پارادوکس بیان وحشت کلام: مراسم آیینی و کفن در درمان هنر درمانی خلاق پریشانی پس از سانحه

Western treatment protocols for psychological trauma often prescribe recitation of narratives, despite evidence that the human brain's storage of traumatic memories undermines verbalization. Creative arts therapists overcome this paradox in trauma recovery through nonlinguistic communication. Ethnographic research among holistic groups that rely on cultural rites, rather than words, as instruments of healing in the wake of massive violence can enrich creative arts approaches. Relevant case material, analyzed with reference to theories of ritual structure, is used to illustrate the interplay of symbolization, ceremony, and the verbal and nonverbal among war-affected children from the developing world. Included is the author's venture into psychological syncretism in Sierra Leone. There, the fusion of locally inspired expression with dance/movement therapy improvisation facilitated recovery in a group of boy combatants.

Survivors of extreme traumatic exposure commonly exhibit difficulty recounting the terrible events they have suffered or witnessed. Nonetheless, within most psychiatric discourses, verbalizing the trauma history is deemed central to “processing” its meaning, and, in turn, to recovery from the psychological, emotional, and somatic sequelae. The contradiction inherent to this directive—to put into the logic of words experiences that utterly defy human comprehension and capacity for reason—amplifies already significant challenges to restoration after traumatic loss. Creative arts therapists may choose to sideline this dilemma on the pathway to healing, bypassing verbalization in favor of nonlinguistic modalities of communication and expression. Contemporary neuroscience largely endorses nonverbal approaches to recovery, particularly given findings about how the human brain stores traumatic memories. The readily observed difficulty that survivors often present in conveying verbally the depth of a phenomenon that even our foremost trauma researchers refer to as “speechless terror” (van der Kolk, 1996b) is rooted in brain physiology itself. There is, in fact, growing consensus that memories of traumatic exposure are stored in the brain's right hemisphere, an area identified as preverbal or nonverbal (Glaser, 2000 and Klorer, 2008). As survivors of all manner of traumatizing incidents attest, such memories are frequently experienced as inexplicably amorphous sensations and images rather than linear narratives with explicit beginnings, middles, and ends. Formed amid the exaggerated autonomic arousal characteristic in moments of extreme personal threat, traumatic memories may intrude into awareness throughout a lifetime as vague impressions that are intensely felt yet little understood. Apparently, this disorientation has its source in the human subject's initial response to traumatic stimuli (van der Kolk, 1996a). It is hypothesized that at the originating moments of terror and hyperarousal, activity decreases in the left side of the brain—the site of language and declarative memory—thereby undermining verbal processing. Specifically, hippocampal function appears to be virtually shut down, thereby challenging the brain's capacity to contextualize the associated memories in space and time (van der Kolk, 1996a). Simultaneously, Broca's area, charged with transforming subjective experience into speech, is likewise largely deactivated (Rauch et al., 1996). Thus, in resisting assimilation at the echelon of language, traumatic memories, as Piaget (1962) would have suggested, appear to be relegated to the “more primitive” somatic and visual levels of information processing (van der Kolk, 1996c, p. 289). As advances in clinical research transform developing hypotheses about the brain into a sturdy theory of the neuroscience of trauma, the rationale for nonverbal creative arts therapy interventions, which do not depend on left-brain linguistic processing, grows increasingly substantial. This paper considers the place of discursive processing in trauma treatment, specifically with regard to the creative arts therapies. It may be, in fact, that our inherited knowledge of the aptness of nonverbal treatment in response to horror forms a legacy that reaches beyond recorded time. In traditional ritual and ceremony, we find lasting expression of that heritage, handed down body to body through generations. Ethnographic research into the healing practices of cultural groups that do not as a rule rely on verbal processing may prove a fruitful source of inspiration and knowledge for the creative arts therapist who is interested in fusing evidence-based practice with the wisdom of the ages (Harris, 2002). Often informed by such ancestral traditions, the understandings of persons working to promote healing among children affected by war and organized violence in the developing world provide an unusual perspective on this broader dilemma regarding the (in)dispensability of words. Attending to interventions performed at the boundary between the wisdom of timeless traditional cultures of the global South and the neurophysiology-informed psychotherapeutic knowledge of the North may potentially bring insight to a fundamental paradox of healing: the way that, in the aftermath of collective horror, rituals in all the world's regions open up an unspoken and often symbol-laden “speaking” of the unspeakable.

Psychologists examining the conscious and unconscious strategies through which people withstand extreme adversity by and large adopt the notion that resilience is the product of a number of tangible and intangible protective factors, including a capacity to attribute meaning even to devastating events. Withstanding the worst effects of witnessing atrocity and undergoing uprooting from their homes is thought to require children, in particular, to “integrate” or make sense cognitively and affectively of what they have endured and may still be enduring. Thus, interpreting the events around them has important implications for a child's physical and psychological well-being. Engaging children's imaginative faculties, Pynoos and Eth (1986) ask those who have been witness to violence to explain not only what has happened but how they would like to have responded in the situation. In thus eliciting children's “inner plans of action” (p. 310), the authors—and others, including the Sanctuary Counselling Team in apartheid South Africa (Straker, 1987) who utilized a variant of this technique effectively—have enabled the sharing of otherwise suppressed fantasies of averting catastrophe or lessening its effects. Such work with fantasy is shown to help defend the child against serious psychological damage, and suggests the value of interventions that emphasize symbolic representations—in this case, of imagined sources of protection or strength. Researchers in other parts of the world, most notably the Middle East, see a corresponding protection afforded by ideologically informed attributions of meaning and corresponding social engagement. Such attributions, of course, imply attainment of a level of development that allows for symbolic thought. For children at earlier developmental stages, exposure may prove more problematic. Moreover, children's capacity to imbue events around them with meaning, and hence to assume an active role in symbolizing aspects of their experience, provides an important entry point and rationale for arts therapy interventions. For the creative arts therapist, attuned to working in symbolic forms, the option of supporting the mental health of traumatized children through preventive interventions designed to strengthen this protective capacity is especially apt. In cultures such as those throughout Africa and much of the global South, in which individual interests are routinely subordinated “to the good of the collectivity” (Shweder & Bourne, 1984, p. 190), the disruption of social cohesion is the terrible analogue of massive violence. Reparative processes in the wake of such rupture necessarily focus on reconstructing social order. Generally holistic as well as sociocentric, the indigenous cultures of developing countries partake of an ethos in which, as a landmark 1996 United Nations study on the impact of war on children stated, “body and mind are perceived as a continuum of the natural world” (Par. 174). Armed conflict may thrust upon such a society not only social disintegration, but also fragmentation of an utter oneness of body, thought, emotion, and spirit. Given the dualistic Cartesian belief system on which the sciences of the North are predicated, and the disengaged, etic perspective of conventional psychotherapeutic intervention, there may be scant recognition of the implications of violent rupture on the peoples of the South. In such contexts the appropriate, culturally syntonic remedy is rarely the management of intrapsychic anxiety through Western psychotherapeutic intervention, but rather, as anthropologist Englund (1998) succinctly put it, “the regaining of sociality” (p. 1166). Whereas in the North, the self is defined and bounded by the individual body, this notion of selfhood is rare in the South (Chakraborty, 1991). In cultures such as those in much of Africa, the boundaries of the body are, instead, permeable, enabling seamless connection with others, with the land, the ancestors, and the cosmos (Okeke, Draguns, Sheku, & Allen, 1999). Rituals designed to repair and revitalize this unbroken participation with the social and natural realm, thus, are body-oriented and non-discursive. Rather than representing realities in some removed, “essentialist sense” (Englund, 1998, p. 1166), these performative rituals are physically immediate enactments on the living body of the people. Investing this ritual process with an extraordinary transformative potency—relevant in the North, as in the South—is Turner, 1976 and Turner, 1977a analysis of society as a process that involves meaningful fluctuation between structure and anti-structure, or communitas. In this view, societies create rituals that may transport celebrants to the very margins of ordinary life, carrying them across its portal to a liminal space of pure communitas, the otherworldly site of a social bond that defies temporal understanding. Ritual thus ensures not so much social cohesion as social enchantment, with liminality its very center. It is through access to the liminal that collective, holistic cultures encounter the sacred and contact the promise of restitution and reintegration. In the ritual province, brokenness of body and spirit may be healed and reunified. Before returning to a revivified daily sociality, soma and psyche are annealed again as one resilient alloy. Creative arts therapists, and others seeking ways to promote social re-aggregation of the sort described by Turner (1977a), appropriate his radical rethinking of ceremonial transformation. The need for sociality, for rejoining the world of others, especially as in the context of severe disturbance consequent to exposure to the extreme stressors of mass violence, is often hampered by an experience of psychic numbing, or alexithymia, a classic PTSD symptom. The withdrawal from social interaction that is a common correlate of this experience challenges all attempts at social restoration and, hence, recovery itself. Alexithymia further hinders psychotherapeutic interventions that utilize verbal processing as a means of integrating traumatic memories. van der Kolk (1996b), in response, posited utilization of creative arts techniques as an alternative “language” that may successfully overcome the disadvantage inherent in the sufferer's difficulty conveying feelings in words. Advocating a therapy that is at once “mindful” of the present and engaged in advancing conditions for the creation of “symbolic representations of past experience” (p. 205), he inferred a path for reunifying body with mind. This renowned authority on posttraumatic treatment suggested that mindfulness and symbolization—related to identifying triggers to intrusive recollections of the inciting incident—are necessary precursors to restoration. In the absence of such reparative processes, there is an increased risk of somatic problems and addictive behaviors (Johnson, 1987), with the former an especially likely outcome in the South and the latter in the North. War-affected children may experience comparable impediments to verbal expression, or may avoid discursive processing as culturally dystonic. Artistic means that are culturally syntonic offer children opportunities, nonetheless, to represent their feelings, and may help bring “coherence in their inner worlds” ( Rousseau & Heusch, 2000). Surveying briefly some of the case material documented in the preceding pages may afford a useful perspective on various reparative approaches to the interplay of symbolization, the verbal and nonverbal, ritual, and recovery among young individuals from disparate regions of the world affected by war, organized violence, or—in the sole example from the U.S.—childhood abuse. The therapeutic interventions employed with Paulo, Tomas, the youths of Poimboi Veeyah Koindu, and Sandra represent a range from discrete cultural fidelity to bicultural syncretism. Paulo's father, a traditional healer in rural Mozambique, invents for his young son, upon the boy's homecoming, an emboldening rite to symbolize rupture with an undoubtedly horrific past ( Honwana, 1997). The child performs in a necessarily active and full-bodied way his escape naked from a burning hut—an act that represents leaving a life of terror behind him for good. For Tomas, also a survivor of the Mozambican civil war, a local rehabilitation agency creates the conditions for his personal restoration ( Boothby, 1996). Techniques of sociodrama, originating in the North, give Tomas permission to direct his peers in a staging of the events surrounding his family's massacre. Afforded in this dramatization process an occasion for agency and symbolizing, the child discovers resolution of his feelings of guilt and grief, and begins to accept the nurturance of an adult volunteer in the program. In Sierra Leone, under the auspices of an international humanitarian organization, Western psychotherapeutic processes are again introduced within a context of postconflict communities facing obstacles to rebuilding all aspects of social life. Borrowing consciously from the various practices and concepts here articulated, the author ventures a form of psychological syncretism in fusing the free association of dance/movement therapy improvisation with local customs and forms of cultural expression. Programmatic assessments indicate that these efforts effectively served Poimboi Veeyah Koindu's and our other war orphan clients’ need for restoration through active embodiment of sometimes deeply hidden symbolic meanings ( Harris, 2007a and Harris, 2007b). Finally, in the U.S., Sandra experiences significant social re-aggregation through the medium of her own imaginative play, and Harvey's (1995) keen attunement to her developing capacity for symbolization. With the almost ritualized container of constructive play affording the little girl a vehicle through which to enter the liminal space of transformation, she grows increasingly invested in symbols of security, and through this attenuated process of reattachment, learns to accept the love and support of her adoptive parents. In each of these four narratives, children separated by incursions of violence from the opportunity for parental nurturance and support find recovery from the devastation of brutality or abuse through means of creative symbolization. In each of these cases, moreover, this journey is both non-discursive and palpable, an event enacted on the body itself; in effect, a ritual, whether by design or not. Guided by an intervening therapist—or in Paulo's case by a father whose therapeutic intercessions are deemed, from an outside perspective, traditional healing—these children find agency and eventual restoration through a ritual process; that is, through a process of immersion in the subjunctive possibilities of the liminal. The notion of Turner's (1977a) liminal space thus overlaps significantly with the transitional space that is Winnicott's (1971) critical contribution to the psychotherapeutic understanding of play and individuation. When infants outlast the utility of symbiotic ties and begin to move into the transitional territory between self and not-self that will host initial encounters with intersubjectivity, their separation from the old ushers them at once into a similarly liminal realm. In this realm of transitions, agency and creativity arise within mindfulness of being, and specifically, being separate. Imagination, fantasy, and transformative symbolizations become as one—in what dance/movement therapist Dosamantes (1992) referred to as an “illusory space” (p. 263), akin to the shaman's sacred ground. Like the site of liminality, the transitionally as if space of individual and group transformation, too, affords the body a transcendent purpose as an instrument of consciousness. Hence, it seems that the expanse that ostensibly divides the traditional ritual process of liminality from the psychodynamically inflected process of transitioning may, in fact, be non-existent—no more than virtual. Whether formulated in the context of the ceremonial dancing circle, the creative arts therapy group, or the intimate maternal-child dyad, profound relational bonds invest the human species with the talents to survive even the most unthinkable of ruptures and, sometimes in the face of speechless terror itself, to divine symbolic means for expressing them.