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Unmasking the agony: Combat troops turn to art therapy

Courtesy of the National Intrepid Center of Excellence

For soldiers suffering from traumatic brain injury and the psychological effects of war, a Department of Defense art therapy program hopes to provide relief.

The skull’s left corner is gone, leaving a jagged, diagonal edge drenched in red. The eyes are black and frantic. All of it resembles the Iraqi man who, in his final minute alive, stared up at Maj. Jeff Hall.

For five years, that face tortured Hall, once a sharp Army leader later shoved to his own ragged edge. Not long ago, a woman handed Hall a blank mask, brushes and paints. She asked him to see what may emerge on the surface.

“That image, seared into my mind, began leaking out of me,” said Hall, one of hundreds of active-duty troops who have created masks as part of an art therapy program at Walter Reed National Military Medical Center. “I almost needed to regurgitate it. To be honest, it helped me let it go.”

Many more masks, some resembling Hall’s violent creation, some depicting abstract demons, adorn walls at the National Intrepid Center of Excellence (NICOE) on the Walter Reed campus.

They reveal scars once carried and cloaked inside the minds of men and women back from war — troops diagnosed with mild brain injuries and secondary psychological issues, including post-combat stress.

Hall, 43, who titled his mask “The Shock of Death,” served a pair of year-long tours in Iraq spanning 2003 to 2005. Ultimately haunted by violent events he saw and survived in Iraq, including the loss of friends, Hall eventually contemplated suicide and became more isolated. His commander noticed Hall's behavioral changes and guided him into counseling in 2008. Two years later, Hall was invited to seek treatment for a traumatic brain injury at then-new NICOE, a Department of Defense facility offering research, education and treatment focused on TBIs and psychological health. 

When service members initially enter the art-therapy studio, their faces often are blank and unyielding, hiding unwelcome war souvenirs within — the mental cargo they’ve lugged home but can’t shake. On their masks, they expose that secret turmoil: vulnerabilities, anger, grief or, often, fragmented identities.

“It’s intense. They get really invested in this. It becomes very meaningful for them,” said Melissa Walker, an art therapist who coordinates the masks program at NICOE.

Participants at NICOE must be active-duty troops who are dealing with a combination of TBI and psychological health concerns. Typically, they are referred by their primary health care provider or their commander. A designated team at NICOE determines which service members are most appropriate to receive treatment there. Attendees participate for four weeks. Art therapy is just one of the tools offered and the service members usually make one mask — done during their first week at the center. 

“I tell them: ‘Don’t worry about the finished product; worry about what you are symbolizing in the mask.’ That makes it more powerful to them. It gives them a way to express to us, visually, what they’re going through,” Walker said. “It’s a little less intimidating then handing them a blank piece of paper.”

Art therapy has become a staple in the treatment of a wide array of traumas, from child abuse to PTSD. Making art can help people unlock dark emotions or memories that they can't yet vocalize, pulling those buried anxieties from their subconscious and placing them onto a canvass or into a lump of clay, said Donna Betts, a professor in the art therapy program at George Washington University.

As a patients' pieces are taking shape, art therapists help them talk about what they believe they are trying to express in their creations, Betts said.   

"It's especially effective in the treatment of trauma in service members. When trauma is experienced, it tends to be stored in the nonverbal part of the brain," Betts said. "This is why so many of them can't even put into words what they've been through. Art therapy helps them retell their story through art. It translate that trauma from the nonverbal part of the brain to the verbal part so they can start dealing with it.

"They then become more aware of the trauma. This is where that healing starts to take place."

After the paint is dabbed and stroked at NICOE, many of those papier-mache masks offer chilling accounts of what it is like to live inside the minds of combat veterans.

One brown face with the mouth agape and with bloodshot eyes upturned is squeezed by a metal clamp that reads “TBI” on the left and “PTSD” on the right.

Another mask is coated by small chunks of amber bark — two tiny holes remain for eyes — symbolizing the outer camouflage the maker felt is necessary to blend back into the civilian world.

Some masks show mouths locked or sewn closed, whispering of an inability to speak of what they’ve witnessed. Many are divided down the middle — for example, one displays part of an American flag on the left and a skull on the right.

“There is a split sense of self. They feel like they’re one person when they’re deployed and one person when they return home,” Walker said. “Or, they do a really strong, warrior exterior with a vulnerable inside but they don’t feel like they can express that.”

The troops who come to NICOE for therapy can take their masks home. But many purposely leave them to hang from the walls to speak to — and perhaps even soothe — incoming troops trying to cope with the same thoughts and impulses.

The creations give service members a format “to say what they can’t say out loud — because it’s too painful or because we just don’t feel like anybody really wants to hear it,” said Hall, who remains on active duty, stationed at Rock Island Arsenal in northwestern Illinois.

“I absolutely believe it is a method to calm your mind.”