Clown Doctoring and the Role of Positive Psychology in Geriatric Care

Candace Hind

B.A. Dramatic Arts and Psychology

MSW

Contact:

hind3@uwindsor.ca

226-346-8410

Photos courtesy of Bernie Warren, PhD and Fools For Health, www.foolsforhealth.ca

“Dr. Ange Jolie”

Clowns work in Hospitals and Healthcare

across the life span

With many benefits to patients, families and staff and the community.

Clowns have moved outside the pediatric unit and even beyond the hospital into other healthcare settings

Clown-doctors

Parody the work and medical procedures of doctors, nurses and the health care team

wear a red nose , a white lab coat, but little or no traditional clown make-up.

are called DR. e.g. Dr. Haven’t-a-Clue, Dr. Cha-Cha, Dr Fuzz E Wuzzy

are often identified by a distinctive trademark [e.g. yellow taffeta tutu (Dr. Twinkle-Toes), Giraffe ears (Dr. Giraffe)] connected to their name

work in pairs (often dubbed a “clown marriage”), providing support for each other and widening the scope of material that can be utilized.

communicate using silence and simple gesture through to loud and gregarious dialogue as the situation demands

Do not target a specific group, i.e. they work with all seniors

What is an Elder-clown? • An Elder-clown is a

professionally trained artist who works in a program providing clown work with seniors at a residential care facility.

• They are known by many names e.g.:

• Familial-clown,

• ElderField

ELDER-CLOWNS: USE

laughter; magic; music; slapstick; song;

story-telling; and, reminiscence techniques

TO

stimulate memory;

improve cognitive functioning,

spread smiles; and,

change the mood of residents and

the atmosphere of the facility

HIPPOCRATES (The Father

of Western Medicine) advised that

:

Physicians should cultivate a

serious and respectable image,

but at the same time use wit in

interacting with patients

because “dourness is repulsive

both to the healthy and the

sick.”

Presently, clowns work in hundreds of hospitals and

healthcare settings in at least a dozen different

countries around the world

including America, Canada, Britain, France, Brazil, Austria, Germany, Israel, Italy, Switzerland, Spain and Australia.

WHAT IS THE VALUE OF A SMILE 2004 - 2007 Funded by Social Sciences and Humanities Research Council of Canada

•Interviews conducted with :

•18 clowns (3 times)

•18 healthcare team members

(towards the end of the project)

Data collected on the work of 18 clown-doctors

Through Instruments /observations of Work in:

12 Healthcare Facilities

(6 Hospitals / 6 facilities for Seniors )

Each facility visited

1-3 times per week

40+ weeks per year

Down Memory Lane Program 2005-2007

Funded by Ontario Trillium Foundation

16 clowns working in pairs

10 facilities (senior residences, assisted living, complex

continuing care and nursing home)

Each facility visited 1-3 times per week

40+ weeks per year for 1-3 years.

Visits to 200-225 residents (plus their families

and staff) per week

Clinically significant 20% reduction in agitation symptoms in SMILE

The same effect size as is achieved by antipsychotic

medications used to treat agitation without the adverse side

effects

OR

SMILING and LAUGHTER Help to:

• STRENGTHEN immune ‘system’ • REDUCE stress, anxiety & depression • IMPROVE mood + ability to cope with sadness

& loss • REDUCE perception of & tolerance to Pain • INCREASE blood oxygenation and blood flow • IMPROVE cardio-vascular/ heart health

• (Warren, Hind, & Holmes, 2014)

Elder-clowns help seniors:

• connect to their immediate surroundings

• recognize family members

• remember the past

• improve cognitive functioning and communication skills

• increase the quality of life for seniors, their families and for the healthcare staff who work with them

“NO ONE IS EVER DYING” Hunter “Patch” Adams

“… all I can do is give him drugs for pain...

in many ways you are doing more for him than I can..” palliative care physician

“Doctors, nurses and other therapists work

with the parts of the patient that are sick

…

Clown-doctors work with everything else.”

Ami Hattab

(Dr. Balthazaar,

Le Rire Medecin, Paris)

CANADIAN COUNCIL ON HEALTH SERVICE ACCREDITATION (2007)

IDENTIFIED

FOOLS FOR HEALTH’S

CLOWN-DOCTORS

Fools for Health and Positive Psychology

Positive Emotion

PERMA as described in Flourish (Seligman, 2011)

Engagement

Relationships

Professor David Currow

Chief Cancer Officer and CEO Cancer Institute, NSW Previously Chair Palliative and Support Services, Flinders University, SA

“Facing a life threatening illness....

(is) a time of heightened emotions,

and therefore humour and

laughter have an integral place”

Meaning

Accomplishment

Smiles Are Everywhere

Integrating Clown-Play into

Healthcare Practice

Bernie Warren, University of

Windsor, Ontario, Canada and

Peter Spitzer, Humour Foundation, Australia

www.routledgementalhealth.com/artstherapy

Could fill books and books:

The ‘Naked Clown’

What are some ways that we can take the lessons of clowns into our work in gerontology?

Humour Board

Wearing Bright Colours

Confronting Culture

“Antennae Up!”

“clown doctors can learn lots about patients that the rest of us are too busy to see” Dr. Sheila Horen.

Hospitalist, LDMH

The Power of a Smile

Thank you

For listening

CONTACT INFORMATION FOR Dr. Warren:

E-mail: merv123@uwindsor.ca

Website: www.foolsforhealth.ca

Thank you to Bernie Warren, PhD for content, images, and …everything else!

Candace Hind, B.A., MSW Please contact:

By email: hind3@uwindsor.ca

226-346-8410

SELECTED REFERENCES (Compiled 25th March 2010) CLOWNS/ FOOLS /JESTERS 1. Ballantine, B. (1982). Clown Alley. Boston: Little, Brown and Company. 2. Erasmus, D. (1946). The praise of folly. 1511 Reprint. New York: Hendricks House, Farrar, Straus. 3. Billington, S. (1984). A Social history of the Fool. Brighton: Harvester Press; New York: St Martin's Press. 4. Citron, A ( at Press) “Medical clowning and performance theory” 5. Otto, B.K. (2001). Fools are Everywhere: The Court Jester around the world. The University of Chicago Press, Chicago 6. Poliakoff, N. (1950). Behind my Greasepaint: Coco the Clown. London: Hutchinson & Co Ltd. 7. Remy, T. (1962). Entrees clownesques. Paris: L’Arche. 8. Remy, T. (1945). Les clowns. Paris: Bernard Grasset. 9. Towsen, J.H., (1976). Clowns. New York: Hawthorn. 10. Warren, B. (at press) Foolish Medicine- some connections between medieval fools and modern clown-doctors. Les Cahiers de l’idiotie, 2(2) 11. Welsford, E. (1968). The fool: His social and literary history. 1935 Reprint. London: Faber and Faber. 12. Willeford, W (1969) The fool and his scepter. Evanston, IL: Northwestern University Press RESEARCH ON LAUGHTER 1. Bennett, M. & Lengacher, C. (2009) Humor and Laughter May Influence Health IV. Humor and Immune Function Evidence-based Complementary and Alternative Medicine, 6: 159 - 164. 2. Bennett, M. & Lengacher, C. (2008) Humor and Laughter May Influence Health: III. Laughter and Health Outcomes Evidence-based Complementary and Alternative Medicine, 5: 37 - 40.. 3. Bennett, M. & Lengacher, C. (2006) Humor and laughter may influence health: II. Complementary therapies and humor in a clinical population. Evidence-based Complementary and Alternative Medicine, 3(2) pp 187-190. 4. Bennett MP, Lengacher CA. (2006)Humor and laughter may influence health. Evidence-based Complementary and Alternative Medicine 2006; 3(1):61-63. 5. Berk, L.S., Tan, S.A., Napier, B.J., & Eby, W.C. (1989). Neuroendocrine and stress hormone change during mirthful laughter. The American Journal of the Medical Sciences, 298, 390-396. 6. Cousins, N. (1979). Anatomy of an illness. New York: Bantam. 7. Dean, R. A.K. (2007). Expressing Sensibilities: Healing functions of humour in palliative care. Warren, B. (Ed.) Suffering the Slings and Arrows of Outrageous Fortune: International Perspectives on Stress, Laughter and Depression. Amsterdam and New York: Rodopi. 8. Fry, W.F. (1992). “The physiologic effects of humor, mirth and laughter.” Journal of the American Medical Association, 267, pp. 1857-1858 9. Fry, W.F. (1977). “The respiratory components of mirthful laughter.” Journal of Biological Psychology, 19, pp. 39-50. 10. Fry, W.F. & Savin, M. (1988). “Mirthful laughter and blood pressure.” Humor, 1, pp. 49-62. 11. Fry, W.F., & Stoft, P.E. (1971). “Mirth and oxygen saturation levels on peripheral blood.” Psychotherapy Psychosomatic Medicine, 19, pp. 76-84. 12. Hudak, D.A., Dale, A., Hudak, M.A., & DeGood, D.E. (1991). Effects of humourous stimuli and sense of humor on discomfort. Psychological Reports, 69, 779-786. 13. Mahony, D.; Burroughs, W.J.; Lippman, L.G. (2002). Perceived attributes of health-promoting laughter: a cross-generational comparison. The Journal of Psychology, 136(2), pp. 171-181. 14. Martin, R. A. (2004) Sense of humor and physical health: theoretical issues, recent findings, and future directions. Humor: International Journal of Humor Research, vol. 17(1-2) pp 1–19 15. Martin, R.A. (2001). “Humor, laughter and physical health: Methodological issues and research findings.” Psychological Bulletin, 127, pp. 504-519. 16. Miller, M., Mangano, C., Park, Y., Goel, R., Plotnick, G.D., & Vogel, R.A. (2006). “Impact of cinematic viewing on endothelial function.” Heart, 92, pp.261-262. 17. Oppenheimer, D., Simonds, C., & Hartmann, O. (1997) Clowning on children’s wards. Lancet, 350,pp. 1838-1840. 18. Penson, R.T., et al. (2005) Laughter: The Best Medicine? Oncologist.10: 651-660. 19. Rosner, F. (2002). Therapeutic efficacy of laughter in medicine. Cancer Investigation, 20 (3) pp 434-436. CLOWN-DOCTORS AND THERAPEUTIC CLOWNS 1. Citron, A (at Press) “Medical clowning and performance theory” 2. Cohn Jones, R. (2000) Clowning as a therapeutic intervention in hospital and nursing home settings: A proposed caring clown training program. Dissertations Abstracts International Section B: the sciences and engineering: 61 (2-B), p. 1074. University of Hartford 3. Gervais, N., Warren, B., & Twohig, P. (2007) “’Nothing seems funny anymore’: Studying Burnout in Clown-doctors” in Warren, B. (ed.) Suffering the Slings and Arrows of Outrageous Fortune: International Perspectives on Stress, Laughter and Depression. Amsterdam and New York: Rodopi. 4. Linge, L (2008) Hospital clowns working in pairs- in synchronized communication with ailing children International Journal of Qualitative Studies on Health and Well-Being 3; pp 27-38 5. Jando, D. (2003). Big Apple Circus- 25 years. New York: Big Apple Circus in association with Odyssey Guides. 6. Kingnorth, S., Blain, S., & McKeever, P. (2010) Physiological and emotional responses of disabled children to Therapeutic Clowns : A pilot study Evidence-based Complementary and Alternative Medicine, 5(1) pp17-25. ( advance e-publication: 4th Feb 2010) 7. Koller, D. & Gryski, C. (2008) The Life Threatened Child and the Life Enhancing Clown: Towards a Model of Therapeutic Clowning Evidence-based Complementary and Alternative Medicine, 5(1) pp17-25. 8. Meincke, J. (2000). ClownSprechstunde lichen ist leben. Bern: Verlag Hans Huber. 9. Schwekbe, S. & Gryski, C. (2003) Gravity and levity - pain and play: the child and the clown in the pediatric health setting. In Klein, A.J., (Ed.) Humor in children’s lives: A guidebook for practice, pp. 49-68. 10. Simonds, C. & Warren, B. (2001). Le Rire Medecin: Journal du docteur giraffe. Paris, France: Albin Michel. 11. Spitzer, P., (2006) Hospital clowns—modern-day court jesters at work The Lancet, Volume 368, Issue null, Pages S34-S35 12. Vagnoli, L., et al. (2005). Clown doctors as a treatment for preoperative anxiety in children: a randomized, prospective study. Pediatrics, 116(4), 563-567. 13. Van Blerkom, L.M. (1995). “Clown-doctors: Shaman healers of Western medicine.” Medical Anthropology Quarterly, 9, pp. 462-475. 14. Warren, B. (at press) Foolish Medicine- some connections between medieval fools and modern clown-doctors. Les Cahiers de l’idiotie, 2(2) 15. Warren, B. (2008a). Healing Laughter: The Role And Benefits Of Clown-Doctors Working In Hospitals And Healthcare. In Warren, B., (Ed) Using The Creative Arts In Healthcare And Therapy, Routledge, London & New York pp 213 – 228. 16. Warren, B. (2008b). The Fools Are Come Hither. Research In Drama In Education, Vol: 13 No. 3 pp 365-369. 17. Warren, B. (2004) “Bring me sunshine: the effects of clown-doctors on the mood and attitudes of health care staff.” In Twohig, P. & Kalitzkus, V., (Eds.) Interdisciplinary perspectives on health illness and disease. Rodopi: Amsterdam and New York. pp 83-96 18. Warren, B. (2002). “Fools for Health: Introducing clown-doctors to Windsor hospitals.” In B. Warren (Ed.) Creating a theatre in your classroom and community. North York: Captus University Publications pp. 225-246 DEMENTIA / CLOWN WORK WITH SENIORS 1. Ballard, C., et al. (2001) Quality of Life for People With Dementia Living in Residential and Nursing Home Care: The Impact of Performance on Activities of Daily Living, Behavioral and a. Psychological Symptoms, Language Skills. International Psychogeriatrics, 13(1), 93- 106. 2. Brooker, D. (2003). What is person-centred care in dementia. Reviews in Clinical Gerontology, 13,215-222. 3. Buffum, M. D. & Brod, M. (1988). Humor and well-being in spouse caregivers of patients with Alzheimer's disease. Applied Nursing Research, 11(1), pp. 12-18 4. Coaten, R. (2001). Exploring reminiscence through dance and movement. Journal of Dementia Care 9(5), 19-22. 5. Killick, J. (2003). ‘Funny and sad and friendly’: a drama project in Scotland. The Journal of Dementia Care 11(1) pp 24-26. 6. Kontos, P.C. (2005) Embodied selfhood in Alzheimer’s disease Dementia 4(4) pp 553-570 7. Kontos, P.C. & Naglie, G. (2007) Expressions of personhood in Alzheimer’s disease: an evaluation of research-based theatre as a pedagogical tool Qualitative Health Research 17 (6) pp 799-811 8. Langley, G.E. (1983) “Reminiscence” in Langley, D.M. & Langley G.E., DRAMATHERAPY AND PSYCHIATRY, Croom Helm: Beckenham, Kent 9. Langley, G.E. & Kershaw, B. (Eds.) (1982) Reminiscence Theatre, Dartington Theatre Papers Series 4 No.6: Totnes, Devon 10. Mak W, Carpenter BD.(2007) Humor comprehension in older adults. Journal of the International Neuropsychological Society ;13:606-614. 11. Pavlow, R. (2001) “ ‘…Secrets I never told before...’ “: Creative drama and dramatherapy with handicapped elderly”, in Weisberg, N. & Wilder, R., Expressive Arts With Elders: A Resource,Jessica Kingsley: London Richman, J., (1995) The lifesaving function of humor with the depressed and suicidal elderly. The Gerontologist. 35: 271-273 12. Richman, J., (1995) The lifesaving function of humor with the depressed and suicidal elderly. The Gerontologist. 35: 271-273 13. Sixsmith, A., Hammond, M. and Gibson, G. (2008) Quality of Life and Dementia in Vaarama, M.,Pieper, R., & Sixsmith, A. (Eds) Care-Related Quality of Life in Old Age: Concepts, Models and Empirical Findings, Springer, New York 14. Spector, A., & Orrell, M., (2006) Quality of Life (QoL) in Dementia: A Comparison of the Perceptions of People With Dementia and Care Staff in Residential Homes Alzheimer Disease & Associated Disorders 20(3) pp 160-165 15. Spitzer, P., (2008). LaughterBoss: Introducing a new position in aged care. In Warren, B., (Ed.) Using The Creative Arts In Healthcare And Therapy, Routledge, London & New York. 16. Vinit, F. (2008), « Des clowns thérapeutiques auprès des personnes âgées : perspectives sur la place de l’humour dans l’accompagnement contemporain du vieillissement », Revue Humoresque, sous la direction de Catherine Garitte et Nelly Feuerhahn, n°27, printemps, pp.20- 25. 17. Vinit, F. (2007), « Perspectives sur la place de l’humour dans l’accompagnement contemporain du vieillissement », La Gérontoise, Vol.18, n°1, janvier, pp.6-10. 18. Westburg, N. (2003). Hope, laughter, and humor in residents and staff at an assisted a. living facility. Journal of Mental Health Counseling, 25(1), 16-32. 19. Whitehouse, P.J., & Rabins, P.V., (1992) Editorial: Quality of Life and Dementia Alzheimer Disease and Associated Disorders, 6(3): 135 20. Williams, H. (1986). Humor and healing: Therapeutic effects in geriatrics. Gerontion, 1(3), pp.14-17