Documents 

Hospitalized children who undergo painful procedures are more susceptible than others to experiencing iatrogenic effects, such as anxiety, pain, and severe stress. Clowns in clinical setting have been found to be effective in reducing children’s experiences of these effects during hospitalization and before procedures. This article provides an overview of clowning in health care settings; reviews major studies conducted on clowning for hospitalized children, discussing evidence that clown interventions decrease pain and distress in pediatric patients; and concludes with a discussion of health care clowning as a profession. [editor summary]

Within the past decade, there has been a surge of interest in investigating the effects of clown intervention in a large variety of clinical settings. Many studies have focused on the effects of clown intervention on children. However, few studies have investigated clowning effects on adults. This paper presents an overview of the concept of medical clowning followed by a literature review conducted on the empirical studies drawn from three data bases (PubMed, PsycINFO, and Google Scholar), with the aim of mapping and discussing the evidence of clowning effects on non-children, namely adults. The following areas were investigated: Adult and elderly patients (mainly those with dementia), observers of clowning, namely non-hospitalized adults who are at the hospital as relatives of patients or health-care staff, and finally clowns themselves. The main results are that 1) clown intervention induces positive emotions, thereby enhancing the patient’s well-being, reduces psychological symptoms and emotional reactivity, and prompts a decrease in negative emotions, such as anxiety and stress; 2) clown doctors are also well-perceived by relatives and healthcare staff and their presence appears to be useful in creating a lighter atmosphere in the health setting; 3) few pilot studies have been conducted on clown doctors and this lacuna represents a subject for future research.

Working in health settings as a clown requires the ability to differentiate between the own persona and the clown persona, and to stay in the role despite a variety of challenging situations. This passage requires a cognitive shift that can be interfered, or facilitated, by several variables. This study aims at operationalizing the components involved in the shift, and relating them to psychological characteristics and other relevant aspects of the training necessary to become a clinic clown. A preliminary 34-item version of the Clown Shift Questionnaire (CSQ) was developed and administered to a sample of 130 Italian clinic clowns. Relevant information such as sociodemographics characteristics, various aspects related to the training received such as length, issues taught, internship carried out, psychological knowledge, and competences in clowning were collected. Four dimensions in the shifting process were identified: Reflective awareness, positive beliefs, interference and anxiety. These dimensions represent a profile of individual differences that may be used to predict the success of the clown intervention. Reflective awareness positively correlates with the aspects related to the training and the years of clown activity, while positive beliefs is a dimension not related to training. Anxiety is higher among females and younger people, and correlates negatively with training aspects and years of activity. Interferences are more frequent among those who received higher psychological knowledge and leads to less satisfaction. Further implications for using the concepts of CSQ in research and in the work of clowns in health settings are discussed. [editor summary]

In recent decades, humour has come to be viewed not only as a very socially desirable trait for any human being but also as an important component of mental and physical health. Clown therapy represents a peculiar way of using humour in order to promote people well-being. Clown Therapy officially started in 1986, but it is thank to the well known 1998 movie “Patch Adams” that clown therapy has gained worldwide popularity. Nowadays, it is very easy to find clown doctors in hospitals and it is therefore paramount to define their status and role. When thinking about clowns in hospitals, people tend to see them as volunteers dressing in clown’s clothes whose main purpose is to improve hospitalised children’s and adults’ mood. In actual facts, clown therapy is much more than this. Every year many people express their interest in becoming clown doctors. Consequently, the necessity of creating adequate training courses has emerged. To this end, some Clown Care Units in Italy have founded an association called Federazione Nazionale Clown Dottori, which aims to establish the role and status of clown doctors, along with providing adequate training. Key words: humour, well-being, clown doctors, clown therapy. [author summary]