An Israeli Patch Adams – Novel Impressions

By Anat Tanner and Timna Hurwich

This article was originally published in Hebrew by Anat Tanner, a reporter for Yediot Ahronot, who resides in Skokie, IL (“פאץ’ אדאמס בעברית“). The translation is by Timna Hurwich.

Medical clowning is no joke. It is an art form, combining an array of skills, from music and dance to jests and juggling. And now, in Israel, it is also academic.

Introducing Amnon Raviv, Ph.D. – aka Dr. Clown.

Social media followers of Prof. Atay Citron, former chairman of the Theater Department at Haifa University, recently learned of Israel’s and the world’s first Ph.D. in medical clowning. “His name is Dr. Amnon Raviv,” Citron wrote, “so please show him all due respect …even if he’s wearing a dress and a wreath of sunflowers on his head.” Dr. Raviv was awarded his degree by Haifa University, with Prof. Citron and Prof. Guy Enosh of the School of Social Work serving as his advisors.

Dr. Raviv’s academic output consists of four published articles and a book, Medical Clowning: The Healing Performance, scheduled for publication in 2017 by Seagull Books and for distribution by the University of Chicago Press. This pioneering work, which draws on decades of research, education and practice, is a testament to Raviv’s contribution to the field.

His scholarly concentration – medical clowning with patients suffering from malignant and incurable diseases – expounds the importance of a carnivalesque atmosphere in hospitals, where questions of life and death hang in the balance. Dr. Raviv’s findings illustrate that the clown’s presence reduces the anxiety of patients and their families while alleviating depression and assisting the medical staff. “The need to be silly and playful is inherent in every human being but is suppressed during terminal illness,” Raviv explains. “Comic relief is an existential imperative, which facilitates and allows for one’s lighthearted quietus”.

Dr. Raviv teaches at Ben Gurion University’s School of Medicine in the Negev. He equips medical students with assorted tools to develop their interpersonal skills of compassion, attentiveness and encouragement as they learn to integrate the medical clown in more than 40 different procedures, from drawing blood, dialysis and chemotherapy to calming a patient and his or her family prior to invasive surgery.

After completing his military service, Amnon Raviv studied theater in London and honed his clowning skills while traveling across Europe as a street performer. But, it was fatherhood that first inspired him to perform in hospitals and to join the Dream Doctors Project in 2006.

A year later, while he was employed at Barzilai Medical Center in Ashkelon, a rocket exploded near a bus taking children to school. The children were not hurt physically but suffered from anxiety and were brought to Barzilai. There, they were assembled in the cafeteria for counselling with a psychiatrist, a psychologist and a social worker. “The medical clown wasn’t invited,” Dr. Raviv recalls, but he rushed to the hospital anyway.

There was silence in the hall as the children listened to the psychiatrist, who spotted Raviv and, with a gesture, instructed him not to enter. “Clowns have selective hearing” he admits. “I ignored the instruction, pulled up a chair and, as I took my seat, all my musical instruments ‘accidently’ fell out of my sack. Snatching them up, I blew the whistle and the trumpet to make sure they were working, and the room quickly filled with children’s laughter.” In the afternoon, snacks were laid out, and Raviv again elevated the morale with a “French-fried food fight.” Anxiety was supplanted with joy, and the children were discharged to their homes.

“A few days later, I was summoned by the deputy director of the hospital, Dr. Emile Hai. Fearing the worst, my knees felt like they would buckle beneath me.” Yet, to Raviv’s utter surprise, Dr. Hai said he had just completed an article titled, “Who Needs Psychiatrists and Psychologists for Anxiety Victims When There’s a Medical Clown on Hand?” And today, there is an active effort to recruit medical clowns for crisis situations in Israel and around the world.

Nevertheless, despite his expertise and the reliably wonderful feedback from patients and their families, Dr. Raviv is frequently targeted by hospital administrators in their pursuit of budget cuts. Twice he was let go, and twice the protests and pressure from patients brought him back.

Dr. Raviv routinely reports to work at several Israeli hospitals with his guitar, various costumes and accessories, including skirts, a wedding dress, a red nose and plenty of games. Under his direction, hospital spaces are veritable stage sets and the equipment his props. Thus, the chemotherapy room may become a bustling dance studio and a rolling infusion stand a smooth-moving dance partner. Or, a maintenance trolley might double as a duty-free cart and disinfectant as a pricey eau de parfum. Amid a paroxysm of laughter, the oncology unit is suddenly transformed yet again – this time into a jumbo jet climbing up to the clouds and carrying patients to their dream destinations. There are no limits to Raviv’s imagination and creativity – and apparently no rules. Occasionally, he and a patient will co-write a dark-humored song as a means of staring down the disease with laughter instead of fear.

“I want to be a medical clown,” Dr. Raviv says, “because I see the importance of the profession and derive great satisfaction from my work.” As the sole Ph.D. in this field, he hopes to educate and influence both hospitals and institutions of higher learning – to inculcate them with a better understanding of medical clowning for the advancement of the profession.

Beyond its therapeutic rewards, what makes medical clowning such a fascinating occupation is its theatricality and mischief-making, which can be traced back to antiquity’s Roman “King for a Day” and the British “Lord of Misrule.” Carnival is a custom with roots in ancient Jewish culture as well. The Babylonian Talmud explicitly instructs one to revel on the Purim holiday by drinking until he (or she) can no longer distinguish between “the blessed Mordecai” and “the cursed Haman.” So, even as these rituals endure, we would do well to underpin the same spirit of revelry with academic support grounded in scientific research. And we can start by training additional Ph.D.’s like Dr. Amnon Raviv, an exemplar for the integration of theatricality and scholarship, who will soon be delivering workshops and participating in international conferences worldwide.