A clown is an artistic figure who is always surrounded by the unexpected and who knows how to make the most of every annoyance. They are performers who provoke failures but also overcome them by playing with imagination and poetics. The clown is a character firmly situated in the present who always exhibits a contrast, either through their image or their actions, consequently achieving laughter and humor. Approximately 50 years ago, they began moving from the stage to visit places where healthcare was offered (
Clowns are also symbols of human vulnerability who empathize with patient uncertainty and cope with and fight stress, anxiety, and pain (
Professional clown visitors reduce the anxiety and stress levels of hospitalized children and their families.
Initially linked to pediatric healthcare, hospital clown organizations have expanded their scope to adult and senior care settings (
Healthcare clowns are affectionate and attentive artists who act in the present, channeling emotions and stimulating their audience with surprise, but without generating agitation or nervousness (
Their aim is to support each individual, making each person feel valued and special, enriching their interactions with resources ranging from music and magic to juggling and poetry, which allows their audience to process grief and difficulties related to illness, including severe conditions in oncology and palliative care.
As mentioned, research experiences have supported the appropriateness of the presence of specialized clowns in these sensitive spaces. In pediatric oncology, findings include lower levels of the stress biomarker salivary cortisol, lower fatigue scale scores (
Studies have shown that hospital clowns also work well with the adult population.
Understanding the specific way in which clowns achieve these outcomes requires consideration of the precise functions that benefit the psychosocial well-being of patients, their families, and staff. The following five functions are not limited to oncology and palliative care; however, it is in these services that they can play a particularly outstanding role.
Clowns operate primarily by reacting from the logic of emotions, and the first emotion present in an encounter with a clown is surprise (
Clowns in hospitals are highly unexpected interlocutors. Novelty, naturally linked to surprise, is a powerful property of stimuli that directly captures attention (
A fundamental aspect of a clown's basic training is broadening the capacity to enhance unexpected ways of responding to stimuli or solving problems. This imaginative attitude is in constant use and lived naturally.
This can be expressed by the term “playfulness”, which refers to the disposition to find new meanings in everyday or normative objects or situations, accompanied by feelings of joy, fun, and spontaneity (
For a clown, play is not infantilization but rather an imaginative strategy full of humanity, warmth, enthusiasm, closeness, and, of course, empathy. A clown's main mission in a hospital is to construct a space for imagination, transforming that space through play. Together with the patient, clowns physically embody and develop the patient's creative, living stories (
Clowns can find laughter on many occasions, breaking the tension and stress present in these spaces by using the unexpected contrast of humor, but never forcing it. What happens is always done with sensitivity and their ability to build a shared expression.
Healthcare clowns employ several skills to enhance communication, which is especially beneficial when interacting with patients who have verbal impairments. This is illustrated first of all by their proficiency in using non-verbal expressiveness and gestures. Second, communication happens using music, either by bringing songs that are meaningful to patients in the hospital or by leveraging their high sensitivity to listen to and respond to the rhythms of the space, adjusting to the tempo of the interaction established between interlocutors. A third benefit lies in establishing communication through the gaze and basic emotional expression, which also stimulates the expression of others' emotions.
This becomes especially relevant when considering older adults receiving oncology and palliative care who may also be experiencing dementia or speech problems derived from neurological damage. This was demonstrated using an ethogram of micro-gestures, which found a significant increase in communicative intent among the older population in interactions with healthcare clowns (
The hospital clown is clearly a supportive figure (
In addition, clown support also extends to staff. Brief encounters with members of staff provide relief through distraction and playfulness (
Additionally, clowns are a source of artistic tools that enrich and support healthcare teams, offering great opportunities for physical and cognitive stimulation, and encouraging initiative when performing sensorial, speech, or movement rehabilitation exercises. Furthermore, clowns encourage eating, taking medication, or accepting invasive practices such as injections (
Healthcare clowns surprise and stir emotions in settings of grief and pain through humor, but are also attuned to opportunities to channel and process negative emotions through play and imagination. They are effective figures of support and reminders of the right to imagine and play, regardless of condition or age. This makes the clown duo a highly versatile tool for addressing needs that arise in the contexts of oncology or palliative care, whether with pediatric or adult patients, celebrating all possibilities and reinforcing every achievement and attempt at communication.
Another important point is the capacity of clown interventions to generate a strong psychological impact in a relatively short amount of time. A single performance can create intense memories due to its significance and unexpected presence. Another essential aspect of clowns is their ability to work in the absence of verbal language, always respecting reality and individuality while using their creativity to encourage patients' expression.
The clown is an interlocutor who naturally experiences all facets of being human. Ultimately, this is the essence of the clown: their poetic presence and actions transform the place and channel the emotional circumstances of extreme moments (
SC-S: Conceptualization, Writing – original draft, Writing – review & editing.
Author acknowledge Clowntigo, Fundación Universidad de Oviedo (FUO-24-037), and Fundación Alimerka to support this work.
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The author(s) declared that generative AI was not used in the creation of this manuscript.
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