View of Arts-Based Practices in Regions Affected By War

[Research Voices: Review article]

Arts-Based Practices in Regions Affected By War

An Overview of Where and How Arts-based Practices are Applied and Studied in Countries Affected by War

By Alpha M Woodward

Abstract

Post traumatic stress disorder (PTSD), cultural disintegration, political confusion and unresolved inter-ethnic conflict are just some of the hurdles that can face citizens in war affected areas. After the Dayton Peace Accord[1] was signed in 1995 ending the deadly armed conflict in Bosnia and Herzegovina (BiH), international government and charity organizations and a variety of NGOs flooded into the country to help rebuild the infrastructure and to offer transitional economic and political support for the beleaguered, fragmented population. Although arts-based activities, therapies and projects were also part of the international influx, this form of psychosocial intervention was piecemeal, somewhat random, and often unable to sustain a long term or systemic approach to the massive psychosocial needs of the people. There appears to be little peer-reviewed fieldwork research to support claims of effectiveness of arts-based projects in post-conflict regions. Therefore, considering the growing number of projects that use the creative arts as an intervention for trauma, conflict transformation and community building in war affected populations, the purpose of this paper is to search for, and to critically examine, empirical arts-based research conducted in war affected areas and/or any population that may have been directly impacted by activities of armed conflict.

Keywords: Creative arts therapies, community music therapy, social activism, peace building, refugees, war affected regions, research methodologies.

alt text
Sarajevo’s lost innocents: The children of Bosnia under fire. Photo by R. Richards via digitaljournalist.org (Richards (1993) Remember Sarajevo, p. 70).
Scholars tell us that culture is implied, that we take it for granted. We begin our socialization at such an early age that it is difficult to recognize these implied realities. It's like the inside of our bodies. We don't see them so we don't think about them. We assume that all will go well until something goes wrong. Then we notice. Kenny and Stige (2002, p. 1)

The purpose of this critical research review is to review empirical research in the literature that pertains to arts-based social action projects or activities that are related to regions and populations affected by armed conflict. It is my opinion that the arts are marginalized in terms of policy-making, psychosocial intervention approaches and community building efforts by larger international NGOs in peace-building efforts. As a result, the thinly funded arts-based projects tend to be piecemeal, short-lived projects that do not contribute to the general epistemology governing post-conflict recovery. On an operational level, the short-term projects do not contribute to any collective systemic approach or sustainable vision for social change, and as such, may lack the resources to conduct research, especially in the area of longitudinal studies. My research topic is focused, for the most part, on those creative arts professions that are not indigenous to the war affected country and, therefore, are independent projects imported into the country through various aid organizations, NGOs, or are independent fieldwork studies conducted by international educational institutions.

In the past 14 years the developing discourse in cultural and community perspectives within the profession of music therapy has provided robust theoretical frameworks (Ansdell, 2002; Ruud, 1998; Stige, 2001, 2002) that have provided a rationale to the growing interest in fieldwork in regions of inter-ethnic conflict, but the realistic opportunities for such undertakings may be limited by operational concerns. Although the profession is currently identifying ways in which it is a culturally informed approach (Stige, 2002) and frequently referred to as community music therapy (Ansdell, 2002, Stige, 2002), it is also still rooted in the traditional client-focused care from which it evolved.

Positioning and Context

My interest in studying arts-based research in war affected areas stems from my work as a team leader and senior music therapist in the Pavarotti Music Centre (PMC) in Mostar, Bosnia and Herzegovina (BiH), from January 2004 to August 2007. After an initial shaky period of uncertain funding, the program morphed from being dependent upon the two parent charities, Warchild NL and Warchild UK[2] into an independent NGO. Under pressure to continually fundraise, organize its services within the community, and provide a comprehensive clinical outreach program to children in the surrounding areas, it had too few human resources to also conduct research on its activities. The program spanned a nine year period from 1998 to 2007 and provided music therapy to hundreds of children in special needs facilities, schools, refugee camps, hospitals and orphanages. Although the program had attracted global attention and respect, no evaluation or study was conducted on the effectiveness of the work on PTSD, the impact on the clients or the community, or the perspective of the cyclical roster of therapists who came and went over that period. Three of the earlier music therapists from the program wrote one chapter in a book (Sutton, 2002), where they discussed their experiences and challenges of distance supervision in fieldwork (Lang, McIrneny, Monaghan, & Sutton, 2002). It was an important perspective of the work, but more was needed. Kochenderfer’s (2006), ethnographic comparative inquiry on three different music-based NGOs in Mostar with its embedded misconceptions, convinced me that further research was needed to be conducted by therapists themselves in order to connect to, and report on, the systemic nature of the issues facing fieldworkers providing therapy in traumatized cultures. And although meticulous client records and session documentation were kept, no research was ever done on the efficacy of the work, or the long-term effects of music therapy with hundreds of children in these exceptional circumstances. This does not cast blame upon the personnel, but rather speaks to the loss of opportunity of evaluating a unique program in a situation that had global implications. The program closed its doors in 2008 and it is likely that all records were destroyed by local personnel to protect the privacy of the individuals who were treated at the centre. Therefore, even statistical research is no longer possible.

I was curious to explore what and where empirically-based research has been done—specifically in music therapy, but also in the creative arts therapies (CATs)—in war affected regions, and war affected populations (which may include refugees in host countries). A broader knowledge of how the arts are being used in high-stress regions and traumatized populations may have implications for sustainable practice and research for arts-based programs and fieldworkers in war affected areas. This review, therefore, examines each article for its "mission"—an overall intention of the fieldwork that may be unstated in the study. Examples of this might be peace building, conflict transformation, therapeutic recovery from PTSD, social action, and so forth.

At this point it is useful to understand music therapy in an operational and theoretical context. Music therapy is practiced in a wide range of populations where individuals or populations are at risk, marginalized or vulnerable - through the intentional and skillful use of music, or elements of music, to increase one’s sense of agency, vitality, belonging and meaning-making (Ruud, 1998). And it is an interdisciplinary field that encompasses a broad landscape of knowledge, different research traditions, philosophies of science and systems of values. Stige (2002a, 2001, 2002) and others have been proponents to broaden the conceptual definition of music therapy to understand itself as a discipline that works with individuals within a community context and also for change in a community. It is my view that the CATs empathically, philosophically and theoretically share similar theoretical professional frameworks with overlapping features of performing and educational roles. From this I believe that collaborative ventures may lead to future sustainable work, and/or a rich environment for empirical research. Therefore, I have included all creative, therapeutic and performance arts in this search because 1) we are a family of therapeutic modalities that share similar objectives and understandings of the import of nonverbal symbolic representation in the therapeutic process, 2) the CATs evolved along a similar time-trajectory after WWII, and 3) the role of all the arts in cultural health, and in building and maintaining societal cohesion is consistent with my earlier platform[3] which was presented in my Nature of Leadership essay (May 2009). I have defined arts-based social actions to include both creative art therapy treatment modalities as well as performance and/or community arts programs; that is to say, it includes any project that has music, art, theatre, dance, bibliotherapy or poetry at its centre of operation. And the terms conflict or post-conflict may include past and/or present war affected regions or populations.

There is an abundance of literature in peer-reviewed journals and books that provides persuasive analytical or theoretical argumentation for the effectiveness of the creative arts in trauma work—work that reconnects individuals with "meaning", identity and agency through enlivening and empowering one’s internal resources (Ruud, 1998, 2008; Rolvsjord, 2006) through stimulating neurophysiological processes (Osborne, 2009; Demorest, Morrison, Stambaugh, Beken, Richards & Johnson, 2010), or through communicative and empowering socio-cultural activities (Stige, 2002; Qaudros & Dorstewitz 2011; DeNora, 2005)[4]. These articles and chapters often use case material as context for their central theoretical argumentation, but the material is often gathered in non-conflict regions or based in a different societal context—trauma in the family system, trauma connected to a natural disaster, or situational western practices, for instance. Even so, as in the case of community arts therapies, one can infer from such theoretical studies that arts-based activities in general, and the arts therapies in particular, have a substantive role in trauma work, or remedial psychosocial activities, and can provide the "glue" for rebuilding identity and reconnecting individuals to meaning making in his/her personal orientation and social milieu—no matter what the original cause of the dissociation. The premise for making such an inference is well covered in the milieu of literature (Dissanyake, 1992; Florida, 2009), but also is at the base of my own theoretical stance that the evolution of humankind in robust and socially coherent groups and cultures is enabled by our relationship to an aesthetic landscape that includes artistic behaviours such as music, dance, theatre, and ritual (Woodward, 1998, 2004)[5]. Also, the CATs operate from a common philosophical understanding that art media offer opportunities for non-verbal expression of the "unspeakable" (Bergmann, 2002; Clements-Cortes, 2008; Harris, 2009) and thus provide a universal resource for the traumatized or disenfranchised individual to find coherence as a social being.

The Search Method

My literature search was greatly assisted by invaluable advice from Deborah Baldwin, Doctoral Research Librarian at Antioch University who suggested using a five-step search process. Essentially, these five steps[6] involved the following:

  1. Subject Search in bibliographic subject index data bases.
  2. Mining the citations
  3. Citation searching
  4. Deep journal searching
  5. Searching outside sources.

Two subject areas formed the scope of the search: creative arts and armed conflict and war. Subcategories in each subject area were used as keywords to identify studies within the intended scope of the search, and a thesaurus was used to capture different ways in which armed conflict may be referenced (Table 1). Using an algorithmic process, I cycled through the key words in both columns.

Table 1. Venn table for key words
Creative Arts[7]
Armed Conflict and War 

Music therapy

Drama therapy
Art therapy
Dance therapy


Music events*
Art events*
Theatre events*
Dance events*

War
Inter-ethnic conflict
Conflict resolution
Conflict transformation
Peace building
World War II
War-affected areas
Refugees
-Soldiers/military
-Trauma/PTSD
-Prisoners of War

*performance/community

 

The search yielded 75 peer reviewed journal articles, 15 book chapters and 5 dissertations. The bulk of these were found through PsychInfo, SocIndex, Google Books and RLIM search engines. After reading the abstracts of the 75 articles, I downloaded and read 38 in more detail. The final selection of 27 empirical studies was comprised of 21 journal articles, 1 dissertation and 5 book chapters. Moving to strategy two, I mined the articles for further resources, and, in many cases, this led to material I had already uncovered. A citation "forward-looking" search (step three) was done through the Web of Science, but somewhat counter-intuitively, this led me further away from my area of interest. Deep journal searching (step four) was done within two journals: Music and Arts in Action, and The Arts in Psychotherapy because the journals were content-laden in my area of interest. This led me to field reports and compendiums that were relevant but not useable in this review. Step five was a less formal process that involved conversations with colleagues and browsing the internet for online newsletters related to peace building. This led to a broader knowledge of the use and application of music activities in the third world and conflict resolution issues at political levels. Although I had uncovered enough literature for this paper, using the other strategies helped to validate that a level of saturation had been achieved and that most of the relevant material was found. The casual nature of the last strategy was fruitful in adding an historical perspective of Music Therapy because I was reminded that the profession had gained traction during and after World War II, working primarily with recovering “shell-shocked” war veterans (Rorke, 1996).

Selection and Elimination

I used Aigen’s (2008) critical analysis of qualitative research in doctoral studies in music therapy as an exemplar and guideline for my selection and elimination process. His review was a naturalistic inquiry in that his own process of discovery was revealed through a reflexive engagement with all of the studies—both those that met his criteria, and those that did not. As such, I have followed a similar process within this critical review of the literature.

The most salient feature of many of the downloaded articles and chapters was that a methodology was not clearly stated, although in most, a demonstration of reflexive process was present. The most philosophical, abstract and theoretical articles, where clearly stated, were eliminated during the selection process. But from my own experience, it may be an endemic feature that fieldworkers are often dealing with their own cultural adjustment while working under the duress of collective trauma. Research methodology may not be the primary interest of the fieldworker, and published articles may surface after a long period of reflection and contemplation. This view is supported by articles that were published several years after foundational fieldwork was completed (Kalmanowitz & Lloyd, 1999; Darvin, 2009). In reviewing, again, my own intention of having a broader and deeper understanding of how the arts have been involved in community-building, or assisting war affected populations—and how these have been studied, I re-included some papers, while, by the same thinking, eliminated others that were highly relevant, but not empirical. The process at times seemed subjective and arbitrary. I noticed that most journal articles, although scholastically responsible, had flavours of many methodologies, and this integrative, non-articulated blending was more the standard than it was an exception.

Many articles were discarded because they dealt with non war-related trauma or with conflict resolution in culturally functional populations. In other cases I had to "best-guess" whether the paper had an evaluative component to it, or provided enough empirical case material to count as a "study." Case by case, a decision was made to include papers that clearly stated a rationale, purpose, process and discussion in the use, evaluation, or application of the creative arts in war affected areas, or populations. Hart (1998, p. 93) suggests that one can "infer" a particular qualitative approach, and, where possible, the philosophical position of the if a clearly stated methodology is missing. Two literature sources were not included but provided valuable insight into where music-based projects were occurring globally: “Music as a Natural Resource: Solutions For Social and Economic Issues Compendium”[8] and “Music Therapy in War Affected Areas” (Heidenreich, 2005).

Categorizing the Literature

This section lists the breakdown by region, population, modality and methodology. Appendix A is a matrix that is organized by region and offers a comprehensive overview of the literature with respect to methodologies, modalities, populations, summaries and thematic categories.

Regions Affected by War

Table 2. Empirical studies by region
Region+host countries # Studies
Former Yugoslavia 9
Africa 6
USA 5
Israel 3
Germany (WWII) 4

This breakdown was done to get an overview of where the studies were conducted (Table 2). Most studies were evenly distributed throughout former Yugoslavia as follows: Bosnia and Herzegovina (6), Croatia (2), Slovenia (1). The geographical area of former Yugoslavia had splintered its constituent republics into autonomous countries at the start of the wars in the early 90s, and except for Slovenia which accepted refugees from Bosnia, each remains politically distinct from each other, while being tied through the common historical events of many wars over the centuries. For the purposes of this paper, however, these entities will be represented by either Bosnia or Croatia where most of the studies occurred.

Seven studies were clustered in Africa, but were evenly distributed between Sierra Leone, South Africa, Sudan, Ghana and Uganda – with Uganda being a host country for refugees from Sudan and the Republic of Congo (DRC). Four studies were conducted in the U.S. but three were related to the complex issues of PTSD with refugees from Argentina, Cambodia and Bosnia. Historical studies that focused on World War II (WWII) in German concentration camps were unique to the other studies because they made use of archival material, narratives, interviews and memories of holocaust survivors or their children. Inter-cultural tensions, grief, abuse, personal deprivation and trauma were common issues in all of the studies regardless of the region or time of the study.

 

Populations Affected by War

alt text
Figure 2. Empirical studies by population.

This category was added because studies must identify a specific population of interest and rationalize the approach and purpose around this context. Also with the mass migrations that occur during civil unrest and armed warfare, refugees warrant similar approaches and interventions as those who stayed in the home country, and are often easier to access without the researcher living in the field.

By far the highest correlation of search items on war affected populations and war zones was found in nine articles that concentrated on children in Bosnia and Herzegovina (Figure 2). Seven of the studies used a historical perspective and studied the use of art amongst prisoners of war in WWII, or oppressed civilians under siege in and around Waco, Texas. Five studies were conducted with refugees in host countries – most notably the U.S.A. Gender-related articles about women, preadolescent girls, preadolescent males, and male ex-soldiers, accounted for five studies. Two studies focused on rehabilitating boy combatants back into their communities. One study stood unique to the others in working with adult children of holocaust survivors from WWII. Two studies, each using ethnographic techniques, targeted the work and the role of local artists. One of these studies interviewed members of an interfaith choir and the other analyzed the art of 30 artists in view of the political/artistic climate before, during and after the armed conflict in Bosnia. This suggests there may be a gap for certain sectors of society in need of psychosocial assistance. For instance, orphans, women’s groups, the elderly, ex-soldiers, and teachers and caregivers for the young are underrepresented.

Creative Arts Modalities

All of the arts were represented in the literature (Appendix A). The majority of articles dealt with the therapeutic application of the arts to assuage the psychosocial consequences of war, rather than arts-based activities or community events. The most frequent modality used was music therapy, appearing in 10 articles. Seven articles focused on art or art therapy. Four studies related to drama therapy. Two articles focused on movement or dance therapy, and one article described a bibliotherapy workshop with preadolescent girls. Four articles analyzed case material from more than one art modality.

Methodology

In this section, I outline five of the main methodologies in the literature, describe my perspective about these and, where necessary, provide a few examples to substantiate my interpretation of the methods used in these articles (Appendix A). I have included three "umbrella" cultures of inquiry, such as phenomenology, action research, and arts-informed research because they are inclusive of a number of different qualitative approaches, and therefore an appropriate fit for integrative studies as well as for those that follow a singular methodology.

Out of a final selection of 27 articles, 24 were classified as qualitative studies. Two used mixed methods and one used quantitative methodology. From this it appears that the preferred culture of inquiry for arts-based studies in war affected populations lay within the family of qualitative methodologies and this may be because ethnographic techniques are a natural fit for research taking place within unknown cultural frameworks. Within this outcome there were some generalizations. All 27 studies, including those that involved mixed methods and quantitative methodologies, made extensive use of interpretation in data analysis. The most salient feature of the qualitative articles was the use of one or more cultures of inquiry. Where qualitative studies made use of one or more methodological frameworks, or borrowed technical aspects of other methodologies to enable the primary research approach, I distilled what appeared to be the most prominent methodology. For example, Robertson (2010) used an ethnographic approach to penetrate into a different culture and to contextualize his research about conflict transformation within an interfaith choir in post war Bosnia. He used grounded theory protocol to gather and analyze interview data, music forms and his journal of personal experiences. By focusing on a target population around a single issue, and blending in a thick description of key elements, ethnographic perspectives with a thematic outcome—a case study design was implicated (Stake, 1995). Although many of the studies did not claim an explicit root philosophy, or research methodology, each of the final selected articles included (in varying degrees) a reflexive research process, a substantive literature search, in-depth contextual data, empirical case material, and a rational, reflective discussion of the process, the observations, and the results of the application of a particular arts-based modality within a cultural context.

Case Study.

The case study was the most common of methodologies, but a careful interpretative reading of the text was required to opine an implied methodological framework, because none of the 9 articles explicitly claimed to be a case study. Hart (1998) states that it is possible to determine a methodology from inferred intention. Although “Art Out of the Rubble” (Blotner, 2004), a phenomenological arts-based study, was not included in this category, it might be considered a case study for describing a complex cultural portrait within the framework of interviewing artists and their art in context to the impact of armed conflict on artistic expression, and the intrapersonal and interpersonal cultural challenges of the time (Stake, 1995). Softic (2011), a native to the region of his study, focused on the use of music amongst scattered survivors of the Srebrenica genocide. Conducting an ethnographic case study, he immersed himself in the musical lives of different pockets of survivors (also called interlocutors) and found that traditional music had been abandoned in favour of religious music. In all cases, where case study has been assigned to the research inquiry, the interpretive role of the researcher was prominent (p. 43) in penetrating the complexity of clinical therapeutic processes, in witnessing evolving social phenomena at the centre of an arts-based project, or in studying specific arts-based phenomena within populations. For example, Darvin (2009) describes inter-ethnic encounters of preadolescent girls in daily workshops at a summer camp in Bosnia where bibliography helped bring understanding and empathy for the "other" through metaphor and story.

Ethnography

According to Wergin’s elegant Decision Tree model[9], any study that is concerned with "characterizing a culture" qualifies as an ethnographic design. This would suggest that most of the studies here would be ethnographic, but for this literature search, only four studies could be defined as ethnographies, and each of these bore the characteristics of a case study. Behar (Knowles, 2008, p. 530), a cultural anthropologist, claims that “we go to find stories we didn’t know we were looking for in the first place.” Three out of the four studies reveal the reflexive, naturalistic inquiry to which Behar alludes. Geertz (1973) reminds us that “… the essential vocation of interpretive anthropology is not to answer our deepest questions, but to make available to us answers that others, guarding other sheep in other valleys, have given, ...” (p. 30). Ethnographic inquiry fits well with arts-based research within the context of cultural norms,[10] (and to this point, all 27 articles involved an ethnographic attitude). One study, a dissertation, claimed to be ethnographic (Kochenderfer, 2006) but it was more interpretative than descriptive. The other three studies (Byers, 1996; Kalmanowitz & Lloyd, 1999; Bingley, 2011) employed thick description which brought me, also, into the scene as a distant witness. In working and living amongst displaced refugees, Kalmanowtiz and Lloyd (1999) found their traditional notion of therapeutic working space and boundaries to be "impossible" but learned their most important role to be "witness to" the unfolding "outside-art" of the children who built, over and over, their homes from stones and sticks. “Not only were we witness to the fragmented lives, loss of home and tremendous resilience, but to the details and complexities held in the images.” (p. 24). In contrast to the witnessing of unfolding events, Kochenderfer’s (2006) complex, multiple methods dissertation, primarily ethnographic, detailed five specific objectives embedded in its aim to compare three different music programs in Mostar, BiH over a 13 month period. Bingley’s (2011) immersion into a rural community in post-conflict Sierra Leone provides a compelling thick description about her mixed roles as witness, recipient and foreigner in her study about music and healing. With these examples, as with other studies that used an ethnographic approach, a familial relationship to phenomenology is evident (Bentz & Shapiro, 1998, p. 101). In view of the complex distinctions between the various qualitative methods, I wonder if Wergin’s “Decision Tree”, which offers two choices in the qualitative section of the flow chart, may need refinement or, perhaps expansion to offer more representation of qualitative research approaches.

Mixed Methods and Quantitative.

Two articles were mixed method studies and only one article was singularly quantitative. Bensimon, Amir and Wolf (2008) pointed out that very little empirical research existed around the use of drumming for those diagnosed with PTSD. Their study used drumming and other music therapy techniques in their work with six Israeli ex-soldiers who were referred for PTSD. The methodology was primarily phenomenological for therapeutic process, content analysis of interviews, and sessions. An additional correlational design component measured specific musical variables for frequency, intensity and tempo. It would have been helpful to have an example of the interpretative process, but overall this was an exemplary study. Barath’s (2003) ambitious mixed method design was one of the few studies that took place during the armed conflict, and used a progressive semantic analysis with a quasi-experimental design with pre and post tests on four variables. I question its treatment fidelity because of the widely different backgrounds of the evaluators who were trained to interpret and analyze the children’s artwork, and the widely different conditions in the different regions of war where the studies were conducted. Participant participation would be impacted by constantly changing circumstances of war activities. The use of emotive, anecdotal and judgmental argumentation in the conclusion, that was uncharacteristic for a research inquiry indicated researcher bias. In searching the reference list, it was clear that the study was heavily framed and reliant on the author’s previous studies that numbered 13 out of 36 cited references.

The only quantitative article was an ex post facto design (Jolley & Vulic-Prtoric, 2001) that compared the artwork of two non random groups of 30 children each in post war Croatia in 2001. The control group consisted of children who had not lost their father or a family member in the war. It concluded that there was no relationship between war experiences and the size and placement of emotive topics on paper. However, in this culture, teachers and principles tend to promote only the very best students for research studies, so that research findings reflect positively on their work and the school’s reputation. Therefore, this study may need to be evaluated in light of the fact that it is likely that only the best, brightest and most well-adjusted students were participating in this study.

From my experience and perspective, quantitative studies have a potential to be exploitive in traumatized and vulnerable populations. I had, at first, wrongly rejected the ex post facto design for this reason, but included it after considering it to be an informative piece of the research landscape. In retrospect, one of the authors was a local psychologist, and since the educational culture of Bosnia had been under a communist regime, quantitative approaches in research and learning were the only acceptable method of inquiry in all of the disciplines and professional practices.

Arts-based Research and Phenomenology.

Knowles and Cole (2008, p. 79) suggest that arts-based research is an “…’umbrella’ term for many methodologies that follow from a constructivist, emotive, empiricist research aesthetic.” They assert that there are numerous ways in which experiences can be interpreted and illuminated through the artist’s interpretation of the world. Bentz and Shapiro (1998) state that the primary tool for phenomenological research is the researchers’ own consciousness. In this sense, six research articles were categorized as phenomenological arts-based research. One study analyzed the meaning of art, and the meaning the artist bestowed upon the art within a temporal, cultural/political context (post-conflict BiH). The other (Madsen, 2009) used a reflexive, interpretive arts-based performance within a contextualized cultural phenomenon (assault on a religious cult). Madsen transforms her research data into an audio-sound dramatization of the 1993 sonic-assault on the Branch Davidian religious sect in Waco, Texas. Moreno’s (1999) phenomenological study of the meaning of music in WWII concentration camps reveals the multiple—positive and negative roles—music played in the experience of the prisoners. We begin to understand a macabre paradox where desperation is born from degradation, despair and humiliation to the extent that music was both the cause of, and the solution to, the situation. Also framing her study in the concentration camps, Ornstein (2006) explores human creativity in view of the fact that these "artists" created from an inner necessity, and often in the midst of horror and atrocity under threat of severe punishment, or possible death.

Action Research.

Action research is a separate culture of inquiry, but it is often a repository of many different methods (Benz and Shapiro, 1998) incorporating a statement of intention and values (p. 127). It was a salient feature within the literature, that social activism was conceptually present in varying degrees in all 27 studies. Out of these, 10 of the studies came firmly under its umbrella because agency, personal empowerment, or social change, were inferred and/or deeply embedded in a reflexive research process between the researcher and the participants, towards a specified outcome. Most of the studies looked at community building within or between cultural groups affected by war, but two studies focused on change within the individual. Barath’s (2003) mixed method study endeavors to build coping skills through art for individual children in Croatia and Bosnia as well as self-empowerment skills for teachers and health care providers. Koch and Weildinger-von der Recke (2009) combined verbal therapy, dance/movement psychotherapy and cultural dance customs for refugees suffering from PTSD to reveal and heal past traumatic experiences.

Conflict resolution and transformative measures within, or between, groups were predominant in the remaining studies. For example, Darvin’s (2009) study worked with preadolescent girls from three different ethnicities in Bosnia with the purpose of "uniting" them through the writing, telling and sharing of their stories because “writers are shapers of their own cultures and of their individual and collaborative identities within those cultures.” (p. 50). Baker (2006) relates how a quilt-making project helped resolve trauma, revive memories and help build community through the sharing of stories in the patchwork. Harris’ (2009) study takes place in Sierra Leone where he combines local cultural rituals with dance therapy and improvisation to facilitate recovery and the reintegration of a group of boy soldiers.

One study was exemplary as participatory research with goals for social change through drama role-play, and with the intention to have an impact reaching far beyond the original study group. Kirby and Shu (2010) used culture drama to work with missionaries from two diametrically opposed cultural groups in Ghana. Their study showed how interactive role play on real issues, each of which was decided upon by the missionaries themselves, contributed to a developing trust and understanding from each group as they learned to see the "other" with different eyes. Skill and experience notwithstanding, most of the studies were informed by a profound relationship to the arts, and within that context, a desire to make a difference in their target population. Bensimon, Amir, and Wolf (2008) used drumming and other music therapy techniques to assist ex-soldiers suffering from symptoms of alienation, isolation and a sense of helplessness, towards feeling more connection, intimacy, closeness expressivity and integration with others through the group process.

Arts Informed Research

Research in this category is influenced by the arts, or artistic activities, but not necessarily based in the arts (Knowles & Cole, 2008). Although there were a number of studies in my primary search that fit into this category, few were selected for the final review. I make mention of this methodology because of the high number of articles that described art, analyzed art, theorized about art or simply reviewed the arts in connection to a war-related topic which loosely framed them as arts-informed studies. An overall understanding of arts-informed research is that the author’s perspective in "witnessing" or analyzing art, or transforming art from one form to another, is for the purpose of enhancing one’s understanding of a human phenomenon (p. 59) in a given context. However, there are other rigorous qualifications for this methodology. For instance in qualitative inquiry, the researcher is a research "instrument" but in arts-informed inquiry the research instrument is the "artist-as-researcher" (p. 61). For example, Weine (1996), a psychiatrist, looked at genocide through the art of activist-artists with the view to gauge if their art had any influence in changing social behaviors or attitudes away from the inevitability of genocidal thinking. However, he did not provide credentials or reflections that would qualify him as a credible "artist-as-researcher" instrument in this case. Articles in this category also tended to be more theoretical and conceptual rather than empirical, such as those by Bergh and Slobada (2010) and Quadros and Dorstewitz (2011). Other acceptable articles that were considered arts-informed (and phenomenological) were those that described the experiences of the artists in the German concentration camps towards understanding the meaning of art in that circumstance.

Discussion on Methodology and Analysis

Through the process of elimination—mostly on the basis of methodological criteria—it was important to not to have such a selective construction of the research topic that voices were eliminated that “may challenge dominant conventions” (Alvesson and Skoldberg, 2000, p. 188). However, the studies seemed to be inhabited by a culture of compatible, integrated styles and methodologies. And there is perhaps a discrete difference between a formal methodology and the "style" a research study adopts. Although it was not made explicit, the style of each study seemed to reflect the etiology of a therapeutic process in the course of a treatment plan. This may be because many of these studies followed the pattern of a typical treatment plan that includes an assessment procedure, goal statements, and applied techniques towards specific therapeutic outcomes. Many of these studies, especially those in action research or case study appeared to follow this format. It is my opinion, as a clinician and clinical supervisor, that many of the authors may have used robust theoretical frameworks to support their position, but more or less designed their project as if it were a treatment plan, and this may be why it was difficult to attach a singular research methodology to many of the studies.

In general there was an articulated sophistication in the beholding of the events described in each study—like an unfolding story that stood unique, but not alone in its relationship to the observer, or the reader. As a reader, I was drawn into each story, event, or phenomenon because there were aspects that were generalizable to my own understanding and experience of interactive, psychosocial fieldwork in a war affected region. As a scholar practitioner, I noticed all studies were robustly embedded in a theoretical framework and/or philosophical understanding, but many were also informed by an arts-based professional practice, and thus followed a treatment procedure that I recognize from being a member of a family of creative art therapies. This, in the thinking-framework of an arts-based therapist, might be assumed to be the methodology. Still, I felt that some of the primary categorizations I made were arbitrary and descriptive because it was often difficult to determine the dominant, or foundational, method of inquiry. For instance, in assigning "arts-informed" as a methodology, I was describing the study, rather than declaring it to have a specific system of research protocols and procedures to which arts-informed inquiry follows.

Themes

There were several ways in which the articles either overlapped or connected with one another. But the most consistent and impressive theme emerged through the dynamic role of the arts as a mediating connection to "life", to meaning, to identity and to cultural expression—all of which involved processes of transformation, resolution, dehumanization, survival, healing or acceptance. So the role of the arts took on many guises in these studies, but the underlying a priori in each case spoke to the universal and fundamentally intrinsic relationship humankind has with the arts and the creative imperative (Dissanyake, 1992). In her research, Dissanyake provides persuasive argumentation to show that art is a biological necessity that we are “predisposed to satisfy, whose fulfillment gives satisfaction and pleasure, and whose denial may be considered a vital deprivation” (p. 38). The following sub-themes that reveal art as a strategy for survival, transformation, recovery, healing or oppression of a population, in the terrible face of war, echo that hypothesis (see also Appendix A, p. 45).

Art as a Survival Strategy

All articles in this theme speak to the power of the arts to ground one’s perception of self, to bear the unbearable, and to sustain a sense of hope through the symbolic representation of an inner reality that belied the external atrocities and experiences of war. Pictures were painted, sketches and artifacts were made and music composed and performed at the risk of torture or death to do so.

Benchoam’s (1993) autobiographical study is an extraordinary account of her internment as a political prisoner at the age of 16 in Argentina, and the secret art-life strategies she imposed upon herself to survive four years in extremely perverse conditions. Although she had never considered herself to be an artist, the creative process and the artifacts she produced, represented her sanity, reclaimed her identity and became her lifeline for survival. These strategies evolved to become a theoretical framework for her five phases of moral development through the doing of art.

Zelizer (2003) examined the extent to which theatre, film and music played a strategic role for citizens under siege in the Bosnian wars, in spite of the constant threat of sniper attacks and mortar shelling. An example of this is shown in Richard's photo above. Seligman’s (1995) study reveals a similar phenomenon within the concentration camps in Germany where prisoners held theatrical and musical productions that took place as "underground" cabarets attended by hundreds of prisoners huddled in a circle around the artists. Ornstein (2006), Moreno (1999), and Seligman (1995) are broader in their historical analysis of art artifacts and written accounts. Through quotes and analysis of artifacts, the articles suggest the holocaust victims used art, music and theatre to maintain a grip on their inner reality, a reminder of their cultural identity and a sense of personal dignity amidst external degradation, dehumanization and physical and mental atrocity. Individual arts activities were forbidden and punishable by death.

Art as a Weapon of War

Three articles provide evidence that the arts—in particular music and theatre—were used to torture or to manipulate prisoners of war against one another, to provide a cover for the true nature of concentration camps, or to assault a captive/target population through amplified, alternating sonic-bombardments of pop music and tortuous sound affects (Moreno, 1999; Seligman, 1995; Madsen, 2009). Prisoners sometimes colluded with the deception in order to maintain a sense of identity and because it gave them a slightly better quality of life. These articles pointed out that the macabre abuse of the arts by the oppressor was imposed upon the other to create divisiveness, further degradation, and a false sense of normality. For example, prisoners in the Belzec camp were forced to sing while their co-prisoners were lead to the gas chambres, enforcing a bizarre antithetical connection of artistic expression to self-survival in a co-conspiracy against one’s own cultural community and personal ethics (Moreno, 1999). Musicians and artists in Theresienstadt were ordered to organize theatrical productions to impress visitors, while those at Veyslitz and Potashinsky were ordered to provide performances every Saturday and Sunday to allay fears and counter-rumors of German atrocities (Seligman, 1995, p. 123). In most cases the subterfuge worked also to dehumanize the actors, because they were aware of what their performances were covering.

Madsen (2009) exposes the antipathy of art-as-a-survival-tool. Her forensic narrative describes how blaring continuous music and sound effects were used to disorient and destabilize the Branch Davidian religious sect in Waco Texas to a point of complete debilitation that ended in a siege of fire with the entire human community inside. But a more benign article by Bergh and Sloboda (2010) warns about the potential negative outcomes where the misuse of music by culturally incompetent musicians could unintentionally generate a conflict, rather than a resolution in post conflict regions. By exposing both the life-enhancing and the destabilizing affects of music, the articles support Dissanyake’s claim that there is an existential connection of art to humankind – embedded in a biological template that is inexorable to life.

Art in Social Transformation and Peace Building

Six articles (see Appendix A) show the creative arts to be focused in conflict transformation or social reconstruction in post conflict war affected areas when cultural disintegration, and trauma are part of the emotional landscape. In this grouping of articles, drama therapy was engaged in participatory action research in cultural mediation between two fractional cultural groups in Ghana. Ethnographic studies (Bingley, 2011; Robertson, 2010) focused on how music is used by local cultural groups to mediate community inter ethnic involvement and cultural reintegration in Bosnia and in Sierra Leone. Each of these studies recognizes the attitude of the local leaders in role modeling a positive, reconciliatory response in the populace. Fouche and Torrance (2011) use a music therapy community-based approach to transform aggressive behaviours between conflict-ridden groups of teenaged adolescent boys. Kirby and Shu (2010) used culture-drama to mediate through inter-ethnic conflict of missionaries from different ethnic groups in Ghana. Through role reversal techniques and exercises in staged scenarios, the Konkombas and Dagombas learned the intricacies of the "other" through understanding their own deeply embedded cultural assumptions.

Blotner (2004) assesses post-conflict art in Bosnia to determine if there is a role for visual art in social reconstruction. After interviewing 30 artists and examining their art, she found that conscientious social activism is determined by the age of the artist when war broke out. The transformative power of the creative arts in conflict resolution and community building is an area of interest for my overall research, and it was disappointing to find a paucity of literature in this category. Still, the quality of the literature, the methodology, data collection and discussion was robust and compelling. This may be because most of the literature has been written in the last few years and has the benefit of professional maturation in research education and techniques.

Arts in Healing and Identity Formation

Although I speak through the lens of a music therapist, it seems apparent to assert that all CATs utilize symbolic representation through gesture, dramatization, movement, sound, music or imagery. In all articles where the arts were applied with a therapeutic or transformative intention, this was explicitly expressed as a fundamental epistemology of the CATs. Healing trauma can and does occur through the doing, the being in, or the witnessing of artistic expression. That is to say, we can gather what is unspeakable and project it through an art medium (art, dance, music), converting it into a verbal testimony (Baker, 2006).

Six of the articles spoke to deep process work with individuals and were persuasive in the depth and breadth of their assessment, rationale and analysis of the need for the arts to be active in specific ways in post-conflict areas, or with migrant populations of refugees who have had their personal lives, their identity as a social human being, and their purpose in life disrupted by events outside of their control. Each of the articles in this group recognized the individual as a social being with complex internal emotional issues in relationship to the external realities of a war-damaged socio-political environment. For instance, Harris’ work with child ex soldiers (2009) provides argumentation from his fieldwork on how embodied trauma can be expressed through nonverbal approaches, such as dance therapy to make visible and to express the “speechless terror” that resides in victims of war. Along with being sensitive to, and understanding the importance of, local traditional rituals, his work showed how the CATs can facilitate recovery from PTSD and the reintegration of these children back into their community.

For those of us who have worked with traumatized populations in post conflict areas, it is a fundamental reality that a healthy community requires healthy individuals to contribute to, and to interact with, the demands of complex social, economic and political systems. This is compromised when those (human) systems and relationships are destroyed through armed conflict. Just as there is a measure of personal "healing" in community building, there is also an element of social reconstruction in working with trauma in the individual. Baker’s (2006) work with refugee women from a Bosnian concentration camp covers a five-year period where none of the women would speak of their past, until they were shown how to collaborate on a quilt-making project. The making of quilts was not a tradition in their home culture, but as they learned the craft, each patch of the quilt became a personal story that enabled each woman, not only to express her profound losses, but also to connect with, and relate to, the stories of the others. The quilt – and the making of it – facilitated the construction of a community narrative, one that connected the women through their art, their stories and their memories.

Additional Themes

This brings to the fore three different, but related themes that emerged through reading deeply into the text and through empathizing with the perspective of the author. By this, I mean that I became aware of mechanisms that facilitated the work that were not necessarily assessed or even reviewed in the discussion. In the first case I noticed how leadership, the modus operandi of arts-based researchers in foreign cultures, or facilitation in groups and subgroups was, or was not, applied in these studies. I had become impressed with the differences in approaches by the ethnographic researchers and those that arrived into a host culture with a view to offer change or to teach a new skill. Ethnographic researchers (Sliep, Weingarten, and Gilbert, 2004; Harris, 2009; Bingley, 2011; Darvin, 2009) deferred to local leadership and cultural forms while balancing this with respectful mentorship throughout the process. By way of distinction, the ethnographic style of research and leadership were evident not only in foreign cultures, but also in those studies that worked with refugees within the host country (Baker, 2006; Golub, 1989). Other studies, such as that done by Barath (2003) offered their perspectives as an external expert to introduce coping skills to the population. In my experience the external expert was, more often than not, the rule rather than the exception[11], especially in the early years following the cease-fire in Bosnia.

Secondly, the issue of translation and reliance on a transitional figure within the culture of the participants became prominent (Golub, 1989; Baker, 2006) whether or not they were in their home country or in a host country.

And finally, combat fatigue, self-care and vicarious trauma as experienced by the therapist/fieldworker was inferred or explicit in some instances (Pavlicevic, 2002; Kalmanowtiz & Lloyd, 1999), but may have been magnified by my response to these studies through my own lived experiences with traumatized communities in fieldwork. For example, Pavlicevic demonstrates how the empathetic qualities of the fieldworker-therapist is a conduit for countertransference mechanisms that can both jeopardize the client’s therapeutic process, and put herself at risk. “There doesn’t seem to be someone there to either like or dislike – this child is vacant and I experience myself as non-existent when I am with him.” (p. 108). In this case, Pavlicevic admits to this having an effect on her treatment as well as her subsequent lack of interest in his disappearance from the program. One can also adopt the prevailing narrative that is shared within the client population as is shown in the tone of the comment made by Barath, “What we heard, instead, were rumors that the administrators and employees of these international NGO programs felt “quite comfortable” with their large salaries, while they paid miniscule wages to their local servants.” (p. 167). Whether or not the statement is true, the fieldworker can fall into the same blame game, suspicion and paranoia that is existent in a traumatized culture. However, as an example of ethnographic transparency, Kalmanowitz and Lloyd (1999) describe the confusion and disarray they felt while working with a very needy refugee population in Croatia, “We were afraid we would be drawn into the apathy and were in danger of imposing yet another unwanted structure.” Three years later she describes the difficulty in writing about the work, which was filled with “so many contradictions that it is almost impossible to express coherently.” (p. 20). Ethnocentrism, transference of values, and worldview frameworks can go both ways in fieldwork, and to this point Golub (1989) suggests that therapists must go through a process to clarify their values and gain a clearer understanding of their client’s worldview to avoid the dangers of imposing their "status quo paradigm" (p. 34). It is my view that more empirical research needs to be done in understanding the mental and emotional health of the fieldworker who is vulnerable to mass projection, client burnout, and various forms of culture shock, and who may be left to his/her own defenses – unsupported and unsupervised over prolonged periods of time.

Limitations

The overall intent of my search was to attain a "bird’s-eye" view of arts-based research in regions of war, and how the arts were being applied in those regions, or on populations affected by war. But the large number of variables that fell under the combined domain of war affected areas and populations may have confounded this by adding geographical complications, overlapping themes, and a need to go deeper into the material. Therapeutically, this is not so much a conflict, but in looking for thematic threads, there are deep, systemic and dynamic issues that need further exploration.

Further, the selection process to include articles may have seemed to be arbitrary rather than from strictly adhering to the search parameters. For instance WWII studies appear not to fit the criteria since 1) they were completed long after the war was over and 2) it might be opening a Pandora’s box[12] to include all historical studies of the arts and war. However, these studies were empirically designed, and accounts of prisoners of recent conflicts (Benchoam, 1993) validate the evidence within those studies.

A deeper, but less complex study may have been achieved if the search had not included refugees or migrant populations fleeing from armed conflict. However, I would not have learned the extent to which the arts are involved in recovery and reintegration efforts. The literature clearly shows profound traumas are prevalent within refugee populations, indicating an urgent need for more work and research in this area.

In five instances I was personally familiar with the population and/or the authors (Blotner, 2004; Kochenderfer, 2006; Softic, 2011; Robertson, 2010; Darvin, 2009), and this served to create some biases in my analysis. I felt my criticisms of Softic’s article may have been biased by my opinion of the sources of his data not upon his interpretation of the data. In the instance of Kockenderfer (2006), my viewpoint was in opposition to the way in which interview material had been interpreted, or possibly misunderstood. In most studies, I do not have the benefit of being privy to additional information about the resources cited in the paper. The connection I had to the Bosnian articles did not influence the selection of these articles for review, but it did vitalize my interest to glean from these studies, potential alternative perspectives of phenomena with which I was familiar.

Further to these clarifications, my relative expertise as a music therapist does not qualify me to evaluate the effectiveness of other modalities. Unfortunately, the literature search did not uncover significant research in the area of collaborative projects where the rationale and epistemological framework of each modality might be transparent. Finally, my inability to read other languages limits this review to only studies published in the English language.

Discussion

My intention to build an epistemology around the role of the arts in war affected areas, found robust empirical evidence in the literature that the arts provide dynamic resources both for individuals and for the community in the throes of prolonged armed conflict and in the recovery process afterwards. Until recently the CATs professions were more client-focused and embedded in the psychodynamic, humanistic or cognitive/behavioural traditions of therapy—but the literature clearly shows that these professions are now beginning to step up to, and engage with the complex psychosocial interface issues between the individual and his/her community. But it is in the more recent literature that we can see a peace building role (Kirby and Shu, 2010; Darvin, 2009; Robertson, 2010; Harris, 2009; Baker, 2006; Sliep, Weingarten, and Gilbert, 2004). The appearance and development of community approaches within the CATs along with the supportive perspective of music sociology research (DeNora, 2005) emerged into the discourse only in the last decade, and appears to be related to the surge of creative arts therapy projects and programs in post-conflict regions. From this one senses that the CATs will continue to evolve and broaden competencies concerning multicultural fieldwork using cultural approaches for social change—especially in those cultures affected by war.

Most of the studies represented a singular modality, rather than a collaborative of multiple modalities, which leaves room for fieldwork to develop as a multi-pronged framework. This gap in the literature does not indicate there are not collaborative approaches in war affected areas, but it leaves room for research to be done[13]. Thus it is pragmatic to move in this direction given the competition for grants and funding. In addition to this, a collaborative approach could be more effective by providing an exchange of multiple perspectives, a pool of materials and resources, and a co-creative environment for mutual empowerment.

Through reviewing the philosophies, theories, and approaches as well as the empirical research, we can better understand how to mobilize our inclusion into the bigger picture of foreign development organizations, such as the United Nations Human Rights Council (UNHCR). To this end, the UNHCR commissioned the development of a Compendium (Music As A Natural Resource, 2010)[14]—not included in this review—to the International Council for Caring Communities (ICCC) in collaboration with representatives from the music therapy faculty at New York University. This work contains a comprehensive list of viable music programs and projects taking place around the world. The projects comprise five major categories.

It is not clear how the UNHCR or music therapy associations will use this, but it has been publicly presented that projects listed in the compendium have a better opportunity to receive funding than those that are not. Thus, the information is very useful, but it is also exclusive to those projects that may not be large enough to be included – and also because data gathering was by word of mouth. The compendium identified 37 post war zones where music projects are operating. This needs deeper investigation, but compared to these 37 war regions, my search yielded a total of 11 distinct war areas out of 16 (not including the USA or Germany) where empirical research had been done.

Bergh and Sloboda (2010) are cautionary about the misuse of the arts in areas of ethnic conflict in answer to the myths and rhetoric around music as a universal elixir that heals the wounds of war, disperses conflict, and begins the work of peace. The following is but one example of how rhetoric can run away with this notion:

“During war, Music brings serenity, happiness and hope. After war it brings dynamism and energy for reconstruction, galvanizes juvenile minds for action and makes happiness an object of desire. During peace, it brings comfort of mind, awareness on love and motivation for the future. In front of different cultures or ideologies it brings cooperativeness, understanding and create unperceived ties among people. Even in front of different languages, songs become understandable for everyone and appreciated when your mind is touched.” Antonio Pedro Monteiro Lima in Music As A Natural Resource (2010, Introductory Statement III).

It is this rhetoric that opens wallets and brings charity to those NGOs that fly this flag high and wide. But dependence upon charitable donations may also have impeded the arts from becoming a sustainable resource in community building, and kept them marginalized by the nature of the short-term projects available to them. Bergh and Sloboda make the claim that music can make its “own contribution in shaping health discourses, framing policy issues and dealing with problems of disease burden …” (2011, p. 60). Therefore it is important to review the empirical literature to understand, and to build an epistemology around art as a cohesive element in society, where the skillful, intentional, and respectful use of the arts in damaged cultures, can help rebuild communities and give individuals back their sense of "self."

Evstafiev-bosnia-cello
Vedran Smaijlovic performs in Sarajevo partially destroyed National Library in 1992. Photo by Mikhail Evstafiev, 1992, [GFDL CC-BY-SA-2.5 ]via Wikimedia Commons.

But before a pattern of conflict arises between worthy arts projects that do not have empirical research, and the "experts" who have conducted studies, it is important to understand ourselves as colleagues working in different and difficult circumstances and that our best way forward is to collaborate in a supportive framework that builds a viable and sustainable arts-based network. On this point, I add a quote from Kalmanowitz and Lloyd (1999, p. 16) that coincides with the image of Vedran Smailovic (Figure 3) playing his cello in the middle of the blown up rubble of the National Theatre. Kalmanowitz and Lloyd, both art therapists, used the environment as a kind of "portable" studio for art to emerge in a natural relationship to the surroundings.

“What we aimed to create was what we called a portable studio. This is based on the premise that the internal structure we carried with us as art therapists could allow for work to physically take place inside and outside: in the bedroom, in the dining room, on the hill, in the town dump.” (p. 23).

I think this beautifully illustrates how a conceptual convergence of the arts and the environment could provide a working framework for all of the creative arts modalities and the populations to which they serve. That is to say, that perhaps the "inner wound" heals in direct relationship to the ability of the surrounding human environment to support that process. This is not a vision for the future, so much as it is a reminder that we are, by nature, aesthetic, and that this aesthetic is a resource to build coherence, meaning, and agency within ourselves and our community.

Thus far the literature is growing in support of the efficacy of the arts in community restoration and cultural identity, but it is impossible, and perhaps unworthy, for the arts to be assigned to any paradigm or institutionalized structure. By all accounts, the arts seem to be a wild card in society—both an ally and a renegade. And perhaps that diabolical tension is healthful in keeping a balance between freedom of expression and disciplined structure. As "renegade", the CATs move along a continuum of "shadows and light"– a flexibility that serves the needs of our clients with PTSD so effectively. And diametrically, as an "ally", it is the inherent structure of wide-open accessibility that provides a safe container for a dynamic community to hear, to see, and to accept its privileged diversity.

Notes

[1]A General Framework Agreement for Peace in Bosnia and Herzegovina ended the 3 ½ years war in by bringing the 3 leaders of the warring factions together to negotiate and to sign a peace agreement in Dayton, Ohio, U.S.A. November 1995.

[2]Stewardship of the program passed from Warchild UK in 2001 to Warchild NL during a financial crisis and corruption scandal. In 2004, Warchild NL stopped funding the program whereupon the program became an independent NGO.

[3]Arts behaviours in Addendas 1 and 2 in the Nature of Leadership essay, 2009.

[4]These are but a few examples from the literature.

[5]Also my Doctoral essay "Nature of Leadership", May 2009

[6]Source: D. Baldwin, Doctoral Research Librarian, Antioch University. http://www.antioch.edu/phd/learning-community/faculty/faculty-profiles/deborah-baldwin/

[7]These terms are based upon a platform of arts-behaviours I introduced in my Nature of Leadership Essay, Tables 1 and 2, p. 33.

[8]Fall 2010 United Nations Headquarters series: Age of Connectivity: Better city, Better Life; A Contribution in Support of the Millennium Development Goals and World Habitat Day.

[9] Wergin’s logic flow chart assists in classifying quantitative and qualitative research design.

[10] My research question may have skewed the search results toward ethnographic studies.

[11] Personal viewpoint based upon observation in the field.

[12]Pandora, was the daughter of Zeus in classical Greek mythology, and before she went "down" to earth, she was given a box by her father that she was ordered not to open. But her curiosity got the better of her and when she opened it all manner of evil, chaos, pestilence, war and illness escaped - except for the angel of hope. It was too late to capture evil and put it back into the box, but Pandora later released "hope" into the world.

[13] My unpublished feasibility study (2010) outlined the design of a collaborative project involving theatre, music therapy and film with youth from four cantons in Bosnia and Herzegovina.

[14] Co-edited by: B. Hesser, Professor, New York University and Dr. H. Heinemann, ICCC.

References

Aigen, K. (2008). An analysis of qualitative music therapy research reports 1987-2006: Doctoral studies. The Arts in Psychotherapy, 35(5), 307-319.DOI: 10.1016/j.aip.2008.06.001

Alvesson, M., Skoldberg,K. (2000). Reflexive methodology: New vistas for qualitative research. London: SAGE Publications.

Ansdell, G. (2002, January). Community Music Therapy & The Winds of Change. Voices: A World Forum For Music Therapy, 2(2). Retrieved from https://normt.uib.no/index.php/voices/article/view/83/65

Baker, B. A. (2006). Art speaks in healing survivors of war: The use of art therapy in treating trauma survivors. Journal of Aggression, Maltreatment & Trauma, 12(1-2), 183-198. DOI: DOI:10.1300/J146v12n01_10

Baráth, Á. (2003). Cultural art therapy in the treatment of war trauma in children and youth: Projects in the former yugoslavia. In S. Krippner, T. M. McIntyre, S. Krippner, & T. M. McIntyre (Eds.), The psychological impact of war trauma on civilians: An international perspective (pp. 155-170). Westport, CT: Praeger Publishers.

Behar, R. (2008). Anthropology: Ethnography and the book that was lost. In Knowles, J.G., Cole, A.L. (Eds.), Handbook of the arts in qualitative research (pp. 529-543). London: SAGE Publications.

Benchoam, E. D. (1993). Art as refuge and protest: Autobiography of a young political prisoner in Argentina. Creativity Research Journal, 6(1-2), 111-127. DOI: 10.1080/10400419309534470

Bensimon, M., Amir, D., & Wolf, Y. (2008). Drumming through trauma: Music therapy with post-traumatic soldiers. The Arts in Psychotherapy, 35(1), 34-48. DOI: 10.1016/j.aip.2007.09.002

Bentz, V. & Shapiro, J. (1998). Mindful inquiry in social research. London, UK: SAGE Publications, Inc.

Bergh, A., & Slobada, J. (2010). Music and art in conflict transformation: A review. Music and Arts in Action, 2(2), 1-17.

Bergmann, K. (2002). The sound of trauma: Music therapy in a post war environment. Australian Journal of Music Therapy, 13, 3-16.

Bingley, K. (2011). Bambeh's song: Music, women and health in a rural community in post-conflict Sierra Leone. Music and Arts in Action, 3(2), 59.

Blotner, P. (2004). Art out of the rubble. In E. Stover, H. M. Weinstein, E. Stover & H. M. Weinstein (Eds.), My neighbor, my enemy: Justice and community in the aftermath of mass atrocity (pp. 269-286). New York, NY: Cambridge University Press.

Byers, J. G. (1996). Children of the stones: Art therapy interventions in the west bank. Art Therapy, 13(4), 238-243.

Clements-Cortés, A. (2008). Music to shatter the silence: A case study on music therapy, trauma, and the holocaust. Canadian Journal of Music Therapy, 14(1), 9-21.

Darvin, J. (2009). Make books, not war. Workshops at a summer camp in Bosnia. Literacy, 43(1), 50-59.

DeNora, T. (2005). The pebble in the pond: Musicing, therapy, community. Nordic Journal of Music Therapy, 14(1), 57. DOI:10.1080/08098130509478126

Demorest, S. M., Morrison, S. J., Stambaugh, L. A., Beken, M., Richards, T. L., & Johnson, C. (2010). An fMRI investigation of the cultural specificity of music memory. SCAN, 5, 282-291. doi:10.1093/scan/nsp048.

Dissanayake, E. (1995). Homo aestheticus : Where art comes from and why. Seattle: University of Washington Press.

Fouche, S., & Torrance, K. (2011). Crossing the divide: Exploring identities within communities fragmented by gang violence. In A. Meadows (Ed.), Developments in music therapy practice: Case study perspectives (pp. 215-229). Gilsum, NH: Barcelona Publishers.

Florida, R. (2009). Who’s city are you? How the creative economy is making where to live the most important decision in your life. Toronto: Random House Canada.

Geertz, C. (1973). The interpretation of cultures. U.S.A.: Basic Books, Inc.

Golub, D. (1989). Cross-cultural dimensions of art psychotherapy: Cambodian survivors of war trauma. In H. Wadeson, J. Durkin, D. Perach, H. Wadeson, J. Durkin, & D. Perach (Eds.), Advances in art therapy. (pp. 5-42). Oxford, England: John Wiley & Sons.

Harris, D. A. (2009). The paradox of expressing speechless terror: Ritual liminality in the CATs’ treatment of posttraumatic distress. The Arts in Psychotherapy, 36, 94-104. DOI: 10.1016/j.aip.2009.01.006

Hart, C. (1998). A literature review: Releasing the social science research imagination. Thousand Oaks, CA: SAGE Publications Inc.

Heidenreich, V. (2005). Music therapy in war-effected areas. International Journal of Mental Health, Psychosocial Work & Counselling in Areas of Armed Conflict, 3(2), 129-134.

Jolley, R. P., & Vulic-Prtoric, A. (2001). Croatian children's experience of war is not reflected in the size and placement of emotive topics in their drawings. British Journal of Clinical Psychology, 40(1), 107-110. DOI: 10.1348/014466501163526

Kalmanowitz, D., & Lloyd, B. (1999). Fragments of art at work: Art therapy in the former yugoslavia. The Arts in Psychotherapy, 26(1), 15-25. DOI: 10.1016/S0197-4556(98)00027-6

Kenny, C., & Stige, B. (2002). Contemporary voices in music therapy: Communication, culture and communication. Oslo, Norway: Unipub Forlag.

Kirby, J. P., & Shu, G. (2010). Re-reconciling culture-based conflicts with 'culture-drama'. In E. Leveton, & E. Leveton (Eds.), Healing collective trauma using sociodrama and drama therapy (pp. 207-233), New York, NY: Springer Publishing Co.

Knowles, J. G., & Cole, A. L. (Eds.) (2008). Handbook of the arts in qualitative research: Perspectives, methodologies, examples, and issues. Los Angeles, CA: Sage Publications.

Koch, S. C., & Weidinger-von d. Recke, B. (2009). Traumatized refugees: An integrated dance and verbal therapy approach. The Arts in Psychotherapy, 36(5), 289-296.DOI: 10.1016/j.aip.2009.07.002

Kockenderfer, M. (2006). Music after the war: Therapeutic music programs in Bosnia and Herzegovina (Unpublished doctoral dissertation). College of Medicine and Veterinary Medicine, University of Edinburgh.

Lang, L., McInerney, U., Monaghan, R., & Sutton, J. (2002). Supervision: Processes in listening together – an experience of distance supervision of work with traumatized children. In J. Sutton (Ed.), Music, music therapy and trauma: International perspectives (pp. 211-230). London, UK: Jessica Kingsley, Publishers.

Madsen, V. (2009). Cantata of fire: Son et lumière in Waco Texas: Auscultation for a shadow play. Organized Sound, 14(1) 89-99. DOI: 10.1017/S1355771809000119

Music As A Natural Resource. (2010, fall). Music as a natural resource: Solutions for social and economic issues compendium. Retrieved from http://unpan1.un.org/intradoc/groups/public/documents/un-dpadm/unpan042585.pdf

Moreno, J. (1999). Orpheus in hell: Music and therapy in the holocaust. The Arts in Psychotherapy, 26(1), 3-14. DOI: 10.1016/S0197-4556(98)00040-9

Ornstein, A. (2006). Artistic creativity and the healing process. Psychoanalytic Inquiry, 26(3), 386-406. DOI: 10.2513/s07351690pi2603_7

Osborne, N. (2009). Music for children in zones of conflict and post-conflict: A psychobiological approach. In S. Malloch, & C. Trevarthen (Eds.), Communicative musicality: Exploring the basis of human companionship (pp. 331-356). New York, NY: Oxford University Press.

Pavlicevic, M. (2002). Fragile rhythms and uncertain listenings: Perspectives from music therapy with South African children. In J. Sutton (Ed.), Music, music therapy and trauma (pp. 97-117). London, UK: Jessica Kingsley Publishers.

Quadros, A. D., & Dorstewitz, P. (2011). Community, communication, social change: Music in dispossessed Indian communities. International Journal of Community Music, 4(1), 59-70. DOI: 10.1386/ijcm.4.1.59_1

Robertson, C. (2010). Music and conflict transformation in Bosnia: Constructing and reconstructing the normal. Music & Arts in Action, 2(2), 38-55.

Rolvsjord, R. (2006). Therapy as empowerment: Clinical and political implications of empowerment philosophy in mental health practises of music therapy. Voices: A World Forum for Music Therapy 6(3). Retrieved from https://normt.uib.no/index.php/voices/article/view/283/208

Rorke, M. A. (1996). Music and the wounded of World War II. The Journal of Music Therapy, 33, 189-297.

Ruud, E. (1998). Music therapy: improvisation, communication, and culture. Gilsum, NH: Barcelona Publishers.

Ruud. E. (2010). Music therapy: A perspective from the humanities. Gilsum, NH: Barcelona Publishers.

Schulberg, C. (1997). An unwanted inheritance: Healing transgenerational trauma of the nazi holocaust through the bonny method of guided imagery and music. The Arts in Psychotherapy, 24 (4), 323-345. DOI: 10.1016/S0197-4556(97)00046-4

Seligman, Z. (1995). Trauma and drama: A lesson from the concentration camps. The Arts in Psychotherapy, 22 (1), 119-132. DOI: 10.1016/0197-4556(95)00017-Y

Sliep, Y., Weingarten, K., & Gilbert, A. (2004). Narrative theatre as an interactive community approach to mobilizing collective action in northern Uganda. Families, Systems, & Health, 22(3), 306-320.

Softic, B. (2011). The music of Srebrenica after the war: Attitudes and practice among surviving Bosniacs, music therapy, and music works in the name of Srebrenica. Narodna Umjetnost: Hrvatski Casopis Za Etnologiju i Folkloristiku, 48(1), 161-181.

Stake, R. E. (1995). The art of case study research. Thousand Oaks, CA: Sage Publications.

Stige, B. (2000a). Culture-centered music therapy. Gilsum, NH: Barcelona Publishers

Stige, B. (2001, January). History and Heritage. Voices: A World Forum For Music Therapy, 1(2). Retrieved from https://normt.uib.no/index.php/voices/article/view/59/47

Stige, B. (2002, January). The Relentless Roots of Community Music Therapy. Voices: A World Forum For Music Therapy, 2(3). Retrieved from https://normt.uib.no/index.php/voices/article/view/98/75

Sutton, J. (2002). Music, music therapy and trauma: International perspectives. London, UK: Jessica Kingsley Publishers.

Weine, S. M. (1996). Artists witnessing "ethnic cleansing." In C. B. Strozier, M. Flynn, C. B. Strozier, & M. Flynn (Eds.), Genocide, war, and human survival (pp. 243-255). Lanham, England: Rowman & Littlefield.

Woodward, A., (2004, July). Finding the client in their environment: A systems approach to music therapy programming. Voices: A World Forum for Music Therapy. Retrieved from https://normt.uib.no/index.php/voices/article/view/183/142

Woodward A. (1998). The Emergent voice: a systems theory perspective for environmental music therapy strategies in an extended care facility (Unpublished master thesis). Open University Vancouver, British Columbia, Canada.

Zelizer, C. (2003). The role of artistic processes in peacebuilding in Bosnia-Herzegovina. Peace and Conflict Studies, 10(2), 62-75.

Appendix

Appendix A. Matrix Summary Organized by War Affected Regions.

Bergen Open Access Publishing