Using Puppets to Help Future Docs Understand Chronic Pain

A life of chronic illness shaped this artist’s perspective. Today she uses puppets to help medical students and clinicians learn about personal care and gain insight into their chronic pain patients. 

Marina Tsaplina at workThe challenges of type 1 diabetes taught performing artist Marina Tsaplina a few things about living with a chronic condition. Her interest in puppet theatre started during a trip through India when she was a teenager. Later she worked as a puppeteer in various theatres which led her to develop a humanities course for medical students.

Marina Tsaplina, who was just 2 years old when she was diagnosed with type 1 diabetes (T1D), says that her life-long experience of living with an invisible disability shapes her work as an artist and a puppeteer.

“You know how a tree has all these rings and as it ages, the rings reflect many things?” she explains. “The tree’s rings reflect environmental stress, the sun, the whole history the tree has lived. The same is true for humans. Our bodies hold and reflect our history.”

All too often, she says, this history is ignored by doctors. “We are not taught by clinicians to relate to our bodies as living, breathing, historic forms,” Marina says.

More Than a Calculator: How T1D Forged A Personal Path

As a child, Marina says, she was taught to treat her T1D as if she were a calculator: plug in the numbers, the carb counts, and the insulin dosages. “I wasn’t taught about the emotional or mental part of having diabetes,” she says. “But having a chronic illness creates a unique imprint and a unique path for a person. It creates certain needs and strengths. And pain can be a part of it.”

In the past, the emotional and mental aspects of any chronic illness were pretty much ignored by clinicians, she says. “Medicine has a certain way of teaching clinicians to focus on the body but the bigger picture is important, too,” she explains. “Through my work, I try to add a human element to the way medicine is taught.”

Fortunately, a biopsychosocial model that incorporates the mental and economic aspects of health is being used increasingly in the care of chronic illness across many chronic pain conditions.

Marina Tsaplina giving a demonstration to future doctorsShown here in a lecture to students at Duke University in the summer of 2018, Marina Tsaplina says puppetry helps them hone their listening skills.

Marina, who grew up in the boroughs of New York City and now lives in Brooklyn, earned her Bachelor of Arts degree from the City University of New York in a program that allows students to design their own majors while being mentored by professors. 

In 2013, she founded and directed a nonprofit performing arts and health organization, THE BETES® Organization, and led that group until 2018. In 2016, she was selected as a Kienle Scholar in the Medical Humanities at the Penn State College of Medicine, where she began to develop her curriculum,  Embodiment and Puppetry to train medical students and practicing clinicians.

The Transformative Power of Puppets

Today, Marina offers ongoing workshops around the country to med students and undergrads who are preparing for medical school and she works with patients, too. Her core program, called Embodiment and Puppetry for Health Education, trains medical students in theater exercises, movement, and puppetry. They learn group improvisational exercises, puppet animation, and how to hone their listening skills to help better understand and work with patients.

“We had to learn how each puppet body moved, and how to meet the puppet’s needs rather than force its limbs to move in an unnatural direction,” one student noted in an anonymous student evaluation of the course.

The goal of the workshops, she says, is for students “to gain a deeper disability consciousness, become aware of unconscious disability bias, and attend to their own bodies so that they can provide equitable care with self-compassion.”

showing students how to work with puppets"If we can imagine our bodies as a house with many doors, rooms and windows, the arts provide a different door that can help bring insight other mediums can't," explains Marina who helps medical students understand the experience of pain through puppets.

Learning to Understand Patient Stories

A few years ago, she was invited as an artist to present at the Breath Body Voice: Health Humanitiies and Social Justice conference held at Duke University. It was there that she met Raymond Barfield, MD, a pediatric oncologist. "Dr. Barfield reached out to me because he had nopticed my puppetry work on my resume and though puppetry might be a good vehicle for humanizing and restoring embodied care to the practice of medicine," Marina explains.

At Duke, where she is a visiting artist and scholar, she helped to develop Reimagine Medicine. (Still a New Yorker, Marina spends several weeks at a time at the university.) The ongoing program teaches undergraduate students who intend to enroll in medical school everything from performing arts and improvisation to expressive writing and spirituality—themes frequently not explored in traditional medical school education, Marina notes.

Watch Puppetry in Medicine Video to See How Art Informs Science 

She also leads the students through intensive exercises in puppetry and holds summer programs. (During the pandemic the courses were held virtually.) “Puppetry is a medium through which you can explore many difficult situations,” she says. “You can animate all kinds of experiences with puppets. It’s kind of like storytelling but with your whole body.”

The medical students learn to operate puppets, and working on puppetry animation helps them develop listening skills, teamwork, and communication so they can better hear their patient’s story, Marina says.

And being aware of a patient’s story is key, she tells her students.

“We don’t know how to bring comfort to our bodies, which carry the history of our lives, thoughts, and experiences. We need to bring a sense of ease to the body and release whatever trauma or pain might come up. This is what my workshops can help with.”

Marina’s overreaching goal is to improve the lives of individuals who live with chronic illness and disability. “For someone with diabetes like myself, insulin grants us access to life but it doesn’t give us the tools to live well,” she says. “And this is true of many medical diagnoses. In medical school, students don’t learn how to help a patient flourish with the medical condition that they have. I am trying to change this.”

Marina is in the process of launching her new website. To learn more about her work in the meantime, you may follow her on Twitter. You can sign up for her newsletter or book her for a workshop by emailing her at 



Updated on: 11/13/20
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