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Send in the clowns: looking at humour in aged care

Laughter is the best medicine goes the old saying. A study from 2013 by researchers at UNSW, with help from the elder clowns from The Humour Foundation, seems to support this adage.

They wanted to find out whether humour therapy reduces depression, agitation and behavioural disturbances and improves social engagement and quality of life in nursing home residents. Studying residents from 35 Sydney nursing homes, they found an average 20 per cent reduction in agitation levels in the treatment group, and an overall increase in social engagement and quality of life.

The Humour Foundation came about when two friends, one a doctor who wanted to be a clown and the other a clown who wanted to be a doctor, put their heads together.

The late Dr Peter Spitzer and actor Jean-Paul Bell started the foundation, and their clown doctor program, in 1996.

Jean-Paul Bell and I meet in a Darlinghurst café situated across from the National Art School, a fitting surrounding for a conversation with a life-long comedian, actor and clown.

Seated across from me in a salmon button up shirt and pork pie hat, he is Bill Murray-esque, minus Bill’s craggier features. He has a youthful energy befitting his occupation and is open, instantly putting me at ease. I’m curious as to how one becomes a clown in the first place, I tell him.

“A lot of it’s the family background I had. Not that we were performers, but we certainly did a lot of touring. We moved about 117 times over the 17 years that I lived with my parents,” he says with a chuckle.

“Just avoiders of rent basically.” We are both laughing now. I can already imagine how he makes fast friends with the people he clowns around for.

Named after Satre, Jean-Paul was born in Melbourne to “bohemian parents”and the running family joke was that Jean-Paul and his siblings would dawdle home from school in case his parents moved while they were out.

“I came home at one particular time with a project we had to do. We’d only just not long moved to this neighbourhood and school and I was rather stressed because I didn’t really know how to work on it. ‘Don’t worry,’ mum said, ‘we’ll work it out.’

“So, I brought it home, unfolded it in front of her and she spent about 40 minutes trying to sort it out for me. She said, ‘I can’t make sense of this. I suppose we could always move.’”

“I said, ‘That’s a good idea.’ And we did.”

I’m silent at this point and perhaps sensing some judgement, Jean-Paul says “but it gave me a fantastic, extensive training in people skills. Always, the environment was changing.”

Those skills, combined with a love of the Marx brothers, The Three Stooges, Peter Cook and Dudley Moore, led Jean-Paul to the Youth Theatres in Melbourne and Sydney and a career as a professional actor.

“Then lots of ads and lots of touring for children and it was during that period, probably around the early 90s when I was touring around, I’d stay with my friend Peter Spitzer and we often talked about doing something humour-wise around health,” he says. The duo also saw Hunter Doherty “Patch” Adams speak in Sydney, and the idea for clowns for The Humour Foundation was well and truly underway.

They started out with stints clowning in intensive care, with children and in burns units, which then led to an invitation to work with aged care residents, although this initially didn’t go too well. “They weren’t in really good shape to enjoy anything funny, probably because laughing would create more pain,” he remembers, “then the play therapist said, ‘Oh well then. Don’t worry too much. Why don’t you come down to dementia?’”

“So, we come downstairs. She hits a little button and the doors open up and there’s a woman standing in front of me. She says, ‘I am a princess’. I said, ‘Your majesty,’” he recalls with a grin.

“That just worked really well with her for an actor. It’s like an actor’s paradise. They invited you in, into their world. We spent an hour and a half there. And I left and left my ukulele behind. We went back to get it and we spent another hour there.

“It was a light bulb in the making because then Peter had become very friendly with Professor Henry Brodaty, the head of the Dementia Collaborative Research Centre. And he got into a discussion about doing a study, a blind study, on the effects of humour on elderly people with dementia,” he says.

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This all set the stage for a late career switch, performing for and befriending the residents of aged care homes across the country, first with The Humour Foundation and later as co-founder of the Arts Health Institute.

Jean-Paul’s work across both foundations saw ‘elder clowns’ and latterly ‘humour valets’ brought into aged care homes to connect with residents and bring play into their lives.

The humour valet concept came about because “this was a generation that grew up in uniform on a number of professions. Railway porters, bus conductors, concierges, the ABC used to have fabulous concierges. Elevator attendants. So, I based these characters on an elevator attendant,” he says.

Professor Lee-Fay Low, then of UNSW, worked on the SMILE study and saw first-hand the effect that Jean-Paul and Peter had in the lives of residents.

“It’s not always about laughter. Sometimes it’s about connection. So that’s what they were really good at doing essentially,” she says.

“There’s so much evidence for the arts in health. Whether it’s clowning or art therapy or dance. I think it’s about living life despite your disabilities and when you have disabilities then giving people a means in which they express themselves and do something meaningful is so important.”

Although the Arts Health Institute is now defunct, The Humour Foundation continues to this day. Its current creative director, David Symons, started out as a clown doctor with the foundation, originally auditioning for Jean-Paul and Peter and tells me about the impact they had on his career.

“They set this whole thing up, which was extraordinary. So, they’ve had an everlasting legacy of creating, helping to set up the Humour Foundation, helping to bring clown doctor work to Australia. So that’s a huge impact on my whole career. I didn’t know I was going to do this when I [graduated]. I was just doing various things. I’ve ended up here and it’s a lot because of those two people,” he says.

David said that being an elder clown is not all about boisterousness and loud clothes but creating connections with people and building an understanding of who a person is.

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“That comes from the principle of it’s easier to have more fun with people you know, with your friends, than just with strangers. You can be cheekier with your friends, and be a bit naughtier with your friends than you can with strangers because you’ve developed rapport and trust,” he says.

“Unfortunately, just the way things work is people in aged care facilities tend to be given fewer and fewer responsibilities. And so, they feel less and less valuable as a human being if they’ve got no role or a place anymore. We really try to return that.”

David loves his work – aside from providing fun in the lives of others, he gets immense pleasure from the performances and friendships himself.

“It’s a completely delightful activity to do,” he says. “Almost inevitably, I will finish the day feeling better…. People give back so much to you. They have a delightful time, which then makes it easy for you to have a delightful time.

“And you have this sort of wonderful time together. And you’ve changed the person’s mood, or atmosphere, or feelings, from depressed, or lonely, or sad, or scared. You’ve changed all that to a situation where the people feel relieved or happy or laughing just that you’ve changed their mood. If you’re able to do that, it’s a tremendous sense of satisfaction and pleasure for the performer.”

Heather Gray, chief executive from the Dorothy Impey Home in Victoria has first-hand experience of the positive effects elder clowning and humour can have on an aged care “family”.

“Listen for the laughter. If you don’t hear any, tell the staff a joke,” Heather says. This is her motto for the home. “I think there’s so much sadness in aged care. We’ve got to bring a bit of joy and magic into our residents’ lives.”

Elder clown ‘Bunny’ visits the home each week and, according to Heather, she lifts the spirits of the whole place, residents and workers alike.

“There are residents who won’t even come out of their room, residents who don’t have speech, but when she interacts with them and plays the little ukulele they just come out of their shell, and we, oh, just love it. I wish I could have it every day,” she says.

“Last year we had a few residents pass away before Christmas and I was terribly worried about the staff.

“So, I got her to go and see the staff … and the look on their faces. They wondered what it was all about because they’re not used to Bunny focusing on them. They’re used to them focusing on the residents, so that brought a lot of joy to them,” she says.

Jean-Paul is now semi-retired and has gone back to his nomadic roots, living off his pension – which he calls his “arts funding grant”.

“It’s fabulous. I know I’ve got a guaranteed income, so I just live my life.”

He lives and travels in a caravan now, performing when the mood strikes. And he is happy with his legacy in the aged care space.

“I’m a social capitalist. I’m very wealthy. I’m a billionaire in social capitalism,” he says. “To me people are like a botanical garden, not that I want to sniff them all but that they’re all bright and colourful.

“Laughter has got that wonderful ability to separate you from the pain for a brief moment. Laughter is a kind of cheap, out-of-body experience in a sense that as you’re laughing, you’re sort of hovering over the situation but when you settle back down you’re a little more able to cope with the pain of it all,” he says, with a laugh.

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