Medical Clown Project Reaching the Person Inside the Patient

by Jody Morgan, Danville Today News, October 2013medical clown project in danville

The seven professional clowns of the Medical Clown Project (MCP) bring skills honed with Cirque du Soleil, the Big Apple Circus and other world-renowned companites to medical facilities throught the Bay Area. Laughter, proven by recent scientific studies to be excellent medicine, is only one part of the therapy they provide. Whether relaxing pediatric patients by stimulating their inherent desire to play or temporarily reconnecting dementia patiens with their ability to respond to others who care, the clowns engage the person inside the patient. In 1986, the Big Apple Circus started Clown Care, the first program in the United states utilizing professional clowns to provide therapy in medical facilities. Today the group visits 225,000 pediatric patients a year. In 2002, Dream Doctors, also targeting pediatric patiens, introduced therapeutic clowing in Israel. In the past decade, scientists have proven that laughter promotes better blood circulation, relieves stress by regulating the secretion of the anxiety-response hormone cortisol, promotes the release of endorphins (natural painkillers), and even reduces blood sugar levels in diabetics. Although 90% of medical clowning worldwide focuses on pediatric care, MCP devotes much of its time to adults, particularly patiens diagnosed with dementia or Alzheimer’s. “Pediatric patiens going into a hospital are scared. All clowns have a sense of play that gives permission to the patiens to play. When they do, they feel comfortable and it relieves their anxiety,” MCP clown Calvin Kai Ku explains. “The approach with adults is different from the approach with children. For adults, we provide a sense of camaraderie and friendship as someone who isn’t going to prod you and talk about your medical situation.” How did MCP, the first program of its kind established on the West Coast, come to address the needs of patiens of all ages? Artistic Direcotr Jeff Raz also founded the Clown Conservatory, the only comprehensive clown-training program in the United States. His students were performing outside a hospital when the nurse in charge of one of the adult units rushed up to them. “Do you work on adult units?” she asked before exclaiming, “I need you now!” As Raz notes, medical staffers often grasp the significance of what MCP provides before the clowns complete their introductory demonstration, Kai Ku adds: “Having an excellent rapport with the medical staff is important. We have the same goal, but the form of therapy we offer is very different. By working together, we enhance the therapeutic experience.” In 2010, MCP ran its first pilot program at California Pacific Medical Center where Sharon (Sherry) Sherman, MCP Executive Director, has practiced. Dr. SHerman, Raz’s spouse, is a LIcensed Psychologist and Community Health Consultant with a specialty in Health Psychology. She recognized immediately the role medical clowns could play in treating adults as well as children. Robert Sarison, Program Manager & RCFE Administrator at California Pacific Medical Center, describes why clown therapy is so successful. “The goal of clowning therapy is to ground people in the here and now. Patiens laugh, clap and sing, finding richness in the moment. It does not need to be theatrical because ultimately it is about being with people and not performing for them. People become more alert when the unexpected is introduced. A patient left sitting all day in a wheelchair without stimulation tends to shut down mentally.” Putting the patient in charge is an MCP hallmark. “The patient directs each interaction,” Ben Johnson, head clown, notes. “We use their verbal and non-verbal cues to determine duration, tone content, etc.” Patients always have the option of reusing a visit. “We play to the person and not the patient,” he continues. “Hopefully that gives them the breathing room to interact on a human level which in turn generates a renewal of the energy needed to heal.” Clowns receive a staff briefing at the beginning of every shift so that they have a sense of what each patient might find comforting. Clowns perform wherever they are needed: patient rooms, intensive care, group settings and even at the nursing stations. MCP clowns work in pairs. Because they take their cues from patient response, improvisation is the order of the day. “Each of our performers comes to the table with an individual repertoire of skills” Johnson notes: “We also have common performance vocabulary including bits of business everyone knows, so your partner can step in and play any role that the situation requires.” Clowns are prepared to simply have a conversation of that is what the patient wants. “You need to be open with what’s going on with the patient. It’s not about you as a fabulous performer, but what each patient can get from you,” Kai Ku elaborates. “We are capable of temporarily dissolving dementia patients’ confusion. Through this we can get them to talk about themselves so we can discover what brings each individual joy and happiness.” Michelle Fouts, Executive Partner for Secure Dementia Unit at Laguna Honda Hospital, expresses her enthusiasm for MCP success on residential floors known as “neighborhoods.” A staff nurse discussed one patient labeled unresponsive. “She used to talk to me regularly, but she hasn’t spoken for the last year. But she was talking today with the clowns!” Fouts continues, “Agitation in persons with dementia is a symptom of an unfulfilled need. They are not able to tell us that need, and we have to be detectives. Some people end up on medication to treat the agitation. Our goal is to be great detectives so that less medicine will need to be taken and people with dementia will be able to live the fullest life possible. One of our needs is for fun and engagement. The Medical Clowns help bring spontaneity and joy to the moment.” Music plays an important role in relaxing patients. “Music creates movement within a person, a kind of vibration that reaches something within a patient and generates an emotional release,” explains Mahsa Martin, who can be seen performing in San Francisco as the one-person Beat Feet Orchestra. “The unexpected is what we generate. At first you need props, but as you get better all you need to be successful as a medical clown is yourself.” While medical clowns may delight their audience by doing handstands on a walker or performain up-close magic tricks, much of the time they spend with adult patients involves finding the connection that generates joy. Raz believes the MCP clowns have in innate ability to understand and respond taking taking on whatever role is appropriate. “In a performance dropping out of character is a negative, but in the case of medical clowning, you sometimes need to drop out of character and become just a human being in order to engage the patient. Once you have the patient finishing telling a story or completing another interaction, you can go full into a routine and then slide back halfway out of character to let the patient know you’ve had fun spending time together.” One challenge the MCP clowns face is transitioning between perceived realities. “Our job is not to take people anywhere but where they are. We need to enter their world and at the end of the session find our way back into our own world,” Raz says “For patients who have no one left, we can become family. Our visits onece a week replace that socializaiton.” Having witnessed the clowns’ impact, Fouts notes, “If I had my way, I would have them perform on every neighborhood on a regular weekly schedule 2 or 3 days a week.” Click here for a link to the original article.

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