1) This article proposes the similarity between a unit of professional clowns and shamans, both healers congruent with the folk sector of alternative medical systems. The clowns work in pediatric wards of New York City hospitals, where they interject “joy and mayhem” into the lives of patients, their families, and medical staff via performances of “funny-bone removals, squeakectomies, and bed-pandemonium” (page 462-463). The author argues that adoption of an additive, integrationist model of disease with collaboration between biomedical and complementary practitioners (like clowns) would facilitate better health outcomes.
2) Like shamans, the clown healers are “liminal figures” and “metacultural texts”, reversing and distorting cultural conventions, in the latter case to invoke hilarity, ameliorate pain with mental distraction, or provoke transference or catharsis through humorous devices such as satire and irony. Thus, their technique is production of emotional release by violating or inverting cultural rules. The healers assume clown doctor characters and use mime, farce, physical comedy, children’s theater, magic tricks, ventriloquism, and gags to produce psychological healing for patients and families.
They tailor their performances to the target audience age and affliction and supplement traditional biomedical care without being intrusive; they do not intervene while examinations are in progress, avoid quarantined zones, and employ sterile measures. Their social ranking is inferior to biomedical practitioners, as they must heed restrictions imposed by biomedical practitioners. Their skits are also aimed at patient empowerment, equalizing the doctor-patient power dynamic by parodying physicians and hospital procedures.
Furthermore, both shamans and clowns are viewed ambivalently, enter altered states of consciousness, and use music and rhythm to evoke a different reality. Importantly, they both entail a mystical element to which children are susceptible. For instance, with slight-of-hand, the clowns employ “symbolic healing” via manipulation of culturally-embedded symbols to “promote psychosomatic transformation,” by “enlisting the power of suggestion or placebo effect” (page 464, 469). They also mobilize psychosocial support, reduce family tension, and boost institutional morale by engaging all parties.
3) Although the clowns belong to the folk sector in their resemblance to shamans, they operate within the professional sector of health care. While practitioners in the folk sector share the cultural values of the society and view the body holistically (treating the psychological, spiritual and social realms and the subjective, experiential aspects of illness), the professional sector under which Western biomedicine falls delivers bioreductionist allopathic care geared toward clinical symptoms of disease entities based on a scientific, authoritative knowledge scheme. This latter sector predominates in developed and industrialized societies where the body is viewed through the lens of Cartesian dualism. Whereas practitioners in the professional sector are legally sanctioned and enjoy elite status and reputation, the clowns and other folk healers of traditional, non-Western societies are inferior on the social hierarchy and possess less prestige. The professional sector utilizes specific, compartmentalized approaches to somatic complaints, while the clowns and folk healers treat “the whole person, the social milieu, and the mental predicates of illness” (page 471).