The clown/fool/jester is a recognizable fgure in every culture. The clown is an archetype, a universal image that’s embedded in the brain. These images dwell in the unconscious mind. They can be animals, people, gods/goddesses, or objects (a tree, a house, a cross, or mandala) that are a staple in many myths and legends.

The clown lightens the mood; encourages us to laugh at ourselves (and the ridiculousness of life), pokes fun at convention, provides social commentary, and can get away with revealing that the emperor has no clothes. The clown is irreverent, faunts taboos, and difuses anxiety; in many cultures, the clown is a sacred healer, wisdom keeper, and serves as the community’s psychotherapist.

This also is the purpose of psychotherapy; we psychiatrists help patients look at their In many cultures, the clown is a sacred healer, wisdom keeper, and serves as the community’s psychotherapist. The clown’s purpose is to help us look at the familiar from another perspective. old landscape with new eyes, and in so doing help them create new endings to their old stories.
It took me until midlife to embrace myself as clown healer, and I took this step only after many years of working with Native Americans as chief of psychiatry at the Phoenix Indian Medical Center. I went fnally went public after meeting Dr. Patch Adams, perhaps the world’s most recognized humanitarian clown, more than 20 years ago.

This is the third year we have been conducting mental health clinics in the streets of Iquitos, Peru, which I have described before, most recently last year. These street clinics are stafed by clowns who also happen to be health professionals representing many disciplines (doctors, nurses, psychologists, social workers, counselors, body workers, chaplains). They’re also part of a humanitarian clown trip that I make every year with Dr. Patch Adams and the Gesundheit! Institute in Hillsboro, W.Va., along with more than 100 clowns from around the world.

The impact of the clinics and on both ”patients “ and “therapists” has been profound. These encounters remind us that even in the presence of unimaginable sufering, connecting in this heartfelt way and remaining actively present in every moment makes sufering more bearable. They also remind us of the value of incorporating culture into treatment plans.

What is clown therapy?
Our clown-therapists will talk to people about anything that’s troubling them and work with them in open spaces (football felds, storefronts, loading docks, markets), sitting in a tight circle (with an interpreter for non–Spanish-speaking therapists) wearing a clown nose. We listen intently and are acutely present in every moment. We see people for 20 minutes and do not make diagnoses or prescribe pills, although we sometimes hand out amulets and give blessings.

As clown-therapists, we welcome the opportunity to get out of their heads and connect with people at the heart level. We delight in spontaneity, which facilitates opening channels into our unconscious minds, trusting that we will come up with something to say or do that will be helpful.

These clinicians can acknowledge sufering without becoming consumed by it … in the midst of crisis and/or pain they don’t “awful-ize” or “catastrophe-ize”; instead they have the capacity to identify people’s strengths and resilience and get a sense of what gives meaning to their lives. In a short time, such heartfelt connection can have a profound impact on not only the recipient but also the provider.

A case study
As a rule, we see people only once, but this year, I saw Maria, a 42-yearold woman twice. She was acutely suicidal, and after her morning prayers, decided today was the day she was going to kill herself. After 6 months of unbearable torment, she’d reached the end of her rope; she told me that her 20-year-old daughter had been raped 6 months earlier and was now pregnant. Maria’s family blamed her, saying that if she hadn’t divorced her husband 15 years earlier, this would not have happened. Maria knew she was not to blame, in which I concurred, but alas, she could not (as her family suggested) get over it and move on.

After listening, I told her I thought today was a miracle; this morning, she was ready to die, and this afternoon, we happened to show up on her street. I also said I believed the seriousness of her suicidal intent and told her she had two choices; I could hospitalize her, although I had no idea if that was even possible, or she could make me a promise – at least for today – that she would not kill herself.

I gave her an amulet that had been blessed by Navajo and Huichol shaman and said I wanted her to hold onto it during tomorrow’s morning prayers; she would feel our blessings and remember this miraculous day that we found one another. Perhaps tomorrow she could promise herself to also live for another day.

After the clinic, I couldn’t get her out of my mind, so after dinner I asked my clinic coordinator to check in on her the next day. We were going to be conducting another clinic not far from her home in a few days, and I asked her to invite Maria to the next clinic and to please bring her daughter, too.

Maria showed up not only with her 6 months’ pregnant daughter, but also with her younger 18-year-old daughter. Together, they told me the rest of the story. Both girls had been raped (the younger more than a year ago), and both by diferent maternal uncles. They had never spoken about it to anyone outside of their family, and although Maria had confronted her brothers, she refused to press charges. This is not a culture in which women prosecute their rapists.

Before we ended, I gave both girls an amulet and blessed the family; whatever they faced, they would face it better together; their love for one another would be showered on this new baby, and they would carry our blessings with them and those of many relatives all over the world.

In most Latin cultures, there is a strong belief in the power of spells, curses, and witchcraft, as well as in traditional healing practices and the power of faith. A critical element for successful healing in all cultures is the patient’s belief in the practice and in the practitioner.

As mental health professionals, we magnify our power not only with the pills we prescribe, but also with the blessings and amulets we may bestow. And it doesn’t take a long time to connect at the soul level if you are actively in the moment, and it is in those miraculous moments that we are reminded of our shared humanity. Imagine if we used our 15-minute medication reviews to actually connect with people at this heartfelt level and talked about what’s really important to them. I’m thinking we could reduce our prescription writing by half and be reminded of the joys of psychotherapy.

Dr. Hammerschlag is chief of community mental health at the Gesundheit! Institute. He is also the author of several books on healing and spirituality, including Kindling Spirit: Healing from Within (New York: Turtle Island Press, 2012) and The Dancing Healers: A Doctor’s Journey of Healing With Native Americans (San Francisco: Harper, 1988). Scan the QR code to read more commentaries at clinicalpsychiatrynews. com.