Theatre, Cancer and Catharsis: The Hospital as an Agora

Alberto Pagliarino*

Abstract: The article analyzes the Social and Community Theatre project Cantiere San Giovanni Antica Sede (2006-08). The project took place at San Giovanni Antica Sede Oncological Hospital in Turin. Led by a team of professionals, the artistic process engaged the entire hospital community—doctors, patients, nurses, caregivers, chefs, custodians—by means of theater workshops, training courses for high school students, dramaturgy readings in the day hospital waiting room, visual installations, performances and big ritual events open to the public. The hospital became a place of “Agorà” in the context of a great cathartic ritual for the community.

Keywords: Theatre, Oncology, Medicine, Narrative Τheatre, Community Theatre

In the fifth century B.C., Hippocrates treated his patients on the beautiful island of Kos and, along with traditional therapy, he prescribed watching comedies and tragedies. In this way, treatment also took place through a catharsis which came about by watching theatre within a community context. This perception of care recognizes that an illness—particularly one, such as cancer, that profoundly affects the life of a person—is not only a pathology of the body, but also a social and symbolic condition.

Can we return to the island of Kos today? It seems so. In the last twenty years, numerous scientific studies have been conducted confirming a relationship between social and cultural activities and health. In Europe, one of the first important scientific studies that highlighted the correlation between health and culture is a Swedish analysis conducted by Bygren, Konlaan and Johansson, which focused on a target group of 12,000 people, from 16 to 74 years of age, over a nine-year period. The study concluded that rarely partaking in cultural events—such as reading books, going to exhibits, singing in a choir—is linked to a risk of mortality that is 60 per cent higher than that of those who do so regularly (Bygren, Konlaan and Johansson 1996, chap. 2). Was the “catharsis” that Aristotle referred to, that purifying effect experienced in the face of tragic agon, a “public health” act?

From 2006 to 2007, director and playwright Alessandra Rossi Ghiglione^[1] of the Teatro Popolare Europe—in scientific consultation with Doctor Rossana Becarelli and under the supervision of the University of Turin—carried out a theatre project in Turin on the narration of oncological diseases. The Social Community Theatre project took place at the San Giovanni Antica Sede hospital, Turin’s most important civic hospital specializing in oncological diseases. Actors, musicians, singers, set designers and a notable number of Social and Community Theatre professionals worked on the project.

The San Giovanni Antica Sede hospital was established in 1680 and is the oldest hospital in the city, built on the historic borderline where at one time the City of Turin ended and fields began. At the end of the 1600s and in the centuries that followed, it was a place where not only sick people, but also street people, beggars, and down-and-out and abandoned women with illegitimate children found refuge. Over the last few centuries, Turin has expanded and the hospital today is situated in the heart of the city. It faces two squares where people of all ages and social ranks meet. Children play in the garden in front of the hospital; its benches serve as meeting places for young people and as beds for the homeless; the paths are traversed by managers on their lunch breaks, by young mothers pushing baby carriages, by families and elderly joggers. From within the hospital you can see life through the eyes of those who are in contact with a potentially mortal illness every day. Citizens, however, tend to avoid the hospital, because they see it as a dreadful place; a place of encounter with a fatal illness like cancer.

For the first few months, director Rossi Ghiglione, along with her actors, remained within those walls to watch and listen, to get to know the place and the ways of relating within it, to listen to stories told spontaneously and to understand the interaction between different roles, situations and types of language. She was able to undertake this journey because she was accompanied by the social worker of the hospital, a sort of “Virgil” from the inside, guiding Rossi Ghiglione through the hospital as the poet once famously guided Dante through Hell and Purgatory. In addition, the director wore a white coat: a “costume” which indicated belonging to the hospital community. Right from the beginning, what struck her was one of the structural conditions of being a patient: the person submits to being placed entirely in the hands of care providers, undergoing a loss of role and identity.

Work with the hospital community progressed through a first phase of interviews conducted according to the Social and Community Theatre methodology. In this instance, the person listening was a theatre professional, and part of his/her expertise during the conversation with patients and caregivers included noting a glance, posture, proxemics, the type of questions asked and the quality of listening. The act of interviewing created a story in a context within which the narrator and the listener were both on the set. The narrative became a possibility for both to act upon perceptions that each had about their personal experiences, role and circumstances.

Hospital administrators had asked Rossi Ghiglione to dramatize the story of the hospital, of disease and death. But, after those first few months of listening, her question shifted to “How do we look at life from within the hospital?” In other words, how do we look at life from the perspective of an ill person, or from that of someone who takes care of a relative, or who is treating the illness in the operating room, or has to convey a diagnosis, or helps a patient in daily activities like washing themselves, eating or getting dressed.

The first theatre activity of the project, which took place in the waiting room of the day ward during the hours when patients were waiting for anti-tumor treatment, actively involved about seventy people including staff and patients. Even though the event was carried out by theatre professionals, it was not solely a performance. In fact, the staging of the space, the dramaturgy of the actions, the texts and the timing were defined to the finest detail to permit those present to live a unique experience much like in a community liturgy.

The day ward waiting room, which is normally unadorned, was decorated with flowers and loaves of bread, immediately bringing to mind hospitality and a folksy quality. Those in attendance were enveloped in colors and the scent of flowers. An accordionist played various kinds of music, including folk songs. The dramaturgical material was thought out expressly for that experience and included four personal accounts by two doctors and two patients—present in the room at that moment—as well as literary selections, some songs and music, and a personal account by one of the actresses about her experience with the disease.

An actor interpreted the story of a hospital surgeon, perceived by many as too abrupt, but who at the same time was capable of incredible humanity with patients. During the monologue, the actor-as-surgeon told the story of when he had the room of a terminal patient dismantled to set it up again on the top floor of the hospital because the patient could see her home from the window of that room. He talked about the strain of finding a patient in front of him to operate on and how, at that moment, he had to forget that it was the same person who had asked him to be cured a few minutes earlier; he had to force himself to see only a liver, a kidney, a lung.

The story personified by the actor was told in front of the surgeon, his colleagues, nurses, the patients waiting for treatment and their relatives. It was a risky passage but was executed discretely and with respect for the circumstances of that place and the people who were living in it on a daily basis.

This is why the eyes of those waiting in the room were no longer looking toward the lit-up sign that indicated whose turn it was to go for treatment. What occurred in the San Giovanni hospital that day was very similar to the effect that onions have in the novel The Tin Drum by Günter Grass. Some patients cried as if they had never cried before and, with those tears, people began to talk. Aristotle would have called this catharsis. And so, when it was their turn, various patients entered the treatment room and, for the first time, they talked to the healthcare workers. They talked not only about their illness but also about what took place in the waiting room; about who told their stories; about the unusual shapes of the loaves of bread that were used to adorn the tables; about the flowers; about what they were offered to eat; and they talked about how they felt. The patients opened up during the encounter with the nurses.

From a medical point of view, this dynamic meeting with the healthcare worker was seen in a positive light by hospital administrators and staff. Researchers Franklin Miller, from National Institutes of Health, and Ted Kaptchuk, from the Faculty of Medicine, Harvard University, would have referred to it as “contextual healing,” that is, the complex benefit “produced, activated and enhanced” by the encounter between the patient and the caregiver. Taking into consideration numerous laboratory studies, this encounter, when managed with care, improves the effect of treatment and the relationship that the patient has established with his/her illness (Miller and Kaptchuk 2008, chap. 3).

From that moment on, everyone wanted to tell their own story. Not only medical personnel and patients, but also maintenance workers, cooks, cleaning staff, security guards and mortuary personnel wished to participate. The director and the actors were subsequently stopped in the hallways, during rehearsals and after readings. A permanent theatre workshop was established inside the hospital during which the residents of that community were interviewed, training workshops were organized and rehearsals took place.

The dozens of stories that were put together over the months that followed were a first important step toward creating a shared sense of community among the residents of San Giovanni Antica Sede. As Yuval Noah Harari reminds us, the great evolutionary jump which allowed Homo sapiens to spread across the planet and dominate it happened about 50,000 years ago with the birth of a complex language. Up until that moment, Homo sapiens in Africa and Neanderthals in Europe, were able to become organized into groups of a maximum of 50 to 100 individuals—about the same number as a troop of bonobo monkeys. Harari also asserts that we were able not only to communicate easily, but also to create shared narratives and myths, thanks to the birth of language. With the birth of language and the creation of shared narratives, Homo sapiens were able to form tribes made up of 500 to 1,000 individuals (Harari 2014, chap. 1 par.3). Both simple gossip and articulated narration itself are means human beings use to create social relations and establish communities. As Cavalli-Sforza affirms, one of us possesses a circle of acquaintances that vacillates between 500 and 1,000 individuals (Cavalli-Sforza 2016, chap. 12). The inhabitants of San Giovanni Antica Sede also oscillated around those numbers. During the theatre project, telling one’s story was guided by the knowledge of Social and Community Theatre professionals and was oriented toward creating common theatre events.

The hospital is already a place of ritual and liturgy. Within its walls, we repeat the redeeming ritual of sacrifice (the operating room); we announce a verdict on the causes (the diagnosis); the officiants there (doctors) possess specific strictures and shadowy knowledge—possess specialized knowledge and an aura of indisputable authority over others, and ritual procedures are articulated through protocols and guidelines (Rossi Ghiglione 2014, chap. 1 par. 3). The hospital is where the primary rituals, namely birth, illness and death, are performed. Yet, all of these elements, which replicate ancient ritual procedures, are completely devoid of a symbolic component today. Can theatre draw nearer to this environment and become a concrete vehicle for artistic and anthropological research? Is it possible to re-establish a complex dramaturgy of death? How can Social Community Theatre bring to life a dramaturgy of actions and gestures aimed at giving back a sense of sharing and a mutual respect for the thresholds of life, illness and death to the community?

Keeping these questions in mind, it was decided that an exceptional event should take place on June 20, 2007, in conjunction with the summer solstice: an opening to the community at large together with the residents of the hospital through the theatre performance Porte, Soglie e Passaggi [Doors, Thresholds and Passages]. The show was performed by professional actors and artists with the active participation of hospital residents. Around 200 spectators-participants, who were from outside the structure, participated in the event. Each spectator-participant was welcomed into one of the internal courtyards of the hospital and, under two flowering magnolia trees, was asked to perform a symbolic gesture—washing their hands in a basin—and was offered a piece of bread.

A scale model of the San Giovanni, made by a doctor, was in the middle of the courtyard. Nurses, doctors and patients became guides. They accompanied the spectator-participants to visit the places that were “doors, thresholds and passages” inside the hospital: a terrace on the fourth floor of the building from which they could see children playing in the gardens of Via Cavour; the day ward where patients were waiting for their treatment; the altar of the historic chapel of the hospital where patients, doctors and relatives sometimes retreated for a personal spiritual moment. In the chapel, a woman—a patient of the hospital—read a poem on a fallen summer leaf and a young person dressed up with sheaves of wheat and flowers recounted his cancer-healing process.

A passage brought the spectator-participants back to the courtyard and, upon descending a set of stairs, they found themselves in front of an installation with trees and flowers and two girls dressed in white, who were turning over fresh earth with their bare feet.

A patient’s son played Armenian music on the viola, walking barefoot in a small pool of water. The theatre event became a collective ritual which involved an agora of citizens. In this way, the initiative celebrated the circumstances of thresholds, bringing to the fore the themes of that place: life, illness, death and healing. At the end of the performance, the residents of San Giovanni started to feel like part of a community for the first time. The performance was subsequently repeated as part of the Torino Spiritualità national festival.

The year 2007 closed with a final noteworthy event that changed the way the city perceived the hospital. On December 31, 2007, New Year’s Eve was celebrated in the hospital through a civic theatre party entitled Mille candele per l’Ospedale San Giovanni [A Thousand Candles for San Giovanni Hospital].

The party was organized by hospital staff and more than 300 people participated. The network of hospital volunteers was joined by that of local businesses, who donated food and drink. Various theatre companies from Turin and the Region of Piedmont also offered their services free of charge, along with two Scout groups. The spaces in the hospital were turned upside-down with respect to their daily functions, while still maintaining their symbolic importance.

The day ward waiting room became a playroom for children with puppet shows and fable storytelling; the chapel hosted a shadow performance; and the historic crypt under the chapel was turned into a dance hall. The hospital terrace became the site of small nocturnal processions during which actors recounted brief passages from the stories of San Giovanni.

The hospital’s internal courtyard was transformed into an installation with about one thousand candles placed on long bamboo canes. Each participant was asked to bring a candle and a bottle of wine or bubbly. A bonfire was lit in the courtyard, representing memories to burn and aspirations for the New Year.

Over the course of the evening, wine, food and art was shared in the hopes of participating in, and being a witness to, a notion of the hospital not so much as a place of separation but as the centre of a system of human relations nourished by caring.

On the New Year’s Eve night leading into 2008, people who had never set foot in the place were present, along with those who would have been celebrating alone, and others who had been patients there twenty years ago and were returning again for the first time.

On that day, gathered together, all of them unexpectedly made an important life transition. During the final days of preparation for the party, news spread that on January 2, 2008, the process of dismantling certain hospital wards would begin, as well as a gradual downsizing and a transformation of health services.

In addition, a tragedy struck the City of Turin those same days. Seven workers were killed in the Thyssenkrupp plant on an accident caused by company negligence. On the night of December 31, due to a citywide period of mourning, parties organized in downtown city squares were cancelled as a way to express the pain of the city in this tragedy. The doctors, patients, artists and the entire community ceased all activity. What to do?

The Iliad ends with a description of the celebration organized in Troy to honorably commemorate the funeral of the great hero Hector “the horse tamer,” killed by Achilles. Having recuperated his body, Troy was not silenced. Instead, it raised the funeral pyre and organized competitions, games and banquets for ten days. During those ten days the war ended and peace returned. The knowledge revealed at the end of the poem demonstrated awareness that celebration can, in effect, help people come to terms with pain and grieving. On New Year’s Eve at the San Giovanni hospital, instead of grieving in silence, the city mourned with a celebration. Our society has lost this knowledge and grieving is carried out in silence. We live through loss in silence because we have lost that ritual, that capacity to celebrate the type of theatre that once had accompanied us in our grief.

On January 2, 2008, the San Giovanni Antica Sede began its makeover: the surgery department was transferred and hospital stay was terminated. But its inhabitants did not remain immobile. As of spring 2008, the project, still run by Rossi Ghiglione, acquired the name: Sotto il segno del cancro [Under the sign of Cancer]. The activity expanded into the neighbourhood, the schools, the City of Turin and the province. Theatre and health, healthy eating, women’s health, music therapy and chi gong workshops were conducted. Dozens of high school classes took part in theatre visits inside the hospital. Instead of visiting a museum, young people moved through the spaces of the hospital, listened to the stories of doctors and of patients, learned how things work inside a hospital, how to take care of a sick person, and how to live with an illness without being overwhelmed by desperation. A theatre and health festival took place which involved more than 3,000 people and many citizen networks. A professional performance was produced entitled Passioni, Cabaret, Concerto [Passions, Cabaret, Concert]. A documentary on the San Giovanni experience called Porte, Soglie e Passaggi [Doorways, Thresholds and Passages] and directed by Enrico Carlesi was presented internationally.

In an era of auspicious technological progress and scientific rigor, we are paradoxically living a path to healing in a context of solitude and disconnectedness from the essence of living. Theatre, in effect, teaches us that any place of healing can also be a community where we can build a shared vision of life.

Endnote

[1] Alessandra Rossi Ghiglione is co-founder, along with Professor Alessandro Pontremoli of the University of Turin, of the international Social Community Theatre Centre (www.socialcommunitytheatre.com).

Work cited

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Bygren, Lars Olov, Konlaan, Boinkum Benson, and Johansson Sven-Erik. “Attendance at Cultural Events, Reading Books or Periodicals, and Making Music or Singing in a Choir as Determinants for Survival: Swedish Interview Survey of Living Conditions.” British Medical Journal 313 (December 1996): 21–28.

Harari, Yuval Noah. A Brief History of Humankind. London: Harvill Secker, 2014.

Miller, Franklin, and Ted Keptchuk. “The Power of Context: Reconceptualizing the Placebo Effect.” JRSM Journal of the Royal Society of Medicine, 101.5 (1 May 2008). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2376272/

Rossi Ghiglione, Alessandra. Teatro e Salute. Torino: Ananke, 2014.

*Alberto Pagliarino, holder of a PhD in Theatre and Cinema, is Adjunct Professor at the Master of Social Community Theatre of the University of Turin. He is co-ideator and member of the board of Social Community Theatre Centre. He is ideator and Director of several European large-scale projects of Social Community Theatre, among which: Terract Project (2017 – 2020) Interreg; Caravan Next Project (2015 – 2019) Creative Europe large scale cooperation; Caravan Artists on the road (2011 – 2014) Cultural Europe large scale cooperation (www.socialcommunitytheatre.com).

Copyright © 2018 Alberto Pagliarino
Critical Stages/Scènes critiques e-ISSN: 2409-7411

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