REVIEWS

The funny world of medical clowns

Manjulika Vaz, Helen Makri

DOI: https://doi.org/10.20529/IJME.2016.034


The Hope Doctors, Director: Diya Banerjee, Producer and Commissioning Editor: Rajiv Mehrotra, Duration: 52-minute documentary, Language: English/Hindi

Many emotions are encountered in a hospital; distress, apprehension and fear, juxtaposed against relief, gratitude and happiness. Both sets are manifested in different people or in the same individual at different points of time. So interlinked are these two sets of emotions, and so frequent their occurrence, that doctors may sometimes become immune to the patient’s emotional state while focusing on the physical aspect. Taking medical histories, recommending investigations and treatment procedures, conducting medical examinations have all become mechanical, sometimes “detached”, procedures. They can also be a source of stress for a medical student who is trying to recall the “right” things to be done. However, the importance of a happy, cooperative patient cannot be over emphasised, both for the doctor to arrive at the right diagnosis as well as to aid in the process of healing itself. Studies have shown that anxiety, anger and such emotions tend to increase the perception of pain; something that the medical encounter aims to alleviate. It is, therefore, critical to address the patient’s negative emotions and prevent their physical manifestations (1).

An important role in caring for emotional health can be played by the “clown doctor”. As part of a team of doctors, paramedics and health service providers, the clown doctor can effectively assist in the diagnosis, treatment and care of patients, particularly in the paediatric age group. Medical clowning can be most relevant during a medical examination, as therapy for post-traumatic stress disorder (PTSD), before anaesthesia (2) and even as a palliative measure for terminally ill children.

The documentary “The Hope Doctors” directed by Diya Banerjee won public accolades at the film festival Open Frame ’15, held from September 18 to 22, 2015, hosted by the Public Service Broadcasting Trust of India (http://www.psbt.org/), (https://www.youtube.com/watch?v=qt4Dq9FLtJM). The film brings to the fore the role of laughter and jest in a hospital that replaces, as if by magic, the pain and tears of young patients with light heartedness and smiles. The flamboyantly dressed medical clown lightens the stark, sterile environment of the examination room or the subdued atmosphere of the paediatric ward, putting the child at ease. Of all the possible results of medical clowning the most noticeable and positive outcome is laughter. Apart from signalling a shift in mood, no matter how transient, laughter has been associated with the production of endorphins that raise the pain threshold, as well as the development of trust and the doctor–patient rapport (3). The beauty of medical clowning lies in its “speechlessness”, thereby reaching a greater population without being limited by language. Communication between the clown and the patient becomes an exchange of facial expressions and amusing acts with peals of laughter.

In the video, the clowning is done by a theatre artist taking performance off the stage and into the children’s ward of a hospital. Not only is it rewarding to the patients and the caregivers but as he says “you get an applause when somebody lying on the bed smiles … smiles through their eyes… and this is equivalent to millions of applause you can get in a theatre”. This medical clown can be part of the team especially in a paediatric department or a palliative care setup. However, apart from the specialist medical clown, medical training for doctors could also include some classes in theatre and humour and clowning which could build the repertoire of a potential clown doctor. What better way to include the humanities in medicine! An interesting and valuable offshoot of this intervention in the formation of the doctor either at the undergraduate or postgraduate level would be the inculcation of humility, the ability to laugh at yourself and possibility give up the paternalistic and hierarchical approach of the doctor.

Other areas where medical clowning has benefit is in allaying the child’s fears before a forensic examination in cases of child abuse. This may prevent possible re-traumatisation (4).

Despite its long list of possible positives, medical clowning could face possible negative results in patients with coulrophobia, the fear of clowns. The elaborate getup and exaggerated features could incite fear and other negative emotions in this set of individuals. Adults may also not be very susceptible to clown antics and there could be cultural issues of acceptance. However, medical clowning, now in its infancy, has the potential to become an integral part of patient care. Its benefits as a therapy, however, still require more comprehensive scientific data. It should therefore be subjected to more research, probably interdisciplinary, ranging from basic neuroscience to behavioural science, using mixed quantitative and qualitative methods.

References

  1. Peters ML. Emotional and cognitive influences on pain experience. Mod Trends Pharmacopsychiatri. 2015;30:138-52. doi: 10.1159/000435938. Epub 2015 Sep 18. Review.
  2. Manyande A, Cyna AM, Yip P, Chooi C, Middleton P. Non-pharmacological interventions for assisting the induction of anaesthesia in children. Cochrane Database Syst Rev. 201514;7:CD006447. doi: 10.1002/14651858. CD006447.pub3. Review.
  3. Dunbar RI, Baron R, Frangou A, Pearce E, van Leeuwen EJ, Stow J, Partridge G, MacDonald I, Barra V, van Vugt M. Social laughter is correlated with an elevated pain threshold. Proc Biol Sci. 2012;279(1731):1161-7. doi: 10.1098/rspb.2011.1373. Epub 2011 Sep 14.
  4. Tener D, Lev-Wiesel R, Franco NL, Ofir S. Laughing through this pain: medical clowning during examination of sexually abused children: an innovative approach. J Child Sex Abus. 2010;19(2):128-40. doi: 10.1080/10538711003622752.