Music Therapy, War Trauma, and Peace: A Singaporean Perspective

By Wang Feng Ng

AUTHOR'S NOTE: This article is dedicated to Edith Hillman Boxill, who passed away on Tuesday, October 11, 2005, in New York City. She was 88 years old; she would have been 89 in November. Edith's enthusiasm, compassion, and grace inspired me and helped me to persist in this project and beyond. "I am deeply grateful, Edi! Thank you for showing me the way."

Abstract

Music therapists have traditionally worked with survivors of different types of trauma. But they are increasingly involved in providing services to war trauma survivors. In the post 9/11 world, many have been, and continue to be traumatized by war, acts of terrorism, and violence worldwide. Some music therapists have sought to respond actively to these events and the resulting trauma, by reaching out to trauma survivors. In addition, some are also involved in peace advocacy. From information obtained from interviews conducted with eight music therapists regarding the nature and outcomes of these therapeutic practices and their involvement in peace advocacy (as applicable), the relevance of this realm of work within the Singaporean context is explored.

Keywords: Music therapy, war trauma, terrorism, peace, Singapore.

Introduction

Music therapy in the United States has its origins in response to World War II veterans' homecoming. Today, the world is still violent. Terrorist attacks on the U.S., Indonesia, Spain, and the United Kingdom., crises like those in Sudan and Rwanda, and the ongoing Iraq war, serve as powerful reminders of the scale and extent of devastation that catastrophes of human origin can inflict (Solomon, 2003).

As Moreno (2003) pointed out:

. . . [national economic and political conditions directly influence] the availability of the requisite support for music therapy services, thereby determining who will receive music therapy, as well as creating circumstances that may contribute to some of the very kinds of problems that music therapy addresses...(Moreno, 2003, para 1)

[Therefore, music therapists] cannot, and perhaps should not try to escape the fact that our role is shaped by political contexts. And, along with this, comes the obligation of assuming a level of political responsibility (Moreno, 2003, para 5).

More specifically, how can music therapists contribute to the world within such a context? Amir (2002) proposed a two-pronged solution—to deal with the consequences of violence by reaching out to trauma survivors, and to engage in prevention work, via the creation of models of peace, tolerance, and mutual respect via community music-making.

While music therapists have worked with war trauma survivors and/or actively promoted peace, there has not been any systematic examination of the nature of these efforts, their purposes, and outcomes. The purpose of this paper is therefore to provide a preliminary overview of music therapists' work with war trauma survivors, and approaches to peace building. This paper will also attempt to contextualize these findings within the Singaporean context.

Music, War and Music Therapy

In the beginnings of music therapy in the United States, music and war were intertwined. Music was recognized primarily for its role in military ceremonies before its therapeutic value gained recognition (Ainlay, 1948). When medical services were insufficient to rehabilitate the injured WWII veterans, the Army's Reconditioning Program was initiated to address soldiers' unmet needs. This program was the "first actual recognition given to music as a definite means to be used in a hospital to help the sick and injured" (Ainlay, 1948, p. 323).

Specific methods and techniques, such as Guided Imagery and Music (GIM), and improvisation have been used with Vietnam veterans (Blake, 1994; Blake & Bishop, 1994; Burt, 1995). Music therapy services have also been provided to the general civilian population and have addressed a whole range of trauma issues, including physical, emotional, sexual issues (Short, 1991; Slotoroff, 1994; Ventre, 1994) and specifically, childhood trauma (Blake & Bishop, 1994; Bray Wesley, 2003; Montello, 1999; 2003).

Trauma: Definitions and Symptoms

War trauma refers to an "experience that meets the definition of trauma as described in the DSM IV under PTSD that results from exposure to war conditions" (Hanscom, 2001, p. 1033).

Traditionally, diagnostic categories relating to war trauma have been focused on combatants. These include "shell shock," "combat exhaustion" and "combat stress" (Binneveld, 1997). However, war trauma "may also occur - and persist within the affected society in the aftermath of war - in the lives of civilian noncombatants" (Graves, 2003, p. 204).

The symptoms of war trauma are manifested in somewhat different ways in different populations (Brosse, 1950; Child Soldiers Global Report, 2001; Layne ,et al., 2001; Macksoud, 1993). Behaviors peculiar to children include excessive clinging, bed-wetting, dumbness, difficulty in expression, and morbid aggression (Brosse, 1950; Macksoud, 1993). Adolescent-specific responses include poor academic performance and lack of preparation for future professional or family life. Adolescent and adult trauma survivors may exhibit the following behaviors: substance abuse, mistrust in social institutions, flashbacks, suicidal thoughts, antisocial behavior, and problem with peers (National Institute of Mental Health, 2002; Layne et al., 2001). Generally, typical responses include sleep disturbances, somatic complaints, anxiety, withdrawal and isolation.

Music Therapy and Healing War Trauma

Throughout the last century, there has been relatively little concern for the civilian victims of war (Graves, 2003). The research focus on combatants is justified for earlier wars, since about 85% of victims killed in WWI were combatants (Graves, 2003). However, "today, some 90% of all people killed in wars are innocent, civilian women and children" (Ehrenreich, 1997; Kolb-Angelbeck, 2000, cited in Graves, 2003, p. 203). In recent decades, civilians have been deliberately targeted in "ethnic cleansing," massacres, hostage situations (Yule, Stuvland, Baingana & Smith, 2003), and protracted violence within the context of war (Bowden, 2003). Given this context, there is a growing need for services to help civilians suffering from some level of post-traumatic stress due to years of exposure to war. As Moreno observed, " Music therapists are becoming increasingly involved in volunteer work in war-torn and developing countries and the growing need for this was brought out. at the last World Congress of Music Therapy in Oxford." ( Moreno, 2003, para 3)

Music therapists have found their way into postwar societies in need of healing and rebuilding, e.g. Bosnia-Herzegovina (Sunflower Project, n.d.). Here, the Pavarotti Music Centre (PMC), the humanitarian organization, "Sunce," and the Sunflower Project have been providing music therapy services for clients with trauma issues and special needs (Lang & Mcinerney, 2002; Watts, 2004). Music therapists have also worked in the Gaza Strip (Yawney, 1993), in South Africa (Pavlicevic, 1994, 2002), in Sierra Leone (McKay, Burman, Gonsalves, & Worthen, 2004), as well as treatment centers for torture victims in London (Dixon, 2002) and in Berlin (Zharinova-Sanderson, 2004).

Although not specifically examples of music therapy, there have been a number of programs developed in postwar contexts that used musical and other creative artistic experiences to rehabilitate trauma survivors, and to promote peace, healing and reconstruction (Barenboim, 2004; Gould, 2000; Zelizer, 2003). It is also noted that art therapy has been used in trauma work (Golub, 1989; Graves, 2003).

Music Therapy and Peace Activism

The United Nations Educational, Scientific, and Cultural Organization (UNESCO) Constitution states, "Since wars begin in the minds of men, it is in the minds of men that the defenses of peace must be constructed (UNESCO, 1945). Any discussion involving war trauma would be incomplete without looking at the other side of the equation: peace.

"Peace," being one of the central constructs in this paper, is not defined explicitly within the music therapy literature. Music therapists have written about peace, or alluded to it, without defining it (Boxill, 1988; Kenny, 1988; Moreno, 2003). It was even suggested that the implications of peace may be "beyond the grasp of language as we know it. Maybe we can only play it" (Crandall, 1989, p. 122). For the purposes of this project, "peace" will refer more broadly to a state of harmony, and an atmosphere of dialogue, cooperation, and respect, particularly on the interpersonal and community level. This notion of peace is congruent with the field of peace education where peace is defined:

. . . [peace is] not only as the absence of open hostilities, or negative peace, but [also] the presence of peacemaking processes and conditions likely to ensure a secure, durable, positive peace. It implies a state of wellbeing, a dynamic social process in which justice, equity, and respect for basic human rights are maximized, and violence, both physical and structural, is minimized (Reardon & Cabezudo, 2002, p. 4).

While the links between music and peace activism are historical (and beyond the scope of this paper), the phenomenon of activism within music therapy does not date back that far. As Bruscia states:

[ In ] its short history as a profession, music therapy has played a significant role in various social, cultural, and political movements, using the unique perspectives and skills inherent in its focus on music and the ability of its members to network and organize themselves to effect change (Bruscia, 1998, p. 233).

Specific to peace activism, there is one music therapist who deserves mention: Edith Hillman Boxill, founder-director of Music Therapists for Peace, Inc. (MTP), an international movement whose mission is to "have music therapists maintain a conscious awareness of contributing to the healing of our wounded planet" (Boxill, 1997a, p. 158).

Music Therapists' War Trauma and Peace Work

From the interview data, two categories seemed immediately obvious: therapists who focused only on working with clients who had experienced war trauma, and therapists who worked with trauma survivors and promoted peace simultaneously.

Music Therapists Who Worked With War Trauma Survivors

Music therapists in this group focused on addressing certain aspects of war trauma, and related forms of violence, such as terrorism. These included examining the effects of trauma and the therapeutic issues around them. The clients targeted include children, adults, seniors, relief workers and caregivers. These services were often provided in the field, in various settings, as opposed to the "traditional" treatment room.

Highlights from Interviews with Music Therapists

Andrea Frisch Hara - New York City Music Therapy Relief Project

Andrea was the program field director of the New York City Music Therapy Relief Project. Headed by the American Association for Music Therapy (AMTA), this initiative was developed to "provide direct music therapy services to children and adults in the New York metropolitan area struggling with the aftermath of the attacks of September 11, 2001" (American Music Therapy Association (AMTA, 2002a, p. 2). Direct service provision commenced in January 2002 and lasted until June (AMTA, 2002a, p. 2). Andrea also facilitated sessions in which the use of improvisation and songs, specifically, rounds, allowed for the experience of "family" or "group" (Frisch Hara, personal communication, October 15, 2004). The project outcome was highly favorable. Letters of appreciation poured in from principals, administrators and recipients of music therapy. Participants in the project expressed that music helped them cope with the traumatic experience (AMTA, 2002b).

John Mahoney - New York City Music Therapy Relief Project and MTP

As 1 of the 33 music therapists who took part in the New York City Music Therapy Relief Project, John worked in Chelsea Daycare, a day unit for seniors with dementia and Alzheimer's Disease. The goal of music therapy was to "offer a safe environment in which participants could feel safe to bring up feelings and to explore their fears" (Mahoney, personal communication, October 14, 2004). John emphasized that the opportunity to "communicate one's feelings to others, and to feel that others care is comforting, is capable of promoting self awareness" (Mahoney, personal communication, October 14, 2004).

[ In music] there was a result of people coming together, as much as they could. A certain amount of group cohesiveness evolved. Sort of a feeling of a collective sense of purpose to share something that was of emotional significance. And that is something they don't experience often (Mahoney, personal communication, October 14, 2004).

Another of John's contributions was his involvement in the production of the MTP song, "Citizens of the World," that was selected for a United Nations award in 1998 (Mahoney, personal communication, October 14, 2004).

Maria C. Gonsalves - Girl Mothers in Sierra Leone

Maria worked with war-traumatized girl mothers in Mambolo, Kambia district, Sierra Leone. (Girl mothers refer to girls associated with a fighting force who were under 18 years of age when their child was conceived.) Upon their return from combat, these girls and their children often faced a hostile community with poor infrastructure, various health problems, and social stigma. The project was research-based and its objective was to examine the "psychosocial reintegration of girl mothers and their children," and the factors for a successful reintegration into the community by "evaluat[ing] several data gathering methodologies" (McKay et al., 2004, p. 10).

Maria assessed the psychosocial needs of the girl-mothers through interviews with them, and with female elders in the community. In verbal interviews, the girls expressed their tangible needs, such as medicine for their babies, and food. It was only through music that the girls expressed their intangible psychosocial needs (Gonsalves, personal communication, October 21, 2004). They "conveyed through song. thoughts and feelings about their relationships with men and boys, including their anger and distrust and their general states of sadness and loneliness" (McKay et al., 2004, p. 11).

Peace-promoting Music Therapists Working With War Trauma Survivors

Music therapists in this group worked both with war trauma survivors and also in peace building. The focus of these music therapists' work has been on youths, including pre-kindergarten children, "gang members" from dire family and community conditions, and juvenile delinquents.

Highlights from Interviews with Music Therapists

Prof. Edith Hillman Boxill - Music Therapists for Peace, Inc. (MTP)

As founder-director of MTP, she saw her work in MTP as heeding her calling to foster peace through our modality. Through music we can make a contribution to peace in the world on all levels of existence (Boxill, personal communication, October 14, 2004).

Edith is passionate about MTP's vision for music therapists to be "ambassadors of peace" (Boxill, 1997a, p. 166). She wrote about the founding of MTP in 1988 in Boston, Massachussetts,

What music therapists immediately became aware of was that the very nature of music therapy is that of peacemaking and that we are already doing the work of peace. But how many of us know it" (Boxill, 1997a, p. 165)

In furthering this vision, MTP has collaborated with various peace, humanistic and cultural organizations to further the cause of world peace (Boxill, personal communication, October 14, 2004), and implemented numerous initiatives.

In response to school violence that was "taking more virulent forms at younger and younger ages," Edith began the Students Against Violence Everywhere -Students Against Violence Everywhere ( S.A.V.E.) - Through Music Therapy program in 1993 to foster "conflict resolution and harmonious relationships through the conscious use of music" (Boxill, 1997a, p. 169-170). As an early intervention practice, the program sought to provide positive alternatives to children's violent and destructive behaviors to improve impulse control, to learn to disagree peacefully, to use peace-giving language, and to engage in peer mediating (Boxill, 1997b). The outcomes were immensely favorable (Boxill, personal communication, October 14, 2004).

Another of MTP's unique feature is Drumming Circles for Peace (DCP). Occurring in community settings "to encompass individuals, groups, communities, nations," DCP seeks

[to raise the] awareness of people(s) of all ages, background, and conditions that nonviolent means of conflict resolution are imperative if we are to survive as a human species. in ways that are inspirational, transformational, and enjoyable. Nonviolence is key" (Boxill & Roberts, 2003).

In order for DCP to continue spreading the message of peace, a grant application to sustain this feature was underway (Boxill, personal communication, October 14, 2004).

Edith also submitted a proposal to Olara Otunno, the Special Representative to the U.N. for Children and Armed Conflict, to provide music therapy to war-traumatized children, in June 2000. Presently, the project was still pending due to lack of funding (Boxill, personal communication, July 11, 2005).

Immediately post 9/11, MTP made plans to reach schools, community centers, child day care centers, churches and synagogues (Wheeler, 2002) and "mobiliz[ed] music therapists in NY to give service to traumatized people" (Amir, 2002). Edith was the first to go into action on the day of 9/11 to mobilize music therapists to go into public schools. She contacted the New York City Board of Education, and upon gaining its consent, provided music therapy, through the end of the school semester of fall 2001, at Stuyvesant High School which is near Ground Zero and where students and faculty witnessed the attacks on the World Center and were instantaneously traumatized (Boxill, personal communication, July 11, 2005). In some cases, due to scheduling problems, continued sessions were not possible (Boxill, personal communication, October 14, 2004). "Finally, in response to Albert Einstein's encouraging statement that we shall require a substantially new manner of thinking if humankind is to survive. and a critical mass of five percent of like-minded people can effect a shift in consciousness" (Boxill, 1997a, p. 158).

Edith has been deeply committed to the issuing of "wake-up calls" to raise music therapists' conscious awareness of contributing to world peace. Her most recent call was issued at the opening session of the 2004 annual AMTA Conference in Austin, Texas. There, Edith co-facilitated a session titled, "MTP addresses the global climate of violence and fear," with Joe Moreno, a founder of MTP, and Norman Goldberg, president of MMB Music, Inc. and staunch supporter of MTP (Boxill, personal communication, July 11, 2005).

Dr. Judy A. Weissman - MTP and Soka Gakkai International (SGI)

Judy is on the Board of Directors of MTP and a music therapist in the cultural department of Soka Gakkai International (SGI), worldwide movement for peace education and culture. Judy's dedication to peace was in part implemented through the S.A.V.E. program, in which she worked with juvenile delinquents in the New York State Division for Youth in Highland, NY. The youths were able to "get past their own aggression, write and perform their own music" as a result of the "weight of my presence. my own determination that peace was possible" (Weissman, personal communication, October 30, 2004). The culminating performance earned them respect in the community. Judy also assisted in the writing of the S.A.V.E. program curriculum, and the UN grant submitted to Olara Otunno. Judy co-led, with Edith, the Continuing Music Therapy Education (CMTE) course titled, "Music Therapy for War-Traumatized Children," at the 2000 AMTA National Conference in St. Louis, MO. One of the most important objectives was to develop empathy for war-traumatized victims, regardless which side of the battle they were on: combatants or civilians (Weissman, personal communication, October 30, 2004).

María Elena Lopez Vinader - MTP and Transcend: Arts and Peace Network (T:AP)

Co-founder and international director of MTP, María Elena has also been an active Transcend: Arts and Peace Network (T:AP) member. The integration of logotherapy and music therapy formed the basis of her clinical practice and approach toward promoting peace. She has presented on MTP at numerous International Congresses of Music Therapy and Logotherapy. She was also a convener of Art and Peace for the International Peace and Research Association (IPRA) (Lopez Vinader, personal communication, November 15, 2004). In mid 2004, she contributed lyrics of a song, "War is a crime against humanity" to a T:AP music project and coordinated the "Humanitarian Art Manifesto" event, "in resonance with other artists from around the world with dance, music and drama to create the culture of peace" (Lopez Vinader, personal communication, July 17, 2005). Based in Argentina, she also has a weekly radio program called "Imaginate: la Paz es Posible" (Lopez Vinader, personal communication, April 7, 2004) where she has discussed music and peace with guests from various countries, in English and Spanish. She has also conducted numerous workshops in Argentinean schools about music and peace.

Sharon Katz - Peace Train

Sharon, South African music therapist and "multi-talented peace emissary" (Weinstein-Moser, 2003, p. 9), initiated the Peace Train project in 1992, in KwaZulu/Natal, the seat of civil strife between two political parties: Inkatha Freedom Party and African National Congress. This community music therapy project gathered 500 youths, between the ages of 7 and 18, from "previously separated races and cultural groups in South Africa in a shared experience" (Katz & Cohen, n.d., p. 3) to form a tradition-defying multiracial and multilingual choir to perform at the culminating event, "When Voices Meet." Following this concert, Sharon led a subset of the original group on a nationwide and international tour to spread the message of democracy and peace to educators, community leaders, and youth (Katz & Cohen, n.d.). These youths were from extremely poor, violent and oppressed communities. In their attempts to achieve status and a sense of belonging in their communities, many were gang members (Katz & Cohen, n.d.). Fundamental to Sharon's work is the use of music performance as the transformational tool to break down barriers, and to facilitate dialogue and resolve conflicts peacefully (Katz, personal communication, September 30, 2004). Outcomes of the project were extremely positive: "marginal students began earning top rankings. introverted individuals became much more communicative, gang membership disintegrated, and initiative and creativity blossomed" (Katz & Cohen, n.d., p. 10-11). Presently, all members were gainfully employed, and many had success stories to share (Katz, personal communication, October 26, 2004).

Ellie Watts - Suncokret Projekt [Sunflower Project] (SP)

As co-director of SP, a charity committed to bringing peace, hope and joy to children and adults in need, Ellie was committed in many ways to promote peace (Watts, personal communication, October 31, 2004). SP provides services to Bosnian orphans and children, between the ages of 4 and 18, through a multidisciplinary approach in this postwar context where a social care system was conspicuously missing (Watts, personal communication, October 31, 2004). Ellie was also a member of the Advisory Board for Music as Therapy's (a United Kingdom Charity) work in Romania.

In addition to music therapy services, Ellie has been active in the promotion and delivery of skill-sharing courses to local professionals. Ellie emphasized that the training was not to make them music therapists, but to "identify some basic, appropriate principles of music therapy" that they could incorporate in their work, so that they can deliver services independently (Watts, personal communication, October 31, 2004). Improvisation was commonly used in therapy. In working with clients dealing with developmental issues, more structured activities were used. Ellie reported outcomes such as improved communication skills, increased emotional expression, improved maintenance of difficult memories, healthy progression through grieving, and reduced stress and anxiety levels (Watts, personal communication, October 31, 2004).

The Singaporean Context

Given recent trends, working with war trauma survivors and peace building are relevant everywhere in the world. Terrorism, with its "global scale[,] trans-national nature.[and] capabilities to cause catastrophic damage. has quickly become the biggest security challenge for many countries" (Teo, 2004, p. 37). Of particular interest is that Southeast Asia, especially the Malay archipelago, has come into focus as the so-called 'second front' in the war against international terrorism (Tan, 2003). The Jemaah Islamiyah (JI) network in Southeast Asia was responsible for the bombings in Bali and Jakarta, and others in the region. An affiliate of Al-Qaeda, its aim is to "establish a pan-Islamic entity encompassing Indonesia, Malaysia, Singapore, the Philippines and southern Thailand" (Teo, 2004, p. 37). In fact, Singaporean JI members were directly involved in its operations, which included the planning of attacks on several foreign embassies in Singapore, water pipelines and the Changi Airport (Desker, 2003).

In Singapore, steps have been taken to counter the threat of terrorism. They include legislative and policy changes to address the risk of hazardous materials being hijacked and misused, and to counter threats to computer technology that can affect national security (Wong, 2005). Wong (2005) also alluded to the establishment of community programs in Singapore to foster inter-racial and inter-religious understanding. However, such preventive and protective measures taken by governments "will only address the symptoms ... [as] is an ideological struggle. ultimately, only Muslims themselves - those with a moderate, modernist approach - can effectively counter the ideology that has been twisted out of a perverted interpretation of Islam" (Teo, 2004, p. 37).

I would like to suggest that music therapists in Southeast Asia may have an opportunity to contribute to world peace, perhaps in the way envisioned by Edith Boxill. Music therapists may collaborate with other professionals and members of the community, to bring diverse groups of people together to facilitate dialogue, through musical initiatives such as Drum Circles for Peace (DCP) and community concerts. In addition, it is important to work with the youths and introduce constructive, creative and peaceful alternatives to violence, through programs such as Students Against Violence Everywhere (S.A.V.E.). While music therapists may not all see their work as being directly related to world peace, many recognize the implications of their work with clients in terms of promoting world peace. For example, "I believe that the best 'guarantee' for world peace is for every individual to attain inner peace and the road to inner peace is often filled with 'demons' that must be examined and worked through [sic] for a lasting peace to take its place" (Frisch Hara, personal communication, June 6, 2005.

As for survivors of war trauma and related forms of violence, music therapists have much to offer. As music is deeply meaningful to people of all ages, especially those in crisis (Brodsky, 1991; Moreno, 1999), music therapy has been shown to be an effective method of intervention for trauma survivors (Moreno, 1999; Pavlicevic, 1994). For example, as David Wilson, former Pavarotti Music Centre (PMC) director, pointed out, "When the lights go out, when the food runs out and when death is ever-present, you still find music" (Wilson, n.d., para 8). While music encompasses a range of feelings, urges and instincts, including violent ones, as a process, it "will naturally tend towards intimate and creative interpersonal engagement" (Dixon, 2002, p. 129). Moreover, music-making, being a creative and expressive act, represents the polar opposite of trauma, which is synonymous with destruction and violence (Dixon, 2002). Thus, music therapy can be seen as an adjunctive treatment modality that complements verbal therapies (Zharinova-Sanderson, 2004). Particularly in southeast Asia, after the terrorist attacks in Indonesia and also the survivors of earlier and ongoing wars, such as in Cambodia, Sri Lanka, and Aceh, just to name a few, the urgency of providing services to war trauma survivors is felt. The proposal submitted to the U.N. by Music Therapists for Peace (MTP) in 2000 was an important first step towards ensuring the provision of music therapy services to war traumatized children, hopefully some time in the near future.

Conclusion

Music therapists have, in recent years, become increasingly involved in reaching out to survivors of war and related forms of violence, and have reported positive outcomes in their ventures. Among these, some have been actively using music and/or music therapy to work towards their vision of peace. These practices are relevant to Singapore and southeast Asia, given the international nature of terrorism acts in this post 9/11 world. Moreover, while governments are taking protective measures to safeguard national security, music therapists still have much to contribute in terms of promoting peace and helping war trauma survivors on the healing path.

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