MAPACA

Mid-Atlantic Popular &
American Culture Association

Despite exposure to Ronald McDonald and the clown-doctor Patch Adams (played on film by Robin Williams), mature Americans do not look upon clowns favorably. Stephen King’s narratives and other horror fiction have contributed to a perception that clowns are fear-inducing. Everyday clowns are also untrusted, with the stereotype of a painted performer at children’s birthday parties, suspected of ill intentions.

In spite of these American perceptions, a significant body of clinical evidence shows that clowns in fact reduce anxiety when hospitalized children undergo medical procedures. Randomized controlled studies have examined the impact of clowns (in tightly controlled experimental studies) based on physiological measures of anxiety including cortisol level, blood pressure, heart rate, and oxytocin levels in saliva. Clowns have been shown to improve all these measures, as well as to reduce crying and to lower pain. Clown intervention has been widely shown as effective for reducing preoperative anxiety in children undergoing minor surgery, at levels equal to if not better than sedation.

This paper considers a puzzle: If clowns are effective at lowering children’s anxiety in clinical situations, how can this be explained in light of American adults’ media-derived wariness of clowns? First, consider that the medical evidence in favor of clowns has been largely generated outside America, raising the possibility of a cultural explanation. A second issue is the way that hospital clowns interact with children. Hospital clowns do not just perform or entertain as ordinary clowns do. Clowns participate in a kind of play therapy that shifts how children perceive a situation. Clowns modify a patient’s emotional state by their sensitivity to the patient’s emotional dilemma.

This presentation draws from 76 peer-reviewed studies of medically based clowns, as well as the author’s informant interview with Patch Adams, the renowned clown-doctor.