Education
Posters presented at the 114th annual conference of the American Psychological association, New Orleans, LA August 12, 2006
- Staging a Musical for Hospitalized Children: The Volunteer Experience
- Brightening the Outlook of Sick Children: The Effects of a Play
Tails - A Fairy Tale on Furry Tails:
A 14 Year Theatre Experience for Hospitalized Children Created by Health Professionals
Ami Rokach, Ph.D. and Ben Rokach, B.Sc.
York University
Psychology Dept.
Toronto, ON
Canada
e-mail: arokach@yorku.ca
Abstract
The poster deals with the functions of humor, theater and entertainment as aides in dealing with stress. More specifically in assisting sick children and their parents who face illness, hospitalization, painful or uncomfortable treatment, and mostly- being different from the ‘healthy world’. We describe a theatre production that has completed 700 shows over 14 years at Toronto’s Hospital for Sick Children. Its contribution to the hospitalized children’s parent’s and staff’s quality of life and self-esteem is discussed.
The impact of hospitalization on children
Hospitalization is stressful. It is so for adults, and more for children. Sick children, who are hospitalized, are usually taken away, often unexpectedly and unwillingly from their home, family, school and friends; from a comforting familiarity and play, to a new place, filled with constant activity, medical procedures [which may be invasive and painful], nurses and physicians [which may not all be empathic and pleasant], and-at times-separation from their parents (Favara-Scacco, et. al. 2001; Scudder, 1995). In addition to being invaded physically and emotionally, hospitalized children commonly witness their parents, who are their source of strength and safety, relinquishing their control to unknown strangers. Gibson and Williams (1997) observed that “children have special health-care needs as they are in a state of constant development, both physically and psychologically” (p. 201). Children are amongst the most vulnerable members of our society and hospitalization only increases their vulnerability (General Assembly of the United Nations, 1989).
There is extensive evidence that the whole family may be adversely affected when a child is hospitalized, especially when it is for a lengthy period and/or for a serious or life threatening illness (Savarsdottir, 2005; Sahler, 2002). The parents of sick children need not only face their child’s illness and its consequent ramifications, but also the child’s emotional reactions and loneliness, and their own reactions to the situation (Savarsdottir, 2005; Hoekstra-Weebers et al. 2001).
The role of humor in pediatric hospitalization
The idea that humor, laughter and play exert positive health benefits has become increasingly popular in the past decade (Martin, 2001). Research demonstrated that humor that provokes laughter has both, psychological and physiological effects. It has been shown to reduce the levels of stress hormones, lessen depression and improve mood. Laughter has been shown to stimulate an increase in the activity of defensive immune cells, including T-cells that attack and kill tumor cells and viruses (Zand, Spreen & Lavalle, 1999; Pp. 600-601). The indication that laughter has salutary properties dates back to the Bible that proclaimed that “a merry heart doeth good like a medicine” (Proverbs 17:22, King James Bible, in Martin, 2001).
Humor plays an important role in interpersonal communication, social competence and, of course, in facing and surviving stressful situations, such as hospitalization (see Murstein & Brust, 1985; Masten, 1986; Martin 2002). Argyle (1997) and Edwards and Cooper (1988) maintained that humor may affect health through the positive emotional states which accompany laughter, and may have analgesic or immuno-enhancing effects (Bruehl, Carlson & McCubbin, 1993; Stone at al. 1994).
Martin (2001) highlighted the moderating effects that humor may have when used as a coping strategy by adopting a humorous outlook on life. This is particularly important for children, and more so for those with serious illness who may be repeatedly hospitalized. They are expected not only to undergo hospitalization, invasive procedures (painful at times), and deal with their illness, but also face their peers’ reaction in school, other kids who may single them out and even taunt them for being sick, absent, or (in case of chemotherapy or disfiguring surgery) appear differently than the rest of the children (see Hopia et. al. 2005; Gibson & Williams, 1997).
The Bear Theatre and “Tails”
To the best of our knowledge, this is the first and only regularly performing company of health professionals based in a pediatric hospital. By staging a play, Dr. G. Koren, the pediatrician and scientist who created and staged the play, wished to share the non-medical/professional selves of hospital staff with pediatric patients and their families in order to help humanize the hospital experience. Hence, “Tails: A Fairy Tale on Furry Tales”, an original musical about being different. Every Thursday evening, since July 1992, on entering the Theatre, the children and parents receive a pair of animal “ears”. The play starts with Quincy Taylor handing out and tailoring tails to members of the audience and the cast creating an atmosphere of a forest filled with animals. Only Honey Bunny, who arrives late, does not get a tail. After unsuccessfully, trying to convince the audience to sell him a tail, he retires to his bunny hole, lonely and sad. Eagle Joe, a space pilot, arrives looking for someone to accompany him on his flight to Venus. All the children who, naturally, want to accompany Eagle Joe, fill out application forms, with the help of the cast. But Eagle Joe can’t take just anyone; proclaiming that because the shuttle is small, there is no room for a pilot with a tail.
To his great surprise, Bunny is chosen precisely because he does not have a tail. Bunny then addresses the kids and points out to them that he feels special (going to space) but so are they, despite whatever may differentiate them from other children. The Teller Penguin reiterates this concept: “Honey is special. He always was. He simply didn’t know it. We are all special. We just have to accept ourselves the way we are and not to try to be “somebunny” else. The musical ends with the song, “Everyone is special in his own way.” There is considerable audience participation: singing, dancing, waking up Honey Bunny, and filling applications to fly to space. Humor and puns are rampant throughout the show. At the end of the show, one of the application forms is drawn, and the winner receives a copy of the book “Tails”. All the children receive a colouring sheet of a scene from the play. Finally, a postcard is sent home to the children, wishing them well, based on their address on the application to go to space; that’s if they provided the address.
Tails: A short history of the play
The first show was performed on July 6, 1992. Ever since, Tails has been performed without fail every week to an audience of between 40 and 80 hospitalized children and their families. Since eighty percent of the Hospital’s children change weekly, the majority of children and parents are new to the show. Yet children who experience long hospitalizations have seen the play as many as thirty times. (The “application forms” help the team trace who has seen the play previously). These children know the text and songs by heart, recognize all the characters and correct them when they make “mistakes”. The play is particularly important to these children and their families, as is documented in two cases.
Ben’s Story:
Four year old Ben was a liver transplant recipient. Due to rejection of the new liver, he had to undergo various treatments over prolonged periods of hospitalization. He used to sit in the front row of the theatre and dance with the team. When the music tape of Tails came out, he received the first copy which, his mother said, he cherished and listened to many times per day. Ben died during surgery to replace his failing new liver. When members of “Tails” attended his memorial service, they were moved to hear the happy music of Tails in the church. Ben’s mom explained that “this is the music he wants to listen to now”.
It would, of course, been been advantageous if we were able to conclude this paper with a methodologically sound research on the benefits of “Tails” on the outlook, stress level, and coping of the young patients and their caregivers. However, since the children remain hospitalized typically for a week or less, and since it may not be possible to conduct a ‘follow up’ at home, such is not the case.
Instead, we have gathered several additional anecdotes suggesting that the play is, indeed, beneficial and has positive effects on:
- The children. Verbal feedback from nurses, in the various departments, that were shared with the authors confirm that, after watching the play while they are hospitalized, the children seem less lonely, and more comfortable in the hospital surroundings. A child of a medical trainee in the hospital attended the play l numerous times. His father later told us that the child has a learning disability and the play (which deals with the notion that being different is ok and not shameful) helped the youngster and his parents cope with his learning disability. Moreover, the book and videotape of the play were used to deal with the child’s special challenges. Says Dr Koren: “Trying to imagine what a hospital experience is for a child, I think about a prisoners’ of war [POW] camp”. Prisoners (albeit trying to be friendly) invade the child’s body and soul, and inflict pain. The child is disconnected from almost everything he/she is familiar with. And the parents who suppose to protect the child are tired, fearful and helpless. They are inmates too. Remembering this context, “Tails” is a modest attempt to remind the children and their parents that the staff are not prison guards, but rather compasionate and caring people.
- The parents. They, consistently, express gratitude and appreciation for the play and its message, indicating that it is, indeed, needed and beneficial. This has been done both directly to the actors, as well as in their written input at the end of the hospital stay.
- The actors. They related to the authors that they benefit by staging a play for sick children, and are rewarded by evidencing the enthusiasm with which their work is received.
Conclusion
Theatre in Health Education [THE] aims to empower children by providing them with information, and with opportunities to examine their attitudes, beliefs, values, and lifestyle (see Toye & Prendiville, 2000). “Tails” is geared towards empowering children who [because of their illness and hospitalization] are perceived by their peers to be disadvantaged, weakened, and dependent. It attempts to help them realize their personal and social potential, despite their illness and its ramifications. It also transforms the hospital into a place where good people try to create fun for hospitalized children.
As Ball (1991) so poignantly indicated “it is important to recognize that scientific evaluation methods with their tight controls and systematic objective-oriented procedures, may be appropriate for testing routine operations of a cognitive nature but are unsuited to the complex human interactions inherent in a THE programme” (p. 237). It is hoped that future research may come up with appropriate evaluations which will quantify the, often, subtle change in those who participate, as an audience, in a Tails-like production. In the meantime, the creator of Tails is pleased to share the production with colleagues everywhere, a gesture that has already been adopted in Tel Aviv, Israel and Long Beach, California.
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