Music Credit: “Annibelle June” written by Abigail Washburn, performed by Abigail Washburn and Bela Fleck from the cd The Appalachian Picking Society.

Jo Reed: Welcome to Art Works, the weekly podcast produced at the National Endowment for the Arts. I’m Josephine Reed. Memorial Day gives us all the chance to honor our veterans and to listen to their experiences and concerns. Later on in the show, we’ll hear from Sebastian Junger whose recent book Tribe, looks at the profound sense of loss many veterans feel when they leave the military.

But first, a look at a program created by the National Endowment for the Arts, with the Department of Defense and the Department of Veterans Affairs. Creative Forces: NEA Military Healing Arts Network supports creative arts therapies for service members with traumatic brain injury and associated psychological health issues at 11 clinical sites around the country. The NEA's partnership with the DoD dates back to 2004 when Operation Homecoming: Writing the Wartime Experience was created by the NEA for U.S. troops and their families. In 2011, the NEA Military Healing Arts Partnership was launched when the National Intrepid Center of Excellence Walter Reed (known as the NICoE) invited the NEA to help build out its creative arts therapy program. The following year, Fort Belvoir in Virginia invited the NEA to replicate the program in their new care facility. And then in 2016, under the leadership of Chairman Jane Chu, the NEA expanded its Military healing arts program and launched Creative Forces. Chairman Jane Chu.

Jane Chu: Well this Creative Forces initiative has been so satisfying and meaningful in so many different ways. Specifically, the opportunity to expand the military healing arts therapy program to communities across the nation and we're so very appreciative of Congress giving us increases to be able to do that so now we've moved from the two sites—the original sites in Maryland and Virginia—to ten other places, which does include a telehealth component. But the reason it's been so satisfying is because, for one thing, what we hear specifically from our service members and veterans who are participating in this program, when service members say they get to create art, they also get to manage their stress and they talk about their memory being more enhanced. They talk about their ability to communicate more clearly and they can even manage their physical pain better, but then we hear also in the whole system that family members and caregivers of these service members and veterans have also noticed a significant and positive change not only in their loved one, but also in their relationship that they have with their loved one, so when they say that they've experienced positive results and they can communicate more and that it soothes any potential family disruption, we know that that's a benefit also for the service member as well as her or his family. And then we hear clinicians talk about how this type of process is noninvasive and that it really allows them to have their dignity as they go through this process, we think this is a win-win-win.

Jo Reed: Larry Miller would agree. He is a physician assistant and retired Navy commander who works at the James A. Haley VA, a recent site in the Creative Forces network. But it turns out he is no stranger to the benefits of art therapy. When he was on active duty, he was assigned to the NICoE on the Walter Reed campus, the first clinical site of Creative Forces. Larry Miller:

Larry Miller: I’ve had the absolute privilege of working and helping establish the NICoE. I worked with Dr. Jim Kelly at Walter Reed and helped develop that program so this is something that was near and dear to my heart. In that program, they have a fantastic art and music program. I could tell you that at the beginning being a hard-charging emergency medicine, general surgery-type guy, art therapy seemed a little fluffy to me but I quickly became a believer when I saw some of the results and talked to some of the patients that were there, in particular the special operations folks in that community. They were able to open up in a whole nother dimension.

Jo Reed: Those observations echo was Chairman Chu has heard, as she’s traveled to bases in the Creative Forces network to speak with and listen to clinicians and service members. Jane Chu.

Jane Chu: The clinicians in these very highly-regarded locations—Camp LeJeune, Alaska— talked about how they saw almost a transformation almost immediately. And that speaks to what the arts can do. We celebrate the arts and the wonderful products that it produces: wonderful performances and programs. And what we've undersold in terms of the arts in general is that the process of creation in the arts is just as important as the product and so the process of creating and the process of developing and cultivating what’s within each of these service members who participate in the program, the clinicians there and the people there in the post or the base or the military site comment about how it's almost transformational. Almost from the beginning.

Jo Reed: Rusty Noesner is a former Navy Seal who experienced blast concussions and other blows to the head while he was serving in Afghanistan. After deployment—when he was experiencing some symptoms of TBI—irritability, anxiety, isolation—he was sent to the NICoE for treatment. He arrived a sceptic about art therapy.

Rusty Noesner: I was resistant to art therapy. It took a while, you know, to kind of drop that shield a little bit, and then you realize how effective it is and how important it is for your cognitive processes in order to say "No, actually it's helping me process, it's helping me focus, it's helping me do a lot of other things that I took for granted." And it's kind of the tangible manifestation of what's going on in your brain.

Jo Reed: Larry Miller understands from a practitioner’s viewpoint how valuable a tool art therapy can be.

Larry Miller: The challenges of taking care of mild-to-moderate TBI patients is vast and quite enormous. I feel the arts in brain injury brings a whole another dynamic to the picture.

Jo Reed: Rusty Noesner

Rusty Noesner: Art therapy really, really spoke to me. I know it speaks to a lot of folks like me with TBI. I don't think it's necessarily like a light bulb switching on. It's more actually like a light bulb, you know, fluttering to life.

Jo Reed: Larry Miller.

Larry Miller: They learned a lot about themselves through what they were creating in art and it allowed the therapists to help analyze from a different perspective - and tailor their care. Fantastic.

Jo Reed: An important leg in the Creative Forces program is building and supporting community-based Arts Programming at each of the 11 clinical sites. Jane Chu.

Jane Chu: Joining up with wonderful community arts organizations in each of these communities who are going to be there to support the service member so you can have clinical and community engagement at the same time.

Jo Reed: Creative Forces is bringing State agencies and local arts organizations together with the military to tailor arts programming that support not just military members, and veterans, but their families as well. Margi Vanderhye is Executive Director of the Virginia Commission for the Arts. Virginia is the home to one of first clinics in the Creative Forces network at Fort Belvoir as well as the most recent at Naval Special Warfare in the Hampton Roads area.

Margi Vanderhye: One in ten Virginians is a veteran so we have veterans in every corner of the state. Having the Creative Forces expansion with both a clinical and community element to it particularly in the Hampton Roads area is going provide the individual service member and for his or her family that transition to continue on a path to wellness, to continue on a path to being integrated into their community.

Jo Reed: A sense of community has a particular resonance for the military and their families.

Margi Vanderhye: Community-based arts programming is essential because many of the people who are involved and benefit from it have lived in many places. For them the sense of community is even more compelling because the great dislocation that they have sustained both in terms of the distress from deployments, whatever they may have endured in those deployments, and the reentry and reintegration into a more permanent sense of community can be a very different and difficult transition. The community-based arts programs that Creative Forces has provided really provide an asset to these families and to the community at large because the whole community benefits when the members of it feel welcome and feel integrated.

JO: It’s been years since Rusty Noesner was in art therapy at the NICoE, so he’s had time to think about and assess its continuing value for him.

Rusty Noesner: I still continue to do art. Art definitely allows you to access a part of yourself that has been systematically shut off and for good reason. It doesn't serve any purpose in combat environments. And I've referred to it before as flipping the switch. That's essentially what we're doing. As you understand that you're no longer in a combat zone, you're no longer in intense scenarios where you need to make very quick, rational decisions. You can actually take a pause and figure out kind of the internal workings of what's going on below the surface so that you can better understand kind of your next avenue or your next goal in life as you move along, because if you don't then you really do have this kind of I'd say built-up pressure. You're not able to listen to yourself at all. You have to do that, and art is just a great way to do that.

Jo Reed: Larry Miller believes that the use of art therapy in treating patients with TBI will only grow.

Larry Miller: I think that the advancing therapy through the National Endowment of the Arts is a part of medicine that we are lacking in our country. I think art therapy—and like I said before I was not a believer and now I am a total believer and actually sitting here talking about it—I think it’s going to add this whole nother area where we’re going to be able to take better care of our patients. If you ask me from my standpoint the future of art therapy is alive, well and I think it’s going to grow.

Jo Reed: Margi Vanderhye is enthusiastic about arts programming serving as a bridge not only to wellness but also to fuller community engagement.

Margi Vanderhye: The National Endowment for the Arts has had the vision and the guidance to work with state partners and recognize that both active-duty and veteran populations can benefit tremendously both at the clinical level and at the community level in terms of their well-being, their reintegration through art-related programs. I think one of the real assets of this Creative Forces expansion program is the ability to see that and to provide the avenues for people both in civilian life and in military and veteran populations to get there.

Jo Reed: Chairman Jane Chu.

Jane Chu: My dream is that this is only the toe in the water for what can really happen. That we can expand well beyond the 12 sites where we are located now. But I think even more than that because of the solid and substantive scientific research that's accompanying this Creative Forces initiative, I really think that there will be a time where other sectors, non-arts sectors, non-military places, will say "We see that this entire environment that has been created through Creative Forces is a model of how to work together." Well I think it's going to be a model for the nation in so many different ways.

Jo Reed: You can find out more about Creative Forces at arts.gov. My thanks to Larry Miller, Rusty Noesner, Margi Vanderhye, and most particularly to outgoing Chairman for the National Endowment for the Arts, Jane Chu. You're listening to Art Works, I'm Josephine Reed. When we come back, author Sebastian Junger talks about the loss of belonging to a tribe that vets often feel.

Welcome back to Art Works, the podcast form the National Endowment for the Arts. I'm Josephine Reed. The award-winning journalist, author, and filmmaker Sebastian Junger has made war and the people who fight in them the focus of much of his work. Not surprisingly, he has recently turned his attention to the complexities soldiers find when they return from war, most recently in his book Tribe: On Homecoming and Belonging. In Tribe, Sebastien Junger notes that there are primal human needs—for loyalty, a sense of belonging, and a connection to something bigger than ourselves. And because service members find this connection when they are deployed, returning home can leave some 21st-century combat veterans with a profound sense of loss. Add to that loss, a society disengaged from the war in which these veterans fought and, according to Junger, this might account for the high-percentage of service members suffering from PTSD. Sebastian Junger’s book interested us greatly at the National Endowment for the Arts because of our own work through the Creative Forces program with service members suffering from PTSD. I wondered about possible intersections between Creative Forces and the ideas that Junger offers in his book, which begins with provocative observations about modern society.

Sebastian Junger: One of the ironies of wealthy modern society is that as wealth goes up, people have enough money, enough affluence to live more and more individualized lives, which is a great freedom for them, but it also removes their access to community. In fact, individuals don't need the community to survive, and the community doesn't need individuals in order to stay together. And the whole thing is sort of subcontracted to the state and to corporations. So there's a real—some advantages to that, but there's a real loss in human terms, in sort of emotional and psychological terms.

Jo Reed: Okay, now let's take that loss and bring it to the military because while I think most of us can at least imagine the trauma of war, the ugliness, and the brutality, you make the point in the book that it also can confer something else on people who fight.

Sebastian Junger: Yes. What we know is that the best, most pro-social human behaviors come out in the worst circumstances. So if you ask war reporters, "Well, how can you stand to do this job? It's humans at their worst." It's actually humans at their best. I mean, what you see on a front line, you never see racism. You really never see any bias according to politics or sexuality, or really anything. I mean, right on the very front line, there's a profound egalitarianism that happens, and a commitment to the group good, which of course is deeply embedded in our evolutionary past. And we know that when people live in tight, communal situations like that, they experience really improved mental health. So you take modern society, which of course we know, as wealth goes up in society, the suicide rate goes up, the depression rate goes up, the PTSD rate goes up, anxiety goes up, child abuse goes up, violence against others goes up, with wealth. So modern society is actually quite hard to live in psychologically.

Jo Reed: So let’s translate that thinking specifically to the military.

Sebastian Junger: So for soldiers, for the purpose of soldiers, they're in a war zone. If they're on a front line—which is not most soldiers. Most soldiers are not in combat actually, but the ten percent of so of our military that is actively in combat, they're subjected to trauma and fear and horror and all those other things, but they're also sort of marinated in this close communal connection that is a platoon. A platoon is 30, 40, 50 men, often operating in very close concert with each other, and somewhat independently of other groups. That is our evolutionary past. We evolved to live in groups of that size, functioning pretty much like that. So they get to enjoy and appreciate that ancient human system of sort of communality and connection, and then whether they've been traumatized or not, and this is true of soldiers from a rear base as well. When they're taken out of that group, that sort of primordial group of 40, 50 individuals, and brought back to the United States, they experience a really traumatic transition from communalism to individualism, and that is individualism is not what we evolved for, and it's actually, for all the opportunities it offers, it's extremely hard on us psychologically. And I think a lot of PTSD, what's called PTSD, is often applied to soldiers who never saw combat, who were never traumatized. You know, most of the military was not shot at, but many of them are really suffering during this transition, and I think what they're suffering from is this very difficult transition from a close-knit communal society in their platoon, in their unit, to the sort of isolating individualized society that we've created in this country.

Jo Reed: I think people understand that PTSD is an issue in the United States, but I don't think—I certainly didn't get the extent of it, or more importantly, how unusual it is when one looks at other countries.

Sebastian Junger: Yes. I mean, if you talk to the Peshmerga fighters in Iraq and Syria, they have no idea what PTSD is. Like in Israel. There's mandatory military service in Israel, and as a result, the PTSD rate among veterans is one percent in Israel. In our country, it's 20 percent. And keep in mind, only one percent of the military actually sees any combat, and our PTSD rate is 20 percent. It's double what even the combat rate is. That's bizarre. And it’s not that American soldiers are less tough than other people or whatever. It's nothing like that. It is, I think, just evidence of the fact that if you're traumatized, we are wired as a species, we're wired to overcome trauma. I mean, if a large percentage of people were psychologically incapacitated by trauma, by a lion attacking the encampment, and effectively became wards of the state afterwards, the human race wouldn't exist. Right? Of course, we recover from trauma; we have to. So what's happening in America right now, enormous numbers of veterans are being put on basically lifelong disability because they feel that they were traumatized. There's something very real going on here. The thing that I think a lot of them are traumatized by is having to give up this close, interconnected, very, very loyal human community that they were in during this incredibly intense part of their lives, having to give that up and return to the great American suburb.

Jo Reed: To add to this, to exacerbate it, such a small percentage of people in the United States are actually in the military. And a very large percentage don't even know anybody who serves.

Sebastian Junger: Yeah. Yeah, absolutely, and it's not just the military. I own a car; the car runs on gasoline. I don't know anyone who works in an oilfield. Likewise, logging. I mean, my house is made out of wood. I mean, somebody cut those trees down. I had fish the other night. Somebody caught that. None of us know any of these people. And so in a small scale, communal tribal society, you would know everyone engaged in producing the things that you need in order to survive. You would know those people personally, even if not personally you would appreciate their hard work, their dangerous work. In a complex, modern, technology-heavy society, people don't know personally anyone in any of the industries that allow them to live. And that's because we're very lucky to live in a kind of society like this. No one's saying it's a bad thing, but there is a downside. And the military is one of those industries, and it is an industry, where very few people know anyone in it, even though they depend on it to protect their country.

Jo Reed: You know what it's like to return from a war zone, because you've done it so many times. What do you find within yourself? What did you find when you returned?

Sebastian Junger: When I was doing my work overseas with American soldiers, I also affiliated with this group and also had a very hard time giving it up, and I was enormously depressed afterwards, partly because I had grown to psychologically need that group. I didn't know it was happening. I didn't think that was going to happen, but that's my only explanation for the really difficult emotions that I had over there when I came back. You know, I wasn't particularly traumatized when I was with those guys. We were in some fire fights, but that wasn't the problem. It was giving up that group, and really, I was quite a mess when I came back. There's no evolutionary wiring that allows you to like gracefully transition from being a valued part of close group to just being on your own. That is not something we've evolved for and it's clearly very hard for us and dangerous to do. People are prone to depression, to suicide. They're prone to high rates of PTSD. People do not do well on their own, and that's what this society has created is 350 million people that are basically individuals who are not affiliated with close communities.

Jo Reed: I don’t know how much you know about Creative Forces, the initiative that is led by the National Endowment for the Arts in partnership with the Department of Defense and the Department of Veterans Affairs. And it offers creative arts therapies to military patients, and it’s found that in fact the arts really have been very helpful in easing those traumas.

Sebastian Junger: Right. Yeah, that’s right. I mean, the National Endowment for the Arts has been so committed to working with Service Members and has done such an incredible job with them. I mean, I think creative expression is enormously beneficial. I think it's empowering. I think the process of writing, of making music, of making art, theatre, is enormously empowering. So instead of feeling like you're subjected to emotions that you can't control, that you don't understand, I think what happens with artistic expression is that you're using those emotions and now the tables have turned, and actually, instead of being subjected to them, you are employing those feelings. You're creating something constructive with them. I think for someone who's suffering from grief and the loss of a partner, or loss of a brother or sister in combat, or depression, or PTSD, or what have you, I think it's enormously beneficial to have that kind of outlet.

Jo Reed: Well you know military patients, veterans who suffer from PTSD or traumatic brain injury. I mean obviously, their families suffer as well and often it’s through art in fact that service members can tell their stories and communicate with their families.

Sebastian Junger: Yeah, that’s right. I mean, using art, using music, using any creative force like that, to express one's emotional experience, spiritual experience, can be lifesaving. I mean, I think it's absolutely essential, and frankly, it's one way for people to make a statement, to protect something that's sacred. And the community is sacred, the nation is sacred, and it really will be up to—it's up to all of us, and it's particularly up to veterans to protect that sacred thing.

Jo Reed: Yea, I’m thinking about the issues you detail in your book and one other thing a newer component to Creative Forces is bringing local artists in to work in conjunction with arts therapists with service members with their families in part to really create an expressive local community for service members. It really does help create community.

Sebastian Junger: Absolutely. The act of expressing your experience to a group that wants to understand what you went through and values your existence. That is ancient. That's extremely valuable. And so one of the things I did in researching my book Tribe was to look at some of the processes, some of the ritual processes, some of the ceremonies, that Native American tribes in this country, in the United States, would do to reincorporate returning warriors back into the community. And these ceremonies are still done. Really interesting, Native Americans comprise the largest percentage of the US military by population. In other words, there are more—a higher percentage of Native Americans are in the armed forces than of any other population group, any other demographic in this country, and they have some of the lowest rates of PTSD. So what would happen is that people would come back, and I talked to some guys that were in the 173rd Airborne that I was over there with, who were Native American, from Oklahoma and Texas. They came back and went through this process where basically, the community gathered, and they had a dance, a ritual, and the veterans would dance and sing and tell the story of their deployment. That's absolutely ancient. This is something that has been going on centuries. And the context has changed. It's not the old days with the buffalo and the teepees, but it doesn't matter. The point is that you get to tell your community what you did for them. And they get to participate in the moral burden and the celebration. The moral burden of conducting war and killing other people, and the celebration of your bravery and your accomplishments, and the grief at losing people. The community has to participate in all of that and share it, and that's very healthy for both sides of the equation.

Jo Reed: And it's up to us to listen to veterans.

Sebastian Junger: Yeah.

Jo Reed: In Tribe, you mentioned that Papago Indian tribe thought war was nuts.

Sebastian Junger: Insane.

Jo Reed: Insane. But when it came time and they had to fight, the people who fought, they gained a kind of wisdom through that experience. Do you think this is true for the people fighting today?

Sebastian Junger: Yes. I mean, I think anyone who confronts death gains wisdom, and I think that's also true of people who've been very ill. If they survive, they come back from their disease with a wisdom that, you know, other people don't have, and won't have till much later in their lives. And likewise for soldiers, some soldiers, not all soldiers. I mean, some people are just doing a job in a rear base, and they're really not engaged in war, except in a very conceptual sense. But people that are really seeing death, risking death, yes, they do have a special wisdom, and it is kind of sacred knowledge. And traditional tribal societies understand that and use it. They protect it, and they use it, and they honor it.

Jo Reed: Sebastian, thank you.

Sebastian Junger: My pleasure.

Jo Reed: I really, really enjoy talking to you.

Sebastian Junger: It’s a real pleasure speaking with you and really doing anything I can to support what you’re doing. I think it’s incredibly important to the nation.

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Jo Reed: That’s author and filmmaker Sebastian Junger. His most recent book is called Tribe: On Homecoming and Belonging. You can find out more about it at SebastianJunger.com. And you can find more information about Creative Forces at arts.gov. You’ve been listening to Art Works produced at the National Endowment for the Arts. You can subscribe to Art works wherever you get your podcasts so please do and leave us a rating on Apple—it does help people to find us. For the National Endowment for the Arts, I'm Josephine Reed. Thanks for listening.