- June Rabson Hare

Midreshet Ben-Gurion, Negev, Israel 84990.

As with the application of all drama to social issues, when one looks into the history, one finds that the father of psychodrama and sociodrama, J. L. Moreno (1889-1974) has been there before. Thus too with ethico-drama.He used the term axiodrama as early as 1918 to refer to "the activation of religious, ethical and cultural values in spontaneous-dramatic form." (Moreno, 1953, 1978). Further back of course one has only to look at ancient Greek theatre and later morality plays for themes of social and moral ethics. However, it is true that these were what Moreno would refer to as artistic "cultural conserves" and not a context for personal exploration and relevance of timely themes.

It is certainly true too that the literature is very sparse, with hardly anything published and very little done formally with the use and applications of role playing, sociodrama and improvisation in the field of bioethics education. Where it was used it has been described with enthusiasm and vigor (Sofaer, 1991) I myself have used these methods in informal class presentations, at conferences and meetings, to focus on specific themes, to promote sensitivity and awareness of issues, and in exploring decision-making alternatives, and am convinced of the contribution they make (Hare,1991, 1992).

These are some of the ways that action methods, role playing, sociodrama, drama, improvisation, active story telling and psychodrama or psycho-dramatic techniques have been used in education and professional training and could be applied to topics of concern to bioethics.

1. As in the article being discussed, the use of published texts, or texts created from improvisation or written so as to incorporate different points of view or tensions to be used as starting off points for discussion. These can be used in a structured fashion wherein the texts are "performed" by persons whose roles have been assigned before-hand, or in a spontaneous fashion where the texts provide the context for participants to explore, move off at tangents, improvise in a more extended impromptu fashion. Biblio-drama, or texts from the Bible, might be used for illustrative, or stimulus material. (Pitzele, 1995) Similarly, biblio-drama, with a small "b", is the format which employs published texts or sections of suitable books or plays for stimulus or context.

2. Role playing of typical situations confronted in medical settings, fraught with moral issues and difficult decision-making priorities. These situations might also be structured in advance, or be drawn from student or practitioner's own experience and enacted with role "players being drawn from the participants present. "Role training" would be the term applied to situations which the participants are anticipating having to confront in the future or for which they want to try out in a "fail-safe" manner various alternatives so that they can experience in action the different possible outcomes.The "as-if" real nature of the dramatic context enables participants to move beyond the boundaries of time-space and reality. Situations can be freeze-framed, and subjected to examination in a way that one could hardly do in a time-pressured life-and-death situation. The dramatic context provides a bridge between the outside world and the safety of the action space in which experimentation with action steps and consequences may be made with no risk. Thus not only a bridge between medical humanities and literary and performing arts as is suggested by the contributor of "Ethico-Drama" but also between the real and the close-to-real. Feelings, emotions and situational dynamics of the role-played reality not only approximate but are similar to those in the "real" world. Herein lies one of the foremost values of the dramatic medium for such experiential learning.

2. Active exploration of situations or events in which participants have personally been involved in the past. Such situations can be replayed, and "re-visited", perhaps in a slow-motion fashion with the use of psycho-dramatic depth and enhancement techniques for looking beyond, below and within for insight, and possibly for internal resolution, ventilation and relief.Social and ethical themes might be teased out and examined and decisions or action steps taken replayed or done different.

The dramatic medium is flexible and adaptable. It sharpens focus and condenses symbolic themes into observable common data, stimulates discussion and involvement, humanises and individualises, and makes abstract themes personally relevant and enables practise by learning-by-doing rather than discussion only. It stimulates spontaneity and creativity and can make learning and grappling with difficult issues enjoyable and meaningful. These might be dismissed as the claims of an "afficianado". However, these claims are indeed backed up by objective research and empirical data. (Corsini,1966; Blatner,1973; Kipper,1986)

References

Blatner, H. A (1973) Acting-In: Practical Applications of Psycho-Dramatic Methods, New York: Springer.

Corsini, R. F (1966) Role Playing in Psychotherapy, Chicago: Aldine.

Hare, J.R. (1978) "Breaking the News".Psychodrama session. Conference of Family Physicians's, Cape Town.

Hare, J.R. (1990) "The story of Sarai, Abraham and Hagar as structure for exploring issues of surrogacy and infertility". Lecture, action presentation at Hadassah Conference, San Diego.

Hare, June Rabson (1994) "Sociodrama of medical decision-making"Lecture, action presentation, Soroka Hospital, Beersheva.

(Hare), Rabson, J. S (1979) Psychodrama: Theory and Method, Department of Sociology, University of Cape Town.

Sofaer, Beatrice (1991) "The Ethics of Pain Management: Educational and Communication Issues for Health Professionals" Lecture, 4th International Congress on Ethics in Medicine, Jerusalem.

Moreno, J. L (1978) Who Shall Survive? New York: Beacon House, p.xxvi