Play in Healthcare for Adults

Using play to promote health and wellbeing across the adult lifespan

Alison Tonkin, Julia Whitaker, Alison Tonkin, Julia Whitaker

• Publisher: Taylor & Francis
• Year: 2016
• Print ISBN: 9781138931237
• eBook ISBN: 9781317395393
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

PLAY. We all do it: wordplay, love play, role-play; we play cards, play sport, play the fool, and play around. And that's just the grown-ups! It features in every aspect of our lives, whether we call it by that or another name. We all do it, but why do we do it? What does it mean to play and what, if any, difference does it make to our lives? Most crucially, and central to the theme of this book, is the question, 'Does play have a positive impact on our health and wellbeing, and consequently a role in modern healthcare delivery?'

The contributors to this book provide a comprehensive overview of how play and play-based activities can be used throughout the adult lifespan to promote health and wellbeing within the context of healthcare service delivery for patients, their families and communities, and for the staff involved in their care. Responding to current global health concerns such as obesity, coronary heart disease, dementia and mental health, the book argues that play and playfulness offer a means of protection, promotion and recovery of positive health and wellbeing. The human tendency for play and playfulness as essential to personal growth and development lie at the heart of the discussion.

This book will be of interest to all those working in health or social care settings, including nursing, social work and allied health students and professionals and those working within the therapeutic disciplines of art therapy, music therapy, and recreation alliances.

1

PLAYING FOR HEALTH

Julia Whitaker and Alison Tonkin

Play, we all do it: wordplay, love play, role-play; we play cards, play sport, play the fool, and play around. And that’s just the grown-ups! Play features in every aspect of our lives, whether we call it by that or another name. We all do it, but why do we do it? What does it mean to play and what, if any, difference does it make to our lives? Most crucially, and central to the theme of this book, is the question, ‘Does play have a positive impact on our health and wellbeing, and consequently a role in modern healthcare delivery?’

Exploring play in an adult world

There have been many and various attempts to define the meaning of play – mostly in the context of childhood development and learning. Definitions include: play as an innate characteristic necessary for the survival of the species (Groos 1901); play as an outlet for surplus energy (Schiller 1795 [2012]); play as a means of achieving mastery or power (Freud 1920); and play as a key stage of social and cognitive learning (Piaget 1962; Erikson 1965). The definitions of play are as diverse as the variety of play phenomena that fall under that heading – from daydreaming (playing with thoughts and ideas), military re-enactment (playing at soldiers), stand-up comedy (playing with convention), to skate-boarding (playing at youthfulness).

Almost anything can allow play to occur within its boundaries.

(Sutton-Smith 1980)

What all theorists seem to agree upon is that play is a crucial feature of both animal and human existence, endowing life with an essential element of self-determined pleasure, creativity and generalized enhancement (St Clair 2005). Brown and Vaughan (2009) re-state for the twenty-first century the notion that play is as important to the human condition as breathing, an energizing life-force that maintains its importance throughout the lifespan.

I sometimes compare play to oxygen – it’s all around us, yet goes mostly unnoticed or unappreciated until it is missing.

(Brown and Vaughan 2009: 6)

Kets de Vries (2012) proposes that play has been essential to the survival and evolution of man from his earliest emergence in prehistoric times, as depicted in the cave drawings found in France and Spain. Noting the care and attention to detail within these drawings, Kets de Vries (2012: 3) explores the motivation behind them, asking ‘were these ancient scrapings and paintings the sophisticated creations of serious artists or merely the playful graffiti of Palaeolithic teenagers?’

Play theorists of the modern age, since the time of the European Enlightenment and the Romantic period, have tended to emphasize play as a means to personal growth and development at the start of life. Rousseau (1712–78), Pestalozzi (1747– 1827) and Froebel (1782–1852) have all contributed to an understanding of play as a learning tool belonging to the early years, yet play ‘inhabits all spheres of human activity’ (Huizinga 1949). Play and playfulness are evident in our cultural legacy from the most primitive times and the earliest portrayals were certainly not childish matters. The play depicted in word (e.g. Shakespearean comedies), art (e.g. the Kama Sutra) and architecture (e.g. the grotesque gargoyles of medieval church architecture) are distinctly adult representations of play.

If we accept the popular premise that play is about growth and adaptation to one’s social and emotional environment, we might also question why adults continue to play once fully grown and adapted. This might be explained by Erikson’s (1965) playful suggestion that, whilst children move forwards in their play, adults move sideways. Sutton-Smith (1997) offers a complementary construction of play: as a waiting game, a pastime and as a means of generating positive feelings at times of hardship and adversity.

Play is also a means by which the individual seeks personal actualization or the attainment of existential completeness. In the fifteenth letter of ‘On the Aesthetic Education of Man’, written in 1795, Friedrich Schiller (1795 [2012]: 80) writes of play,

man only plays when in the full meaning of the word he is a man, and he is only completely a man when he plays.

Schiller proposes that play represents the supreme expression of the human spirit, reconciling the artificial divisions for which civilization is responsible. Schiller (1797 [2012]) divides the creative impulse into three sense drives: the desire for sense, the desire for form and the desire for play. He calls play (Spieltrieb) the ‘salvation’ of the other two in that it integrates reason and sensation and synthesizes from their union the true essence of humanity.

We play because we want to and because we can, not because we have to. What seems to make an action or activity playful is the absence of functional necessity and a creative disregard of the established order. Consider the commonality of theme and style in the rough-and-tumble play of young mammals and the hilarious clowning of the great comics of the silent screen.

In The Ambiguity of Play, Sutton-Smith (1997) offers one of the most comprehensive reviews of the literature on play in the form of Seven Rhetorics of play which serve to organize and extort the meaning of play in all its various forms. This attempt to create some coherence in the field of play theory, by clarifying the cultural rhetorics, or ideological narratives, that underlie the various popular play theories is a concept which lends itself to the consideration of play as concomitant to health and wellbeing.

1 Play as progress generally applies to the play of children and is seen primarily in terms of imitative development rather than pure pleasure. This includes theories of play as adaptation, training for life and socialization.

2 Play as fate or destiny contrasts with the popular notion that play incorporates an element of free choice. This, the oldest rhetoric in historical terms, is reliant on a belief that both human life and play are in the hands of the gods or of Fate – except through the use of magic or prayer to achieve mastery over life’s circumstances. The current popularity of games of chance (office sweepstakes, lotteries and online gambling) would fall in this category and implies that play can be passively voluntary even when it involves risk-taking.

3 Play as power, as a route to glory, status and belonging (Huizinga 1949). This is play as usually applied to sports, athletics and interpersonal competition and relies on the notion of conflict as a route to hero-status. This bracket might also include Freudian intrapersonal explanations for play as mastery over both emotions and the other.

4 Play as identity as it applies to traditional community and seasonal festivals and celebrations, confirming and promoting membership or ‘belonging’ within a community.

5 Play as a representation of the imaginary embraces playful improvization in literature and the arts, as well as play as a route to creativity and imagination. Sutton-Smith includes in this rhetoric the fantasy play of childhood, highlighting the inversion and irrationality that is typical of play’s flexibility. This is enacted in the clowning and nonsensical performance evident in contemporary comedic displays.

6 Play as self-satisfaction, as a form of fun, relaxation and escapism: hobbies and high-risk sports fall into this category.

7 Play as frivolous, as a deviation from the ‘work ethic’ view of play as significant and purposeful. Historically tricksters and fools, ‘the frivolous’, were protagonists who enacted playful protest against the status quo; the court jester, the heckler, the class clown.

Play and the playful

A distinction is often made between play (which is well organized, eagerly pursued and valued) and playfulness (which refers more to a mood of light-heartedness, recklessness and humor). Play may incorporate the playful but playfulness is not necessarily fundamental to a definition of play. Whitehead (cited in Moyles 1994), writing in the context of childhood education, outlines the dichotomy between play and fun and questions whether or not all play needs to include an element of the latter. This view contrasts with a growing recognition of the need to incorporate fun into the delivery of healthcare for children (Carter et al. 2011) and the emergence of clown doctors within both pediatric and elderly care over the last five years (Ford et al. 2014). There is a growing evidence base of efficacy which suggests that fun is a necessity rather than an optional extra (Tonkin 2014a). The idea of play as fun suggests an element of light-heartedness and superficiality, which is now being utilized to boost productivity and innovation in the workplace, enabling workers to take more creative risks (Robinson et al. 2014).

However, the evidence also exists to suggest that much play can be quite the opposite of fun (Henricks 2008). Consider the intensity of a chess game or the risk inherent in certain adult role-play scenarios. This so-called ‘deep play’ (Geertz 1976) which subverts authority and often makes a play for power, as exhibited in many forms of creative activity as well as in games of chance and the high-risk play of gamblers and sky-divers, might not be included in the lexicon of ‘fun’ activities yet this pushing of acceptable boundaries may be critical to what it is that makes life meaningful and worthwhile. Deep play distances the individual from the practical demands and constraints of their particular circumstances, creating a separate and personal space – what Winnicott (1971) calls a ‘third area’ where one can truly be oneself.

What becomes evident is that definitions of play may lie in the experience of the player or within the characteristics of the play itself (Smith and Vollstedt 1985). Children – the experts in this field – tell us that play is about pleasure, voluntariness, friends, and the outdoors – and not about work (Nicholson et al. 2014).

Defining play

Despite the rich history and the celebrated diversity of adult play (Henricks 2008), its value and associated benefits are often ‘vastly underrated’ (St Clair 2005). For many commentators, the difficulty lies in the use of the term ‘play’ and how the definition of play links to the associated activities. For example, Kuschner (2010) questions Brown and Vaughan’s (2009) conceptualization of play noting that ‘the activity of climbing cliffs or baking bread may be satisfying, rewarding, enjoyable [and] intrinsically motivated … all qualities that can be associated with play – but are they necessarily examples of play’ (Kuschner 2010: 375). This shows how trying to provide a single working definition of play can lead to an overextension of play as a concept which ultimately minimizes its clarity and usage. Climbing and baking bread have much to offer in terms of the enjoyment and therapeutic value they provide for the individuals concerned and supply a rationale for the integration of leisure and recreational activities when considering what may contribute to the health and wellbeing of adults.

Broadening the scope of activities beyond play still results in difficulties when it comes to providing standard definitions. Hurd and Anderson (2011) suggest that the benefits of defining the concepts of leisure, recreation and play lie in the provision of firm foundations on which services, facilities and programs can be built. Hurd and Anderson provide a useful overview of the differing concepts, which also necessitates the breaking down of leisure into three primary areas, as defined in Table 1.1.

Although the clear differentiation of what constitutes play, leisure and recreation has been made, it is still difficult to compartmentalize the differing concepts. This may also detract from the content that is being explored and in many ways is unnecessary for a book of this nature. Therefore, whilst acknowledging there is conceptual variation, the word play is predominantly used herein as a generic term, unless the terms leisure and/or recreation are specifically used for contextual purposes.

The benefits of play for health throughout the adult lifespan

Play is considered to be ‘fundamental to the health and wellbeing of individuals and communities’ (Playwork Principles Scrutiny Group 2005). This ‘principle’ relates to children and young people but there is an emerging body of evidence that demonstrates the efficacy and necessity of play for adults.

TABLE 1.1 Definitions of leisure, play and recreation (Hurd and Anderson 2011)

Concept	Definition
Leisure as time	Leisure is a time free from obligation, work (paid and unpaid), and tasks required for existing (sleeping, eating).
Leisure as activity	Leisure is a set of activities that people engage in during their free time – activities that are not work-orientated or that do not involve life maintenance ta...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of illustrations
• Foreword
• Acknowledgements
• Contributors
• Introduction
• 1 Playing for health
• 2 Conceptualizing play in healthcare provision
• 3 Lifespan development
• 4 Creating and growing a family
• 5 The concept of health and wellbeing across the lifespan
• 6 Using play as a means to widen access to health and wellbeing
• 7 Lifestyle trends and their impact on health
• 8 Playing for mental wellness
• 9 Music as medicine
• 10 The game of chamber music in dementia music therapy
• 11 Drama, dance and play: creative play as therapy
• 12 Art for health
• 13 Play and social therapy
• 14 Playing with words
• 15 Playing with technology
• 16 Aspire Leisure Centre: inspiration through integration
• 17 The facilitation of play and playfulness through alternative healthcare provision
• 18 Playful design
• 19 Playing together: festivals and celebrations
• 20 Playing for spiritual health
• 21 Using play for lifelong learning
• 22 Playing politics
• 23 Playing for health, wealth and happiness
• Index