On October 10, 2016, health professionals, political leaders, activists and patients from all over the world, among others, celebrated World Mental Health Day— a day for global mental health education, awareness and advocacy against social stigma. Here in Dhaka, in a small corner amidst the slum areas in Kamrangirchar, girls aged 10-19, and even a few women in their late thirties, also celebrated the day—by painting a mural of butterflies.
Art therapy for mental wellbeing
Art therapy, sometimes known as creative art therapy or expressive art therapy, is used for psycho-therapeutic treatment by mental health professionals all over the world. The process of using mediums of creative expression has been seen to aid in self-expression, promote positive self-esteem, social skills, self-awareness and overall mental health. “The method is used in private practice in very limited scope, but the idea of employing creative or expressive art therapy to help women from slums is indeed new and ground-breaking,” explains mental health counsellor Farhana Naznin Mitu.
Mitu is an assistant clinical psychologist at a clinic in Kamrangirchar, Dhaka District, in the Urban-Slum Medical project of international medical organisation Médecins Sans Frontières (MSF), also popularly known as Doctors Without Borders. MSF’s health clinics for women in Kamrangirchar were established in 2013 in order to to provide community- based services that are easily accessible. The overall MSF project comprises of a range of services focusing on sexual and gender-based violence, adolescent reproductive health and family planning, among others.
Guided by a female artist, the women and girls worked on a mural showing a sky with clouds made with cotton and butterflies painted pink, trailing the way to the mental health section of the clinic.
Expressions through art
One reason why Sexual and Gender-based Violence (SGBV) survivors may find it difficult to access healthcare is a lack of knowledge about where to go to for services. “As it’s a very personal issue, they are often reluctant to even go to a clinic in the first place, let alone to ask for directions once inside,” explains Manisha Kumar, Medical Coordinator for MSF in Bangladesh. “The paintings of butterflies in the MSF clinic serve as confidential guides, leading the SGBV survivors to the area of the clinic that provides services for them.” Many of the girls who partook in the painting activity were SGBV survivors –a whopping 30% of cases approximately that MSF has treated in Kamrangirchar this year on Intimate Partner Violence (IPV), were young women below the age of 20.
MSF’s teams have begun to spread this message in the community for SGBV survivors: just follow the butterflies. “We want to not only treat survivors of sexual and gender-based violence, but also to educate them about ways they can be comforted in ways that give them back confidence and happiness,” said Maurice Van Gammeren, Project Coordinator of the MSF Kamrangirchar Urban Slum project.
“Symbolically butterflies represent the ability to fly at will. And that’s what psycho-social therapy, and creative activities they can be eager to engage in, aims to achieve,” said Mitu.
Indeed, eager they were. What started out as lines drawn by the muralist ended up filled with paint and glitter by girls of diverse ages and personalities. They smiled, competed, asked for markers to add more lines, and sang along to the familiar rhythm of National Poet Kazi Nazrul Islam’s “Projapoti, projapoti, kothae pele bhai emon rongin pakha!” (butterfly, butterfly, where did you get such colourful wings).
Violence and mental health
After finishing what happily became their own painting project, the girls sat around a circle as Mitu chatted with them while teaching fundamentals of mental health, regulating one’s own emotions— and of course, what it means to paint or sing or dance to feel happier. “I have watched professionals scribe advertisements around Kamrangirchar, but I never thought it would feel so nice to paint,” said Rupa (name changed for confidentiality), an adolescent support group beneficiary, as she proudly signed her name below her butterflies. “I can’t wait for more of these activities!” They held mirrors gifted by the support group coordinators, and journaled their emotions and goals after a period of self-reflection.
Mitu finished the day by paying a visit to a local school, one of the many where MSF provides health education sessions free of cost. The girls at the school in Kamrangirchar eagerly, and admittedly confusedly, journaled down their feelings, conflicts and dreams. “At the end of the day, if they learn how to express themselves, whether with words or with pictures, they can learn better how to help themselves throughout their lives,” finished Mitu.
Many women suffer with mental health problems—day workers, mothers, daughters, children taking care of their young siblings. “In a population of 156 million, roughly 8% suffer from mental health conditions . You can do the math,” Mitu further explains, adding that “social stigma prevents women from coming forward, especially when their partners are also perpetrators of violence. But patient confidentiality encourages more health-seeking behaviors”.
A recent research study by WHO in Bangladesh shows mental health disorders such as depression, stress related conditions, and suicide are consequences observed in the context of violence in women’s lives. Abused women are more likely than others to suffer from depression, anxiety, psychosomatic symptoms and many reproductive health problems.
MSF’s clinics in different areas of Kamrangirchar treated almost double the amount of victims of sexual and gender-based violence in 2015 compared to the previous year - with 1,154 patients compared to 684 in 2014.The MSF operated clinics remain the only health facilities in the area offering free and confidential psycho-social counselling and medical services to adolescent girls and survivors of sexual and gender-based violence.