Robin Williams brought a lot of great characters to life on screen. You might remember him fondly as the Genie from Disney’s Aladdin, or as the nanny Mrs. Doubtfire. Perhaps it’s his performance as the inspirational English teacher John Keating in Dead Poets Society that sticks with you. But it’s his role as the titular character in the award nominated 1998 biographical film Patch Adams that helped bring attention to a (then) relatively young therapeutic field: medical clowning. 

A brief history of medical clowns

Set in late 1960s/early 1970s America, the movie tells the story of Patch Adams who - while admitted at a mental institution - discovers that a humorous approach to psychotherapy helps patients. Now motivated to become a doctor, he butts heads with some of the professionals at medical school because he believes that humour and personal connection result in better patient outcomes and should be part of patient care. 

Dr Hunter “Patch” Adams is very much a real person. He is a medical doctor, a clown and a social activist who – according to his website – believes that laughter, joy and creativity are an integral part of the healing process. On some corners of the internet he is hailed as the first hospital clown, but the history of medical clowning is thought to stretch a bit further back…

It is thought that clowns worked in hospitals even as far back as the time of Hippocrates because doctors believed that humour had positive effects on health. In early 19th century France, a famous clown trio by the name of “the Fratellini Brothers” began visiting hospitalised children to improve their moods, according to a paper in Europe’s Journal of Psychology. 

However, this paper notes that it wasn’t until 1986 when the presence of professional clowns as members of hospital health care teams started. This happened when professional clown Michael Christensen of ‘Big Apple Circus’ founded ‘Big Apple Circus Clown Care’ in New York; a program with the aim of preparing professional clowns to use humour and clowning skills in visits to hospitals to assist in patient healing. 

By parodying the work of medical doctors, “clown doctors” made young patients less afraid of what the doctors were doing. These clowns were able to bring smiles and laughter to patients using their circus skills, tricks, and improvisation. 

Since the set-up of Big Apple Circus Clown Care, other clown care units have been formed across the United States of America and beyond. In 2020 there were at least 40 Healthcare Clowning Organisations operating in 21 countries in Europe alone, according to the European Federation of Healthcare Clown Organisations.

What does it take to be a medical clown?

David Duffy, who is the co-owner of a family-run travelling circus that’s over 150 years old, explained to the BBC that in order to be a clown you have to be really adaptable, and be able to think on your feet. He explained that a clown has to be able to read the audience and get a rapport going within minutes. 

In a review of studies investigating clowning effects on adults in hospitals, it was noted that the aim of the medical clown goes beyond humour. Clown doctors have therapeutic relationships with patients and on top of reducing the negative effects associated with illness, medical clowns contribute to patients' well-being and help create a lighter atmosphere in the hospital. 

Medical clowns are often comprehensively trained so that they are well equipped with artistic skills and strategies to deal with psychological issues in the healthcare system.

The Big Apple Circus Clown Care program employs specially trained professional performers to be clown doctors. These performers are trained in all hospital hygiene protocols and are familiar with all forms of medical clearances. 

Medical clowns from The Dream Doctors Project in Israel are required to have a professional background in the performance arts. They undergo a 5 month long intensive program which includes specialised courses to transform clowning from a performance into a therapeutic profession in the medical setting. Medical clowns under this project learn nursing skills, hospital practices and procedures and are also taught how to integrate with medical care teams. 

In the Netherlands, to be a medical clown with CliniClowns in addition to liking clowning and tragicomedy, you need good improvisation skills. An educational background in theatre or drama (such as creative drama therapy or acting training) is appreciated. Experience in theatre, drama and/or clowning is also welcomed. Training for new CliniClowns includes shadowing experienced CliniClowns for a few weeks and attending training courses in the first year on the job. 

What does the science say about medical clowning?

There are a few studies about the benefits of medical clowns. 

In 2020, researchers from Brazil and Canada carried out a review of 24 studies that explored the impact of hospital clowns on a range of symptoms in (collectively) 1612 children and adolescents.

These are just some of the results that these researchers reported:

In 12 studies, young patients visited by hospital clowns showed significantly less anxiety and better psychological adjustment, or showed a reduced increase in anxiety scores. This was the case in the preoperative room before painful procedures, and when they were given anaesthesia. 

In 3 studies evaluating chronic conditions like cancer, hospital clown intervention resulted in a significant reduction in stress, fatigue, pain, and distress. 

In 2 studies, a significantly shorter crying period was noted when clowns were present. 

In 1 trial, there was no difference in distress levels in children who interacted with hospital clowns compared to children who didn’t. 

Overall, this review’s results suggested that medical clowns interacting with young patients during medical procedures, routine care for chronic conditions, the induction of anaesthesia, and in the preoperative room helped patients manage symptoms like anxiety, stress, pain, and fatigue.

 A lot of the focus in the field of hospital clowning has been on how it relates to children, but the truth is that it can help adults too! This includes adult patients as well as younger patients’ relatives, and is explored in the earlier mentioned review of studies on hospital clowns' effects on adults. 

In that review, it was observed that clown intervention helps reduce stress and anxiety in the parents of hospitalised children. When adults themselves are patients, clown intervention contributes to better well-being, a reduction in psychological symptoms, and a decrease in negative emotions. In fact, more and more clowns are being included in healthcare settings because their work is appreciated not only by patients and relatives, but by doctors and nurses too.

What do the patients say?

If the science hasn’t convinced you of what medical clowns have to offer, check out some personal stories of patients who spent some time with CliniClowns during their hospital stays. 

Like Shane, a baby who was in the hospital with RSV and pneumonia. His mother Naomi recalls how he had low oxygen intake, and a high heart rate. He was inconsolable, and while getting treatment nothing they tried would distract him. Then came the medical clowns with a soothing song and a toy. His mother watched his heart rate go down on the monitor as the medical clowns calmed him down. 

Ms Van der Velden is a local celebrity who impressed the medical clowns with her singing skills and song knowledge. Through a shared love of music, she was able to connect with them and feel recognition for a part of her that was and remains important. The CliniClowns go to the care centre where she stays every fortnight to visit residents with dementia. 

CliniClowns are hard at work improving the wellbeing of patients. Check out our United Action for Accessible Healthcare to see what CliniClowns and other organisations are doing to help in healthcare, and how you can help out too.