Writings

TEACHING VOICE, published by Nick Hern Books, is now available from http://www.nickhernbooks.co.uk. This is a book to support drama facilitators, and all those working with young people through drama. It  has workshop plans, a programme for the facilitator themselves, and support and advice materials . here is the link to a blog post on my reasons for writing the book.

‘A voice for life’: Max Hafler on teaching voice to young people

Check out my list of writing, most particularly my plays, on my resume. If you have any interest in reading them then let me know.

The article below was published 18 months ago , and tells of one of my applied drama projects. I hope you find it interesting and useful!

 

Operating theatre: A theatre devising project with fourth-year medical students.
Max Hafler, National University of Ireland [first published in the Journal For Applied Arts and Health ]
Abstract
This article tells the story and explores the experiences of a group of fourth year medical students led by a theatre director/facilitator at the National University of Ireland Galway in 2012 to create a piece of theatre on a theme directly pertinent to their future careers. It considers the process and decisions made by the facilitator/director, the fine balance required between content and skills, between facilitation and direction, and through the development of the piece how participants opened themselves in a unique way to the power of emotional honesty, teamwork and reconnection to their commitment to heal.

Keywords
Drama facilitation
theatre
medicine
devising
Michael Chekhov
experiential learning

In our medical training we have to constantly work hard to learn endless amounts of knowledge.
As a medical student I have been programmed to learn facts and information. Our teaching is very scientific, as it probably has to be. We are not encouraged to be creative. (Extracts from participants’ journals)

Introduction
As an experienced theatre director and facilitator, when I was first approached to work dramatically with fourth year medical students at the National University of Ireland, Galway, my instincts were not to work primarily on theatre skills, but to involve the students creatively and to devise a piece of theatre based around the concept of healing. This piece was to be presented to the rest of their year, approximately seventy students, at the end of the final session. One might ask the question; of what practical value or relevance could such a project be to prospective doctors?

Medical training already uses drama role play to teach patient/doctor interaction and diagnosis. Additionally, many professions are discovering that theatre skills are immediately transferable: Voice, relaxation, body awareness and presentation skills, for example, are invaluable throughout a doctor’s career, and several of the students on this module wanted more time to develop these aspects of the work we did together. However, whilst these are valuable uses of drama within a non-drama setting, it was not my main focus. I wanted to involve the students in the transformative power of creativity for them better to understand themselves – and their role as potential health professionals – on an emotional and philosophical level. I wanted them to find these connections and express them. The theatre skills element of this module would have to be fed into the demands of the piece of theatre we were to create together using principally their writing, thoughts and feelings. I hoped that the creation and performance of this piece on the students’ future vocation would encourage them to think deeply about their relationship to their profession, and to the patients they would be treating.

I am a theatre teacher and director and have worked with a whole range of students, with professional and amateur actors, and with specific focus groups. I spent a period teaching in the theatre dept at Massachusetts Institute of Technology, on an arts programme for highly intelligent, high-achieving, engineering and science students. The policy at MIT was to give students an opportunity to explore the arts and develop artistically, emotionally and creatively. Artistic experience and expression were valued for themselves but, in addition, were also seen as a means of helping students to make a more creative and balanced contribution to their continuing development in science.

This module was to be a step in the dark, not only for those whose idea it was, but even more for the students themselves who, through their education, had been encouraged to write and experience in an intellectual rather than an emotional way, and for whom using their bodies expressively, initially felt awkward, childish and very exposing. They ultimately embraced the experience wholeheartedly with an extraordinary honesty and joy.

Doctors need emotional ‘muscle’ in some ways, like an actor. They need to be open, to be sensitive, but not in a way that will incapacitate them. Dramatically, this is explored in Michael Chekhov technique as ‘radiating and receiving’ energy, or working with an ideal centre of energy within the body. In everyday life, this kind of ‘opening’ is often perceived as weakness, especially by men when, in actual fact, it is a strength. I wanted them to have the experience of these physical principles.

I was convinced that to allow the students to create artistically, exploring the role of the doctor and what it feels like to be a patient, using material from their own lives, could give the students a platform to explore their own feelings about some of these areas. At the end of the module, a student told me that though they had had ethics lectures, no one had really opened up in this way before, though they had been encouraged to contribute.

Structure of module

Originally I planned to do four introductory workshops with interested students, before the three week window set down for the module. Due to curricula and practical constraints, the module had to fit into the three-week window with a set number of hours. This divided into ten three-hour sessions. Nonetheless I broke an important rubric for devising, that everyone must be present, to have an earlier introductory session with only half the group available. Some of the ten who had opted for the course were on placement in other counties. This half attendance created a problem later because the ground rules were not fully understood by everyone. As the project focused so vitally on the trust of the whole team, everyone ideally needed to start together. As this was a new project with non-performers, some of whom needed encouragement and reassurance, I thought that by enthusing half the group, the others would go along with the process. From this point of view, this proved to be an effective result of the introductory session

The introductory session

We were introduced to the inner energy of the body. Through a quick meditation we were able to access this latent energy. It was an empowering experience. It has complemented my existing ‘more scientific’ knowledge. (A participant’s journal)

I thought we would be doing lots of plays and a bit of speech work but it doesn’t seem like that at all!! I really don’t see how we will be able to put on anything too serious, considering none of us have any acting experience. (A participant’s journal)
A whole month before the project was due to start we had our introductory session, before their end of year exams. I was not happy about a meeting which had to take place so long before the project began but we had to work within the schedule. It is also important to know that throughout this module I had a faculty member who assisted me. This doctor had considerable acting experience, provided invaluable support and was often a useful bridge between myself and the students.

The aim was to set ground rules, relax the students, give them a feel of what they might be capable of and where we might be going. I likened creating a piece of theatre to team sport to which, since it was quite a sports-orientated group, some of them related.

The rules for devising and the ones I presented to the students in the introductory session were:
That all material was confidential and stayed within the group.
That all ideas were tried (as much as was possible).
That no mocking or denigrating of people’s ideas was permitted.
That no one dominated. [Although the director/facilitator might have to limit the material or be trusted with taste, this prerogative was not to be used indiscriminately].
That there was an understanding that some pieces might not be used but that each student would have opportunities to perform, and no one would be sidelined.

We began, as we were to do throughout the module with body and voice exercises, relaxation work, and group coordination and sensitivity; exercises which develop qualities which are important not only for acting, but for being.

The participants were perceptive and game. By the end of the workshop we had already begun exploring vocabulary for our final piece. Though not quite as alienated as the factory workers in Theatre of the Oppressed (Boal 1979), whose ‘conception of theatre will probably have been distorted by television, with its emphasis on sentimentality’, for most of the group, this work was completely new and challenging. I kept things light and allowed lots of giggling and embarrassment but warned them that it would have to ultimately be left behind. Encouraging people to feel and think with their bodies as well as their minds and to play creatively opens a lot of emotional doors, and giggling is a great way to dispel and sabotage intensity and emotional truth, and for a few of the participants this challenge was strong. This was a subject we returned to as a group, on more than one occasion. Devising a piece of theatre based on peoples’ experiences is a very far cry from being in a conventional play; it involves creativity on a deep level.

There were to be two important pieces of written work; first they were to produce a poem or other piece of writing about an experience they or someone close to them had had, as a patient . They would need to write something they would be comfortable reading out. These poems, stories or songs would be the starting point for our piece. As Dymphna Callery says in her book, Through the Body (2007), ‘Devising is really collaborative writing in the broadest sense of the word, “write”’.
The second piece would be an ongoing learning journal, about the journey they travelled in creating this work.

Sessions 1 and 2: The starting point

It was actually quite a unique experience as each person spoke of something which was quite personal to them. It was a difficult thing to do and again was something which made me think of the similarities between our vulnerability and that of any other patient. It also showed me the importance of respect and I really felt a new sense of admiration towards each person who had revealed something which was important and personal to them. (A participant’s journal)

All devising requires a starting point. Sometimes it begins with a concept, with movement, scenes or a song. I had chosen to ask participants to take a more literary route to begin with, to make the process less threatening .The physical and dramatic language was both little known to them, and more than a little disturbing. I asked them to write a poem or story because I thought they might be more honest. After all they would have had to do some creative writing at school at least, and the act of writing is in itself, private. This proved to be a very effective approach. After all, the goal of the project was to utilize theatre as ‘a way of understanding, exploring, representing, responding to, sharing, questioning, reimagining, debating the world as it is, and as it might be …’ (Neelands 2007–2008).

I told the students we would not necessarily use the pieces of writing as they appeared but perhaps develop some of them into scenes, or songs. As it was, only one of the pieces did not ‘fit’ into the puzzle and that person wrote something else and was in several of the scenes. One story became a powerful scene about a medical student meeting an old school friend who was a patient in a psychiatric facility whilst he was on placement in the same hospital. Another became a piece of choral speaking; another, which began as a poem, became a piece of revealing narrative on childhood trauma in hospital.

When devising, there is always a time limit, and the facilitator needs to decide his or her goals. In the module, I did not initially focus on the quality of the written material, other than it had to be as honest and truthful as the student could manage. As they remarked in their learning journals, they were overwhelmed by the honesty and frankness of the stories and poems that were told. As they listened to each other’s work, they started to get a sense of what they wanted to say, and several of them developed their work, often unprompted. One poem about a child’s asthma attack began as a mediocre rhyme, and was rewritten by the participant into an incredibly powerful piece. Later, issues of quality and of writing emotionally and creatively, rather than in a scientific factual way, became part of the process, as I gained their trust and worked for short periods one to one on phrases and modes of expression.

We discussed the architecture of the hospital; squares, sharp angles and corridors, and someone remarked how their experience of the hospital environment is everyday, and totally unlike the experience of the patient. It is as if they are operating in two parallel worlds.

Session 3: The creative frame, making material and an injection of humour

… this was something which would be beneficial to us as doctors as we were putting ourselves in a vulnerable position similar to that of a patient’s position in hospital. (A participant’s journal)

When the students arrived, I had marked out a rectangular space surrounded by corridors with white tape and chairs. It immediately had the feeling of a waiting room. I wanted to place the poems in the ‘waiting room’ environment. The deviser needs to create some kind of frame in which the students can create. The frame needs to be flexible, but it needs to be there. With limited time, this is to me, crucial. This creative frame involves both the actual space within which the performers work, and the shaping of the material they create.

A number of the poems were about waiting in the Accident and Emergency department, and one particularly struck the group as powerful. I split the text of the poem between different students and we made a piece of choral speaking as desperate people waited to be seen. I remember remarking about how much waiting there is when one is ill.

It is important to revisit here the objectives of the project and the time frame in which it was constrained, lest I be thought too directorial in my approach on occasions. To begin with, our contact time was very limited and I gave the students much more say on structure once they became comfortable with the process, and their theatrical vocabulary developed. Also, whilst the primary objective was to open the students and explore their feeling and thinking around their relationship to their oncoming careers, and to develop some of the skills they may find along the way, something else was important to them. At the end of the process, the theatre was to be full of their friends and peer group to watch their ‘show’. I have always believed that it is important that inexperienced participants are not just thrown onto the stage, and they can present as professionally and effectively as possible. I feel it is part of my role to make what they create as effective as possible, so they and their audiences can be proud. They are far more likely, in my opinion to take what they have learned and experienced into their lives, if they are truly excited by the result. This is a difficult balancing act which I am sure all devisers with inexperienced actors recognize.

We began to develop a strong sequence where a confused and disturbed patient was admitted to hospital. The movement precision required to perform this sequence was something we returned to again and again with exercises and group awareness work.

However, neither they nor I wanted the whole piece to be grim and serious. In the first session, we had discussed what situations they might like to dramatize from their lives as medical students. I knew they would have fun with this. They created two scenes which ended up in the final piece; medical students on the rounds with an authoritarian consultant and the other, a student against the clock at an Objective Structured Clinical Examination. They created these scenes in a basic way, but with enough skill for us to see how the scenes might work. As with the written pieces, I did not focus overmuch on developing their skills at this point; that came later.

Whilst the morale and teamwork was good on the whole, the arrival of a new student who had missed the first two sessions, turned out to be quite disruptive. Students were being asked to use their voices and bodies in new ways, become less self-conscious, to think ‘out of the box’ and produce material based on challenging real-life situations. But the work was completely new to him, so he was nervous, and he frequently disrupted the class by giggling or sabotaging with an inappropriate remark. This then excited the others, especially one or two of the other male students who were only just settling down, and so they indulged in it too. Together we went some way to tackling what I felt was disruption due to his own emotional discomfort and he did contribute a moving poem. One of the greatest gifts that working with theatre allows is the permission to explore the concept of emotional honesty. In his journal he spoke quite movingly about it.

This module has brought me back to my ideas on how I pictured my life as a doctor. Given the years that have passed in the meantime, I have seen a lot more of the world, in Medicine and outside. It was refreshing to have these thoughts brought back to me and it really helps me in my approach to my professional life now and in the years ahead. (A participant’s journal)

Session 4: Getting into shape and an angry moment
In this session I tried to put our current material into some kind of shape and pushed them quite hard. Whilst there was some good work done, it was the day we experimented with things we later left behind. This always occurs in devising. You always create more material than you will use.

We started very constructively. We created the ‘overture’ to our piece, with the whole cast playing anxious, despairing patients, crying out for attention, looking for doctors, which rose to a crescendo. It was raw and powerful. Then when the panic rose to a crescendo, we changed the scene to a lecture about The Role of the Doctor, in which they demonstrated to their audience the various roles, the doctor might inhabit. They came up with a variety of possibilities, such as The detective, the businessman, the scientist, the carer, the wise one, and most amusingly, the emotional sponge. This part of the presentation was light and amusing, but emerged from a serious exercise and discussion.

This came about by using material from a discussion in session 1 in which we had explored a number of archetypes around the idea of the doctor. Physicalizing Archetypes is a powerful acting tool in Michael Chekhov Acting Technique. ‘There are no things without an archetype… there are so many fathers in the world but there is still the father’ (1983: 67). In considering their future careers, it was very useful to consider the archetype of the Doctor in all its guises, exploring it physically, creating powerful statues, and ‘radiating’ them into the room. (e.g. Chekhov: On the Technique of Acting (1991), New York, HarperCollins). When we created these in an exercise, we examined and discussed each Archetypal Statue as if in a museum.

This ‘Overture’ prepared the students, and later on, the audience, for the fact that actors can create either something very serious or very funny, and have the power to change the atmosphere and mood in a moment.

In working on new material that day, there was a desire to focus on the good things about being a doctor and the students offered saving lives and curing people. I asked them to make a realistic scene around their ideas, and got some stereotypical insincere pieces I would liken to a bad episode of a television hospital drama. I feared that this might happen, but the students wanted to try it. They were rather surprised both scenes reduced them to giggles. For inexperienced actors, I have found it is often incredibly challenging to address serious issues in a naturalistic way, though the participants’ instincts tell them they could do it easily, because they feel familiar with it. Sometimes a more stylized poetic approach can be deeper. We worked with a freeze-frame scenario, slowly moving from one tableau to another, and this was far more successful.

By this time, participants were really starting to relax and take risks. However, when a student whilst trying his best to do something intense and serious, was undermined and ridiculed by another, I got angry. The disruptive participant was the one who had missed a number of sessions, so quoting the ground rules was of limited use, and he found it very hard indeed to change this behaviour in a group. When you open up a person to dramatic involvement, the level of challenge this can present can be extreme. It’s an illogical and emotional response, whatever their educational background, and playground behaviour took over occasionally with a few of the others, when the work got intense. I realised I had to rethink my strategy. One of this project’s crucial goals was to help develop teamwork and emotional maturity, both of which they would need in abundance in their future profession. I resolved to give more breaks, and try and stop people getting too hyperactive.

I have learned a lot about myself and about my fellow class mates. I learned the importance of good team work when you are working together on a common goal. This will help me work in the multi-disciplinary environment that is medicine. (A participant’s journal)

Session 5: Honesty and listening
After the previous session, I decided not to start with the warm up, but to work more slowly, beginning with a conversation about how they were coping with this revealing and challenging process of making a piece of theatre. I remembered my intentions for the project. I felt I needed to slow down and be calm. I considered again the time constraints, and the emerging anxiety for them of their ‘performance’.

I brought a sheet in of the running order of poems and scenes thus far. I had separated the proposed final presentation into movements, like a piece of music. Written down, it all seemed to have a reality for the students and a feeling we were making something together. I started to get a sense that they were all seeing the value of the work, and we strongly reconnected.

The discussion was powerful. Some new poems were produced, a number of which had arrived unsolicited. Everyone was struck by the honesty and sincerity of the work. The student who earlier had found the work difficult brought in a disarmingly simple but deep poem. The student who had written the poem about asthma brought another draft; radically different, more mature. (She eventually spoke this whilst another student acted out an asthma attack, which was very effective).

One student wrote a poem about an early hospital experience. I encouraged him to just tell us the story using his own words, and he did so very beautifully, with an incredible intensity. The whole room went silent. I asked if he would mind very much telling us the story like that in the piece, and setting aside his poem; he agreed.

For me this was a very successful session, and as important as the performance itself. There was a realization in this session that everyone might be able to go deeper than they thought and it was as if a breath of fresh air found its way into the theatre. There was a real sharing around their lives and work, which the whole group recognized. Furthermore, I felt that by changing my strategy, I had got closer to the group and they to me.

I also felt a remarkable energy which I was able to transmit around the group. It was a captivating experience, not just for me but also for everyone who was listening. The power of emotional honesty was something I had never considered before. (A participant’s journal)
Sessions 6–10: Short scenes and the ending
I am going to try to write a piece on my childbirth, which will fit in with the imagery of Irene with her baby, which is still in the concept stage. Hopefully I can make it workable. … my childbirth was uneventful and I don’t have any significant memories of it other than holding my baby for the first time and the day we left to go home on my daughter’s first journey. They were wonderful experiences. Let’s start there. (A participant’s journal)

These sessions, running up to the performance, involved warm-ups, consolidation and some skills teaching, both in staging and writing. There were run-throughs, and working carefully through the transition or sequence from one scene to the next. In addition, I was able to see individuals and smaller groups about specific pieces of the work that I felt would benefit. They really enjoyed working on these skill aspects, and working with me in smaller groups. Our powerful waiting room sequence, which involved the students speaking their poems and stories individually, really benefitted from more personal attention. We worked on the ending. The student whose song had not been included in the mix wrote a short poem about bringing her newborn baby home for the first time. This, I suggested, might be our ending. It was sincere, and contained something positive we were all trying to say. Another student played the woman with the child, and said ‘thank you’.

The last two sessions involved a certain nervousness, and in these final hours, the bonding in the group became much stronger. There is something about performing in this kind of work where the whole cast’s reliance on each other evokes a fiercely strong team spirit. They informed me most of their year was coming (around 65 students) and the little theatre would be full. They were afraid of the reaction they might receive.

When they came into the theatre after a break on the day of the performance, and the stage lights were on, they became very excited. Some of the voice exercises I had taught them through the module were actually being used in the dressing room. The lighting was simple but effective, and the students nervously awaited their audience.

The performance

It wasn’t long until we began the show and suddenly I felt all my anxiety diminish. I was really enjoying it. It was a feeling that words cannot describe, a sort of exhilaration that only something like this could provide. (A participant’s journal)

The performance lasted 25 minutes, and was attended as promised by about 65 students and staff members. The participants had written or devised nearly all the material. I as director had contributed my own ideas and shaped it, but most of it belonged wholly to them. We had prepared it in 32 hours of contact time.

What I had not bargained for was the generosity, and genuine wonder of the audience, as they watched their classmates reveal sides of themselves they perhaps did not know existed. I felt very strongly that the students who had devised the piece were speaking to a large extent for their classmates, their audience. This is what I believe to be the whole purpose of theatre; that we may express and further share our experience with others. The performing students achieved an intense team spirit and had explored, emotionally and intellectually, aspects of themselves that had direct relation to their chosen vocation.

One student’s piece, which though very short, concerned Asclepius. In his journal he explained why he had written it:

I really like the idea of healing and various forms of healing being ancient. Medicine today is very technological and modern; however, we tend to forget that people have been trying to heal the ill since the beginning of time almost. It’s for this reason that I included a reference to the Greeks and Asclepius. I hope that this was understood by the audience during our performance. If not, it might stimulate them to look up Asclepius and gain a greater understanding of the origin of our vocation. Who knows? (a participant’s journal)

Conclusion
Through participating in this module of experiential learning, students developed an emotional honesty with themselves and each other, thought and wrote about their profession, had fun, learned physical discipline, discussed ethics, developed confidence, developed teamwork, and touched on performing and relaxation skills. It was a wholly appropriate mode of development for young doctors. Much of the experience was later written up in the students’ learning journals, which they kindly allowed me to use in this article.

References
Boal, Augusto (1979), Theatre of the Oppressed, London: Pluto Press. pp 103 – 107

Callery, Dymphna (2007), Through the Body, London: NHB/Routledge. pp 159 -166

Chekhov, Michael (1983), ‘Chekhov on acting, a collection of unpublished materials (1919–1942)’, The Drama Review, 27:3, pp. 46–83.

____ (1991), On the Technique of Acting, New York: HarperCollins. pp 114 – 117

Neelands, Jonothan, ‘Essentially Youth Theatre’, Youth Drama Ireland, No. 10. (2007–2008) pp13 -16

 

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