Foundation for Therapeutic Clowning

This article first appeared in the “Terravita Spirit” in the winter edition, 2001.

The Hospital Clown
By Arne Swensen

Why Have a Clown in a Hospital?

The old cliché is that "laughter is the best medicine." This is the theory first espoused by Norman Cousins, often credited as being the inventor of the use of humor in medicine. In fact, he cured himself with Vitamin C and doses of laughter. There is more and more clinical evidence that supports the value of humor to the healing process. Much research has been done, and is continuing. In September 2001, Premiere hospital clown, Dr. ?Patch? Adams, on a tour of China, presented a lecture to some of the Chinese medical community pointing out how humor increases the endorphins, which have a positive effect on control of pain and emotions. Laughter increases oxygen to the brain. This is well documented.

We all know circus clowns, and many of us have seen rodeo clowns or attended birthday parties where clowns were invited to add fun to the festivities. All clowns are fun based….humor driven. That includes hospital clowns.

If you’ve been a patient in a hospital you know that hospitals can be scary places, especially for children. The equipment can be intimidating and the language often foreign to us. Hospital stays include uncertainty, endless testing, and long periods of waiting to get answers. This often breeds loneliness, and fear, from not knowing what will happen next. Time pressures on the medical staff, and the circumstances of the patient’s condition, often create a mood of high tension and drama.

It is into this environment that the Hospital Clowns bring their special mix of humor and sensitivity. The clown’s presence is unique….a very different and usually happy encounter. The hospital environment is sterile by design. The clown balances this by bringing color into the hospital room….fanfare….a positive farce. It is generally a welcome change, a pleasant surprise in the hospital experience

As individual clowns develop their skills and a good relationship with the medical staff, doctors and nurses begin to recognize the value of this type of therapy. They often suggest that clown visits be made to specific patients who could use a boost in morale. And the fact is, the clowns have an uplifting role to play in the interaction with the staff as well.

The stress of the day can sometimes be very intense when dealing with life-and-death issues. A smile, a kind word, a piece of candy, a little song or magic trick is a welcome break for nurses, and sometimes doctors too. My hospital has a cardiologist that loves to play my keyboard when I make my clown rounds. He’s very accomplished. It’s a great minute of joy for the entire crew.

There are many instances where clowns are asked to be involved with situations where patients are dying. Some are children. Some are not. Sometimes clowns are used to distract a child or adult from a particularly painful procedure, or to deflect fear. Sometimes, their focus is on comforting and supporting the patient’s family!

What Exactly is a Hospital Clown?

Hospital clowns are a specialty within the Clowning community. They are a branch of what are known as caring clowns, which are normally found in hospitals, hospices, nursing homes, orphanages, health education and grief support roles throughout the world. This is not to say that other types of clowns are not found in these institutions and/or roles, because they often are. The hospital clown focuses mainly on the hospital environment and has a regular schedule of hospital visitations.

How Does a Hospital Clown Differ from Another Type of Clown?

Hospital clowns use typical clown devices; costume and makeup, juggling, magic, singing, joke telling and bazaar behavior. In the hospital environment, clowns must customize the visits to fit the individual situation. This requires a great deal of flexibility.

A key difference for the hospital clown is the heightened awareness required for a very sensitive operating environment. Clowns must be aware that they are surrounded by very expensive equipment and have little room to play. And they need to position themselves so a patient can see what they are doing. Sometimes this is a complicated task.

Hospital clowns must learn how to approach the hospital setting and the patients. Questions like: What actions are required of the clown when they encounter a medical emergency? What precautions must be taken to prevent the spread of infections? How is the institution organized? What are there rules? What method do I use to gain entrance to a patient room? Answers to questions like these will govern the conduct of the individual hospital clown.

Hospital clowns often rely on intuition to carry out their mission. They must be perceptive and able to quickly size up a situation in order to effectively proceed with patient interaction. An understanding of the components and stages of various diseases, or injuries, is very helpful.

The skillful hospital clown knows instinctively how much humor to apply to a given situation. Sometimes the clown’s presence, the colorful costume and radiant smile, are sufficient medicine for the moment ….no words need be spoken or actions taken. Some patients are too sick to respond but still find ways to send a message back to the clown, using a smile, the blink of an eye or the movement of a finger.

Because the clown comes to the patient in a friendly, non-threatening way, the connection is informal. “Hey, someone is here who won’t stick another needle in my arm and who can take me away from my present world of pain and mental anguish, if only for a moment.” This often strips away barriers to communication. The clown becomes the relief valve. Often the hospital clown is, more than anything else, someone to talk to. And the best hospital clowns develop an early mastery of being good listeners.

What is the Future for Hospital Clowning?

Including humor in a hospital patient care program is a growing trend. A group in the west is developing standards for hospital clown training and conduct. A manual has recently been published which gives the point of view of a nurse and a hospital clown on the subject of hospital clowning. There are clown newsletters in Europe and in the United States. States throughout the country have hospitals that have regular hospital clown visitations. Some clown programs are part of the auxiliary volunteer program. Others employ clowns through grants. The Big Apple Circus has a Caring Clown Unit that operates in many children’s hospitals using professional performers.

Other organizations that provide regular clown support to hospitals are the Shriner’s and the Jewish Women’s Organization. The Arizona Public Service has a clown organization that provides support to hospitals. Individual clown alleys or organizations often provide clown hospital visitation on an occasional basis. The World Clown Association has a program to support the VA medical facilities through out the United States. Organizations such as Clowns on Rounds and Clowns Care have been formed to support communities of hospitals. The trend toward utilizing hospital clowns is definitely upwards.

How Can You Support The Caring Clown Program?

There are several things YOU can do:

1. YOU can become a caring clown. If you think you might enjoy it, talk to people who do this work! Find out what is involved. It’s not for everyone by any means, but it is very rewarding and appreciated by the patients the world over.

2. If YOU are a patient and get a visit from a clown, let the hospital know you appreciate it. It helps the clowns when they get the support of the administration.

3. YOU can donate to Foundations that support research and caring clowns. Caring clowns programs need funding for training, and costs of supplies. Some programs specialize in crisis intervention such as Patch Adams trip to Bosnia and Afghanistan during the refugee crisis. They need expenses for travel and supplies.

4. When donating to a hospital, YOU can direct a portion of the entire gift to the Humor program. A part of our program at Scottsdale Healthcare is the Humor Cart. The function is to provide games, cards, and movies for patients to pass the time, and to be able to have their Polaroid picture taken with the clown if they like. Clowns also pass out treats to nurses and families in waiting rooms. They provide stickers, balloons, and other items to patients and their families. There are also expenses of cleaning and costume replacement, makeup, etc.

5. You can donate things such as electronic games, toy animals, and cards at holidays. Patients enjoy small items, or favors, and take them home as reminders of their time in the hospital and the clown visit, sometimes for years. To many elderly patients, the little stuffed beanie animal is the only companion they will have in their entire hospital stay. Little things make a huge difference.

6. YOU can tell others about it. Inform them! This will go a long way toward helping the caring clown movement become more viable and visible in order to gain and maintain the necessary momentum.