Content warning: The following paper contains themes of war, trauma, mental ill-health, addiction, domestic violence, and suicide.

 

Today, perhaps more than ever, there is a concerted focus on trauma and overcoming it. From the early acknowledgement of war-induced trauma, once known as ‘shell shock’, to the nuanced understandings of post-traumatic stress disorder we have today, understanding and overcoming trauma has never been more part of the zeitgeist.

The University of Canberra’s Ian Drayton established and manages the Arts for Recovery, Resilience, Teamwork and Skills program (ARRTS), which works with current Australian military personnel to apply arts therapy to address trauma.

The researchers of this paper, Jessica Abramovic and Samuel Byrnand, interviewed Drayton about his innovative program, which is located within the Centre for Creative and Cultural Research (CCCR) at the University of Canberra. The following discussion piece looks at how ARRTS is run, its importance, and its potential future directions.

 

Jessica Abramovic: Ian, can you provide us with a brief pitch of the projects purpose and design?

Ian Drayton: The program was originally conceived after the Long Way Home project back in 2013–14.1 The idea was to provide assistance through creative arts therapy to Defence personnel who had been wounded, injured or fallen ill, and put out of service, predominantly on coming back from deployment in the Middle East.

The creative arts practices the ARRTS program covers are quite broad, and are in the areas of creative writing, visual arts, drama and music. The idea behind utilising these four practices was that the current serving Defence members would be given a new way to express themselves that was well outside of the previous therapy they had been receiving, which includes a range of clinical treatments: physiotherapy, psychological therapy, and neurotherapy.

Samuel Byrnand: This program is undertaken on university grounds and seems to be, essentially, like a course?

Ian: All participants are current serving Defence members across the three services (Army, Airforce and Navy). Defence actually do the promotion within the Defence Force, and these are members who volunteer to become participants of the month-long program. It’s a full program that requires the participants to undertake one of those four creative practices and culminates in a biennale at the end of the month, allowing participants to share their practice and trauma with friends and family.

Samuel: How does one brief a course instructor or a teacher to prepare to work with traumatised service personnel?

Ian: It’s an interesting question, and was initially a bit of a dilemma for us because our academic team are not trained in art therapy – they are not therapists, they are academics with a specialty in creative writing or visual arts or drama. One of the beauties of the program is that, because it’s a Defence-specific program, Defence provides the program with supporting staff. So, on every program we have physiotherapists, nurses, and a chaplain – all Defence personnel. We also have psychologists on site all the time, so if any issues arise, say with a particular participant who may react to something in a way that’s not particularly great, there are Defence support people there to take them away, to talk to them, to do whatever they need to do.

Our academic team are also briefed prior to every program. On the Friday prior to the Monday commencement, the whole team are all briefed: not particularly about the individuals on the program – no names are ever mentioned – but on the needs and requirements of the participants. As an example, a brief might go something like, ‘We have 24 members of whom 15 have been diagnosed with post-traumatic stress, two have missing limbs …’ et cetera. The discussion centres on the range of different issues support staff may expect to be confronted with on the following Monday. And then they are briefed on any particular individual who may be of a higher risk.

It’s also important to include within that brief to the academics that we’re working with current serving or ex-serving soldiers or Defence personnel who have been in conflict zones and have now come back into a normal way of life. It’s very hard for veterans to adapt. One day they’re on the front line, and the next day they’re sent down to the shops to buy eggs. So, to come into a university, adapting could be made even more difficult. I was very careful to give the academics a good briefing on what it meant to be a soldier, what it would be like to be out of this country and serving on deployment, and then also potentially what these guys have seen.

Jessica: It sounds like everybody involved is learning something new, including the teachers.

Ian: Absolutely. One of the most gratifying parts of the whole program is that the embedded academics have said that it has been a professional development program for them. And, while it’s been very challenging, they’ve actually enjoyed working on this program as much as their actual job, which is fantastic.

I believe this is due to the commitment that the Defence personnel have. They (the participants) are Defence or Emergency Services personnel, with a specific mindset brought about by intensive training and rigour. While they might have a variety of medical issues, they follow instruction, and they really enjoy being there. It’s a pretty intense program, but both the participants and the academics get a lot out of it, much of which is life changing.   

Samuel: In your essay, ‘Returning the Service: The Healing Use of Creative Art’,2 you explain that the ARRTS projects came about during efforts in ‘Finding ways to mitigate stigma and barriers to accessing mental health care for our military personnel’. What are these barriers, and are they experienced solely by military personnel; or are these the sorts of things that non-military folk can come up against as well?

Ian: There are barriers across the whole community to accessing mental health care. I am not a mental health care professional but, just in the research I have undertaken, I understand that there are many and varied personal barriers. These barriers are breaking down somewhat compared to five or ten years ago, and it’s possibly due to a combination of things, including a higher profile of mental health awareness, organisations including Beyond Blue and Black Dog Institute;3 and it’s really becoming more – I hate to use the word – mainstream. I don’t think there is as much of a stigma attached to mainstream mental ill-health as there used to be.

In the military and emergency services, however, the stigma remains, and this is something I looked at while I was in the UK and the US last year. Imagine that I am a current serving member and I am in an active unit, and I put my hand up and say I’ve got a mental health problem … I would immediately be downgraded as unfit for deployment. If you have a mental health problem, you are not going to be deployed, and that is a huge issue for Defence personnel. In fact, some of the personnel who have undertaken the program developed a mental health problem because they hadn’t been deployed.

Jessica: Is this akin to a self-worth issue?

Ian: Absolutely. When you are in the military, the military is your family. It is a lot broader than you and me going to work every day. It actually defines who you are. You are embedded in a unit and a team, and if you are taken out of that team because you have a mental health problem, you have a high likelihood of becoming lost.

Samuel: You have previously discussed some of the symptoms of trauma, which include intrusive thoughts, hyper-arousal and emotional numbing. How does the ARRTS program address these symptoms specifically? And further to that, what were some of the responses you received from the participants to the program in direct relation to their symptoms?

Ian: An indirect response to this question is, when we give a briefing at the beginning of the program, we often see people who display signs of stress and post-traumatic stress. They can be identified because they typically wear, for example, a hoodie pulled down, or sunglasses so that you can’t see their eyes; you can’t define who they are. They also won’t turn their backs to an exit, and they like to look around to see where the exit and windows are.  

The transformation between day one and day twenty, when the participants are up on stage presenting their poetry or showing the work that they have been doing in the visual art exhibition or through their music and drama, is amazing. We see a breakdown of those barriers throughout the program. Of course there’s no requirement for participants during the program to stand up on stage if they clearly do not want to. But most of them do.

I still remember in one of the first programs, there was one participant who was classically post-traumatic stress. At the commencement of the program he was standing at the back of the group, but by the end he was standing up on the stage singing Jimmy Barnes songs and having a ball, as a completely changed person. At the end of some of the programs, I have also had some of the participants come up to me and say that they have gotten more out of the last four weeks than they have gotten out the last two years of going in and out of psychiatry hospitals.

Jessica: That’s an incredible end result.

Ian: Absolutely. Some of our academics maintain contact with the participants after the conclusion of the program. We know of at least two participants who have said that they have used the skills they were taught through the program to pull themselves back from suicide.

Jessica: In your essay you quote Lieutenant General Gillespie as saying: ‘The Army’s culture did not make allowance for a soldier’s combat injuries unless they were the kind that bled’. This seems to highlight the fact that emotional trauma, suffered by service personnel, is somewhat ignored or passed over. Would that be fair to say of today’s modern defence forces?

Ian: Yes. I think back to my day when I was in the military, and it’s clear that if you did not have a broken arm or a broken leg or you did not bleed, then you weren’t considered injured.

Samuel: The ARRTS program challenges the notion that if it doesn’t bleed it’s not a problem. Have you met any resistance from within the service as a result of this challenge?

Ian: Quite the opposite actually. I anticipated resistance, given my background and my knowledge of the military, but clearly it has been a long time since I left the service. There has been a marked cultural shift in the way that the military operates and in the ways that they perceive things.

I haven’t really received a lot of push-back at all. In fact, I’ve spoken with the various service heads, and the upper echelon of Defence at the very highest levels, and they are all for this program. Further to this, all of the service chiefs, Chief of Army, Chief of Navy, Chief of Air Force, and the Vice Chief of the Defence Force, have been to every project biennale that we have run. There is significant support and interest from the very top levels.

Samuel: That seems to show that our modern military is genuinely looking for new ways to deal with these old problems. Would you agree?

Ian: They are embracing change. But are they there yet? No.

The ARRTS program, as a concept, is still in some ways on the periphery of clinical treatments and treatment options for the military. ARRTS has certainly made art therapy more visible and also more accepted as a viable treatment option for military members or veterans. In Australia we are still a little on the periphery, as compared to the US and the UK.

The need is there though, so change must follow. Eleven to 22 per cent of serving personnel who have been in areas of combat, areas of operation, suffer post-traumatic stress. Some are saying it’s up to 30 per cent long term, but initially within six months of deployment, 11 to 22 per cent of people who have been deployed suffer PTSD. Further, the War on Terror has been our longest war, it is longer than Vietnam ... We sent 60,000 to Vietnam and we have sent 73,500 to the Middle East. For these reasons, change must happen, and it’s happening.

Samuel: If an institution like the military can stand on the forefront of something as important as mental health, do you think that this might act as some sort of inspiration for civilian medical services? That they might embrace what’s being undertaken by the military right here and now?

Ian: Totally. I think there are opportunities to extend the type of work – not only the work that we are doing, but also other organisations in the community – to use art and art therapy as a mechanism to assist people across all sectors of society. Clearly the emergency services – fire, ambulance, paramedics, police – are in need of this type of option. And I’m in discussion with the likes of the Australian Federal Police and ACT Fire and Rescue around use or facilitation of creative arts as a treatment option for their members that might be undergoing both physical and psychological stress.

Samuel: One of the reasons I am actually here personally talking with you today, Ian, is that myself and my brother have both suffered trauma that has had lasting and long-reaching effects. While neither of us are military, we are both in different stages of recovery at the moment. My trauma results from prolonged years of family violence compounded by almost 20 years of substance addiction and all the issues associated with that lifestyle, and my brother’s trauma stems from a physical brain injury he received during gang-related violence around ten years ago. Does the ARRTS project have space for people like my brother and myself?

Ian: Currently no, unfortunately, because it’s military-specific program. It’s funded by military and it’s for Defence personnel. However, where I’m wanting to take an art-based program like ARRTS is to other cohorts of people who clearly would benefit from a creative approach.

On your brother’s head injury, I have spoken to the Defence Centre of Excellence for Psychological Health and Traumatic Brain Injury in Washington and they indicate that the American military have over 400,000 Defence personnel who have suffered a wide variety of traumatic brain injuries in the Middle East conflicts since 9/11.

Clearly then there are opportunities to use creative arts for other, non-military cohorts, including women who have suffered domestic violence and sexual abuse; kids who are undergoing cancer treatments in paediatric wards; people involved in motor vehicle accidents; rural women; Indigenous women; long-term veterans; corrections groups, including youth detainees; refugees … All are classic groups of people who would benefit greatly from a more arts-integrated health approach.

Jessica: Are you able to report on any program outputs?

Ian: In terms of quantitative outputs, we have put through about 140 Defence members thus far. We run two programs a year and we are now in the fourth year. Defence psychologists formally evaluated the first two programs, which were pilot programs. The pilots provided us with 42 individuals who participated in a pre, during, and post program survey. It was a psychoanalytical survey, and Defence Science and Technology Group (DSTG) came up with statistically significant results across a whole range of parameters from improvements in insomnia, reduced stress, reduced blood pressure, better moods, fewer mood swings, less aggression, et cetera. While I do not recall every parameter, there were statistically significant results across the board. As a result of these outcomes, Defence went to tender, and we were fortunate enough to win that tender as a part of a panel of service providers.

Qualitative outputs include, as I discussed previously, that there have been at least a couple of participants we know who have not committed suicide, which they credit directly to the program. We know of marriages that have been saved, and generally we also know that some Defence personnel who were on a trajectory to civilian life have been able to get themselves into a mental state where they’ve actually stayed in the military. Besides the health and wellbeing of the individual, these results produce an economic benefit to the military as an organisation.

To add to post-output data, for each program run, we also create a closed Facebook group where we can follow the participants and their discussions. We know that there has been ongoing engagement within the groups. The groups also prove valuable, because one of the issues identified very early on in the program was the ‘what if?’ – what if we bring people into the program, teach them a whole range of skills, get them feeling really good about themselves and then on day 20 the program stops. Do they fall off a cliff and actually end up worse off than they were before, because they were doing really well and all of a sudden there is nothing? We were quite worried about that, and to be honest I would still like to do more.

Finally, I would also like to do a follow-up program that goes beyond collecting post-output data. It might only be a long-weekend, possibly a three- or four-day program, three to six months after their completion. That hasn’t eventuated yet, but if funding comes we will be able to implement it.

Samuel: Looking again to your essay, Lieutenant General Gillespie declares that a modern military employs adaptive responses to complex environments. It seems that it took this kind of a mindset to get a program like ARRTS underway.

Ian: It’s important to remember that no one response, no one clinical solution, is right for everybody. And I’m not a clinician, I’m not a physio, I am not trained as a clinician, but just from what I’ve observed, people gain so much from being to be able to create something and tell their story.

I have also seen the results of arts therapy in real time as I watched a veteran doing an art therapy program while undergoing an EEG (electroencephalogram test). The changes in brainwaves during the art session, the change to the amygdala and the frontal cortex of the brain while the person is actually undertaking an art therapy session, were phenomenal. So when people talk about post-traumatic stress and hyper-arousal and anxiety and this constant on-the-go, you can see that occurring in the frontal cortex, which is actually red when you see it on a computer screen.

Samuel: It seems then that we are not just diving in and drawing pretty pictures and walking away. This – creative arts therapy – appears to be a legitimate scientific endeavour that is being undertaken by the ARRTS program.

Ian: Absolutely. I have spoken to neuroscientists about the program and the results and they are convinced there is hard evidence around the benefits of creative arts therapy now. As I discussed, the therapy does not suit everybody, but you should it a give it a go. If there is a change it will ameliorate some of the suffering and daily obstacles so many participants face.

 

Notes

1. The Long Way Home (written by Daniel Keene) was a verbatim theatre performance presented by the Sydney Theatre Company, using returned service personnel to tell stories of what it was like to participate in the military action. See https://www.tracesmagazine.com.au/2014/03/long-way-home-tours-australia/

2. Ian Drayton, ‘Returning the service’ (2016); see also Drayton’s Churchill Fellowship report, ‘Exploring the use of creative arts to manage and promote recovery from combat-related post-traumatic stress disorder’ (2017).

3. Beyond Blue (https://www.beyondblue.org.au/) is an Australian non-profit established to address mental health and to raise community awareness of psychological illness. Black Dog Institute (https://www.blackdoginstitute.org.au/) is also a non-profit, established to diagnose and treat mental illnesses.

 

Works cited: 

 

Drayton, Ian 2016 ‘Returning the service: The healing use of creative arts’, in Bob Douglas and Jo Wodak (eds), Trauma-related stress in Australia: Essays by leading Australian thinkers and researchers, Weston ACT: Australia 21 Ltd, pp. 97–99

Drayton, Ian 2017 ‘Exploring the use of creative arts to manage and promote recovery from combat-related post-traumatic stress disorder’, Churchill Fellowship report,
https://www.churchilltrust.com.au/fellows/detail/4116/Ian+Drayton

Keene, Daniel 2014 The Long Way Home, Sydney Theatre Company, Sydney