Re-Membering: Putting mind and body back together following a traumatic brain injury by Ann Millett-Gallant is an honest account of her unabashed and unapologetic determination to recover from a potentially life-threatening brain injury. Ms. Millett-Gallant, a congenital amputee and long-time advocate for disability rights, draws from her persistent desire to not be hemmed in by any physical or societal limitation about what she may accomplish. Her story is as much about overcoming real and perceived obstacles, as it is about trusting her body, and her therapeutic use of art, as it is about her journey to recovery from a Traumatic Brain Injury (TBI). Her love of the arts and their integral role in the reconstruction of her life are apparent in her book, as demonstrated by the use of art as a means of piecing, or collaging, the fragments of her life into a cohesive self over time. The inclusion of color illustrations created both on her own and in art therapy sessions with her art therapist, and my friend and colleague the late, Ilene Sperling reflect the careful re-collection and mirroring process of her transformation. Ms. Millett-Gallant draws from her background in Art History to find inspiration from such historic artists who have overcome physical suffering as Frida Kahlo but sadly does not include these paintings in her book when she speaks of such works.
As many as 1.6 million people suffer from Traumatic Brain Injury every year (CDC, 2017a). TBIs cause 30% of all injury deaths and in 2010, 2.5 million emergency department visits, hospitalizations, or deaths were associated with TBI – either alone or in combination with other injuries in the United States (CDC, 2017b). Ms. Millett-Gallant’s memoir, told from her perspective about her experience, could have been made stronger by the inclusion of her family member’s emotional experiences immediately after her injury and during her early recovery. As cited by Ms. Millett- Gallant, “When one member of a family sustains a brain injury, the treatment, and rehabilitative process inevitably becomes a family affair” (Cassidy, 2009, p. 12). Because she was unconscious much of this time, she relied medical records, photographs her mother took, and accounts made by her friends and family of her treatment to describe the procedures but these accountings seemed sterile considering the emotional volatility that often follows in the wake of such a life-threatening event. Understandably, Ms. Millett-Gallant does not have memory of the accident or her initial recovery as she was in an induced coma or her memory was impaired by the injury.
As a legal guardian of a family member who suffered a TBI, whose outcome was not as favorable as Ms. Millett-Gallant’s, I found her characterization of her family’s reactions to her struggle a bit wanting. She comes across as lacking empathy for the way her own injury impacted those around her, particularly her father. I found myself reliving the pain, fear, and real financial burden of being the caretaker for a TBI survivor: an all-consuming responsibility that swallowed not only me but also other family members including my spouse and young children due traveling, months spent in hospitals and brain injury rehabs, and ultimately nursing homes as well as the time spent navigating the medical and legal systems associated with a suddenly, disabled person. Managing one’s life while picking up the pieces of someone else’s was like running at a full sprint while spinning plates on sticks. I found myself especially moved by, Ms. Millett-Gallant’s conflict with her father over his need to know if she had been drinking when she fell from her scooter as she toured wine country in California with a friend while uninsured and wanted to hear more about the heartfelt struggle that she and her family grappled with adjusting to a new normal. It is without a doubt that her loved ones fought their own battle through the labyrinth of hospitals, healthcare, disability, legal, and insurance agencies on Ms. Millett-Gallant’s behalf, while she fought valiantly and courageously for her life and ultimate recovery.
Cassidy, J. W. (2009). Mindstorms: The complete guide for families living with traumatic brain injury. Philadelphia: PA, DA Capo Press.
“Writing books is better than planting vines, for he who plants a vine serves his belly, but he who writes a book serves his soul” — Alcuin (ca. 735–804), an English scholar, poet, and teacher
Books have been deemed one of the most valuable kinds of art objects in the history of mankind due to their ability to contain some of our most cherished cultural and personal thoughts and ideas. The value of books has been evidenced by their ability to command extremely high prices at art auctions, including the c. 1180 Gospels of Henry the Lion, an elaborate work made for the Duke of Saxony and Bavaria, which sold in 1983 at a Sotheby’s auction for a record £8,140,000 (approximately $15,000,000) to the German government. It held the world record for the highest price ever paid for an art object until three years later when Van Gogh’s Sunflowers was sold. It was the Leicester Codex, a bound manuscript of Leonard da Vinci that fetched a record 30.8 million dollars, the highest price ever paid for a book when it sold at auction to Bill Gates in 1994 (Baer, n.d). The value of books transcends their material worth and ability to command high prices at art auctions. Books are highly valued because they provide spaces for sacred texts, illuminated scriptures, transfers of knowledge, and recordings of personal and communal narratives across generations. They hold individual, community, and cultural legacies and create cultural bridges over time and people.
Myths are collective stories; myths are our personal stories. Myths carry historical knowledge and personal details. The stories we tell about our lives, of the events and people, of the sensations and emotions, are the myths we create in order to tell us who we are. Narrative is how we understand the world as it is intertwined with emotion, context, and imagery. Memory is construed and recalled through a narrative framework and is plastic and flexible in the telling and retelling of a story. Emotion, memory, and story combine to create a truth, even if it is a fictional truth. Body sensations are empathically experienced when telling or listening to an experience, even if not as profoundly as originally experiencing the event. We have visceral reactions to the telling and the witnessing and re-witnessing of a story. We create internal images for the story as it is told. Author Siri Hustvedt (2011) said, “Writing fiction is like remembering what never happened.” Memory and imagination partake of the same mental process as emotion and are central to storytelling in literature and psychoanalysis (Hustvedt, 2011).
Memory and art are inexorably entwined. Remembering is not the same as perceiving because we need concepts, context, and language to name and to bring to mind images. These mental images are now popular in neuropsychological vernacular and are called neural representations.
Within the image are mythical stories. Myths create balance, clarity, and adjustments, making events correspond to the inner necessities of things. The tension between dichotomies—good/evil, black/white, positive/negative, active/passive—gives ambivalent power. The psyche is often invisible without awareness of mythological images because, without them, we are unable to manifest the psyche’s origins, structure, and transformations. The myth, or story, gives voice to the psyche; the book provides a vessel for the voice. “Great books endure because they help us interpret our lives” (Olmert, 1992, p. 299). They offer solace by our knowing so many have come before us and written down their experiences.
Nine Therapeutic Applications for Book Arts:
Ordering & organizing – chronological order storyboarding.
Myth-minding – refers to the ability to think freely, to know what we know, and to know what we do not yet know.
Memory – Recall & life retrospect
Recreating a narrative
Permanence – can be retrieved years after its creation
Objective – creates distance to reflect upon
Books have the ability to promote myth-minded thinking and development. Like other forms of art, they provide a place for projection and objectification. Books provide a place for recollection, mirroring of life’s events, and memories, as in their unwavering ability to concretely recall past events and provide a life’s retrospection. Through creative narrative picture making and writing, a book can tell and retell a part of a life story. The value of a book that has endured the ages remains unfettered by time; it is a permanent record, an archival account, of aspects of the psyche that live on beyond the life of the individual. In addition, books offer containment. They have covers and pages that can be opened and closed as one desires. Contents can be revealed or concealed by a flip of the page. Additionally, books offer order and a built-in organizing device as most books move in a sequential fashion. Pages turn, one preceding after another. The complexity of order can be increased by adding pockets or additional foldout flaps and signatures to the book, but it still has an order.
In telling our story in a book created in therapy, through images and words, we make the truth of our thoughts, our words, and our images known and seen by us. This is a way of recollecting and retelling our struggles and triumphs. It is a way of mirroring our life contemporaneously and a way to be nostalgic about memory that we recall from the past.
Mark and Michelle have been teaching in NYC! The 2016 Expressive Therapies Summit was held November 10 – 13 in New York City. This conference addressed the healing arts in art, drama, music, writing, psychodrama, dance, sand and play therapy. This rich format included daylong intensives, master classes, workshops, community events, symposiums, and papers. Mark and Michelle were both honored faculty at this year’s Summit. Mark co-lead a panel presentation, and Michelle facilitated a workshop and a master class.
On Friday, Mark was a part of a day-long panel entitled Jungian Archetypal Approaches to Creativity and the Arts for Healing. His co-presenters included the esteemed Jordan S. Potash, Ph.D., ATR-BC, REAT, LCAT, Chair, Fanny Brewster, Ph.D., MFA, LP, Mark Dean MA, ATR-BC, LPC, Sondra Geller, MA, ATR, LPC, LCPAT, and Maria Taveras, LCSW
In this daylong symposium, Jungian analysts and art therapists discussed their work as it relates to Jungian psychology. Ther focus had an emphasis on making this information relevant to clinical work with clients in the expressive therapies. The panel speakers and the topics were selected to appeal to those who are new to Jungian ideas as well as those with more advanced training. Although primarily didactic, the day included some hands-on exercises and small-group discussions. Participants were encouraged to identify how they can incorporate the concepts presented into their daily work in clinical, educational, and community settings.
On Saturday, Michelle facilitated the workshop entitled, “Sacred Creations: Ex-votos and
devotional art in psychotherapy,” in which participants explored devotional paintings and objects, in historically and culturally sensitive ways. The ex-voto and its significant ability to express gratitude for surviving traumatic events were given particular attention as participants engaged in their devotional art experience.
In the day-long master class on Sunday, “Cultivating the Quest: Embodying the Hero of Your Life,” Michelle led participants on a journey of exploring the iconic elements of the Hero’s journey, as described by mythologist, Joseph Campbell, and other storytellers. Participants utilized this framework for writing a personal Hero’s Journey informed by image-making through writing and art. Michelle said, “It was truly an honor to hold the space for these mystical and transformational spaces and the inspirational work done within the context of these workshops.”
Mark and Michelle were sincerely appreciative of the opportunity to be faculty members at the 2016 Expressive Arts Therapies Summit. If you would like Mark or Michelle to visit your area for an educational experience, please contact us at firstname.lastname@example.org.
Adolescence can be a challenging time in a child’s development, but when losses, adjustment issues, or trauma affect the child, it makes it all the more difficult. Teenagers often feel self-conscious, under stress, and shut down. Sometimes teenagers in traditional talk therapies fail to feel engaged. Imagery and art tap into our earliest ways of understanding the world, they invigorate and give a voice at times when language is inaccessible. Art combined with an empathic therapeutic relationship can bridge resistance and offer outlets to painful emotions and provide creative problem solving to life’s challenges.
Art Therapist and Licensed Professional Counselor, Michelle Dean, MA, ATR-BC, LPC, CGP was recently invited to speak to clinicians at Reading Hospital about her use of art therapy and adolescents. Her presentation helped clinicians understand critical developmental issues of adolescence and how art and imagery-based interventions support the sometimes, rocky transition from childhood to adulthood through a powerful means. Below are some of the discussion points that were shared.
Critical milestones of adolescence include:
Time of transition and individuation
Time of self-absorption and self-reflection – a part of identity formation
Increased dependence on peers
Pulling away from parents
The ability to understand abstract concepts – Starting around the age of 12, the cognitive ability to think abstractly forms as result of brain development.
Often teenage development is asynchronous, with varying degrees of maturity in interpersonal relationships among peers, teachers, and parents. Although the adolescent may appear physically developed, emotional or cognitive development, especially judgment, may lag behind. These differences are normal and usually temporary but become intensified under pressures of academics, peer and family relationships, and stressful situations such as conflicts and trauma. The difference between expectations for the young adult and his or her capabilities can lead to frustration for the adolescent and for those who care about him or her. The struggle for independence and individuation is real with frequent vacillations between wanting to take care of things independently versus having support or being cared for by others. This is often confusing as loved ones struggle to find how much and when to help the adolescent.
Art therapy is a good development fit for adolescents because:
It can be a pleasurable experience
It stimulates a desire to express – “Make their mark.” This can be seen in the repetition of writing’s one name as well as in graffiti often done by young adults.
Imagery is an extension of memory and conceptualization processes – If we can see it, we can better remember it.
Metaphoric and mythical language is crucial – it allows for fantasy and role-playing. With increased abstract abilities, language and imagery can be metaphoric and no longer literal. Art created in therapy can hold many meanings simultaneously.
It is a way of communicating that, which is both objective and subjective. It is a way of seeing both the external world and one’s inner world and helps facilitate understanding of the intersection of the two experiences.
It represents multiple perspectives and relationships at once – It is a polyvalent method.
It is both tangible and permanent – growth can be seen and recorded over time and is undeniable due to the permanent nature of the work. It can be visited again because it is tangible and concrete.
When combined in a group context, it assists with interpersonal relationships and absorbs the sometimes, angry, and at times, defiant stance that is common in adolescence.
Art making in therapy provides structure so the adolescent may thrive.
Art Therapy: When to refer an adolescent
Knowing when to seek help through the specialized care of an art therapist, includes:
When concerns about abuse, depression, lack of self-esteem, eating disorders, social or academic struggles or failure
When there is limited abilities or resistance to verbal interventions
When a more action-oriented therapy is needed
About the Author:
Michelle L. Dean, MA, ATR-BC, LPC, CGP is a board certified art therapist, licensed professional counselor, and certified group psychotherapist who co-founded of The Center for Psyche & the Arts, LLC (http://psychearts.org), a clinical practice and professional continuing educational center, with two locations in the Philadelphia area. She works with individuals who struggle with addictions, eating disorders, relationship issues, and survivors of traumatic experiences. In addition to her clinical practice, she is an author, supervisor, educator, and consultant. She has been an Adjunct Professor at Arcadia University since 1997 and has several publications to her credit, including her book, Using Art Media in Psychotherapy: Bringing the Power of Creativity to Practice. Her work has been recognized through many distinguished awards, including the prestigious Honorary Life Member Award from Delaware Valley Art Therapy Association and the American Art Therapy Association’s 2015 Pearlie Roberson Award. She serves on Executive Board of The American Art Therapy Association as the elected Secretary.
Blos, P. (1962). On adolescence. New York: The Free Press.
Dean, M. L. (2016). Using art media in psychotherapy: Bringing the power of creativity to practice. New York: Routledge.
Dean, M. L. (2008). Preserving the self: Treating eating disordered individuals who self-injure with art therapy (pp. 56-82). In Brooke, S. (Ed). Creative arts therapies with patients who have eating disorders. New York: Charles C. Thomas.
Isis, P. (October 2007). Using Art Therapy with Troubled Adolescents. The Australian and New Zealand Journal of Arts Therapy, 2, 1, 1-33.
Riley, S. (2001). Art therapy with adolescents. Western Journal of Medicine, 175, 1, 54-57.
Riley, S. and Malchiodi, C. (1994). Integrative approaches to family art therapy. Chicago: Magnolia Press.
Rubin, J. A. (1984). Child art therapy. New York: Van Nostrand Reinhold.
Some injuries sustained in war are not immediately fatal; instead, they linger and fester like a parasite consuming its host and infecting those closest to him.
This Memorial Day, as we remember and give thanks for the great sacrifices our military and their families have made, I would also like to remember those who have fallen not just by active duty but also from suicide. Servicemen and women who have taken their lives, leave a complicated wake for which there is no monument or recognition of valor but instead leave a ghostly vacuum in which families often grieve alone, isolated or ashamed, and its effects can last for generations. This has been shown in research related to veterans and survivors of war and trauma. I also know because my family is one such family that has experienced the intergenerational effects of suicide.
It is estimated that 22 veterans commit suicide each day according to a report from Iraq and Afghanistan Veterans of America, ABC reports. While veterans have a suicide rate 50% higher than those who did not serve in the military, the rate of suicide was, as the LA Times reported, “…slightly higher among veterans who never deployed to Afghanistan or Iraq, suggesting that the causes extend beyond the trauma of war.” The rates were highest during the first three years out of the military; this was assumed due to Post Traumatic Stress Disorder, which was not identified until after the Vietnam War but other contributing factors impact the transition to civilian life. One such example that Junger identifies in his book, Tribe: On homecoming and belonging, is the abrupt transition combat veterans find themselves missing the incredibly intimate bonds of platoon life. He says that it is the loss of closeness that comes at the end of deployment may explain the high rates of post-traumatic stress disorder suffered by military veterans today even if they have not experienced active combat. I suspect, it was the adjustment and loss of tribe, coupled with early childhood trauma that contributed to my uncle Dale’s death in 1972; suicide is always a constellation of complex factors.
Dale came to my grandparents’ home as a scrawny, boy dressed in a threadbare, cowboy shirt at the age of six. Taken from, or surrendered by, his biological mother as a very young child, he spent much of his early childhood in foster homes until he was placed with an elderly couple in a nearby town in western Kansas. Shortly after coming to live with them, they died, within three months of each other, right before Christmas. He was placed again, this time with my grandparents who were seeking a boy to round out their family of two girls, one who was also adopted. He arrived at my grandparent’s home only with a small parcel of belongings that included a tiny suitcase and several Christmas gifts that had been carefully wrapped by his late parents before their sudden deaths. Over the years, his petite frame grew into tall, lanky teenager who was to carry on working the family farm. But when the Vietnam War started he enlisted in the Navy.
Dale was stationed on a battleship but what happened during his tour of duty is unknown to me; he didn’t talk about it or if he did, not with anyone that wanted to discuss the “ugliness of war.” Like many men returning from Vietnam, he was met with confusion and misunderstanding. Confusion about the political and cultural unrest that accompanied it and misunderstanding about the complexity that many returning vets faced in their struggle to reintegrate into society and deal with their post-traumatic stress, a nascent psychological disorder at the time.
After months of struggling to fit in and return to farming life, Dale was unable to stay focused, find meaningful work, adequate support or happiness. So one bleak, winter day as the blanket of the north artic wind of swept this small, rural community, he drove his car to an empty field near the country airstrip, placed a gun in his mouth, and pulled the trigger. He was 23.
As a result, my grandparents buried the only son they had known and his sisters were devastated; they could not speak about their pain due to the shame of the suicide they experienced. One of his distraught sisters was my mother. I, an infant niece, lived with the reverberations of these events. I tell this story as means of remembering my uncle Dale, and all the men and women who have so bravely served our country and for the sometimes silent, scarifies they and their families have made.
About the Author:Michelle L. Dean, MA, ATR-BC, LPC, CGP, DVATA HLM is a Board Certified Art Therapist, Licensed Professional Counselor, and Certified Group Psychotherapist in the Philadelphia area working with families who have been affected by trauma, addictions, eating disorders, and suicide. The effects of trauma do not know intergenerational boundaries, nor do they have to be loved ones’ burden to carry alone.
Printmaking can be a source of fascination and challenge that requires an indirect way of working (Hurwitz & Day, 2001). To create a print is to weave the artist’s experience and perception, insight, and differentiation into one (Neumann, 1974). In order to create a print, something must be done to one substance in order for another to emerge, like an alchemical process, there is a series of steps that must be undertaken that lend themselves to the process to a ritualistic method. These steps also help to create distance from the final outcome, so many times, the self-consciousness of the accuracy of a shape or object to be portrayed is minimized during the process due to the seeming disconnect from the final picture. The details associated with shading, more appropriate to drawing, are not needed in the print-making process, but in the place of this perceived limitation comes the power of strong impact images made through simplification and contrast (Hurwitz & Day, 2001).
Many printmaking processes employed in therapy result in reversed images. This reversal may change or distort one’s original composition, intentionally or unintentionally (Dean, 2016a). When one is printing letters and words, reversals can lead to illegibility or a kind of coding. The image is printed in reverse, “so any handwriting has to be done backwards and thus already feels as if one were writing in secret code” [italics original to source] (Nissen, 2008, p. 19). This secret code writing can be seen in many of Leonardo da Vinci’s journals, which was meant to be both a challenging mind exercise and a protective measure to keep his inventions safe from potential theft (Chastel, 1961). Reversed writing in a print can be seen in a mirror, setting the writing into a legible form.
Reversal is also considered a defense mechanism; its primary purpose is to defend or hold emotional and cognitive dissonance. The dissonance arises when there are two or more conflicting beliefs and results in exceptional discomfort because there is often no way to reconcile these states of being. For example, in Aesop’s fable The Fox and the Grapes, the fox rejects the grapes after being unsuccessful in obtaining them. In this retelling of the tale, one can see how the rejection of the unobtainable is illustrated (Dean, 2016b).
A fox, feeling very hungry, made his way to the vineyard, where he knew he would find a hearty bounty of grapes. In the vineyard, the glistening grapes cascaded in the sun and made him all the more hungry.
Upon this sight, he was overwhelmed with joy as he licked his lips, although his elation was short-lived. Try, Try, Try as he might, the grapes were just beyond his reach. At last exhausted by his efforts, he turned away in disgust remarking, “Anyone who wants them can have them; they are too sour for my taste.”
It is easy to disregard, strongly dislike, or hate what one is unable to obtain, which is both the moral of this story and the protective function of the psychological process of reversal. The reversal expresses the opposite of what is desired, calling the grapes too sour even though they were very much desired.
Jung stated, “There can be no doubt, either, that realization of the opposite hidden in the unconscious—the process of “reversal”—signifies reunion with the unconscious laws of our being, and the purpose of the reunion is attainment of conscious life or, expressed in Chinese terms, the realization of the Tao” (CW 13:30). Tao is considered the path or way of life and signifies the fundamental nature of the universe and its primordial essence. It is a part of traditional Chinese philosophy and religion and is a way of creating harmony with one’s will or nature, coming into being or enlightenment or experiencing an aliveness. This aliveness can also be experienced as the tension that is created in the printmaking process. By engaging in art making, such as one of the many forms of printmaking in a therapeutic context with a qualified art therapist, one can benefit from psychological insight into some of the many underlying processes that manifest in daily life because life is a creative process and art reflects life.
Marbled cloth – a printmaking technique done at a workshop offered at The Center for Psyche & the Arts, LLC
Chastel, A. (1961). The genius of Leonardo da Vinci: Leonardo da Vinci on art and the artist. New York, NY: The Orion Press.
Dean, M. L. (2016a). Printmaking: Reflective and Receptive Impressions in the Therapeutic Process. In D. Gussak & M. Rosal [Eds.]. The Wiley Handbook of Art Therapy. Hoboken, NJ: Wiley-Blackwell.
Jung, C. G. (1967). Alchemical studies (R. F. C. Hull, Trans.). In H. Read et al. (Series Eds.), The collected works of C.G. Jung (Vol. 13, 2nd ed.). Princeton, NJ: Princeton University Press (Original work published 1957).
Art is a universal process among children in cultures around the world and is something that all adults possess the capacity for into old age. All people may call themselves artists if they create artwork, reserving the term professional artist for those who receive money for their work. Developmentally, there is a universally accepted progression of art-making skills and schema that coincide with physical, emotional, and cognitive developmental milestones; these include such typical shapes as a circle, cross, square, and rectangle (Lowenfeld & Brittain, 1987). The content of a child’s drawing often times focuses on certain motifs (e.g., trees, houses, or people) and is significantly correlated with gender. But equally as important as the content is the manner in which it is created.
It is accepted that exceptions or deviations from typical artistic milestones in children may be attributed to personal factors, such as the two psychological types: visual (ideoplastic) and haptic (physioplastic) types of creative expression (Read, 1966). Although one type does not create superior artists, it is important to note the type because it produces a significant difference in presentation and aesthetic.
Therefore, there is a natural dichotomy in art expression in children based on these two types. The visual type represents items in artwork close to the way they appear in space with attention to nuance and realism, much like a spectator, while the haptic type tends to display expressiveness, including exaggerations, related to internal somatic sensations and emotionality (Lowenfeld, 1965; Lowenfeld & Brittain, 1987; Read, 1962, 1966). According to Read (1966) these types were first recorded by Vernworn in 1914, who noted correlations for the visual type with concerns about conceptualization, and for the haptic type with sensations of the body; this idea is similar to Kühn’s imaginative and sensorial types described in 1923.
So for parents, teachers, and those who work with children in helping professions it is important to understand that there are innate differences in children’s works of art andone type should not be valued over another type but instead appreciated for their unique attributes and qualities that they hold.
Lowenfeld, V. (1965).The nature of creative activity. London, England: Routledge & Kegan Paul.
Lowenfeld, V., & Brittain, W. L. (1987). Creative and mental growth (8th ed.). New York, NY: Macmillan Publishing Co.
Read, H. (1962). The meaning of art. London: Faber & Faber Limited.
Read, H. (1966). Psychology of art. Encyclopedia of world art (Vol. XI). London, England: McGraw-Hill Publishing.
Vernworn, M. (1914). Ideoplastische Kunst. Mill Valley CA: Enthnographic Arts Publications.
While biological, genetic, and psychological factors contribute to the etiology of eating disorders, the influence of cultural beliefs and attitudes has long been appreciated as a significant factor to the continuum of disordered eating behaviors. Cultural beliefs and attitudes are meant to assist in societal structure and relationships within an identifiable group of people, and are passed down to future generations through messages about ideals and values; they may be seen in food rituals, as well as traditions, gender roles, body size, and beauty, as well as personal, spiritual, and ascetic values. They often are carried via images such as views of family life, holidays, illustrations of religious scenes, imagery of myths and fables, and popular culture as seen in art, on television, in movie theaters, and, more insidiously, through advertising campaigns. With the expeditious development of a global society and rapid social change, exposure to different cultures and beliefs brings a wake of potential clashes. These cultural fissures may create a disavowal of social customs and beliefs that, in many regards, are considered the glue that holds communities and societies together. The resulting loss of stability in a cultural foundation, a loss of purpose, a loss of meaning, and a loss of personal value that leads in turn to a heightened need for control may contribute to the emergence of eating disorder behaviors (Gordon et al. 2012; Katsounari 2009; Soh et al. 2007). Cultural instabilities and clashes are often not perceptible just as words may be understood differently, even for people of the same cultural background.
In practice, working with the nuances and complexities of language as well as cultural issues are often overlooked in treatment. Amplifying meaning and understanding through a visual and symbolic process such as art therapy may be beneficial for illuminating individual and cultural meaning with all of its subtlety. For example, creating a graphic image such as a representation of one’s family as food and placing this depiction of a meal in a setting (Earley 1999a & 1999b) can provide opportunities to explore family dynamics, food preferences, as well as dialog regarding cultural beliefs as they pertain to food, family, and society. As an art therapist, I have assisted clients in utilizing their artwork to explore attitudes about food, including the messages about food imparted by family, food rituals related to personal and societal practice, as well as messages portrayed in the media which may polarize “good/bad” foods; thus the artwork provides a metaphorical canvas for understanding cultural beliefs and individual meaning.
The emergence of eating disorder symptoms and their meanings are constantly in flux as they are influenced by a plethora of factors, many of which still are not fully understood due to their complexity, symbolic meaning, and evolution. Eating disorder behaviors may be conceptualized as a “system of signs and symbols with multiple meanings” (Brumberg 2000, p.7). “Rates of these disorders appear to vary among different racial/ethnic and national groups, and they also change across time as culture evolves” (Miller and Pumariega 2001, p.93). Like the disorder itself, it is a shape-shifting expression of symbolic conflict and issues that take shape as a physical voice through the overindulgence, purging and/or restriction of food.
Hesse-Biber et al. (2006) suggested shifting focus from a medical/psychological view to a sociocultural/economic perspective that examines messages that perpetuate derogatory values in gender roles as well as the mind/body dichotomy. While cultural attitudes may be seen in images portrayed in media that idealize thinness and other attributes, they are not the only sources of cultural information, neither are they a singular cause of disordered eating. It is thought that “[t]he experience and exposure to the difference between two cultures, rather than a particular culture itself, is also hypothesized to contribute to the aetiology [sic] of eating and body image disturbances” (Soh et al. 2006, p. 58), and that it is a “culture-change syndrome of communities modernizing” (Miller and Pumariega 2001, p. 103). Although the above authors were referring to immigrants or cultures whose community ideals have been influenced by another society’s cultural values, it would be the cause of an assimilation clash as is so often the case with Western capitalism or consumer–corporate culture and the individual’s original culture. It may not be the industrialization itself that is problematic, but rather an attitude of parasitic proportions that accompanies it. In other words, a “parasitic” cultural attitude latches onto the host culture (invaded by the new ideals) and is consumed by it or at least radically changed, altered, or ravished by the invading culture. Often working from the inside out, this most affects those with poor esteem, unstable cultural identities, and a host of other factors including trauma, childhood ruptures, and attachment issues. The external conflict of the differing cultures and internalization of the cultural conflict provide the pregnant constellation of factors necessary for the emergence of eating disorder symptoms.
From an ecopsychology viewpoint, as cultures become fragmented and communities are severed in order to seek economic development and opportunity, meaning and relational aspects to our environment, place, and culture are lost. Rudderless and vulnerable in these modern roles, women in particular are more prone to enact the conflict symbolically through the dismembered remnants of a central core of prior value: food for sustenance and well-being.
According to Woodman (1980), “This one-sided consciousness can be corrected by focusing attention on a creative approach to the body loving-understanding of its mechanism” (p. 45). Likewise, “People who are in touch with the spontaneous archetypal creative/imaginative impulse are always in a state of creative ferment” (Taylor 1992, p. 113). Art and image making carry the dichotomy of cultural bias and conflicts simultaneously. Art images create distance while also providing opportunities for relatedness. Thus, this mirroring in the image becomes the individual’s response to a cultural attitude or pattern and can be related to and engaged in a therapeutic dialog (Woodman 1980; Dallett 2008). In art therapy, the image becomes the carrier of new meaning and offer opportunities for the reintegration of splits or voids that once were filled by actions of the eating disorder.
Brumberg, J. J. (2000) Fasting Girls: The History of Anorexia Nervosa. New York: Vintage Books.
Dallett, J. O. (2008) Listening to the Rhino: Violence and Healing in a Scientific Age. New York, NY: Aequiteas Book from Pleasure Boat Studio: A Literary Press.
Earley, M. L. (1999a) ‘Art therapy: Body image, media & art.’ The American Art Therapy Association Conference, Orlando, FL.
Earley, M. L. (1999b) ‘Art therapy with eating disordered clients.’ The Renfrew Center Conference, Philadelphia, PA.
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Taylor, J. (1992) Where People Fly and Water Runs Uphill: Using Dreams to Tap the Wisdom of the Unconscious. New York: Warner Books.
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Michelle L. Dean, MA, ATR-BC, LPC, CGP is the cofounder of the Center for Psyche and the Arts, LLC. She is a board-certified art psychotherapist, licensed professional counselor, and certified group psychotherapist. In her clinical practice, she provides a warm and compassionate approach in which to explore and heal. She is also a clinical supervisor and an esteemed, nationally recognized educator and consultant. Her work has been recognized through many distinguished awards and several interviews in print, radio, and television.
Merit, wife of Egyptian official Maya, wearing the ceremonial attire of temple singer and an amulet.
Three-dimensional artwork spans from amulet to monument and despite its scale, it has a similar essence, qualities of architecture and sculpture that share a material spirit. The amulet is a small portable charm worn as protection against evil or insurance of fertility and the monument, a structure permeated with spirit. It is believed that some of the earliest monuments were phallic shaped, columns, pillars, or obelisks, jutting toward the sky, linking heaven and earth. Originally the towers were intended as sculpture only but over time it became customary to make openings and hollow chambers within and deposit images of the divine, like a shell enclosing a seed (Read, 1977), a container for those things precious. Aspects of the monument are like the sarcophagus, “a flesh-consuming” stone deriving its name from arx meaning “flesh”, and phagein meaning “to eat”. Tombs, natural caves, grave mounds, stupas, hemispherical structures containing Buddhist relics, and pyramids often recorded the events of the deceased through murals or relief carvings on their interiors. Doorways into such structures serve as passageways, a transition into the interior while pediments, supported by pillars, turn our gaze upward toward the sky upon entering inside for contemplation. “As the art develops, in history or in sensuous experience of the individual, we may begin to associate with each shape an idea; we inhabit the shape with our spirit; and finally, if we are artists, we try to realize ideas as specific shapes, to create symbols for our indeterminate feelings-to become conscious, in the forms of art, of the dimensions of reality” (Read, 1977, p. 4 – 5). Through time, the temple and the tomb were merged and the spatial relationships transformed – enlarging spaces to enter into like cathedrals, or scaling the divine into carried devotionals or transportable sacred spaces like alters and devotionals.
As Read points out in The Art of Sculpture (1977) more than nine-tenth of the sculpture found in museums is devoted to the human form. There is a convention between the human form and sculpture, unlike landscape or still life, which are typical subjects of painting. To sculpt a form a three-dimensional memory is necessary, one which visual perception alone does not provide. To clearly see a form in its entirety, memory coupled with sensation and imagination are required. These abilities, gradually acquired through a phylogenetic history, are laden with psychological and cultural attributes. The image we possess of ourselves is not one that is inherent at birth but instead constructed through growing awareness of our external and internal worlds. Immediate sensations both seen and felt, contribute to this image as well as the observation of others, cultural ideals, and external feedback. By conceiving an image of our body, can we place an idea of ourselves in the external world. This image is considered our body image. But our “vision is colored, as we say. It is distorted by memories, associations, and above all desires, and to a considerable extent we see what we want to see” (Read, 1977, p. 31). We look at others and see ourselves, a projection of our desires.
Ernest Eugene Hiolle (1834-1886) Narcissus. 1868. Marble
Like the Greek myth of Echo, a verbose nymph who has been cursed by Hera to repeat only the last words of others, and Narcissus, a handsome youth for whom Echo has fallen in love with while he was ensnaring a deer in the forest, the two, manifest aspects of a colored reality in which desire has grave effects. Narcissus calls out to inquire who is in the woods with him and is met by Echo’s mimicking response. Narcissus cruelly rejects her for she lacks the ability to express the substance of her true herself. Thus she retreats to a cave where she pines and withers away, leaving only her echoing voice for others to hear. Counterpoint justice is served by Nemesis who upon witnessing Narcissus’ cruelty curses him to fall in love with his reflection. While attempting to embrace the noncorporeality of his reflection he succumbs to the spring waters and dies, leaving in its place his namesake, the pale flower, narcissus. Both are lost as Echo, lacking a voice, is hindered; her inability to speak about who she is results in a lack of embodied as self, while Narcissus is unable to be desirous of anything other than himself. Echo and Narcissus carry the potentiality that we all possess to destroy ourselves when unable to speak or see the reflected gaze of another while compulsively pursuing desire.
The flipside of a negative outcome to desire is the creation story of the artist Pygmalion who falls in love with one of his sculptures. He asked the Goddess Aphrodite to give her life. His wish was granted and upon marrying her named her Galatea. In some legends, Galatea was Aphrodite, goddess of love and procreation. Pygmalion is an excellent example how artwork, like the amulet and monument, become imbued with the love, or spirit, of the artist. These stories have captured the imagination for centuries and as can be seen in more modern adaptions such as in My Fair Lady and Pinocchio giving physical form to a mental projection of one’s desire and self. Utilizing three-dimensional work in therapy possesses the same enlivening processes, which are discussed further in my forthcoming text and future blog posts. Please share your thoughts in the comment section below.
Read, H. (1977). The Art of Sculpture. Bollingen Series XXXV. 3: Princeton University Press.
Each year thousands of men and women are fortunate to receive the specialized treatment that is needed to help them recover from their eating disorder. These specialized treatment facilities and agencies understand the importance of the arts in recovery and employ credentialed art therapists. Art therapy is a creative, psychotherapeutic process that helps patients express themselves when they have lost their words. It helps to provide the ability to accurately, and more fully, link feelings with expression. The art therapy process gives individuals who have become stuck, whittled down, or overwhelmed an outlet that fosters growth and change. It is a mirror for past events, current situations, and future dreams and aspirations. And just as the form and structure of the art medium can be stretched and boundaries redrawn, so too with the aide of a qualified art therapist can the psychic structure be supported and compassionately pulled into a flexible and more comfortable place.
These sculptural works are representative of hundreds of brave souls, courageously embarking on their journey of recovery with the aid and support of their treatment teams, families, and friends. They are warriors and journeyers; they, as do we all, do battle with personal and cultural demons along this path we all call life and these are some of the images that reflect their process. I thank them and IAEDP for allowing me to share their work with you.
Broken and Mended, Stronger Than Before submitted by Laura Riss, PsyD at Kaiser Permanente
The following treatment facilities and individuals submitted work for the 2015 Art Competition:
Beauty from Ashes; emerging new hope and life Submitted by Eating Disorders Treatment Center – NM
Imagine Me Beyond What You See Awards Ceremony will be held Thursday, March 19 during iaedp’s Opening Night Dinner. The evening opens iaedp’s signature International Flag Procession spotlighting the International and United States Chapter Delegations followed by Imagine Me Awards Presentation including the Professionals Choice Award, voted on by iaedp membership, Symposium attendees, and the general public.
2015 Judges includes Michelle Dean, MA, ATR-BC, LPC, CGP, Board Certified Art Therapist and Professional Member of American Art Therapy Association, Fritz Liedtke, Photographic Fine Artist and Author, along with Leigh Cohn, MAT, CEDS, Author, Artist and Owner Gurze Books.