertaken at Kent by Oliver Double: Lecturer (1999-2006), Senior Lecturer (2006 -Present).

References to the research

2. Saint Pancreas, 90 minute live performance, premiere 3 November 2006, Horsebridge Arts Centre, Whitstable; DVD recording and release through University of Kent, December 2007 (including film, contextual interview, 10,000 word essay [see 3 below]).

Details of the impact

The live performance and the DVD of St Pancreas reached beyond the academic community by both enhancing public understanding of diabetes and challenging some of the assumptions about the condition. The principal user groups who benefited were diabetes sufferers, their families and carers, diabetes organisations, healthcare professionals and charities. Additionally, stand-up comedy culture — fellow comedians, critics, and audiences as a central part of this community — benefited from the work's exploratory and challenging expansion of the genre's accepted conventions.

Diabetes sufferers and their families, and the public understanding of diabetes

By July 2013, 292 copies of the DVD Saint Pancreas had been sold through the University of Kent. Order addresses show a distribution across the UK and some internationally. The DVD was also acquired by the British Library, by more than ten Universities (other than Kent), and by Diabetes UK. Further free copies have been made available to journalists as well as professional comedians. Many of these copies will have been seen by multiple viewers.

The show and DVD were reviewed in The Guardian by William Cook, who wrote that despite its `highly unlikely subject for comedy,' the show was `a tender and uplifting monologue that's surprisingly funny' [6]. Furthermore, the DVD received positive responses from specialist diabetes publications [7, 9].

The responses captured in the audience interviews published on the DVD itself are indicative of this type of response, and thus of the significance of the show's impact. Double also received numerous personal letters from parents of children with diabetes suggesting that the sharing of experiences was valuable to them, offering a sense of relief and validation [1]. For example, one parent comments that the show `made me feel less alone...someone else out there "gets it."' Another wrote that `Watching Saint Pancreas allowed us to have a good laugh with someone who truly understood what living with diabetes is really like. It was very cathartic but also made us feel that we were a part of something with other families. Instead of feeling that our family life was different and we had to avoid talking about diabetes too much, we felt more normal' [2].

The diabetes community: professional healthcare and charity organisations

The release of the DVD and the further dissemination of its underpinning research, both scholarly and practice-based, led to an invitation to Double from the leading charity, Diabetes UK, to write an official blog for their website. Joe Freeman, Digital Engagement Manager at Diabetes UK comments in an email to Oliver Double (18.10.11) that `reactions to what you've written have been more varied and frequent than those on posts from other bloggers... Parents of children with diabetes seem to relate well to what you write ... and your posts are the most popular on the site' [3]. To end of July 2013, 30 blogs have generated a total of 15,319 unique views and Double's posts have been shared 1437 times on Facebook and 150 times on Twitter.

Double's activities with Diabetes UK in turn led to invitations to perform St Pancreas at key national and international conferences and events, aimed at diabetes sufferers, their families and professionals. These included the Friends for Life family conferences organised by the US-based NGO Children with Diabetes (CWD) in Windsor, UK (2010 and 2012), Orlando, Florida (2011 and 2012), and Glasgow, UK (2013) [9,10]. Double's stand-up comedy show was also performed at the Diabetes Wellness Day in Greenwich, UK (2011), organised by the UK Charity Diabetes Research and Wellness Foundation (DRWF), and at the Type 1 Discovery Evening in London, UK (2013), organised by the leading charitable funder of diabetes research, the Juvenile Diabetes Research Foundation (JDRF). Through these routes, the show has been seen, as of July 2013, by approximately 4,710 live audience members.

Jeff Hitchcock, founder and president of CWD, explains why stand-up comedy in general is a valuable activity for diabetes organisations, and the benefit of Double's performance in particular: `Humour makes the difficult possible...when you are on stage...we are free from the burden of the challenge before us, even if just for the few minutes of your performance' [4].

St Pancreas has also created direct financial charitable benefit as each DVD sale generates a donation to JDRF, totalling by July 2013 £541.60, and an additional £286.80 of donations from ticket sales for the live performance.

Stand-up comedy culture

The research had an impact within the stand-up comedy community in terms of its distinctive and challenging contribution to the development of the form. This has been evidenced by, for example, responses from significant comedians in the field, including Arthur Smith and Mark Thomas [7, 8]. Thomas' acclaimed 2012 one-man show Bravo Figaro tackled his experiences dealing with his father's dementia with a similar blend of comedy and empathy. Thomas wrote to Double to confirm that:

The important thing with [St Pancreas] is that it deals with a medical subject that is not often an area of comedy. This allows people to laugh at the situations people with these issues find themselves, which makes it (for want of a better phrase) easier to talk about. It helps break through the stigmas of health being talked about by professionals in medical terms or lay people in hushed and worried tones [8].

The impact of Double's St Pancreas project therefore can be seen to range from its pragmatic and inspirational value to diabetes professionals and organizations; to its beneficial role as a source of relief and validation to individuals and families affected by diabetes; to its cultural significance in helping to broaden the thematic range of stand-up comedy; and through all of this, to its role in deepening public understanding of type 1 diabetes.

Sources to corroborate the impact

1. Letters and emails from people affected by diabetes: a selection of these, including fuller versions of those cited above is available online http://www.oliverdouble.com/page12.htm. They corroborate the impact on diabetes patients and their families.
2. kate fazakerley, parent of a diabetic child, whose email to Double is quoted in the case study, and who can corroborate the benefit for diabetes sufferers and their families
3. Joe Freeman, Digital Engagement Manager at Diabetes UK, who can attest to impact on diabetes community of Oliver Double's blogs http://blogs.diabetes.org.uk/?cat=7.
4. Jeff Hitchcock, head of Children with Diabetes (CWD) charity, who can corroborate the benefit for diabetes charities
5. Siobhan Murphy, Diabetes Research Foundation, who can corroborate the significance of Saint Pancreas for diabetes organisations and healthcare professionals
6. William Cook, `Oliver Double, DVD & Canterbury, Whitstable,' The Guardian (The Guide section), 26 January 2008, p.40. This review corroborates the reach and significance of the work within and beyond the diabetes community.
7. Arthur Smith, `Arthur's Armchair View: Bent Double over diabetes,' Balance, July-August 2008, p.78. Comedian Arthur Smith corroborates the impact of the work on both the diabetes community and on stand-up comedy culture.
8. Mark Thomas, stand-up comedian, can corroborate the impact on stand-up comedy culture and how Double's work has contributed to the development of this form.
9. Media coverage, which further corroborates the reach and significance of St Pancreas' impact:

• `Saint Pancreas DVD', Diabetes Breakthrough, Autumn 2007, p.15.
• `Making illness a laughing matter', Times Higher Education, 10 January 2008, p.13.
• Nicky Findley, `Double trouble raises a laugh', Sweet, December 2008, p.18.
• Hayley Jarvis, `Seriously Funny', Linkup, Autumn/Winter 2009, pp.7-8.
• http://www.youtube.com/watch?v=LzUzNFBYkt0 (excerpts from 2010 Windsor show).
  http://www.childrenwithdiabetes.com/activities/Orlando2011/OliverDouble.htm (full video of the 2011 Orlando show).