Can Clowning Cure Burnout and PTSD?

Welcome to a new blog series, with contributions by CWB – USA’s wonderful board members!

Board member Tim Cunningham is a graduate of the Dell’Arte School of Physical Theatre (’01) and has performed with CWB in 11 countries outside of the United States. Within the borders of the US, Cunningham has performed, lectured and facilitated workshops about CWB’s mission and work at universities and high schools. He received his doctoral degree from Columbia University’s Mailman School of Public Health. Board president David Rosenthal is currently an Associate Professor and the Director of Management Programs in Health Policy and Management in the Mailman School of Public Health and a behavioral faculty member in the Center for Family and Community Medicine, Columbia University.

If you read anything about hospital care nowadays, specifically about physicians and nurses, you’re likely to read about B.O. 

No, not body odor, but burnout! It’s a major issue, and unlike body odor it can be contagious. If you want to read some journal articles, search for names like “Dyrbye, Shanafelt and West.” (Here’s a good one.) Burnout is nothing new and as with many things, interest in its effect ebbs and flows. It was popularized in the 1970s by Herbert Freudenberger, and in the early 1980s, when Christina Maslach helped define our current understanding of burnout. Now, we find ourselves talking about the same thing as though it’s a new crisis. 

Burnout also occurs in the military and can be related to Post Traumatic Stress Disorder (PTSD). In fact, the New York Times Magazine recently published a haunting but important read about rates of burnout among some of our nation’s drone pilots. The story highlights people who work out of remote offices, limiting their interpersonal connections.  

If you want to do a deep dive into medical research, nursing research, and military research, you’ll find lots of papers about the prevalence of burnout and PTSD. You’ll find far less conversation about what we can do about it, and how it can be treated. Honestly, we social scientists are pretty good at measuring the existence of something, but it’s more difficult to study interventions and create evidence-based strategies.

So what does all of this have to do with clowns? We’ll tell you.

Clowns Without Borders just might offer a unique tool to fight burnout and make PTSD a little less painful. It’s neither costumes, nor magic tricks. It’s not our acrobatic routines or the famous “newspaper bit.” Nope. It might actually have little to do with us and more with how clowning brings people together.  

Lots of papers (including one that we published) scramble to understand how we can treat burnout or PTSD. One common thread is that people with a sense of camaraderie fare better when it comes to these two phenomena. Nurses who treated patients together during the Ebola outbreak, physicians who worked in a refugee setting in Greece, soldiers who fought with people they know and trust, all report a stronger ability to deal with life’s stressors. Drone pilots, on the contrary, find themselves working alone, thus losing all sense of camaraderie. That loss can rip people apart, emotionally, when they go through traumatizing experiences. Many people struggle with PTSD once they’re no longer surrounded by a team with similar experiences. The power of relationships and social support, as a healing and coping tool, cannot be minimized.

In fact, CWB has a special workshop called Find Your Funny. This workshop is specifically designed for care providers, educators and humanitarian aid workers—anyone whose job consists of a lot of emotional labor. In December, 2017, CWB – USA led just such a workshop for Médecins Sans Frontières-France (MSF-France) healthcare providers in Haiti. Aid workers and health care providers are impacted by Secondary Trauma Exposure, which can lead to compassion fatigue and burnout. CWB’s “Find Your Funny” workshops address how these professionals can use laughter to alleviate the stress of their jobs and have a compassionate response. The project objective is not only to bring levity to patients, but also share tools with care-providers so that they too can spark moments of joy for themselves, each other, and their patients. (You can read more about the clowns’ experiences teaching the workshop, here.)

During CWB tours, which most frequently focus on the needs of a community in crisis, these relationships are highlighted and celebrated. CWB clowns set a stage, wherever that stage needs to be, and they welcome anyone who can squeeze into the audience space. Sometimes our shows are for 10 people, sometimes they’re for 1,000. When CWB clowns set a stage, people gather. People who have been ripped apart by governments, by war, by poverty and by disease, sit, stand, and play with us. People who have been forced to migrate from their homes or forced to move from their neighborhoods and their social supports, have an opportunity to connect. In that togetherness, people laugh. Children laugh at the clowns, parents laugh at the children laughing at the clowns, and the clowns laugh at refugee camp guards who often laugh along. Spending time together begets camaraderie, which begets mutual trust—laughter is icing on the cake. 

As for our claim to “cure” burnout and PTSD…well, our work is really more of a balm, a treatment for emotional wounds. But that’s just one of clowning’s many ethical interventions that can help our brothers and sisters along their own journeys towards healing. As for the “common cold” claim, some suggest that social support and relationships (and possibly chicken soup) can make a difference!