Medical clowns are valuable tool according to “Dream Doctor” at ASU talk

Atay Citron speaks at ASU about the history and practice of medical clowning in Israel. (Daniel Perle/DD)

A terminally ill man was having a deathbed conversation with his doctor, Amnon Raviv.

“Amnon, I’m sorry to tell you that I’m going to stop farting soon,” the man said.

“Oh, well we’ll all miss the odor,” Raviv replied.

Raviv is a member of the Israeli Dream Doctors, a project which integrates medical clowns into the medical staff in 33 hospitals across Israel.

Atay Citron, an instructor for the Dream Doctors and Raviv’s teacher, paid a visit to Arizona State University’s downtown campus Monday to discuss the history and practice of medical clowns as well as the activity of the Dream Doctors.

Citron began the night by discussing the movie and the man: Patch Adams. Adams was a doctor who was kicked out of medical school in 1973 for clowning with his patients, which was considered unacceptable in a regular hospital environment.

“The hospital deals with issues of life and death — it’s solemn. But it shouldn’t be solemn,” Citron said. “Humor was actually good for his patients, and his interaction with them was much better than his peers.”

However, Adams wasn’t a true medical clown. Citron said that to Adams the spirit of clowning was the most important part, and anyone could do it.

Citron traces the modern phenomena of medical clowning to the Big Apple Circus in 1986. Michael Christensen, one of the co-founders of the Big Apple Circus, founded the Clown Care Unit, a division where the clowns are trained to work in hospitals.

The practice of medical clowning soon spread internationally, with several of Christensen’s students coming from foreign countries. After their training, they returned to start medical clown practices in their home communities.  

Medical clowning in Israel began in Hadassah Medical Center in Jerusalem. Citron said that as massages and inoculation became more popular in Israel, those types of alternative medicine became subsidized by the government, leading to less skepticism of medical clowning.

Citron then drew the conversation back to the Dream Doctors. He contrasted the practice of medical clowning in Europe, saying that while 10 countries there had 345 medical clowns, Israel itself had 111.

Citron said that being a full-time medical clown would be impossible, given the emotional burden that would bring. Medical clowns usually work three days a week, for three to four hours a day, he said.

Citron highlighted several cases involving traumatic experiences where medical clowning was helpful. He cited a study on forensic examinations performed on rape victims, where the victim had received clown therapy prior to the exam.

“In this process, the clown spends time with the girl for an hour,” Citron said. “It is the clown who determines when they stop doing that and go into the treatment.”

The study found that in 80 percent of the cases where a clown was involved in the examination, the victim chose the clown as the adult to accompany to her, instead of a parent or any other family member. The victim, according to the study, did not associate the clown with the rape and was distracted from it.

Medical clowns are also participants in hospital procedures such as surgeries. Initially, Citron said, there was some resistance to this by hospital higher-ups in Israel.

“They did want the clowns to be associated with pain,” Citron said. “When clowns are part of the procedure, it distances the pain from the procedure.”

Citron also detailed a very painful operation that children with juvenile Arthritis have to go through — made painless by medical clowns. The procedure involves injecting corticosteroids directly into their joints. While the doctors perform the injection on one of the patient’s limbs, a medical clown distracts the patient by telling them they’re receiving a stick-on tattoo

“Afterwards the doctor asks the clown if they can start the procedure,” Citron said. “The clown and the patient say yes, but the doctor is already finished.”

The Dream Doctors have worked in a variety of areas around the world including Haiti following the 2010 earthquake and AIDS and TB patients in Ethiopia. Citron hopes they will next be able to work with kids with developmental disabilities.

Deborah Harbinson, a faculty member at the College of Nursing and Health Innovation, said that she is currently trying to get a medical clowning program at ASU.

Harbinson said she does not know which college to take it up with but has mentioned the Herberger Institute as one party that could cooperate in the training of medical clowns, as well as faculties from other schools across the country that already have such programs. She said that a potential program would involve students being able to not only take courses in medical clowning but earn degrees and certificates in medical clowning.

“With this, we were trying to attract community partners and make students and faculty aware of what the impact of this could be,” Harbinson said.

Those interested in a medical clowning program at ASU can contact Deborah at

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