3.1 Qi

The notion of Qi is fundamental to Confucius and Taoist philosophy and to Chinese, Japanese, and Korean thinking. Some words given to the description include energy, air, breath and wind. Definitions of this idea can vary and indeed sometimes even contradict each other. This makes it a dynamic process when seeking to describe the notion in English. Most frequently, however, Qi is defined as a life force that flows through everything and implies a connection between all things. Chinese traditions tend to look towards nature to define their concepts and Qi is sometimes compared to water. Where it cannot flow freely, it stagnates; where it flows too fast, it can cause destruction.

Qi is also captured in the process of calligraphy and Chinese landscape paintings where it stands as a metaphor for the natural scenery of mountains and water for the vibrations of life itself. The making of the image and the image itself are not only about art for art’s sake but represent, for the individual, the right spirit and the energy or Qi through action and metaphor. McNiff (2016) suggests “…there is no hierarchy of ch’i in art and in life…” (p. 18) and that both art and life are in a continuous “reciprocal process of creative transformation” (p. 18)

3.2 Tai chi

Tai chi is a martial art. The principles of Tai chi are drawn from Taoist philosophy and highlight the natural balance of things. The emphasis is on slow and balanced movement; the principles are of yielding, centering, grounding, rootedness and softness. Contemplation and reflection on nature are also fundamental to Tai Chi and are as seen in the names given to the movements – namely “White Crane Spreads Wing,” “Snake Creeps Down” or “Repulse monkey”. By linking movement to nature, meditation and the cultivation of Qi, the practice of Tai chi and Qi gong also emphasizes a link to the morality of life. This underlies an approach that stresses the importance of living in harmony with nature rather than in competition with it. According to Chan (2006), this is in contrast to “the Western values of striving for excellence, competition, achievement, and success of life” (p.16).

3.3 Health and Wellbeing

In Chinese philosophy, yin and yang describe the idea of the interconnectedness of contrary forces and represent the complementary and interdependent nature of contradictory or opposite polarities. The contradictions exist together and are inseparable.

Health and wellbeing are connected to this notion of yin and yang. In the traditional Chinese medicine paradigm, the balance between these two opposing forces is fundamental and the correct balance between the two must be reached for harmony to be achieved. An increase in one will bring a corresponding decrease in the other, leading to an imbalance.

This connection between yin and yang represents an overall unity of things and is expressed in human form in terms of the unity of the body and the spirit. In Eastern classification, the physical, emotional and spiritual are considered indivisible while still forming distinct aspects of the same reality (Chan, 2006).

This unity and harmony exist both inside and outside the individual. In traditional Chinese medicine, health and wellbeing result from the balance of Qi between the internal aspect of the person, the external environment, nature and the universe (Chan 2006).

Here we see the broadening of the spectrum of harmony to include not only the internal balance within one person but also the interaction between the external systems and inter-relations between people and society and the natural world. All of these aspects are understood to contribute to a unified whole. Health is seen as an harmonious equilibrium between Yin and Yang, the five elements (earth, wood, water, metal and fire), the internal environment (dry, wet, hot, cold, wind, flame), external conditions (physical harm, insect bites, poison, overeating, too much sex and overwork), and the emotions (joy, sorrow, anger, worry, panic, anxiety and fear) (Yin et al., 1994) (in Chan 2006, p. 4). This connection to nature exists in art therapy thinking too. McNiff (2016) refers to art making as a “force of nature” (p. 17) and suggests a reciprocal relationship between nature and our artistic expression.

This holistic approach is similar to ecological and systematic approaches in psychology. Western classifications both acknowledge and work with the connections between different approaches. The body and the mind, (cognition, emotions, social and individual behavior) are still, however, understood to be discreet entities. When considered as a whole in traditional Chinese thinking, the body and the mind are indivisible – both impacting on and influencing each other. In this kind of thinking, somatic complaints cannot be separate from emotional suffering – with the flow of Qi forming one of the most important concepts in traditional Chinese medicine (Chan, 2006).

4.1 Energy and somatic psychology

By equating two things with each other that come from different systems, with distinct origins, and that speak two different languages, there is a chance of flattening both. At the risk of doing so, I would like to align for the reader the notions of Qi and yin and yang with the ideas of somatic psychology. As already defined above, Qi and yin and yang are broad terms with encompassing implications; however, in relation to health and well-being, they refer to the holistic approach and connection between the body, mind and spirit. The connection between the body and the mind is represented in Western thinking too.

In the 1930s, psychiatrist Wilhelm Reich noticed what he defined as ‘an energetic connection’ that was shared by all living beings. He called this energy Orgone. He understood this energy to exist in the atmosphere, in space and in living organisms and to be synonymous with life energy itself (Sharaf, 1983). Reich’s attention to the body, energy, movement and his notion of muscular armour have shaped body psychology today. Alexander Lowen (1994), a student and patient of Reich’s, built on Reich’s ideas to develop Bioenergetic Analysis – a form of analysis which connected muscular tension to mental health and was based on the idea that there is continuity between the body and the mind and that emotional blocks reveal themselves in the body (Lowen, 1994). Bioenergetics and other body therapies or somatic therapies like Gestalt Therapy (Fagan & Sheperd, 1970), Hakomi Method (Kurtz,1990) and Sensorimotor Therapy (Ogden, Minton & Pain, 2006) all draw on this same idea.

4.2 ‘Top-down’ or ‘bottom up’

The psychobiology of trauma (van der Kolk, 1987, 2014) has challenged our notions of the effectiveness of pure psychotherapy in the field and has forced us to see the connection between the mind and body in trauma. Descriptions of the hierarchical organization of the brain (Ledoux, 2002, 1996) have allowed us to understand that there are “two distinct directions of processing information – from the “top-down” or the “bottom-up” – and “the interplay between them holds significant implications for the treatment of trauma (Ledoux, 2002)” (in Ogden, Pain & Fisher, 2006, p. 6). Studies show that the front part of the brain (which impacts executive functioning) becomes impaired in trauma (van der Kolk, 2014).

At the top of the hierarchy is cognitive functioning and at the lower level is the limbic system and sensorimotor experience. In the traumatized person, the intensity of emotions and overwhelming sensorimotor reactions can disrupt the individual’s cognitive capacity. This is described by Ledoux (2002) as “bottom-up hijacking”.

The imprint of trauma doesn’t “sit” in the verbal, understanding, part of the brain, but in much deeper regions – amygdala, hippocampus, hypothalamus, brain stem-which are only marginally affected by thinking and cognition. These studies showed that people process their trauma from the bottom up-body to mind – not top down. But if trauma is situated in these subcortical areas, “then to do effective therapy, we need to do things that change the way people regulate these core functions, which probably can’t be done by words and language alone.” (van der Kolk in Wylie, 2004)

The introduction of Tai chi, Qi gong and mindfulness meditation relates in part to “bottom-up hijacking” by engaging the body in movement, breath, fluidity, meditative and present focus. Despite the prescribed forms of Tai chi and Qi gong, the overriding principle is to move with nature, not against it. Tai chi masters teach us to initiate movement from the dantian (energy centre); to yield and not resist. By choosing to go with the movement as opposed to resisting it, we can mobilize the energy that has formed from cooperation with nature. Let us now return to looking at some of the aspects of art therapy with Laura.

5. Return to Laura

We left Laura, above, stuck – caught literally in a frozen body and in ruminative negative thought patterns. These patterns had come to define her personal narratives; they continued to negatively reinforce her actions and her day-to-day functioning and they dominated her sense of identity. Ogden, Minton & Pain (2006) write that traumatized people can develop “inflexible, maladaptive interpretations of the trauma or other life experiences” (p. 9) which then forms inadvertent, generalized thoughts that are negative and erroneous. This way of describing the repetitive, circular thinking is compatible with the way in which it is described in Cognitive Behavioural Therapy (CBT) (Beck, 2008).

Maladaptive emotions and cognitions are also referred to in the Buddhist tradition as one of the targets of mindfulness meditation. The Theravada Buddhist tradition defines the aims of meditation practice as developing awareness and a stable mind (a clear mind, able to observe itself and examine itself, unaffected by volatility of emotions) so as to lead to the end of maladaptive emotions and cognitive impurities. Such impurities include feelings such as desire, hatred, jealousy, worry and the cultivation of awareness, wisdom and virtuous qualities which allow us to behave and think without the distortions or biases inherent in our thoughts and perceptions (Collins, 1982).

Theravada Buddhists connect thoughts with action paralleling the findings of Ogden, Minton & Pain (2006) who connect each one of our thoughts to mental actions, sensorimotor reactions and emotions (Ogden, Minton & Pain p.9).

In terms of Chinese philosophy, this sense of stuck-ness/stasis points to the theories of yin and yang and to an internal imbalance and an obstruction of the flow of chi. Frozen by terror, immobilized by uninvited memories, Laura had literally become immobile in her body. She could not move her neck or shoulders and her torso had become a solid block. She felt like she could barely breathe.

For many months, Laura recalled images and memories of rape, torture, death and destruction. Her eyes lowered, she slouched physically and her energy was sluggish. There seemed to be no entry point for communication or interaction. I wondered if I could ever reach her. It seemed that nothing could come in and nothing could go out. While Laura may have survived initially by constricting her movement (both physically and mentally), this no longer served her; in fact it did the exact opposite. Laura’s compulsive need to draw and redraw the traumatic events had long passed the stage of telling her story. It caused her great distress and led her to forget where she was as she relived the experiences again and again.

Figure 1 - Laura memories of her home under attack

Figure 2 - Laura memories of injury and death

Laura’s image-making perpetuated the circling of the same horrific events in spite of her desire to end her suffering. Equal to this however, was her terror of getting up from the chair. After some months in art therapy, Laura agreed to breathe with me. I introduced some very basic mindfulness breathing exercises alongside a mindful focus on sound and body sensations.

In our sessions, I tried to encourage Laura to abandon her position on the chair – so leaving less time for the art and more and more for the mindfulness exercises with a focus on the present moment and on a compassionate, non-judgmental and forgiving attitude towards herself and others. Together we did a combination of mindfulness meditation, walking meditation, Qi gong and tai chi exercises, beginning with breath (with which she was already familiar). These slow and gentle movements exhausted Laura and she frequently had to retreat to the edge of her chair to rest. Despite this, however, she agreed to undertake a sequence of exercises I had suggested she complete during the days in between our sessions. These exercises would be carried out both morning and night at home. Many months passed during which we moved together, following a traditional form, (tai chi, Qi gong), but not in a prescribed way; this allowed Laura to interpret these movements as she wished. Slowly she gained more mobility in her torso and more movement in her neck. Slowly, she agreed to join me in printmaking.

Choosing a material she had not used before allowed Laura to move back to the page and this time she was making marks on large sheets of paper. Creating monoprints meant making sweeping gestures on a sheet of glass, and then using rubbing movements on the page to allow for the image to be imprinted. Rubbing the large sheets created a different type of movement, and the way in which the materials were set up demanded that Laura stand while making them. In printmaking, the marks were made indirectly and the shapes that were made in the ink were not solidified until the paper was placed on top – so creating a veil between the ink and the movement. This allowed Laura to be present in the room – and with what she was feeling – and produced images that were not the compulsive drawings of the months before.

Figure 3 - Monoprint

The movement fundamental to this process reminded Laura to breathe and she began to speak about her breath as a new-found ability. Her husband reported that she was having bursts of returning to life and spent less time on the sofa. The social workers also reported that Laura was more engaged and spent less time staring into space. It was as if they were seeing Laura for the first time. She was managing to maintain eye contact and even volunteering to help.

6. Polarities and Dualities

The symbols of yin and yang give us a visual understanding of the ebb and flow of energy and the connectedness of polarities. Maciocia (2009) writes that according to Chinese philosophy “…the spirit, soul and body are nothing but different states of “condensation and aggregation of qi” (p. 4) and that the “symbiosis” (p. 5) or unity of the two polarities (in this case the body and the mind), in a circular direction is understood to be an “organismic” (p. 5) process – both of which need each other (Maciocia, 2009). Maciocia (2009) reminds us that “The word “spirit” means “breath” and comes from spiritus, the Latin rendering…” (p. 2) of the word. The Greeks viewed spirit as a “refined form of matter” (Maciocia, p. 2) and the crystallization of the duality and polar opposites as represented in a more linear fashion which arose with the Christian religion with the division between “a subtle non-material “spirit” and the material body becoming firmly established” (Maciocia, 2009, p. 2).

When Laura first came to art therapy, she lived a reality of duality. She described herself as third generation Christian. Religion and God were important to her identity. However, as a result of feeling contaminated and adulterated, Laura’s connection with God had become severed – as had her connection to her body, emotions and thoughts. Laura attached the loss of connection to God to the death of her soul. Laura’s understanding of soul was connected to her religious beliefs and laden with the meaning given to it by Christian scripture; together with this, Laura described her loss of soul as the loss life within her.

This former perception of her spiritual self, along with her now physical pain and an inability to recall any good memories from her childhood or adulthood (before the trauma), led Laura to perceive herself as ill with very little likelihood of healing. Her split view represented not only her view of herself but also that of the broken society from which she had come.

Our western thinking tends to place our different parts at two ends of a spectrum – divided rather than all part of one whole; the arts and science, imagination and logic, internal and external, good and bad, them and us, safe and unsafe. Papadopolous (2005) reminds us that the ways in which we relate to violence are also divided and polarized.

Violence too leaves little margin for grey areas and tends to make us see things in terms of ‘black’ and ‘white’. This is understandable. When exposed to violence, our primary response is self-preservation and our impulse would be to choose the safest option in the shortest possible time (p. 37)

We identify immediately with our own pain and suffering or that of a victim and this creates a pressure – within both us and them – “demanding an instant cessation of the pain. This overwhelming pain, (theirs and ours) threatens to disrupt all external and internal order and is difficult to tolerate” (Papadopoulos, in Kalmanowitz & Lloyd, 2005, p. 37).

Once violence erupts, this schism becomes complete and, in so doing, contradictions and internal conflicts are resolved, not only at an individual and community level but at a state level as well (Papadopoulos, 2005). Individuals and societies lose their ambivalence and become one way or another. It is this singular position within which our clients, and often we ourselves, are ensconced. Entrenched in our ways of viewing the world, we too need help to see things differently and to make new connections.

We know that this dual position directly impacts our ability to imagine; McNiff (1999) writes “As soon as the mind becomes fixated on a singular position, it loses the ability to see the creative interplay and benefit from it” (p. 8). This creative interplay is the place we art therapists try to hold in the understanding that this is fundamental to change.

The combination of art making, movement and mindfulness meditation in art therapy sessions allowed Laura to just be with the doing. Here, doing refers to engagement in process – in the direct experience of activity or inactivity – thus moving away from these dualities. Laura was able to feel herself in the movement of Tai chi and Qi gong as well as in her art making and this engagement allowed her, at the same time, to be with the sadness and suffering, to connect to her own strength (both personal and cultural) as well as, in her own words, to rekindle “connection to her soul”. Levine (2015) and McNiff (2016) suggest that the word Qi is equivalent to soul and that “If a work or practice does not embody soul, it has no power to move us. It is lifeless and inert.” (Levine 2015 p. 23)

7. Conclusion

In Laura’s therapy Eastern and Western thinking came together. Integrating these two philosophies allowed us to address her difficulties and concerns united by our relationship to suffering and well being.

A combination of Eastern and Western understanding of the psyche facilitated a model of work to which Laura responded. Engagement of the body and the art making (mark making and imagination) allowed her to gain awareness – to build a sense of control and regulation – and to enable a slow but significant ability to locate herself in the present time as well as developing the potential to reconnect herself with the natural world and with her God. In her early stages of work, traditional art therapy notions of expression through art seemed to trigger Laura into a state of dissociation: a more holistic approach to process and materials alongside an attitude of acceptance (common to both approaches) helped Laura to connect and collect her fragmented parts. Although not illustrated here, continued work with Laura led to her return to the art making and art process and to the use of materials in very different ways.

I have laid out the importance of linking to a whole in working in this context. Not only do we try to give place to the sensory and physiological experience of trauma, but we try to create a space to link the individual to their personal sense of morality, to the group, the society, the culture and the natural world through being in the present with an openness and acceptance. As difficult and slow as it can be when a person is frozen (as Laura was) working through this process with the body and imagination seems to offer a key to moving from duality (from which Laura was forced to detach) to polarity (experiencing the connections between her disconnected parts) and the flow between them.

There are no easy answers to working with trauma, to mending body-mind splits or the splits in our society. I am however, convinced that the methods used are more productive when we engage in the inter-relations between the multiple aspects of our being. Engaging with the former facilitates an understanding of many complex and subtle issues and allows for deep exchange. Han Shan’s verse from his poem “Cold Mountain” with which I began this paper suggests that in order for us to understand our world we need to travel our own path. Assumptions of purely linear relationships belong to a dualistic way of understanding the world and can be seen as an oversimplification (Lee, Ng, Leung, Chan, 2009); they prevent us from reaching exactly those sources of strength and support we seek. Dealing with the body and the mind – with social and natural structures simultaneously – may lead us into the area of nonlinear relationships. ‘There’s no clear way’, writes Han Shan; yet through a willingness to connect all aspects of our reality, a way may become clear.