Article published on 7 September 2001 in The GP Journal  by Dr. David Wheeler.

 “The art of the clown consists of freeing ourselves from all roles except one: our own.” 

(A. Simon: La planete des clowns)

“ The purpose of the doctor is to entertain the patient while the disease takes its course.” (Voltaire).

Want to revitalize your personal and professional life and have fun? Like to understand your patients’ bizarre stories and help them to move on? Then clowning might be for you.

When I was invited to my first clown workshop at the Blackthorn Centre, Maidstone, I hesitated at the thought of circus clowns and juggling acts as I am neither extrovert nor exhibitionist. However the advert said “discover your clown within” which implied a form of self-discovery that was alternative as well as challenging. I was feeling inadequate as a doctor dealing with psycho-somatic problems that obstinately refused to be resolved or slotted into any guidelines. I had a busy home-life and a lively demanding young daughter. My workload was increasing and I found myself wanting to avoid patients altogether. I needed a fresh approach.

The two day workshop was attended by about ten people all of different occupations (including three doctors). It was led by Vivian Gladwell, a member of a French group of clowns – Bataclown*. We began each day with a series of  physical exercises to explore how we could use our own body movements, voice and the space around us to convey feelings and be receptive to others. Then we did improvisations. Vivian outlined a scenario or task. Each person in turn chose a costume and a red nose whilst the rest of us were the audience. The simplest task for the clown was to relate to whatever was on stage or simply show what you were thinking or feeling. Later in the workshop the task became more complex as two or more clowns appeared on stage together and had to relate to each other as well as to the audience. After each performance clowns removed their costumes and received feedback from Vivian and the audience.

A number of important ideas about clowning emerged during feedback. It struck me that these ideas mirrored those familiar to teachers of consultation skills. The clown is a professional empathiser. He has to listen and respond to others on stage, to his own feelings and those of the audience. He is an improviser and has no pre-written script. If a problem arises on stage the clown is advised to “stay with it” in order to resolve the problem in an imaginative way. Improvisers on stage together are encouraged not to “block” ideas and suggestions from each other but to listen and respond to the other clown. However one clown does not have to give in completely to the other but express his own character too. He accepts the challenge posed by the other clown’s suggestion and then transforms it. The clown responds also to emotion but is not overwhelmed personally by it. He distances himself from it sufficiently to understand the drama objectively and to play with it. In so doing he has to be sensitive to the audience’s response and expectations.

Playing without a script was disconcerting but allowed me to observe more clearly what was happening around me. So, if I put to one side my “biomedical scripts”, my concern with disease descriptions, would I observe better my patient’s own stories? If I  “stayed with” the problem in the way the patient presented it would I discover new unexplored management options? If I could accept my patient’s ideas, no matter how odd they appeared, could I achieve a better, shared understanding of the patient’s problem and its management? This would mean listening carefully to the patient’s story and asking questions that clarify that story in preference to (though not to the complete exclusion of) pursuing ideas in the doctor’s own mind. If I could respond to my patient’s emotion without being overwhelmed personally by it then could I help to transform that emotion?

 Of course if, as a doctor, I involve myself in the patient’s experience of events, I am no longer the “expert” in charge of the consultation. My patient is regarded as an equal expert. The challenge in both clowning and doctoring is to listen and respond with no script or clear guide to follow and to trust that an outcome favourable to all participants will emerge. 

Apart from giving me new insight into my more difficult consultations I experienced an immediate sense of achievement at being able to improvise in front of an audience. At work I could see how the rules of clown behaviour could apply to cooperative team working. Back home I found the same rules helped me to deal more effectively with my daughter’s truculent behaviour. I felt stimulated and de-stressed. I have attended a number of workshops and still discover more about myself as a clown**.

Of course there is much more to clowning than I have described here. And, after all, is it not a performing art  - to entertain audiences? So why not entertain people who are depressed or have chronic ailments? Patch Adams, the American doctor-clown, does just that and advises all doctors and carers of sick people to be as “silly” as he is. A group of clowns called Le Rire Medecin (Laughing Doctors) put on shows for children and their families in paediatric wards in eight hospitals in France to help “humanise the care of children” and there are other groups of clowns across the world performing similar functions. Could clowning perform that function in the consultation? There have been moments of spontaneous humour that have transformed a consultation or at least lightened the prevailing mood, if only for the doctor. I have more to learn before I would sell myself as an entertainer but I have wondered if I could use clowning to teach communication skills to aspiring GPs.

Whatever your view of clowning I recommend the experience of a clown workshop to anyone who wants to develop skills of intuition. I certainly recommend it to any doctors who want to improve their consultation skills or to find out more about themselves. The benefits spread beyond the individual who “discovers their clown within” to all those around.