By Dr. Richard Snowberg
For those persons experienced in working as clowns in hospitals or nursing homes, we’ve witnessed the benefits of our presence. We’ve seen the positive reactions. We’ve had opportunities to get responses from non-verbal or non responsive patients. We’ve been able to help health care providers in transporting, calming, and distracting patients in positive ways. Even the simple fact that our presence brings smiles to otherwise sad or stressed faces, has been a positive motivation for our visits. However, actual observational and statistical research on the effectiveness of caring clowns has largely been overlooked.
Traditional clown periodicals, such as Clowns International’s “The Joey”, Clowns of America, International’s “The New Calliope, and the World Clown Association’s “Clowning Around” seldom address themselves to scholarly attention regarding the serious literature of the effects of clowning. Likewise these publications do not include bibliographic references to other articles or sources for follow-up information or validations regarding the effectiveness of clowning. One needs to do library research or visit the World Wide Web in order to address these issues in an appropriate manner.
Much of the research that is related to caring clown work is not specific to clowning. Some of it is psychosocial research. Some of it is research on the effects of humor. Some is related to play therapy. While little of it deals specifically with clowns interactions or case studies, we can learn a lot about our potential effectiveness from what has been reported in specific studies, journals, texts and on the World Wide Web.
Some examples or relational literature which one might find helpful include such sources as:
Adams, Elizabeth R., McGuire, Francis A. “Is Laughter the Best Medicine? A Study of the Effects of Humor on Perceived Pain and Affects”, Activities, Adaptation, and Aging. 1986, pp. 157-75.
Coser, Rose L. “Some Social Functions of Laughter: A Study of Humour in a Hospital Setting.” Human Relations 12, 1959, pp. 171-182.
D’Antonio, Irma J. “The Use of Humor with Children in Hospital Settings.”, Humor and Children’s Development, New York, Paul McGhee, 1989, pp. 157-71.
Dean, R. A. “Humor and Laughter in Palliative Care.”, Journal of Palliative Care 13.1, 1997, pp. 34- 39.
Eredman, Lynn. “Laughter Therapy for Patients with Cancer.” Journal of Psychosocial Oncology 11.4, 1993, pp. 55-67.
Klein, Allen. “The Lighter Side of Death and Dying: Listening for Laughter.” Journal of Nursing Jocularity 4.1, 1994, pp. 10-11.
Mallett, Jane. “The Use of Humour and Laughter in Patient Care.” British Journal of Nursing 2, 1993, pp. 172-175.
Ridd, Patty, B.A. (Hons.). “There ought to be clowns… Child Life Therapy through the medium of a clown.” Child Life Department, Winnipeg Children’s Hospital, Health Sciences Centre.
Rosenberg, Lisa. “A Qualitative Investigation of the Use of Humor by Emergency Personnel as a Strategy for Coping with Stress.” Journal of Emergency Nursing 17, 1991, pp. 197-203.
Saper, Bernie. “Humor and Healing.” Psychiatric Times. 10.5, Mai 1993, pp. 20-21.
Williams, H. “Humor and Healing: Therapeutic Effects in Geriatrics.” Gerontion 1.3, 1986, pp.14-17.
Ziegler, John B. “Immune System May Benefit from the Ability to Laugh.” Journal of the National Cancer Institute 87.5, 1995, pp. 342-343.
In reviewing the previous citations, you will see that they don’t come from clown publications, but instead from scholarly journals in areas of oncology, nursing, psychiatrics, child development, emergency care, geriatrics, etc. Most deal with the use or effectiveness of humor, but some do indeed specify the role of clowns.
We would be remiss if we did not mention some excellent text sources dealing with humor. While, for the mostpart, these books don’t review specific research, they do include research summations and appropriate bibliographic information. Here are some valuable additions to the literature which include:
Berger, Arthur Asa. “Healing with Humor: An Anatomy of Humor”, New Brunswick (NJ), Transaction, 1993, pp. 155-162.
Cousins, Norman, “The Anatomy of an Illness”, New York, NY, W. W. Norton & Company, 1979 (Paperback reprints are now currently in print)
Klein, Allen. “The Healing Power of Humor”, Los Angeles, CA, Jeremy PP. Tarcher editor, 1989.
Salameh,Waleed A., Fry, William F. “Humor and Wellness in Clinical Intervention”, Westport, CT, Praeger Press, 2001.
Swebke, S, Wooten, Patty, “The Hospital Clown: A Closer Look”, Jest Press, 2001
Wooten, Patty, R.N. “Compassionate Laughter: Jest for your Health!”, Salt Lake City, Commune-AKey Publishing, 1996.
The International Society for Humor Studies is a valuable source for insightful information. This organization can easily be reached through its website at:
http://www.hnu.edu/ishs/

Once you visit this site, you’ll see a link to the International Journal of Humor Research, which is a high-quality publication reproducing theoretical papers, original research reports, scholarly debates, short notes, book reviews and letters to the editors. The editorial board is international in scope, with members from the United States, England, Canada, Switzerland, and Israel.

For more meaningful information on research sources, visit the ISHS’s page: http://www.hnu.edu/ishs/resource.htm
Here you will find a vast number of links to specific topic areas such as satire, laughter, medicine, and clowns and comedians. Unless you are a ISHS member you won’t be able to explore the individual categories. However, if you are a serious scholar, this may be enough information to convince you that a personal membership is right for you.
Don Nilsen, a professor from Arizona State University, is the historian for the abovementioned bibliographies of humor research. He is himself, a prolific writer and one of his valuable contributions to the literature is the following:
Nilsen, Don L. F. “Humor and Medicine.” Humor Scholarship: A Research Bibliography. Westport, Greenwood, 1993, pp. 15-20.
For the most current information, readers should frequently visit the World Wide Web. Here are some valuable websites to stimulate interest regarding the effectiveness of clowns and/or humor.

Big Apple Clown Care Unit:
http://www.bigapplecircus.org/CommunityPrograms/ClownCare/
The Big Apple Clown Care program has ninety professional clown doctors working with children in seventeen different hospitals throughout the United States. While this organization has conducted research, you will not find specific research citations at the website.

Clown Doctors:
http://www.humourfoundation.com.au/
Clown Doctors is the core project through which the Humour Foundation reaches sick children. This is a program serving all children’s hospitals throughout Australia and some of the country’s general hospitals and hospices. The site contains an excellent summation on research findings ( http://www.humourfoundation.com.au/index.php)

Dr. Clown:
http://www.drclown.ca/english/home.htm
This site provides information on the Montreal, Canada programs of caring clown work at several hospitals. This popular and very professional program has been carefully documented via several research studies. The website also contains a valuable bibliography of research.

Fools for Health:
http://web2.uwindsor.ca/fools_for_health/research.htm
This is a clown doctor program founded in Windsor, Canada. The website contains program information, as well as a list of world-wide humor and healthcare conferences, a valuable bibliography and links to other clown-doctor web sites.

The Hospital Clown Newsletter:
http://www.hospitalclown.com
The Hospital Clown Newsletter is a quarterly newsletter containing stories, props, routines, and articles by caring clowns and others related to clowns in service in health care facilities and compassionate service around the world. The publications website makes available over 100 articles from past issues of the HCN. This website also contains very useful links for Red Nose Relief groups and disaster response teams.

Jest for the Health of It!
http://www.jesthealth.com/
Noted author, lecturer, registered nurse, and clown Patty Wooten has a website that not only tracks her professional activities, but also includes articles and useful resources for caring clowns. Her bibliography includes many useful research sources, which are all downloadable. Included here is a summation report entitled,
Physiological Effects of Laughter at: http://www.jesthealth.com/frame-resources.html
Rosenthal Center for Complementary and Alternative Medicine
http://www.rosenthal.hs.columbia.edu/clowntherapy.html
Here readers will find one of the most succinct summaries of research on Clown Therapy and the Pediatric Surgical Patient. This research was conducted at Babies and Children’s Hospital at Columbia-Presbyterian Medical Center in New York City.

Therapeutic Clown Program:
http://www.sickkids.ca/therapeuticclownprogram/
Established in 1993, the Therapeutic Clown Program at the Hospital for Sick Children is a well run Toronto, Canada entity. The website describes the program, provides a useful history of therapeutic clowning in Canada, and offers a helpful list of useful links to other related web based resources.
A review of any one or several of the above websites will begin to instill a better sense of the overall research studies and findings that have evolved over the past 10-15 years. Continue to search the World Wide Web, as updated information becomes available on a daily basis.