Professional Documents
Culture Documents
EDITORIAL
ROSS W. PRIOR
Principal Editor, JAAH
A warm welcome to the first issue of the Journal of Applied Arts and
Health (JAAH). This has been an ambitious undertaking. However,
with tremendous support from Intellect Publishing, and those around
me, we have given birth to a sustainable vehicle for on-going scholar-
ship within this important and ancient, yet developing, field.
Last year on a trip to Greece I was reminded of the long-standing
acknowledgement of the therapeutic value of the arts. The sanctuary
of Asclepius at Epidaurus is a spiritual place visited by the ancient
Greeks in order to pay tribute to Asclepius (the god of medicine and
healing in ancient Greek mythology) and to ask the gods for remedies
for their physical ailments. Epidaurus was built around the third cen-
tury BC and it is adorned with a multitude of buildings, most famous
of which is the ancient acoustic marvel the ‘Theatre of Epidaurus’.
Epidaurus was a healing centre as well as a cultural centre – the two
purposes closely entwined in ancient times. Whilst standing in this
ancient healing place I realised that these arts-based healing tradi-
tions still continue today.
This is the first international journal of its type specifically address-
ing the interdisciplinary concerns of applied arts and health. The arts
and health movement has gathered considerable momentum in the
1. Arts and Healthcare last thirty or so years. It is a movement which has built upon long-
event ‘Open to All’:
Mental Health, Social standing practices yet has seemed to largely ignore two vital areas:
Inclusion and Museums what precisely is meant by the use of the term ‘arts’ and how we
and galleries, The understand ‘evidence’ – verification of the subsequent benefits of arts
Wallace Collection,
Tuesday 16 September within health contexts.
2008. This speech is Firstly, let’s take the notion of ‘arts and health’ as a beginning point.
available at http://
www.dh.gov.uk/en/ I support the value of art for art’s sake. I abhor the notion that art must
News/Speeches/ have a particular purpose other than that which art already does best
DH_088160
2. A copy of the review
and that is use and play with aesthetic qualities. Aesthetics act upon
can be downloaded our senses to make us feel more, hear more and see more than we oth-
from http://www. erwise might. Yes, art is highly manipulative and it should make no
dh.gov.uk
apology for that. However, alongside the arts is recognition of the pow-
erful affect they can have for health; after all feelings are intertwined
with mental, physical, spiritual and social health. Arts which are applied
to a purpose outside of their usual context can be termed ‘applied arts’
which defines them more clearly than the use of the term ‘arts’ alone.
The term ‘applied’ within the arts has a more explicit recent history.
In the visual arts the term ‘applied art’ has been used for some time in
a limited way to suggest that some particular art created has a func-
tional use, particularly within design. The performing arts have activ-
ity used the term ‘applied theatre’ since the early 1990s. The applied
theatre movement is significantly influenced both in theory and prac-
tice by the work of Bertolt Brecht in the 1930s. Brecht was an actor,
director, theorist, playwright and poet. Brecht hoped to ‘re-function’
the theatre to a new social use in developing the combined theory and
practice of his ‘epic theatre’. He synthesised and extended the experi-
ments of Piscator and Meyerhold to explore the theatre as a forum for
political ideas and the creation of ‘critical aesthetics’. Brecht’s modern-
ist concern with drama-as-a-medium led to his refinement of the ‘epic
form’ of the drama. However, there have been many others who have
moved this agenda forward. For example Paulo Freire (1972), whose
work was a significant exploration of dialogue and the possibilities for
liberatory practices, and Augusto Boal (1979), who developed a thea-
tre for the oppressed and created the now often used ‘forum theatre’
form as participatory theatre.
More recently Alan Johnson (Secretary of State for Health in the
United Kingdom) publically declared that ‘access and participation in
the arts are an essential part of our everyday wellbeing and quality of
life’.1 This explicit and high-level acceptance and support for the role
that arts have to play within the delivery of healthcare, and the sup-
port in developing individuals’ own sense of wellbeing, demonstrates
a positive shift towards a growing orthodoxy.
A significant attempt to move the agenda forward in the United
Kingdom was the publication of A prospectus for arts and health (2007).2
This prospectus, produced jointly by the Department of Health and
Arts Council England, celebrates and promotes the benefits of the arts
in improving wellbeing, health and healthcare, and supports those who
work in and with the National Health Service (NHS) in England. The
prospectus aims to demonstrate that the arts can, and do, make a major
contribution to key health and wider community issues. The publica-
tion stems from the recommendations of the Review of Arts and Health
Working Group, commissioned by the Department of Health.
The will to make change is political and this notion has given birth
to the rise in the use of the arts for change and empowerment. This
journal, therefore, is specifically concerned with the ‘applied’ nature
of the arts; it is a combined attempt, along with launching an inter-
national conference entitled ‘Inspiring Transformations: Applied Arts
and Health’, co-convened by Cath Poyser and myself in 2009 at The
University of Northampton, UK. The aims (of the first international
Applied Arts and Health conference) were to share and critique various
practices; create innovative connections between the arts and health;
probe how knowledge can be advanced by their conjoined applica-
tion; explore what is meant by ‘evidence’; and interrogate debates and
future agendas.
Evidencing applied arts practices has been variously dealt with but
has largely been ignored in the scholarly canon. To these ends there
appears to be a significant, but not insurmountable, tension between
the arts and health sciences. Historically these fields have drawn from
two distinct methodologies: arts have been largely qualitative and
health sciences largely quantitative. Having said this there has been
a tremendous shift in the last fifteen years or so where the division
between these methodologies has been weakened in favour of
understanding the merits of both methodologies. It is therefore in this
fascinating interplay that we see great progress and potential for the
future of health and healthcare.
The nature of how we evidence the effectiveness of applied arts
practices is very much at the core of this journal. In fact the very idea
of what actually constitutes ‘evidence’ is a particularly interesting one,
and we hope that we will see lively scholarly debate within future edi-
tions of JAAH.
In this inaugural edition of JAAH we have an opening article by
Professor Robert J. Landy, who presents a paper on the way drama
can be used therapeutically following trauma. The paper draws upon
the work that he undertook with children in New York City follow-
ing the 9/11 atrocity. This paper discusses an applied use of drama
in preventing the onslaught of symptoms following 9/11. The author
discusses one drama therapy approach called ‘Standing Tall’, which
transformed the roles and stories created by 9-year-old children who
witnessed the attacks into a theatrical performance.
Professor Stephen Clift et al. investigate the use of choral sing-
ing and psychological wellbeing. In a fascinating study, this team of
researchers present their quantitative and qualitative findings from
English choirs in a cross-national survey to identify how singing may
impact on wellbeing and health.
Dr Victor I. Ukaegbu takes us to Nigeria where he explores curious
performative encounters in the marketing of health products. With
ROBERT J. LANDY
New York University
Drama as a means of
preventing post-traumatic
stress following trauma
within a community1
ABSTRACT KEYWORDS
Drama persists as a natural form of healing and has existed as a ritual heal- drama
ing process for thousands of years. Developmentally, children naturally use drama therapy
dramatic play to master difficult moments in their lives. Historically and role
cross-culturally, individuals and communities have sought out the perfor- trauma
mative qualities of shamans to contact the spirit world and apply its healing post-traumatic stress
medicines to various forms of personal and communal ills. When confronted
by unexpected trauma, people can also turn to an applied form of drama
to contain their fears and forestall debilitating symptoms of post-traumatic 1. A version of this
paper was originally
stress. This paper discusses an applied use of drama, that of drama therapy, presented as a key
in preventing the onslaught of symptoms following the terrorist attack on the note address by the
author at Inspiring
World Trade Towers in New York City on September 11, 2001. The author Transformations: Arts
discusses one drama therapy approach called ‘Standing Tall’, which trans- and Health Conference
at The University
formed the roles and stories created by 9-year-old children who witnessed of Northampton in
the attacks into a theatrical performance. Through the dramatic process and September 2007.
the subsequent performance, the children were able to begin to make sense
of the events they observed and share their roles and stories with their com-
munity, leading to a mutual sense of support and hope.
the universe – the outcomes of war and uncontrolled nature, the inevi-
tability of sickness and death, the vagaries of extreme behaviour and
mental anguish. By performing their rituals, they attempted to mas-
ter or at least forestall that which is beyond human mastery. Although
no longer shaman and priest, the theatrical actor retains some of their
spiritual and healing qualities. Like shamans, actors often experience an
altered state of consciousness as they inhabit and bring forth the life of
archetypal roles for the benefit of their audiences, and like priests, they,
too, create a sacred space for others to engage in a shared moment of
joy, contemplation and, at times, transformation.
And yet actors are not trained as dramatic healers. Within the
domain of applied forms of drama and theatre, those who do practice
a therapeutic form are drama therapists. The practice and theory of
drama therapy, like that of theatre, evolved from ancient ritual and
shamanic practices (see Emunah 1994; Landy 2008). However, the con-
temporary practice of drama therapy claims its roots in western forms
of psychoanalysis (see Landy 2008), psychodrama (Moreno [1946]
1994), and educational drama (see Jones 2007; Landy 1994). Drama
therapy incorporates elements of ritual and theatre, shamanism and
dramatic play in the service of healing the wounds of psyche and soci-
ety. Its preventive power lies in treating people who have experienced
trauma, helping them to discover the internal and relational strength
necessary to prevent the onset of symptoms of post-traumatic stress.
Such symptoms include: persistent flashbacks, dissociated thoughts,
avoidance and phobic reactions, emotional numbing, hyper-vigilance
and hyper-arousal, among many others (see van der Kolk 1994).
Drama therapists consciously apply play and drama to help individu-
als and communities discover some form of mastery and balance. Like
the shaman, the drama therapist makes use of expressive actions, work-
ing through story and role as the basic means of restoration. Although
the metaphor of the spiritual journey is not apt for many drama thera-
pists, the metaphor of the hero’s journey is. Like the shaman, the drama
therapist is a guide on this journey toward awareness and transforma-
tion: a kind of Virgil guiding Dante into the wonders and dangers of the
inferno, or Athena guiding Odysseus across the magnificently terrifying
waters of the wine dark sea toward home. In Eliade’s (2004) terms, the
guide is a psychopomp, a mythical figure like Hermes, who shepherds
the souls of the dead into the underworld.
Although based primarily in an art form, drama therapy is also
informed by recent advances in neuroscience that suggest that the
brain itself is a dramatic entity (see Demasio 1994, 1999) as it trans-
lates external reality into representational internal images, and by
classical literary metaphors such as Shakespeare’s notion of drama as
a mirror held up to nature.
The dramatic nature of the brain is buttressed by the recent discov-
ery of mirror neurons. Mirror neurons are structures that link percep-
tion and action, as they fire in a common fashion when one acts and
when one observes another performing a similar action. Researchers,
10
11
12
archetypal heroes, villains and victims. The facilitators took the chil-
dren through an intensive but also playful process where they could
make fun of the villains. The film portrays one example as the children
imagine the pregnant parents of Osama bin Laden discussing their
hopes and plans for their new baby boy.
This experience allowed the children to look at other sides of the
roles of hero, victim and villain and humanize the figures. For example,
after exploring certain obvious heroes like firefighters and police, the
children chose Mom as hero, because she tells her son to express his
feelings and not hide them. The villain, Osama, is made fun of and
then humanized – he had a mother and father who had hopes and
dreams for their son. ‘He wasn’t born bad,’ says one girl. And, adds
another, ironically, ‘Perhaps he fell on his head when he was small.’
Once the children’s roles and stories were explored and many
polarities and complexities discovered, I wrote a play based upon their
creations. The play was performed by the children to the faculty and
students in the school, as well as to the parents and friends of the
children living in the community. Moving into performance gave the
children a chance to dramatically tell their stories to an audience that
needed what they did: a sense of clarity and a ritual through which to
share a common disturbing historical moment. After the play was per-
formed, at the end of the school year, all involved – children, peers,
teachers, parents, community members – engaged in a reflective and
emotional discussion. For some adults, that was their first opportunity
to openly express their own thoughts and feelings regarding 9/11. For
many parents, this was their first opportunity to acknowledge their
children’s depth of feeling and courage to speak out and to create a
beautiful memorial through their drama. As so many voices of children
and adults were expressed and witnessed following the performance,
the community bonded and asserted its common need for connection,
support and hope. In the interaction of parents and children, adults
and young people, ‘Standing Tall’ offered a model of how drama, story-
making and performance can enable an intergenerational community
to transform a tragic event into one of hope and connection.
I’d like to now address ways that educators, therapists, administra-
tors, social workers, arts professionals, and parents can think about
this model of preventive drama therapy and even in small ways apply
it to their interactions with children. The following are some of the
specific objectives I had in mind for ‘Standing Tall’:
13
For those who are familiar with and skilled in implementing such
creative and therapeutic objectives, the ‘Standing Tall’ model can be
replicated with modifications based upon particular circumstances.
This experience does not need to be a response to a catastrophe on
the scale of 9/11, but rather can be a way to process any significant
and/or troubling moment – an earthquake or senseless crime, a tragic
accident or family disturbance, a clash of races or cultures or ideolo-
gies within a community.
For those less trained in implementing such a model, there is a fun-
damental philosophy at work that can guide similar work with chil-
dren. The main idea is that children process reality through a variety
of creative and playful means, some of which are more powerful than
traditional cognitive and verbal approaches to learning. This creative
learning recapitulates the child’s natural inclination to make sense of
the world through play. If expressive, playful approaches, such as role-
playing, story-making and performance, can be incorporated in educa-
tion, healthcare, therapy and even parenting, the adult has a powerful
way into the mind and emotional life of the child. Many adults who
work with children will be able to make use of the kind of approaches
exemplified in ‘Standing Tall’. They do not have to be playwrights or
directors. Rather, they have to have an ability to listen carefully to chil-
dren’s stories and the imaginative ways they tell them in role. And
they need to embrace the idea of play as a means of making meaning
and the significance of a community ritual to share collective stories.
Finally, in keeping with a main principle of role theory, they need to
guide children into a place of integration, where villains and victims
and heroes can co-exist not only as characters in stories, but as aspects
of all human beings, where each stereotype can be humanized.
At the conclusion of the play, ‘Standing Tall’, one child took on
the role of Mayor Guiliani, who held a memorial service at the his-
toric St. Paul’s Church that stood in the shadow of the twin towers.
Mayor Guiliani’s dialogue was taken verbatim from his actual memo-
rial speech. Included in the text is a song written by Anna and several
classmates. The children performed the song. The following is the text
that concludes the play:
NILES (AS MAYOR GUILIANI): We are a city that has withstood the
worst attack of any city in the history of America and people are stand-
ing up as tall, as strong and as straight as this church. We are in a very
holy place, hallowed in very special ways, by the presence of George
Washington and all of our brave heroes that gave their lives. We should
think about how we can find the most creative minds possible who love
and honor America and can express that in artistic ways. And we should
14
think about a memorial that just draws millions of people here. We have
to be able to create something here that allows people to build on it and
grow from it – a soaring beautiful memorial.
VICTORIA: We are the artists. We are the builders. We are the children,
the hope, the reason this city must be rebuilt.
LEE: And so we went to work.
JESSE: We made art and installed it on our classroom windows.
CATIE: It was the first thing we saw when we looked out at the empty
space in the skyline where the tall, shining towers used to stand.
DYLAN: We put art in the windows so we’d see things that would
make us feel better. We wrote songs about the New York that we
knew and loved.
ALEX: This is Anna’s song.
Look out! There’s Harlem blues,
Watch out, those 42nd Street tunes,
Change lights at the bust of the horn,
You’ve gotta be grateful that New York’s
Where you’re born.
Yankees, get a hat and a tee,
Bronx for the zoo and Natural History.
You’ve gotta get to Chinatown
And Little Italy.
CHORUS:
City lights,
Ba dooba dooba dadoo.
City lights,
Ba dooba, dooba dadoo.
City lights,
Ba dooba dooba dadoo.
City lights.
Central Park, the best in the spring,
Statue of Liberty, take a ride to Fort Greene.
Want toys? The biggest of course
Are found at FAO Schwarz.
CHORUS.
Macy’s, Thanksgiving parade,
Taxi cabs, buses and trains,
Shopping, as easy as one step out the door,
A dizzying mix of department stores.
The Empire, big buildings that shine,
Cafes, nice places to dine,
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process for the children and adults involved in the workshops and
in the audience?
• When a student says that he understands the ‘true value of com-
edy’, what does he mean? What is the true value of comedy when
working with children who have witnessed a tragedy?
• Will the drama therapy experience have a lasting effect on the chil-
dren and the teacher months or years later?
• When a student says that without the drama class she would have
been ‘dead in my mind’, what does she mean?
• Were you surprised by the depth of the children’s understanding
or expression of feeling about the events of 9/11? How did watch-
ing them express their thoughts and feelings affect your views of
9/11 or similar catastrophes?
REFERENCES
Brockett, O. (1991), History of the theatre, Boston: Allyn and Bacon.
Demasio, A. (1994), Descartes’ error: Emotion, reason and the human brain,
New York: Putnam.
Demasio, A. (1999), The feeling of what happens: Body and emotion in the making
of consciousness, New York: Harcourt Brace & Co.
Eliade, M. (2004), Shamanism: Archaic techniques of ecstasy, Princeton: Princeton
University Press.
Emunah, R. (1994), Acting for real – Drama therapy process, technique, and per-
formance, New York: Brunner/Mazel.
Gallese, V. (2003), ‘The roots of empathy: The shared manifold hypothesis and
the neural basis of intersubjectivity’, Psychopathology, 36:4, pp. 171–180.
Gallese, V. (2005), ‘“Being like me”: Self-other identity, mirror neurons and
empathy’, in S. Hurley and N. Chater (eds), Perspectives on imitation: From
cognitive neuroscience to social science, Boston: MIT Press.
Glaser, B. (2004), ‘Ancient traditions within a new drama therapy method:
Shamanism and developmental transformations’, The Arts in Psychotherapy,
31, pp. 77–88.
Jones, P. (2007), Drama as therapy. Theory, practice and research, London:
Routledge.
Jung, C. ([1921] 1971), Psychological types: Collected works, 6, Princeton:
Princeton University Press.
Landy, R. (1993), Persona and performance – The meaning of role in drama, therapy
and everyday life, New York: Guilford.
Landy, R. (1994), Drama therapy – Concepts, theories and practices, Springfield,
IL: Charles C. Thomas.
Landy, R. (2008), The couch and the stage: Integrating words and action in
psychotherapy, Lanham, MD: Jason Aronson.
Lewis, P. (1993), Creative transformation: The healing power of the arts, Wilmette,
IL: Chiron Publications.
McNiff, S. (1988), ‘The shaman within’, The Arts in Psychotherapy, 15,
pp. 285–291.
Moreno, J. L. ([1946] 1994), Psychodrama, 1, Beacon, New York: Beacon
House.
Stern, P. (2004) (producer/director), Standing Tall, 24 minute video, Boston:
Fanlight Productions.
17
Van der Kolk, B. (1994), ‘The body keeps the score: Memory and the emerging
psychobiology of post traumatic stress’, Harvard Review of Psychiatry, 1,
pp. 253–265.
Van der Kolk, B. (2002), ‘Post-traumatic therapy in the age of neuroscience’,
Psychoanalytic Dialogues, 12:3, pp. 381–392.
SUGGESTED CITATION
Landy, R. J. (2010), ‘Drama as a means of preventing post-traumatic stress
following trauma within a community’, Journal of Applied Arts and Health
1: 1, pp. 7–18, doi: 10.1386/jaah.1.1.7/1
CONTRIBUTOR DETAILS
Robert J. Landy, Ph.D., RDT/BCT, LCAT is Professor of Educational Theatre
and Applied Psychology and Director of the Drama Therapy Program at New
York University. A prolific researcher and writer, Landy has published numer-
ous books, articles and plays in the fields of Drama, Musical Theatre, Drama
Therapy and related topics.
Contact: New York University, Drama Therapy Program, 35 West 4 Street,
room 777, New York, New York 1012, USA.
E-mail: rjl1@nyu.edu
18
STEPHEN CLIFT
Canterbury Christ Church University
GRENVILLE HANCOX
Canterbury Christ Church University
IAN MORRISON
Canterbury Christ Church University
BÄRBEL HESS
Canterbury Christ Church University
GUNTER KREUTZ
Carl von Ossietzky University
DON STEWART
Griffith University
KEYWORDS
ABSTRACT choral singing
Over 600 choral singers drawn from English choirs completed the WHOQOL- psychological
BREF questionnaire to measure physical, psychological, social and environ- wellbeing
mental wellbeing, and a twelve-item ‘wellbeing and choral singing scale’. WHOQOL-BREF
They also provided accounts of the effects of choral singing on quality of life, cross-national survey
19
INTRODUCTION
A recent systematic review (Clift, Hancox, Staricoff & Whitmore 2008)
identified 35 research reports addressing connections between singing,
wellbeing and health in non-clinical samples and contexts, published
since the early 1960s. The literature is highly diverse theoretically and
methodologically, and low levels of cross-citation indicate an aca-
demic field in an early stage of development. Nevertheless, a number
of important findings have emerged from the more substantial studies
undertaken to date.
A range of small scale qualitative studies using ethnographic,
interview and focus group techniques with diverse samples have
shown that singers commonly report a wide range of social, psy-
chological, spiritual and health benefits associated with singing
(e.g. Bailey & Davidson 2005; Silber 2005). These findings are sup-
ported by questionnaire surveys in which choral singers are asked
to respond to a range of statements about the effects and benefits
of singing. Beck, Cesario, Yousefi & Enamoto (2000), for example,
report that 67% of semi-professional choral singers in their survey
agreed or strongly agreed that ‘Singing has contributed to my per-
sonal wellbeing’; Clift & Hancox (2001) report that 71% of singers in
a university choral society agreed or strongly agreed that singing was
beneficial for their ‘mental wellbeing’, and Hillman (2002) reports a
significant perceived improvement in ‘emotional wellbeing’ among
participants singing in a large community choir. A number of stud-
ies have also shown significant improvements in affective state after
singing, using previously validated mood questionnaires (e.g. Kreutz,
Bongard, Rohrmann, Grebe, Bastian & Hodapp 2004; Unwin, Kenny
& Davis 2002).
On a more objective level, a range of studies has assessed the
impact of singing on physiological variables assumed to have well-
being and health implications. Several studies, for example, have
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21
(Power, Harper & Bullinger 1999). For the WHO, health is defined as
follows: ‘Health is a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity’ (WHO 1946).
Quality of life is defined as: ‘A person’s perception of his/her position
in life within the context of the culture and value systems in which they
live, and in relation to their goals, expectations, standards, and con-
cerns’ (WHOQOL Group 1994).
The WHOQOL project has produced a range of validated quality
of life instruments for use in cross-national research. The WHOQOL-
BREF was developed for use in large-scale surveys to avoid too much
demand on participants completing a lengthy questionnaire. A con-
siderable body of research, in many different national contexts, has
demonstrated high levels of factorial stability, internal consistency,
reliability and discriminative validity. The WHOQOL-BREF was con-
sidered particularly appropriate for the current study as versions of
the scale are available for use in the UK, Germany and Australia, and
published data are available from previous studies with UK, German
and Australian samples (see e.g. Skevington, Lofty & O’Connell 2004;
Hawthorne, Herrman & Murphy 2006).
The present paper reports on findings from English choirs and
choral societies participating in the study. A fuller account of the sur-
vey and findings from the three national groups can be found in Clift,
Hancox, Morrison, Hess, Stewart & Kreutz (2008).
METHOD
Aim
To assess the relationships between perceived experiences and effects
associated with choral singing and broader dimensions of health-
related quality of life (as assessed by the WHOQOL-BREF) among
singers in English choirs and choral societies.
Objectives
1. To develop a new scale to assess experienced wellbeing effects
associated with choral singing.
2. To examine differences between men and women in their experi-
ences of singing using this scale.
3. To further explore the value of choral singing for wellbeing, draw-
ing on qualitative accounts gathered through written answers to
open questions.
Procedure
Questionnaires were distributed to members of participating choirs at
the start of rehearsals during May 2007 for completion at home and
return in a sealed envelope at a subsequent rehearsal.
22
Questionnaire
The questionnaire contained three main sections.
Section 1 asked for personal data (e.g. sex, age, partnership status,
employment) and experience of singing and music-making (e.g. time
in the choir, ever auditioned, singing lessons).
Section 2 included three open questions on the effects of singing
on quality of life, wellbeing and health, followed by a structured 24
item ‘Effects of Choral Singing’ questionnaire with a five-point ‘agree-
disagree’ response format. The 24 statements on the effects of singing
were based on instruments used in two previously published studies
with choral societies. Clift & Hancox (2001) developed a question-
naire based on an initial detailed qualitative analysis of choral singers’
views on the benefits of singing and impact on wellbeing and health.
Analysis identified a substantial component concerned with ‘well-
being and relaxation’. The highest loading items on this component
were selected for this survey instrument. Additional items were taken
from the ‘Singers’ Emotional Experiences Scale’ developed by Beck et
al. (2000). All items used in the earlier studies were positively worded.
To counteract possible response bias, half of the items included in the
current survey instrument were positively worded, e.g.: ‘I find singing
helps me to relax and deal with the stresses of the day’ and half were
negatively worded e.g.: ‘I wouldn’t say that singing is an activity that
has made me physically healthier’.
Section 3 contained the WHOQOL-BREF – the World Health
Organization Quality of Life Questionnaire (short version). The
WHOQOL-BREF consists of 24 questions answered on five-point
scales, which serve to measure four dimensions of life quality: phys-
ical (e.g. How much do you need medical treatment to function in
your daily life?), psychological (e.g. How much do you enjoy life?),
social (e.g. How satisfied are you with the support you get from your
friends?) and environmental (e.g. How satisfied are you with the con-
ditions of your living place?).
Sample
The sample consisted of 591 choral singers drawn from eight choral
societies and choirs in the South East and North East of England.
Response rates by choir ranged from 50–70%. The sample was sup-
plemented by a further 42 choral singers from across the South East of
England acting as volunteers in the Silver Song Club Network (www.
singforyourlife.org.uk), giving a sample of 633 choristers. See Figure 1
for an image of one of the participating choirs.
Analysis
Numerical data were analysed using SPSS PC+ Version 16. Given
the finding of a significant sex difference in responses to choral sing-
ing found by Clift and Hancox, analyses were conducted separately
23
Figure 1: The Silver Singers, The Sage Gateshead: one of the choirs participating in the English arm
of the survey. (Reproduced with the permission of The Sage Gateshead, Silver Singers.)
for men and women and for the total sample. Principal Components
Analysis was used to analyse the structure of the choral singing items,
resulting in a single perceived effects of choral singing scale. Pearson
correlations were used to analyse the relationships between the sing-
ing scale and WHO measures. A preliminary qualitative analysis was
undertaken with a small sub-sample of singers reporting high impact
of singing on wellbeing, but low scores on the WHOQOL-BREF psy-
chological wellbeing scale. Written answers to open questions on the
questionnaire were analysed thematically to identify sources of chal-
lenge to wellbeing and potential mechanisms linking participation in
singing with improved wellbeing and health.
RESULTS
The average age of choristers was relatively high (mean = 61 years),
and women outnumbered men 3:1 (77% versus 23%).
The 24 effects of choral singing items were subject to Principal
Components Analysis separately for males and females and for
the total sample. A strong first component emerged with substan-
tial loadings from twelve items for each sex group (see Table 1). The
main themes defining this factor were: improved mood, enhanced qual-
ity of life, greater happiness, stress reduction, and emotional wellbeing.
Substantially the same pattern was found for males and females analysed
separately. These twelve items (eight positive and four negative) were
24
25
Effects of singing
26
27
Three people had been recently bereaved and this is, of course, to
be expected given the high average age of participants in the sam-
ple. The sense of social and emotional support which membership
of a choir, and other musical groups, can provide following the loss
of a significant person is very tangibly expressed in the following
accounts.
28
When you sing, you cannot be sad for long. It really lifts your
spirits. Being in a choir means you are in a team – you all help
each other which gives tremendous satisfaction.
Female, 52
29
Choral singing offers a sense of social support and friendship, which amel-
iorate feelings of isolation and loneliness. Just as singing is inherently
dependent upon breathing, so membership of a group is intrinsic to
choral singing, and group membership per se can be helpful in pro-
moting a sense of wellbeing, as the following examples show.
The choir has been a lifesaver for me. I live alone and have no
family. I belong to two choirs and enjoy them both.
Female, 69
Choral singing involves education and learning, which keeps the mind
active and counteracts decline of cognitive functions. This factor is espe-
cially important given the high average age of the participants, and
the following accounts highlight how significant singing can be in
keeping ‘the brain active’.
Apart from the relaxation benefits, I believe that for me, aged 57,
keeping the brain active and having to concentrate for long peri-
ods will delay if not completely prevent senile dementia!
Female, 57
30
DISCUSSION
A small number of previous studies have documented potential well-
being and health benefits associated with group singing. These earlier
studies are diverse and often small-scale and exploratory, with little
consensus in theoretical perspectives and appropriate measures, and
include only one example of a planned replication to validate previous
findings (Kreutz et al. 2004).
This study contributes to a process of addressing these shortcomings
by undertaking a large-scale, cross-national survey of singers in choirs
in England, Germany and Australia, based on the WHO definition of
health, and using a rigorously developed cross-national instrument for
assessing health-related quality of life, the WHOQOL-BREF. It builds
upon the earlier surveys of Clift & Hancox (2001) and Beck et al. (2000)
in producing a simple and reliable measure of the perceived effects of
choral singing on wellbeing. Choristers’ perceptions of the effects of cho-
ral singing can therefore be examined in relation to a broader validated
framework for the assessment of wellbeing in four dimensions.
In this paper an analysis of data from over 600 English choristers is
presented. The results confirm previous findings from Clift & Hancox,
(2001) and Beck et al. (2000) that a large majority of choristers per-
ceive the experience of singing to be a positive and beneficial one. In
itself this is not too surprising given that choral singing is a voluntary
activity people undertake through a love of music and the pleasure
they derive from it. Nevertheless, there is considerable variation in
the extent to which singers endorse the idea that singing has ben-
efits for their wellbeing and even health, and an interesting finding
from the survey is that such perceptions are gendered, with women
significantly more likely to report benefits compared with men. This
difference, originally reported by Clift & Hancox (2001), has not been
explored in any of the previous research on singing and wellbeing,
even where samples have included both men and women. The find-
ing may contribute to understanding why choral societies commonly
have more female members than males, and should certainly be a
focus for further research.
31
32
REFERENCES
Bailey, B. A. and Davidson, J. W. (2005), ‘Effects of group singing and per-
formance for marginalized and middle-class singers’, Psychology of Music,
33:3, pp. 269–303.
Beck, R. J., Cesario, T. C., Yousefi, A. and Enamoto, H. (2000), ‘Choral singing,
performance perception, and immune system changes in salivary immu-
noglobulin A and cortisol’, Music Perception, 18:1, pp. 87–106.
Beck, R. J., Gottfried, T. L., Hall, D. J., Cisler, C. A. and Bozeman, K. W. (2006),
‘Supporting the health of college solo singers: the relationship of positive
emotions and stress to changes in salivary IgA and cortisol during singing’,
Journal of Learning through the Arts: A Research Journal on Arts Integration in
Schools and Communities, 2:1, article 19.
Clift, S. M. and Hancox, G. (2001), ‘The perceived benefits of singing: findings
from preliminary surveys of a university college choral society’, Journal of
the Royal Society for the Promotion of Health, 121:4, pp. 248–256.
Clift, S. M., Hancox, G., Morrison, I., Hess, B., Stewart, D. and Kreutz, G. (2008),
‘Choral Singing, Wellbeing and Health: Findings from a Cross-national
Survey’, Canterbury: Canterbury Christ Church University, pp. 1–82, avai-
lable at: http://www.canterbury.ac.uk/centres/sidney-de-haan-research/.
Accessed 4 June 2009.
Clift, S. M., Hancox, G., Staricoff, R., Whitmore, C., with Morrison, I. and
Raisbeck, M. (2008), ‘Singing and Health: A Systematic Mapping and
Review of Non-Clinical Studies’, Canterbury: Canterbury Christ Church
University, pp. 1–135, available at: http://www.canterbury.ac.uk/centres/
sidney-de-haan-research/. Accessed 4 June 2009.
Cohen, G. D., Perlstein, S., Chapline, J., Kelly, J., Firth, K. M. and Simmens,
S. (2006), ‘The impact of professionally conducted cultural programs on
the physical health, mental health, and social functioning of older adults’,
The Gerontologist, 46:6, pp. 726–734.
Harré, R. (1972), The Philosophies of Science, Oxford: Oxford University Press.
Hawthorne, G., Herrman, H. and Murphy, B. (2006), ‘Interpreting the
WHOQOL- Bref: Preliminary population norms and effect sizes’, Social
Indicators Research, 77:1, pp. 37–59.
Hillman, S. (2002), ‘Participatory singing for older people: a perception of
benefit’, Health Education, 102:4, pp. 163–171.
Houston, D. M., McKee, K. J., Carroll, L. and Marsh, H. (1998), ‘Using humour
to promote psychological wellbeing in residential homes for older people’,
Aging and Mental Health, 2:4, pp. 328–332.
Kreutz, G., Bongard, S., Rohrmann, S., Grebe, D., Bastian, H. G. and Hodapp,
V. (2004), ‘Effects of choir singing or listening on secretory immunoglo-
bulin A, cortisol and emotional state’, Journal of Behavioral Medicine, 27:6,
pp. 623–635.
Kuhn, D. (2002), ‘The effects of active and passive participation in musical
activity on the immune system as measured by salivary immunoglobulin A
(SigA)’, Journal of Music Therapy, 39:1, pp. 30–39.
Pawson. R. and Tilley, N. (1997), Realistic Evaluation, London: Sage.
Power, M., Harper, A., Bullinger, M. & The World Health Organization Quality
of Life Group (1999), ‘The World Health Organization WHOQOL-100:
tests of the universality of quality of life in 15 different cultural groups
worldwide’, Health Psychology, 18:5, pp. 495–505.
Silber, L. (2005), ‘Bars behind bars: the impact of a women’s prison choir on
social harmony’, Music Education Research, 7:2, pp. 251–271.
33
SUGGESTED CITATION
Clift, S., Hancox, G., Morrison, I., Hess, B., Kreutz, G. and Stewart, D. (2010),
‘Choral singing and psychological wellbeing: Quantitative and qualitative
findings from English choirs in a cross-national survey’, Journal of Applied
Arts and Health 1: 1, pp. 19–34, doi: 10.1386/jaah.1.1.19/1
CONTRIBUTOR DETAILS
Stephen Clift is Professor of Health Education at Canterbury Christ Church
University, and Research Director of the Sidney De Haan Research Centre for
Arts and Health, Folkestone, United Kingdom.
Bärbel Hess is an Associate of the Sidney De Haan Research Centre for Arts
and Health, Folkestone, United Kingdom.
34
VICTOR I. UKAEGBU
The University of Northampton
Performative encounters:
Performance intervention
in marketing health
products in Nigeria
ABSTRACT KEYWORDS
The integration of performance in the sale of medicaments dates back performance
to ancient shamanic practices. The shift from total reliance on healers performative
from the 1960s to new products and models of healthcare delivery saw interaction
itinerant salesmen in Nigeria turn the sales of healthcare products into medicine sales
sophisticated participatory performative acts. Historically shamans advertising
contextualised healing as performed enactments in which trance, shamanism
possession, and choreographed actions were important in convincing cli- sales-performers
ents of their pedigree. The performance quotients deployed by shamans
were significant in how results were viewed: a strategy that Nigeria’s
post-civil war (1967–1970) itinerant medicine salesmen later honed
into theatricalised displays. From the early 1970s to 1990s modern
itinerant medicine salesmen invaded public transports using a com-
bination of spontaneous dramatisation, role-play, costuming, devised
narratives and audience participation to ensure sales. The Nigerian
government banned this activity from public transports in the late
35
1990s, but it persists in other settings. This paper explores the market-
ing of healthcare as a form of ‘direct theatre’ (Schechner 1992) and
how the deployment of performance to functional intentions results in a
unique form of theatricality in which medical products are significant
‘actants’ (Hilton 1987).
INTRODUCTION
Healthcare in pre-colonial Nigeria was delivered by healers and
herbalists, and by spiritualists whose training involved periods of
apprenticeship with expert healers. Whether delivered through
trance, séance or medicaments, healing was an act that depended
on aspects of performance practice. From independence in 1960, but
especially from the mid-1970s, the sale of healthcare products by
itinerant salesmen grew astronomically, becoming a social phenom-
enon between 1980 and 2000; this was due to the wake of growth in
the country’s GDP, migrations of people from rural to urban settings
and the movement of goods across large geographical areas. The
majority of the post-independence salespeople neither produced
the medicines they sold nor underwent the rigorous training and
apprenticeship of their predecessors. Their training, usually brief,
emphasised presentation techniques and prioritised performance
skills over knowledge of medicines.
36
37
38
39
40
SCRIPT 1 (LOX)
(Salesman gets up, clears his voice to attract attention … whistles a
familiar tune.)
SP: Let us pray (prays)…. Amen! Why don’t we make that Amen
convincing? (diverse response) Sir! Long time no see. How’s life
with you?
PA 1: Brother, life is complicated … but we will survive this regime.
A child that keeps its father from sleeping also loses its sleep.
SP: Na true…o! We dey here before ‘am…we go dey after am too!
(That’s true! We were here before and will be here after him ….!)
(clears voice, then proceeds) … some (gesturing towards audience)
know me, but for the benefit of others, I will introduce myself
again even though the ‘International Assembly of United Nations’
41
42
very proper for this … (hands over medicines) … Abeg [please] pay
treasurer quick quick …
PA 2: (protests jokingly) But you say money be for new research …
SP: True! … I dey research why pensioners no get money to buy
medicine, why them depend on their children wey government
no dey pay … why the blood in some people body no dey flow
well well …
(Interaction continues for about ten minutes in several directions, it
involves several passengers and culminates in sales.)
SCRIPT 2 (JAL)
(The passengers are mostly boisterous undergraduates travelling home from
university … opening glee is uncertain, insufficiently theatrical.)
SP: … So I go to University of Wellington in Liverpool … Australia.
PA 1: Wellington is in New Zealand my friend!
PA 2: … (general laughter) he doesn’t know what he’s talking about.
He failed his GSCE Geography!
PA 3: No! He passed. He had an A** but mistook it for the privilege to
transfer towns wherever he likes (prolonged laughter).
SP: So you think I don’t know book. Look, let me tell you people …
PA l: … Shhh…. Silence everyone! Professor … (peers at salesman’s
coat) Schlumberger Drills wants to speak. Lend him your ears …
(Passengers seize opportunity for comic banter, ignoring salesman who
goes quiet.)
PA 2: How much will he pay me for lending him my expensive ears?
PA 3: At least he’ll give you a Chinese balm for your old grandmother.
PA 2: (jokingly) Hey! Don’t insult me. My grandmother is a perfect
eight …
PA 1: (in affected anger)…. What!?
PA 2: Wait … let him finish … he means eight decades, the Course (degree
programme) he’s studying tells you he has problems with figures.
PA 1: I mean ‘figure eight’. Isn’t that why your grey-haired uncle has
been wooing her?
PA 3: You don’t have to display your ignorance, we can tell her age
from your …
SP: (exasperated) Wetin I do you people? [What have I done wrong?]
Na me be Gov’ment wey close university? … Please hear me, even if
you won’t buy anything!
43
(Students continue in satirical vein for several minutes, salesman tries unsuc-
cessfully to get someone to read packages: each gives reasons for declining.)
SP: (exasperated) … You louts! I wan sell medicine to feed my children …
una no dey gree [but you won’t let me]. Which kin people be dis? [what kind
of people are you?] (Packs up, defeated.)
44
45
46
47
‘in’ and ‘out’ of roles. Without the rich complexity of their language
providing a visual contender or equivalent to images on television and
billboard advertisements, salesmen would hardly sustain their captive
audiences’ interests, let alone direct and manage their actions.
CONCLUSIONS
Since the ban ejected salesmen from public transport their presenta-
tion strategies (using language to evoke spectacle and to communicate
effectively in a short space of time in the absence of visual equivalents,
and aligning themselves with the healthcare needs of potential clients)
continue in the marketing of herbal medicine (Adegoju 2008) and
in creative copy-writing in Nigerian media advertising (see Nworah
2007). Performed sales, like ancient shamans and the government-li-
censed herbalists that now dominate the air waves, were driven by
commerce. They all use ‘argumentum ad vercundium’ (Adegoju 2008)
to convince clients that their medicines are not simply panaceas; they
have larger-than-life properties. The aims were, and, in the cases of
herbal medicine and pharmaceutical advertisements, are, to destabi-
lise audiences’ scepticism, establish their ‘sales character’ or integrity,
and to convince audiences that their sincerity and trustworthiness are
synonymous with ‘concern for the well-being of the audience’ (Lucas
1992: 326). Performed sales, herbal medicine and global pharma-
ceutical advertisements use performance to ‘create and make present
realities vivid enough to beguile, amuse or terrify …, they alter moods,
social relations, bodily dispositions and states of mind’ (Schieffelin
1998: 194). The difference is that, unlike herbal and modern medicine
advertising, shamans and sales-performers framed this strategy for the
solo performer without the backing of sophisticated organisations and
professional actors.
Sales-performers devised their routines from unwritten ‘scripts’ to
suit different contexts. Unlike Meyerhold’s inspirational actor who
rejects technique and ‘is content to rely exclusively on his own mood’
(Braun 1969: 129), they used established, tested techniques without
surrendering to character or role as in naturalistic acting. Their train-
ing was mainly by way of Schechner’s (1985) ‘restored behaviour’
which facilitates periodic recalls, retrieval, and the manipulation of
established sequence of actions for new performances. Such retriev-
als may lead to new skills and acts but they essentially allowed these
salesmen to ‘rebehave according to these strips, either by existing
side by side with them’ (Schechner 1985: 36) or by passing them
on to others. Sales performers sustained proxemic relationships with
audiences without the spatial ruptures there are in conventional
communal performances. Despite this the dramatic action ‘is not
limited to one group or to one place exclusively, but rather eddied
through all those present’ (Chaney 1993: 29). There are unrestricted
exchanges among passengers, as well as between them and the
salesmen, resulting in ‘“inclusive” tactile dramatisation’ (Chaney
1993). The acts are not social drama as Turner (1974 and 1986) and
48
Schechner (1994) define the form, but a good salesman creates his
acts to include ‘mundane experience thereby imbuing it with new
levels of meaning’ (Chaney 1993: 28). In effect, what we have is not
only a set of paratheatrical activities which dissolve the audience-
performer opposition (Schechner 1994: 122) but ‘direct theatre’,
that ‘is not “about” something so much as it is made “of” some-
thing. It is actual and symbolic, not referential and representational’
(Schechner 1992: 104).
In the cited examples the acting self and other self differ for, as
Schechner put it, ‘the self can act in / as another; the social or transin-
dividual self is a role or set of roles ….’ (1985: 36). Some activities
in sales presentations happen spontaneously, others are rehearsed
till they become second nature and are stored and retrieved for use
when required. The performative context of performed sales was, and
remains, undeniable. Like many commercial activities in which the
performative intent is non-defined (as in aesthetic theatre), performed
sales functioned on the same socio-theatrical dimension and aes-
thetics as those found in all product advertising and marketing, from
medicine to the most sophisticated electronic goods.
REFERENCES
Adegoju, Adeyemi (2008), ‘A Rhetorical Analysis of the Discourse of Advertising
Herbal Medicine in Southwestern Nigeria’, (unpaginated) Linguistik, 33:1,
available at: E:\Review of ARt and Health\Adepoju\A_ Adegoju Discourse
of Advertising Herbal Medicine.htm. Accessed 24 April 2009.
Barba, Eugenio and Savarese, Nicola (1991), The Secret Art of the Performer: A
Dictionary of Theatre Anthropology, London: CPR / Routledge.
Barba, Eugenio (1999), Land of Ashes and Diamonds: My Apprenticeship in
Poland, Aberystwyth: Black Mountain Press.
Barber, K., Collins, J. and Ricard, A. (1997), West African Popular Theatre,
Bloomington & Oxford: Indiana University Press & James Currey.
Bauman, R. (1977), Verbal Art as Performance, MA: Newbury House.
Bharucha, Rustom (1993), Theatre and the World: Performance and the Politics of
Culture, London: Routledge.
Braun, Edward (1969), Meyerhold on Theatre, London and New York: Eyre
Methuen; Hill and Wang.
Burns, Tom (1992), Erving Coffman, London & New York: Routledge.
Chaney, David (1993), Fictions of Collective Life: Public Drama in the Modern
Culture, London & New York: Routledge.
Goffman, Erving (1984), The Presentation of Self in Everyday Life, London:
Penguin.
Grice, Herbert Paul (1999), ‘Logic and Conservation’, in Peter Cole & Jerry L.
Morgan (eds) (1975), ‘Syntax and Semantics’, 3, Speech Acts, New York:
(Academic Press) pp. 41–58.
Hilton, Julian (1987), Performance, Basingstoke: Macmillan [New Direction in
Theatre].
Jennings, Sue and Minde, Ase (1993), Art Therapy and Dramatherapy: Masks of
the Soul, London: Jessica Kingsley Publishers.
Jeyifo, ‘Biodun (1984), The Yoruba Popular Travelling Theatre of Nigeria, Lagos:
Nigeria Magazine.
49
50
SUGGESTED CITATION
Ukaegbu, V. I. (2010), ‘Performative encounters: Performance intervention in
marketing health products in Nigeria’, Journal of Applied Arts and Health
1: 1, pp. 35–51, doi: 10.1386/jaah.1.1.35/1
CONTRIBUTOR DETAILS
Dr Victor I. Ukaegbu is a Senior Lecturer and Course Leader for Drama at
The University of Northampton. He has written on African and intercultural
theatres, postcolonial performances, gender, black British theatre, applied
theatre, including a book; The Use of Masks in Igbo Theatre in Nigeria: the
Aesthetic Flexibility of Performance Traditions. He is Associate Editor of African
Performance Review and a member of the Editorial Board of World Scenography
(Africa /Middle East).
Contact: Division of Performance, School of The Arts, The University of
Northampton, St George’s Avenue, Northampton, NN2 6JD, United Kingdom.
E-mail: victor.ukaegbu@northampton.ac.uk
51
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BILL RIBBANS
Northampton General Hospital and
The University of Northampton
ABSTRACT KEYWORDS
This article reviews the musculoskeletal problems of dancers. An over- dance
view of the benefits of dance is given and background problems increasing injuries
injury risk explained. The article follows dancers from infancy to retirement ballet
through the ‘five orthopaedic ages of a dancer’ and highlights some of the orthopaedics
orthopaedic problems commonly encountered at each age. The specific prob- multi-disciplinary
lems of a major ballet company are discussed and the requirements for a healthcare
multi-disciplinary team of healthcare professionals to support the organisa-
tion outlined.
53
and Health Conference generation, a form of thanksgiving, an invocation of the gods, a wel-
at The University
of Northampton in come to guests and a preparation for battle.
September 2007. Two hundred years ago, the poet, Lord Byron (1788–1824), wrote
2. There were seven years
between the songs
glowingly of its charms in Childe Harold’s Pilgrimage (1812):
and he had clearly
changed his mind
about ladies dancing
On with the dance! Let joy be unconfined;
on the stage! no sleep till morn, when youth and pleasure meet.
To chase the glowing hours with flying feet.
Who knows this might have been the first description of an all night
rave!?
With the advent of films, our forbears flocked to the cinemas and
amongst their matinee idols were dancers such as Fred Astaire, Ginger
Rogers and Gene Kelly. More modern cinema audiences have been
entertained by dance and musical blockbusters such as Saturday Night
Fever, Grease, and Dirty Dancing. Not to be outdone, BBC television in
the United Kingdom has screened its own dance-themed programmes,
such as Come Dancing and Fame, providing escapism and promoting
participation for all ages. More recently, vivid images of David Brent’s
grotesque disco dancing routine in The Office, and attempts by stars
of sport and screen to master routines in Strictly Come Dancing have
attracted massive television audiences for the same broadcaster.
Dance is accessible to all ages, for example: ballet classes for pre-
school toddlers; Jive, Ballroom and Ceroc classes for adults; and Tea
Dances and Line Dancing for the even ‘younger at heart’. The benefits
of dance for its participants’ health should be self-evident. It provides a
reasonable degree of cardiovascular training and respiratory exercise. It
improves coordination and balance – an important protection against
falls in the elderly – and builds and maintains muscle and bone mass
to counter osteoporosis. The calories consumed can form one strand
of a weight-control programme. Less easily measured benefits include
the feeling of wellbeing that accompanies regular exercise, the forma-
tion and maintenance of social skills in the young, participation in team
building, and, for the elderly, helping to offset feelings of isolation (Fiske
1997; Lobo 2006; Matarsso 1997; McHenry 2009).
Noel Coward was clearly aware of the benefits of dance when he
wrote the lyrics to Dance Little Lady in 1928: ‘Dance, dance, dance little
lady, leave tomorrow behind’ (Coward 1928). However, by 1935, his
views had changed for reasons unknown to this author. He implored:
‘Don’t put your daughter on the stage Mrs Worthington, Don’t put
your daughter on the stage.’
Clearly a seven-year itch! 2
54
55
this country and abroad performing. They are required to learn, prac-
tice and execute up to eight different dance productions per year.
Despite being The English National Ballet, 48 of the present sixty-six
performing in the ensemble (73 per cent) are from overseas. By itself this
can produce difficulties for the treating medical staff. New recruits may
have language barriers when discussing medical problems, detailed past
medical notes are not always available, cultural differences are inevita-
ble and a suspicion of ‘all things foreign’ is not confined to the British!
As in many sports, dancers may have a preference for home physicians
or for ‘alternative therapy’. In addition, the spectre of home sickness for
the young dancer can lie barely hidden just beneath the surface.
CUMULATIVE INJURIES
So what does the ‘ugly duckling’ have to go through to become the
‘beautiful swan’? Brinson and Dick published their survey into danc-
ers’ health in 1996. It revealed that 83% of ballet dancers were likely
to have sustained injury in the previous twelve months and 58%
of professional dancers require time out each year to recover from
such problems. The Australian Dance Council Survey (Geeves 1990)
revealed that 65% of professional dancers carried long-term injuries.
By the age of 25, 75% had chronic problems and only 5% of all pro-
fessional dancers were over 35. Similar injury patterns are seen in all
forms of dance and, regionally, the back, knee, foot and ankle were
amongst the most common areas of concern.
56
57
58
59
CONCLUSION
Galen (130–200 AD), sometimes known as the ‘Father of Anatomy’,
said over two thousand years ago that ‘the best exercises are those
that train the body and delight the mind’ (reference unknown).
Dance fits both of these criteria. Ballet gives pleasure to millions
of people every year around the world. However, the stresses and
strains experienced by student dancers and professional performers
are enormous. To maintain a healthy body and mind that allows a
dancer to enjoy a long and, hopefully, comfortable career, and enjoy-
ment of their post-performance life, requires expert input from many
medically-related disciplines.
REFERENCES
Abraham, S. (1996), ‘Characteristics of eating disorders among young ballet
dancers’, Psychopatholog, 29:4, pp. 223–229.
Brinson, P. and Dick, F. (1996), Fit to Dance? Calouste Gulbenkian Foundation,
London.
Byron, Lord (George Gordon). (1812), Childe Harold’s Pilgrimage.
Coward, N. (1928), Dance little lady. Song Lyrics. From Album of Eight Songs.
Publisher Chappell & Co.
Coward, N. (1935), Don’t put your daughter on the stage Mrs Worthington. Song
lyrics. From Noel Coward on the Air. Publisher Warner Bros Inc.
Cuesta, A., Revilla, M., Villa, L. F., Hernández, E. R. and Rico, H. (1996), ‘Total
and regional bone mineral content in Spanish professional ballet dancers’,
Calcified Tissue International, 58:3, pp. 150–154.
Fiske, E. B. (ed.) (1999), Champions of Change: The impact of the Arts on Learning,
Washington DC: Arts Education Partnership.
Frusztajer, N. T., Dhuper, S., Warren, M. P., Brooks-Gunn J., and Fox, R. P.
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SUGGESTED CITATION
Ribbans, B. (2010), ‘Best foot forward: An orthopaedic odyssey through
the world of dance’, Journal of Applied Arts and Health 1: 1, pp. 53–61,
doi: 10.1386/jaah.1.1.53/1
CONTRIBUTOR DETAILS
Professor Bill Ribbans Ph.D., FRCSOrth, FFSEM (UK) is a Consultant
Orthopaedic Surgeon at Northampton General Hospital and Visiting
Professor at The University of Northampton. He is Honorary Orthopaedic
Surgeon to the English National Ballet and involved with many profes-
sional sports organisations, particularly involving rugby union, association
football, cricket, athletics and badminton.
Contact: Pavilion Clinic, 500 Pavilion Drive, Northampton, NN4 7YJ, United
Kingdom.
E-mail: billribbs@uk-doctors.co.uk
61
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ANNE FENECH
University of Southampton
Inspiring transformations
through participation in
drama for individuals
with neuropalliative
conditions
ABSTRACT KEYWORDS
Purpose: The aim of the service evaluation was to use an occupational sci- leisure
ence focus to describe the effects of drama with variable levels of sensory drama
content and a potentially active, rather than a passive, participant role on engagement
engagement by individuals with neuropalliative conditions. neuropalliative
Method: The service evaluation involved time sampled observations of conditions
engagement during a single session for each of the fourteen participants
during a passive spectator role in the audience at a live drama, a potentially
active interactive performance and a control condition.
Results: The observations of engagement showed a significant difference
between the engagement scores for the control condition and the drama.
Conclusions: Whilst drama appears to be satisfying their engagement it
depends on the role offered to them (e.g. potentially active versus passive),
63
INTRODUCTION
Neuropalliative conditions (Turner-Stokes et al. 2007) are usually caused
by brain damage, and include rare conditions such as Locked
in Syndrome (Krasnianski et al. 2003) or Huntington’s disease
(Huntington 1872). They also include common conditions in their
advanced stages such as Parkinson’s disease (Hudson et al. 2006) or
Multiple Sclerosis (Multiple Sclerosis Society 2007). Their complex-
ity is derived from a combination of physical, cognitive, perceptual,
communication, sensory gating and awareness limitations; the con-
sequence of these limitations can be profound levels of disability
(Fenech 2009). This can result in Barthel scores (Shah et al. 1989)
in the region of 0 out of 100, (e.g. individuals in a minimally con-
scious state), to 30 out of 100 (e.g. individuals with late stage Multiple
Sclerosis). Such profound disability complicates the achievement of a
good quality of life because as the complexity of disability increases
the options for satisfying occupational engagement decrease, which
can lead to a passive/spectator role (Stanley & Dolby 1999; Farrow &
Reid 2004), and because the disability is outside the individual’s
control, this can lead to a state of occupational deprivation (Wilcock
1998; Whiteford 2004).
Sensory gating deficits such as those found in Huntington’s dis-
ease (Uc et al. 2003) and Head Injury (Kumar et al. 2005; Arciniegas
et al. 1999) are where the Reticular Activating System is damaged
and unable to filter out irrelevant and excessive information. Sensory
deprivation on the other hand results from under-stimulation,
and sensory overload from over-stimulation: both also impact on
participation. Therefore several similar concepts have been devel-
oped such as the sensory diet (a selection of individualised sensory
stimuli offered across a range of sensory receptor organs), sensory
regulation (the limitation of the level of sensory stimuli encoun-
tered at any point in time) and sensory integration (combinations
of sensory stimulation tailored to increasing physical and cognitive
functioning).
The terms ‘leisure occupation’ and ‘occupation’ are used through-
out this paper. Human occupations have been defined as ‘any activity
in which a person is engaged’ (Webster 2003), and as ‘an activity in
which one engages’ (Webster 2003) and this is a study of engage-
ment. The difference therefore between an activity and an occupation
is the degree of engagement by the participant. Human occupations
include everything that people do to occupy themselves, including
looking after themselves (self-care), enjoying life (leisure), and con-
tributing to the social and economic fabric of their communities
(productivity) (CAOT 2008). However for individuals with neuropalli-
ative conditions, opportunities for engaging in human occupations
64
65
66
ETHICAL ISSUES
This study was conducted as a service evaluation, i.e. it was
designed to observe and describe current clinical practice without
allocating participants to intervention groups and therefore did not
require Research Ethics Committee approval (NHS Research and
Development Forum 2006) however, permission for the service
evaluation to take place was granted following the local research
governance procedure. The majority of the participants had cognitive
dysfunction and therefore it was important to consider the ethical
implications of including them in the service evaluation. No indi-
vidual was excluded from, or included in, live performances because
of the service evaluation. The participants’ written consent to partici-
pate in the service evaluation was sought.
Using a study design, which allocates individuals to a specific
experimental group by any means other than their own choice, would
negate a key principle which turns an occupation from just something
to be carried out into a leisure occupation, i.e. freedom of choice.
Therefore there are ethical issues about comparison trials in case an
individual is allocated to an occupation which is not of their own
choosing. As such a series of single case studies may be more appro-
priate with comparison to a control condition through time sampled
data being gathered.
METHOD
Other satisfaction studies published have used levels of engage-
ment as reported by third parties (Delle Fave & Massimini 1988
& 1991) or standardised self-reporting tools such as the Leisure
Satisfaction Scale (Di Bona 2000). However, as a result of the dif-
ficulties in expressing preferences and feelings caused by cogni-
tive dysfunction and communication difficulties, self-reporting has
limited data collection to participants who can express their own
opinions consistently.
Observation of engagement (using a single marginal partici-
pant observer and a structured observation format) is an appropriate
method of observation given the facility’s philosophy of non-intrusion
and protection of vulnerable adults (Protection of Vulnerable Adults
Policy, POVA). This limits the number and type of observers who can
be used and precludes the use of video recording (where the indi-
vidual could be identified). Kishida & Kemp’s (2006) simple measure
of observed engagement is designed for use in practice and with indi-
viduals who cannot report their own experience and so is ideal for use
with this population.
Single-case methodologies can establish the effect of an interven-
tion on a single group by focusing on a particular behaviour such as
engagement with the intervention (in this case leisure occupations)
being altered (Robson 2002), i.e. present or absent. The number of
observations for each single group study is guided by the concept that
67
DESIGN
The service evaluation involved:
PARTICIPANTS
The same fourteen participants were observed during the control con-
dition, the live drama and the interactive drama performance.
The service evaluation participants were residents of a long-term
care facility (specialising in the care of individuals with neuropallia-
tive conditions) who have been reported by the Residence Manager
as able to discuss their opinions consistently. Participants who did not
consent or have the capacity to consent to be part of this evaluation,
who are unwell or are under the age of eighteen were excluded from
the service evaluation.
68
RESULTS
Setting the scene for the observations of engagement
The observations were conducted by a single observer who was
seated (facing the group) in order to be able to see the participants,
whilst trying to be as unobtrusive as possible. Each observation
69
CONTROL CONDITION
Here the participants were awaiting the arrival of a live performer in
a familiar room with dimmed lighting and no TV or radio on in the
background. The potential sensory stimulation included seeing and
hearing only and no performance components (motor or processing)
were required.
INTERACTIVE DRAMA
Interactive drama is a particular form of drama in which audiences
participate as ‘Spect-Actors’ (Green & Reinhard 1995), with their
interventions being used as part of the performance. The charac-
ters treat everybody the same – engaging participants, supporter
and family members in their world, and listening and responding
in character to whatever they have to say in return. This offers
audiences the opportunity for active participation. The characters
regard everyone’s stimulation as valuable and so accept every-
thing they’re told and use it to develop their story, activities and
interactions.
70
Control 2
Live Performance 4
71
Live
Control performance
DISCUSSION
Drama appears to offer individuals with neuropalliative conditions
an engaging way to use their free time. The anticipated reduction
in engagement at the higher levels of sensory stimulation (given the
effects of sensory overload, and sensory gating deficits) did not occur.
In fact engagement with the three conditions appeared to increase as
the sensory stimulation levels increase. Additionally there is a slight
difference between the engagement levels in potentially active and
passive occupations. The potentially active occupations were also
the ones which had the higher supporter to participant ratios and
therefore the higher potential for supporters to facilitate participant’s
engagement. Participant engagement may therefore be influenced by
a three-part combination of supported facilitation, the sensory stimu-
lation level of the occupation, and the potential for active as opposed
to passive participation.
The supporters were observed to use techniques such as physi-
cal assistance, modelling, gesturing or verbal direction in order to
keep the participants attention on the performance and enable their
participation and engagement. This 1:1 facilitation may have added
additional sensory stimulation and therefore had the potential to
overload the participants (and so may have added further to the
engagement if sensory overload had not been a factor). Supported
facilitation appeared to have the desired effect of maintaining and
encouraging engagement given that the higher-supporter participant
72
Spectating
at a live Interactive
Control Group performance Drama
Supporter to 0:1 0.5:1 0.66:1
resident ratio
Maximum senses 2 3 4
73
74
CONCLUSION
Participation in drama appears to offer individuals with neuropalliative
conditions an engaging leisure experience. However the occupations
need to be adjusted/adapted in order for individuals to research their
optimal level of engagement. Sensory barriers to participation have
long been acknowledged in the domain of occupational therapy.
However the effect of the long term preclusion from occupational
engagement experienced by individuals with profound disabilities
does not appear to have been fully acknowledged. It is therefore
likely that the personalisation and enabling of leisure occupations,
such as drama participation, may not be taken as seriously as these
individuals deserve.
The results of this service evaluation show that the factors to take
into consideration when doing this include the individuals’ sensory
processing capacity, the level and type of support offered by others in
order to facilitate their engagement, and whether the individual feels
that they have a choice to watch or participate actively.
75
Minute 10–11
Minute 15–16
Minute 20–21
Minute 25–26
Minute 30–31
Minute 35–36
Minute 40–41
Minute 45–46
Minute 50–51
Minute 55–56
Minute 1–2
Minute 5–6
Passive non- – does not interact with the environment and does not do what is expected
2
engagement during the activity.
Undifferenti-
ated engage- 3 – interacts with the environment automatically/repetitively.
ment
Passive
4 – interacts with the environment without manipulation or vocalisation.
engagement
Active – participation with the environment appropriately/manipulating materials
5
engagement or vocalising.
76
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Arciniegas, D., Eadler, L., Topkoff, J. C., Awthra, E., Filley, C. M. and Reite, M.
(1999), ‘Attention and memory dysfunction after traumatic brain injury:
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Journal of Leisure Research, 12:1, pp. 20–33.
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Delle Fave, A. and Massimini, F. (1991), ‘Modernization and the quality of
daily experience in a Southern Italy village’, in N. Blerchrodt & P.J.D.
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Green, M. Y. and Reinhard, R. When art imitates life: A look at art and drama
therapy. Public Welfare 1995; 53:2, pp. 34–43.
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77
78
SUGGESTED CITATION
Fenech, A. (2010), ‘Inspiring transformations through participation in drama
for individuals with neuropalliative conditions’, Journal of Applied Arts and
Health 1: 1, pp. 63–80, doi: 10.1386/jaah.1.1.63/1
79
CONTRIBUTOR DETAILS
Anne Fenech is currently a Lecturer at the University of Southampton School
of Health Sciences. Her background is in management (MBA), gerontology
(MSc) and occupational therapy (DipCOT).
Her career history has included several Head Occupational therapist posts
before moving into general/policy management and more recently a research
fellowship. She is currently the English Board Member for the South East
Region of the College of Occupational Therapists and also a Registration
Assessor for the Health Professions Council.
Contact: 41 New Elms Cottages, Firle, Lewes, East Sussex, BN8 6NA.
E-mail: annemfenech@aol.com
80
MICHAEL J. LOWIS
The University of Northampton
Emotional responses to
music listening: A review
of some previous
research and an original,
five-phase study
ABSTRACT KEYWORDS
The paper firstly reviews four studies on the power of music to generate emo- music
tional responses in the listener. Using scientific methodology, the research emotion
comprised experiments with sacred versus secular music, the effect of differ- peak experiences
ent modes and rhythms in hymn tunes, music and task performance, and spiritual
the respective influences of nature and nurture on musical ability. Secondly, experiment
the paper describes the five phases of a research programme to assess the
frequency and nature of peak emotional experiences generated through lis-
tening to music. This study made use of surveys, laboratory experiments
and EEG measurements in its investigation. Whilst the combined outcomes
add to the knowledge and understanding of the role of music, many oppor-
tunities for further work remain.
81
INTRODUCTION
This paper firstly reviews four earlier studies on the nature and effects
of music, before describing the five phases of a research programme
on peak emotional experiences triggered by music, carried out at The
University of Northampton.
Music is universally enjoyed, and it has survived since the dawn of
civilisation when there is little evidence of a good evolutionary reason
for doing so. Musical sound has been described as energy in vibrating
motion, which is produced by beating, blowing, plucking, striking, or
frictionising with a bow (Bernstein 1976). Bernstein adds that, unlike
random ‘noise’, music is structured into time and space, forming the
components of melody, rhythm, tone colour (timbre), and harmony.
Music is found in every known culture and historical period for which
there are records (Trehub et al. 1993). The Guinness Book of Records
(1994) stated that bone flutes have been discovered that date back
some 27,000 years, whilst Hawkes (1997) writing in The Times sug-
gested that more recent finds may be from 43,000 to 67,000 years old.
This was a time when Neanderthals as well as Homo sapiens inhabited
the earth, and when humanoids were still in the hunter-gather stage
of development. However, the origins of music may extend much
further back in time, and Storr (1993) speculated that it might have
predated speech, originating from vocal exchanges between mothers
and babies.
Music is a non-verbal form of communication, associated with emo-
tion and feelings (compared with speech, which communicates facts
and ideas), being processed predominantly in the right cerebral hemi-
sphere (Garland & Kuhn 1995), whilst speech is processed mainly in
the left hemisphere. For this reason, to investigate the effects of music
per se, vocal selections should be avoided as they add the confound-
ing variable of verbal communication to the equation. Unless there are
specific reasons to the contrary, the items used should be sufficiently
complex to require cognitive processing, for example classical compo-
sitions, rather than superficial background music.
82
83
84
The contrast between this latest finding that music in the major
mode had the highest emotional impact, and the outcome of the
study by Hughes & Lowis (2002) where the trend was for hymns in
the minor mode to have the highest rating, adds weight to the notion
that there are two types of emotional impact: arousal (latest study)
and introspective/spiritual (hymn study).
85
86
87
computer records, the total number of ‘hits’ for each 20-second period
of the music was noted, and then the musical scores of the pieces were
scrutinised for events that coincided with high incidences of PEEs.
Results: Examples identified for the gentle music included the start
of a climax sequence, the entry of a different solo instrument, the
change to a ‘dark’ minor section, and a first significant fortissimo. For
the upbeat music, there was the start of a rousing piece, the impacts of
gong and bass drum, again a fortissimo and start of a crescendo, and
a powerful ensemble. The highest cluster of peaks for either selection
was the stirring conclusion of Stravinsky’s ‘Firebird’ music. Most of the
examples identified can be regarded as rousing, and Berlyn (1971) sug-
gested that there was a relationship between the complexity of an art
form (including music) and hedonic value, adding that novelty, surprise
and ambiguity can cause arousal.
When clusters of peaks were totalled and plotted for each piece
of music, an interesting pattern was revealed for the gentle selection.
The highest incidence was for the first piece, but this was followed
by a pattern of alternating low and high clusters but with an overall
downward trend (See Figure 1).
A possible explanation for this is that each item had similar num-
bers of potential triggers, but the listener experienced emotional
saturation that could not be sustained, requiring a refractory period
as does a muscle or nerve fibre. Full recovery, however, could not be
attained before the exposure to more emotional triggers occurred.
Further studies, with varied orders of presentation of the music pieces,
are required to confirm this (Lowis & Touchin 2002).
88
Head viewed from above, with nose at the top. The narrow, light strip between the ear region and
dark inner banding indicates an area of high activity in this monochrome image.
89
90
ACKNOWLEDGEMENT
I am extremely grateful to Oxford Instruments, UK, Ltd who, at
no cost, provided two Neurophysiology Support Specialists and a
Medilec® Profile multi-media EEG apparatus for a day. Without this
help, the EEG tests could not have been accomplished.
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91
SUGGESTED CITATION
Lowis, M. J. (2010), ‘Emotional responses to music listening: A review of some
previous research and an original, five-phase study’, Journal of Applied Arts
and Health 1: 1, pp. 81–92, doi: 10.1386/jaah.1.1.81/1
CONTRIBUTOR DETAILS
Dr Michael Lowis is a chartered psychologist, and currently Visiting Fellow,
Occupational Sciences, The University of Northampton. His research interests
include the psychology of music, the psychology of humour, and life satisfac-
tion in the later years. He is the author of over 70 academic papers and con-
ference presentations, and is called upon by the media from time to time for
specialist opinion. He is also an amateur musician.
Contact: 47, Allard Close, Northampton NN3 5LZ, United Kingdom.
E-mail: mike.lowis@virgin.net
92
HANNELE WEIR
City University London
ABSTRACT KEYWORDS
The context for the article is a workshop that takes place at Tate Modern art museum
in London, with a focus on exploring violence. The material is drawn from violence
two small-scale research projects. The participants, who come from a vari- learning
ety of occupations, observe and deal with violence in their work in varying practice
degrees. The rationale for the art gallery based session is that ‘live’ visual
works of art stimulate engagement in cognitive and emotional processes
whilst exploring societal phenomena relevant to professional knowledge and
development.
There are two main themes: the first focuses on the art gallery visit
as a means of learning, and the second is to consider the impact on stu-
dents and whether learning in an art gallery might give insight into their
practice.
INTRODUCTION
Whilst there has been a growing interest in using art as an educa-
tional medium the following rather strong reactions still reflect the
93
“When I was young museum was the most boring shit mum
could take me to. I’m turning twenty on Saturday and this visit
made my soul better.” (Graffiti on the wall of a Tate Modern lava-
tory 2007)
‘I couldn’t believe I was getting into this.’ (Mature student)
BACKGROUND
Why art – in education?
There is accumulative evidence of ‘use’ of art in teaching (see
Blomqvist et al. 2007; Simons & Hicks 2006), which indicates a variety
of reasons and outcomes, for example, Blomqvist et al. refer to art as a
94
skilful interpreter of emotions (2007: 89); Simons & Hicks argue that
the use of different art forms in teaching facilitates trust, confidence
and the expression of emotions (2006: 80).
Whilst these writers appear to prioritise emotions in the use of art
in learning they also make reference to reflective thinking (Blomqvist
et al. 2007: 92) and integrating the emotional level with the intellectual
and cognitive aspects (Simons & Hicks 2006: 85). We might expect
arts to generate such processes, in addition to the aesthetic apprecia-
tion of the work created by artists, but the increasing utility of muse-
ums as places of teaching and learning within a formal curriculum is
less obvious. However, I want to emphasise the point of engagement
in and with art. Whilst ‘using’ art is often seen as the shorthand way
of describing how artworks increase our insight and comprehension
in an educational or therapeutic context, the attempt here is to con-
vey how focused viewing of art compels engagement, and draws into
some depth of exchange between the viewer and the piece in ques-
tion. ‘Use’ therefore may refer to a more transient impact; and argua-
bly devalue the energy and emotion invested by the artist in the piece.
In our case the engagement is guided and enhanced by the specialist
facilitation and group work.
For novice viewers there are inevitable questions about the pur-
pose of educational visits to an art gallery, as it might turn out to be
seen as just a nice idea and a mildly interesting afternoon. The con-
cern of the type and extent of engagement is to do with how art could
challenge our thinking and emotions, and reveal something that was
hidden; expose something about the way we construct explanations
about events and the world around us.
The claim that art is not only an aesthetic experience but also ‘the
consciousness of the world’ (Doran 1978, quoting Cezanne’s thoughts
on ‘the stages of man’ cited in Marion 2007) leads us to academic
debates about the purpose and value of art. There are sophisticated
academic arguments about art and its value both as art and as an
investment (see, for example Berger 1972), the skills and choice of top-
ics by artists, and whether galleries should purposefully widen their
doorways to the public. We may also draw attention to learnt assump-
tions about art, and ways of looking at art, to which Berger (1972) in
Ways of Seeing refers, and that the way we see things is connected to
what we believe or know (1972: 8).
The understandable scepticism that viewers may feel and express
is rooted in larger domains than just those of personal prefer-
ences. Elitism still surrounds art galleries and artworks that appear
obscure to the majority of people. For example, Bourdieu (Savage
& Bennett 2005: 8) has observed that the art museum serves as a
site of cultural and social distinction and that there are significant
inequalities of access to works of art and participation in cultural
activities. After Wolff (1993) it could argued that art can be effec-
tive not only in enlightening viewers politically and historically but
it could also be a tool in learning about the other societal issues
95
96
97
Each work of art is accompanied by other activities that tie in with the
piece and help the association between our world experience and the
work on view.
METHODOLOGY
The methodological approach is underpinned by the experience gained
from the previous sessions that have taken place within the module
programme at Tate Modern. The session format is always the same
and starts with a brief introduction before touring the gallery, dur-
ing normal opening hours, and concentrating on between five and six
pieces of art, around which discussion and some activities take place.
Following the viewing the group meets in another room in the gallery
for feedback and reflection.
98
Ethical approval
Approval was sought and granted by City University London and all stu-
dents were given written and verbal explanations of the session format; all
99
RESULTS
The biographical data for the group in 2006 was similar to the group in
2008 in terms of a mix of participants and with reference to age, occupa-
tion and ethnicity. The age range in both groups was from late 20s to 49
years of age. The groups consisted of nurses, police officers and people
working for voluntary organisations; and people from different ethnic
groupings. Four out of six students in the 2008 cohort had visited Tate
Modern before the session and two had not, but only two said they
visited museums more than three times a year, the others did so infre-
quently. This was close to the visiting pattern of the 2006 group.
The data is not strictly organised into themes. The insights and
contributions made by the participants concern firstly the initial reac-
tions and surprise that they found the workshop interesting, useful
and enjoyable. A second theme was formulated from the comments
that were to do with the artworks themselves, the discussion and
insights generated in the discussion, and how connections were made
with other aspects of life. The third area focuses on the comments that
could be linked with work life and practice. In the narrative that fol-
lows these themes are enmeshed in the reported discussions.
Shibboleth
Liz Ellis explains: ‘Shibboleth’ – a political word, borders, deliberate,
about poverty, justice.
100
Four participants look at the crack that runs the length of the Turbine
Hall. Five observed how they reacted and generally how the audience
walked around and reacted to the crack.
Discussion: could be all kinds of things; ripped into; could be pushed back
together; mouse trap – we could be trapped.
There are remarks about divisions in society, and how powerful it felt
seeing it in concrete (no pun intended) terms, and which you could
not escape as it commanded the whole length of the hall.
Rothko room
We were instructed to keep certain words (below) in mind as we look.
Again the discussion took place in groups.
Meditation: not brightly lit; compare to the other environment outside the
room; cool down zone; painting on the back wall: easier to look at – others
are more offensive; womb like; bodily sense.
Fluid: physicality of the paintings; like dried blood; first on the left ‘drizzling’;
colour; extremes of experience.
Trapped: not uncomfortable; the paintings pulse.
The paintings polarise people – we have diverse and opposite views; and
different feelings were generated as reflected in the words.
As the Rothko room generated rather diverse views and feelings, some
referring to rather personal feelings, Liz Ellis explained: ‘What we do
here is never therapy, but we are thinking of a way into art works.’
The point is important as otherwise the impact of the works could be
diminished to consist only of the introspective reaction rather than
exploring what is on view and opening oneself to wider considera-
tions and social interpretation.
101
The beds were placed in a roped off area (for security and protection of
the works), but that became also symbolic of a quarantine; the whole
work was troubling physically and mentally.
As the maps on the beds were a mix of different places (not
geographically correct) they could have been representations of
migration or being a refugee as the beds appeared to have been
bunched together in an austere gallery, suggesting regimentation
and a lack of space. So we had a number of visual messages pre-
sented to us that appealed to our previous knowledge: displaced
people, who did not know where they were, possibly children as
the beds were child-size; discrepancy between part of the material
covered in pretty flowers but soiled, and white painted bed frames,
that made the beds look quite nice and conventional. Thus view-
ing the beds was quite difficult for us, as it brought out so many
issues to do with poverty, migration, displacement, loss, possibly
abuse. We could tap into a number of personal and societal issues
and feelings.
The engagement with the beds is an example of leading partici-
pants to focus on uncomfortable areas of life. In this instance the beds
reflected particular types of violence. The fact that maps could be read
in so many different ways is like a metaphor on education and how
people can be led to read what is presented in more than one way.
Maps show you roads, places, perhaps terrain – if we can read maps
and understand the symbols. And we take for granted how maps
should be read as a direction to places you want to visit; surely it is like
reading a book – except that you can view them in different, focused
ways, as the beds suggested.
Bacon: Triptych
Started 1948, finished 1988. In three groups looked at the three parts.
My notes read:
1. Physical form; incomplete; deformity; hate content, love the colour; broken
rule about body; put on a mask when sees disabled body.
2. Image of life; seed – to survive; body that could snap; incomplete; stains
just outside the painted area of canvas: were they deliberate?
102
Impact on students
This section of the report will draw data from the discussions with the
group in 2006 and the group who participated in the session in 2008.
The reasons for this are that the two groups (2006 and 2008) reflect
the impact that learning in an art gallery may produce, and therefore
reporting on the combined data gives a more extensive idea of art in
teaching and learning.
It has become clear that many students are initially apprehensive
about the session, partly due to the unfamiliar space and the sense
that they do not understand art, and there is anticipation that they
should like what they see.
Once in the gallery the important point for the students was to
realise that stopping and looking, ‘taking time to look properly’, as
103
one participant put it, was rewarding. It meant going beyond the
observations about beauty, ugliness, like and dislike dichotomies
and also giving pointers for subsequent discussion. Because of the
juxtaposition of the pleasure of beauty and the challenge of the dis-
turbing and violent, the message at the beginning of the session that
we do not have to like the works we are going to view, put aside
the issues about assumed sophisticated or educated appraisal of the
works. The approach rests on the premise that art is like a text and
can be read, with ‘seeing’ (after Berger), as a symbolic text, in which
signs and works mediate our self-knowledge (Ricour 1981, cited in
Solheim & Borchgrevink 1993), and I would argue that as part of that
process, viewing art mediates understanding of other people. That
leads us to consider art as mediated ‘lived experience’. For example,
violence observed on the canvas or in an artefact is, as Solheim &
Borchgrevink note, what the artist has objectified through signs and
expressions. What we come to ‘know’ about that experience is one
side of the knowledge, and what we gain in self-knowledge by look-
ing and absorbing the work/exhibit is the result of how it resonates
in us and in our understanding. Cezanne referred to ‘an abyss into
which the eye plunges, a voiceless germination’ (Doran 1978, cited
in Marion 2007: 60), which serves as a withdrawal from a literal-
minded approach and confusing ‘symbolic imagination with fantasy’
(Tacey 2004: 161).
‘Symbolic’ refers to an understanding that experiences and phe-
nomena can be presented by symbolic signs, images and words
whilst referring to real observations and events. Cezanne exhorts
us to ‘lose consciousness, descend with the painter into the dark,
tangled roots of things’ (Doran 1978, cited in Marion 2007: 60). But
unlike Cezanne, who resurfaces with colours, we may find that the
visual presents discomfort that dredges up the hidden within us. On
the other hand, Tacey (2004) sees the role of arts as bringing new life
or ‘making new’ of tradition and linking it to contemporary aware-
ness and experience.
Looking at conflict and turmoil of life with the eyes of the artist, as
artists “represent the world through their eyes” (Tate Modern 2007),
adds to the comprehension of how we feel about, and approach, vio-
lence, and how it may help our dealing with it. One participant offered
her experience in the following contribution:
104
The words reflect a variety of comments and emotions when the par-
ticipants viewed Francis Bacon’s work: for one participant it was ‘too
much’ with the sense of ‘being complicit’ in viewing it, whilst someone
else appreciated the colours Bacon had used. Thus we can see how one
work, as an example, resonated in different ways between the viewers.
The way artists construct their view of social reality encourages us
to engage with ourselves, and the wider world, using our creativity and
interpretation. For example, Paul’s (2006) comment on Kandinsky’s
work (Tate Modern exhibition in 2006) is useful when she notes that,
‘it is the mood of violence and chaos that is more important than the
literal interpretation of objects or narrative’ (2006: 9). It echoes what
some students found liberating in that personal meaning and inter-
pretation was possible and acceptable, as in the following quote by a
participant on the meaning of the viewing: ‘It doesn’t matter what the
artist intended and that is revelatory… it is how you interpret it that is
important and I didn’t know that before.’
The following extract from ‘random musings’ by a Mental Health
Nurse taking part in the session go straight to the point about paral-
lels between the art and the personal:
105
Yet, the comments by six participants some months after the ses-
sion give pointers, and sometimes surprising connections, to the
potential change on a personal level with influence on practice situa-
tions. One participant gave a concrete example:
106
there is a place for art when you work with violence; that generating
different ideas and considering so many sides and perspectives pre-
sented by participants has parallels to working in teams, and opens up
a way of looking at real life.
Simons & Hicks (2006) have pointed out that using art in education
facilitates trust, confidence and the expression of emotion. The above
participants’ contributions also communicate the dilemmas between
our perceptions of reality and the way we try to cope with it. Yet, if we
dare to look, it is a challenge, but I would argue that it also locates our
fears and hope into a more realistic place in which engagement with
art provides a revelatory reflection. For one group of students the ses-
sion offered a space to think and think differently – a point that should
be applied to practice more regularly. Further links with work was the
observation that there are so many boundaries in everyday life, and
coming to a space like Tate Modern frees us from those barriers.
107
108
ACKNOWLEDGEMENTS
I would like to thank the students who took part in the module ses-
sions in 2006 and 2008, and especially those students who enthusias-
tically came back for two more sessions in 2008 and 2009. My heartfelt
thanks to Liz Ellis and Alison Cox, both curators at Tate Modern, with-
out whom none of the work would have been possible; and thank you
to Tate Modern for the use of the facilities. The project was made pos-
sible with the help of a grant from the Learning Development Centre,
City University London.
REFERENCES
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Blomqvist, L. Pitkala, K. and Rautasalo, P. (2007), ‘Images of Loneliness:
Using Art as an Educational Method in Professional Training’, The Journal
of Continuing Education in Nursing, 38:2.
Bourdieu, P. (1977), Outline of a Theory of Practice, Cambridge: Cambridge
University Press.
Chamberlayne, P. and Smith, M. (2007), ‘Editorial’, Journal of Social Work
Practice, 21:3, pp. 263–270.
Cox, A. (2006), A qualitative study of the ‘Art into Life’ workshop programme at
Tate Modern, unpublished mini research project.
Crossick, G. (2006), Knowledge transfer without widgets: that challenge of the
creative economy, lecture to the Royal Society of Arts, 31 May.
Crotty, M. (1998), The Foundations of Social Research: Meaning and Perspective in
the Research Process, London: Sage.
Da Costa, J. L. (2006), ‘Changing adult learning environment as viewed from
a social learning perspective’, International Electronic Journal for Leadership
in Learning, 10:1, pp. 1–17.
Denzin, N. K. and Lincoln, Y. S. (2000), ‘The Discipline and Practice of
Qualitative Research’, in N. K. Denzin & Y. S. Lincoln (eds) (second
edition), Handbook of Qualitative Research, London: Sage Publications.
Hatch, M. J. and Yanow, D. (2008), ‘Methodology by Metaphor: Ways of see-
ing in painting and research’, Organization Studies, 29, pp. 23–44.
Layder, D. (2006) (second edition), Understanding Social Theory, London: Sage.
Lindblom-Ylanne, S., Trigwell, K., Nevgi, A. and Ashwin, P. (2006), ‘How
approaches to teaching are affected by discipline and teaching context’,
Studies in Higher Education, 31:3, pp. 285–298.
MacNeill, N., Cavanagh R. F. and Silcox, S. (2005), ‘Pedagogic Leadership:
Refocusing on learning and teaching’, International Electronic Journal for
Leadership in Learning, 9:2, pp. 1–13.
Marion, E. (2007), ‘The Phenomenology of Art: the site of the work of art, the
place of the collection’, Museum, 59:3.
Martin, M. (1994) ‘Another look at the doctrine Verstehen’, in M. Martin and
L. C. McIntyre (eds), Readings in the Philosophy of Social Science, London:
The MIT Press.
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SUGGESTED CITATION
Weir, H. (2010), ‘You don’t have to like them: Art, Tate Modern and learning’,
Journal of Applied Arts and Health 1: 1, pp. 93–110, doi: 10.1386/jaah.1.1.93/1
CONTRIBUTOR DETAILS
Hannele Weir is a Lecturer in Applied Sociology, City University London,
Department of Interdisciplinary Studies in Professional Practice, School of
Community and Health Sciences.
110
KATHARINE LOW
Centre of Applied Theatre Research, University of Manchester
Creating a space
for the individual:
Different theatre and
performance-based
approaches to sexual
health communication
in South Africa
ABSTRACT KEYWORDS
Sexually transmitted infections such as HIV are illnesses that affect both a theatre and
person’s physical health as well as their mental and social wellbeing. Yet, performance
the global development of public health responses have, for the most part, applied theatre
remained focused on the physical wellbeing of people with little attention sexual health
paid to the individual’s emotional wellbeing. With the highest number of South Africa
HIV positive people worldwide, South Africa requires ‘a new and positive HIV/AIDS
approach to the pandemic’(Ross 2008). This article aims to bring attention
111
1 . Margaret Silberschmidt to practice, in this instance, theatre and performance-based work, which
(2004) has considered
male sexuality and HIV
considers the people and communities affected and afflicted by HIV, and
transmission in East other sexual health concerns, as individuals with individual thoughts and
Africa, Gregory Herek emotions, for greater inclusion in a more positive approach to tackling
(1991) has studied the
impact of stigma on AIDS. This article will consider three examples of such practice, namely the
people living with AIDS Themba HIV/AIDS Organisation, the Etafeni Centre and ‘our place, our
and their families, and
Paul Flowers and stage’ (OPOS) project.
colleagues (2002)
have examined the role
of relationships in gay
men’s sexual decision INTRODUCTION
making within the
context of AIDS.
2. This is not the WHO’s The past eight years – or even longer – of AIDS denialism in
official definition of South Africa have been tragic and have cost many lives, but
sexual health but it was
developed following
the time has now come for a new and positive approach to the
a 2002 WHO- pandemic.
convened meeting of (Ross 2008)
international experts to
discuss sexual health.
For more information: Sexually transmitted infections such as HIV are illnesses that affect
http://www.who.int/
reproductive-health/
both a person’s physical health as well as their mental and social
gender/sexualhealth. wellbeing. Since the emergence of AIDS, there have been numerous
html. studies which have explored the effects of sexuality, stigma and rela-
tionships on an individual’s response to the syndrome and their emo-
tional health.1 Yet, the global development of public health responses
have, for the most part, remained focused on the physical wellbeing
of people. As Tony Barnett and Alan Whiteside describe in their book,
AIDS in the Twenty-First Century, ‘[the] effects of disease are rarely con-
sidered [by governments and other leaders] beyond the clinical impact
on individuals’ (2006: 5). Although it is comprehensible that the speed
of infection and the scale of the AIDS epidemic may make it difficult
for public health programmes to consider the multiple outcomes of
the disease, bar the effect on a person’s physical health, this approach
remains one-sided. Furthermore, considering a working definition, as
noted on the WHO website, where sexual health is described as ‘a
state of physical, emotional, mental and social wellbeing in relation
to sexuality and the aforementioned research’,2 it appears essential to
also focus on the social health of those affected by AIDS and other
sexual and reproductive health (SRH) issues and not to view those
infected as simply being statistics.
However, as Barnett & Whiteside have acknowledged ‘[it] is hard to
measure things – quality of life, quality of relationships, pain of loss – for
which measures are partial or non-existent. If it is hard to see these
things, it is all the easier to deny them’ (2006: 6). This perceived dif-
ficulty in calculating such effects may explain Andrew Irving’s view
that ‘[for] a literature concerning a blood-borne disease, much of it is
surprisingly bloodless; the person’s thinking, emotions, and dilemmas,
their very flesh and being, are reduced to statistics, the biological body
or social structures. Surprisingly few people inhabit these texts’ (2007:
204, emphasis in the original). Irving is not alone in drawing attention
112
to the lack of focus on the individual; Bolton & Wilk (2003) and Thomas 3. Didier Fassin’s When
Bodies Remember:
(2007) have also done so, arguing that this does not provide a rounded Experiences and
response to the epidemic, especially in developing counties. In the fight Politics of AIDS in
against AIDS, it is vital to consider the wellbeing of the individual, pro- South Africa (2007)
provides an excellent
viding a space in which they can speak, share and discuss their dilem- commentary on the
mas and where they can be heard. lack of governance
over AIDS and the
Speaking about South Africa’s response to AIDS, Mamphela mismanagement of the
Ramphele remarks on the limited research into the psychological Health Department,
wellbeing of childbearing women living with HIV and proposes that as does Mamphela
Ramphele in her
a public health approach ‘would do well to factor psychological sup- monograph Laying
port into the comprehensive care of people living with HIV/AIDS’ Ghosts to Rest:
Dilemmas of the
(2008: 239). Ramphele’s suggestion could be one aspect of the ‘new and Transformation in
positive approach’ that Ross describes, providing a more comprehen- South Africa (2008),
sive response to the epidemic. In addition, this new approach has the Chapter 13.
113
4. Laedza Batanani, a the lack of governance over this issue has resulted in a situation
theatre group from
Botswana, who used where an estimated 5.7 million (4.9 million – 6.6 million) people
popular theatre in are infected with HIV in South Africa, the greatest number of infec-
combination with
traditional forms
tions worldwide. Of those millions of individuals infected, only
to educate their approximately 460’000 (398’000 – 520’000) are receiving antiretro-
participants, was viral therapy, a response which falls significantly short of the 1.7
the main forerunner
to TfD. The Laedza million (1.3 million – 2.1 million) citizens whom UNAIDS considers
Batanani group called should be receiving antiretroviral treatment (UNAIDS/WHO 2008a,
their performances
popular ‘because
2008b). Although the appointment of a new Minster for Health in
they are aimed at the September 2008 has re-energised the fight against HIV and other
whole community, sexual health issues, prompting comments such as Ross’, both the
not just those who
are educated’ public health service and the citizens of South Africa have been
(Kerr 1995: 151). neglected for a long time and any changes will take time to come
Laedza Batanani had
developed many new into effect. Thus, there is all the more reason to examine organisa-
manners of working, tions that focus on individuals, providing them with opportunities
and one of the most to speak and be heard.
important additions
to their techniques
was an ‘organised
discussion at the end HISTORY OF THEATRE-BASED WORK IN SRH
of the performance in
order to facilitate a EDUCATION IN AFRICA
process of community
education and
Current theatre groups in Africa, which use theatre as an educative
mobilisation’ (Byram medium to transmit public health messages to the population, owe
and Kidd 1978). much of their present working methodologies to the travelling univer-
5. Irobi acknowledges
Werewere Liking, a sity theatres of the 1960s. Many of the universities in Kenya, Malawi,
Cameroonian theatre Nigeria, Uganda, and Tanzania had travelling theatre troupes which
practitioner working in
the Côte d’Ivoire, as
would travel to rural areas and workshop devising plays in the local
the creator of the term. languages in an attempt to address the community’s problems. This
manner of working has become a framework for today’s Theatre for
Development (TfD) (Epskamp 1989; Kerr 1998; Kidd 1984).4 Although
the history of TfD has been well documented and critiqued elsewhere
(Mlama 1991; Kerr 1995; Salhi 1998; Pompêo Nogueira 2002; Boon
and Plastow 2004), it should be acknowledged that TfD, alongside
the broader educational theatre field, has had a significant influence
on current performance-based responses to SRH issues. Indeed,
Esiaba Irobi argues that the AIDS pandemic in Africa has resulted in a
‘Theatre of Necessity’,5 where practitioners across the continent have
employed song, music, drama, dance, and television and radio dra-
mas to educate and support people, thereby creating a theatre that is
‘about survival’ (2006: 34–38).
One of the first examples of this was in 1988 in Uganda, where
AIDS education was approached through a School Health Education
Programme initiated by UNICEF and the Ministry of Education, using
‘dramas’ as a means of ‘sensitizing’ the children about sexual health. In
a subsequent interview, one of the leaders of the project, Rose Mbowa,
described how the performers used an improvisational style in order
to involve the audiences more in the performances, emphasising how
‘it is important in community-based theatre to leave the tool, the solu-
tion, with the people’ (Mbowa cited in Sicherman 1999: 111–117).
114
115
6. The term ‘community’ is hence to query if this is a notion that is appropriate for the South
used here to describe
the gathering of people African communities in question. In her monograph, Steering by the
within a theatrical Stars: Being young in South Africa, Ramphele argues: ‘[t]oo much indi-
event. For example, vidualism leaves you overly focused on the self and denies you the
the schools in which
Themba perform could enrichment that comes from relationships with others’ (2002: 102).
be described as This creates a conundrum as the representational projects chosen for
communities.
7. For more information analysis all focus on the individual in a society which has traditionally
about Themba: http:// been community-focused. Yet, if we consider the medium of thea-
www.geocities.com/
thembahiv/
tre and performance, its basis lies in communication and it requires
some form of interaction with others in order to exist. Thus, although
these projects all provide an arena for the individual to speak and be
heard, it is within an existing ‘community’ or group; the individuals
are not isolated from others, rather they are in dialogue with oth-
ers and are reflecting on, or responding to, their own communities.6
It can thus be argued that theatre and performance practice helps
to enable ‘the enrichment that comes from relationships with oth-
ers’ (Ramphele 2002: 102). Furthermore, considering recent research
conducted in Uganda, which concludes that increased social commu-
nication and a greater acknowledgement of the existence of AIDS in
the community has had an impact on HIV prevalence (Green 2003;
Low-Beer & Stoneburner 2004), it is possible to propose that theatre
and performance-based projects that have a particular focus on the
individual can be part of a more positive response to the AIDS pan-
demic in South Africa.
116
Themba’s interactive performance approach, which is more than the 8. One such project is
Lucky the Hero!, a
usual question and answer session that other projects describe as being ‘mini-musical’ run by
their interactive element,8 utilises a content based on differing indi- the Africa Centre
vidual experiences of HIV. In his editorial to African Theatre: Youth, for HIV/AIDS
Management, based
Michael Etherton concludes from the different accounts of practice that at Stellenbosch
the communication of messages is much more powerful when there is University. Developed
in 2004, the musical
more space for audience interaction and when it is the youth them- delivers a high-
selves who have devised and created the dramas (2006: xii). Although energy performance,
portraying the process
Themba does not involve the schoolchildren in devising the play, it does of being tested for HIV,
provide numerous opportunities for the students to involve themselves to farm workers across
in the performance. The different interactive opportunities for the audi- the Stellenbosch area.
Each performance is
ence include voicing their own opinions on a topic, giving suggestions followed by a
of what the protagonist (Tumelo) could do next, and trying out a scene question and answer
session. For more
from the play to see ‘how it feels’ (a form of role-play). This approach information about this
involves the audience in a twofold manner: firstly, individuals are invited project: http://www.
to share their ideas and thoughts from the safety of their seats, and sec- AIDScentre.sun.ac.za/
community_work.html
ondly, for those who desire it, they can get up and physically be in the
scene, trying out a particular response. In the performance I watched,
the audience of schoolchildren, aged between 13 to 15 years old, were
extremely eager to participate and to communicate their ideas, giving
many suggestions to anyone who went onstage.
In his recent overview of educational theatre, Anthony Jackson
explores the role of the aesthetic experience in the making of mean-
ing, proposing that theatre can help to dramatically heighten under-
standing of a subject. In particular, he argues that ‘the meaning has
to be made and experienced within the drama,’ explaining that the
aesthetic and ‘ludic’ (or ‘playfulness’) qualities of the drama have a
greater impression on participants and audiences than ‘overtly seri-
ous, message-driven elements’ (2007: 175, 198). Considering Jackson’s
argument, it is possible to propose that Themba has developed an
approach that trusts that the meanings embodied within the aesthetic
experience can be understood without making the meanings explicit
at the end of the performance. Themba employs both aesthetic and
‘playfulness’ qualities in its theatre techniques to embed messages in
the performance. One example of this is the stylised cameo scenes,
which portray three homosexual and heterosexual couples who have
different responses to HIV. Each cameo presents a different possible
response to the threat of HIV in a relationship, thereby providing an
opportunity for the audience to both observe different reactions and
decisions that individuals can make, and to discover for themselves
the diverse meanings and ideas embodied in the performances.
In addition to this, Themba uses the security of an already estab-
lished character through whom the audience members can express
their individual opinions and thoughts. Through the use of speech
and discourse within the theatrical moments, Themba is encouraging
the beliefs and notions of the individual in a safe environment – an
approach that was very well received at the performance I observed. It
is a model of theatre that is suitable for the community Themba works
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9. At the time of the in, as it provides a means of generating and stimulating important dis-
interview, in May
2007, Richardson cussions in environments like schools or correctional facilities, which,
explained that Themba as Themba have stated, sometimes ‘have cultures which tend to ostra-
was in the process of cise people who are HIV positive’ (Creative Exchange 2007).
developing teaching
materials, which they The performance at the school raised issues about sharing your sta-
hoped to leave with tus and living with HIV; it challenged the young people to think in
the teachers to enable
them to provide different ways as well as demonstrating that opinions can be differ-
support for the students. ent, which in turn raised many questions. At the end of the perform-
ance and interactive process, the actor-educators were swamped with
students asking questions and the performers strived to ensure that
everyone had had an opportunity to speak, even continuing the con-
versations in the car park. Furthermore, as some of the teachers also
watched the performance, there was the implicit suggestion that stu-
dents are able to continue these conversations with their teachers and
that they can turn to their teachers for support in the first instance.9
Yet, it is important to recognise that the school environment may have
had some bearing on the students’ responses, as within schools chil-
dren are supposed to behave in a particular way.
One drawback of Themba’s approach is that apart from the train-
ing it offers to businesses, prison services and schools, it has little
engagement with other services which could support Themba’s work,
such as the local clinics. Moreover, Themba’s interactive performances
are only a few hours long and thus it does not have a continuous
involvement with its participants, unlike Etafeni or OPOS. Although
this is, in part, due to financial considerations and the large number
of schools Themba works with, it seems unlikely that without long-
term involvement and support from other services that Themba will
be able to achieve its aim of influencing behavioural change. Perhaps
if Themba’s aim to start conversations about HIV and sexual health
could be combined with mobile VCT clinics and the establishment of
peer-education programmes similar to the ones DramAidE has imple-
mented, supported by the local clinics, it could then form part of the
‘new’ approach required in South Africa.
Nevertheless, Themba does have long-term engagements with
people from the disadvantaged communities it works in: the actor-
educators themselves. Actively recruited because of the importance of
using appropriate languages when communicating with the audience,
the actors are trained by Themba and given yearly contracts, thereby
creating a sense of longevity and commitment as well as an oppor-
tunity for those individuals to be heard and have their experiences
validated. One actor-educator mentioned how, before they came to
Themba, they would not talk openly about sex or relationships but now
they do feel free to do so. This description of feeling free to speak, and
thus to be heard, is an extremely important example of what happens
when an individual is given the attention and the chance to share, try
out and discuss her or his ideas with others. I would suggest that this
is one of Themba’s underlying aims within both the performances and
the support and development offered to its staff.
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119
These responses from the women emphasise how strongly they feel
about the dancing and singing: how it provides them with an oppor-
tunity to express themselves, reconnect with their culture and provide a
physical break from their stationary work of beading or sewing. Taking
part in these dances together means that the women are able to recollect
and share their experiences while also building strong links with other
group members, who share similar experiences. In addition, these links
and interactions between the individuals can create avenues for sup-
port between them. This is similar to findings described by Irving in his
account of using ‘fieldwork performances’ (a type of photo elicitation and
social drama) to draw upon the emotions and memories of people liv-
ing with HIV in order to better understand the experience of HIV/AIDS
in Uganda. Describing one particular performance, Irving explains how
conversations about the experiences of HIV-positive people in Europe
and North America enabled one participant to diminish his ‘sense of
isolation and abnormality and allowed him to understand himself as
part of a wider cosmopolitan experience of HIV/AIDS’ (2007: 196).
Regarding the performance-forms used in this approach, the songs,
which come directly from the women, and the dances, which many of
them know from their childhood, do ‘fit’ in the community at Etafeni.
Furthermore, these art forms help to create communication channels as
the women are interacting through the music, dances and songs. This
work here at Etafeni is both self-focused (as the individual’s contribu-
tion of her song is reinforced) as well as strengthening bonds within the
Etafeni group. Although Etafeni describes this programme as ‘therapy’,
it is actually much more focused on celebration, and on promoting the
emotional and physical wellbeing of the women and children who are
part of the Etafeni community. However, within the dancing workshops
there seems to be few opportunities for the participants to devise their
120
own dances, as they tend to practice traditional dances or ones which 10. It is important to note,
however, that the field
the facilitator has choreographed. Nonetheless, the interactions within of SRH is extremely
the groups and between the groups, through the performance, help to complex and that the
foster a sense of being part of a community of support, something which topic of ‘rape’ does not
stand isolated from HIV
Etafeni strives for. Moreover, Etafeni as a model centre of holistic care or crime, hence all the
and support is being replicated in the Vrygrond community, located in proposed issues were
touched upon during
another part of Cape Town. This indicates that, as a whole, Etafeni is both projects.
already viewed as a ‘new and positive approach’ for South Africa.
121
11. The participants’ names the fictional worlds created through theatre practice to explore different
have been changed.
12. Community meetings ways of protecting their SRH health. Similarly to Themba’s audiences,
are meetings organised the participants tried different roles in scenarios that explored teenage
by the various street pregnancy and the boundary between unprotected sex and rape as a way
and community
committees in most of better understanding how and why these situations come about, dis-
townships. The cussing how they could be avoided. In addition to this, the participants
community meets in the
community hall when also devised short scenes and interactive dramas which they presented
there is something to different audiences at Etafeni, which, recalling Etherton’s aforemen-
important to discuss.
tioned conclusion, can lead to better communication of information.
An important feature of this work has been the opportunity to work
in the supportive, community-based environment that is provided at
Etafeni. This positioning, combined with the theatre workshops provision
of opportunities to reinforce and validate each individual’s experience and
opinions, has meant that some of the participants have felt more inclined
to discuss SRH within their community. Nkosazana is one example:11 dur-
ing a follow-up visit she described how she spoke to her younger sisters
and her neighbour’s young daughters about teenage pregnancy, which
resulted in her taking one of the young girls to the clinic, explaining:
However, there were a few in the group who did not feel able to speak to
their community, for reasons outside their control. Vuyiswa, in response
to a question asking her if she would discuss the topics they examined
during the workshops with her community, replied that she would not as
she would be too afraid of their reaction to her, explaining ‘I would rather
just keep it to myself and my family.’ Vuyiswa was a strong and confi-
dent member of the group, always contributing and sharing her views,
frequently getting up to participate in a scene. It could be suggested that
within the theatre space, she felt safe and comfortable and thus was able
to share her opinion and discuss things that she would not feel comfort-
able or safe doing outside of that space. This demonstrates the impor-
tance of providing such space where people can debate, discuss and
share, without fear of recrimination or being at risk. However, there are
some limitations in this approach, mainly because it is a research project,
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123
ACKNOWLEDGEMENTS
Many thanks to the participants in the OPOS projects, to all at Etafeni
for their help, and finally, thank you to James Thompson, Jenny
Hughes and Zoe Zontou.
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SUGGESTED CITATION
Low, K (2010), ‘Creating a space for the individual: Different theatre
and performance-based approaches to sexual health communication
in South Africa’, Journal of Applied Arts and Health 1: 1, pp. 111–126,
doi: 10.1386/jaah.1.1.111/1
CONTRIBUTOR DETAILS
Katharine Low is a practice-based Ph.D. student in the Drama department
at the University of Manchester, supervised by James Thompson and Jenny
Hughes. Through her research project, ‘our place, our stage’ (OPOS), she is
exploring the role of applied theatre in sexual and reproductive health com-
munication in the Nyanga township in South Africa, focusing in particular on
concepts of spatiality, risk-taking and resistance.
Contact: c/o our place, our stage, Centre for Applied Theatre Research, University
of Manchester, The Martin Harris Centre for Music and Drama, Manchester,
M13 9PL, United Kingdom.
E-mail: katharinelow@gmail.com
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REVIEWS
REVIEW
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E-mail: hayley.singlehurst@northampton.ac.uk
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