May 4, 2023 \u2013 <\/span>In the hospital is a girl of 5 or 6 named Cindi.\u00a0<\/span><\/i><\/p>\n Dr. Graves enters her room. He\u2019s very busy.<\/span><\/i><\/p>\n Cindi is afraid that she\u2019ll get sicker.<\/span><\/i><\/p>\n Then a clown appears with Winnie the Pooh stickers!<\/span><\/i><\/p>\n Cindi smiles. Her red-nosed friend puts a finger to her lips.<\/span><\/i><\/p>\n She\u2019s telling Cindi, \u201cBe quiet, I\u2019m going to do a trick.\u201d<\/span><\/i><\/p>\n She sneaks behind Dr. Graves and puts a sticker on his shoe.<\/span><\/i><\/p>\n He\u2019s so intent on Cindi, he has no clue!<\/span><\/i><\/p>\n Cindi starts giggling.<\/span><\/i><\/p>\n Dr. Graves says, \u201cStop jiggling.\u201d<\/span><\/i><\/p>\n The examination ends.<\/span><\/i><\/p>\n Dr. Graves looks grim.<\/span><\/i><\/p>\n But as he turns to leave and continue his rounds,<\/span><\/i><\/p>\n Cindi hears \u201cExcuse me, sir!\u201d coming from the clown.<\/span><\/i><\/p>\n \u201cI\u2019m not sure how to say this, but I think it\u2019s best I tell you,<\/span><\/i><\/p>\n Dr. Graves, you\u2019ve got Pooh on your shoe!\u201d<\/span><\/i><\/p>\n \u201cThe kid was in stitches,\u201d recalls Mollypenny, a clown at the Children\u2019s Hospital of Eastern Ontario in Ottawa, Canada. \u201cAnd when the doctor realized what was going on, he started laughing too. I never thought he had a sense of humor, but he left that sticker on his shoe the entire day.\u201d<\/span><\/p>\n<\/section>\n This is just one of many heart-warming stories from the 21-year career of Ruth Cull, aka Mollypenny. (She officially retired last month, having passed the ceremonial rubber chicken \u2013 literally \u2013 to her successor, Zedd.) Originally an operating room nurse, she traded her stethoscope and scrubs for a banana phone and blue wig because \u201cclowning makes a bigger difference,\u201d she said.<\/span><\/p>\n That\u2019s no joke: Growing evidence reveals that hospital clowns, also called medical clowns, therapeutic clowns, or clown doctors, can be incredibly valuable in clinical care. In\u00a0<\/span>one study<\/span><\/a> published this year, researchers at Tel Aviv University and the Israel Center for Medical Simulation identified 40 skills used by hospital clowns. They concluded that these clowns \u201chelp patients, their parents, the medical team, and the achievement of therapeutic goals. In fact, through various communication skills, clowns enable patients to overcome crises and move towards healing.\u201d<\/span><\/p>\n<\/section>\n<\/div>\n Among the skills the study called out:<\/span><\/p>\n Distraction:<\/strong> Mollypenny\u2019s Pooh stickers illustrate this. \u201cDiverting a patient\u2019s attention from a negative emotion\u201d or situation changes the atmosphere, the researchers explained. It \u201cbreaks the [patient\u2019s] cycle of negativity,\u201d even when it\u2019s something as small as making a serious doctor laugh. Mollypenny calls this \u201cdistraction medicine.\u201d<\/span><\/p>\n<\/section>\n Anchoring:<\/strong> Clowns look for objects in a patient\u2019s room that can be used as icebreakers to make a connection. Mollypenny once noticed a bottle of pink nail polish on a child\u2019s nightstand and suggested they paint her dad\u2019s toenails while he was napping in an adjacent bed. He woke up before they could do it, but whenever Mollypenny saw the child on the ward, she\u2019d whisper \u201cCode Pink\u201d to make her laugh. That bottle of polish became their private joke, and they bonded over it, helping the child feel less alone.<\/span><\/p>\n Empowerment:<\/strong> Patients can feel powerless. Clowns help restore a sense of control and autonomy by providing them with choices. \u201cThe first question we ask is, \u2018Can we come in?\u2019\u201d said Zachary Steel, program director for the University of Southern California\u2019s Comic+Care, which trains medical clowns. \u201cIf the patient says no, we go away. That\u2019s not happening with doctors and nurses. Empowerment is at the center of our work.\u201d<\/span><\/p>\n<\/section>\n Empathy: <\/strong>While hospitals provide care, the pace and atmosphere can often suck the warmth out of the word. While medical personnel are pressed for time, clowns don\u2019t have a schedule. While doctors and nurses do most of the talking, clowns excel at listening. While hospitals are designed to move patients along, clowns try to be fully present. Amid everything a patient is going through, clowns provide understanding. One way they do this is by using the first-person plural. By acknowledging patient emotions without judgment and including themselves in their experience (\u201c<\/span>We\u2019re<\/span><\/i> in this together, and <\/span>we\u2019ll<\/span><\/i> get through it!\u201d), clowns provide validation, support, and relief.\u00a0<\/span><\/p>\n Exaggeration: <\/strong>It\u2019s easy to lose perspective in a hospital and adopt a woe-is-me attitude that can hamper treatment and recovery. Clowns counteract this by taking negative feelings to the extreme: \u201cYou\u2019re right! We shouldn\u2019t have to do these stupid exercises. I\u2019ll tell them we\u2019re on a general strike, and that you\u2019re never going to move again!\u201d According to the Israeli researchers, exaggerating patient frustrations invites them to laugh and reexamine the situation from a different perspective.<\/span><\/p>\n<\/section>\n<\/div>\n Partnership:<\/strong> To make patients feel heard, clowns become their advocate. If a child admits she can\u2019t do any more chemotherapy, a clown might say, \u201cI will come with you and tell them how much it hurts. We will tell them to try it themselves!\u201d By taking the patient\u2019s side, legitimizing the difficulty, and becoming their partner, clowns give children the strength to endure. Once, Mollypenny helped a little boy send his cancer into outer space by launching it in a balloon. \u201cHe\u2019s healthy and 25 years old now,\u201d she \u00a0said.<\/span><\/p>\n Laughter: <\/strong>This is the skill for which clowns are renowned. Indeed, laughter has been scientifically shown to reduce stress hormones, increase oxygen uptake, improve immune function, raise pain thresholds, and activate areas of the brain that produce feelings of connection and joy. Most of these benefits result from the release of opioid neuropeptides and beta-endorphins. These have many feel-good effects. The act of laughing itself also physically stimulates the heart, lungs, and muscles, which reduces tension and makes breathing easier.<\/span><\/p>\n<\/section>\n But clowns don\u2019t have to be stand-up comedians. \u201cIt\u2019s not a matter of being funny, but of having fun,\u201d Mollypenny said.\u00a0<\/span><\/p>\n Here’s an example: Mollypenny is pushing a boy in a wheelchair around the hospital. They\u2019re checking people for \u201cfreckle-itis,\u201d a highly contagious made-up condition for which Mollypenny has appointed him \u201cchief inspector.\u201d They come across some med students who are anxiously awaiting internship interviews. The boy asks one of them if he would mind being screened for freckle-itis. He agrees, the boy inspects him, and then applies a green sticker to his suit to signal he\u2019s passed. But the boy doesn\u2019t stop there. He puts 15 to 20 stickers all over the guy. When he gets called for his interview, he looks ridiculous, and he must explain to the review board that \u201cI got attacked by a kid and a clown out there.\u201d\u00a0<\/span><\/p>\n \u201cHe ended up getting the internship,\u201d Mollypenny said.\u00a0<\/span><\/p>\n How Humor Heals<\/strong><\/span><\/p>\n Yipeng Ge, MD, is a third-year resident at the Harvard T.H. Chan School of Public Health in Boston. As a medical student at the University of Ottawa, he signed up for an elective where he got to dress up as a clown and shadow Mollypenny on her rounds, introducing himself as Dr. Yippy.\u00a0<\/span><\/p>\n<\/section>\n<\/div>\n \u201cI was way out of my comfort zone,\u201d he said, \u201cbut I learned so much. In med school, you\u2019re taught to diagnose, treat, and manage illness. Clowning taught me how to bring play and humanness into that space, along with the value of being present and connecting with patients. In that respect, Mollypenny is like an ER doctor, providing that important patchwork care within the system.\u201d<\/span><\/p>\n Indeed, the Israeli study mentioned earlier also concluded that doctors and nurses could improve patient care and outcomes by adopting some of those clown skills. The researchers aren\u2019t suggesting they wear oversize shoes and squirting lapel flowers, but rather that they simply be aware of the therapeutic effects of things like distraction, anchoring, and humor. \u201cDoctors often think of clowns as just there to \u2018cheer up\u2019 patients, but it\u2019s about much more than that,\u201d lead study author Orit Karnieli-Miller, PhD, told\u00a0<\/span>The Times of Israel<\/i><\/a>.<\/span><\/p>\n These skills can have dramatic effects. A 2015 study compared two groups of children (ages 2 to 16) having the same type of outpatient surgery. One operating room had a clown; the other did not. Kids who interacted with the clown had less anxiety before and after surgery, less time in the operating room, lower reported pain levels, and shorter times to discharge. Cost savings also resulted from less time in the operating and recovery rooms.<\/span><\/p>\n<\/section>\n In more recent research, hospital clowns lowered anxiety and pain in children having catheter insertion as effectively as sedation. Their presence during an EEG (a test for epilepsy that involves placing electrodes on the scalp) led to better patient cooperation and higher-quality test data.\u00a0<\/span><\/p>\n Among children getting cancer treatment, clowns enhanced short-term emotional well-being across all age groups, leading researchers to recommend clowns for all pediatric oncology wards. Indeed, a 2019 study determined that children having surgery reported lower levels of pain when admitted and when discharged, as well as 12 hours after their operation, than those who did not interact with a clown. There\u2019s even preliminary research that therapeutic sessions with clowns can improve communication among children with autism.\u00a0<\/span><\/p>\n<\/section>\n<\/div>\n Although hospital clowns have traditionally worked with children, that is changing. Research is finding that adults in a variety of health care settings can also benefit:<\/span><\/p>\n According to Steel, whose Comic+Care program has trained 50 to 60 clowns, there\u2019s also a growing opportunity to reach people outside care facilities who may be struggling with mental health.\u00a0<\/span><\/p>\n \u201cDuring the pandemic, we created a virtual clowning program,\u201d he explained. \u201cWe were concerned it wouldn\u2019t be as impactful, but we were still able to make people smile and laugh. \u2026 The revelation came when a woman in Hungary signed up for a Zoom session. We assumed she was in the hospital, but she was quarantining in her home. She just needed some cheering up because she was feeling anxious and alone.\u201d<\/span><\/p>\n Since then, Steel has opened USC\u2019s free clowning consultations to \u201canyone who needs us.\u201d He half-jokes that maybe one day, there will be a bank of clowns at a call center waiting to address everyone\u2019s mental health needs.\u00a0<\/span><\/p>\n That may be far-fetched, but clowns have been an increasing presence in hospitals ever since medical doctor Hunter \u201cPatch\u201d Adams \u2013 who was depicted by Robin Williams in the 1998 film <\/span>Patch Adams<\/span><\/i> \u2013 pioneered the trade in the 1970s. The first structured hospital clown program was established in New York City in the late 1980s. And dozens of medical clown training schools now exist around the world, serving hundreds of hospitals in many countries. In 2015, Argentina even legislated all of its hospitals must have a clown.\u00a0<\/span><\/p>\n<\/section>\n Joking Aside<\/strong><\/span><\/p>\n Although there was little mention among the experts we spoke with of \u201ccoulrophobia,\u201d or the fear of clowns, hospital clowns are certainly aware of it and avoid elaborate makeup to appear more relatable. Mollypenny says she occasionally meets parents who are a bit anxious but, like everything else, she uses humor to defuse it.<\/span><\/p>\n<\/section>\n<\/div>\n \u201cI was alone in a hospital elevator once,\u201d says Mollypenny. \u201cOn the second floor, five or six teenagers got in. The last guy pushed the button, turned around, and yelled \u2018OMG! There\u2019s a clown in here! I\u2019m afraid of clowns!\u2019\u201d\u00a0<\/span><\/p>\n To which Mollypenny replied: \u201cOMG! I\u2019m afraid of teenagers! I\u2019m not looking at any of you!\u201d\u00a0<\/span><\/p>\n Hospital clowns face other, more serious challenges, however. Chief among these is the mental stress from dealing with sick children and other struggling patients. Sure, their smiles and laughter help, but their pain can become the clown\u2019s pain too, if they\u2019re not careful.<\/span><\/p>\n<\/section>\n Marion Fauconnier, PhD, is the psychosocial director for the Dr. Clown Foundation in Montreal. As a licensed psychologist, she not only helps train therapeutic clowns but also supports them emotionally. \u201cWe talk through the difficult situations they\u2019re dealing with as a group and individually,\u201d she says.\u00a0<\/span><\/p>\n![](\"https:\/\/img.webmd.com\/vim\/live\/webmd\/consumer_assets\/site_images\/article_thumbnails\/video\/news_hybrid_clown_doctors_video\/1800x1200_news_hybrid_clown_doctors_video.jpg?resize=750px:*&output-quality=35\")
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