Clowning around with disease and dying

For 24 years, Dr. Patch Adams and his troupe of humanitarian clowns have traveled the globe delivering mirth and joy to the sick, all the while proving the old adage true:

Laughter really IS darn good medicine.

by Rachel Holman

It's not easy to track down Hunter Campbell "Patch" Adams, MD/master clown.Any given week, he could be inRussia or Tibet or New Zealand or Argentina or Bosnia or China or El Salvador or Australia; his travels take him and his troupe of humanitarian clowns to the far ends of the world. For nearly the past quarter century, Patch Adams has sought to ease the suffering of diseased people worldwide with the gift of laughter. And given the impressive results, he's not about to slow down.

The Adams approach does not resemble standard Western medical practice, but the funny thing is, it seems to work. By way of example, one of Adams' clown lieutenants, Jundid Suhail, reflects on one memorable encounter in Russia.

"I found myself in the room of a young man who was dying of cancer at the age of seven. For the two hours we were there he was showered with love," Suhail says in a low voice, fragmenting his recollections. "Just our presence and what clowns meant to him. This young kid whose language I couldn't speak. We left him with pure smiles on his face."

While the clowns danced and mimed around the room, the young boy fell in and out of consciousness. Each time he awoke, there was a new antic or song to be laughed at.

"As we were leaving, his mother cried because she hadn't seen him smile so much since he had gotten ill," Suhail continues. He later found out that the young boy died a month after their visit. Although laughter cannot cure everything, Suhail says he believes the time he and the other clowns spent with this boy lightened his path to death.

Suhail says that's the essence of the life-and-death work at The Gesundheit! Institute, Patch Adams' organization dedicated to revolutionizing healthcare by replacing competition, greed and corporate medicine with generosity, compassion and big belly laughs. He pauses, then corrects himself: "That's just the tip of the iceberg of what we do."

Patch Adams attained a measure of national fame nearly ten years ago as subject of the Robin Williams film, Patch Adams which depicts Adams' work from 1971 to 1998. Today, ten years later, Gesundheit! continues to recruit volunteers, regardless of age or experience, and send them globetrotting on humanitarian clowning trips.

This winter, Suhail will embark again with Adams-his fifth trip-heading for Peru. Suhail, whose day job is working with at risk youngsters in Berkeley, has been to El Salvador and Russia with Patch, clowning in hospitals, orphanages, nursing homes and just about anywhere else possible.

Explaining why he continues clowning with Patch year after year, Suhail quotes another famous clown and friend, Wavy Gravy (also known as Hugh Romney): "You put your good where it's the most effective.'"

"What I try to do, and what Patch encourages us to do, is to leave someone with an experience of love. An experience of happiness. An experience of "I remember when the clowns came," Suhail says. "It's a relief, for a few minutes to not [think about] being in the hospital."

Patch Adams spoke with us from the Gesundheit! Institute headquarters in West Virginia, just back from another sojourn. Asked about his motivation for his crusade, he says: "I was in medical school and studied health care delivery systems. When I graduated in 1971, I wanted to create a model that addressed every single problem of the way care was given."

Many of the problems that Adams identified in the health care system 37 years ago still persist today. Privatized health care persists more as an industry than as an institution of health. Adams believes that the cost, quality and mindset of Western healthcare have all worked over the decades to create a sick, dysfunctional relationship between the patient and their healthcare provider.

"An apparent secret in the practice of medicine (so easily erased when business is the context) is how care is bidirectional," says Adams. "This intimacy is as important for the care giver as it is [for] the patient." Adams calls it "the bidirectionality of healing." Adams points to the stranglehold insurance companies-both health and malpractice insurers-have on American healthcare. He says "malpractice insurance forces fear and mistrust into every medical interaction. We espouse the politics of vulnerability and are clearly aware that we can only offer caring."

Gesundheit! Hospital will address these issues head on, providing free medical care-for free-in an eco-friendly setting.

"I am a doctor, I learned the things that a doctor learns, but there are a lot of things a doctor doesn't learn," Patch says. "Doctors don't learn care. They learn the kidneys."

The original incarnation of Gesundheit! Hospital opened in 1971. Until 1983, Adams and 20 other adults fashioned a free hospital out of a six-bedroom house, treating as many as 1,000 people per month. Adams wrote of the experience, "It was truly ecstatic, fascinating, and stimulating."

Adams believes strongly that health care should not make a patient feel indebted, so the Gesundheit! Institute's hospital never received a cent for the care it offered. Not even barter was accepted. Many of the staff who worked with Adams took part-time jobs so they could continue their work at the hospital.

But by 1983 the stress of running a free hospital without any financial assistance was overwhelming. The Gesundheit! Institute decided that the hospital would close its doors and instead devote itself to fundraising o that a larger, sustainable facility could be built. The goal: a full service facility integrating all the healing arts. Adams says he wants to see "allopathic medicine, including surgery, ob/gyn, pediatrics, internal medicine, family practice and psychiatry, [working] hand in hand with complementary medicine, including acupuncture, homeopathy, naturopathy, chiropractic, ayurvedic, anthroposophic, herbal, body work and faith healing.

24 years later, a new, greatly expanded Gesundheit! Hospital is planned, but unfortunately has not been built yet. The doctor who famously worked to remove money from healthcare acknowledges his own shortcomings when it comes to fundraising. "I could feel frustrated, even sad, that the hospital is still unbuilt. However, in the long run it may prove to have been a very positive time line. After 33 years, we have built a much larger, more diverse, more intelligent, more globally influential model than we ever dreamed of."

Reflecting on his goals, Adams says "our ideas were too radical to get conventional funding, and so I realized that we had to go to the people of the world to get the needed funds. The model for that in modern society is through publicity and fame. So I broke a basic tenet of our philosophy-no publicity-and became public. For the last 20 years we have climbed that fame and fortune ladder in hopes that we would attract funds to build our ideal. This went to monstrous extremes when the film, Patch Adams, was released." Adams also wrote 2 books and hit the lecture circuit.

These efforts brought Adams and his group a 317 acre farm in West Virginia, complete with waterfalls, a pond, a forest of hardwood trees and chemical-free land. Two buildings are already constructed and Adams has drawings for the hospital from his architect. "We owe no money and have a good start for Phase One," he boasts.

When their first, homemade hospital closed its doors, the Gesundheit! Institute decided they would take their show on the road with an annual humanitarian clowning trip. In his role as clown, Dr. Patch dresses in bright, silly clothing, appearing inmost photographs wearing a red nose. He is a self-professed "bad boy" and "imp." But Adams makes no jokes about the fact that the Gesundheit! Institute's humanitarian clowning trips are just as much for the participants as they are for the people they visit.

"I want our people to experience poverty and have it hurt them and make them question the world and [see] that there are a lot people in it with no care," Adams says about the program's design. Adams takes his volunteers to places where people are most in need

of care, regardless whether it's a psychiatric ward or a refugee camp. "I'm interested in relieving suffering," Adams says.

Asked how clowning can truly relieve suffering, Adams admits there's no simple explanation. "I don't think it's easy to know what's going on. I shove a fish in somebody's face, make a farting sound, and how can that possibly help somebody? But it seems to do just that."

The Gesundheit! Institute's approach to health is not as goofy as it may sound. Medical professionals have long studied how emotional well-being relates to their patients' physical health. In 2003, Sheldon Cohen, Ph.D., of Carnegie Mellon University, published a study in the journal Psychosomatic Medicine, which concluded: "The tendency to experience positive emotions was associated with greater resistance to objectively verifiable colds. Positive Emotional Style was also associated with reporting fewer unfounded symptoms and Negative Emotional Style with reporting more."

In other words, the happier you are, the healthier you are. Norman Cousins, legendary editor (The Saturday Review) author and educator, popularized this concept some years ago in the most personal manner. Given a "death sentence" diagnosis in 1980 for a deadly form of arthritis-doctors said he'd be dead in a few weeks-he improvised his own cure. He decided he would literally laugh it off. Nothing made Cousins laugh harder than Marx Brothers movies, and so watch them he did. Sure enough, he discovered that upon guffawing at Groucho,Harpo and Chico, his pain subsided, allowing him to get some sleep, to rest up for his life and- death battle.

Soon, Cousins felt a whole lot better, and eventually, the disease passed. He attributed this to laughter's ability to check apprehension and panic, allowing the body to get on with the work of fighting the disease all-out.

Cousins had effectively demonstrated his theories of combating illness with positive emotions when he died-more than a decade after his supposed fatal arthritis diagnosis-of heart disease. Negative feelings, such as stress and anxiety, have long been identified as the culprit behind many health issues. Marilyn Skaff, Ph.D. and associate adjunct professor in the department of Family and Community Medicine at the University of California San Francisco, has made a career of studying stress and its relationship to health.

Skaff is currently working with colleagues examining how stress and negative emotions impact the daily glucose levels of patients with Type II diabetes. The Behavioral Diabetes Research Group kept diaries of behaviors and feelings of patients including details of diet, exercise, incidents of stress, and general mood.

"What we found was those people who had higher levels of negative affecters or 'bad moods' also had higher levels of blood glucose," says Skaff. Although no evidence was found that a positive mood could bring down one's blood glucose level, it was clear that a bad mood can aggravate the disease.

"People who are more optimistic tend to be better off mentally and physically," says Skaff.

As for Patch Adams, 37 years after he graduated medical school, there is no question that a solid medical basis for Patch Adams' clowning around can be demonstrated. Adams' books and philosophies are now a part of routine medical dialogue and training.

Patch tells the story about the time his mother had a below-knee amputation resulting from diabetes and a lifelong smoking habit. "When she was regaining consciousness in the recovery unit, I smiled at her and said, 'Well, mum, how does it feel to have one leg in the grave?' She laughed out loud. Till the day she died she told that story to friends, and each time, she laughed again." And every time he heard it, so did he.