Seriously Foolish and Foolishly Serious: The Art and Practice of Clowning in Children’s Rehabilitation

  • Julia GrayEmail author
  • Helen Donnelly
  • Barbara E. Gibson


This paper interrogates and reclaims clown practices in children’s rehabilitation as ‘foolish.’ Attempts to legitimize and ‘take seriously’ clown practices in the health sciences frame the work of clowns as secondary to the ‘real’ work of medical professionals and diminish the ways clowns support emotional vulnerability and bravery with a willingness to fail and be ridiculous as fundamental to their work. Narrow conceptualizations of clown practices in hospitals as only happy and funny overlook the ways clowns also routinely engage with sadness, despair, discomfort and many other ways of being and doing. Our exploration of clown practices as foolish exposes the ways children’s rehabilitation upholds particular neoliberal models of success and invites a re-centring of rehabilitation and health care research and practice towards relationship building, supporting meaningful projects and a continued nurturing of aesthetic and pleasurable ways of being-in-the-world in the present moment as valuable unto themselves.


Therapeutic clowns Children’s rehabilitation Childhood disability Applied performance Failure 



Julia Gray is supported by a Social Science and Humanities Research Council of Canada Postdoctoral Fellowship; Matching funds are from The Kimel Family Opportunities Fund through the Holland Bloorview Kids Rehabilitation Hospital Foundation.

Barbara Gibson holds the Bloorview Kids Foundation Chair in Childhood Disability Studies.

We would also like to recognize friend and colleague Jamie Burnett, who was Holland Bloorview’s first therapeutic clown practitioner, was author Helen Donnelly’s clown partner for three years, and who died in 2011 at age 33. Jamie practiced as a truly foolish clown: his work inspired his colleagues and stretched the field of therapeutic clowning. We are forever in awe of his commitment and passion.


1 We use the term ‘disabled children’ rather than ‘children with disabilities’ in keeping with current usage in critical disability scholarship. Disability is not considered a condition of individuals as is implied by the phrase ‘with disabilities’ but rather something experienced as a result of prejudice, discrimination and social exclusion.

2 Throughout this paper, we will refer to both ‘clown practitioner’ and ‘clown persona.’ As a general note, a ‘clown practitioner’ refers to the practitioner/performer who embodies the clown persona as the character on the unit; the clown practitioner takes on a ‘character/clown’ name and persona.

3 Donnelly’s clown persona is named Dr. Flap.

4 As part of this example, we will use the clown persona name (e.g. Ricky or Dr. Flap), when referring to the clown character in the story, and we will use both clown persona name and practitioner last name when referring to the clown practitioner as health care practitioner (e.g. Ricky/Burnett or Dr. Flap/Donnelly).


  1. Babbage, F. 2004. Augusto Boal. London: Routledge.Google Scholar
  2. Bailes, Sara Jane. 2011. Performance Theatre and the Poetics of Failure. New York: Routledge.Google Scholar
  3. Beckett, Samuel. 1983. Worstward Ho. New York: Grove Press.Google Scholar
  4. Billig, Michael. 2005. Laughter and Ridicule: Towards a Social Critique of Humour. Thousand Oaks, CA: Sage Publications.Google Scholar
  5. Bishop, Claire. 2012. Artificial Hells: Participatory Art and the Politics of Spectatorship. London: Verso.Google Scholar
  6. Boal, A. 1979. Theatre of the Oppressed. Translated by C. A. Leal McBride and M.-O. Leal McBride. New York: Theatre Communications Group.Google Scholar
  7. Burman, E. 2008. Deconstructing Developmental Psychology. Sussex: Routledge.Google Scholar
  8. Butler, Laurel. 2012. "’Everything seemed new’: Clown as Embodied Critical Pedagogy. Theatre Topics 22 (1): 63-72.Google Scholar
  9. Carp, Cheryl, E. 1998. “Clown Therapy: The Creation of a Clown Character as a Treatment Intervention.” The Arts in Psychotherapy 25 (4): 245-255.Google Scholar
  10. Citron, Atay. 2011. “Medical Clowning and Performance Theory.” In The Rise of Performance Studies: Rethinking Richard Schechner's Broad Spectrum, edited by J. Harding and C. Rosenthal, 248-263. New York: Palgrave MacMillan.Google Scholar
  11. Claxton, Dana. 2008. “Curatorial Essay: The Medicine Project.” Accessed June 15, 2018.
  12. Davies, M. L. 1997. “Shattered Assumptions: Time and the Experience of Long Term HIV Positivity.” Social Science and Medicine 44 (5): 561-571.Google Scholar
  13. Donnelly, Helen, and Greg Vanden Kroonenberg. 2018. “A Therapeutic Clown Emerges: Our Story of Recruitment and Training.” Documentary Film. Donnelly-Vanden Kroonenberg Production, in association with Holland Bloorview Kids Rehabilitation Hospital: Canada. Accessed August 17, 2018.
  14. Duffin, C. 2009. “Send in the Clowns.” Nursing Management-UK 16 (3): 22-24.Google Scholar
  15. Dupuis, Sherry, Pia Kontos, Gail Mitchell, Christine Jonas-Simpson, and Julia Gray. 2016. “Re-claiming Citizenship through the Arts.” Special Issue on Citizenship, Dementia: The International Journal of Social Research and Practice 15:358-380.Google Scholar
  16. Ehrenreich, Barbara. 2009. Bright-Sided: How the Restless Pursuit of Positive Thinking Has Undermined America. New York: Metropolitan Books.Google Scholar
  17. European Federation of Healthcare Clown Organizations. 2018. Listing of clown organizations. Accessed August 17, 2018.
  18. Fadyl, J., K. McPherson, and D. Nicholls. 2015. “Re/creating Entrepreneurs of the Self: Discourses of Worker and Employee ‘Value’and Current Vocational Rehabilitation Practices.” Sociology of Health & Illness 37 (4): 506-521.Google Scholar
  19. Finlay, F., A. Baverstock, and S. Lenton. 2014. “Therapeutic Clowning in Paediatric Practice.” Clinical Child Psychology and Psychiatry 19 (4): 596-605.Google Scholar
  20. Ford, Karen, Helen Courtney-Pratt, Leigh Tesch, and Caddi Johnson. 2013. “'More than just Clowns' - Clown Doctor Rounds and their Impact for Children, Families and Staff.” Journal of Child Health and Care 18 (3): 286-296.Google Scholar
  21. Foster, Susan Leigh. 2010. Choreographing Empathy: Kinesthesia in Performance. London: Routledge.Google Scholar
  22. Gervais, Nicole, Bernie Warren, and Peter Twohig. 2007. "’Nothing seems funny anymore’: Studying Burnout in Clown-Doctors.” In Suffering the Slings and Arrows of Outrageous Fortune: International Perspectives on Stress, Laughter and Depression, edited by B. Warren, 175-189. Amsterdam: Rodopi.Google Scholar
  23. Gibson, Barbara E. 2016. Rehabilitation: A Post-critical Approach. Boca Raton, FL: CRC Press.Google Scholar
  24. Gibson, Barbara E., H. Zitzelsberger, and P. McKeever. 2009. "’Futureless’ Persons: Shifting Life Expectancies and the Vicissitudes of Progressive Illness.” Sociology of Health and Illness 31 (4): 554-568.Google Scholar
  25. Gibson, Barbara E., and Gail Teachman. 2012. “Critical Approaches in Physical Therapy Research: Investigating the Symbolic Value of Walking.” Physiotherapy Theory and Practice 28 (6): 474-484.Google Scholar
  26. Gibson, Barbara E., Gail Teachman, and Yani Hamdani. 2015. “Rethinking ‘Normal Development’ in Children’s Rehabilitation.” In Rethinking Rehabilitation: Theory and Practice, edited by K. M. McPherson, B. E. Gibson and A. Leplege, 90-103. Boca Raton, FL: CRC Press.Google Scholar
  27. Gibson, Barbara, E. 2018. “Post-critical Physiotherapy Ethics: A Commitment to Openness.” In Manipulating Practice; A Critical Physiotherapy Reader, edited by B. E. Gibson, D. Nicholls, J. Setchell and K. S. Groven, 35-54. Oslo, Norway: Cappelen Damm Academic Publishing.Google Scholar
  28. Golan, G., Tighe, P., Dobija, N., Perel, A. and Keidan, I., 2009. “Clowns for the Prevention of Preoperative Anxiety in Children: A Randomized Controlled Trial.” Pediatric Anesthesia 19 (3): 262-266.Google Scholar
  29. Goldberg, A., T. Stauber, O. Peleg, P. Hanuka, L Eshayek, and R. Confino-Cohen. 2014. “Medical Clowns ease Anxiety and Pain Perceived by Children Undergoing Allergy Prick Skin Tests.” Allergy 69 (10): 1372-1379.Google Scholar
  30. Goldenberg, M. J. 2016. “On evidence and Evidence-based Medicine: Lessons from the Philosophy of Science.” Social Science and Medicine 62 (11): 2621-2631.Google Scholar
  31. Goodley, D., and K Runswick-Cole. 2010. “Emancipating Play: Disabled Children, Development and Deconstruction.” Disability & Society 25 (4): 499-512.Google Scholar
  32. Government of Canada. 2018. “Provincial and Territorial Culture Indicators, 2016.” edited by Statistics Canada. Ottawa. Accessed August 17, 2018.
  33. Gray, Julia. 2019. “Working within an Aesthetic of Relationality: Theoretical Considerations of Embodiment, Imagination and Foolishness as part of Theatre Making about Dementia.” Research in Drama Education: The Journal of Applied Theatre and Performance 24(1): 6-22.Google Scholar
  34. Gray, Julia, and Pia Kontos. 2018. “An Aesthetic of Relationality: Embodiment, Imagination and the Centrality of Playing the Fool in Research-informed Theatre.” Qualitative Inquiry 24 (7): 440-452.Google Scholar
  35. Grinberg, Z., S. Pendzik, and R. Kowalsky. 2012. “Drama Therapy Role Theory as a Context for Understanding Medical Clowning.” The Arts in Psychotherapy 39 (1): 42-51.Google Scholar
  36. Halberstam, Judith (Jack). 2011. The Queer Art of Failure. London: Duke University Press.Google Scholar
  37. Hendriks, R. 2012. “Tackling Indifference - Clowning, Dementia, and the Articulation of a Sensitive body.” Medical Anthropology: Cross-Cultural Studies in Health and Illness 31: 459-476.Google Scholar
  38. Holmes, D., S. J. Murray, A. Perron, and G. Rail. 2006. “Deconstructing the Evidence-based Discourse in Health Sciences: Truth, Power and Fascism.” International Journal of Evidence-Based Healthcare 4 (3): 180-186.Google Scholar
  39. Howcroft, J., S. Klejman, D. Fehlings, V. Wright, K. Zabjek, J. Andrysek, and E. Biddiss. 2012. “Active Video Game Play in Children with Cerebral Palsy: Potential for Physical Activity Promotion and Rehabilitation Therapies.” Archives of Physical Medicine and Rehabilitation 93 (8): 1448-1456.Google Scholar
  40. Jackson, Shannon. 2011. Social Works: Performing Art, Supporting Publics. New York: Routledge.Google Scholar
  41. Kafer, Alison. 2013. Feminist, Queer, Crip. Bloomington and Indianapolis: Indiana University Press.Google Scholar
  42. Kersten, P., C. Ellis-Hill, K. M. McPherson, and R. Harrington. 2010. “Beyond the RCT–Understanding the Relationship between Interventions, Individuals and Outcome–the Example of Neurological Rehabilitation.” Disability and Rehabilitation 32 (12): 1028-1034.Google Scholar
  43. King, S. 2010. “Pink Diplomacy: On the Uses and Abuses of Breast Cancer Awareness.” Health Communication 25: 286-289.Google Scholar
  44. Kingsnorth, S., S. Blain, and P. McKeever. 2011. “Physiological and Emotional Responses of Disabled Children to Therapeutic Clowns: A Pilot Study.” Evidence-based Complementary and Alternative Medicine. Article ID 732394.
  45. Koller, D., and C. Gryski. 2008. “The Life Threatened Child and the Life Enhancing Clown: Towards a Model of Therapeutic Clowning.” Evidence-based Complementary and Alternative Medicine 5 (1): 17-25.Google Scholar
  46. Kontos, Pia, Karen-Lee Miller, Romeo Colobong, Luis I Palma Lazgare, Malcolm Binns, Lee-Fay Low, Claire Surr, and Gary Naglie. 2016. “Elder-clowning in Long-term Dementa Care: Results of a Pilot Study.” Journal of the American Geriatrics Society 64 (2): 347-353.Google Scholar
  47. Kontos, Pia, Karen-Lee Miller, Gail J. Mitchell, and Jan Sterling Twist. 2017. “Presence Redefined: The Reciprocal Nature of Engagement between Elder-clowns and Persons with Dementia.” Dementia: The International Journal of Social Research and Practice 16 (1): 46-66.Google Scholar
  48. Kontos, Pia, and Alisa Grigorovich. 2018. “Rethinking Musicality in Dementia as Embodied and Relational.” Journal of Aging Studies 45: 39-48.Google Scholar
  49. LeCoq, J. 2001. The Moving Body. Translated by D. Bradby. New York: Routledge.Google Scholar
  50. Linge, L. 2008. “Hospital Clowns Working in Pairs - in Synchronized Communication with Ailing Children.” International Journal of Qualitative Studies in Health and Well-being 3 (1): 27-38.Google Scholar
  51. ----. 2011. “Joy Without Demands: Hospital Clowns in the World of Ailing Children.” International Journal of Qualitative Studies on Health and Well-Being 6 (1). doi:
  52. ----. 2012. “Magical Attachment: Children in Magical Relations with Hospital Clowns.” International Journal of Qualitative Studies on Health and Well-Being 7 (1). doi:
  53. ----. 2013. “Joyful and Serious Intentions in the Work of Hospital Clowns: A Meta-analysis based on a 7-year Research Project Conducted in Three Parts.” International Journal of Qualitative Studies on Health and Well-Being 8 (1). doi:
  54. Parsons, Janet, Brenda Gladstone, Julia Gray, and Pia Kontos. 2017. “Re-conceptualizing 'impact' in Art-based Health Research.” Journal of Applied Arts & Health 8 (2): 155-173.Google Scholar
  55. Pendzik, S., and A. Raviv. 2011. “Therapeutic Clowning and Drama Therapy: A Family Resemblence.” The Arts in Psychotherapy 38 (4): 267-275.Google Scholar
  56. Reder, Deanna. 2010. “Preface.” In Troubling Tricksters: Revisioning Critical Conversations, edited by D. Reder and L. M. Morra, vii-ix. Waterloo, ON: Wilfred Laurier University Press.Google Scholar
  57. Reder, Deanna, and Linda M. Morra, eds. 2010. Troubling Tricksters: Revisioning Critical Conversations, Indigenous Studies Series. Waterloo, ON: Wilfred Laurier University Press.Google Scholar
  58. Salverson, Julie. 2006. “Witnessing Subjects: A Fool's Help.” In A Boal Companion: Dialogues on Theatre and Cultural Politics, edited by J. Cohen-Cruz and M. Schutzman, 146-157. New York: Routledge.Google Scholar
  59. Salverson, Julie. 2008. “Taking Liberties: A Theatre Class of Foolish Witnesses.” Research in Drama Education 13 (2): 245-255.Google Scholar
  60. Spitzer, P. 2007. “LaughterBoss - The Court Jester in Aged Care.” In Suffering the Slings and Arrows of Outrageous Fortune: International Perspectives on Stress, Laughter and Depression, edited by B. Warren, 165-174. New York: Rodopi.Google Scholar
  61. Sridharan, K., and G. Sivaramakrishnan. 2016. “Therapeutic Clowns in Pediatrics: A Systematic Review and Meta-analysis of Randomized Control Trials.” European Journal of Pediatrics 175 (10): 1353-1360.Google Scholar
  62. Stanley, Sarah Garton. 2013. “Failure Theatre: An Artist's Statement.” Thesis for graduate degree in Cultural Studies, Queen's University, Kingston, Ontario. Accessed June 24, 2019.
  63. Tannahill, Jordan. 2015. Theatre of the Unimpressed: In Search of Vital Drama. Toronto: Coach House Press.Google Scholar
  64. Thompson, James. 2015. “Towards an Aesthetics of Care.” Research in Drama Education: The Journal of Applied Theatre and Performance 20 (4): 430-441.Google Scholar
  65. Thrift, N. 2007. Non Representational Theory: Space, Politics, Affect. London: Routledge.Google Scholar
  66. Walkerdine, V. 1993. “Beyond Developmentalism.” Theory and Psychology 3:451-469.Google Scholar
  67. Warren, Bernie. 2004. “Treating Wellness: How Clown Doctors Help to Humanize Health Care and Promote Good Health.” In Making Sense of Health, Illness and Disease, edited by P. Twohig and V. Kalitzkus, 201. Amsterdam: Rodopi.Google Scholar
  68. ----. 2011. “Foolish Medicine: Reflections on Thepractices of Modern-clown Doctors and Medieval Fools.” Les Cahiers de l'idiote 2:179-195.Google Scholar
  69. Warren, Bernie, and Peter Spitzer. 2011. “Laughing to Longevity - The Work of Elder Clowns.” The Lancet 378:562-563.Google Scholar
  70. Wiles, David. 2005 [1987]. Shakespeare's Clown: Actor and Text in the Elizabethan Playhouse. New York: Cambridge University Press.Google Scholar
  71. Yingfeng, Lui. 2018. “Not Just Clowning Around: Red-Nosed “Doctors” Brighten Up Taiwan’s Hospitals.” Taiwan Panorama. Accessed August 17, 2018.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Bloorview Research InstituteHolland Bloorview Kids Rehabilitation HospitalTorontoCanada
  2. 2.Department of Physical TherapyUniversity of TorontoTorontoCanada

Personalised recommendations