Literature reviewFollowing the title of the research, three themes are dominant: The stigma around mental health in Lebanon, dance in Lebanon, and Dance Movement Psychotherapy in Lebanon. It is necessary to look at the wider picture when it comes to the literature used for this research because there is a lack of specific material regarding the subject chosen.
Mental health in Lebanon
Starting with the first theme, we will be looking at literature focused on stigma specifically in Lebanon. It is important to say that mental health care in Lebanon is not only not talked about, but it is also underdeveloped. There is no authority to inspect mental health facilities or oversee the rights of people with mental health issues. Before 2010, there was a lack of data regarding mental health care in the country, which made it difficult to work towards improvements. The World Health Organization therefore issued two mental health reports; the first one in 2010 and the second in 2015. Both studies, aimed towards collecting information on how to improve the mental health system in Lebanon in order to identify important targets and provide a baseline to monitor change. Once the data and the statistics were provided, the Lebanese Ministry of Public Health established the National Mental Health Program in 2014, in collaboration with the World Health Organization, the UNICEF and the International Medical Corps. In April 2017, the Minister of public health in Lebanon announced the financial coverage of mental health care by the Ministry of Public Health in certain hospitals and centers across the country. These noticeable steps towards promoting mental health as an issue worthy of discussion in Lebanon are very recent, which means that improvements exist but are still small. The progress has been taking place ever since people in positions of power started taking initiatives. For instance, the government is now raising awareness just by recognizing mental health as a worthy issue. It is also challenging the stigma by taking active initiatives such as implementing a five year mental health strategy plan involving the organization of promotion strategies among other goals. However, it’s important to say that journalists, mental health activists and Non-Governmental Organizations have been trying to raise awareness long before the Ministry of Public Health’s recent initiatives. For example, IDRAAC or Institute for Development, Research, Advocacy and Applied Care, is a non‐profit organization whose work started in 1982. It has worked towards raising awareness and has published several studies regarding mental health. Another Lebanese NGO is Embrace, launched in affiliation with the Department of Psychiatry at the American University of Beirut Medical Centre (AUBMC) in 2013 and works towards better awareness around mental health in Lebanon and the Middle East. The work of these NGOs would be interesting to look at in the context of mental health stigma. In terms of the research, it would be interesting to include in the literature review, studies affiliated with the Lebanese National Mental Health Program as well as other articles and studies essentially about stigma in the country, conducted by journalists and Non-Governmental Organizations.
Dance in Lebanon
The second theme would be the culture of dance in Lebanon. The literature that is going to support the research will be centered on the culture of dance in general but also the culture of dance specifically in Lebanon. Throughout this study, dance in Lebanon will be looked at in its historical context and how it evolved as an art but also as an indirect form of communication in its societal context. It is commonly discussed that the creation of the Lebanese Dabke, a traditional Lebanese dance, took place in Lebanese villages when the villagers gathered for the “aouna” which is Lebanese for the word “help”. In the past, the roofs of the village’s houses were made of tree branches topped with mud, meaning that during the rainy season the mud would start to leak. In order to fix the roofs, the villagers would need to be many to stomp on it with force and synchrony. The house owner would therefore call the neighbors for “al aouna”/help. Later on when the right tools were invented to fix the roofs, the villagers still met up and danced the Dabke to keep the tradition alive. Therefore, Dabke is a dance that came naturally to people, aiming to help each other in achieving the goal of survival and a better way of living, which is funnily enough, the same aim of psychotherapy. The Dabke has since evolved into more contemporary styles which have been the subject of many controversies such as the ones treated in a film by Philippe Aractinji titled “Bosta”. This movie about Dabke, treats this dance as a metaphor for the recovering Lebanese society after the civil war. It’s a metaphor about keeping the essence and the tradition alive, while trying to adjust to the modern changes that the rest of the world had accomplished when Lebanon was still at war. It’s a metaphor for recovery after trauma but this time through art and body movement, much like dance movement psychotherapy.
Dance Movement Psychotherapy
In regards to the third theme of this research, it is important first, to look at Lebanon in its societal context, in other words, in the context of continuous conflict. Lebanon has faced many wars and clashes which means that around 47 percent of the population have witnessed one or more war-related traumatic events. Suffering is engraved in the Lebanese history, which has had an impact on the general well-being of the society. In the aftermath of war, people discover that the body is one of the few entities that survived the destruction. War memories, or traumatic memories are therefore engraved on the body. According to Koch, Fuschs, and Summa (2012), memory is seen as embodied which means that it doesn’t strictly belong in the brain, but rather in the totality of the embodied individual. People in the Lebanese society have suffered so much but still don’t seek help mainly because of the stigma surrounding mental health as previously mentioned. In the context of stigma and war conflict, working with body and movement psychotherapeutically seems like a good approach. Both traumatic memories and habitual motor skills such as dance are considered as part of body memory. In people’s habitual everyday tasks, the body acts mostly as a silent medium that achieves certain tasks. However, through dance, the body is the subject and the object of the performance where the movement is highlighted. The body is no longer simply a physical entity but instead becomes a subjective experience even without verbalizing it. The silence of dance seems passive but it allows the individual to speak of things that are hard to verbalize. Things that can’t be expressed with words can therefore be embodied through dance and movement with less restrictions and limits.
Dance movement psychotherapy views mind and body as inseparable, therefore what a client can’t express through words, they can express it with their body movements. Accordingly, in a stigmatized society, where people would rather suffer in silence than seek mental health care, dance movement psychotherapy could be found as helpful. In Blanche Evan’s methods, she acknowledges the fact that all experiences, emotions, memories and thoughts include a kinesthetic factor, that she calls Psycho-physical (Evan, 1949). It is through dance that the psycho-physical can be expressed and lead to therapeutic change (Evan, 1949). According to Evan (1950), improvisation is characterized by free association in movement guided by psychological and physical themes. It is where fantasy and reality meet (Evan, 1950), it is a guide to the unconscious as well. In the Evan’s method there are many improvisation techniques such as “externalizing”, “physicalizing”, “enacting”, and “rehearsing” (Bernstein, 2014). All these techniques work towards embodying memories, feelings, or experiences through movement without having to verbalize. Improvisation and other interventions from Blanche Evan’s methods and theories, were used in her work with sexual assault survivors who often enter therapy with symptoms related to shame. Working with shame was important in Evan’s work with victims of sexual assault. Stigma is essentially characterized with disgrace and shame, therefore Evan’s methods could be beneficial in working with all kinds of stigmatized client groups, and not strictly with victims of sexual assault. Individuals enduring the shame of stigma, suffer from an overall state of inhibition which stops them from expressing themselves. In working with shame, movement works as a bridge to weighed-down themes and content. In other words, working with body movement will serve as a way to explore memories and unexpressed emotions, progressively leading to more and more verbalization.
Therefore, for this third theme, it is important to look at literature about working with silence, stigma and shame in dance movement psychotherapy.
The subject of this research is based on a certain social construction that has had a negative impact on the society and population in question: Lebanese people often stay silent about their mental health because the general narrative of society dictates that it is a taboo. For this reason, I would like to look at the subject of this project through a feminist lens. The concern of feminist research is with issues of more extensive social change as well as social equity. Therefore, by following a feminist methodology, there is the possibility to seek knowledge that challenges unfair social constructions, especially because feminist research begins from the premise that society is unequal. According to Allegranti (2009), post structuralism and contemporary feminism are movements that critically contemplate established philosophical and political traditions. Modern feminist researchers have looked at old epistemological concepts from a new perspective and have also introduced news ideas, giving research participants a “voice”. Through this lens, the multiplicity of approaches and strategies is validated which means that contemporary feminism adopts a political commitment to diversity, encouraging the overcoming of strict biases. Therefore, it would be interesting and beneficial to look at the stigmatized Lebanese society and the subject of this research using the feminist approach.
The research is aiming towards an answer to the question: How can dance movement psychotherapy help change stigmatized attitudes towards mental health in Lebanon? In order to explore this question, what would be useful is interviewing several practitioners in the field. In Lebanon, dance movement psychotherapy is still not very well established. However, there are a few centers that do provide dance movement psychotherapy and I think it would be beneficial to interview two dance movement psychotherapists practicing in Lebanon. Another interview that could also be useful would be with a dance movement psychotherapist based in London who works with people from different countries and cultural backgrounds. As previously mentioned, many mental health professionals and Non-Governmental Organizations have been working with stigma and aiming towards mental health awareness in the society. It would be interesting in terms of our research, to know more about what they think as professionals in the field, of the current state of stigma and how it is to work with it. Accordingly, I would like to distribute a questionnaire that mental health professionals will fill out. The questions asked would be centered on mental health, the stigma around it, and psychotherapeutic approaches. Therefore I would be using qualitative methods for this research.
As a dance movement psychotherapy trainee my research would have to be conducted under the ADMP UK code of ethics and professional practice. It is important for dance movement psychotherapists and trainees to follow the code of ethics in order to protect clients from harm and unethical practice. In the context of conducting research, the safety and confidentiality of the participants is a priority. Therefore, the participants will have to be informed about the aim, nature and conditions of the research and I would need to obtain their consent in order to move forward.
Doing this project in the way proposed in this paper is combining three major themes together. Due to the lack of research already produced on this subject, we will have to look at all different areas that are crucial to our research question separately and then bring them together. This project will be beneficial on so many levels: It will benefit first of all, the society because we would be shedding the light on a subject that hasn’t been really explored before. But it would also benefit the practice of dance movement psychotherapy in Lebanon, to see where it stands and how it can be beneficial when working with stigma. As previously explained, in dance movement psychotherapy, body movement will express what cannot be said with words because mind and body are seen as inseparable. In that sense, this approach could hypothetically be beneficial in a stigmatized society where people are too afraid to verbalize and speak up about their mental health.