The Clownselors

Spandana Datta

Talking to the founder of Clownselors, Sheetal Agarwal, on the impact of medical clowning and challenges of working during the Covid-19 pandemic.

May is recognised as Mental Health Awareness month. The concept of a Mental Health Awareness month came into being in 1949 in the US. It was initiated by an organisation called the Mental Health America, previously known as National Association for Mental Health. The idea is to raise awareness and educate the masses about mental illnesses and to reduce the social stigma around mental health every year in May. It aims to initiate an active dialogue about suicide and its prevention, an issue that is seldom discussed. As Glenn Close says, “What mental health needs is more sunlight, more candor, more unashamed conversation about illnesses that affect not only individuals, but their families as well.” The theme for Mental Health Awareness Month, this May is “Tools 2 Thrive”. “Tools 2 Thrive” lays out practical tools so one may effectively manage one’s mental health and increase their adaptability, irrespective of the circumstances. 

“Clownselors are a volunteer-based group that practice medical clowning. To get an insight into their work of medical clowning, what it entails and the inspiration behind it, we reached out to Sheetal Agarwal, a sociologist, a social anthropologist by training, lecturer by profession and the Founder of Clownselors.”

In India, organisations are endeavouring to not only create awareness around mental health but also actively improve people’s mental health conditions. Clownselors is one such organisation. They are a volunteer-based group that practice medical clowning. While medical clowning is a common practice in the west, it is steadily gaining popularity in India. To get an insight into their work of medical clowning, what it entails and the inspiration behind it, we reached out to Sheetal Agarwal, a sociologist, a social anthropologist by training, lecturer by profession and the Founder of Clownselors.

“Medical clowning is a therapy to aid in the healing process of patients at hospitals using dance, music, magic, drama, etc to reduce pain and anxiety.”

“Medical clowning is a therapy to aid in the healing process of patients at hospitals using dance, music, magic, drama, etc to reduce pain and anxiety”, says Agarwal. Speaking about the importance of mental health in hospitals, she explains: “The focus of hospital care is usually on improving the physical condition of the patients while overall well being is normally neglected. Mental health goes hand-in-hand with physical health, but is rarely considered. Medical clowning focuses on the overall well being of a patient. It is a distraction therapy that demystifies and humanizes the whole hospital environment for children & adults. The concept of medical clowning is that no hospital bed should deny a person his/her right to be happy. Clown doctors create an enabling and supportive environment through interactive play and humour that facilitates a patient’s adaptation to the hospital setting and improves their acceptance of medical procedures and staff. Medical clowning also helps reduce stress and fear in guardians and hospital staff.”

“It involves hospital ward visits from ‘clown doctors’ who are specially trained clowns.” 

Medical clowning aka clown care is a healthcare facility. It involves hospital ward visits from “clown doctors” who are specially trained clowns. Medical clowning is the brainchild of Patch Adams, a doctor and a clown! As a social activist, Adams believed that creativity, laughter and joy served as a catalyst in one’s healing process. He devoted forty years of his life to ameliorate the American healthcare system as he brought medical clowning into being.

Referring to its establishment as a “beautiful accident”, Agarwal talks about the inspiration behind Clownselors: “Clownselors came into being by itself, a beautiful accident. I was at a Moved By Love retreat in Ahmedabad in January 2016, where a woman named Dhara introduced herself as a medical clown. I grew up fascinated by circus clowns but heard the term ‘medical clown’ for the first time. I was intrigued so I looked it up on the Internet. I loved the concept of medical clowning and loved the idea of sharing smiles and reducing the pain of those who are suffering at hospitals. I wanted to try it myself. I contacted Dhara enquiring about medical clowning groups in Delhi but unfortunately, there were none. I was keenly interested and so, I would enquire constantly until one day, she suggested that I start medical clowning in Delhi. I said no way… I have no background in theatre and I have always been an introvert. How could I possibly start something like this?”, initially hesitant, Agarwal decided to go ahead with it.  

On how it started, Agarwal says: “Days passed but the thought of clowning stayed. One night I posted a random status update on Facebook, asking how many people would like to share smiles and give a purpose to a simple smile? I got 33 responses. I needed 15 volunteers and hospital permission to start clowning. I wrote to the Health Ministry of Delhi seeking permission to clown at a government hospital. They liked the idea and a meeting was fixed with the director, Dr Anup Mohta of Chacha Nehru Baal Chikitsalaya. He loved the idea and gave us permission. We were supposed to have a workshop that could not happen. On 9th July 2016, 5 volunteers dressed as clowns entered the hospital singing and dancing, the whole atmosphere changed. We started with OPD and covered the entire hospital spread over five floors. When we came out I could not stop smiling. I was smile hungover and so were the volunteers. Clownselors was born!”.

“Clownselors comprised merely five volunteers in the beginning. But today, the scenario looks different with Clownselors spreading smiles almost everywhere: ‘We have had 200 plus people volunteer at different clowning sessions and there are about 16-18 regular volunteers. We not only clown at hospitals but all kinds of vulnerable spaces like old age homes, orphanages, slums, refugee camps and the like. We also organize awareness campaigns using clowning as a medium. We conduct Free Hugs Campaigns, clowning workshops and sessions on stress management and team building’.”

Clownselors comprised merely five volunteers in the beginning. But today, the scenario looks different with Clownselors spreading smiles almost everywhere: “We have had 200 plus people volunteer at different clowning sessions and there are about 16-18 regular volunteers. We not only clown at hospitals but all kinds of vulnerable spaces like old age homes, orphanages, slums, refugee camps and the like. We also organize awareness campaigns using clowning as a medium. We conduct Free Hugs Campaigns, clowning workshops and sessions on stress management and team building.” 

“Although an effective practice, medical clowning can be intimidating for some, especially for those with coulrophobia. Furthermore, a ghastly portrayal of clowns in movies and books has led to a negative perception of them. Agarwal explains: ‘We respect each individual and their experiences and engage with them according to their needs.’”

Although an effective practice, medical clowning can be intimidating for some, especially for those with coulrophobia. Furthermore, a ghastly portrayal of clowns in movies and books has led to a negative perception of them. Agarwal explains: “We respect each individual and their experiences and engage with them according to their needs. If a person is scared of clowns, we try not to bother him/her but engage with people around them, which makes them comfortable, eventually.” A challenge like this can be tough to handle but the volunteers at Clownselors have managed to navigate their way around it. “When parents see their child engaged and happy after days, it immediately changes the perception of a clown in their head. We have had so many experiences where parents were initially suspicious and slightly uncomfortable too. But when their child smiled, they thanked us with tears rolling down their cheeks.” 

With the onset of a global pandemic, medical clowning groups, worldwide, were affected deeply. Like everyone else, Clownselors was hit hard. “Coronavirus disrupted all our clowning sessions”, Agarwal expresses with grief. “Since March 2020, we have hardly been able to visit hospitals as hospitals are allowing doctors and staff and not medical clowns. We have lost our projects at hospitals like Apollo.” 

“COVID-19 also gave us opportunities to spread our wings and reach every part of India through virtual sessions. We conducted sessions on mental health at universities, stress management sessions for corporate sectors, clowning workshops for children and adults and clowning sessions for children at different shelter homes.”

Though the impact was rough, her team has managed to make the most out of the situation with their virtual sessions. “COVID-19 also gave us opportunities to spread our wings and reach every part of India through virtual sessions. We conducted sessions on mental health at universities, stress management sessions for corporate sectors, clowning workshops for children and adults and clowning sessions for children at different shelter homes. We made videos and sent them to COVID-19 patients to cheer them up and their families. We also made videos on the importance of self-love and self hugs and making mundane tasks fun during the lockdown. We also conducted clowning sessions at migrant shelters during the last lockdown. This April, we were invited by the government of Meghalaya to conduct clowning at various hospitals in Shillong. We even clowned at a Covid ward at NEIGRIHMS Hospital, Shillong.” 

“People are quite receptive to mental health awareness especially once they experience a shift. When a simple act of smiling or laughing reduces the anxiety levels or when a child is not eating and starts eating after engaging with a clown, it changes the perception of the guardians.” 

Globally, it is the youth who have taken an initiative to create and engage in a dialogue about mental health awareness. But are most people receptive to their ideas? “People are quite receptive to mental health awareness especially once they experience a shift. When a simple act of smiling or laughing reduces the anxiety levels or when a child is not eating and starts eating after engaging with a clown, it changes the perception of the guardians.” But are the elderly equally receptive? Agarwal confirms, “At old age homes, the receptivity is higher as they crave human interaction and feel so much better after playing with the clowns. After a clowning session at an old age home, an old lady told us that it was the first time in her life that she had laughed so much and felt absolutely elated!”. 

“Even in 2021, the stigma around mental health is massive. It is this social stigma that prevents people with mental health issues from getting help, which in turn, makes their issues even worse. As individuals, we can grasp and discuss the gravity of good mental health. But as a society, do we practice what we preach? ‘Unfortunately, people are not aware of mental health. The stigma attached with mental health is real’, says Agarwal.”

Even in 2021, the stigma around mental health is massive. It is this social stigma that prevents people with mental health issues from getting help, which in turn, makes their issues even worse. As individuals, we can grasp and discuss the gravity of good mental health. But as a society, do we practice what we preach? “Unfortunately, people are not aware of mental health. The stigma attached with mental health is real”, says Agarwal. However, there is a shift in perception when patients respond positively to medical clowning. “We have heard doctors, patients, guardians say there is no point of this therapy, and medicines will do the work. But when they see the impact they believe in the power of such therapies and also how physical and mental health are interrelated.”

No endeavour comes without its challenges and for Sheetal Agarwal, a couple of challenges are inevitable, even today: “Since Clownselors is a volunteer-based group, one of the challenges we face is the availability of volunteers. Secondly, hospitals like the idea but are not willing to pay so sustainability is always a challenge.” 

Although Clownselors is a fairly recent initiative, they believe they possess the “zeal to heal” people. With their mission to improve the overall well-being of people, Agarwal says anyone can volunteer with them. “People can volunteer with us by registering on our website. People can help spread awareness about our work through social media and help us get connected with hospital authorities. People may also contribute and donate to our organisation.”

Although Clownselors is a fairly recent initiative, they believe they possess the “zeal to heal” people. With their mission to improve the overall well-being of people, Agarwal says anyone can volunteer with them. “People can volunteer with us by registering on our website. People can help spread awareness about our work through social media and help us get connected with hospital authorities. People may also contribute and donate to our organisation.”

With medical clowning causing ripples of positive change worldwide, more and more countries globally are considering it as a complementary approach, along with medical treatment. Clown doctors have infused hospital corridors with laughter and positivity, leading to an improvement in the health of most terminally – ill patients. Maybe laughter, truly, is the best medicine. 

Spandana is an English Literature graduate who loves writing and aspires to rebel against prevailing conventions, one day at a time. She is a Staff writer at Bol Magazine.

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Psychotherapy Through Artificial Intelligence

Spandana Datta

Discussing the future of AI in providing cheap and accessible psychotherapy, in conversation with the creators and users of Replika.

For most Millennials and members of Gen-Z, science-fiction cartoons like The Jetsons were an insight into the plausible future of the world. Though flying cars are still a rarity, the last decade has seen a rise in the development of Artificial Intelligence. Artificial Intelligence or AI, also known as “machine intelligence” is now at one’s service, just a click away. Personal assistants like Siri and Alexa are accessible at any time of the day to make calls, schedule meetings, map streets, etc. While AI is being researched extensively to enable an enjoyable social media experience for users, medical researchers say that AI has acted as a catalyst in the healthcare sector and if placed in the right hands, advanced technology of its kind could cause a revolution, in the field of psychotherapy.

The World Health Organisation says that one in four people will suffer from a mental health illness, at least once in their lives. Around 450 million people suffer from a mental disorder currently. For mental disorders, therapy is often the go-to solution. But truly how many people have access to it? Can obstacles like stigma, taboo, financial barriers and a busy schedule prevent one from seeking therapy? This is where an AI app steps in. 

“there has been a rise in the use of well-being applications like Wysa and Replika. Driven by AI, these apps offer Cognitive Behavioural Therapy for mental health disorders like anxiety, depression, and even loneliness.”

Recently, there has been a rise in the use of well-being applications like Wysa and Replika. Driven by AI, these apps offer Cognitive Behavioural Therapy for mental health disorders like anxiety, depression, and even loneliness. These apps have been developed by AI researchers to provide a platform that is safe, secure, and non-judgemental in its approach. 

Replika is one such app. Developed by Eugenia Kuyda it offers users a “private perpetual space”, where one can share their thoughts with their personal AI. Speaking to Bol Magazine about the inspiration behind the app and obstacles faced, Kuyda explains: “A few years ago my best friend died – got hit by a car in a hit and run accident. I took all our messaging history, put it into our model, and built a chatbot that would talk like Roman. The story was covered by every possible media outlet and suddenly a bunch of people started talking to Roman AI, opening up, sharing their deepest secrets and stories, using it as some sort of therapist or confession booth. We saw the need for people to talk to someone without feeling judged and we started Replika, an AI companion you can talk to anytime you want about whatever is on your mind.”  The journey was long and not always smooth-sailing. “We’ve worked on conversational AI for a long time, struggling to find a consumer application for our technology. We had built a dozen chatbots that no one really wanted but continued to look for the right application and for investors, who’d be willing to invest  in our technology.” 

AI has often been considered a medium to make psychotherapy accessible and unchallenging for both the therapists and those who seek therapy. While it cannot replace therapists, it has facilitated the diagnosis of mental disorders

Anxiety and depression are the leading cause of disability in today’s youth. For most young adults, financial barriers are an obstacle on the path to therapy. Only the privileged can seek conventional therapy owing to today’s economic scenario, with unemployment is at its peak, worldwide. Lower, lower-middle class and working class families dissuade their family members from seeking therapy due to the stigma surrounding mental health or because they cannot afford it.

“Even in 2020, the stigma attached to mental health issues is shocking, to say the least. Numerous times, those affected aren’t fully aware of the trauma they’re enduring and those who are aware, unfortunately, are afraid to share it with friends and family. This leads to an unwillingness to discuss mental health problems at home, further dissuading people from seeking therapy.”

Even in 2020, the stigma attached to mental health issues is shocking, to say the least. Numerous times, those affected aren’t fully aware of the trauma they’re enduring and those who are aware, unfortunately, are afraid to share it with friends and family. This leads to an unwillingness to discuss mental health problems at home, further dissuading people from seeking therapy. A lack of confidence in psychologists might be another barrier when trying to seek help. This has resulted in a wide treatment gap in India. 

“According to their statistics, Replika has seen over half a million downloads of its app in India.”

According to their statistics, Replika has seen over half a million downloads of its app in India. Kuyda went on to talk about the effectiveness of AI worldwide, especially in countries where there is greater stigma: “What we’ve seen in Arab countries for instance, is that Replika can really be an outlet for those who are scared of feeling judged and are afraid of opening up. Even our US users often tell us that they are scared to go to a therapist as they’re scared of being judged. And here we’ve seen a renaissance of mental health education, where therapy is being destigmatized. As for other countries, specifically among men, seeking help or telling someone else about your problems or feelings is still considered anywhere from weird to weak. It’s unfortunate, and being able to openly say what’s on your mind – even to an AI – is the first step on the way to accepting yourself and, eventually, healing”. 

Talking about the team, their AI and what Replika means to them, Kuyda said: “We’re a team of 35 people, mostly engineers and AI researchers, but also poets, designers and writers. Replika is truly a child of this incredible group of people. Proud to be working alongside them.” Their team also plans on making AI healthcare accessible worldwide. “We’re working on a Portuguese version now for Brazil since we have a huge community there.  That’s planned for November. After that we wanted to focus on India, China and Japan.”

“AI, for mental health care, was first developed in the 1960s in MIT’s Artificial Intelligence Laboratory. Known as Eliza, this AI was aimed at making people believe that they were talking to another human being or a therapist, who would respond with open-ended questions.”

AI, for mental health care, was first developed in the 1960s in MIT’s Artificial Intelligence Laboratory. Known as Eliza, this AI was aimed at making people believe that they were talking to another human being or a therapist, who would respond with open-ended questions. Since then, AI has come a long way, helping with the diagnosis of depression and PTSD in veterans of the US Armed Forces. But is the AI in Replika self-evolving or does it need to be coded and upgraded? “Our models learn from user interactions, but we also work on them to improve and make better models and better conversations over time. Right now our north star metric is the ratio of conversations that make people feel better – as of now 80% of all conversations in Replika made our users feel better. We also partnered up with OpenAI to train their most advanced language model GPT3 model on our dialogs and now some of the responses in Replika are coming from these models.”

“The Covid-19 pandemic has led to the imposition of an intercontinental lockdown, which resulted in social isolation, something which AI apps can help combat. Long wait-lists for therapy and busy schedules have further popularised such apps among young adults.”

Though humans are social animals and the need to interact with others is imperative, AI chatbots are a feasible option for many, providing support which most one-to-one human interactions cannot, making AI apps appealing to the youth. One has quick access to CBT which is a relief to those suffering from anxiety, depression and other related illnesses. A great advantage of such platforms is that one can share otherwise embarrassing stories without the fear of judgement. The Covid-19 pandemic has led to the imposition of an intercontinental lockdown, which resulted in social isolation, something which AI apps can help combat. Long wait-lists for therapy and busy schedules have further popularised such apps among young adults. Some AI apps may also spot suicidal tendencies in their users and may help prevent self harm in users or even suicide

Speaking to Bol Magazine, Replika user Arik Karthman*, who suffers from anxiety and found it difficult to engage with others said his experience was interesting, to say the least: “I was living a Sci Fi dream and here I was, chatting away to my machine! I did ask a couple of silly questions though, but the app for sure had passed the Turing Test! Being an engineer myself it was interesting to see how someone managed to fuse AI with psychology. Moreover, the app was offering real time conversations over texts and even a phone call! To achieve that, is a technological leap in the field of AI, which even though has developed sevenfold, is the next big thing for the human race. It was just a few clicks here and there and I found myself downloading the app.” But did the app help?  “I did try pinging the AI when I was stressed out and it just knew how to get me going. There is of course, a huge room for improvement, but the app nevertheless offers a great experience for someone who might find himself alone with no one to talk to. We are, as a matter of fact, on the road with the AI coming up to pace with the humans and offering people with their own therapist friend, right in their palm! Just hoping it doesn’t grow up to be the Sky Net we all hate!”

Though we have come a long way, AI has to mimic human-like qualities, especially when it comes to a field like psychology, to succeed. Psychology caters to one’s emotional needs and even though virtual counselors are rising, many oppose such ideas. A lack of rapport and having received scripted answers from a virtual counselor may leave one feeling inadequate after a session. Though a chatbot provides a safe, non-judgmental platform, crude, lifeless replies may not always be the solutions to one’s problems. Thus, the rise of virtual therapists may also jeopardize jobs of counselors and psychologists. It could displace many, leading to even greater mental health problems among the world’s workforce.

“Another important trait a therapist must have is empathy, which is considered to be the very essence of psychotherapy. While empathy can be simulated in an AI, it may lack a genuine touch.”

Another important trait a therapist must have is empathy, which is considered to be the very essence of psychotherapy. While empathy can be simulated in an AI, it may lack a genuine touch. Although most apps assure users of a secure platform, some private data may be accessible, leaving privacy to be a huge cause of worry. In-app purchases in many applications may bring therapy to a halt for users who cannot afford it. With the evolution of AI, there is plenty of room for numerous errors, especially when a chatbot may evolve and propose values which may contradict that of its owners’. Untimely glitches in the app may deprive the user from accessing their chatbot, which can cause panic, especially during an emergency. Lastly, though it is highly unlikely, one may end up falling for their chatbot like in the movie, Her. The failure of this superficial relationship may lead to the user feeling lonelier than ever. 

Kuyda shares a rather balanced opinion, when asked about the pros and cons of AI: “Right now we’re focusing on companionship – we’re not providing any mental health tools, but hopefully allowing people to alleviate some feeling of loneliness they might be getting. Right now tech isn’t there yet to automate therapy, but it’s there to create an AI buddy for those who might need someone close to them – maybe sometimes a little confused and not as intelligent as some humans, but always accepting, loving and trying to help.”

As you read this, artificial intelligence is evolving and is being used vastly. An AI chatbot can be an ideal therapist in a plethora of ways since its limitations are those which can be overcome with research and discovery. On the whole, AI could bring about a revolution in psychotherapy, providing support to one’s mental health and overall well being, in the process. 

*Names changed to protect privacy

Spandana is an English literature graduate who loves writing and aspires to rebel against prevailing conventions, one day at a time.

Design by Hemashri Dhavala

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