Lights, Camera, Education! the Potentials of Forum Theatre in a Learning Disability Nursing

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Lights, camera, education! The potentials of forum

theatre in a learning disability nursing program

Alex McClimens a,*, Rachel Scott b

a Department of Mental Health and Learning Disability Nursing, University of Sheffield,

Rotherham S63 7ER, United Kingdomb Dead Earnest Theatre Company, Sheffield, United Kingdom

Accepted 21 April 2006

Summary Learning disability nurse education, with a current emphasis on inclusivepractice and a history of listening to the person with the disability, is well placed totake advantage of more experimental forms of classroom teaching. In this articlewe argue for the use of forum theatre as a method of addressing topics from practicewithin an educational setting. Based on our emergent and exploratory work with stu-dents we detail at length the theoretical background that supports such an approachandcontextualisethe issueswithreference toa short piece ofdramawe have used suc-cessfully with different student groups. We feel that the success of this method is dueto theinvolvementof students in directing their own educationas well as the inclusionof individuals labelled with learning disability as an integral part of the process.

c 2006 Elsevier Ltd. All rights reserved.

KEYWORDSReflection;Education;Drama/theatre;Learning disability;Nursing

. . .all theatre is necessarily political, because allthe activities of man are political and theatre isone of them.

Augusto Boal, 1979

Introduction

Foucault asserts that

any system of education is a political way of main-taining or modifying the appropriation of dis-

courses, along with the knowledge and powerswhich they carry(1981: p. 64).

Hence, anyone who stands before a group of stu-dents to deliver a lecture or tutorial is engaged in apolitical act as surely as if they had registered their

vote. Likewise anyone who cares for another hu-man being is also involved in politics because suchactions invoke power relations. When we bring to-gether the two domains of nursing and educationthe political is personal. With the addition of thecontested concept of learning disability the per-sonal becomes political.

In this article, we will draw on our experiencederived from a small pilot study aimed at realising

0260-6917/$ - see front matter c 2006 Elsevier Ltd. All rights reserved.doi:10.1016/j.nedt.2006.04.009

* Corresponding author. Tel.: +44 112 222 9665.E-mail address:[email protected](A. McClimens).

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the potential of using forum theatre in teachingsessions. The students were in their first year ofa pre-registration learning disability nursing pro-gram. We found that drama appears to bring to-gether many elements considered to be essentialfor a successful teaching and learning experience.The work, and student feedback confirms this,

suggests that learning is enhanced when a moreproactive approach to topics is taken. Studentsare more engaged, more inclined to participateand more likely to remember. In short, studentslearn better.

This article then begins with some discussion ofrelated theoretical aspects from three interlinkedarenas; education, research and theatre. Whenaligned with the use of drama in education theseperspectives combine to form a persuasive argu-ment for an approach that addresses the need toengage students more actively in their owneducation.

It says here. . .

The literature on education, research approachesand the political uses of theatre is divergent in itsscope but convergent in its desire to producechange/action. This goes beyond a simple stimu-lus/response model and aims for the kind of perma-nence associated with lifelong learning (Yeaxlee,1929; Knowles, 1998). Williams further endorsesthis with her comment that

the rapid changes in health care, diminished life-span of useful information, and increasing com-plexity of practice make it essential that nursesmaintain competence throughout their careers(2004: p. 277).

In order that the system can produce practitio-ners of a suitable calibre thinking in nurse educa-tion has adopted certain strategies proposed byearly theorists. A contemporary of Yeaxlee, JohnDewey emphasised particular aspects of learning.For Dewey, learning was almost a by-product of

thinking (1910/33) and most famously his assess-ment of this is captured in the term reflection(1938).

For our purposes though, the salient points areto be found not in the varieties of reflection iden-tified by Dewey, nor even in the many volumes thathave since been inspired by his work, but in thatvery necessary corollary to reflection: action. AsRodgers observes,

. . .for Dewey, reflection must include action(2002: p. 855).

Jackson connects this to drama when he ob-serves that at the very heart of Boals work is thedual meaning of the word act, to perform andto take action(2002: p. xxii).

Freire, a compatriot and contemporary of Boal,was overtly political in his work. His emancipatoryintentions were apparent in the way he saw educa-

tion as a shared process where the student was en-gaged in a dialogue with the teacher. This is farremoved from the curricular approach to educationthat emphasises the distances in this pedagogicalrelationship. Freire wanted, in all of his work, tofree the learner from the constraints of a formalapproach. This complements current thinkingwhich seeks to promote self-directed learningwithin higher education. We shall return to thistheme in more detail later with a discussion onthe uses of theatre.

The expert/lay dichotomy will be familiar tothose working within the nurse education arena

generally and the learning disability branch in par-ticular. It is as expert/lay that the lecturer/studentrelationship is often characterised. This produces atendency to make the student reliant on the tea-cher. And it is precisely in this arrangement thatFreire wanted to see a change in the relationshipsof knowledge production with more emphasis beinggiven to the student as a self-directed learner. Fre-ire called this conscientization.1 More recentlyKnowles has indicated support for this position.He says that

. . .self-directed learning is conceived of as per-sonal autonomy

. . .

[which]. . .

means taking controlof the goals and purposes of learning and assumingownership of learning. This leads to an internalchange of consciousness in which the learner seesknowledge as contextual and freely questions whatis learned(1998: p. 135).

Still the question remains, how are we to act in away that promotes reflection in the students in ourcare? One obvious and commonsensical answerwould be to provide a stimulating educationalexperience. Curricular restraints, however, do notalways allow for such an imaginative approach.

And yet in order for students to be engagedthere is some onus on the lecturer to present mate-rial in such a way that what Andersen refers to asthe pragmatic difficulties associated withauthentic contexts do not impinge too much(2004: p. 283).

It was in response to a situation like this that ourown intervention began. The remit was to provide

1 Learning to appreciate the social contradictions apparent insociety and reacting against this oppression.

204 A. McClimens, R. Scott
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a session on user involvement in learning disabilitypractice to first year students. As a policy back-ground to this the white paper Valuing People(2001)is founded on four principles of rights, inde-pendence, choice and inclusion. The educationalresponse is to make students aware of the issueswithin a theory based session with a view to imple-

menting these principles in a practice setting.Typically this had been achieved through a stan-dard didactic format with a presentation to stu-dents of relevant literature followed by somediscussion on examples from practice with debateon how to promote more user involvement.

Our feeling was that a session on user involve-ment was compromised without genuine userinvolvement and so, with input from individuals inreceipt of services, we set about devising a scriptthat we felt would address this issue. We will de-scribe this in more detail later but for now it is timeto consider the influence of research. In particular,

we will examine the contribution of the participa-tory research paradigm.

Peru, potatoes and participatoryresearch

In a discussion on participatory action researchSample (1996) outlines how a project Transitioninto Community Life, designed to assist youngadults with developmental disabilities to accessleisure and recreation facilities, borrowed method-

ologically from earlier work byRhoades and Booth(1982).

Rhoades and Booth were interested in the agri-cultural application of shared knowledge produc-tion. In Peru seed technologists were workingalongside local farmers to increase storage capac-ity. An immediate problem arose with a failure onthe part of the experts to recognise uses for whatthey classified as spoiled potatoes. When the farm-ers had highlighted how these could be used foranimal feed the experts then further compromisedtheir status by designing excellent seed trays thatwere way beyond the budget of their hosts. Againnative knowledge provided a solution with the pro-vision of locally available materials by which allparties were satisfied. This brief example illus-trates well the way that a combination of thinkingthat takes account of native or lay perspectivescan produce better results.

In the literature on the research process as itimplicates learning disability issues there is somedebate on the political advances that may be madeavailable with an emancipatory approach. Thomasprovides a useful definition that can easily be

applied to the purposes of education with thefollowing:

Emancipation refers to the process of separationfrom constraining models of thinking or acting thatlimit perception of and action toward realizingalternative possibilities[1993: p. 4].

Learning disability nursing has always exploredthese alternative possibilities both in practiceand in education. The principle of normalisation,for example, (Wolfensberger and Nirje, 1972; Wol-fensberger, 1992) and the social model of disability(Oliver, 1992) have both, in recent years, beeninfluential in changing policy and practice. In self-advocacy too learning disability has been promi-nent (Charlton, 1998; Goodley, 2005).

Allied to this the place of research has beeninstrumental in securing better lives for those in-volved (Chappell et al., 2001; Coles, 2001).

Atkinson is aware that such claims can be re-

garded suspiciously and concedes that while somevarieties of research cannot offer material gainsthey may yet enable people labelled with learningdisability to develop historical awareness and thusto view their lives differently(2004: pp. 692/693).It is in adopting this perspective, of viewing thingsdifferently, of exploring alternative possibilitiesthat we aim to promote a change in attitude forour students and a desire for change in the livesof the people they care for.

So far it appears as if research approaches thatvalue the involvement of participants share some

key concerns with education; crucially around theneed to produce change/action in the minds ofthose most closely involved. In the following sec-tion we will find out whether theatre can comple-ment this by providing a vehicle by which tofacilitate the process. Here we investigate in moredetail the work of Augusto Boal.

Boal and forum theatre: questionchallenge and change

Boal shared Freires concern for oppressed minori-ties and all of his theatre work is aimed at redress-ing what he saw as the imbalance of powerbetween the audience and the stage, and by anal-ogy, between the indigenous populations of SouthAmerica and their governments. In dramatic termshe essentially wanted to relieve the theatre audi-ence from the passivity of their role by removingthe monologue that characterises much stagedrama. The parallels here between what goes onin a typical classroom are plain. In both situations

Lights, camera, education! The potentials of forum theatre in a learning disability nursing program 205


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a paid professional takes a central position before aseated audience and delivers spoken content. Fre-ire refers to precisely this with his remarks that

A careful analysis of the teacherstudent rela-tionship at any level, inside or outside the school,reveals its fundamentallynarrativecharacter. Thisrelationship involves a narrating Subject (the tea-

cher) and patient, listening objects (the students)(original emphasis)(1972: p. 45).

In order to get away from what he described asthe banking method of teaching, by which teach-ers deposit information in the minds of their stu-dents (known locally as the mug and jug scenario)Freire then went on to outline what he calledproblem-posing education. Now better known innurse education at least as problem based learn-ing the intention was to allow students to reflecton their own experiences in order to arrive at theirown solutions.

Boal too was unsatisfied with this arrangementand attempted to create dialogue, by which theaudience is encouraged to interact and becomepart of the performance. He did this as part ofhis agenda for social change. His insistence onthe transformation of the audience is clear fromthe following:

In order to understand this poetics of theoppressedone must keep in mind its main objec-tive: to change the people spectators, passivebeings in the theatrical phenomenon into sub-jects, into actors, transformers of the dramaticaction(1979: p. 122).

Boals way of producing this transformationcame in the shape of forum theatre. He rejectsAristotles Coercive System to Tragedy where theworld is known, complete and ultimately, imposedupon a passive audience. The characters experi-ence the trials and triumphs for the audience,who then vicariously feel the emotion. The audi-ence is encouraged to absolve themselves ofpower, pass on the responsibility to the character,but come away purged, through second handcatharsis. This, Boal argues, ultimately disempow-ers the audience. Real action, real life action issubstituted for the false, dramatic action and theaudience gives up its ability to make changes on be-half of themselves.

Boal was no more impressed by the Brechtianmodel. Here the audience is encouraged to think(rather than feel) on behalf of the characters. Theysee, for example, Mother Courages plight and areenraged by the circumstances that force her to sac-rifice her children. This thought means that theworld is organic, and truth subject to change. How-

ever, this change is confined to the truth of thestage and the theatre, and not that which goeson outside.

Boals essential contribution takes us a stagefurther. Historically, Boals method of forum the-atre came about as a tool for social and politicalchange. Forum theatre is over 20 years old and

has its beginnings in the barrios (slums) of Brazilwhere the peasants were encouraged to stand upto their oppressors, in this case the landlords. Ithas since become an international tool for socialand political change, a means of giving [all] peoplethe strength and confidence to overcome oppres-sions. (Jackson, 2002: p. xxii).

Boal sought to break down the fourth wall that inthe Stanislavskian model separated action fromaudience. This fourth wall exists today most recog-nisably in the form of television where we are notinvited to participate in the lives of the characters.Their actions and words will remain the same de-

spite any wish on our part to intervene. This paral-lels Freires desire to move away from didacticmodes of education. In his introduction to Educa-tion for Critical Consciousness Goulet highlightsFreires encouragement for us to adopt a methodwhich fosters dialogue and reciprocity. . . (2005:p. x).

Boal and Freire abhor man as mere spectator.Freire likens the term spectator to that of object,or that which reduces a persons humanisation.Boal coined the term Spectactor, so that thewatcher becomes empowered and takes part in

the action in a real and meaningful way. Similarly,Friere extols the position of Subject over Object inthe world, so that the human is part of the world,with the power and capacity to change it, ratherthan the world being something that happens tohim . . .no longer mere spectators. . .[they] de-mand intervention. . .they want to participate(1974: p. 11).

Transferring these thoughts into the realm ofnurse education, the learner learns best when theyactively participate in the world. In this case theworld of the real life scenario as acted by the edu-cators. As the audience/learners are encouraged tofind solutions to the problems presented, the ac-tors/educators become the educated and thepower shifts for the student to become spectators,and subjects of the scenario. Solutions are foundwith the students, not presented to them as al-ready having been discovered and imposed uponthem. They become the experts. In this way, theeducator (in forum theatre, the actors) does nottry to impose their view. Rather He can discuss[the students] respective positions (Freire,1974: p. 9).



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Through forum theatre this discussion becomesaction, and new scenarios are created. There isnot only one right answer. The only absolute is thatthe original scenario is not the best way to dealwith things. The students are encouraged to try arange of scenarios. This is particularly importantwithin nurse education as what will work for one

person as a practitioner may not work as effec-tively for another. This form of education, identi-fied by Friere, allows people to reflect onthemselves, their responsibilities. . .(1974: p. 13).

Learning lessons?

When we consider the lessons from educationaltheory, from participatory action research (PAR)and from forum theatre there are clear areas ofcommonality in their goals and those that we aspireto in nurse education. Principal among these is the

necessity to promote some change in behaviour bymanufacturing circumstances that enable studentsto take a more proactive role in their owneducation.

This is alluded to by Elden and Chisholm whonote that action research typically contains theseelements: commitment to values, a situated con-text, aims for change, is participatory and finally,disseminates knowledge(1993: p. 124). As a tem-plate for nurse education it could hardly bebettered.

In this example there are clear echoes of an older

calltoarmsfirstarticulatedbyMarxwhenheencour-aged thinkers to move beyond reflection and into therealm of action (Marx: pp. 1842/1970). Today wehave the term action learning which suggests thatits authors were familiar with Marx. In defining theterm McGill and Beaty, for example, emphasise theneed for change/action when they describe it as acontinuous process of learning and reflection, sup-ported by colleagues, with an intention of gettingthings done(2001: p. 11).

Above all else Freire believed in the practicalrelevance of learning. This surely speaks to nurseeducation. Rolfe describes it this way. He said,For Freire, the learner must start with concreteexamples from her own experience. However,these examples are reflected on not only to learnabout the world, but more importantly, to learnabout learning, that is, to learn how to changeones position in the world(2001: pp. 22/23).

If we extend this to the nurse education realmthen it offers the possibility of a truly autonomouslearner, released from the bonds of simply listeningto the teacher. Just as Boal wanted the audience todispense with the artificial boundaries that separate

the stage from the auditorium so Freire and Rolfeare looking to a more independent learner/audi-ence, released from the confines of the curriculum.

With this in mind we set about to provide somelearning opportunities for the students that wouldsimultaneously allow then to draw on their ownexperiences while giving them the opportunity to

act, and effect change in a safe environment.

Tales of the unexpected

Pfund et al. highlight how the very unpredictabilityof practice can place sudden and severe strain onstudent nurses(2004: p. 112). The curriculum can-not cover every eventuality and some students willinevitably be faced with emotionally challengingsituations that they are not necessarily preparedfor. The idea that shared reflection can help towork through these feelings is suspect if it is done

in a vacuum.In seeking to address this we have found that by

using forum theatre students can bring a problemfrom practice, and through the medium of drama,explore alternative courses of action before theyreflect on it. This reinforces Boals assertion thatforum theatre is a rehearsal for reality.

To enact this in a live setting we co-opted themembers of Words & Actions, a theatre group com-prising people with a variety of disability/impair-ment, to perform with us in the session on userinvolvement. We rehearsed the piece several times

before presenting it before the student group.Our chosen scenario was played out by Words &

Actions with Rachel as facilitator and Alex as in-jured party and members of the group playingother parts. The action progresses with Alex, play-ing the part of someone with a learning disability.His carer is escorting him to his GP for treatmentto an injured ankle. A brief consultation ensues: amedically focused outcome unfolds one thatleaves the learning disabled patient frightenedand confused. The story ends at this point.

As the scenario is re-run the audience is invitedto stop the action to suggest alternative ways forthe characters to behave. These suggestions arethen performed by the actors. Typically these fo-cus on the quality of communication and the ne-glect of the person with the learning disability asa person with an overemphasis on their subordinaterole as patient. Ultimately, and ideally, an audi-ence member is invited to take the floor and dem-onstrate what they see as a preferable course ofaction. In this way the audience become the per-formers and the opportunities to explore alterna-tive scenarios increase exponentially.



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Our example is just that; an example. Any num-ber of situations from practice would readily lendthemselves to the forum experience.

Reflections

From our experience we identify three main areasthat arose from our work.

Power relations suffuse learning disability as aconcept, the practice of learning disability nurs-ing and at a structural level inform a societalresponse to individuals so labelled.

Theatre/drama has a universal appeal. Reflection is now an established part of nurse

education. From Dewey through Schon and Ben-ner to Rolfe the advantages are clear: engagedstudents just learn better.

We will comment on each briefly by turn.

Power relations are not only apparent in the waythat society is structured with regard to thoseminorities labelled with a variety of disability/impairment but they are equally plain in theeducation system. The hierarchy, however, canbe temporarily suspended. As Wasylko and Stick-ley note, for the teacher who is prepared torelease some control to their students, dramaas a learning medium can be empowering andpromote personal growth(2003: p. 445).

Further to this point we are finding that learn-ers are made more aware of these power rela-tions when individuals labelled with learningdisability perform the forum theatre. This givesadded impetus to the educational content sincethe learners are made more aware of the impactthat diagnosis can have on an individual. And bytaking part in the session they are coming toappreciate what Cooper meant when he saidthat Through responsibility for ourselves webecome socially responsible(2004: p. 84).

The universality of theatre is plain from the pop-ularity that attaches to a wide range of socialand cultural values invested in various media.From the opera house to soap opera audiencesare attracted to staged drama. However, evenif we ignore the therapeutic benefits that accruestudents were very clear in their feedback thatthey enjoyed their own participation in thesesessions. This is something as educators thatwe cannot ignore.Fundamental to the successof forum theatre as an educational tool is thesafe challenge it presents to the Spectactors.As Jackson remarks, anyone can act. And cru-

cially participants are acting as they themselveswould in any given situation so no performanceexperience is necessary.

This leads into the final point. Students whoenjoy their classroom time are more likely tobe motivated to study and so to make connec-tions between theory and practice. The reflec-

tive component is prominent within forumtheatre and this aspect is valuable in promotingthe idea of the much sought after reflectivepractitioner.

Conclusion

The need for change/action to consolidate reflec-tion has been the focal point of many influentialeducationalists and thinkers. Researchers who aremotivated by political imperatives share similarconcerns. Thus researchers who adopt qualitative

methodologies and participatory paradigms arefurther coerced by beliefs about ownership andauthority. The need to effect change/action is stillprimary.

With reference to a small pilot project we havehighlighted how our own efforts have amalgamatedthese ideas and have been successful in beginningto alter the way students think about topics.

In nurse education in general, and in learningdisability nurse education in particular, with a pol-icy emphasis on rights, independence, choice andinclusion, there is an added onus on the would-bepractitioner to effect some change in the lives ofthe people they work with. By using forum theatrewe feel that we have given these students a usefultool for affecting future change. To paraphraseMarx, while nurse educators and practitioners havethus far interpreted the world of health and socialcare, the point, surely, is to change it.

Acknowledgements

Acknowledgement is due to the students in thedepartment and to the members of Words & Actions

for their contribution to the paper. We would alsolike to thanks the two anonymous reviewers whosecomments enabled us to produce this article.

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