Personality of Clown Doctors

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1 Original Article Personality of Clown Doctors An Exploratory Study Alberto Dionigi Department of Education, Cultural Heritage and Tourism, University of Macerata, Italy Abstract. In recent years, both professional and volunteer clowns have become familiar in health settings. The clown represents a peculiar humorist s character, strictly associated with the performer s own personality. In this study, the Big Five personality traits (BFI) of 155 Italian clown doctors (130 volunteers and 25 professionals) were compared to published data for the normal population. This study highlighted specific differences between clown doctors and the general population: Clown doctors showed higher agreeableness, conscientiousness, openness, and extraversion, as well as lower neuroticism compared to other people. Moreover, specific differences emerged comparing volunteers and professionals: Professional clowns showed significantly lower in agreeableness compared to their unpaid colleagues. The results are also discussed with reference to previous studies conducted on groups of humorists. Clowns personalities showed some peculiarities that can help to explain the facility for their performances in the health setting and that are different than those of other groups of humorists. Keywords: clown doctors, personality profile, Big Five, volunteers, professionals Humor is an important part of life. Numerous studies have been conducted in order to understand why people laugh, and theories have been proposed to explain the mechanisms of humor (for a review, see Ruch, 2008). Research has mainly dealt with individual differences in the appreciation of humor by most people while the psychological characteristics of comic performers, such as cartoonists, humor writers, stand-up comedians, and clowns, have only marginally been investigated. In particular, studies have been conducted on humorists aimed at investigating whether they have particular personality traits that differ from those of the others and whether there are differences with amateur or less effective humor producers. Generally, a distinction in personality traits depending upon being a creator (e.g., writers) or an interpreter (e.g., actors) was highlighted (Kogan, 2002). The psychological research in this field has mainly focused on comedians personality, which revealed a specific pattern. In an early study, following a psychoanalytical approach based both on projective tests and analyses of dreams, comedians were found to be sad, depressive, despondent, and angry (Janus, 1975). When investigating gender differences, male comedians were more introverted than females, who were found to be vivacious, frenetic, and hypomanic (Janus, Bess, & Janus, 1978). When compared to the general population, both professional and amateur comedians showed significantly lower conscientiousness, extraversion, agreeableness, and higher openness compared to college students (Greengross & Miller, 2009). Interestingly, comedians and actors were also found to score higher in Psychoticism with respect to the rest of society s norms (Ando, Claridge, & Clark, 2014). These findings are consistent with research conducted on male professional British cartoonists (Pearson, 1983), who were found to be high on Psychoticism suggesting a link between artistic creativity and Psychoticism. The psychological profile of professional comedians was also compared to clowns profiles in a Rorschach inkblot test (Fisher & Fisher, 1981). Comedians showed more references to themes of good and evil and a lower perception of self-worthiness and made a higher number of negative remarks about themselves. According to these results, an unusual personality structure may help to explain the facility for comedians performances and be helpful in making people laugh. As Psychoticism is closely related to creativity (Eysenck, 1995), the high P-scorer is more capable of coming up with unusual, incongruous, and wittier punch lines (Köhler & Ruch, 1996). Research on the personality of humorists has mainly focused on comedians, although clowns as pranksters, jesters, jokers, harlequins, and mythologized tricksters have been around for quite a long time and have attracted much popular interest. The clown is, by definition, a curious figure that projects itself on a different wavelength than that of societies status quo (Dionigi, Ruch, & Platt, 2014). The clown is a performer who acts foolishly and childishly in order to elicit positive emotions, and it is strictly associated with the performer s own personality, physical body, and subjectivity (Lecoq, 2011). This personality is often also reflected in a specific costume, as adopting a costume frequently helps to construct and define a new role (Miller, Jasper, & Hill, 1991). Differently from an actor, a clown does not play a character and develops this based on the performer s physical and psychological characteristics DOI: / /a000187

2 50 A. Dionigi: Clown Doctor s Personality (Peacock, 2009). Clowns have appeared in a large variety of environments, and, in the last three decades, many more have been integrated into health settings. This practice was first started by Michael Christensen in 1986, a professional clown who set up the first Clown Care Unit (Dionigi, Flangini, & Gremigni, 2012). The art of clinic clowning is rooted both in the figures of fools and jesters and in shamans and folk healers. In many cultures, people believe that fools, clowns, and tricksters possess magical powers, enabling healing (Grinberg, Pendzik, Kowalsky, & Goshen, 2012). Although the figures of the circus clown and of the clown doctors are often linked, fundamental differences exist between them. These differences lie in the goal and methodology of clowning utilized in a health setting. The main aim of circus and street clowns is to entertain and amuse audiences, while the purpose of clown doctors is to assist patients in the healing process, distracting them from painful procedures, reducing anxiety triggered by hospitalization, and enhancing their moods (Dionigi, Sangiorgi, & Flangini, 2014; Grinberg et al., 2012; Pendzik & Raviv, 2011). To accomplish this goal, clown doctors must be bright performers and talented humorists, yet be empathetic and attentive to patients needs. Moreover, they must have high emotional intelligence as their purpose is to modify the moods of patients and change their emotional states to positive ones (Dionigi et al., 2012; Warren & Spitzer, 2013). Research has been carried out on a variety of other humorists and social groups, as yet no empirical studies have been done on the personality traits of clown doctors. Therefore, to further understand the effectiveness of these clowns in their dual roles as healers and humorists, it is of interest to establish what the typical psychological characteristics of clown doctors are. The purpose of this study is to investigate the personalities of a sample of clown doctors, using the five-factor model of personality (FFM) (McCrae & Costa, 2003). The hypothesis was that the personality profiles of clown doctors are significantly different from the general non-clown population. As performing artists, clowns show similarities in personality when compared to actors and comedians as clown doctors perform in front of crowds to elicit positive emotions. High extroversion is associated with the desire for being the center of social attention (Nettle, 2006), so clown doctors were expected to score high on extroversion. Clown doctors, similar to comedians, tune their acts to the crowd s reactions (Greengross & Miller, 2009). They must also put the patients needs first and cooperate with colleagues, healthcare staff, and patients relatives. Therefore, clown doctors were predicted to score high on agreeableness. Previous studies have shown that creative people are low on conscientiousness and high on openness (Greengross & Miller, 2009; Nettle, 2006; Nowakowska, Strong, Santosa, Wang, & Ketter, 2005). Creativity is required in clown doctors as well; however, since they perform in peculiar settings, such as hospitals, they must manage their emotions and be self-disciplined. Clown doctors were thus expected to score high on both conscientiousness and openness. Neurotic individuals are more prone to experience anxiety, worry about life events, and evaluate themselves more critically (Costa & McCrae, 1992). Furthermore, anxious individuals are more susceptible to focusing on potential threats in their environment (Eysenck & Derakshan, 2011). High neuroticism in performers leads to stronger stage fright (Steptoe et al., 1995). As clown doctors are required to stay in tune with patients and manage their and others emotions in order to perform well and accomplish their task, they were predicted to score low on neuroticism as compared to the general non-clown population. Finally, as an increasing number of people practice as clown doctors, they include a wide variety of professional backgrounds (Koller & Gryski, 2008). Currently, it is common to find both professional and volunteer clown doctors in hospitals (Dionigi, Ruch, & Platt, 2014), so differences in personality traits between volunteers and professionals were also investigated. Aim of the Study At the time of this writing, there is no reported research about personalities of clowns working in health settings. The purpose of this study was to investigate the psychological characteristics of a sample of Italian clown doctors, both professionals and volunteers, and to compare findings with published normative data. Due to the characteristics required to work as a clown in health settings, it was expected that clown doctors would score higher in agreeableness, extraversion, conscientiousness, and openness and lower in neuroticism when compared to the normal population. Moreover, as friendliness and sociability go along with the need to help it was expected that volunteers score higher in agreeableness compared to professional clowns. Method Participants The total sample consisted of 155 clown doctors (40 males, 115 females) varying in age between 21 and 66 years (M = 37.99, SD = 10.25). Participants were well-educated adults (0.6% primary school, 5.8% low secondary school, 41.9% upper secondary school, 52.3% university). With reference to marital status, 86 were not married, 51 were married or cohabiting, 15 were divorced, and three were widowed. Participants had different levels of experience in the art of clowning in health settings (M = 5.51 years, SD = 3.07, range = 0 13 years). Instruments Participants completed a short demographic questionnaire and the Big Five Inventory (BFI; John & Srivastava, 1999) Journal of Individual Differences 2016; Vol. 37(1):49 55 Ó 2016 Hogrefe Publishing

3 A. Dionigi: Clown Doctor s Personality 51 to assess the Big Five dimensions of personality. The BFI consists of 44 short-phrase items, rated on a 5-point scale (1 = disagree strongly to 5 = agree strongly). The items assess the core traits that define each Big Five domain. The BFI items are assigned to five scales measuring Extraversion (E; 8 items), Agreeableness (A; 9 items), Conscientiousness (C; 9 items), Neuroticism (N; 8 items), and Openness to experience (O; 10 items). Prior researchers have presented adequate evidence of the reliability and validity of the BFI scales (John & Srivastava, 1999). In this study, the Italian version translated and validated by Ubbiali, Chiorri, Hampton, and Donati (2013) was used. Procedures Data was collected in an online survey, and the study was conducted among a broad sample of Italian clown doctors. Participants were recruited via s sent to the coordinators of Italian clown care units asking them to forward to clown doctors belonging to each unit. The contained a link to the survey created on Survey Monkey and an explanation of the aim of the study. All participants were guaranteed anonymity. The sample that fully completed the questionnaire was composed of 155 clown doctors. All statistical procedures were performed using the software package SPSS (21.0, IBM Inc., New York, NY, USA). Results Comparison Between the Clown Doctor Sample and the General Population Comparison data for the FFM personality traits were taken from a large Italian general sample composed of 1,023 participants (female = 56.9%, M = 34.80, SD = 14.53, range years old) recruited to study the psychometric properties of the Italian adaptation of the BFI (Ubbiali et al., 2013). The clown doctor scores on the scales showed good to acceptable reliabilities (Cronbach s a: Openness to experience:.80; Conscientiousness:.79; Extraversion:.77; Agreeableness:.70; Neuroticism:.75). Comparisons between means, standard deviations of BFI traits, as well as correlations with age, and education are reported in Table 1. Each dimension of the FFM was compared to the values of the Italian population (Ubbiali et al., 2013) using a onesample t-test (Table 1). A significant difference in each concept of the Big Five was found (all p <.001), with a largeeffectsizeino(d = 0.86) and medium effect size in A (d = 0.67), N (d = 0.66), E (d = 0.46), C (d =0.42). Thus, the sample of clown doctors investigated can generally be described as more extraverted, agreeable, conscientious, open, and low in neuroticism compared to the general population. In the clown doctors sample, a positive correlation (r =.19, p <.05) emerged between age and agreeableness while older clown doctors scored lower in neuroticism (r =.16, p <.05). No significant correlations were found between the five personality traits and education. An independent-samples t-test was also conducted to compare the scores on the Big Five dimensions of male and female clown doctors (Table 2). Female clowns scored higher in neuroticism compared to males (M males = 2.37, SD =0.66; M females = 2.69, SD =0.64);t(153) = 2.76, p =.06, with a moderate effect size (d = 0.49), while no other significant gender-related differences emerged. In their study, Ubbiali et al. (2013) computed a point-biserial correlation, showing a significant relationship between genders of Italian population and specific dimensions of the Big Five: Females were found to be significantly higher in Agreeableness and Neuroticism compared to males. Table 1. BFI scale means, standard deviations, associations with age and education of clown doctors and italian population Clown doctors General population E A C N O E A C N O Min Max M SD t-test values (df = 154) t 6.88*** 8.94*** 5.78*** 9.17*** 12.64*** d Associations with age and education Age.06.19*.11.16* **.26**.18**.06* Education **.14**.08** Notes. E = Extraversion; A = Agreeableness; C = Conscientiousness; N = Neuroticism; O = Openness; Min/Max = minimum/ maximum; M = Mean; SD = Standard Deviation; df = degree of freedom; d = Effect size; Number of Clown Doctors = 155 (%female = 74.20, M =37.99, SD = range years old). Source of general population data: Ubbiali et al. (2013), n = 1023 (%female = 56.9, M = 34.80, SD = 14.53, range years old). *p <.05. **p <.01. ***p <.001. All tests were two-tailed.

4 52 A. Dionigi: Clown Doctor s Personality Table 2. Independent t-test for gender differences in five factor model personality traits in clown doctors Females Males M SD M SD t Effect size Extraversion Agreeableness Conscientiousness Neuroticism **.49 Openness Notes. Number of female clown doctors = 115; number of male clown doctors = 40; Effect size = d. **p < 0.01 (two-tailed). Differences Between Volunteers and Professionals In order to assess differences between clowns, two subgroups were established: Volunteer and professional clown doctors. The volunteer group was composed of participants whose clown activity does not represent their main job and who are not paid for it. The professional group includes participants who reported to do this activity as a job and who receive money for it. The volunteer group was composed of 130 clown doctors (31 males and 99 females; M =38.15, SD = 10.61, range = years old) while the professional group included 25 people (9 males and 16 females; M = 37.16; SD = 8.28; range = years old). In the next step, the Big Five dimensions of volunteer and professional clowns were compared. Due to the small sample of professional clowns, the assumption of normality of all five dimensions of the Big Five was examined using normal probability plots. No apparent deviations from normality emerged. Following, Levene s homogeneity of variance test was conducted: The variances of the Big Five dimensions of the two groups were not different from each other (Extraversion: F(1, 153) = 0.32, p =.57; Agreeableness: F(1, 153) = 0.26, p =.61; Conscientiousness: F(1, 153) = 1.61, p =.21; Neuroticism: F(1, 153) = 3.19, p =.77; Openness to experience: F(1, 153) = 0.95, p =.33). Therefore, it was safe to continue with the ANOVA, controlling for both age and gender. Results are presented in Table 3. Table 3 shows the comparisons among volunteer and professional clown doctors groups based on the Big Five personality. An ANCOVA [between-subjects factor: professionalism (volunteer, professional); covariates: age and gender] revealed a significant group difference for Agreeableness as volunteer clowns scored higher than professionals, F(1, 151) = 6.29, p <.01, and a moderate effect size ( f =.57). ANCOVA revealed no main effects of gender, F(1, 151) =.02, p =.88, and a main effect of age, F(1, 151) = 5.67, p <.05. Discussion Table 3. Comparisons between volunteer and professional clown doctors This is the first study aimed at investigating personality characteristics of clown doctors; the data for this study shows that this sample of clown doctors showed peculiar characteristics that distinguish them from the general Italian non-clown population. Clown doctors score higher in Extraversion, Agreeableness, Conscientiousness, and Openness to experience, and lower in Neuroticism compared to published normative data of the populace. These results confirm what was suggested by theoretical manuscripts written in this area (Dionigi et al., 2012; Warren & Spitzer, 2013). The clown doctor is a comic character required to be creative in order to improvise according to what is found in the healthcare setting. Extraversion is related to the fluency component of creativity (Eysenck, 1995) and humor, creativity, and extraversion have been found to be positively correlated (Koppel & Sechrest, 1970). Extraverts are characterized by traits such as being sociable, lively, active, assertive, tending to enjoy human interactions, and being enthusiastic, talkative, assertive, and gregarious. In the field of humor, extraverts (as compared to introverts) are more cheerful, less serious, and able to produce a higher quantity Volunteer clowns Professional clowns M SD M SD F Effect size Extraversion Agreeableness **.57 Conscientiousness Neuroticism Openness Notes. Number of volunteers = 130; number of professionals = 25; Effect size = f. **p < 0.01 (two-tailed). Journal of Individual Differences 2016; Vol. 37(1):49 55 Ó 2016 Hogrefe Publishing

5 A. Dionigi: Clown Doctor s Personality 53 of humor content (Köhler & Ruch, 1996). As clowns expose themselves with the intention of being the laughing stock for others, probably extraversion may provide responsiveness toward the interpersonal reward of being the center of an audience s attention (Nettle, 2006). Clown doctors show high Agreeableness compared to other people. This dimension is related to the ability to be sensitive toward others needs, compassionate, and cooperative. Moreover, other public figures who want to be loved and appreciated, such as actors and politicians, are high on this dimension (Caprara, Barbaranelli, Consiglio, Picconi, & Zimbardo, 2003; Nettle, 2006). Agreeableness represents the core dispositional trait contributing to prosocial behaviors as agreeable individuals are altruistic, straightforward, trusting, softhearted, modest, and compliant (McCrae & Costa, 2003). Researchers found significant positive relations between agreeableness and volunteering, as people scoring high on Agreeableness are more likely to comply with requests from others (Carlo, Okun, Knight, & de Guzman, 2005). In the present study, volunteers scored higher than professionals in agreeableness. One possible explanation can be that volunteers are more altruistic, modest, and compliant compared to their paid colleagues (Liao-Troth, 2005). The sample of clown doctors was also high on Conscientiousness compared to normative data. Clowns are required to attend rigorous training before entering the health setting and must be aware of their role as well as of the risks related to a wrong approach to patients or to a lack of competence. As conscientious individuals are able to manage emotions, be self-disciplined, and focus on goal achievement, it is not surprising that clown doctors score high on this trait. As predicted, clown doctors have been found to be more open to experience than the general population. This finding is consistent with those of previous studies that showed that other creative groups are also high on Openness to experience (Nettle, 2006). Clown doctors are required to be curious and possess a high imagination as they must look at the world in a different, unconventional, and imaginative way where (almost) anything is possible and permitted (Dionigi, Ruch, & Platt, 2014). Furthermore, Openness to experience has consistently been positively related to creativity in general, and clown doctors need to continually adjust their way to approach patients in order to make their work evolve. Finally, clown doctors scored low in Neuroticism. This result is not surprising, as neuroticism is made up of traits like anxious, depressed, guilt feelings, low self-esteem, irrational, and shyness; that is not representative of the clown s profile. Moreover, neuroticism was found to be negatively correlated with cheerfulness (Köhler & Ruch, 1996). Studies on other creative people like poets and writers show that they are high in this dimension. However, differently from clown doctors, they do not have to perform their creation on stage (Nowakowska et al., 2005). Research conducted on comedians showed no differences in neuroticism compared with the rest of society (Greengross & Miller, 2009). This finding is consistent with what has been recently found about the ability to remain in the role during the performance. Clown doctors who were better able to differentiate between their persona and their clown persona were less interfered by external cues and internal thoughts; they experienced less anxiety before and during the activity (Dionigi, Ruch, & Platt, 2014). The results of the present study also shed light on how groups of humorists may differ. A cheerful temperament is involved in the sense of humor and it goes along with high extraversion, emotional stability, agreeableness, and openness, and low conscientiousness (Ruch & Köhler, 1998). Compared to this, clowns are relatively similar with the exception that they are higher (and not lower) in conscientiousness. In particular, volunteers are high on both agreeableness and conscientiousness. Clowns thus seem to be very different though from the witty professionals and witty amateurs. Cartoonists (Pearson, 1983) and those able to provide funnier punch lines are high in P (Köhler & Ruch, 1996) and stand-up comedians are higher in schizotypy (Ando et al., 2014). Likewise, stand-up comedians in Greengross and Miller s (2009) study were significantly lower in both Conscientiousness and Agreeableness. High P is an indicator of low Agreeableness and low Conscientiousness, and here we can assume that witty people and clowns are on the opposite poles of the Psychoticism dimensions. However, clowns (in this study), comedians (Greengross, Martin, & Miller, 2012; Greengross & Miller, 2009), and witty people share higher openness to experience. In their study, Ruch and Köhler (1998) showed that the ability to produce witty punch lines goes along with high openness and low seriousness. The clowns in the present study were higher in Extraversion and lower in Neuroticism, which is again different from the witty. Comedians were lower in Extraversion (Ando et al., 2014; Greengross & Miller, 2009; Greengross et al., 2012). The results of this study showed that the sample of clown doctors examined possess specific personality characteristics in comparison to Italian non-clown population. Significant differences were found between volunteers and professionals. Although these findings shed light on a topic that previous authors have only addressed theoretically, some limitations to extending the findings to other clown doctors need to be acknowledged. The study was conducted on a sample of Italian clown doctors, and further research is needed to confirm these results for other cultures and nationalities. The relatively small sample of professional clown doctors further limits the findings, and replications on larger samples are required. A comparison was not possible with published normative data where study samples had been separated into subgroups by age and gender, which prevented verification of personality differences using these criteria. Future studies will include a control group, instead of comparing results with published data, in order to address this concern, as well as to investigate possible differences in personalities of clinic versus circus clowns. Finally, as personality is a complex phenomenon, further research should explore specific personality traits that can play a role in clinic clowning, such as narcissism and emotional intelligence. Narcissists support their self-image through feedback and admiration received from others (Atlas & Them, 2008), which may lead to feelings of

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7 A. Dionigi: Clown Doctor s Personality 55 Pendzik, S., & Raviv, A. (2011). Therapeutic clowning and drama therapy: A family resemblance. The Arts in Psychotherapy, 38, doi: /j.aip Ruch, W. (2008). Psychology of humor. In V. Raskin (Ed.), The primer of humor research (pp ). Berlin, Germany: Mouton de Gruyter. Ruch, W., & Köhler, G. (1998). A temperament approach to humor. In W. Ruch (Ed.), The sense of humor: Explorations of a personality characteristic (pp ). Berlin, Germany: Mouton de Gruyter. Steptoe, A., Malik, F., Pay, C., Pearson, P., Price, C., & Win, Z. (1995). The impact of stage fright on student actors. British Journal of Psychology, 86, doi: /j tb02544.x Ubbiali, A., Chiorri, C., Hampton, P., & Donati, D. (2013). Psychometric properties of the Italian adaptation of the Big Five Inventory (BFI). Bollettino di Psicologia Applicata, 266, Warren, B., & Spitzer, P. (2013). Smiles are everywhere: Integrating clown-play into healthcare practice. London, UK: Routledge. Date of acceptance: May 12, 2015 Published online: February 29, 2016 Alberto Dionigi Department of Education Cultural Heritage and Tourism University of Macerata Piazzale Luigi Bertelli (Contrada Vallebona) Macerata Italy Tel Fax alberto.dionigi@unimc.it