Tears of a clown

It's occasionally said that stand-up is the hardest job in the world. (It isn't, as Stewart Lee has pointed out.) So what would happen when a stand-up - albeit a rather unique one - swapped theatre audiences for hospital wards full of sick children, as was the case in BBC4's excellent Nina Conti: Clowning Around?

Like most of us at some point in our lives, ventriloquist Conti had the urge to do something a bit more worthy than her day job (making audiences laugh by good-naturedly humiliating people on stage), and thought that her act with puppet Monkey would lend itself naturally to entertaining children. Upon enrolling in training to become a hospital clown - or "giggle doctor", to use the preferred nomenclature - she received her first blow: Monkey would need to be regularly hot-washed on infection control grounds and so couldn't be part of her routine.

The documentary traced Conti's experiences shadowing fully trained clowns and trying to find her own clown identity, without Monkey and without a great deal of success. Her proficiency in stand-up turned out to count for very little indeed, and she was frustrated by her inability to be funny, her confidence and self-assurance visibly waning. In the job, both sensitivity and emotional robustness are essential, and she had too much of the former and not enough of the latter. You could see she was upset by the predicaments of some of the children she encountered, and genuinely hurt when her attempts to provoke laughter had quite the opposite effect. It got to the point where she couldn't carry on - all of which underscored quite what a remarkable job the professionals do.

Conti wasn't the only one undergoing a crisis of confidence and identity, though. During the course of the two years over which the documentary was filmed, Theodora Children's Trust, the charity through which she was training, opted to remove all references to clowns and clowning from their work. The decision was met with great sadness by many of the giggle doctors (and, by implication, Conti herself), but was taken as a result of the negative image of clowning among medical staff, some parents and, most importantly, donors.

As Conti observed following a trip to Italy, the antipathy towards clowns is peculiarly British (in a European context, at least), our characteristic reserve preventing us from indulging in silliness ourselves or indulging silliness in others. The clowns in Italian hospitals are treated as integral members of support staff, whereas in the UK they're often perceived by nurses as a frivolous nuisance - a sad state of affairs, when you see just one child's face light up as a result of their efforts.