You're joking: Exploring humour and humiliation as forms of shame and obstetric violence within medical encounters.

Despite medical guidelines delineating respect towards patients, many encounters between patients and clinicians are problematic, in which patients feel disrespected, unheard, shamed or abused. This article uses an anthropological lens to focus on the imbrication of humour and humiliation as forms of shame and obstetric violence within obstetric encounters. Humour as a form of speech play creates a substrate for the occurrence of humiliation and shaming of obstetric patients. Humour enhances patients' feelings of shame, making them vulnerable to verbal and physical forms of obstetric violence. Ethnographic methods of observation and interviews were performed in two hospitals in the Mexican city of Puebla to uncover clinicians' perceptions and narratives about their patients as problematic others. Narratives about patient worth underscored interactions. Humour and humiliation were centrally present within these interactions. Ultimately, both humour and humiliation functioned as shaming mechanisms that increased the presence of obstetric violence in these encounters. The article examines whether an understanding of shame can improve clinical practice and concludes with implications to clinical practice.