Gesundheit Institute | Patch Adams | TEDxUtrechtUniversity

As a medical doctor, a clown, and a social activist who has devoted 30 years to changing America's healthcare system, Patch Adams talks about how he has devoted his life to the study of what makes people happy.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

In one year, when I was 18,
I was hospitalized three times

because I wanted to kill myself.

I didn't want to live in a world
of violence and injustice.

In the third hospitalization,
I had the realization

you don't have to kill yourself;
you can make revolution.

So, I decided to make, and give my life,
to a revolution, to loving.

I came up with this first desire:
How can I, in ever single waking moment,

be an instrument for peace
and justice and care?

So I decided - that was quite
an easy decision -

that I would be happy, disgustingly happy,
every single second of my life.

What I actually realized very quickly
was that it was six qualities:

Happy, funny, loving, cooperative,
creative,and thoughtful,

and that I'd decided to do it
because my mother gave me self-esteem.

All I, then, had to do, was to do it.

So, as an extreme extrovert,
I went out there,

and was radiantly happy, and I noticed

that, of all the six qualities,
it was love that was so difficult

to get close to people in a very
suspicious world around love.

That's because I had been clownish before,

I noticed that if I was clowning,

that clowning was a trick
to get love close.

So I've clowned everyday for 49 years.

Maybe I'll quote your great
humanist, Erasmus,

who said, "Thus it comes about,

that in a world where men are differently
affected towards each other,

all are at one in their attitudes
towards these innocents, these fools;

all seek them out, keep them warm,

give them food, give them aid
as the need arises,

and give them leave to say
and do as they wish, with impunity.

So true it is that no one
wishes to cause them harm

that even wild beasts by a certain
sense of their natural innocence

will refrain from doing them harm.

They are indeed held sacred by the gods,

and especially by me; and not impiously
do all men pay such honor to them."

This is your own dutchman's,
wise statement.

So, where that led me was ...

I come from an extremely
violent country.

So, as a total pacifist, I wondered,
"How can I stop public violence?"

both verbal violence of really loud
yelling between a couple in a parking lot

or in a grocery store where you see
a child and a parent fighting.

Actually, you're allowed to hit them
and beat them, verbally and physically.

So, I thought, "Well,
I've been a clown all this time,

so, I could actually
kind of be a 'weird-superhero.'

I could see the event
in the grocery store,

and then come back and take
my normally conservative appearance,

and change it into a ... "

Now, normally, at this phase,
I would reach in my pocket -

I have about 30 toys in my pockets -
and take out a nose,

but four years ago,
I went into the dental profession;

we all love technology,
and I'll start talking like this.

(Laughter)

I found out that that really affected
the environment I was in.

(Laughter)

Then of course, technology is additive,

so I curled up what I called
"a triple threat."

This is one; triple is three,
so I would also ...

put in my oh-so-handsome jelly teeth,

and snot.

(Laughter)

So, you understand;

I turn that corner and they're fighting.

And they see me,

(Laughter)

they stop fighting.

(Laugher)

Now, I've done this for 30 years,
and it has stopped every single fight,

I estimate, 4,000 - 5,000.

Desire and design.

Okay, so, I made two decisions
in that mental hospital:

One was a personal decision,
to be an instrument all the time.

The other was to serve
humanity in medicine.

I had an aptitude for science.

And I knew how embarrassing it was

that I come from the richest
country of the world,

and we don't take care of our people.

We deny care to our people.

So, I decided that I would be
a free doctor at 18,

and I, again, did a lot of reading
and studying and interviewing,

and by the time I entered
medical school in 1967,

I had decided I was going to create
a free hospital, but then,

as I was in medical school,

I saw there were so many problems
of healthcare delivery,

and that's where the second desire came,

and that was to create a hospital
that addressed every single problem

of the way care
was delivered in one model.

Okay, to show that, no matter
what the problem was,

you could show a solution,
not "be" the solution,

but just show that it's possible
to have solutions.

So I started the Gesundheit
Institute in 1971.

We did a 12-year pilot project
of 20 adults, three of us doctors,

living in a large six-bedroom house.

And we said we were a hospital,
open 24 hours a day.

We had 500 to 1,000
people in our home each month

with five to 50 overnight guests a night.

Everything was free;
in fact, we wanted to eliminate

the idea of debt
in the medical interaction.

We never wanted anyone to think
they owed something.

We wanted them to feel excited

they belonged to something
called "community."

And so, we didn't accept health insurance,

which is the way wealthier people
pay for health care in the United States,

but as soon as you take insurance,
you have all the forms to fill out,

and all the control,

and all you have to do
is not take insurance.

The reason we've had
trouble getting funding

is we are the only hospital refusing
to carry malpractice insurance.

We think it's wrong to eject the guilt
of making a mistake in medicine.

And, of course, there was an outcry
for a lot more care,

a lot more time, all over the world.

It's the loudest screaming
from the 120 countries

I correspond with medical students.

So, our initial interview with a patient
is four hours long, unbelievably intense.

My ideal patient is somebody

who wants a deep, intimate
friendship with me for life.

I'm a family doctor,
and I know our relationship

will be the strongest force
whenever they suffer.

So I insisted that I visited their home.

When I made a house call,
I opened every drawer,

went in every closet;

it's kind of like Sherlock
Holmes-voyeur, visiting your home,

because I wanted to know
every single thing about you

that I possibly could.

Finding that kind of information,

I found that less than three percent
of my population had self-esteem,

less than five percent had any idea

of what a day-to-day vitality
for life was about.

The normal adult didn't like themselves,

didn't like their marriage,
and didn't like their job,

That wasn't why they came to a doctor.

And we made a decision never
to give psychiatric medicine.

We don't like psychiatric medicine;

it never addresses
the issue of mental health.

So we wanted to create an environment,
so we decided that the culture

of the hospital would be the same
that I decided for myself:

happy, funny, loving, cooperative,
creative, and thoughtful.

Now, hierarchy is a huge problem.

Doctors are rude everywhere in the world,

there aren't any happy hospitals.

So we eliminated hierarchy by saying,

"Let's pay the cleaning person
and the surgeon the same amount."

That's right - 300 dollars a month.

Now, that figure is so low,

because we wanted to show the gradient
between the greed of medicine,

which offers a surgeon
two million dollars a year,

and the love of medicine,
which offers them 3,600,

and thousands apply a year
to work for that.

In fact, by the design that we have,

we've eliminated 90 percent of the cost
of fully modern technological medicine,

by all of the permanent staff

living in the hospital
as a communal eco-village,

because the worst sociological
decision of history was nuclear family;

it's failed, we don't do it anywhere well,

and that we are 80 million years
primates that live communally,

and by the footprint, the ecological
footprint, of nuclear family

it's impossible to feed.

So, we wanted to show that you can
take the most expensive thing in America,

give it away for free, and at ten percent
of the cost by living communally.

We also integrate all the healing arts.

And the way we use
the disease as a trick, you see,

to get them into a university
of human culture,

because if you read 20th century
literature around the world,

you'd know people are lonely.

They're lonely; they're wondering
what the meaning of their life is.

There are some universities in the U.S.

where 40 percent of the freshmen class
are on psychiatric medication.

I claim that depression
is never an illness.

It's a pharmaceutical company diagnosis

that depression
is a symptom of loneliness,

but no one ever will be able
to sell a pill for loneliness.

You cannot be depressed and have a friend
floating in your head at the same time.

That's how you know you have a friend.

And the same, i'm not a religious person,
never had a religious thought,

but I know people
who are full of the spirit.

It's not a label; their spirit lives
in their head, so they don't suffer.

Okay, the third domain that I wanted
to mention is the domain -

that was the domain of the health
of the families and community -

now the health of the world.

After 12 years, our hospital
didn't get a single grant,

didn't get a single donation;

the staff had to work outside jobs
to pay to practice medicine,

which is what I've done for 42 years.

And we knew our model was so fabulous

because the 12 years we lived there,
it was just enchanting,

romantic to be doctors in that form.

So, we realized that we had to break our
one rule that we'd broken in our time,

which was "go public."

We have no respect for the media,

and yet, we knew
that's what sells in our country,

that I would have to become famous.

So, we went public, we closed our doors,

because we realized the next step
was a fully modern hospital.

And now I've been on the road
250 - 300 days a year for 28 years.

I don't think I've been home
two weeks in a row in 28 years.

I've been lecturing,
performing in 70 countries,

but the desire here was,

"Okay, you can't just raise money
and be lecturing if you're a community.

What can the community do as a community?"

We are peace activists, so we said,
"Let's go love the world."

We are very poor, supported
by ourselves, so we said,

"Let's do basic peace work:
go love our enemy."

At the time, it was Reagan years,
Soviet Union was "the red peril,"

so, we said, "Let's go
love Russian people".

So we started our "clown trips" in 1985.

We've gone every year since then;
this will be the 29th year,

we take 40 people,

we want to make sure the people know
you don't need any training as a clown.

Put on the clothes, you're a clown.

We've taken ages three to 88;
we don't screen our people, ever.

We've taken 6,000 people.

22 years ago, we were so upset

with the way orphans
were cared for in Russia.

They have a very bad reputation.

So we started taking care
of our own orphans.

We take care of 400
in Moscow and St. Petersburg.

Then we said, "What the hell?
Let's take clowns into war!"

The films aren't working?
Oh, well ... Beep!

So, you'd be seeing ...

A film was made when we took
clowns into the war in Afghanistan.

Then we said, "Let's go
to refugee camps. What the hell?"

And, as soon as the movie came in,

my figure fees went a lot larger,
but weren't enough to build our hospital,

so I could give one talk and build
a clinic in a poor country,

or a school, or take aid.

Now, since the movie, we do
nine clown trips a year.

Last year: Guatemala, Ecuador, Sicily,
Peruvian Amazon, Costa Rica,

(Laughter)

the "nebula,"

(Laughter)

the universe,

(Laughter)

Palestine, Brazil, and Russia.

We were in Haiti right
after the earthquakes,

Sri Lanka right after the tsunami,

and we were in Romania right
after the "age orphanages" opened up.

I estimate I've been at 10,000
death beds as a clown,

I've probably held several thousand
children the day they died of starvation,

Both my sons do it; they're 36 and 25,
and my brother has been involved,

I'm 66; he's 68.

I might tell you, as a little aside,

by living happy, and also having
1-1/2-hours-a-day exercise program,

I haven't been sick in 50 years.

Want to be well? Be happy,
and have an exercise program.

This works; seven years ago,

we found five-year-old children
with gonorrhoea in the Amazon.

So we started a life time project there
using Paolo Ferrari's work,

and have been there now seven years,

and we take 135 people
every August to there.

One thing is, you know,
the United States' number one care

is nation of the mass
murderers of the world,

I apologize, and am embarassed,
which is coming back to haunt us;

last year, 6,000 veterans
killed themselves,

that's three times the number
that died in the wars we're fighting.

So we've been offering to the military
to take vets on clown trips

to reconnect with their loving.

And they're almost giving us permission.

Hey, time for a poem, right?

"When Death Comes"
by Mary Oliver, American Poet.

"When death comes
like the hungry bear in autumn;

when death comes and takes
all the bright coins from his purse

to buy me, and snaps the purse shut;

when death comes
like the measle-pox

when death comes

like an iceberg
between the shoulder blades,

I want to step through the door
full of curiosity, wondering:

what is it going to be like,
that cottage of darkness?

Therefore I look upon everything
as a brotherhood and a sisterhood,

and I look upon time
as no more than an idea,

and I consider eternity
as another possibility,

and I think of each person
as a flower,

as common as a field daisy,
and as singular,

and each name a comfortable
music in the mouth,

tending, as all music does,
toward silence,

and each body a lion of courage,
and something precious to the earth.

When it’s over, I want to say all my life
I was a bride married to amazement.

I was the bridegroom,
taking the world in my arms.

When it’s over, I don’t want to wonder

if I have made of my life
something particular, and real.

I don’t want to find myself
sighing and frightened,

or full of argument.

I don’t want to end up simply
having visited this world."

I have a little time, I want to say
that I answer all my mail.

I've never used a computer,
or had a cell phone,

so you can't email me, but you
can look on our website.

I've not seen our website,
I don't know how to get to a website,

but on patchadams.org
is a Post Office box.

I write 400 - 600 long
hand letters a month;

I've done it for 40 years,
I'm caught up, I answer every letter.

Make sure your return address
is clear and that it's in English.

(Laughter)

I also have been given
permission of people,

because I've been an activist for 50 years
and have a huge amount of experience,

especially for the young people here,
they've let me have this room,

I think, from five to six to engage you.

I want to be useful for you.

You can write me if you're hurting
and need a friend,

if you have ideas and no one
will listen to them,

or you're stumbling
over something, write me,

if you hate what I'm saying
and want to curse me, cool, okay?

We do nine clown trips a year,
everyone is welcome on all of them,

if you sign up for emails ...

Whatever we do, you can do.

We don't take new clowns
to war zones because when we took.

we went to ... The city of Rome paid
for our trip to Afghanistan,

and seven of the clowns
weren't comfortable clowning

around exploding bodies, you know?

If you're going into war and clowning,

you need to be comfortable
around exploding bodies.

Sorry. Yeah.

Host: Thank you very much.

(Applause)

Patch Adams: Thank you.

(Applause)

(Laughter)

Thank you.

Host: Alright.

I think I say what everybody thinks -

that it's very impressive
to hear you speak,

and I think it's especially impressive

because I think
it's hard to be optimistic.

There's a very famous
American philosopher,

who also once said,
"There is a duty to optimism."

And when I see you,
I think you are the symbol,

but how do you keep up your optimism?

PA: You know, I'm here to say
I've never done anything hard,

I've never had any struggle,
there is no tension.

You know, I am the representative of...

if you are you, if you, as a designer,
make you, make your personhood

and then use that personhood
as you decide, it's going to be hard?

I'm sorry, if you have food and a friend,
what are you bitching about?

You know, what happened
to me when I was 18,

I dove into the ocean of gratitude,
and I never found the shore, you know why?

I can't believe gratitude.

And most all of the work I do
is because I love life.

I had a great mother;

If you like me, my mother
gave me what you liked.

And you know, I actually, I heard
what you said about women.

All the problems of history
are due to men,

there's not a single problem,
and no country was ever safe to its women.

We can name Margaret Thatcher,
but that's not a ...

she isn't the cause
of the problem in the world,

we are, we men need
to get our acts together.

So, you know, I feel so
privileged to be ...

You know, I haven't watched
a TV show in 35 years, okay?

I read 100 - 150 great books
of history a year,

and my sons work with me,

I'm in a revolution,
and I can see that by ...

you know, today, medical students
here gave me a proposal,

and they say our work influences them,

and I've had a chance to see,

from thousands, hundreds
of thousands of letters saying,

"Because of your work, we're doing this."

We didn't set out for that.

We actually set out to have a hospital
but we failed at fundraising,

we are the worst fundraisers
in American history.

Last June, in our 41st year,

a project I thought would take
four years to build,

we started building
our first big building.

So, I want to dispel the ...

Hard is doing what you aren't.

Hard is working in a job you hate,
in a marriage that sucks,

When you look in the mirror
and you are not going, "Oh baby!"

(Laughter)

You know, just, the next week,

every single time you pass by a mirror,
go: "Oh yeah! Me!"

Because once you love yourself,

what anyone ever says
about you doesn't matter.

You're actually never thinking
about it because you love yourself,

you are wondering how to spend it.

(Applause)

Thank you!

Host: Alright, thank you very much.

(Applause)