Aparna Sindhoor and Teestri Duniya Theatre Image: Montreal Life Stories Project

Arts therapies and the refugee crisis

Associate Professor Nisha Sajnani, from CATRU partner Lesley University, argues for the role of arts therapy in the refugee crisis

The following is an edited extract of Dr Nisha Sajnani’s speech, Arts, identity, and healing in the context of the refugee crisis, at the launch of the University of Melbourne’s Creative Arts Therapy Research Unit (CATRU) on 4 August, 2016. You can also read an interview with Dr Sajnani.

In the context of humanitarian crises, “is art just a frivolous distraction, or can it be used to heal and unify?” That was a question asked by our colleagues at the British Council of the Arts. I think the answer is “both” – although I wouldn’t say “frivolous”.

Making art in all its forms can provide a necessary distraction from the travails of everyday life. But it can also reduce anxiety, break isolation, and challenge the status-quo. The arts therapies involve the intentional use of artistic practices such as drama and theatre, dance and movement, music, writing, and visual art to reduce distress and promote health and wellness in a variety of contexts.

This topic is meaningful to me as the daughter of parents who sought refuge in India, and later emigrated to Malaysia and Canada following the Partition of India, Pakistan and West Bengal.

I found a place to express my voice in the theatre. Each role I played offered new insights and embodied new possibilities. Ensembles that I was a part of or directed offered an experience of belonging.

The Living Histories Ensemble perform as part of the 2011 Commemoration of the Rwandan Genocide. Montreal, Canada. Image: David Ward
The Living Histories Ensemble perform as part of the 2011 Commemoration of the Rwandan Genocide. Montreal, Canada. Image: David Ward

Themes relating to identity, migration, violence, place, beauty, ethics, and memory are threaded throughout my artistic and written scholarship.

DISPLACEMENT

Let’s start with some background information on displacement and its effects and then provide a framework and examples of research on the arts and arts therapies with refugees. Many of these examples and more may be found online through a network I host on the arts and displacement.

The office of the United Nations High Commissioner for Refugees (UNHCR) estimates that there are more than 65.3 million forcibly displaced men, women, and children. We are surrounded by images and headlines that reveal contradictory narratives about who has been affected and about how host communities should respond.Dominant narratives tend to reduce public discussion about displacement to the current humanitarian crisis.

Refugees are often cast as burdensome threats to national identity and economy or vulnerable victims in need of intervention.

This binary formulation dismisses the complexities of what it means to be displaced and what it means to belong. It also neglects internally-displaced persons who have struggled to assert their rights over generations before this current crisis, and reveals an empathic deficit in the conversation and a need for shared responsibility.

DEFINITIONS

So what is displacement? And who is a refugee?

The following definitions, taken from the UNHCR, may offer clarification:

An asylum seeker is a person who has fled from his or her country and seeks legal and physical protection (asylum) as a refugee in another country.

refugee is a person who has fled his or her country and cannot return because of a well-founded fear of persecution due to race, religion, nationality, sexual orientation, gender, political opinion, or membership of a particular social group.

Persecution occurs when human rights violations or threats are sustained or systematic, and governments either fail to protect, or in some cases actively participate in the violations.

An Internally Displaced Person (IDPs) has not crossed a border to find safety. Unlike refugees, IDPs are on the run at home. While they may have fled for similar reasons, IDP’s stay within the borders of their lands and remain under the protection of their government even if that government is the reason for their displacement.

As a result, they are among the most vulnerable to exploitation and violence. Using this definition, many Indigenous groups would fall under this category.

Migrants often choose to improve their lives by finding work, opportunities for education, family reunion, or other reasons. Of course, their choice to move may be motivated by disparities in their home countries.

Immigrants are defined by their choice to settle in the country that they move to.

Of course, with all of those definitions, it is important not to lose sight of intersectionality. Refugees, for example, are never just one thing. They are not a monolithic group but also consist of caregivers, adolescents, older adults, children, skilled professionals, people of differing abilities, artists, people with different gender identities, faiths, sexual orientations, and social status, etc.

THE IMPACT OF DISPLACEMENT

The experience of being dislocated from or within one’s homeland will differ depending on many factors, such as the nature and duration of suffering, the relationship to the perpetrators of violence, the presence of preceding traumatic events, and their experience post trauma.

Time also has an impact over how the experience of displacement and resettlement is expressed over generations.

In the case of asylum seekers, the ways in which people are treated upon arrival will affect their attitude towards their host counties and trust in the institutions and people around them. Other social and economic factors that influence matters include the presence of support before, during and/or after the event(s), and the visa status individuals are granted.

The Refugee Health Service (RHS) of New South Wales has put together an excellent resourcedetailing the persecution faced by displaced persons in their home countries while seeking safety in exile, and as they encounter host communities.

Here are some highlights from the RHS’s 2004 publication Working with Refugees: A Guide for Social Workers:

  • Their education and careers will have been disrupted.
  • Many will have experienced or witnessed torture and/or a denial of their human rights to self-determination, work, movement, education, property, leisure, and/or cultural expression.
  • Many will have left without opportunity to say goodbye to loved-ones or pack their belongings.
  • Some will have lost family members and friends in the search for safety.
  • Life in refugee camps is often overcrowded, with food shortages, poor medical care and few opportunities for education, religious practice, or work.
  • Sexual assault and other forms of gender based violence is endemic in many camps.
  • Refugees who spend time in detention have twice the risk of depression and three times the risk of traumatic stress compared to refugees who do not. Those with temporary protection visas have seven times the risk for depression and post-traumatic stress disorder compared to refugees with permanent protection visas.
  • Many are at increased risk of experience isolation as a result of not knowing the language or cultural norms of host countries and as a result of the traumatic event(s) themselves.

MORAL CRISIS

It is also critical to examine the impact of displacement on first-responders, caregivers, and host communities. When presented with the enormity of this crisis, it is only natural that each one will be affected. I have heard this referred to as a moral crisis; a period of reckoning in which we come to question our own sense of stability, safety, and responsibility to each other.

You can find further research on the impact of displacement through the Harvard Program in Refugee Trauma (HPRT) and through the refugee studies program at the University of Melbourne.

The Soldiers Shoot, The Husband Drinks. Image: Common Threads Project
The Soldiers Shoot, The Husband Drinks. Image: Common Threads Project

RECOVERY THROUGH THE ARTS AND ARTS THERAPIES

I will use the H5 Model of Trauma and Recovery developed by the HPRT as a framework to present research on the use of the arts therapies with refugees, caregivers, and host communities. This framework highlights five overlapping dimensions essential to trauma recovery from studies of refugee populations.

These include attention to humiliation, health promotion, habitat and housing, healing (self-care), and human rights. At the centre of these overlapping dimensions is the trauma story.

First, a word about recovery. Recovery may not seem like an appropriate word in that the experience of loss is paramount for someone who is forcibly displaced. One cannot always regain what is gone or repair what is broken.

I use recovery here to signify the process of developing a new relationship to one’s own person, to other people, to place, and to purpose. Central to this process is the experience of transitioning between the known and unknown, between isolation and social support, and between despair and hope.

Trauma stories, in the words of HPRT director Richard Mollica, “are stories told by survivor patients of distressing and painful personal and social events. Sharing these stories serves a dual function not only of healing the survivor but also of teaching and guiding the listener – and, by extension, society – in healing and survival”.

Arts therapists offer a means of symbolic communication to enable a person or group to access their stories safely. As one art therapist put it, “when trauma happens, children draw”.

The use of art and imaginative play can give people who have experienced unspeakable events an avenue for expression. From a neurobiological perspective, non-verbal approaches can be particularly effective as the capacity to connect feelings with language often compromised by trauma. In another project led by Dr. Rachel Cohen, weaving and textiles are used to support survivors in weaving together a sense of meaning.

Sometimes, myths and fictional stories help us make sense of terrifying events like this comic book created by Svang Tor and Dr. Richard Mollica to help survivors and descendants communicate the circumstances of living under the reign of the Khmer Rouge in Cambodia.

Nairobi-born London-raised poet, Warsan Shire, found expression through writing and poetry. She captures the experience of being a refugee in the first few lines of her poem:

no one leaves home unless
home is the mouth of a shark
you only run for the border
when you see the whole city running as well

Of course, it is important to remember that these aren’t the only stories people carry. As one man reminded me in a project in which the oral histories of survivors of genocide were transformed into performance, “people are not their trauma”, and spaces to share irreverent, humorous, hopeful stories were just as important to share as stories about fear and loss for, in his words, such stories gave him the “strength to endure.”(Sajnani, 2011).

It is also important to remember that silence and a return to tradition may be valued over disclosure in some cultures (Rousseau and Measham cited in Kirmayer et al. 2007).

Caregivers and first-responders also use the arts to give expression to suffering. Such was the case with Martin, a music therapist pictured here with a small lifeless child who remains unidentified.

He said: “I began to sing to comfort myself and to give some kind of expression to this incomprehensible, heart-rending moment. Just six hours ago this child was alive.”

HUMILIATION

Humiliation is the result of violent acts as perpetrators of systemic and interpersonal harm communicate to their victims that they are worthless. Quoting Mollica again:

“Humiliation leads to a total loss of self-respect and can have major impacts on a refugee’s personal and social behaviour, being associated with learned helplessness, leading to a lack of self-efficacy. Often, the state of humiliation is re-created in the camp environment when individuals are not allowed to work, grow food, or make money.”

It is so important for each of us to feel like we have value. Strategies involving refugees with agricultural, culinary, medical, or architectural skills, for example, can remind us that people are more than their legal status.

Initiatives such as the Ownership Project and the Refugee Art Project bring the artwork made by refugees to wider audiences in ways that serve to counter isolation, educate the public, and support the transition from the identify of refugee to that of artist.

Recovering cultural forms that were suppressed during collective violence is one way to assert one’s right to belong in the world.  Bringing artists into an exchange with host communities – such as the Somali community in the USA through the Midnimo project or through the Here and Away photo voice project in Canada – can also help to reduce stigma and facilitate relationships based on collaboration, understanding, and mutual respect.

HUMAN RIGHTS

Human rights, as an area, are often overlooked in therapy but are critical as all forms of violence violate a person’s human rights. The right to have past and present experiences of violations recorded and acknowledged is necessary to the pursuit of justice. Justice is a part of healing.

Also implicit in a human rights approach is cultural safety, a term I recently heard used by Richard Frankland, director of the University of Melbourne’s Wilin Centre for Indigenous Arts and Cultural Development.

For example, an art therapy project led by Dr. Savneet Talwar and Sophie Canadé in the USA took the form of a knitting group for women who survived ethnic cleansing in the Bosnian War. Knitting is a culturally embedded form of expression for this group.

In this case and in many instances, this work necessitates translation so that people are able to speak in their chosen language.

HEALTH PROMOTION

Research demonstrates that people who experience adverse events are more likely to die younger, develop chronic illnesses and serious social disabilities.

“Trauma survivors have poorer behavioral health, smoke more, use alcohol and drugs more, exercise less and have poorer eating habits resulting in obesity and the metabolic syndrome. All are risk factors for the development of chronic disease. In other words, trauma generates chronic disease through direct effects and indirect effects through mental illness (PTSD & Depression) and impaired lifestyle” (Mollica, 2014).

The use of puppets, performances, and visual art have been used in refugee camps to raise awareness about health and safety.

Aparna Sindhoor and Teestri Duniya Theatre Image: Montreal Life Stories Project
Aparna Sindhoor and Teestri Duniya Theatre Image: Montreal Life Stories Project

HABITAT AND HOUSING

The HPRT uses the word habitat to communicate the totality of the healing environment that is occupied by refugees and traumatised communities. Several groups are exploring the therapeutic use of gardening and camp design to confer a sense of dignity to an often chaotic environment.

Through my work with the HPRT, I have been examining how caregivers cultivate and endeavor to create healing environments.

In a recent project, Mapping Home: A Global Crisis of Place, I co-curated a selection of photographs from 507 first responders and resettlement specialists who were invited to submit a photograph of what constitutes a healing environment for them as they engage in the work that they do.

More than 65% of the photographs depicted scenes from nature which, to me, highlights our responsibilities to sustain that which sustains us. Climate change and displacement are interrelated issues.

HEALING

Finally, healing, in this context, refers to overall psychological, physical, spiritual, economic, and social health. Our self-healing resources are activated when injured and our neurobiological processes enhanced when reinforced by social support, altruism, work, humour, exercise, and spirituality.

Per the H5 model, “one of the first steps of a traumatised person’s recovery, whether child or adult, is to break his or her social isolation by acknowledging that the forces of self-healing are at work and will ultimately lead to a good outcome, including the return to normal life.

“In this regard, helpers are essential because they can use their empathic skills to reinforce this therapeutic optimism in survivors” (Mollica, 2014).

Here the arts and arts therapies may be particularly useful as a way of promoting a perspective on trauma as a source of powerful transformation and growth.

Dr. Cecile Rousseau and drama therapy colleagues from the Transcultural Psychiatry Institute and the children’s hospital  conducted a study using Playback Theatre to support the adjustment of newly arrived adolescents in public schools.

They found that using the structure of this non-scripted theatrical approach “provided a safe environment for expression while not forcing it, allowing children to relate their experiences indirectly through the use of metaphor” and that hope and empowerment arose from the “recognition that learning and growth can come from enduring suffering, witnessing the suffering of others, and experiencing solidarity” (Rousseau and Measham, 2007).

Hillary Rubesin (and colleagues), a current doctoral student who I supervise, drew similar conclusions in a study examining the potential of art therapy with Burmese adolescents resettling in the USA.

THE NEED FOR FURTHER RESEARCH

From a skill-base that integrates intra and interpersonal care with a nuanced understanding of creative expression and aesthetic reception, arts therapists provide useful insights into how art can support healing in the aftermath of collective violence, especially when practised from within a human rights framework.

Attention to the overlapping facets of the H5 model means that therapy (which is often stigmatised and/or seen as a luxury) does not always look the way one might expect.

We need to continue to develop an evidence base for how the arts therapies are specifically making a difference in the lives of those who are displaced, those who care with and for them, and for host communities.

I look forward to advancing our understanding through the programs that I oversee at Lesley University and through our collaboration with the University of Melbourne’s newly-launched Creative Arts Therapies Research Unit.

Dr. Nisha Sajnani, PhD, RDT-BCT is as Associate Professor; Program Director, Global Interdisciplinary Studies; Coordinator, Clinical Mental Health Counseling: Drama Therapy program; and Advisor, Expressive Therapies PhD program at Lesley University. She is also on faculty with New York University where she teaches Arts Based Research and with the Harvard Program in Refugee Trauma. 

Banner image: Aparna Sindhoor and Teestri Duniya Theatre/ Montreal Life Stories Project