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It’s ironic that Dr. Hunter “Patch” Adams became a household name through the 1998 Robin Williams film based on his life. That film is many things Adams is not: predictable, sappy, and apolitical.

Adams, 62, became famous within medical circles, and then to the rest of the world, as a doctor in clown’s clothing, a social activist who uses humor and his medical training to advocate for a more humane, affordable, and even playful health care system. Shortly after graduating from medical school in the early 1970s, he founded what would become the Gesundheit Institute, which started as a free medical practice operating out of his own home in Virginia. It has since evolved into a far-reaching and multi-faceted nonprofit; among its programs are “humanitarian clowning” trips, which Adams has lead for more than 20 years, taking people dressed in full clown costume to hospitals, orphanages, and prisons around the world. The institute’s ultimate goal is to open a 40-bed hospital in rural West Virginia that offers free, holistic care to anyone who wants it.

“We are committed to building a community that embodies to the extreme the philosophy that art, fun, and connectedness are as important to health as CAT scans and IVs,” writes Adams in Gesundheit!, the book that helped inspire the film Patch Adams.

Adams on a "humanitarian clowning" trip to Phnom Penh, Cambodia. © Italo Bertolosi

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“We want to act as a stimulus to others to create their own ideal medical community and to provide an example that others can follow, at least to some small degree.”

Adams has been raising money for the hospital for nearly three decades. In the meantime, he continues to lecture and lead workshops, often urging medical students to develop an ethic of care built on forming compassionate connections with their patients. His prescription for this kind of care relies on humor and play, which he sees as essential to physical and emotional health.

Now research is starting to back him up, with scientific studies suggesting laughter decreases stress hormones and boosts performance of the immune system. These findings validate ideas Adams has long tried to bring into the mainstream, medical school by medical school.

“When you think about all the medical students who know about him, or who he’s spoken to—he gives them a certain freedom when they go into practice and deal with people,” says Bernie Siegel, a best-selling author and former assistant professor of surgery at the Yale School of Medicine. “They carry his image with them. They may not be a Patch Adams, with the moustache or the hair or the outfit. But they still have a little bit of that playfulness within them.”

Adams recently spoke with Greater Good from his home in Virginia.

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Greater Good: People don’t usually identify a lack of play as a main flaw in our health care system. Why do you see play as so central to quality health care?

Patch Adams: I mean, it’s such a ‘duh’ question. Play is essential to life at all ages. It’s fun, it’s relaxation. It’s probably how we know somebody is alive.

GG: And why don’t we see play embraced by our medical system?

PA: Play diminishes rank. Hospitals are rank-oriented. It’s one of the problems of hospitals that there is a very powerful hierarchy of money and of power-over, and in those settings play is not possible—unless the boss is playing. Then you can play.

GG: And yet you’ve spent your career trying to inject play into medicine and health care. Why and how have you been able to do that?

PA: I was a kid. I was a kid playing, and I’ve never stopped. I’ve gotten in trouble all my life for being a fool, a player, a trickster, a buffoon. And fun was always the driving force—not only the personal fun, but if you like friendship, it’s probably the very center core of developing friendship.

I’ve never burnt out in anything I’ve done, and I know it’s because play is who I am from the moment I wake up to the moment I go to bed.

GG: So in your own experiences, what have you seen as some of the effects on others when you try to preserve play in medicine?

PA: The strongest thing that I do is that I take people on clown trips. I’ve taken people ages 8 to 88. Most people who come have never done any performing or any clowning. I’ve taken multimillionaires. I’ve taken people who think they are really dull. And I give them a bunch of clown clothes, and I take them places where people are suffering, and everyone becomes a player. And it’s usually instantaneous. In the airport before we get on the plane people start saying, “Wow, airports are a lot more fun if you’re playing.”

GG: And what kind of training do you give them beforehand?

PA: None. We want to show people that they can go from 0 to 100 miles an hour in less than a day. In over 20 years, three people didn’t work out. Everyone else dives right into it. They talk like it’s the best thing that ever happened in their life.

We’ve taken clowns into war, into refugee camps. I’ve been at 10,000 deathbeds as a clown. We start with simple things: Blowing up a balloon, blowing bubbles, having a puppet. But it isn’t long before they see that the world of play is a gigantic universe. One 70-year-old accountant waited 20 years to go, and he went last November and now he’s doing it again this year. Because it isn’t just about play, it’s about opening up your life and your being and your ability to connect with people.

You know, the 20th century is full of literature on alienation and meaninglessness, and play connects you instantly with anyone in the world, without language. Most people in this country have gone on a tight-ass trip, and maybe if they were young they connected with a few people. But huge sums of people go to a country and they never meet anybody.

Within the first day of one of these tours, they’ve hugged a hundred people from the country. I’ve taken CEOs of hospitals and chief surgeons. I make sure that these people get right next to people they wouldn’t dare ever stand next to. And then they see themselves laughing and enjoying it. Clowning is a trick to get love close.

GG: And for the people who are receiving this kind of care, what do you see from them? How do they respond in a way that may be different than the way you see other people respond in a typical hospital setting?

PA: You know, I should take an hour to answer your question. I go to hospitals that have no medicine. You see pain relief in people who haven’t had a second of pain relief in months. You see mothers laughing with their dying child. You see hospitals come alive, dancing in the hallways. Food fights! Life! How can anyone convince anybody that life occurred where there was not play?

GG: You mentioned before that with the way hospitals are structured, they don’t allow any room for play. I wonder whether you think it’s possible to rebuild a culture of play in society in general and in medical settings in particular.

PA: The problem is, everything is tied up in the love of money and power. So wherever you’re going to start—medical schools, or elementary schools, or kindergartens, or whatever—you’re going to need a rebellion toward teaching compassion and generosity. There’s not a single medical school in the world that teaches compassion. And we [The Gesundheit Institute] are very active with medical students trying to start a revolution. We’re very active with the American Medical Student Association and medical student associations all over the world. We try to make compassion and generosity the center core of what medicine is.

GG: Looking at the success you’ve had in getting your message out over the last 30-40 years, does that give you hope that we’re ready to find ways to bring more play into our lives? When you look at the last one or two generations of people going into medicine, do you see things changing at all, for better or worse?

PA: I know doctors and nurses that try to make things more playful, but their settings suck. I get a huge number of tear-stained letters from people who went into medicine to care, and then they see the bullshit. And yet I always tell them that, yes, if you buy into it, you will be sucked into it. But no one has to be that way. At any given time, a person can choose not to be a racist or a sexist, not to support the idea of bombing countries or polluting rivers. Anyone can choose in any given second to be a playful, loving person—every second, for the rest of their life.

All you have to do is decide. You can decide thoughtfully, intelligently. You can say, “God, I need more play,” and put a pair of tighty-whities on your head for a week—you know, an introductory course. It’s never too late.