Kate Gompert in the psych ward: sincerity undecidable
jokes and sarcasm were here usually too pregnant and fertile with clinical significance not to be taken seriously: 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
On the psych ward the register-war becomes a diagnostic problem. The resident must be relentlessly literal because irony here is not a defense to be respected but a symptom to be decoded — "jokes and sarcasm… too pregnant and fertile with clinical significance not to be taken seriously," the bottle a depressive floats a plangent scream in. And the scene's recurring crux is that sincerity itself goes undecidable: Kate's expressions make it "clinically impossible for the doctor to determine whether or not she was entirely sincere," and he cannot even tell whether the "ambient blank insincerity" is hers or his own projection. Where irony everywhere else is a chosen armor, here it is an involuntary symptom, and the tragedy is that sincerity and its counterfeit have become indistinguishable even to a trained reader. (The clinical depression / It / Bob-Hope-withdrawal substance is depression-anhedonia's, BUILT; landed here is the register point.)