NALL Working Paper #43-2001
What do clown-doctors
(1) know and how do they learn to do what they do?
EVERYBODY HAS TO START SOMEWHERE
The investigation supported by NALL was
undertaken against a backdrop of previous inquiry into the work of European and
American practitioners which suggested that while clown-doctors are not healers
or teachers they nevertheless appear to play a significant part in the process
of treatment and education that takes place in hospitals. However, clown-doctors
seem to epitomise Michael Polanyi's comment: "We know more than we can
say" (PERSONAL KNOWLEDGE (1962)).
My NALL supported research sought to:
- discover how & what clown-doctors
know on entry to the profession and how & what they learn both
formally and informally in a hospital environment
- examine the linkages between informal
and formal learning in clown-doctor training and practice in Canada in an
attempt to begin to identify "best practices"
- apply any insights gained to new
training programs, (2)
It should be noted that the research
undertaken was part of a bigger picture of continuing worldwide research into
the role of clowns in Health Promotion and Health Care and while the work that
NALL supported focused solely on the work of Canadian clowns several other
initiatives continued to look at European and American practice. Consequently,
within this document occasional reference is made to information gathered from
these other sources, especially where it influenced or reflects upon the work
undertaken in Canada. As a final preface, rather than keep my commentary and
observations to the end of the document, I have added 'editorial' comments which
reflect my analysis of the information gathered at the point that it is
presented. It should be stressed that this is simply one point of view and to
some extent reflects my biases about the work!
- consider how to develop multi-media
training packages that may be delivered, at least in part, at a distance.
BEST LAID PLANS ... the shortest distance
between two points is not always a straight line...
My original plan was to conduct interviews
with clown-doctors from around the world at a symposium in Strasbourg
(3) and to conduct a brief study of three clowns from Le Rire Medecin
in Paris and three clowns at Sick Children's Hospital in Toronto, so as to
compare different approaches to the work. However, NALL's rules did not permit
foreign travel and so this plan was changed. I knew I had to keep my research
plan small, self contained and relatively simple so as to stay within my budget
allocation and to keep to NALL's strict timelines.
In the proposal that was approved, I
intended to focus my efforts on the therapeutic clown program at Hospital for
Sick Children in Toronto and on PLAY IT AGAIN, a conference in Winnipeg where
all Canadian practitioners were to be present. My plan was to conduct individual
interviews and shadow the work of the three clowns in Toronto and then to
conduct individual interviews with clown-doctors in Winnipeg. All interviews
were to be taped, transcribed and analysed.
I spent the first stage of the research
arranging a time to visit the Toronto program. We agreed on a date in February
which was mutually acceptable. At the same time I made arrangements to
participate in the Winnipeg conference. I was fairly happy with these
arrangements until, immediately prior to my visit to Toronto I attended the
Symposium in Strasbourg (4).While at the
Symposium I conducted interviews with five clown-doctors (from France, Germany,
Holland, Italy, Sweden respectively) three of whom had started work with Clown
Care Unit in New York prior to starting their own programs in Europe. At the
Strasbourg meeting I discussed the Canadian research plan. All the European
clowns insisted that I really needed to visit each program and that simply
holding interviews in Winnipeg was not adequate!
The European clowns' wisdom became obvious
when I visited the Toronto program. As soon as I began to shadow the three
Toronto clowns I realised how different each was one from the other in terms of
their training, experience and ways of interacting in a hospital setting. This
first impression was amplified when I started to ask about their own
life-histories and the work in general. Each talked of how different their
program is from the ones in Winnipeg and Vancouver. As a result of these
insights I changed my travel plans and arranged to visit the Therapeutic Clown
program at Children's Hospital in Winnipeg prior to attending the PLAY IT AGAIN
conference. My view at this point was that visiting two of the three established
programs would give me a good picture of Canadian practice.
I should at this point make a qualifying
statement. My original research plans were based on nearly ten years of research
into laughter and healing in general and nearly three years of intensive
investigation into and discussions with clowns working in hospitals. However,
once again the Winnipeg conference illuminated the flaws in my planning. From
discussions, meetings and recorded interviews it became apparent that to get a
real picture of Canadian practice I had to visit the third major clown-doctor
program in Vancouver. However, by this time my budget had all but been used up,
it was at this point that I requested and was granted additional funding to make
the trip to Vancouver. Unfortunately, for several reasons (not all financial) my
trip to Vancouver couldn't happen until late July, much later than I would have
liked and after initial training for the FOOLS FOR HEALTH program had finished.
The final piece of information is that I decided to hold off this report until
the very last minute so that I can include information gained from the work of
the clowns working in the new program in Windsor.
TRIPPING OVER MY OWN FEET... collecting
and making sense of the data
Information was gathered about the
programs in Winnipeg, Vancouver & Toronto via interviews and round table
discussions. All information gathered from these sessions was taped and
transcribed. In addition to the taped sessions. I visited each program and
observed all the clowns at work. While at each of the hospitals I also met and
talked with supervisors and co-workers. I took extensive notes during these
hospital visits . I also kept notes on informal discussions held with the clowns
while visiting their hospital and by phone and e-mail.
In addition to the programs in Winnipeg,
Vancouver & Toronto I collected information about the program in Montreal
(5) through a taped interview with Olivier-Hugues, the round table
discussion and notes taken from informal discussions by phone and e-mail. In
addition Olivier-Hugues was a participant(as was Joan Barrington) in the 2 week
training provided for the Windsor clown-doctors (6)
. Here again many interesting comments were either noted or recorded.
During the life of the NALL research the
FOOLS FOR HEALTH project began in Windsor. While the focus of the research for
this project is different to that being conducted for NALL much of the baseline
information was relevant. Prior to starting the project information was gathered
about the preparation and training of the performers PRIOR to joining the
project. In addition information is being gathered throughout the project
concerning how and what the clowns learn on the job. This information is still
in the process of being collected . Analysis will not begin until the end of
August and so will NOT be available until after this report has been submitted.
All information gathered by tape was
transcribed and colour coded first using keywords and then category analysis.
The keywords and categories were developed from work conducted earlier with
American and European clowns . Salient information was charted using
sub-headings. Information relevant to more than one category was listed in each.
Patterns and contradictions were examined and noted. Cross reference was made to
notes taken outside of the taped interviews. Where appropriate inconsistencies
and questions were checked with the individual concerned. Every effort was made
to ensure the accuracy of information. However it is not inconceivable that
errors may have been made.
A final point , each program suggested
that a single visit was not sufficient to get a true picture of the day to day
activities and learning of the clowns. The work currently being undertaken in
the FOOLS FOR HEALTH project bears this out. So what follows should be
considered a 'snapshot' , a brief summary of the knowledge and praxis of
Canadian clowns. However it must be understood that this a merely a single
picture and while it may be a 'good enough' picture of the work, it is
nevertheless a limited view.
A BRIEF WORD FROM OUR SPONSORS ...some of
the differences between Canadian programs
Clowns have worked in hospital settings at
least since the time of Hippocrates, whose own hospital maintained constant
troupes of players and clowns in the quadrangle. While there were several
precursors from the 1950's onwards, professional clown-doctoring really began in
1986. At that time Michael Christensen (Dr. Stubbs), along with Jeff Gordon
('disorderly Gordoon'), began a clown-doctor program in New York. This work led
to the formation of the BIG APPLE CIRCUS CLOWN CARE UNIT (CCU). Simultaneously,
Karen Ridd ('Robo') a solo performer, who was also a child life specialist
initiated an experimental project in Winnipeg Children's Hospital in Canada.
This became Winnipeg's Therapeutic Clown program. (7)
Both programs are alive and well. They have expanded and acted as catalysts for
many programs around the world and represent two major approaches to the work
Both approaches work with healthcare
professionals to improve the Quality of Life and speed the healing of the
patients they serve. However there are notable differences between the two
Programs influenced by ROB employ clowns
who usually :
Programs influenced by CCU employ clowns who
- wear trademark bright circus style
clothes and make up
- work as part of the child life program
of a single hospital
- work alone on the wards
- carry a lot of props and toys with them
- are non-verbal often silent
- communicate via gestures & simple
sounds eg. squeaks, sighs etc
- do not use music or play instruments
- focus on the child/patient
- are rarely 'theatrical' or 'disruptive'
- play within a contained range in a
'small' & relatively quiet way
It should also be noted that Clown Care
Unit's approach to working in hospitals, while developed in North America, is
strongly influenced by what may be loosely referred to as the 'European School'
- wear a white coat, a red nose and
minimal make up
- are called DR. eg Dr. L'air de Rien,
Dr. Fifi, Dr. Opera, etc
- have an unique personality & name
often identified by a distinctive trademark [eg. yellow taffeta tutu (Dr.
Twinkle-Toes), Giraffe ears (Dr. Giraffe) ...] connected to that name
- are autonomous ie NOT hospital
employees and/or work in several hospitals
- work in pairs (dubbed a 'clown
marriage') on the wards carry minimal props/toys but rather work by
improvising with what is in the room (known as 'empty pocket clowning')
- are verbal and use language
- communicate using a wide scope of
gesture sound and language ranging from silence and simple gesture through
to loud and gregarious dialogue as the situation demands
- use music and song extensively
- focus as much on the family members
& healthcare workers as the patient
- are often 'theatrical' and deliberately
(but appropriately ) 'disruptive'
- play in a wide range-from playing of
quiet 'meditative' music or sitting quietly at a bedside, through to loud,
boisterous and anarchic productions of Shakespeare's plays or Tchaikovsky
ballets that involve anyone (patients, family, nurses, Drs., etc.) in close
proximity at the time
Currently clowns are employed in hundreds
of hospitals and healthcare settings in at least a dozen different countries
around the world. ( including Canada, Britain, France, Brazil, Austria, Germany,
Italy, Switzerland, Spain and The States) . In Canada , at the time of writing ,
there are programs employing clowns in Hospitals in Vancouver, Toronto, Winnipeg
and most recently in Windsor. In addition a pilot project recently finished in
Montreal and a new program is expected to begin before the end of 2001.
The programs in Winnipeg and Toronto are
clearly influenced by ROB's work. Both are directly 'administered' through the
child-life departments of the hospitals and David is employed as a child-life
specialist ('Hubert' , his clown is only part of his job description). The
program in Windsor is strongly influenced(as was the one in Montreal) by the
work of Le Rire Medecin in Paris, themselves 'descendants' of CCU. The Windsor
and Montreal program both operate 'independent' of the Hospital hierarchy and
The program in Vancouver may be considered
a 'hybrid' as it is influenced by both major approaches to the work . Here there
is a solitary clown who does not wear circus clothes or make up, is referred to
as Doc or Dr., is verbal and plays music but also carries lots of props
&toys and works as part of the child life program of a single hospital.
Having given a thumbnail sketch and some
background information about the program I will now move to a discussion of the
clowns who work in them.
LEARNING TO BE STUPID...what clown-doctors
know PRIOR to working in hospitals
At the end of the day I interviewed ten
individuals and shadowed nine of them in their work as clowns in Canadian
hospitals (9). Four of these individuals had been
working in hospital settings for more than three years. Six had less than one
year's experience and of these, three had no experience prior to July 2001.
The four experienced Individuals have
widely different backgrounds and work experiences. Camilla and Joan work in
Toronto, David in Winnipeg and Paul in Vancouver. David has an undergraduate
degree in English and Drama. He also has a teaching degree and for a short while
taught drama and theatre. Paul began a degree in Technical Theatre but left to
study mime in Paris with Marcel Marceau and Etienne Decroux, two of the top mime
teachers in the world at the time. In addition both David and Paul are highly
Prior to their work in hospitals both
David and Paul often worked as professional clowns. Both have extensive training
in clown 'skills', gained mainly from workshops but also from working with other
clowns. Of particular note are the following pieces of information. In the early
1970's Paul worked in the streets of Europe as a clown/ mime with Le Palais des
Merveilles a company whose co-founder was Caroline Simonds, the director and
founder of Le Rire Medecin. David worked with several clown companies in
Winnipeg including one called Lunacy where he worked with Karen Ridd ('ROB') the
founder of the Therapeutic Clown Program in Winnipeg. As may be intimated from
their backgrounds, their connections to the world of clown-doctors started early
in their careers.
Camilla trained as a Montessori teacher
and has a Master's degree in Library Science. Currently she is pursuing graduate
studies at OISE in Holistic Education. Prior to her hospital work she worked as
a teacher and children's librarian and is a published author and a well known
storyteller and workshop leader. She began her clown work fairly recently,
initially developing her clown through workshops with Karen Ridd and with Avner
the Eccentric (Avner Eisenberg), a well known and well respected clown 'master'.
Joan studied Arts Management at Humber
College. She was influenced by her aunt who was both an actress and a teacher of
drama & speech for children. In addition she took classes in movement and
drama with Leah Posland and Maggie Bassett . Prior to working in hospitals she
did some volunteer and party clown work. She also plays a little flute. She
developed her clown through workshops and a 'mentoring' process with Karen Ridd.
The six less experienced clown-doctors are
younger and generally have more formal academic training in drama and theatre
skills. Lucia works in Toronto, Olivier-Hugues in Montreal while Melissa, Judy,
Nick and Crystal are currently working in Windsor.
Lucia is the newest addition to the
Toronto program. She has a Masters degree in Comparative Literature and an
extensive background in various styles of theatre including Commedia D'ell Arte
(which she studied in Italy with one of the top modern teachers) and clown &
mask work which she studied with Richard Pochenko, who was, until his recent
death, probably the top clown 'master' in Canada. Olivier-Hugues studied modern
dance and theatre anthropology at UQAM in Montreal. He later studied physical
theatre in Winnipeg with Richard Fowler's company PRIMUS (one of the top
training grounds for physical theatre currently available in the world). He has
studied with a number of clown teacher's including Don Reider,of KLOWNIATA in
The Windsor clowns have many common
threads to their training. Crystal, Melissa and Judy have all completed, and
Nick is in his final year of, an undergraduate degree in drama and education. In
addition, Judy, Melissa and Crystal are trained teachers. Prior to her clown
work Crystal was the elementary school music specialist for her school board and
Melissa taught English for The National Circus school in Montreal.
Judy, Nick and Crystal had all studied
clowning as part of their academic training. Melissa studied Clown & Mask
with Sue Morrison and had previously worked for almost a year as a clown-doctor
with The Drama Practice in Scotland. Judy originally studied to be a
professional actress both at The School of Dramatic Art at the University of
Windsor and at The Actors Studio in New York. Both Nick and Crystal are trained
and highly skilled multi-instrumentalists, Judy is an accomplished Accordion
player and all four are good singers. All four took a 3 week intensive training
course supervised by myself and Caroline Simonds, prior to being let loose to
work on their own as clown-doctors in the hospital.
In addition to all of their other skills
most of the clowns are able to communicate in more than one language. Olivier-Hugues,
Paul, Melissa and Lucia are all functionally bilingual in both official
languages. Judy and Lucia speak Italian, Joan speaks German, Melissa speaks
Spanish, David is can communicate in a first nations language (or two?) and
Judy, Nick, Crystal and Melissa are an communicate in ASL. This ability to
communicate in more than one language is sometimes a great asset as wards in
urban hospitals are often multi-cultural and multi-lingual environments.
FOOLS AND THEIR MIRRORS ... how DO
clown-doctors learn in hospitals
All ten clowns currently working in
Canadian hospitals have had both formal and informal training that has helped
prepare them for their work as a clown-doctor. However, once hired for a
hospital program each clown has to learn how to survive on a day to day basis.
The preparatory training of new clowns
ideally involves both formal and informal elements that address clown skills and
their 'appropriate' use in a hospital and an orientation to the hospital in
general and to healthcare procedures of the specific ward on which they will
work. To provide some context, Le Rire Medecin and Clown Care Unit make all new
clowns undergo a rigorous training program before being set free in a hospital.
They have the financial resources and personnel available to design, develop and
deliver what they believe to be the appropriate training. Unfortunately in
Canada the mix of preparatory training is more often determined by budgets and
critical mass than by philosophy or pedagogy.
Until very recently Canadian programs
involved only ONE clown. To give a sense of the scale of the problem, Le Rire
Medecin employs 30+ clowns and the Clown Care Unit 90+ clowns . Currently, of
the well established programs, Toronto is still the only program to involve more
than one clown. It is difficult to justify a budget line item to provide site
specific training for even three clowns (for one it is almost impossible). So
training of new Canadian clowns has been an uphill battle
That being said the well-established
programs do have access to hospital staff to give standard talks about hospital
orientation , hygiene and other operating procedures. Sometimes these are
tailored to the needs of the program . They also have the opportunity to shadow
and observe experienced clowns at work. The element that is missing is that they
don't have the critical mass to develop site specific workshops on clowning in
Hospital. What this often means is that the new clown has to take 'off the rack'
workshops that may not meet the needs of the Hospital environment. Toronto is
well aware of the problems and are looking at ways to develop better preparatory
and in-service training modules.
Another problem is keeping the work new
and alive. To continually grow on the job and to develop as a performer, a
clown-doctor and as a person. There need to be opportunities for both informal
and in-service learning to occur. The best example of this is Le Rire Medecin
who run regular in-service training sessions for the company. They have a
consultant clown master who runs frequent day long clown skills workshops. In
addition, about once every 3-5 weeks, Medical personnel give seminars on
specific medical topics relevant to the company's work . Finally once a month
the company meets en masse to discuss an aspect of the work. To my knowledge no
other company has such an extensive and integrated approach to lifelong learning
and none of these elements are in place anywhere in Canada.
Again the sheer size of Canadian
operations make it difficult to run these sorts of in-service opportunities on a
regular basis. The clowns do have opportunities to attend conferences on both
'general' healthcare issues and on clowning or theatre skills, and in some cases
the expenses are paid by the hospital. However, for the most part, clowns
continued development is from informal learning mainly from the following
I'M WITH STUPID - Clowns learning from
- with other clowns
- with healthcare
- with patients and/or
Globally, clown to clown learning occurs
in three ways: formal group meetings; informal talks and discussions both inside
& outside the work place,; and working with a partner on the wards. My
research suggests that most clowns working in hospitals feel that the most
important of these ways of informal learning is through working with a partner
on the wards in direct interactions with any combination of staff, patients and
There are many good reasons why in a
hospital setting it is advantageous for clowns to work in pairs. Some of the
reasons relate to performance. A solitary clown-doctor, no matter how skilled
they may be, is limited. Without a proficient, professionally trained partner
they are forced to either put on a show, to entertain, or 'place 'pressure' on
the patient to be part of the performance. For when a solitary clown performs
there is no one to lend another point of view; initiate a new piece of business;
create improvisational conflict; help reset the volume if the clown is too
'loud' or too 'soft'; or at the end of the day, to discuss the day's events.
Often another professional clown is the
only person who can let his partner know, within the moment of improvised chaos,
when they have gone 'Over The Top' and more importantly know ways to help
retrieve the situation and turn what may have been a potentially traumatic
moment into a cathartic healing one. More than this, 2 clowns can create a
richness in the work where the sum of the whole is greater than the sum of the
parts. Most importantly, this shared experience often enables clowns to develop
coping strategies and problem solving skills simply from watching another
skilled professional at work.
Again the scale of Canadian programs
creates problems. Simply put, unlike European and American clown-doctor
programs, the opportunity for a clown-doctor to learn from another clown are
very few and far between for (except for Montreal and Windsor) most Canadians
work alone. In Winnipeg and Vancouver there are NO other clowns and thus no
opportunity for this kind of on the job learning except when a brother or sister
clown comes to visit and play.
Even in Toronto the opportunities for this
sort of learning are limited to infrequent meetings among the three clowns,
although they are discussing ways that they may occasionally partner one another
on the wards. So in Canada the bulk of (for Paul and David the ONLY) clown to
clown learning, occurs in unscheduled, infrequent and informal meetings with
other clowns and via e-mail.
STOP ME IF YOU'VE HEARD THIS ONE ...
learning from healthcare professionals
Globally, colleagues from other healthcare
professions are probably the next greatest source of clowns' informal learning.
The information gained may also be the most significant . Many anecdotal stories
bear witness to how clowns have learned to deal with weighty topics such as the
death of a child to more lighthearted advice concerning how to cope with
hospital smells, especially those of faeces and urine. Information is gained
from colleagues in different ways, some more formal than others.
All reputable clown-doctor programs have
some form of daily check-in before visiting patients. In most Canadian programs
this involves meeting with a member of the child-life team. In Winnipeg , where
David Langdon is employed as a child-life specialist, on clown days he simply
refers to a cardex system used by all child life specialists. In Windsor the
clowns meet with a charge nurse before changing into their clown costume. These
meetings provide clowns with information about the patients on a day to day
basis and to make requests about who needs a visit and perhaps what sort of
intervention is being asked for from the clown. In some programs, such as
Windsor, the check-in also provides a structured time for healthcare staff
feedback about the clown's work, behaviour and noise levels. This is important
because sometimes what may be beneficial for a patient and their family may seem
'disruptive' to a healthcare team member who is trying to do their job.
In addition to a daily check-in, some
programs participate in 'rounds'. In Toronto the clowns go 'occasionally' to
rounds both to observe and share their observations. David Langdon, in his
child-life role, is a de facto member of rounds. In Windsor, the clowns attend
all team rounds and gain, and share, information about patients' weekly progress
from the perspective of all doctors, nurses, therapists, and other healthcare
professionals who work with them. However as Lucia points out 'I'll get all this
information about a patient' ... 'when I'm in clown I completely forget what I
It must be pointed out that Clowns often
know salient information not cerebrally but 'in their bones'. As I have been
seeing on a regular basis choices made for a patient in clown are directly
related to the patient's treatment program discussed in rounds or even on the
fly in the hallway with a nurse.. However, clowns when complimented on their
planning look blank and make it clear that any connection was subconscious.
However, this 'mindlessness' (mind of a child) rather than being seen as a
weakness is the very reason why the clowns are successful.
In addition to these structured
information gathering and sharing sessions, there are also many ad hoc meetings
on the wards between clowns and healthcare staff where information is shared.
This may range from a brief notification concerning a patient's health, a
request to leave a patient alone through to a need for a clown to visit a
particular room. This sharing on the fly is often essential. It is important to
develop a ritual or routine by which this information sharing may occur. This
can range from a brief word whispered in a clown's ear as they pass to a request
for a moment alone.
For clowns who wear red noses it is a
simple procedure to engage in a conversation with Healthcare staff (or parents)
as themselves NOT their clown as they can go into 'noses down'
(11) mode at anytime . However for clowns who are silent, and/or who
use a lot of make-up to create their clown persona, there are some
complications. It is very hard for the person to appear quickly from behind the
clown to engage in a 'serious' conversation. However, the problem is not
insurmountable and all the experienced clowns who are silent/wear make-up have
developed a code for such interactions as they arise.
In addition to finding ways of sharing
information on the fly it is most important that when necessary the healthcare
staff have a way to 'shoo away' clowns, a simple signal that lets the clown(s)
know they are not wanted. This helps prevent misunderstandings eg where a family
member or a patient invite the clowns in to the room to play at a time when a
healthcare worker is trying to carry out a delicate procedure or begin a
Finally, and perhaps most importantly,
significant learning occurs when clowns go 'inclownito'
(12) to join healthcare staff for lunch or coffee . Once the clowns
have been accepted as members of the 'healthcare family' it is important to
build in times to simply 'hang out' with colleagues and discuss stuff NOT
related to the patients or the hospital.
OUT OF THE MOUTHS OF BABES AND AUNTIES
...it's all in the family
The other major area where clowns learn is
in their interactions with patients and with patients' families. It is a double
mirror because more than any other source patients and their families illuminate
what is 'really, real in the work. Anecdotes abound about how this or that
incident helped to shape the clowns practice.
All professional clowns, especially those
who work in pairs, engage in 'rehearsals' where they prepare lazzi (comedic,
predominantly physical business), songs and other bits of 'schtick' to take onto
the ward. However at least as many new activities are generated by the clowns'
interactions with people on the wards than by 'rehearsal'. A simple example of a
new idea coming from a patient came when I was visiting Paul Hooson in Vancouver
. Dr. Willikers was playing with a young girl who has cancer . Using a standard
lazzi of a 'squeakotomy', Paul was placing and removing a squeak from parts of
the girl's body . However, this young girl had other ideas as to how to use the
squeaker! She used it like a television remote allowing the clown to speak or be
mute, at her discretion. After leaving the room Paul said I'd never have thought
of that but I'm sure she will want to play this game again. Also the way a
patient or a family member interacts with a clown can illuminate their practice
in other ways. Camilla tells a story about working with an East Indian family
who called her 'auntie' and how that made her think about how to adapt her clown
to the patient's own culture.
Often information is freely given to a
clown that either puts the patient's behaviour in a new light or gives ideas
about how to approach the patient or a family member. Many clowns talk about how
sometimes the patient will share information that is NOT contained anywhere in
patient records! For example clowns in Windsor working with a patient who had
had a tracheotomy and was being taught how to speak again found out that she
loved to sing and had a large repertoire of songs. Or they will find ways of
getting the patients to be compliant, to cooperate with their treatment that no
one else can do. The clown can then share this with other members of the
healthcare team. This has added benefits as it increases the interactions and
informal learning with the healthcare team.
The key thing in all the above is that the
clown has to learn to be fully attentive. The French clowns refer to this as
'listening with all antennas up'. For to be successful and to continue to grow a
clown-doctor must be a creative detective. They have to learn to not go in with
a set agenda but must be ready willing and able to listen to any and every clue
they are given. They may not always be able to make sense or make use of the
information immediately. It may take some time and perhaps discussion with other
members of the healthcare team to process how best to incorporate this new
knowledge into their work. However, the point stands that if you have switched
off the receivers you won't hear the incoming message!
A WORD WHISPERED IN THE EAR OF ONE
PERSON... disseminating information
The information gathered from this
research, especially that on "best practices", has already influenced
the training of clown-doctors on the FOOLS FOR HEALTH project. It will also be
shared with all Canadian clowns. Olivier-Hughes is already making use of this
information in Montreal and I feel sure that it will influence other
clown-doctor programs as they develop in Canada. To what extent it will
influence established programs in Vancouver, Winnipeg and Toronto, ... well, It
isn't always easy to teach an old dog new tricks. It will depend on the extent
that they are able to listen to and see the suggestions as beneficial to their
Information gained from this research will
be disseminated through conference presentations, articles and books. In
addition two chapters based in large part on this research are in the process of
being completed :
"THE LONG AND WINDING ROAD TO 'FOOLS
FOR HEALTH': introducing clown-doctors to Windsor Hospitals" to appear in
CREATING A THEATRE IN YOUR CLASSROOM AND COMMUNITY (Ed: Bernie Warren, pub:
Captus University Publications) Estimated publication date: Nov. 2001
Throughout this report I have engaged in a
commentary on Canadian practice.
"THE FOOL AND HIS MIRROR - how
clowns learn and teach in hospitals" to appear in HOW THEATRE TEACHES.
(Eds.: David Booth & Kathleen Gallagher pub: The University of Toronto
Press) Estimated publication date : Dec. 2001
A paper "FOOLS FOR HEALTH:
Integrating East and West, with humour" will be presented at the ART AND
SCIENCE OF HEALING II a medical conference to be held in Vancouver in October
IF YOU WANT TO KNOW WHERE YOU'RE GOING,
LOOK BACK TO SEE WHERE YOU'VE COME FROM ....conclusions
Simple things stand out from this brief
research especially when held against the backdrop of the American and European
research. Here are what I feel to be some of the most important points.
One of the big questions from all my
research is whether there in a generic sense such a thing as "best
practice". It is clear that every successful program I have seen around the
world, even those operated by the same company, are to greater or lesser extent
tailored to the needs of the context in which they operate ie: to a large extent
best practice IS site specific.
Irrespective of their style ALL Canadian
clowns are extremely professional in their interactions with healthcare staff,
patients and their families. In addition there is very little back-biting or
animosity amongst the programs and there is a general willingness to share and
listen to information.
Most leaders of the well established
Canadian programs are happy with the way their program runs. There is absolutely
NO doubt in my mind that all the Canadian programs do what they do very well and
are well received by their hospitals and by the human beings who they 'serve'.
From this perspective all the Canadian programs are all "good enough".
However, based on my global research, the question is not, "Is what
Canadian clowns do good enough?" but rather, "What can they do to
improve their practice and their program(s)?"
Canadian clowns are fiercely loyal and
proud of their connections to ROB. They often contend that what they do is
different to the work carried out by CCU in America and LRM in Paris. However,
there are always things to be learned from expert practice wherever it may be
found. There is no doubt that there are things that may be learned from the
"best practices" of the European and American programs.
HERE ARE SOME AREAS THAT I HAVE
Many of the clowns working in Canadian
hospitals are at very least adequate musicians and/or singers , some are highly
skilled in these areas. Given the documented success of the use of music in
hospital-based clown programs (13) this seems an
area that could easily be capitalised upon with a minimum of effort or expense.
A more contentious issue is the one of
working with a partner. It is clear that in Canadian practice ROB's 'mother
imprint' is very strong! However many Canadian clowns recognise the value of
working in a 'Clown Marriage' and often enjoy when a colleague comes to clown
with them in their hospital. There are simple ways that working in pairs or
larger groups may be accomplished without changing the core of their practice or
their basic approach. For example, In Windsor clown-doctors work in pairs but
from time to time all 4 clowns work together in the lobby and the foyer. Also
once a week they give a short "clown recital", an interactive
performance that brings the patients out of their rooms and together in a
central location for about 30 minutes.
All clowns should have the patients'
well-being and quality of life as their primary focus . Canadian clowns can not
be faulted in this area . Their work is often highly patient intensive. When
this happens, in a sense their work could be described as being closer to play
therapy than theatre.
The downside of what Canadians excel at is
that (with the exception of David Langdon who is a child-life therapist) none of
the Canadian clowns are trained to work as therapists! However, most clowns
agree that the strength of their work results from the fact that they are NOT
This sets up a conundrum. For other than
their costume and make-up or red nose they have no defence against transference
or counter-transference and NO training to deal with 'deeper' personal issues. A
Clown's strength , their defence, is in simply being a clown and doing foolish
things. By being a clown, the lowest of the low in the hospital hierarchy,
patients and family feel safe in telling and doing things they wouldn't do with,
or say to, any other professional. However if Canadian clowns continue to work
in this extremely focused play centred way, it is probably highly advisable that
they gain more training in therapy and therapeutic methods.
While there is no formal or standardised
training currently available (and some may argue there should NEVER be) for the
most part Canadian clown-doctors are well prepared for the work. However, as
more programs develop in Canadian hospitals a closer look may need to be made in
to what skills sets and competencies are necessary to do the work.
The opportunities for professional
development are extremely limited for clowns working in Canadian hospitals. The
availability of in-service training in clown-doctor skills are all but not
existent. This would not be such a problem if the opportunity for informal
collegial exchange was greater and if it were seen as an essential part of the
work, as it is with CCU and LRM. BUT clowns in Vancouver and Winnipeg work alone
and in Toronto, even though there are three of them, as yet the opportunities
for collegial exchange are very limited and appear to be given a relatively low
priority. Even with the injection of new blood, with the addition of extra
clowns, there must be a means of sharing ideas and information not just with
hospital colleagues. It is essential to share and even challenge the work with
other professional clown-doctors. The other alternative is for the work to
remain static and stagnate!
There is an urgent need to examine, design
and develop appropriate professional development and in-service training models
and modules for clown-doctors working in Canada.
1. The term
"clown-doctor" will be used throughout this proposal to describe a
clown who works in a therapeutic
is a specially trained professional artist who works in a hospital .
Clown-doctors use interpersonal and
communication skills coupled with the
skills improvisational techniques of Clowning [ in such skill areas as comic
acting, lazzi (pratfalls comic business), music, movement/dance, poetry,
juggling, magic] to help PROMOTE wellness and IMPROVE physical and mental
health and quality of life of patients, their families and the healthcare
staff who interact with them.
Some would argue that this term
clown-doctor is inappropriate as a generic term and that it should only be
applied to clowns who follow the model developed by CLOWN CARE UNIT. Other
frequently used names include "hospital clown", "therapeutic
clown", "clini-clown". It should be noted here that clowns
working in Canadian programs usually refer to themselves as therapeutic
2. Much of the
information gained from this research is already being implemented , especially
in the Windsor FOOLS FOR HEALTH program, a two month pilot/demonstration
project, grounded by research into international praxis, that employs 4
clown-doctors on the in-patient rehabilitation unit at Windsor Regional
Hospital. This initiative is being supported by grants from The University of
Windsors Research Board & The Windsor Regional Hospital Foundation .
The project is first phase of a proposed
larger community based program being developed by The Hospice of Windsor and The
University of Windsor in association with local hospitals and community health
groups in Windsor and Essex County.
3. The First European
Symposium on the Arts in Hospitals and Healthcare.
4. This visit and
research was supported by a n Academic Travel Grant from The University of
Windsor and by the French Ministry of Culture & ADCEP(the Symposium
5. The only program I
did not visit although I did get a chance to watch Olivier-Hugues at work when
he came to Windsor.
6. The two weeks of
training preceded the Windsor Clowns working in the Hospital. It was conducted
by myself , Caroline Simonds and Merrill Flewelling . Joan and Olivier elected
to take this training to improve their own skills. However, they were also able
to share their own experiences and thus contribute to both their own and others
7. Interestingly enough
neither knew about the others work and to this day they have never it is my
understanding they have never met one another!
8. There are other
models of practice for clowns working in hospitals. For example, Some clowns are
also clergyclowns for Christ, others are simply entertainers either as
volunteers or on a semi-professional basis. while still others are doctors who
use humour as part of their medical practice.
However for the purposes of this document
I have limited my discussion to two major and diametrically different approaches
, which may be considered at opposite ends of a continuum of professional clown
9. Names of Canadian
Clowns , clown names in ( ):
Camilla Gryski*(POSIE), Lucia (NULLA) and Joan Barrington* (BUNKY) - Toronto ;
David Langdon* (HUBERT) - Winnipeg ;
Hooson* (DOC WILLIKERS) - Vancouver ;
Crystal Brennan(Dr. OPERA), Nick Morrison(Dr. TWINKLE-TOES),
Judy Spadafora(Dr. POOPS) and Melissa Holland(Dr. FIFI) - Windsor;
Olivier-Hugues**(Dr. LAIR DE RIEN) -Montreal
* more than 5 years experience
**only person I did not see at work in his
10. This statement
doesn't really apply to the Vancouver and Winnipeg programs as both seem
philosophically resistant to the notion of adding clowns to their program, even
though at first glance it would appear that there is work and money available to
support this. While they do make many good arguments about why they want to keep
the program small, I am not alone in the belief that this is limiting the
development of the programs. On the other hand the Toronto program is looking to
slowly expand its personnel and they are looking to add one new clown later this
11. Clowns who wear a
red nose can simply step out of character by lowering the nose which is attached
by elastic behind the neck.
12. Inclownito , is a
term used to describe when, as part of their work, a clown communicates or
interacts as themself . with hospital personnel and occasionally patients
13. This appears to be
true even where the hospital has music therapists or a visiting musicians