Background

Applied Theatre as developed by Boal (1979, 2000) and in the field of Theatre in Education (O’Toole 1977) and reviewed by Prentki and Preston (2009) has a history of stimulating social action. More recently, ethnodrama is a way to perform research on key social issues that engages diverse audiences both cognitively and emotionally ( Akroyd & O’Toole 2010). Within health and social care, this is an effective and innovative way to engage stakeholders in the complexities and dilemmas of difficult contested areas. It is performance that is artistic but also critical social pedagogy (Shor 1992).

This is part of an ongoing collaboration between us – an experienced theatre director (Bryanston) and an applied anthropologist working in the field of health research (Gillian Lewando Hundt). Each project has been developed from multidisciplinary research carried out by research teams of which Hundt was a member. Working within the Institute of Health at the University of Warwick has enabled us to utilise the findings from the primary qualitative research to develop applied theatre through ethnodrama. The first drew on understandings of stroke in South African rural villages (Stuttaford et al 2006), the second on the dilemmas and understandings of prenatal genetic screening of women and health professionals (Lewando Hundt et al 2011) and Passing On, funded by the Open-space Learning project ans Warwick’s Institute for Advanced Teaching and Learning, developed from a study of end of life care (Jackson et al 2010). The research data in this study consisted of semi structured interviews with health professionals and bereaved relatives of people who had died within 48 hours of admission to a hospital (Jackson et al 2010).

Performing research enables the dissemination and transfer of knowledge beyond the writing of books and papers as well as providing a rich teaching and learning resource in both live and e-learning contexts. The discussions which follow the performances, involving academics, health professionals and theatre practitioners, engage with ethical, conceptual and personal issues. A member of the audience said of our last collaboration.

It has come out of research but it is a piece of theatre and therefore it has a life of its own.

The work of David Bradby and David Williams (1988) puts forward the case for the theatre director as author of the performance as an ‘ecriture scénique’ and indeed the transformative work of the theatre director in taking research and developing it into theatre is in line with this approach.

The development of Passing On stemmed directly from the work undertaken by Bryanston in 2008-09 when she was awarded a CAPITAL Centre Fellowship to explore the potential for creating theatre for learning and social change on issues related to end of life care and death in hospital from this completed study. The Fellowship afforded time to research and develop a new play for performance based learning through drama workshops and collaboration with the Institute of Health and health professionals. This was a multi-disciplinary collaboration in which we explored and worked in a number of different ways but predominantly in the drama studio where we could begin to explore the social meaning given to actions and events enabling us to reflect iteratively and capture contemporary social discourses debates and dilemmas on end of life care and dying in hospital. Bryanston developed collaboration with playwright Mike Kenny and with Peter Glanville, the Artistic Director of Little Angel Theatre, since it was felt that a puppet could represent the dying person more effectively as a theatrical device.

The Open-space Learning project funded the playwright to complete a full script, working closely with Bryanston, and the Institute for Advanced Teaching and Learning funded two rehearsed readings of Passing On, each with a post-show panel discussion which took place on 7 June 2011at Warwick Arts Centre. The performed reading was filmed so that the recording can be edited into vignettes to become an e- teaching resource for medical and social work students and for health professional development and training, accompanied by notes for the facilitator and research findings.

The rehearsed reading of this verbatim piece was a narrative through the voices of selected interviewees testimonies performed by four Midlands based actors who spent three days rehearsing. This choice allowed the puppet to be incorporated into the reading and for small moments of exploration of the use of the puppet to represent the dying person to be shared with an audience.

The play is not gloomy: some is funny and some sad, but it is told with forensic detail by Joyce, the daughter of a dying woman, and her heroic husband Jim, with extraordinary insight and such courage of which they both seem unconscious. The narrative is interspersed with the voices and viewpoints of a number of health professionals covering a wide range of issues, ranging from the frustration of an oncologist who finds he is unable to talk about death with his patients but is trying to offer professional support; to the porter, who sees so much but generally whose voice is unheard, and is there right to the end when a body is removed from the ward to the mortuary.

The only thing that we can do …is that we can treat that patient… the deceased patient with as much respect as we would a living one……the way we move the patient…the way we treat them when we get down to the mortuary. There might not be anybody watching… but it’s in your mind….how you treat that patient. You know I couldn’t live with myself if I was to mistreat a deceased patient in any kind of way when you got them to the mortuary … it would be like slapping a living patient. (Porter)

Collaborations between arts and the academy are complex and time-consuming and issues arise which are unexpected, or contested. Some of the issues that arose in this ongoing collaboration are touched on here.

Use of Puppetry

The use of puppetry in the piece was an artistic decision. It was felt that a life-size puppet could be manipulated on stage, in and out of bed, in a way that was not possible with an actor and could be androgenous, representative and symbolic allowing the audience to use their imagination and engage in different ways.

 

The puppet was made by a free-lance puppeteer recommended by The Little Angel Theatre with whom Bryanston worked closely in the research and development phase. A mock-up version was used during the preliminary workshops.

 

It was crucial to involve the puppeteer from the early stages as the design and structure of the puppet was critical and the movement language of the puppet was agreed and shared. For example, Bryanston wanted to feature the hands as the hands become so important, being held continuously in the final hours by relatives and giving such comfort to both the dying and the carer at that time.

The audience evaluation showed that the puppet’s mere presence and the manner of its handling evoked considerable reaction. The two quotes below from members of the audience.

Cast did a super job of manipulating puppet. The process of live
actors making the inanimate become animate, while it retains a distance
and a symbolic quality.

Skeletal features, gender vagueness, wobbliness of head, seemed bit
smaller than life-sized (excellent decision that), greyness, blobby
legs - all these are very effective elements.

I remembered the feeling of moving my mother when she was very ill – the hands were incredible.

Ethics and Copyright

The original research had ethics approval from the NHS Research Ethics Committee and this requested consent for use of the material for educational purposes. Having discussed the main themes and issues from the research, the playwright decided to develop a script using verbatim text from a range of interviews. This was not expected and was a source of concern. We contacted the Chair of the Ethics Committee who felt that the consent, originally sought and given, covered this. However, in addition, we wrote to every interviewee in the original study, requesting their consent to use their words in a performed text and made adjustments to the text to ensure anonymity. Such theatre in recent years has been used particularly when working with real-life situations when the importance of authenticity and legitimacy are the most potent elements.

Producing the Text and Performance as a Collaborative Iterative Process

The research team met with Bryanston, who would direct the play, Mike Kenny, the playwright, and the Artistic Director of Little Angel Theatre to discuss summarised themes from the research. Discussions included not only the data but participants’ personal experiences. Bryanston then worked iteratively on the dramaturgy with Kenny and the first read-through involved two members of the research team, one of whom was a health professional, as well as the actors and the director. The final version of the script reflected feedback from the rehearsed reading from the audience, the advisory group, the research team and panel members.

The copyright of the play belongs to the playwright although the University of Warwick has the rights to utilise it for two years. These contractual arrangements, common in the world of theatre and intellectual property, do not reflect the negotiated complex collaboration between the research participants, the researchers and the theatre practitioners.

Audience and Panel Discussions

The audience for these rehearsed readings included medical and social work students, and health professionals as well as others interested in the topic and one research participant. The feedback was engaged and useful and the panel discussions engaged with the ambiguity of decision-making in end of life care. There was reflection on how the ways in which care is organised and delivered in nursing and residential homes, hospices, at home, in the community, by ambulance teams or in the hospital may be caring on the individual level, but occurs within organisational constraints that may not meet families’ preferences or needs. Experiences, choices, policies and their implementation in practice were discussed. There was also engagement with the use of the puppet, the artistic experience for the playwright and actors of delivering a verbatim piece of theatre in terms of giving voice.

This is an ongoing collaboration and funding permitting, the play will be performed at the Suspense Festival in London in November 2011. We are grateful to the Open-space Learning in Real World Contexts project and the Institute for Advanced Teaching and Learning for their support.

[Reviews of the performance at the Susapense Festival can be found here from The Stage and The British Theatre Guide.]

References

Akroyd J. and J. O’Toole (2010) Performing Research: Tensions and Tradeoffs of Ethnodrama, Stoke on Trent, Trentham Books

Boal, A. (1979 and 2000) Theater of the Oppressed , London, Pluto Press

Bradby, D. and D. Williams (1988) Directors’ Theatre, London, Macmillan

Jackson, J., J. Purkis, G. Lewando Hundt, L. Blaxter and L. Burnham (2010). Views of relatives, carers and staff on end of life care pathways. Emergency Nurse, 17;10: 22 -26.

Lewando Hundt, G., C. Bryanston, P. Lowe, S. Cross, J. Sandall, K. Spencer (2011) Inside ‘Inside View’: Reflections on stimulating debate and engagement through a multimedia theatre production on the dilemmas and issues of prenatal screening policy and practice. Health Expectations, 14;1:1-9

Prentki T. and S. Preston (2009) The Applied Theatre Reader, Oxford and New York, Routledge