Olivier-Hugues Terreault is preparing Brazilian society to be able to care for their growing elderly population. Through an innovative clowning therapy, he is equipping caregivers and seniors themselves with tools for communication, meanwhile his work with decision makers and the general population creates policies and social norms that will ensure seniors’ wellbeing in society.
A nova ideia
The growth of the elderly population is a global trend. However, families, civil society, and the government in Brazil are particularly ill-equipped to deal with this increase. To address the issue, Olivier-Hugues Terreault is preparing caregivers with the skills to better handle and care for seniors and is working with institutions to design inclusive policies that better address their needs. In Canada, he has successfully developed psychosocial programs in hospitals and elder homes to equip seniors with resilience and a offer a sense of belonging in those environments where they feel out of place, stressed, and anxious. Now, Olivier is spreading these techniques, based on a unique clowning therapy, to Brazil.
Clowning as a form of therapy is a fairly standard tool in pediatric care; however, Olivier’s technique for the elderly goes beyond mere entertainment for the patient. Through projects in both Canada and Brazil, Olivier has developed a method that builds the emotional well-being of the elderly. The clown, who is trained in relationship building, is able to connect with the patient without the usual social filters of health, social status, or age. Hyper-attuned to the actions and mood of the patient, the clown shows acceptance of the person and his or her emotions, meeting them where they are. In this way, the clown is able to address negative emotions and problems that are difficult or avoided in typical social interactions. By dealing with these issues in light manner, clowning offers the possibility of confronting sensitive topics in order to find a solution.
Through experiences during these interventions, Olivier’s comprehensive model intends, besides improving an individual’s quality of life, to transform the way society sees and relates to this population. For this, Olivier organizes trainings with families and health professionals who have difficulty dealing with this group. The trainings cover relational skills, empathy, and resilience-building and emphasize a more humane way of caring for the elderly. Based on his vast experiential learning as well as much research, Olivier is now turning to influence public and corporate policies. Not only does he aim to sensitize decision makers and the general population to the needs of the elderly, he also sees a society where they are valued contributors.
A growing elderly population is a global trend. In Brazil, the over 60 age group has increased by 41% in the last decade and, in 30 years, the proportion of the population considered elderly (over 60 years-old) will increase from 10 to 30 percent. Although this change will be felt across society, institutions in Brazil -- government, health professionals, and families -- are particularly unprepared, both structurally and economically.
What’s more, there is little dissemination of information on prevention, identification, and treatment of diseases related to aging. Forms of dementia, specifically Alzheimer's disease, is an especial source of fear and prejudice because it is not well understood by the general population. In Latin America, nearly 9% of the elderly exhibit some sort of dementia. There are approximately 1 million people living with dementia in Brazil, and this number is expected to double every 20 years.
Families and even health professionals often have difficulty communicating with the elderly, and those suffering from dementia are even harder to reach. This social isolation makes health treatments, which on their own are trying enough, even more stressful. The easiest solution usually is neglect, either inside the home or through institutionalization. However, rather than getting rid of the problem, this lack of attention ends up worsening existing conditions, and can cause further spiral into dementia and more rapid evolution of health issues.
In some countries, institutionalization of the elderly is common; however, in Brazil, seniors tend to remain at home with family. Despite this trend, few families are emotionally and psychologically equipped to deal with caring for their relatives as more complex health situations arise. Behavior change that may occur with age, and especially with dementia, it is difficult for family members to cope with. Families may have trouble accepting this new person and relating to them, and the expectation that the “old person” will return causes pain and communication problems on both sides. The current medical system also fails to address this issue, since it still has a focus on the quality of the patient’s health, rather than in their quality of life.
On a more macro scale, public and corporate policies in Brazil fall far short of dealing with the needs caused by an aging population. Due to the conception that the elderly are not economically productive, there is little interest and investment in the population – they are excluded by the labor market and isolated by cities. Furthermore, Brazil’s decision making process is characterized by strong vertical management and tends to exclude vulnerable populations, such as the elderly, in the decision making process. At Brazil’s corporate level, there is little managerial integration between seniors and youth. Because of the highly competitive environment, the seniors are typically left behind, sometimes kicked out or excluded from the labor market even before retirement age.
After years of direct research with institutionalized elderly and people with dementia in Canada, Olivier developed a clowning therapy methodology to work with this group. In Canada, through his NGO Jovia, Olivier’s interventions have directly benefited 16,000 seniors in long-term care centers, besides their families and health professionals in the cities of Quebec and Montreal. To give patients a sense of familiarity in the context of a place where they do not belong (nursing homes, hospitals), his approach was based on the discovery of the subjects and memories that could trigger a sense of life and resilience in the senior. Through cultural references, Olivier’s approach attempts to take the senior back to their youth, reminding them of happy times when they felt useful to society. Thus, the references in the clown/senior interaction, are based on the 1940s: the clown’s costume, perfume, vocabulary, songs, mannerisms and expressions, objects, and games.
Olivier created his new clown therapy method to specifically work with the elderly and elderly with dementia. To connect with this audience, the clown is not the figure of a physician, but represents a family member, who is presented with clothing and habits of an era familiar to the patient, thereby triggering good memories and sensations. Olivier’s intervention has several dimensions. Through memories, it individualizes the elderly, encouraging their emotional, social, and recreational skills. Its regularity interrupts their feelings of no longer being relevant to anyone. The creation of an atmosphere in which imagination and play are allowed decreases stress and anxiety.
Depending on the response of the elderly, Olivier uses different approaches and forms of communication, giving the senior the control of his or her universe. Depending on the patient’s level of dementia, the communication can be made through sounds, rhythms, or even by breath. Affectionate touch in a context where physical contact is only for basic healthcare is also essential in the process of breaking isolation. Olivier’s interventions are so happy and significant that patients with Alzheimer’s have shown to have memories of the clowns. Always seeking improvement, Olivier studies the best therapeutic clowning practices in the world, working and feeding his reflections in close collaboration with health professionals and professional clowns to improve his methodology.
One of the most important aspects of Olivier’s approach is the acceptance of the senior and his or her emotions as they are. Every patient is treated differently, according to what the patient feels. The clown then deals with the individual’s particular emotions in a fun, light way. One example is that Olivier visited an elderly woman whose family was ashamed of her, because since the onset of Alzheimer’s, her behavior had changed and she would spend the entire day insulting people and cursing. In working with her, Olivier accepted her emotions; instead of ignoring or reprimanding her for the insults, he absorbed them, even insulting her back -- and this is how they started to bond. He even developed an “insulting game” with creative rules; for example, they had to insult each other, but only using vegetable names. They had a lot of fun together and, the more fun she had, the more she was able to open up, and the insulting slowed and she began smiling and showing affection. Olivier then invited the family to participate -- to accept the person that was now there, to create a relationship with her, and to allow themselves to let go of the person they knew.
Through the interventions, Olivier is developing communication tools to bring the principles of empathy to the personal and professional relationships with seniors, creating a community of caring and understanding around them. To do this, he has developed lectures and an educational program to give all the actors that interact with the elderly tools to communicate with this group, especially those with dementia and Alzheimer’s. Treatment or just acceptance of the problem can be more effective if those who work with the elderly are able to relate to them as people and not only see them for their health problems. With the application of such simple tools for building quality relationships, Olivier transforms the lives of the elderly and their families, within the complex reality of a clinical condition that can weaken or even tear apart essential ties.
In Brazil, Olivier has spent a year researching the context of the elderly in the country, in order to to adapt his work in Canada to this reality, and founding the Teatro do Sopro (Theatre of Breath) organization. In terms of framework, Olivier has detected that for his intervention, unlike in Canada, Brazil requires work with the institutional ecosystem into which the elderly are inserted. With this insight, along with incubation and research support from the Center for Aging Research at the Vital Brazil Institute, Olivier outlined his plan of action in the country. Its focus is education, training, and influencing public and corporate policies. In the next two years, Olivier plans to train 2,000 people through lectures and education workshops, to impact more than 7,200 people directly and indirectly. With the support of researchers in the areas of health and aging, Olivier envisions his trainings to fill the gap between research on aging and its actual application in relating to the elderly.
Olivier also gives lectures to sensitize decision makers to the needs and the potential of the elderly, through the clowns’ experiences. His goal is to serve as a bridge between the public and private leaders and this population, bringing a fresh look to the issues around aging and influencing the creation of policies that take the population’s needs into account. Teatro do Sopro has established partnerships with companies such as Lilly and Fiocruz who, motivated by a talk given by Olivier, began thinking of ways to improve their policies with employees and this specific population.
Born in the outskirts of Montreal, Olivier became a professional dancer at the age of 15. In school, he earned a degree in dance and alternative theater. He founded and directed an alternative theater company for 7 years, in which his performances were always grounded in research and had the individual spectator at its center. As a practicing Buddhist since the age of 16 and a meditation teacher, Olivier deeply values and practices empathy and has applied many lessons from this philosophy, such as the acceptance of death and suffering. Buddhism has strongly influenced Olivier’s interest in therapeutic clowning, such as the idea of accepting vulnerability instead of perceiving it as a weakness or something negative. Thus, he created the NGO Jovia in Canada as a meaningful way to merge use artistic and entrepreneurial skills for social good.
Olivier has always been fascinated by the European clown universe. He discovered therapeutic clowning on a special public radio program and immediately understood the connection between the European clown, who never really fits in his environment, and the patient, who is not a part of his medical environment. Olivier also saw in the therapeutic clown the wandering monk figure from the Buddhist tales he had always admired, travelling with humor and lightheartedness to lift spirits with a provocative, funny, and empowering attitude.
Influenced by these figures, and with a penchant for risk-taking and gathering different people together, Olivier started practicing clowning therapy in pediatric hospitals. Then, a nursing home called him to do it with the elderly. He had never dealt with seniors in his life (his grandparents died when he was young), but Olivier accepted the challenge. Trying to see situations through the clown’s perspective of empathy and levity, Olivier started creating relational techniques to deal with this group. Always valuing academic research to support his actions, Olivier then formalized his methodology based on two pillars: research and empathy.
After his success in Canada, in 2011, Olivier moved to Brazil with his Brazilian wife. Since arriving, all of his energy has gone into discovering how to implement his initiative in the country. After a year and a half of research, making contacts, and testing pilots, Olivier has outlined his action strategy to transform the relationships of the elderly and society in Brazil and has no intention of returning to Canada.