the scream that can only arrive as a joke
sarcasm and jokes were often the bottle in which clinical depressives sent out their most plangent screams for someone to care and help them
Context
The whole interview runs on a doubled deafness: Kate's most urgent cries for help reach the doctor only bottled inside sarcasm and jokes, and the clinical method that lets him decode them as significant also forbids him to receive them as a person would, forces him into a literalism she reads as having no sense of humor. Her realest message and the only form it can take are the same thing, and that form is exactly the one the room is built not to answer.