by Jané Nash
“We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.”
T.S. Elliot
The story of my research started in 2016. Before applying to study drama therapy at the University of the Witwatersrand, I worked as a practice manager in a medico-legal neurosurgery. This introduced me to the struggles and treatment-access issues related to traumatic brain injury (TBI). When it came time to choose a research topic for my drama therapy Honours degree, I already had a close connection to the subject matter of TBI and wanted to see what I could do to help this growing population of around 89 000 new diagnoses annually (Arnold-Day, 2020). As I could not find literature on TBI and drama therapy in general, the first step was to explore how the arts had been used for brain injury treatment in the past. Apart from one small theatre study done by Marcelline Gangl (2014) on the effects of theatre on people with mild TBI, I struggled to find literature. So, I set out to create some of my own.
Traumatic brain injury (TBI) is an acquired disability that can easily be overlooked, and there is a need for innovative, accessible, and effective therapeutic models for neuropsychological rehabilitation in the South African context.
The practice-based research I conducted for my Masters in drama therapy explored how Narradrama can help TBI survivors psychologically discover, adapt, and expand their identity. Additionally, it aimed to discover what benefits there may be from participants being witnessed by others in this journey. Narradrama assists participants in exploring and playing with their identities, allowing them to create and re-create personal, social, and cultural meanings in a safe environment. Through storytelling and enactment, individuals can revisit, uncover, and expand their sense of self, integrating them with social and cultural norms. This process invites participants to engage as their complete selves.
“Through storytelling and enactment, individuals can revisit, uncover, and expand their sense of self”
The practical phase of my research involved working with a group of 6 to 12 adult TBI survivors in Johannesburg, more than 3 years after their injury. This phase included a series of six Narradrama sessions, during which I collected data through interviews and observed the participants’ creative expressions. This comprehensive approach allowed me to gain valuable insights into the potential benefits of Narradrama for TBI survivors.
The group members acted as witnesses for each other, establishing a strong bond and influencing each others’ stories. This process allowed them to explore new possibilities and find the right words, often borrowing from each other to express things they previously struggled with. By sharing and witnessing each other’s experiences, participants received support and validation from both the therapist and their peers. This helped to boost their self-esteem and build resilience (Busika, 2015).
Self-awareness, however, was still a challenge for some of the group members. In this regard, the saving grace was drama therapy’s tool of externalisation: distancing.
There are three ways of looking at externalisation that are applicable here:
• In psychoanalytic theory, externalisation is an unconscious defence mechanism where a person projects their internal states onto the outside world.
• As an expressive outlet, externalisation can mean the act of expressing feelings externally through behaviour.
• As a way of transforming thoughts, externalising can refer to the process of turning thoughts into an external form, such as through art, writing or speaking. This can help with cognitive processing by freeing up mental resources and allowing for deeper thinking.
‘Externalising’ in my research used a combination of these definitions. Participants express their thoughts in a way where they can step out of the feeling and look at it as a separate entity. By using distancing and symbolism (Jones, 1996) in fictional story-making, sculpting, drawing and writing (see image examples), participants could express, reflect, or mirror personal issues (Couroucli-Robertson, 1998) in a distanced way. It allowed myself as the student-therapist and the TBI survivors to explore parts of their narrative, and allowed for “the distance necessary for these to be seen in a different light” (Couroucli-Robertson, 1998).
Through sculptures and big body maps, the participants in this study were able to physically step out of their direct experience and look at their story with some aesthetic distance (see images). Aesthetic distance is a concept used in art and literature to describe the gap between the audience’s perception and the work of art (Jones, 1996). It refers to a degree of separation or detachment that allows the audience to engage with a piece of art in a way that can be both critical and appreciative. In this case, the participant is the audience for their own creation. Through the process they created a product outside of themselves to look at, shape, reshape, and negotiate with to find their own meaning. In this way, they are able to explore and transition into a new identity or understanding of their life and changes caused by TBI.
“a product outside of themselves to look at, shape, reshape, and negotiate with to find their own meaning”
One participant had created an image of her body as two villages, an old ancient village and a new modern one. This represented her transition from what it felt like in her body after her stroke (the old village) and the modern, upgraded village of what she felt like now, a few years into her healing journey. When she was presenting her artwork to the group I noticed that in her ‘modern body village’, her face had no mouth. We reflected on this symbol, which brought up a cascade of questions for us to negotiate:
Must the mouth be smiling?
Why must women always smile?
Do I smile to keep people from asking questions?
Is looking happy a mask to hide from people?
If there is no mouth, does that mean she has no voice?
Do I have a voice?
What would this voice say?
She was able to look at her drawing with some objectivity and interrogate her own beliefs. She eventually decided to draw a smiling mouth because she was pleased with her progress and the challenges she had overcome on her journey, not because she had to smile for anyone other than herself.
For some people, the thought of sharing their innermost thoughts and feelings can be daunting, especially when it comes to using their voice in a changed body. Many survivors have been silenced or marginalised in one way or another, whether it be by society, family, or even themselves. This silencing can often lead to a feeling of powerlessness and lack of control over one’s own life. However, through creative outlets, survivors can find their voices again. We can express ourselves in ways that may feel too vulnerable to do with words alone. As clients create and reflect on their creations, they can begin to understand and challenge their beliefs about themselves and the world around them.
It’s not always easy to speak up and use our voice. This group struggled with self-awareness around their shifting identity initially, but week by week, as they paused, created, looked and looked again, named and played with the symbols – their evidence of self-awareness grew. It takes practice and rehearsal, but by the last sessions, I was astounded by their insights.
The alternative stories allowed for the discovery of strengths and the creation of new neurological pathways. From here, they could rehearse feelings of empowerment and control.
There are parts of our work as drama therapists that are, dare I say it, magical. Academically, I would be criticised for using this term, but it is hard to find a different word to describe the beauty of how a supportive space, accompanied by creative symbols, can unlock previously inaccessible possibilities and insights. In this way, drama therapy continues to break new ground.
JANÉ NASH
Jané is a Drama Therapy Intern from Alberton. She completed her Master of Arts degree in Drama Therapy at the University of Witwatersrand, with her MA research centered on how Narradrama can be used with Traumatic Brain Injury survivors. A self-professed geek and earth fairy living in the digital age who loves gaming, gadgets, gardening, the natural remedies found in nature and animals of all shapes and sizes.
REFERENCES
Arnold-Day, C. S. 2020. Prognostication in patients with severe Traumatic Brain Injury. African Journal of Thoracic and Critical Care Medicine, 26(2), 27.
Busika, N. F. 2015. Iintsomi story method a dramatherapy approach. Johannesburg: University of the Witwatersrand.
Couroucli-Robertson, K. 1998. The application of myth and stories in drama therapy. Dramatherapy, 20(2), 3-10.
Gangl, M. 2014. Together building imagination, tbi re-defined: the effects of theater on people with a mild traumatic brain injury. Honors Theses, 40, 1963-2015.
Jones, P. 1996. Drama as therapy: theatre as living. Routledge.
Prigatano, G. P. 2010. The study of anosognosia. Oxford University Press.
Tyerman, A. 2008. Facilitating psychological adjustment. In A. Tyerman, & N. S. King (Eds), Psychological Approaches to Rehabilitation after Traumatic Brain Injury. Blackwell Publishing Ltd.13-347
Worthington, A. D. 2008. Residential services. In A. Tyerman, & N. S. King (Eds), Psychological Approaches to Rehabilitation after Traumatic Brain Injury. Blackwell Publishing Ltd. 91-110.