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The Usage of Creative Expression to Foster Healthy Development in Institutionalized Children
By Emily Merz
Without defining it as therapy, in my teenage years I focused on art. As an art major in college I became aware of my growing need for art as a means of staying balanced emotionally. Most of my art projects focused on my family, and more specifically on my brothers who were adopted internationally from Paraguay and Russia, and domestically from Puerto Rico. Since one of my brothers was one of the first children to be adopted from Russia, we hosted a Russian doctor from his orphanage in our home for a week. The mystery of my brothers' prior lives became more pertinent. I first traveled to St. Petersburg, Russia during the summer after my junior year in college to volunteer in orphanages and study Russian language. There, I discovered how creative expression, which I so valued for myself, could benefit children in orphanages and I decided to return to Russia to pursue this idea after I graduated.
In order to find support, I sent my proposal to several different organizations, and the Worldwide Orphans Foundation agreed to fund my project. The mission of the Worldwide Orphans Foundation is "to identify the immediate and long-term medical, developmental, social and emotional needs of children living in orphanages abroad in order to improve the quality of their lives". The foundation provides grants for college students and healthcare professionals to embark on research and service in orphanages abroad. Under the supervision of Dr. Jane Aronson, the director of the foundation, I included in my research the Denver Developmental Assessment, Goodenough-Harris Drawing Test, and the House-Tree-Person Projective Drawing Technique, which I will describe throughout the article. Although I didn't have a set itinerary from the outset, I spent nine months abroad and traveled not only to Russia but also to Ukraine and Kazakhstan, and worked in orphanages in Moscow, Kiev, Smolensk, Irkutsk, and Almaty. My goal was to encourage children in orphanages to create art as a means of understanding their emotions and enabling them to cope and adapt to their circumstances. Through my research based on their drawings, I hoped to learn more about the development and psychological perspective of institutionalized children.
In this article I am going to describe the orphanages where I worked, the art projects I conducted in each one, and their results. Although my project was focused on school aged children, I also encouraged art-making among three to four year old children in baby homes. In the first few paragraphs, I will present my observations of the baby homes where I worked in Moscow and Irkutsk and the implications of drawing and scribbling for this age range. However the bulk of my article will focus on my experiences in children's homes in Moscow, Kiev, Smolensk, and Almaty.
Baby Home in Moscow
During my three months in Moscow, I worked at a baby home on the outskirts of the city. I learned about the orphanage system and I met the caregivers. The children switch groups and caregivers as they age and if their health or behavior changes. While many of the caregivers seemed defeated by the challenges of the system, the ones who persevered were an inspiration to me. I visited every group of children, spending about two weeks in each group. Within each group, I got a sense of each child's development by conducting the Denver Developmental Assessment, a commonly used tool in the United States. The Denver Assessment gives a general idea of the social, fine motor, language and gross motor development of children up to five years of age. Each child's development is assessed individually as they are asked to complete tasks typical of their ages. In the baby home, almost every child tested as delayed in every category. They showed significant speech and language delays. For example, nearly every time I worked with the groups of three and four year olds, they conveyed their messages through monosyllabic utterances; they understood basic Russian, but most of the three year olds were unable to form a word. By the ages of three and four, most children speak words and sentences.
As I gathered the 3 and 4 year olds in small groups to draw and scribble, I discovered their individual personalities. Many of them were more interested in sucking on the crayons, and this tendency emphasized their developmental delays. Children at the age of 2 are usually comfortable scribbling and speaking words. Most of the children did enjoy experimenting with the materials, as they made lines and dots. As they did not often have the opportunity to use crayons, they had underdeveloped fine motor coordination. Instead of paying attention to their marks on the paper, some focused on the motion of scribbling rapidly. The rhythmic movements of the crayon on paper were similar to the act of "rocking" that children in orphanages engage in as a method of self-stimulation. In the oldest group, the caregivers were teaching the children how to draw straight lines with colored pencils. As a result, these children were more comfortable drawing and had improved fine motor skills.
Baby Home in Irkutsk
Later in my travels, I had another opportunity to encourage young children to make art. I conducted coloring and drawing sessions for the month of March with children in a baby home about an hour outside Irkutsk. The director of the baby home was very supportive of my efforts, and even found me a place to stay with his cousin in the center of the small town. It was clear that he was proactive in seeking support for the children in his care. One of his main concerns was that the population of the orphanage was growing too fast, and he needed another building to house new children. Orphanage administrators also struggled with an insufficient monthly allotment of food. Although the orphanage had a large staff of specialists, there were two caregivers per group of fifteen children.
In this orphanage, I focused my time on the oldest groups, the three to four year olds. By reading their records, I learned about the wide range of reasons the children were placed in orphanages, from homelessness to parental neglect. As I observed patterns in their behaviors, I noticed their survival mechanisms. Each child's personality affected his or her reaction to being institutionalized, and also the level of adaptation. By becoming aware of the strengths and weaknesses of their personalities through art-making, the children would find healthy methods of adaptation and be able to overcome challenges. After I got to know the children's backgrounds and behaviors, the caregivers encouraged me to draw with them in small groups. During playtime, I would arrange a small table with four chairs in a separate room alongside the playroom. I handed out paper and crayons and encouraged them to scribble. For lack of experience, they didn't immediately pick it up, but when I guided their hands they were responsive. Only the eldest ones made a wide variety of marks and only one girl was able to draw a shape. The abilities to create enclosed shapes and to form words typically develop around the age of two. Many of the children used scribbling quickly back and forth as a rhythmic method of self-stimulation. Leaving the orphanage on my last day in Irkutsk, the director welcomed me to return. While the drawing sessions I conducted had illuminated the children's developmental delays, their continuation would help heal them. Scribbling throughout early childhood fosters healthy development from the outset. I believe the director shares my beliefs and would welcome the incorporation of drawing into the daily routines of the children in his care.
In the remainder of the article, I will first discuss my initial experiences engaging orphans in informal creative sessions just outside Moscow. Then I will describe results of both the Goodenough-Harris Drawing Test and the House-Tree-Person Projective Drawing Technique and the qualities of the drawings produced in two very different orphanages: an internat for "invalid" girls in Kiev and a "family-type" orphanage in Smolensk. Finally, I will conclude with some very interesting abstract collages done by children in Almaty.
Orphanage in Moscow
On Sundays in Moscow, I traveled by train to an orphanage about an hour from the city, to provide materials and supervision for art projects among teenagers. As this was my first introduction to a children's home, I discovered that most of the children had poor hygiene, and lived with very minimal possessions and almost no privacy. I got a sense of their individual survival mechanisms and group interaction as I observed them drawing. Most of them were eager for adult attention and an equal mix of girls and boys were very aggressive in seeking the spotlight. When they succeeded in gaining the spotlight and realized all adult attention was fixated on them, they acted reluctant to put much effort into drawings possibly for fear of failure. Instead, they relied on decorative images and techniques. While they were very eager to please, their focus on this objective was easily broken. They were easily discouraged and distracted in the midst of their peers. From this initial experience, I became aware of the need for well-structured projects that place emphasis on the process of creating artwork rather that the beauty of the finished piece.
Internat for "Invalid" Girls in Kiev I spent the month of January working at an internat for "invalid" girls in Kiev. Most of the 6 to 18 year old girls who lived and attended school there were mentally and physically disabled, and further suffered from being institutionalized. From my conversations with the director there, I learned that at certain ages the state evaluates all children in orphanages to categorize them. The ones diagnosed with any type of disability or behavioral problem are put in orphanages for "invalids", and this placement meant that they would be institutionalized for life. As I began to work with the most highly functioning groups, I was saddened that the lack of opportunity for individualized care meant that, despite their capabilities, these girls would live very restricted lives and receive a limited education.
From observing the girls in their groups, I learned about the orphanage routine. On a regular basis, the teenagers did craft activities in the orphanage but the projects did not foster creative expression. Instead, they demanded regimented behavior and were focused on the beauty of the final product. Creative activities, without the strict guidance and step by step instruction of a caregiver, were rare. The first time the director, along with the young gym teacher, Nadia, gathered the 12 to 17 year old girls together in the classroom for a drawing activity with me, they were initially thrilled. However, when I handed out sheets of blank, white paper, crayons and markers, the girls reacted with anxiety. They weren't accustomed to activities without directions. At our next meeting, I was prepared with two simple projects: a series of line drawings of children for them to color in and draw the surrounding environment, and an outline of a girl and boy titled with the question, "Who am I?" for them to answer by drawing the details of the figures from their imaginations. They responded enthusiastically to these projects, as they began to add houses and environments expressively.
There were multiple indications in their drawings that these girls were significantly developmentally delayed for their teenage years. The way they drew the houses for the figures was telling. Most figures hovered elusively within the confines of four lines while only one girl's figure stood firmly on illustrated ground before a convincing dimensional house. The level of detail they put into their drawings and their ability to convey proportion and perspective in their human figures are part of the Goodenough-Harris Drawing Test. The test is used fairly frequently in the United States as a non-verbal assessment of intellectual development. Within a small group atmosphere, the children are asked to draw a boy and a girl on separate sheets of paper, and then the drawings are scored based on detail and proportion. With regard to these qualities, the drawings produced at this orphanage exhibited a low level of mental maturity. Even taking into consideration the diagnoses of mild disabilities, the drawings showed delays sustained by lack of nurture.
By conducting the House-Tree-Person Projective Drawing Technique, and examining and discussing their drawings, I learned about how these girls reacted and adapted to institutionalization. This psychological assessment serves many purposes in clinical and casual settings in the United States. It is often used to gain a valuable perspective in determining a person's outlook on their environment. In a one-on-one setting, each child is asked to draw a house, a tree, and a person and then answer questions about their drawings. The questions are targeted toward the interpretation of elements in the drawings. Only about half the girls in the mildly disabled group I worked with took part in the assessment; some were unable to complete the drawings out of extreme self-doubt and had very emotional reactions. They found it difficult to be separated from the group, as their only sense of security stemmed from the group. The response to the assessment varied widely, but it was quickly apparent that, while some girls felt alien in the orphanage and craved a family atmosphere, others had adapted to institutionalized life and could not imagine living otherwise. (It should also be noted that the yearning for home was not always thoughtful on the part of these girls, as most had been abandoned at birth.)
I noted that most of the girls answered the questions in a very literal manner, and seemed to have difficulty bringing life to their drawings. During one conversation the gym teacher remarked to me that all the institutionalized children she had worked with were incapable of imagining. This coincides with the lack of encouragement to develop their personalities and with their isolation from society. Another surprising effect of being raised in a system of mass child care, was ignorance to aspects of life that are considered to be common knowledge. In response to one of the questions about the tree drawing, several girls indicated that they thought trees needed to be watered by people to survive.
Aesthetic qualities of their drawings reflected characteristics of the girls in this orphanage. Often, their drawings and interpretations of trees suggested underdevelopment or being restrained. They frequently portrayed the tree as having stunted growth from leaves and branches withering or being torn off. Their drawings reflected a well-controlled environment. One girl's technique of rapid bursts of coloring and her depiction of eyes looking to the side, showed her self-image as defined by the reflection in her caregiver's eyes. Caregivers described her as capricious, and were continually reprimanding her for it. Another girl meticulously and methodically colored each section of a drawing, angry with herself if one mark strayed out of the lines. Using whatever technique suited them, drawing served these girls as an outlet for their emotions.
Our final project was an art exchange with artists from my college. They were thrilled by the prospect of outside communication and created drawings which we then stuffed into airmail envelopes. On my last day the director gathered the girls for a group photo in the gym. The caregivers had them all dressed nicely, with fresh haircuts and braids. They were reluctant to see me go, but happy they had been part of the art projects. I believe that the art we made lives on in their souls, through their stories, and I believe it is a source of hope. In Kiev, the director and the gym teacher became my closest friends at the orphanage, as I explained and discussed my project with them. They had continual support and feedback for me. The teacher and I exchanged ideas and I believe she will incorporate my suggestions into her teaching, as I have also learned from her input. Similar to her belief in the healing power of physical exercise, she had a unique perspective on art-making. We agreed that for disabled and institutionalized children art-making is a way to deal with complex feelings and communicate with peers and caregivers.
"Family-type" Orphanage in Smolensk
In Smolensk for the month of February I worked in a very rare type of orphanage that draws sibling groups from various regional orphanages and allows them to live together in groups with common caregivers. This is called a "family-type" orphanage, and it is night and day from the one where I worked in Kiev. This orphanage was much smaller with fewer children per group, and with an overall friendly atmosphere. Within the building itself, four or five sibling groups live together in small "apartments" with dining rooms, livings rooms, bedrooms and bathrooms. Although there is a communal kitchen, they eat their meals in their separate apartments. The children receive a high quality education as they go to neighborhood public schools. Plus, the orphanage has a large staff and there are daily activities and opportunities to learn independent living skills.
Their artwork reflected the quality of care and their drawings were developmentally appropriate. They were capable of bringing their drawings to life, and giving them meaning though stories. For this reason, their drawings also illuminated the depth of which their abandonment had affected them. Unlike most of the disabled girls I met in Kiev, many of these children had lived with their families for a significant period of time. In a few cases their artwork depicted the situations that had caused their parents to put them in orphanages. One girl drew her father carrying flowers at her mother's funeral, and another teenager sketched her 26 year old mother holding a suitcase and waiting for a train after leaving her and her brother. Another subject they drew about was adoption; several of the children drew and spoke about their siblings who had been separated from them when they were internationally adopted. This orphanage in particular had a lot of adoptions and, because of this, a lot of ideas and misconceptions about foreign countries. With regard to my presence, the children had a running dialogue about America. Through different art projects, I encouraged focusing on the idea of family as opposed to differences between countries. It was helpful for the children to use the act of mark-making to release hidden tensions. On a few occasions the children would meet me in the library classroom, where we always drew, and just freely draw whatever came to mind and erase and follow their own speed. I always gave special attention when the children gave in to the feeling of defeat, because then I knew they especially needed to draw and let out their feelings. When I encouraged them one on one, they almost had no choice but to draw on the paper. When they noticed that I wasn't concerned with the aesthetic qualities of the drawings, but with their concentrated involvement in them, they felt more open to trying new projects.
Out of this openness, they participated in the House-Tree-Person Projective Drawing Technique. Each child met with me individually, drew a house, tree, and person, and then interpreted their drawings. Here I will briefly describe two psychological assessments of children who frequently made drawings and who spent a fair amount of time with me. Olga* drew energetically, and always put the subject in the foreground, almost filling the page. Her tree and person were drawn from a frontal perspective. However Olga drew a side view of a house with a girl stepping out the front door. She spent the most time erasing and sketching the person drawing. The least self-assured lines and the darkest lines appeared on the person drawing. Olga's drawing was of a man carrying an elaborate bouquet of flowers. He looked surprised with wide-open eyes and outlined and shaded cheeks, and tense with pursed lips.
The drawings and our discussion showed several aspects of her personality and psychological condition. Olga was open and willing to deal with her emotions as indicated by the depiction of the tree with long, healthy branches, and her use of the foreground. At the same time, the side view of the house indicated the hidden complexity of her feelings. Olga's attentiveness and indecisiveness to the person drawing shows she is worried about close personal relationships because of the past. Her verbal interpretation supported indications in the drawings. Misha* drew a very detailed house with an ambitious attempt at complex perspective. His drawings were neat and contained, detailed and proportionate. While the house appeared in the foreground, the tree and person were in the background, and smaller on the page. The tree's roots were very close to one another, as if tied together. While Misha elaborated on the house drawing, he had difficulty with the person drawing. He drew a man running on a road by a forest. The man's head formed the highest point of the pine trees in the background. Misha spoke about the person drawing as being representative of his father. In his behavior within the group atmosphere, Misha was friendly with the other children, worked hard in school and did chores around the orphanage. He had one older brother, who avoided group involvement, and Misha felt he needed to compensate for that. From his drawings and his interpretation, I would say he was thoughtful about the past. Misha missed his father, but he was determined to succeed given his circumstances. He also had hope for the future. Although Misha's emotions were not readily available through words, they could be found in his drawings. The act of drawing helped him make amends with the past and apply this forgiveness to the future. At the same time, the containment of the drawings indicated that Misha's inability to loosen up and express himself verbally was hurting him.
As I lived in this orphanage in a small room attached to the library, I got to know several of the children quite well. Through my friendship with one teenaged girl, named Sveta*, I was introduced to her best friend, who did not live at the orphanage, but with her parents and younger brother in an apartment nearby. I realized how important it was that Sveta experienced life outside the orphanage. For the teenagers who must prepare to leave the institution and live independently, this orphanage in Smolensk also provided a foundation by teaching cooking and daily household chores. The practice of art-making has a place in the preparation of teenagers for independent living. From my observations in Smolensk, art projects helped the children understand their emotions and begin to figure out how to have meaningful relationships and adapt to their circumstances. While this orphanage has many activities, it would be helpful to focus on allowing the children more independence to learn about themselves. This could take the form of open activities without directions and without the goal of a specified final outcome.
Internat in Almaty
In Almaty, I arranged to work at one large internat and also to visit a local orphanage. At the internat, I worked with a group of children of mixed Russian and Kazakh descent between 6 and 14 years old. The children loved to draw and color and mostly completed the developmental assessments with enthusiasm. Their behavior and results of the Goodenough-Harris Drawing Test indicated that they were mildly delayed. After I received a donation of a box of construction paper, we started doing some abstract art projects. I would cut out random shapes of different colored paper, and spread them all over the table, with glue sticks between each child. They created collages in different ways; some focused on the colors, some on the shapes and the placement of the pieces on the paper, and some created narrative statements. The two girls who dove into the projects before anyone else could take a breath were both disabled. It seemed they applied themselves creatively, in place of a dialogue with their peers. A popular project that activated the group and generated discussion was self-portraiture. They were given two cut out paper dolls and asked to create self-portraits. Some of the children labored over the drawings, while others quickly created crude representations. Both the technique utilized and details of the self-portraits suggested the children's limited self-awareness and lack of self-confidence.
I also visited several orphanages in Almaty where the children only spoke Kazakh and I had trouble communicating with them. Drawing through gestures established another form of dialogue however, and I soon found the means around a minor setback. The younger children in these orphanages were eager to draw, and make marks on paper. At first they were shy about the prospect of a free creative activity, but when premised by a more stringently directed activity they loosened up. Although they preserved their solidarity, they weren't reluctant to show the individuality and narrative quality of their marks. By developing their self-understanding, art-making can be a method of strengthening children in orphanages and enabling them to cope with the challenges of life. Starting in the baby homes, such as those in Moscow and Irkutsk, scribbling is a meaningful part of early childhood development, which coincides with speaking. Drawing provides an alternate mechanism of expression to the disabled. In the internat in Kiev, emotions felt by the girls were built up inside and drawing provided an outlet. For institutionalized teenagers in Smolensk, a healthy self-concept fostered by drawing, helped them deal with abandonment issues and develop independent living skills. Art-making beneficial to children when the emphasis is placed on process rather than the finished piece. Since most children view drawing and painting as fun activities and projects can be structured as learning experiences, art-making assumes a unique position in their lives. When children are engaged in creative expression they learn about themselves, such as with abstract collages in Almaty, and find new ways to relate to others.
This project and my research stemmed from a personal interest, my family. Throughout my journey, I thought about my own adopted brothers and their origins. I thought about what their survival mechanisms might have been, and the conditions of their care in their former lives. Sometimes I see qualities in my brothers that would have served them well in an orphanage and I think about qualities of my own that wouldn't meet these same challenges. I think about the complexity of what is behind the gentle lines of their faces, and I only wish to be able to grasp a small portion of their hidden stories. For me, growing up in a sea of suburban families and exposed to adopted children who are inherently and mysteriously different because of their beginnings, the answer to this question is pertinent. My research has helped me begin to understand. Art is an important medium that children in orphanages have for telling their stories and expressing emotions they weren't aware existed. Since I create art to balance myself emotionally, it is my belief that children in orphanages can also benefit from creative expression. Developing a method of art therapy tailored to their needs is the next step towards this goal.
*All names have been changed.
Emily Merz graduated from Carnegie Mellon University where she majored in art. She is now on the administrative staff at Barnard College in New York