You don’t have Hospital Clowns? You can’t be serious!

On my research Fellowship to Finland, during an interview at TAIKE, I asked what is the public perception of the arts in healthcare in Finland? “Hospital clowns” was the immediate response, followed by surprise and curiosity when I said that these are not commonplace in the UK.

Patch Adams was a hospital clown in the 1970s and is considered the first hospital clown. He was portrayed in the movie Patch Adams by Robin Williams, bringing attention to hospital clowning. I find it fascinating that Robin Williams was himself someone who experienced extremes of mood, and used this to great effect in his acting career, entering the hearts of many.

Professional Clown Doctors began working in hospitals in 1986 under a programme called the Big Apple Circus Clown Care Unit, which was started in New York City. I will visit New York on Part 2 of my Churchill Fellowship to explore best examples of arts and health initiatives there.

Boston Children’s Hospital recently won awards for its cast of clowns and performing artists, who improve children’s stays in hospitals and help keep them calm. Importantly, parents too end up laughing, and the emotional state of parents is where children take their cue from.

Because as I am currently right in the middle of my Fellowship research tour of Finland, I don’t have time now to give this the write up it deserves, but I can think of countless ways in which Hospital Clowns exert benefits. Hospitals and treatment can be scary; clowning around can:

Normalise: familiarise children with procedures
Make it easier and okay to ask questions
Distract from negative emotions…
…which can be a very effective pain management tool
Offer families the chance to play together in challenging circumstances
Foster connection between family members, and between families and staff
Support parents to manage tension and stress, which impacts on child wellbeing
Facilitate imaginative approaches to delivering distressing treatments
Help the child and family to feel that their holistic needs matter to the people caring for them
Essentially reduce the trauma around hospital admissions and procedures
Ultimately in terms of efficacy, research shows that the presence of Hospital Clowns can reduce complications and improve cost effectiveness

Hospital clown pic 2

You can find pictures from Finland’s Hospital Clown Facebook page (Facebook is used heavily here for work and for spreading awareness or messages).

You can watch some entertaining videos here and here, although they are in Finnish only they are well worth watching no matter what your mother tongue!

From the Finnish website:

Hospital Clowns Association is an association whose trained artists circulate in children’s wards entertaining and delighting the small patients and their families. Clown doctors let children forget about their illness for a while and give permission to feel good, releasing laughter and whimsy to the hospital in the middle of working days.

Sairaalaklovnien work always takes place in the child’s conditions and in cooperation with the staff. Happy memorial clowns help the processing of hospital experience afterwards.

Sairaalaklovnien action is constant and regular. Operations today are conducted in all university hospitals, a total of 10 days a week. Clowns have a background in professional performers and they are trained to work in a demanding hospital environment.

‘Lapland Crazy!’

Today I write from Rovaniemi in the Arctic Circle. Matti Selin has kindly lent me his guitar to help keep me sane in a time and place where ‘Lapland Crazy’ becomes possible, now that the sun does not set for 73 days. The midnight sun is invigourating and can make sleep very difficult, and energy rise.

Matti trained in Circus School for four years and has been a hospital clown. I was curious about how much of this training focusses on therapeutic insights and skills, given that clowns portray the range human emotion from the manic to the depressed. Matti explained that one of the basics of clowning and performing is an understanding of how to connect with people through careful listening and remaining in the moment. I recognise parallels to therapy where a therapist must ensure they attend fully and carefully, and provide a safe space very much in the moment.

Research has consistently shown that among differing therapeutic approaches (for example psychodyamic psychotherapy, narrative therapy, solution-focussed or cognitive behavioural approaches), it is not the model of therapy that predicts the outcome, but the quality of the relationship. So, while it is true that the correct selection of a therapeutic model to suit a person can be a result of understanding of a person’s needs, it is the human interaction that really fosters change. I am starting to think this could become a cornerstone in developing ways of hybrid working between artists and clinicians.

Hospital Clowns: The Research

There is evidence that the inclusion of hospital clowning in treatment regimes can negate the need for sedation, lowers pre-operative anxiety, and reduces post-operative pain.

There is increasing interest in the role of creativity and the arts in fostering wellbeing. CUPORE (Center for Cultural Policy Research) is following Top Projects closely, for example, the expanding percent-for-art principle: committing a percentage of budgets to arts in healthcare: http://www.cupore.fi/en/research/research-projects/expanding-the-percent-for-art-principle-110406-19122016

Tomorrow I will visit a number of researchers from the University of Lapland. To be continued…!

Again – thank you to everyone in Finland who has made this possible and made time to meet me, it has been a great pleasure and privilege. Kiitos, hyva jatkoa x

– Avital Dvory, Yaron Goshen, Shoshana Ruimi, Sergei Bikov, Raphael Halevy & Ariel Koren. 2016. Dream Doctor Intervention Instead of sedation: Performing Radionuclide Scanning without sedation in young children: A Study in 142 patients. The Journal of alternative and complementary medicine. Vol 22. No 5. 2016 pp. 408-412

– Laura Vagnoli, Simona Caprilli, Arianna Robiglio & Andrea Messeri. 2005. Clown Doctors as a Treatment for Preoperative Anxiety in Children: A Randomized, Prospective Study. Pediatrics. Oct 2005, VOL 116/ISSUE 4

– Laura Vagnoli, Simona Caprilli & Andrea Messeri. 2010. Parental presence, clowns or sedative premedication to treat preoperative anxiety in children: What could be the most promising option. Pain service. A Meyer children hospital. Florence. Italy.

– Stanislav Kocherow, Yaniv Hen, Sol Jaworowski, Israel Ostrovsky, Arthur J. Edelman, Yakov Gozal & Boris Chertin. 2016. Medical clowns reduce pre-operative anxiety, postoperative pain and medical costs in children undergoing outpatient penile surgery: A Randomized, Contolled trial. Journal of Pediatrics and Child Health. 52(2016) 877-881