Another webpage supplement to

Chapter 10: Theatre in Education:
Theatre for Health

Jessica Alexander

Posted, September 17, 2006

Another type of Theatre in Education has become more widely used to promote mental and physical health. Some of the troupes so generated are composed of relatively untrained players, others have varying degrees of acting experience. Many are organized by general social agencies in order to provide a form of preventive care. Colleges, universities, health care providers, and even programs in high schools are also the sites for theatre troupe organization and funding.

The focus is often on mental health issues, including life style problems, accessing supportive services, and re-entering community programs, clubs, and the like. Sometimes the drama programs address the problems associated with medical conditions–AIDS, hepatitis, sexually transmitted diseases, arthritis, lung disease secondary to smoking, mining, or other inhalants, diabetes, obesity, or life threatening conditions such as cancer. The goal is to affect life style, provide group support, challenge stigma.

Drama is used because it is more engaging and vivid than lectures, hand-outs, pamphlets, and the like. It brings out the mixed feelings of people who are struggling with health issues, such as whether or not to actually take the medication prescribed–the technical term by doctors is “patient compliance”–; how to reach and talk with the prescribing physician about side effects and the need to change the dosage or medication; explanations to family members and evoking support rather than non-constructive criticism; and other intangible elements that make medical care an art and not merely a technology.

Such programs can vary in quality, because the challenge is to address complex and often emotionally loaded situations without being patronizing or simply using the skits to lecture the audience.The plays themselves should not overly simplify the problems in the desire to deliver some pat bit of propaganda. The situations involved are in fact often ambiguous, and good theatre will bring out these dilemmas. That makes it more real and increases the audience’s identification with the roles being portrayed. The plays need to be crafted so as to engage the audience and encourage them to understand the cause and consequences of various life style choices. Some troupes just present their skits and then others engage in discussion among those who were in the audience. Others invite audience members to question the actors “in role” as to why they responded or made the decisions they did in the play.

Adapting the Drama to the Community

The directors of a health players group need to assess the needs of the community, and when exploring doing a program with some group, part of the art involves a process of interviewing and negotiating with the contracting organization. Planning should take age, gender, socio-economic status, cultural backgrounds, language proficiency, and the degree of cultural and language mixing in the anticipated audience. The play designed and created for this audience should, in general, mirror the demographic qualities of the audience.

In constructing a troupe, the actors’ other roles need to be considered. How much time must they devote to work or studies aside from their participation in the program? How far must they commute to get to the site of rehearsals or to travel to other sites? Are the students more mixed in their background or more homogenous? How comfortable are they with dealing with issues related to cultural diversity? Something as innocuous as the sponsoring university’s or community’s prestige may be a contributing factor to the type of theatre work created. Does the community there have a prevailing political ideology? What agency, school, or community policy or sensitivity might affect how the material is created?

For example, in a high school with a policy toward sex education in which the only option that could be discussed is abstinence, a teacher who wanted to create a theatre troupe with her high school students were stymied: The students desperately wanted to examine and explore sexual concerns yet the school policies prevented anything substantial being explored in this arena. To challenge this conundrum, the teacher created a theatre piece to be performed only for school administrators, who found her approach non-threatening, engaging, and likely to encourage dialogue among students, teachers in parents in a productive way.

At the University of Michigan, two theatre for health troupes, “Talk to Us,” and “Res Rep” (Res for Resident), both founded by Scott Weissman, use their programs either in a classroom or more presentational context to examine social and health-related issues for undergraduate students. The Talk To Us troupe offers a more intimate approach for students to dialoging about issues, in classrooms and smaller venues, allowing for more interaction among players and audience; the Res. Rep troupe performed for larger audiences, in a more presentational format.

The students in the troupes may come from not only theatre, but also from fields such as public health or other health-oriented departments, students involved in student affairs, students in education who are learning how to teach peer-mediation and social and emotional skills, and so forth. Depending on funding sources, some students may receive stipends or even hourly wages; others may be granted academic course credits.

Many college and university programs that offer theatre for health programs are housed in university health systems or medical facilities. Some receive their funds from their academic institution, often with some need for a grant. These funds support the director, and often pay stipends to the actor-educators.

Content

The issues associated with health makes for powerful theatrical content. The challenge is to artfully integrate information and address the various attitudes associated with different issues in an engaging fashion. The key is to find the drama, the tension within the subject or issue. Drama comes from the Greek word, Drao, meaning I DO and I struggle. More general topics are sometimes better than very specific ones, so that a piece that looks at eating disorders may offer more dramatic potential than one specific type, such as anorexia nervosa. Also, the personal experience of those who have gone through a condition, the story, the everyday observations, are more compelling, and relevant research or facts need to be inserted indirectly. An audience will connect to the personal over the scientific.

For example, considering a program for addressing the pervasive problem of eating disorders, a troupe, who often act as co-playwrights along with the director, will explore the boundaries of the topic. Since denial is a key dimension in health issues, one element will note the problem of definition–what is or is not an “eating disorder.” Another dimension notes the power of friends, family, and the general culture as channeled through various media, such as women’s magazines. The art lies in not presenting answers, but rather approaches to engaging these questions. Although there is a hidden agenda oriented towards health, interactive theatre must not be “preachy,” and it is better to encourage the audience to question problematic behaviors.
Since health issues are often interrelated, other themes may be mixed in, such as the dynamics of denial. For example, eating disorders are often associated with sexual problems.

Other common themes for presentation, depending on the community’s need, include date rape, violence in relationships, hazing, binge drinking, violence or harassment of gays and lesbians, and stress management. For middle-schools, common themes include bullying, smoking, drinking, and struggles with bodily changes and social cliques.

Methods

The enactments range from being heavily scripted to fully-improvised, and these in turn are associated with a variable degree of interactivity with the audience. Our approaches have included influences by theatre artists such as Brecht, Boal, Rohd, Spolin, Weigler (playmaking) and a range of art forms in addition to improvisation, including storytelling.

Improvisation may be used not only in performance, but also in the early stages of creation, when working out of a fully or partly scripted piece. Improvisation can help to discover what language sounds most natural, rather than forced, didactic, pompous, or manipulative. Improvising helps to build belief between audience and player. For example, since campus culture creates a context for personal experimentation, any challenge to excessive drinking can evoke defensiveness; the art involves engaging the people without arousing resistance.

Scenes can be partly loosely scripted and partly improvised, which opens the process more to audience/player interaction. This approach also can provide more depth to the situation or character being presented, and foster the questioning or reflection of a character’s choices or a situation.

After the performance, troupes may use the technique of “hot-seating”: One of the players, “in role!” stands or sits on a stool and improvises responses to questions put by the audience. Another technique is “situation rewind or repeat,” (used in role playing or Boal’s Forum theatre), which allows audience members to enter the scene at a certain point and show how they would handle a given predicament, thus giving them a stake in the scene’s outcome. Alternatively, the audience makes suggestions which are then enacted improvisationally by the actors.

Selection and Training

At Eastern Michigan University, the author directs “CloseUP,” a troupe of about twelve undergraduate students. While most have had some theatrical experience, they aren’t theatre majors. Some received academic credit and others honorariums. In choosing the cast for various programs, the directors and current troupe members collectively decide on who to add to the ensemble. Our criteria include as considerations, such variables as cultural background, age, gender, race, and other elements of diversity, so as to be able to approach the widest range of groups. We have sought players who could work in ensemble, and had the interpersonal skills for this approach. Improvisational players need to show initiative, a capacity for risk-taking, presence, and a capacity to perform beyond the obvious. Other desirable qualities include a capacity for self-awareness, a willingness to be vulnerable, critical thinking, and awareness of his or her own stories to tell. While there is little specific actual “theatre” training required or provided for these troupe members, a director who understands theatre arts increases program success.
While not having to major in theatre arts, it’s important that performers receive some training in improvisation prior to devising and/or performing work.

There are many rules to successful improvisation foremost: (1) give and take; (2) accept what is offered (players who are new to improvisation often reject or negate what is ‘given’ to them in a situation); (3) simplify, simplify; though health information and messages are often complex, characterizations and situations should be simplistic in nature; and (4) listen; there is a distinction between listening and hearing. In order to improvise one must listen, which requires one to ‘be in the moment’ and not in anticipation of the next moment.

In addition to the types of interactivity mentioned previously, various troupes may vary how this is ued, depending on the size and quality of the audience. Perhaps the process will simply involve a post-show discussion, and this, too needs to be anticipated: Will the audience remain as a single large group or be broken down into smaller groups? Will these groups need moderators? Will the ideas generated in the small group be brought back into the large group in sharing? Who will facilitate the discussions? Will there be teachers or other staff members other than the actors involved? Perhaps the most important variable is the time allocated to the entire program.

In some programs, a single enactment can be followed by small group discussions for an hour or more, depending on the preparation of the group. Younger students also need time for processing, but not all at once and not for as long.

Other programs invite interactivity during the program, allowing the script to shift depending on questions, suggestions, and confrontations. Audiences which number forty or less often use a higher degree of interaction. When there are more than forty people, discussion rather than interactivity is more common. (?)Also, for smaller groups the process can often be conducted more like a workshop, with some preparation of the whole group, including action warm-ups for the “audience,” as well as continued role play after the main presentation.

Examples

I direct the CloseUP Theatre Troupe at Eastern Michigan University as a collaborative program between the University Health service–where the troupe has its main base--and Department of Communication and Theatre Arts. Our aim is also peer education, with our primary focus on serving our own and neighboring university and college communities. The troupe is made up of 10-12 students with various academic interests with some degree of theatrical skill, though prior theatrical training is not a requirement. Our audiences range in size from 50 (a conference presentation) to 1500 (New Student Orientation). Our venues include residence halls and communcal spaces, which we transform into theatrical venues with traveling lights and multi-media projection. Our productions are more formal in that we employ several theatrical conventions yet maintain a degree of informality by including pre and post show audience discussion.

In contrast to some of the other programs, CloseUP bases a majority of our content on the concept of wellness, and the desire for balance. We use a conceptual diagram, “The Wellness Wheel,” which provides a catalyst for our theatrical productions. This diagram has several spokes: mental, physical, financial, family, social, career and spiritual, and we weave and integrate these spokes in designing our productions. The following describe some of our productions:

Fragile: This Side UP focused on touchy issues including masturbation, difficulties disengaging from power struggles–even minor ones, subtle forms of emotional abuse, and problems in being emotionally expressive with male friends.

Another production, The Examined Life: the Good, the Bad and the Ugly, applies Socrates’ dictum that an unexamined life is not worth living. Issues and subject examined here included: the first trip to the gynecologist; alcohol use and denial in the face of consequences, such as being hung over or missing an employment interview; and negative body image.

CloseUP productions do not employ a Boal method of interaction but offer other areas or arenas for audience input. A CloseUP show is a collage of various scenes or vignettes about a range of wellness issues. These pieces often finish with a question posed to the audience, which then serves as the basis for the post-performance dialogue. When our audience size is less than 200, we work with the whole group, but when it’s larger, we arrange for the group to be broken down into smaller groups that are then facilitated by trained students, faculty, or staff members.

Western Michigan University’s Theatre for Community Health Program employs college students in two touring productions: No More Lies and Great Expectations. Student participating are required to have maintained a B average, and class credit is offered. The ensembles in each production fluctuate from semester to semester, though some students participate at longer intervals. Participants receive training in both peer education strategies and workshops in content areas such as alcohol use and sexual health.

The Corner Health Center in Ypsilanti, Michigan houses a theater outreach troupe composed of teenagers (13-19), dedicated to presenting both workshops and performances for upper-elementary through high school age audiences. Since most performing occurs during schools hours, participants must arrange their course schedules as well as receive parental approval for participation. The Corner health holds auditions on a yearly basis. ManyIndividuals remain in the troupe for years (This may have some similarity to the other teen programs described in Chapters 6 & 25 in the book).

The Western Michigan University Theatre for Community Health mentioned above is based in its university health service and employs a full-time theatre director. Two productions are given special support: One focuses on alcohol and other drugs, and the other, focusing on sexual health is called Great Sexpectations. This program consists of approximately ten vignettes, each with different characters, settings, scenarios. The theatrical art is in the style, designed to support the content. Scenes may take various forms: a game show, overlapping soliloquies, realistic scenarios, news flashes, dance/movement-based sequences and expressionistic tableaus.

One of the most effective scenes within this program is titled “In Our Blood,” and opens on a heterosexual couple who rise up from behind a blanket (held up vertically facing the audience) kissing. The male says that he wants to slow down and make sure they are being safe, though the female’s hormone’s are raging, she accepts his offer to discuss their sexual past, making sure there is no chance of contracting any infections. As these two recount the people they have had unprotected sex with (i.e., intercourse without a condom), their past partners begin to pop up behind the blanket, effectively joining them in bed. Throughout the scene, these past partners also go on about their previous partners, revealing a variety of heterosexual, homosexual and bisexual encounters, thus illustrating how easily diseases can be passed through unprotected sex. After the entire production, the actors and director of Great Sexpectations interacts with the audience, posing questions based upon scene content.

Theatre for Community Health’s other production, No More Lies, uses a Boal-Forum approach in focusing on alcohol use and abuse, relying on audience interaction and feedback to further the scene and bring to the front truths and fictions regarding alcohol use.

Some audiences attend these programs as a required part of a class, while others attend on a voluntary basis, such as one provided by a residence hall. Of course, the more voluntary the group the more engaged they tend to be.

The actors in the troupe generally serve for a year or less, as part of their own undergraduate training. They are called “peer educators” and receive training in other peer education approaches, health content as well as interactive and educational theatre. Students participating are required to have a 3.0 GPA, can participate for academic credit and receive monetary stipends for participating.

Mentality, Inc., in Ann Arbor, Michigan, addresses mental health issues. Not only are issues related to stigma, rehabilitation, family issues, and the problems of working with the health care system addressed, but there are some programs that aim at primary prevention, before anyone has developed a diagnosable disorder. They use a Boal-like process (as discussed in the chapter on Theatre of the Oppressed).

The Kaiser-Permanente health care system in Michigan and perhaps elsewhere hires young- looking professional actors to perform in their programs.

Conclusions

Overall, several programs/groups employ a variety of methods and approaches in using theatre for health from the very informal (Mentali ty, Inc. to the more formal (CloseUP). The important aspect to recognize is in being aware of your community and resources as well as your group’s mission. Mentality is quite clear in stating that they are not in the business of producing theatre, but using theatre as tool . CloseUP on the other hand lists as one of its goals the creation of a strong aesthetic product with the belief that a good theatre can be educational and that good theatre will increase audience identification, attendance and interest in the program.
www.mentality.org Using Forum Theatre for Mental Health Issues.