(Written while in post as AD with Hearts & Minds)

Brain Awareness Week got me thinking. Thinking about how unhelpful thinking is when you are clowning. Thinking about how thinking about not thinking is even less helpful. Thinking about brains and bodies.

In face of the prediction that 131.5 million of us in the world will be living with dementia by 2050 and that according to EPAD (European Prevention of Alzheimer’s Dementia Consortium) there hasn’t been a new medication for Alzheimer’s in the last twenty years, it strikes me how important it is that we pay attention to how to be with and celebrate a person once their brain doesn’t work as it once did. To consider that we are more than our brains. We are bodies, and as Jules Montague puts it in her ted talk, ‘embodiment allows people to exist in the world, to be resolutely present...it is our gestures, habits and actions and Dementia can’t take that away.’ 

As therapeutic clowns we are responding with our whole body and not just our head and thinking brain.  The thinking clown might come in to a ward with a plan to entertain, but the embodied clown will arrive with the intention to meet someone in their gestures, habits and actions to create a tailor-made theatrical experience. For it is in this embodied place that we share and recognise our humanity and sense of self, regardless of cognitive capacity.

By using therapeutic clowning to connect in an emotional, person-centered way, we observe that people become more verbal, more interactive and less isolated – observations backed-up by recent compelling research by Daisy Fancourt that the arts can play a vital and central role in the general wellbeing and cognitive health of people living with dementia, ‘enjoyable activities can induce positive affect and heighten arousal which has been shown to lead to improved cognitive performance.’ 
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Intellectual thinking is highly prized to humans, but profound experiences of human connection rarely have anything to do with rational thought.

(Written while in post as AD for Hearts & Minds)

When people ask what I do for a living, once we’ve established that it is not frightening children, they often comment on how difficult and sad it must be.
It’s hard for me to see this job as sad. My overwhelming feeling is that it is rewarding and exciting. I regularly see the transformation of a child lying down in bed with tubes coming out of their arms, pale, unengaged and anxious to a child sitting up in bed laughing and controlling the action. On dementia wards it is the same. People seemingly locked in their own worlds unfurl and begin dancing and singing with us. It is a huge privilege and often joyful.
Of course the reality is that we are often visiting very unwell people and there is potential for this to affect us personally. There are days when we come onto the ward for our handover to hear that someone we regularly visit has died and this is upsetting. But the clown doesn’t just help us to connect – it also keeps us emotionally safe. Once we are in our clown state, the present moment is all there is. And for a clown, the present moment is always full of potential for shared joy and playfulness.
Self-reflection and collaboration are built into our practice. We work in pairs so that we can check-in with one another – take a moment to refresh, breath, reconnect if needs be. Regular confidential supervision as a team gives us space to celebrate and grieve in a natural way. We know that burn-out is a possibility and we look for red flags: when we start to feel indispensable, ‘but it has to be me who goes to that unit’ and a sense of ownership, ‘I’m the only one who can connect with that person’ and then we do something about it. It isn’t always easy, but it is our responsibility to ensure that we are in a fit state to do the job that we are required to do.
Ultimately, we know that their struggle is not our struggle. Any difficulty we encounter is not ours to bear and for this reason we can invite people out of their circumstance to meet us in worlds of play and imagination.

(Written while in post as AD for Hearts & Minds)

“Making fun is serious business. It calls for deep study, for concentrated observation” Charlie Chaplin 
We take the artistic quality of our interactions as Clowndoctors and Elderflowers extremely seriously. In a healthcare or school environment we have no contract with our audience. No-one buys a ticket. No-one books to come to us. There are no reviews from theatre critics. We enter the space, often at a time when people are in a time of crisis, anxiety or pain. The stakes are high and the possibility of us making the situation worse rather than better is real. To make certain that our visits have a consistently positive impact requires artistic rigor, professionalism and continual high-quality training. 
And the training for this work is as rich and nuanced as the work itself.  
We need to attend to ourselves as actors and our ability to work with control, clarity and intelligence. We need to attend to ourselves as clowns and our ability to be truly alive to the moment, able to believe with our whole hearts in the importance of the task at hand. Our improvisation skills need to be constantly honed. We need to work on our technical skill – singing, mime, puppetry, musical instruments – so that we can bring our imaginations to life and transform experiences for the better. We need to understand how to work non-verbally and with all our senses. We need to build trust as an ensemble and in partnerships. We need to understand the complexity of environments in which we work in order to work effectively alongside healthcare professionals and teaching staff.  
Thanks to support from Creative Scotland this year, our bi-monthly team training days have been supplemented by three separate weekends led by outside trainers. Sophie Gazel, Ira Seidenstein and Cai Tomos will between them give us fresh tools, techniques and ways to understand our practice, our artform and our impact. These expert perspectives help us to see ourselves and the work more clearly. To pinpoint where we need to work and how we might do so.  
I understood when I first put on a red nose in 2006 that to call myself clown was to commit myself to a lifetime of learning. That is even more true when that clowning is in the service of others. 

(Written while in post as AD for Hearts & Minds)

How to capture the impact of our interactions more effectively has been a question on my mind for a while. Until a recent meeting with Evaluation Support Scotland, I had the feeling that proof and evidence of our value had to be crunched into numbers, graphs and pie charts to be credible. It felt demoralising. As practitioners we recognise when a child is experiencing being more in control, being immersed in play, feeling happy. As a society we understand the value of these things to our wellbeing, and we understand the importance of wellbeing.
Here are a few stories from my day at a school last week:
My Clowndoctor name is Dr Maybee, and on this particular day I was working alongside Dr Spritely. These visits describe the kinds of interactions that we regularly have in an SEN school setting.
First we met Alfie* who has a room of his own with padding all across the walls and floor. He is strong and he is constantly on the move. This was our second meeting with him. After spending 5 minutes with him, listening & waiting, Dr Maybee took out a sound tube and blew through it like a trumpet. He looked immediately and put the other end to his ear. She made the noise again and he grinned. She built to a beat box rhythm, and every time she did a high-pitched noise through it, he looked at Spritely (equally delighted) and they laughed together with pure joy, looking into each other’s eyes. He stood with us, laughing joyfully, controlling where the sound and vibrations were on his face for a full 5 minutes.
Next we visited Matthew* who spends the day moving from place to place banging his hands against different surfaces as hard as he can. After a few minutes of being in the room with him and mirroring some of his movements he sat down. Dr Maybee sat next to him. He started chewing on the straw of his water bottle. Dr Maybee looked on, very jealous and wanting some. She said, ‘Oh wow, that looks soooooo delicious’. He passed the bottle to her and she pretended to drink from it, making huge slurping noises. He giggled. She passed it back to him and he chewed on it again. Then Dr Spritely asked for some – upset that she had been left out. He gave it to her. More slurps. More giggles. This sequence repeated a few times before he stood up and began his loop of banging on surfaces again. Afterwards, his key worker said that she had never seen him share anything before.
For our final visit, Calum* in P1 started the visit sitting on his key worker’s lap and would look away if we got any closer than around 3 meters. Dr Maybee began playing some music and wanted Dr Spritely to stand in the right spot. Spritely kept moving. When Maybee told her off, she got very upset and had a tantrum. The boy giggled, so each time, the tantrum got bigger and more physical. Then the boy started to encourage Spritely to move to the wrong spot and as he did this, Spritely got closer and closer to him until they were nose to nose. He was giggling in delight the whole time.
I see now that our work isn’t to just speak the language of science in our evaluation but to be confident in communicating the human impact of what we do. As Vassilka Shishkova says in her ETM Toolkit, “The last thing you would want from a public transport service is to surprise you, to bring you to new places or to make you ask questions. Since this seems obvious, why do we still try to evaluate our art the same way?”

(Written while in post as AD for Hearts & Minds)

This month I read two articles that got me thinking about clown’s relationship to failure.
The first article was one on the BMA website (April 2019) stating that the NHS is facing a serious mental health crisis amongst doctors and medical students, with fear of failure sighted as one of the main reasons, “many doctors and medical students can often feel a deep aversion to ‘failing’ and perhaps can’t even perceive what failure would really mean or look like.” (Prof. Dinesh Bhugra CBE).
The second was ‘Seriously Foolish and Foolishly Serious: The Art and Practice of Clowning in Children’s Rehabilitation’ (Julia Gray & Helen Donnelly & Barbara E. Gibson: July 2019) – a reclamation of foolishness as important in and of itself in the context of children’s rehabilitation in an environment that favours ‘certain high forms of knowledge…over lower embodied, imaginative and active knowledge forms’.
I think about the clown’s relationship to failure a lot. Learning to confront and embrace one’s failure is central to any clown training programme and while doing so can be frightening and exhausting, ‘Through clown training, theatre artists aim to be less defensive, exposing naïveté and fragility’ (Gray; Donnelly; Gibson: July 2019) it ultimately gives us freedom to “fail hopelessly, imaginatively, unluckily, triumphantly, heartbreakingly and barely… shrugging off social expectation to shoulder the weight of the world playfully” (Failure as success: On clowns and laughing bodies. Eric Weitz: Feb 2012). This is evidenced beautifully in vintage clips of Lucille Ball, Buster Keaton and Charlie Chaplin.
The clown’s embrace of failure is one way they elicit laughter, but the function of failure goes well beyond humour, especially in a healthcare setting. It allows the people we visit to feel superior and ‘successful’ in a highly hierarchical environment where success might otherwise be perceived as equal to recovery and good health. It allows us to be with people as they are in the here and now, in their pain, sadness, and discomfort. As Donnelly et al argue, as therapeutic clowns, we do not focus on ‘fixing’ the child or solving the problem of their circumstance, rather, find ‘fluid ways of being playful, sensory, emotional, vulnerable and in-relation‘.
As the BMA article demonstrates, fear of failure is isolating and at its worst, catastrophic. When we accept that failure is natural, universal and inevitable, we can find ways to be in the world and with one another that are more connected and humane.

APRIL 2020 (Written for Hearts & Minds)

Adaptation: The process by which a species becomes fitted to its environment.
‘Connecting to our vitality, to play, to our imaginations and creativity is a vital means of survival.’ Esther Perel
Here are 5 things that we have noticed so far when adapting our therapeutic clown programme to an online environment:

1:2D v 3D
When we are in the same space, we notice the tension in the body, whether toes are tapping, subtle invitations for play or for pause. What used to be 360 degree fully sensory experiences are now a flat image on a flat screen and often only a face. ‘Reading’ the young people and ladies and gentlemen that we are visiting is different. On screen, we are learning to take our time even more, to trust ourselves, our instincts and the person on the other side of the screen.

2: Physical space
We are used to inhabiting the same world as each other, transforming spaces together and creating opportunities for laughter and play in the same physical space. Now, no longer in the same world, we create that illusion together. Bumble bees have passed through cameras, balloons launched from the child’s world into ours, noses squeeked through screens. Perhaps we are beginning to subvert TV Land in the same way that we subvert hospital settings?

3: Eye contact
Eye contact has always felt like an important part of this work, ‘an actual meeting of actual eyes transmitted through the air of a shared room’. But on camera the kind of real eye contact that we are used to is not possible. In working with this challenge, we are reminded that this is not fundamental to connection. Many of the young people we visit are visually impaired; have complex learning needs; advanced dementia. We know that we can connect without eye contact. We can still ‘see’ one another without looking into each other’s eyes.

4: Thresholds
After a day of visits we sit together with our partner and talk about the day. We change out of costume, leave the hospital, catch a bus, write our notes. When an online visit ends, we are in our own home suddenly. We land with a crash into reality. It is more important than ever to create a ritual, and ending, a boundary between the virtual world we were just in and the daily lockdown life we are returning to.

5: Meaningful connections
Meaningful and playful connections are still possible and as real as ever. We see it in the responses to visits that young people and their families are actively engaged in imaginative play with us, laughing and controlling the action in the same way that they do when we are in the same space. Ladies and gentlemen living with dementia are laughing, sitting up in their seats and participating during our visits with them. We are able to bring vibrance, joy and laughter to people in times of profound uncertainty and distress. This is a relief.
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We will continue to embrace doubt, mistakes and uncertainty as tools that teach us to do better, to adapt and to grow into this new world joyfully and wholeheartedly.