embodied drawings as expressions of distress among impoverished single bedouin mothers

ORIGINAL CONTRIBUTION

Embodied drawings as expressions of distressamong impoverished single Bedouin mothers

Ephrat Huss & Julie Cwikel

Received: 2 September 2007 /Accepted: 18 February 2008 /Published online: 21 May 2008# Springer-Verlag 2008

Abstract This paper demonstrates how marginalized, Bed-ouin, single mothers define pain through different depictionsof their bodies and their embodied experience. Using visualdata generated through an empowerment group with singleBedouin women living in the Negev, illustrative pictures wereselected. The potential of drawing as an indirect, but deeplycommunicative symbolic vehicle with which to express thewomen’s pain and struggle as marginalized and impoverishedwomen is demonstrated through themes that emerged from acontent analysis of the women’s art and their verbal commentsabout what they had drawn. A central theme identified paindue to painful life circumstances, rather than due to inherentsickness or weakness. Other themes identified included thebody as a site for cultural transition, power negations withmen, intellectual development, and the struggles of mother-hood. This shows how the visual depiction of pain on the pageoffers a socially critical, yet potentially mental healthpromoting medium that locates women’s distress, not as theresult of personal and physical weakness, but as the result ofsocial oppression. The implications for the use of art withsocially marginalized women are discussed.

Keywords Creative therapies . Poverty .

Women’s empowerment . Somatization

Introduction

Psychosomatic illness among Bedouin women in Israel andamong women from traditional societies in general, is anaccepted way of expressing psychological pain withoutchallenging the status quo (Racy 1980; Tal 1995; Thompson2006). The objective of this paper is to demonstrate howmarginalized Bedouin single mothers in a Bedouin town-ship in Israel express the pain, dilemmas, and conflictinherent in their social positions within the symbolic butembodied depictions of their own bodies. Through theirdrawings they embody distress through a narrative abouttheir multifaceted experience of the body as both strong andweak, struggling and changing. By facilitating a groupdiscussion of these pictures, these experiences are then re-embedded within a shared, social narrative, rather thanwithin a personal, somatic definition of sickness or pain.

These pictures demonstrate the potential of art work tocircumvent psycho-somatic reactions, rather than allowingthe pain to be expressed through physical sites in the body,thus empowering marginalized women to envision andcreate social change as per feminist approaches of thepersonal as the political (GlenMaye 1998; Pollio et al.1996; Staub-Bernasconi 1991). The goal of this paper is toanalyze the representations they make about their distressthrough thematic analysis and to suggest how art offers anadditional avenue for the expression of somatization process-es that are common among women with low social capital.

Literature review

Somatic reactions

Mayou et al. (2005) define somatic disorders according tothe DSM-III as a speculative diagnostic category of

Arch Womens Ment Health (2008) 11:137–147DOI 10.1007/s00737-008-0007-8

“I’ve been looking for someone to listen to me for years, I can’t tellmy mother how I feel, it would make her ill” (Single Bedouin Mother)

E. Huss (*) : J. CwikelThe Center for Women’s Health Studies and Promotion at BenGurion, University of the Negev,P.O. Box 653 Beer Sheva, Israele-mail: [email protected]

complaints “not explained by a physical ailment” (Mayou1993). Those who have somatic disorders frequently seekmedical care (Escobar et al. 1998), creating a significantburden on primary care health services (Gureje et al. 1997).Ansseau and colleagues have shown that somatoformdisorders tend to overlap with anxiety and mood disordersand are significantly more prevalent among women thanmen (Ansseau et al. 2004).

Somatization is here used primarily as the expression ofemotional distress through physical symptoms, as a way ofexpressing emotional problems within the symbolic butembodied experience of illness. De Gucht and Fischler(2002) differentiated between somatization as the physicalmanifestation of psychological distress (presenting somati-zation) and the presentation of a series of unexplainedsymptoms in multiple physiological systems (functionalsomatization; De Gucht and Fischler 2002). While attribu-tions of somatic pain to emotional pain can be simplistic,the connections between emotional distress and the sup-pression of the immune system, through generally acceptedmind–body models accepted in the current literature (Selva2006; Mazis 1994; Johnson and Grand 1997). Thus, in thepresence of multiple sources of distress, common in thelives of persons of low educational and economic resour-ces, both types of somatization may be presented (Gurejeand Obikoya 1992; Gureje et al. 1997; Sofie and Solvig2000; Becker et al. 2002).

Women predominate in somatoform disorders as femalesymptoms are defined as psychosomatic over twice as oftenas men’s symptoms by doctors, who perceive of women asemotionally labile (Burhansstipanov 1995). Hoffman statesthat doctors tend not to connect between emotional ormental disorders, and physical disorders, and thus, somaticreactions are not ‘read’ as emotional stress, but as a misuseof health care time arousing annoyance rather than empathy(Hoffman 1995).

Israeli Bedouin women undergoing cultural transition

The Bedouin Arab community in the southern part of Israel,due to enforced sedantrization, has been dealing withcultural transition in the context of gross neglect by thenational funding bodies, resulting in a decline of collectivefamily support and funds and in an externalization of socialresponsibilities to State authorities, who, as stated, investlimited resources and cultural competency in their dealingswith the Bedouin community (Kapri et al. 2002; Perez2001; Meir 1997; Barakat 1993).The consequences of thethis for female Bedouin women includes intenseinterconnected poverty, social and health problems such asdepression, anemia, difficulty accessing health care facili-ties for women, and the ensuing problems of childrenbought up in poverty and social stress (Cwikel et al. 2003).

Due to the above enforced cultural transition, children, aswell as women, have lost their financial power andtraditional roles within Bedouin society and are insteadbecoming economic burdens, and often, the central butsilent victims of this rapid cultural shift, from the positionof poverty.

Somatic reactions in women from traditional Arab cultures

Meleis et al. in Adams (1995) describes the shift of illnessbehaviors in women from traditional Arab cultures to Arabwomen within cultural transition. Illness was traditionallyperceived of as the result of the evil eye caused by thejealousy of others. The mind and body were thus notperceived of as separate, as in the Western bio-medicalmodel, but as a unified whole, and physical symptoms are acommon way of expressing personal and interpersonalproblems. Physical problems were understood as anexpression of emotional stress, for example, depressionand anxiety are often described as poor appetite, fatigue,shortness of breath, heartache, diffuse pain etc. (El-Islam1982; Racy 1980; Sofie and Solvig 2000).

Within traditional Bedouin culture, Al-Krenawi (2000),interpreting psychiatric illnesses through a cultural lens,stated that Bedouin women often express pain by embody-ing it physically; and thus the problem becomes manifestedas physical ailment rather than as a verbal definition ofconflict that can destabilize the status-quo. Empiricalinvestigations have shown that some of the commonparameters of the lives of Bedouin Arab women areassociated with high levels of somatization: polygamousmarriages, marital disharmony, and psychological distress(Al-Krenawi 2001; Al-Krenawi and Graham 2006). Bed-ouin women traditionally express pain and negotiateconflict indirectly through networks of kinship and friend-ship, avoiding direct confrontation, and contact. Forexample, a Bedouin woman can express jealousy in theform of migraines as an indirect form of conflict negotia-tion. Thus, if a woman has recurrent headaches, herhusband will understand that he has to adjust his behavior,without her having to confront his behavior directly orverbally (Tal 1995; Yamini 1996; Lewando-Hundt 1976,1978).

We see that emotions were traditionally expressed andunderstood through physical symptoms, using the body as asymbolic but embodied site for expressing pain, and thisphysical expression of emotion was an effective way tomonitor social oppression and change other’s behavior.This was described in the context of traditional cultures, butis true for women in all cultures, who have less power andthus less direct ways of expressing their needs andinfluencing their surroundings (Sofie and Solvig 2000;Soltis-Jarrett 2004).

138 E. Huss, J. Cwikel

Becker, in her study of somatization in the primary caresetting in Saudi Arabia commented on the constriction ofArab women’s personal freedom and physical mobility andhow this frustration may fuel somatization processes:

“For females in this restrictive culture, somatic com-plaints may be an accepted and traditional way ofcommunicating hidden emotional problems resultingfrom the dependency and passivity that women mustpractice. Since females are not permitted to drive,there is the further problem of access to mental healthcare, and the primary care physician may serve as theonly contact with the health care system for a womanbrought to the doctor by her husband.” pp. 964–964(Becker 2004)

Somatic reactions and cultural transition

The stress for women from traditional cultures of undergo-ing cultural transition is described: “They work hard atbalancing all the values that different entities represent, andthey work at integrating and maintaining country of originvalues. As a result, they may experience role overload,marital stress, discipline problems, and lack of supportsystems. They may cope by becoming depressed andpresent themselves to the health care system with somaticcomplaints (Meleis and Pollara 1995, p 157).

However, as shown above, within Westernized medicalsystems, somatic reactions are seen as a manipulation ormisuse of the medical system, and are not understood asspeech acts aimed at adjusting social situations to meet thewomen’s needs. Sabbagh (1997) claims that while Arabwomen may be seen as weak and thus under constantemotional pressure, within traditional culture they actuallyhave power and support from the extended family, such assupportive elders. However, when the extended family isbroken, they lose these support bases, and need to re-develop alliance with health care practitioners, which asdescribed above, is difficult if their somatic problems areseen as manipulation or misuse of the health system or isseen as a manifestation of a stigmatizing mental illness(Meleis and Pollara 1995).

This process is apparent for the single Bedouin mothersdescribed in this paper, who as stated above are undergoingintense and rapid cultural transitions, from a collective,nomadic lifestyle to an individualistic culture in permanentsettlements in Israel. They have become dependant on thehealth care systems as the natural arena for the expressionof their distress as the relative poverty increases and socialgaps grow between the haves and the have-nots. Thesetrends among the Bedouin of the Negev have resulted in theextended family’s inability to protect or support single orwidowed women as they were traditionally protected. The

rise in single women is also due to the increase inpolygamy and the abandonment of first mothers (Meir1997; Tal 1995). Conversely, impoverished, single Bedouinwomen do not have the financial means to secure housing,mobility or education, as middle class Bedouin women maydo, who are comfortable in the wider Israeli culture (Levi-Wiener 2004). The negative, physical outcomes of the socialtrends described where poverty intersects with culturaltransitions resulting marginalization of impoverished singleBedouin women has been documented high rates of healthproblems such as depression, repeated urinary tract infec-tions, gynecological problems and anemia (Cwikel et al.2003).

Symbolic forms of expression for women

We saw above, that at times of cultural transition, such asthe Bedouin women are undergoing, the culturally acceptedand effective narratives for expressing pain and powerbecome incoherent for those who cannot “afford” to enterthe new cultural narrative forms, such as Westernizedprofessional education, or to solve problems through directverbal confrontation within the public sphere (Levi-Wiener2004; Smith 2002). On this level, the impoverishedBedouin women are left without an adequate, symbolicform of expression.

Spivak describes this ‘invisibleness’ as the difficulty thatprofessionals and agencies such as health services inhearing the women, who:

“[They are] shuttled between different levels ofoppression...disappearing not into a pristine nothing-ness, but into a violent shuttling which is the displacedfiguration of third world women, caught betweentradition and modernization...” (Spivak 1993, p. 292).

Traditionally embroidery and crafts was a verbally‘silent’ but visually ‘loud’ type of expression. Embroiderythat decorates dresses is also an embodied symbolicexpression that is traditionally a non-verbal way ofexpressing status, power, and life transitions. For example,different designs and colors state the wearer’s socialposition, marital status, as well as emotional and socialstates such as being in mourning. The embroidered dress’sbright colors attract attention from others, specifically men,while also working as a charm against evil spirits,protecting important parts of the body, such as the breasts(Tal 1980; Lindisfarne-Tapper and Ingham 1997). Anotherexample is the tendency of Bedouin women and Arabculture in general to use fables, proverbs and metaphors asa way of communicating strongly but indirectly (Abu-Lughod 1993).

Symbolic expression on fabric, in comparison tosymbolic expression within the body, as in somatic

Embodied drawings as expressions of distress among impoverished single Bedouin mothers 139

reactions, can be seen as a place to express strength ratherthan of conflict, although emotional states such as mourn-ing are also depicted by wearing specific colors. However,embroidery is no longer an effective emotional outlet withinthe context of shifting societal norms. In general, theproduction of embroidery is declining due to industrializa-tion, and embroidered clothes, which are now made withone less panel, are less commonly worn by the youngergenerations (Tal 1995).

Spivak stresses the importance of symbolic forms ofexpression for impoverished women from non-Westerncultures. She claims that the place where marginalizedwomen’s ‘speech acts’ can be heard is not in historical andpolitical writings (that are male dominated), but in the areasof symbolic self expression where resistance is removedfrom reality, and thus does not threaten the central malediscourse (Spivak 1987, p. 197–219, 241–268). Art can beseen as a more effective and more empowering zone thansomatizing pain through the body, as is expressed in theliterature on art therapy below.

Art expression as an alternative symbolic zone to expresspain

As we saw in the use of embroidery, art has the potential tobecome a symbolic vehicle to express power, pain andconflict. Art, like embroidery, is non-verbal, visual, andalso can be embodied onto the page, giving an outlet otherthan the body. The art can be a ‘container’ for difficult andnegative feelings, reducing their impact on the body, incontrast to the internalization of feelings which areswallowed, or not allowed expression (Kramer 1971,2000). From a humanistic perspective, once the emotionis symbolized and expressed through a process that movesoutside of the body, it gains a set form which can then bemore easily analyzed or discussed in a group contextpromoting insight (Allen 1993).

From a feminist perspective, a group discussion of this artenables the emotion to be seen as connected to societal factorsexperienced by other women in the group, rather than as apersonal weakness. Issues can be re-defined, and understoodas socially contextualized (Hogan 1997; Liebmann 1996).From a cultural perspective, indirect or ambiguous elementsin art are socially compatible with the Bedouin culture’s useof indirect and non-verbal communication, and the use ofstorytelling, parables and sayings to express opinionsindirectly and thus do not endanger the women with directconfrontation with forces that they are dependant upon(Campbell 1999).

This paper presents the depictions of the body amongimpoverished Bedouin single mothers that are shown to besymbolic sites not only of psychic pain, but also ofstruggle, power, and the demand for social change.

Method

As stated above, this paper presents the spontaneous body-depictions of Bedouin women, showing different conceptionsof the body, as a way of expressing distress. The art presentedhere was drawn and explained in a group of single Bedouinmothers, as part of doctoral research by one of the authors (E.H.) supervised by the second author (J.C.) in a research designthat included groups of Bedouin women using art as selfexpression. The group’s participants were part of an on-goinggroup organized by the local welfare department, whichbrought outside lecturers and activities to single Bedouinwomen as part of an array of social programming provided ina social center. A Bedouin social worker trained in art alsoattended the four sessions held and facilitated and interpretedwhen needed. Each session was approximately 1 h long.

The women in the group ranged in age from 25 to 50, andall wore head covers and traditional Bedouin dress. Thegroups included from ten to 15 participants. The criteria forselecting women was as stated above. The women wereparticipants in pre-existing groups that were run by theWelfare center, and were established in order to meet thepsychosocial needs of women with multiple problems andstressors. All women were dealing with both the transitionfrom nomadic to sedentary life and with poverty. The groupswere help in a settled township in the Welfare offices.

The art sessions provided enrichment by learning a newtype of expression, and amplified the issues of concern asdefined by the women themselves. The participants drew thesubjects they wanted, and interpreted their own drawings orartwork. The women’s own words concerning what theyhoped to gain from their participation in the art group arepresented in italics below and in the rest of the article.

“I want someone to give me attention” “I want to releasetension.” “I want to get to know the other women.” “I wantto express my problems and to think of solutions.”

The sessions were thus jointly designed with the womenin accordance with their aim of using art for self expressionand problem-solving within the context of modernity.Feminist research claims that research has to be beneficialfor the participants as well as for the researcher (Hogan1997; Wolf 1992; Ried 1993; Cory and Cory 1997). Thismeant using art in a ‘diagrammic’ fashion, as a trigger forwords rather than as a central activity (Leibman 1996).Each session started with a short discussion of what eachparticipant is feeling and thinking about today. The womenthen had time to draw or sculpt, and then each womanpresented her work to the group. Clay and panda crayonswere the media utilized in the sessions.

In terms of ethical considerations, all research subjectssigned an agreement to allow their work to be used withinthe context of the research. Their desire not to have the workdisplayed outside of the group did not hinder their opportunity


to join the group in any way. Despite the presence of consentforms, it is important to note that due to the cultural norm ofcompliance with perceived authority and unfamiliarity withresearch, Bedouin women may have felt pressure to give up awish for privacy. All the pictures created were scanned onto acomputer and then returned to the women themselves. All theimages are completely anonymous and any information thatmay disclose the identity of the women through the use of theirchoice of words around the picture has been changed. As thewomen refused to be video or audio taped, the group’s socialworker transcribed the meetings into both Hebrew and Arabic.

It is important to state that arts-based research, as comparedto art therapy, does not use a psychological meta-theory. Thisresearch did not employ a psychological, interpretativeframework and thus it is theoretically closer to arts-basedresearch which uses art for self-expression rather than as anintra-psychic treatment tool (Malchiodi and Riley 1996).

Presentation of the data

The pictures were thematically analyzed by the two authorsseparately and then presented as illustrations to the variouscontent areas identified. Each picture in the following datarepresents a thematic category, divided into differentdepictions of the body as a site for cultural transition,power negations with men, intellectual development,motherhood, pain, strength and struggle. The basis of theanalyses was phenomenological rather than diagnostic, inother words, the women’s own explanation of her art workand the related themes directed the analysis, rather anydiagnostic psychological category (Betinsky 1995). Thisenables the art to be analyzed through the cultural contextaccording to the women’s own world view.

The body as a site for pain

Pain may be an emotion central to all marginalized women,and to the different types of marginalization experienced bywomen, and is, as stated, the basis for somatic reactions.The following symbols, however, were selected as express-ing and containing the pain, and the loneliness of lack ofsocial power within relationships, giving the women adescriptive voice, and pointing to their power and struggle.

For example, the tree drawn by the woman below is animage from nature, a typical subject within Arab arttraditions (Tal 1995). However, a modern narrative of beingalone was ‘poured’ into a traditional subject of, nature thatis also changed aesthetically to a lone tree, rather than to anaesthetic patterned continuum (Irving 1997).

“I drew a symbol of myself, this is me, I am a tree that isstrong and stable, and rooted in the ground, but mybranches are struggling with the wind”

Picture no. 1:

However, while there is pain, the woman defined her‘roots’ as strong. She did not become sick, but as a tree, shestruggled with difficult weather on the outside.

In another picture (not shown in the text) nature wasswapped with the embodied description of a part of thebody, still not sick but struggling against the odds. Thewoman drew a simple spiral in purple on a page with acrayon: The woman said:

“My mind is like this spiral, it goes round and round,and can find no solutions.”

The mind is working and turning, but due to theinterlocking circumstances of the women, can find nosolutions to her problem, however, it is ‘working’ and hasnot given up hope yet for a solution. Similarly, in the nextpicture, the reason for the women’s aching heart, wasdescribed as her life circumstances, rather than a weak heartor body, Thus, she was not somatizing pain, but symbol-izing it, and connecting it to social factors.

Picture no.2:“This is my heart—I drew my heart.”


“I got married at 15 and I have ten children. Themarriage started okay, and then after 2 years the problemsstarted when my brother died. My husband has anemotional problem, it can’t be fixed, and he would hit meand the children. Now it’s okay. Now I am okay, I just wantsomeone to listen to me. I have ten children but I am lonely.This is my heart, I drew my heart—my heart is the onlything I have left.”1

In all of the above examples, we saw how the tree wasstrong with roots, the mind “going around and around” andthe heart is still able to feel emotion. When pain issymbolized and expressed, then the women’s problemsolving is also utilized, through the discussion of thepictures, as in the next group.

The body as a site for integrating cultural transition

The joint discussion of the pictures enabled the definition ofproblems as social rather than physical, and also, the searchfor integrative solutions. For example in the clay processpresented below, women were trying to describe the searchfor a new shape for the impoverished Bedouin women, whocannot maintain her traditional shape, or enter into a moreWesternized shape. A woman (P 1) started to make womenfigurines out of clay, and then ruined them stating:

P 1: “I can’t make a woman, I can’t find the energy tohold the bits together.”

P 2: “We will help you—we are your friends—weknow it’s hard for you—but it will be okay.”

P 1: “No, you don’t understand.”

P 2: “We do understand, we all feel like that sometimes—you should tell us about your feelings.”

P 1: “Thank you, I appreciate your kindness.”

After the above conversation, participant P1 beganjoining her clay bits together, and while the other womenwere talking about their images, she started to add the bitstogether into a ball.

P 2: “I see it has helped put the bits of clay backtogether.”

We see that the search for the shape of a woman becomedefined and critiqued by the women themselves throughdiscussing the art products that enable them to contain, butalso to critically address their pain.

Other pictures showed traditional versus modern Bed-ouin women holding hands, creating different embodied

relationships between the traditional and the modern selves,or, in psychological terms, creating a distance between areal and an ideal self. However, in social terms, they canalso be seen as a protest against the physical inability of thewomen to enter modernity—due, to a lack in the ‘right’body, and the ‘right’ clothes (as compared to Bedouin menwho are allowed to wear Western clothes).

One woman drew a picture of a thin blond woman andstated:

“I want to be thin and blonde like this woman”.

The picture of the woman (not shown in the text butpublished in Huss and Cwikel 2007) is so thin and pale thatshe nearly disappears into the page. It was drawn by a large,brown-skinned, middle-aged Bedouin woman in traditionaldress, with a very different body type. The differencebetween the wished for (Western ideal of beauty) body andthe woman’s actual body (Bedouin ideal of beauty) wasexperienced by the women as a gap between her ideal andher real self. Illness, or disordered eating patterns can resultwhen a woman rejects her body type, which deviates from adifferent body norm than is acceptable in her culture butunappreciated in the dominant, white, Western culture(Striegel-Moore et al. 1995; Williamson 1998; Aruguete etal. 2005). Among Arab populations exposed to Westernthin, white, body types, there is a high prevalence for lowself-esteem based on body size (Ford et al. 1990; Abdollahiand Mann 2001; Jackson et al. 2003). This yearning for adifferent body type can express the difficulty of movingbetween cultures, and also having a body of the wrongcolor and shape to enter Westernized culture. This demandwas stated more directly through a proverb, placed in apicture of a woman dressing up.

“Why did God give us hands, if we cannot use them? Iwant to dress up and to be pretty.”

Within this picture (not shown in the text), the woman’shands are described as strong, but she is not allowed to use herstrength, due to social prohibitions rather than due to inherentweakness. Abu-Lughod (1998) interprets the demand toexpress sexuality as a form of rebellion. She writes:

“Even today, young Bedouin women in Egypt try toresist their elders and the kin-based forms of domina-tion they represent by embracing aspects of acommoditized sexuality—buying make up and negli-gees that carry with them both new forms of controland new freedoms” (p. 13).

Above, we saw how the drama of the difference betweenthe traditional and modern culture, is acted out within thesite of the body, in terms of shape, and clothes. TheWestern ideal body became an object of desire that cannotbe attained.

1 For a different analysis of this picture, see also Huss and Cwikel2007


The body as a site for power negations with men

Conversely, the next picture turned away from Westernbodies and clothes, back to traditional beauty, and asks forthe appreciation and protection of this traditional ‘body’.The women’s body is connected to the beauty of (Arab)nature, and symbolized through a palm tree. One womandrew a picture of an exotic palm tree.

Picture no. 3: “A woman is like a tree, if she is watered,she flourishes”

The picture places a responsibility and demand on themen, to protect the well-being of the women. The true beautyand sexuality of the women as a palm tree can only beexercised when the man protects and respects the womenwithin traditional culture. Interestingly, the women were“embodied” as trees, while the men were described as rain, acosmic element, similar to descriptions of patriarchal poweras an ‘unbound’ force that is not limited to a singleinstitution, and thus difficult to fight against (Bartkey 1988).

Here again, the women was symbolized or distanced ontothe tree, but this tree does not express pain (as in picture No.1) but rather sexual beauty. Both sexuality and pain can beseen as emotions that can disturb the status-quo and so aredistanced onto a traditional tree symbol that is associatedwith objects common in traditional art. However, due to theimpoverishment of traditional norms within the context of acultural transition, the reality is that males often do not orcannot protect women. Single women are not married offwithin the families, and not protected financially.

This is shown in a picture (not shown in text), in which awoman drew a black cloud on a white page. The cloudnearly filled the page and was without boundaries,contrasting with the example above of the palm tree thathad shapely and well defined contours.

“A Bedouin women without a man is like a black cloud”

In kinesthetic terms, the shapeless and colorless state of thecloud shows an experience of having no shape, boundaries or

definition. In psychological, diagnostic terms, the black clouddrawn above can be understood as a sign of depression(Naumburg 1966; Betinsky 1995; Lev-Wiesel and Drori 2000).

However, the interpretation offered by the woman forthis state is socially located, stating that this subjectiveexperience was created by a specific cultural reality,although all of the above female experiences may resonateas true for women in general.

Above, we see that the intersecting ‘lacks’ of aWestern body,and of the traditional protection made the women’s bodiesunable to be experienced as attractive and strong, or protected.However, the “lack” of the body did not originate from anillness, but rather from the rejection of the body by both cultures.

The body as a site for motherhood

A female role and potential function of the body, common toall classes of women is that of motherhood. However, this rolewas described as one of the most difficult situations for poorsingle mothers in terms of lack of status within the familyconstellation and severe socio-economic pressures.

One woman made a small clay statue of a mother andchild, and stated, “This is the main joy of the women—tohave children”.

However, as above, when this role is not protected by menand society, it becomes de-valued, as in the following olderwoman’s description of herself as a discarded ashtray once shehas reached menopause. “A woman who cannot havechildren anymore, is like an ashtray, empty and discarded”


This lack of protection was described in the followingpicture, in which the mother describes her helplessness inraising her son. This lack of power to intervene, leaves herisolated with her own pain, although her narrative describeshow she is constantly ‘acting’ and searching for help.

Picture no. 4 The Pain of MotherhoodShe explained her picture:

“My son had a car accident, and since then he haschanged, gone to drugs. I’ve sought help everywhere,but no one has helped me, all day I cry because mychild is lost. I gave birth to him” [crying].

The above images all expressed the pain of motherhoodwithin the context of being a vessel for having children, andthe overall devaluation of the mothering role. Sullivan(2001) describes the move to modernism in Arab states asdisempowering women through a wide range of re-education of women. As these women cannot afford tofully undergo this ‘restructuring’ or to stay behind, theybecome powerless in the eyes of their children, thesurrounding male society, and themselves.

The dialogue around the art works showed how thechildren are described as ‘lost’ to their mothers, not due tolack of love or to the women’s lack of skills but ratherbecause of the interaction of poverty, lack of status, and theloss of traditional childrearing ways which makes thewomen experience their mothering as ineffective. Thismeeting with their lack of “effectiveness” in relation tomen, and to children, is a meeting with loneliness, and withpain. However, as stated, this pain was addressed in termsof the body, with integration, struggle, and ‘strength’ ratherthan with illness, when it was allowed to be described andverbalized in a way that was distant and thus culturally safefor the women. This strength, or struggle, is shown in thelast category:

The body as site of strength and capable of dreams

In the following pictures, in opposition to a weak body, wesee how both the social, emotional, and political struggleswere embodied into an experience of a woman’s body asstrong, defined as a horse carrying burdens, climbing a steephill, showing, not only a lack of illness, but also the strengthof the body, and it’s motivation to ‘struggle’ up hills. Forexample, one woman made a small cow out of clay:

[Making a small cow out of clay]. “A woman is like acow. If the woman gives milk, it’s looked after, butafter it doesn’t give milk, it’s discarded.” [She burstsinto tears].

Another participant: [Quickly making a horse]. “Awoman is not like a cow, she is like a horse, strong,and carrying burdens on her back.”

The above dialogue around the weakness versus strengthof the female body situated the body’s rejection as from theoutside “she is discarded” although she knows that she has“inherent strengths” in that she is like a horse, carryingburdens on her back. The lack of success of these struggleswere thus all defined by the women themselves as sociallylocated problems, rather than manifestations of the wom-en’s own personal or gendered weakness. Indeed, the bodywas described as constantly climbing, staying awake, andcarrying emotional and physical burdens, showing the bodyas a zone of strength.

In another meeting, the women drew their dreams,showing on the page the spaces that they wished toinhabit. In one picture (not included in the paper) awoman drew her dream of being a teacher, ‘embodying’ itby drawing it as an actual experience. She described goingto school as a child as the happiest time of her life. Shewished to ‘climb back up the path to studies’. As a youngwoman she dreamed of becoming a teacher, but becauseshe has young children at home, formal study remainedonly a dream.

This process contrasts with somatization, in that aphysical image of the body is used to describe a potentialfuture opportunity—a “wished for” state rather than a lack.The body was her imagined self as a teacher. By daring to‘embody’ these wishes, the women resisted their lackssymbolically, pointing to their lack of resources, but also totheir potential. The body was not sick, weak or ill; it wasstrong, persevering, and trying to fulfill these dreams. Here,in direct opposition to the literature on somatic reactions,another side of the story is told, and the body was shown asthe site of resistance, rather than of just a canvas on whichto paint distress and pain. However, the struggle to fulfilldreams is painful, in that it is ineffective, but in keepingwith the emphasis in feminist therapy women were able tolocate their problems as a lack of social power andresources and not something inherent in themselves. Buteven though it was not expressed as a personal, gendered orphysical weakness, they did not yet define their struggle asa united struggle, and thus each woman was isolated andexperienced their outcomes as weak. One solution is thediscussion of these feelings within the group setting,enabling them to envision a different future, and open thedoors to possibilities for change, rather than succumbing tothe isolation of constant struggle with limited resources.

Discussion and summary

The pictures presented here demonstrate how the woman’sbody is consistently described as an arena where anongoing struggle is staged. Impoverished, single Bedouinwomen are constantly battling the hardships of their daily


lives. This struggle is symbolized as the tree against thewind, the mind spinning around in hopes of a solution, thewoman’s demand to use their hands, to emulate modernwomen, to gain protection and appreciation for themselvesand their children. Thus, the body is constantly workingand struggling, although it does not have the social strengthand status to sustain real, social change.

The women above described their pain and their strengththrough different types of symbols of bodies and clothesand movements. Their legs struggled up hills, their mindsspiraled with problems and their hearts ached. Their bodywas experienced as merely a vessel for children, or as thewrong type of body to attract males, or, as beautiful as adate tree, and able to climb up hills and to protect children.They indirectly demanded the right to wear Westernizedclothes, to pursue an education, as ways to enter modernity,or conversely, the traditional right for a man’s protectionand appreciation of them as Arab women. The body wasrevealed as both suffering and struggling, as a site for eithersplitting or integrating traditional and modern conceptionsof femininity. In other words the “shape” of the women,their abilities, strengths, and weaknesses, struggled to shiftand not be left behind, not become fragmented, invisible,displaced, or sick, within the rapid cultural transitions soapparent among Israeli Bedouin culture of today (Al-Krenawi and Graham 2000; Cwikel et al. 2003).

We saw how the group discussion of the embodiedpictures enabled the exploration of new symbolic outlets,enabling the women to “hold the pieces of herself together”in the face of extreme cultural and financial marginalizationin the throes of rapid social change. The use of a symbolicoutlet helped to create a transitional space for the women’sexperience of transition, in which this struggle againstdisplacement, fragmentation, invisibility, or sickness wasexpressed with other women and re-defined as social ratherthan inherent, as in feminist therapy in other settings(Saulnier 1996).

While the limitation of this paper is that it did notactually intervene with Bedouin women with diagnosedsomatoform disorders, or engage in long-term social actionto really fulfill the empowering potential of the abovemeetings, it shows how the women chose to express theirstrength and struggles through both the creation of art andthrough talking about their art. These group dialoguesembodied depictions and symbolic representations of theirbodies.

In the tradition of arts-based research, the above picturesdemonstrate the inherent potential of art expression forwomen from a traditional culture, pointing to the use of anvisual medium as effective in accessing the embodiedexperiences of women and their shifting ‘shape’ from theposition of cultural transition and poverty. Thus, the artmakes the pain audible and tangible to others without

leaving that woman or the audience holding onto thedistress which is then somatatized, as described in theopening quote, where the pain enters the mother’s body andmakes her ill:

“... I can’t tell my mother how I feel, it would makeher ill” (Single Bedouin Mother)

They experienced emotions, dilemmas and struggleswithin the body, and the art enabled this type of experienceto be communicated both to the self and to others. As Jonesin Hogan states:

“For women, in contrast to the linguistic tradition, artoffers a means of expression which is less readily malein its vocabulary, and is therefore more readily open toand able to reference the true experience of thewomen... The image may speak for itself, reducingthe possibility of the artist client being spoken over”(Jones, in Hogan 2003, p.75).

We end with a series of quotes from the womenthemselves, describing the group art experience andpointing to the potential for art to counteract stress:

– “For me, it was fun to learn something new, andespecially to ventilate my frustrations. I have a lot offrustrations as a single mother.”

– “Drawing is fun, it’s calming, it’s expressive—thecolors, the textures. It’s enriching, makes the time lessboring; we didn’t do this stuff as children. The olderwomen, even more, didn’t do this stuff, they had veryhard lives, lighting fires, dragging water. They workedall the time; they didn’t have time for fun things likethis. They had pain, of course they had pain, but theywould hide it. They hid their pain. They were a lot withthemselves, alone.”

– “I loved drawing, I liked the group, and it was a stronggroup. We spoke about everything. We didn’t sit in thegroup in silence, but everyone talked; we had the sameproblems.”

– “Drawing helps you understand what’s going on inside,it lets you get out of the circle you’re stuck in. It helpsyou think how to get out of that circle. Lots ofpsychologists and social workers have worked withme since my divorce, and drawing helped me morethan all the talking, to think how to get out of thatnarrow spiral you’re caught in going round andround.” (Bedouin women from the groups).

Acknowledgements The authors would like to thank the groupparticipants for their candor and creativity and the anonymousreviewers for helpful suggestions on the manuscript.


References

Abdollahi P, Mann T (2001) Eating disorder symptoms and bodyimage concerns in Iran: comparisons between Iranian women inIran and in America. Int J Eat Disorders 30(3):259–268

Abu-Lughod L (1993) Writing women’s worlds: Bedouin stories.University of California Press, Berkeley

Abu-Lughod L (1998) Re-making women: feminism and modernity inthe Middle East. Princeton University Press, Princeton

Adams DL (1995) Health issues for women of color. A culturaldiversity perspective. Sage, Thousand Oaks

Al-Krenawi A (2000) Ethno-psychiatry among the Bedouin–Arab ofthe Negev. HaMeuchad, Tel Aviv

Al-Krenawi A (2001) Women from polygamous and monogamousmarriages in an out-patient psychiatric clinic. Transcult Psychi-atry 38(2):187–199

Al-Krenawi A, Graham JR (2000) Culturally sensitive social workpractice with Arab clients in mental health settings. Health SocWork 25(1):9–22

Al-Krenawi A, Graham JR (2006) A comparison of family function-ing, life and marital satisfaction, and mental health of women inpolygamous and monogamous marriages. Int J Soc Psychiatry 52(1):5–17

Allan P (1993) Art is a way of knowing. Shambhala, BostonAnsseau M, Dierick M et al (2004) High prevalence of mental

disorders in primary care. J Affect Disord 78(1):49–55Aruguete MS, DeBord KA, Yates A, Edman J (2005) Ethnic and

gender differences in eating attitudes among black and whitecollege students. Eat Behav 6(4):328–336

Barakat H (1993) The Arab world, society, culture and state.University of California Press, Los Angeles

Bartkey S (1988) Foucault, feminism and the modernization ofpatriarchal power. In: Diamond I, Quinby L (eds) Foucault andfeminism: Reflections of resistance. Northeastern UniversityPress, Boston

Becker SM (2004) Detection of somatization and depression inprimary care in Saudi Arabia. Soc Psychiatry Psychiatr Epide-miol 39(12):962–966

Becker SM, Al Zaid K, Faris A (2002) Screening for somatization anddepression in Saudi Arabia: a validation study of the PHQ inprimary care. Int J Psychiatry Med 32(3):271–283

Betinsky M (1995) What do you See? Phenomenology of therapeuticart experience. Kingsley, London, pp 15–27

Burhansstipanov L (1995) Health issues for women of color. In:Adams DL (ed) A cultural diversity perspective, Chap. 1. Sage,Thousand Oaks, pp 5–8

Campbell J (ed) (1999) In: Art therapy, race and culture. Kingsley,Philadelphia

Cory M, Cory G (1997) Groups, processes and practice. Clairmont,New York

Cwikel J, Lev-Weisel R, Al-Krenawi A (2003) The physical andpsychosocial health of Bedouin-Arab women of the Negev areaof Israel: The impact of high fertility and pervasive domesticviolence. Violence Against Women 9(2):240–257

De Gucht V, Fischler B (2002) Somatization: A critical review ofconceptual and methodological issues. Psychosomatics 43(1):1–9

El-Islam E (1982) Overview: Arabic cultural psychiatry. TranscultPsychiatr Res Rev 19:5–24

Escobar JI, Waitzkin H, Silver RC, Gara M, Holman A (1998)Abridged somatization: a study in primary care. Psychosom Med60(4):466–472

Ford KA, Dolan BM, Evans C (1990) Cultural factors in the eatingdisorders: a study of body shape preferences of Arab students. JPsychosom Res 34(5):501–507

GlenMaye L (1998) Empowerment of women. In: Gutierrez LM,Parsons RJ, Cox EO (eds) Empowerment in social work practice.Brooks, Pacific Grove, pp 29–51

Gureje O, Obikoya B (1992) Somatization in primary care: pattern andcorrelates in a clinic in Nigeria. Acta Psychiatr Scand 86(3):223–227

Gureje O, Simon GE, Ustun B, Goldberg DP (1997) Somatization incross-cultural perspective: a World Health Organization study inprimary care. Am J Psychiat 154(7):989–995

Hoffman E (1995) Our health, our lives. Pocket, New York, pp 7–18Hogan S (1997) Feminist approaches to art therapy. Routledge, LondonHogan S (2003) Gender issues in art therapy. Kingsley, LondonHuss E, Cwikel J (2007) Houses, swimming pools, and thin blond

women: Arts based research through a critical lens withimpoverished Bedouin women in Israel. Qual Inq 20(10):9–39

Irving R (1997) Islamic art in context. Abrams, New YorkJackson RT, Rashed M, Saad-eldin R (2003) Rural urban differences

in weight, body image, and dieting behavior among adolescentEgyptian schoolgirls. Int J Food Sci Nutr 54(1):1–11

Johnson D, Grand I (1997) The body in psychotherapy. North AtlanticBooks, Berkeley

Kapri H, Roznik R, Budekat B (2002) Welfare services in theunrecognized settlements. Israeli Ministry of Welfare, StudyProject (Hebrew). Israeli Ministry of Welfare, Jerusalem

Kramer E (1971) Art therapy with children. Schoken, New YorkKramer E (2000) Art as therapy. Kingsley, LondonLev-Wiesel R, Drori E (2000) The effects of social status upon the

self-concept of elderly widows and wives assessed by humanfigure drawings. Arts Psychother 27(4):262–163

Levi-Wiener N (2004) In between two worlds: a narrative analysis ofthe Druze women and higher education. Paper read at theConference on Psycho-Social Challenges of Indigenous Socie-ties: The Bedouin Perspective, July 2004. Ben-Gurion Universityof the Negev, Negev

Lewando-Hundt G (1976) Conflict styles between Bedouin women.Notes on the Bedouin, vol. 7. Sdeh Boker Field SchoolPublication, Sdeh Boker

Lewando-Hundt G (1978) Women’s power and settlement: The effectof settlement on the positions of Negev Bedouin women. Thesisfor the degree of Doctorate of philosophy. Faculty of Anthropol-ogy, University of Edinburgh, Edinburgh

Liebman M (1996) Arts approaches to conflict. Kingsley, LondonLindisfarne-Tapper T, Ingham B (1997) Languages of dress in the

Middle East. Curzon, EnglandMalchiodi C, Riley S (1996) Supervision and related issues. Magnolia

Street, ChicagoMayou R (1993) Somatization. Psychother Psychosom 59(2):69–83Mayou R, Kirmayer L, Sharpe M (2005) Somatoform disorders: time

for a new approach in DSM-V. American Psychiatric Associa-tion. Am J Pscyhiatry 162:847–855

Mazis G (1994) Emotion and embodiment: Fragile ontology. Lang,New York

Meir A (1997) As nomadism ends. Westview, ColoradoMeleis AI, Pollara MH (1995) Arab Middle Eastern American

women, stereotyped, invisible, but powerful. In: Adams D (ed)Health issues for women of color. A cultural diversity perspec-tive, Chap 9. Sage, Thousand Oaks, pp 133–164

Naumburg M (1966) Dynamically oriented art therapy. Gune andStratton, New York

Perez H (2001) My skin is my only protection. Notes on the Bedouin,vol. 34. Sdeh Boker Field School Publication, Sdeh Boker

Pollio DE, McDonald SM, North CS (1996) Combining a strengths-based approach and feminist theory in group work with persons‘on the streets’. Soc Work Groups 19(3/4):5–20

Racy J (1980) Somatization in Saudi women: A therapeutic challenge.Br J Psychiatry 137:212–216


Ried P (1993) Poor women in psychological research: Shut up andshut out. Psychol Women Q 17:133–150

Sabbagh S (1997) Arab women. Olive Branch, BrooklineSaulnier C (1996) Feminist theories and social work. Haworth, NewYorkSelva P (2006) Emotional processing in the treatment of psychoso-

matic disorders. J Clin Psychol 62(5):539–550Silverstein M (2007) Disorder of self and somatic reality. A personality

guided approach. APA, Washington, D.C., pp 233–247Smith D (2002) Institutional ethnography. In: May T (ed) Qualitative

research in action. Sage, London, pp 17–53Sofie B, Solvig E (2000) Turkish migrant women encountering health

care in Stockholm: a qualitative study of somatization and illnessmeaning. Cult Med Psychiatry 24(4):431–452

Soltis-Jarrett V (2004) Interactionality: willfully extending theboundaries of participatory research in psychiatric-mental healthnursing. Adv Nurs Sci 27(4):316–329

Spivak GC (1987) In other worlds: essays in cultural politics.Menthuen, New York

Spivak GC (1993) Interview with Spivak: Subaltern Talk-concerningSati 29th October 1993. In: Laudry D, Mclean G (eds) TheSpivak Reader. Routledge, London, pp 287–308

Staub-Bernasconi S (1991) Social action, empowerment and social work—an integrative theoretical framework for social work and socialwork with groups. Social Action in Group Work 14(3):35–51

Striegel-Moore RH, Schreiber GB, Pike KM, Wilfley DE (1995)Drive for thinness in black and white preadolescent girls. Int JEat Disord 18(1):59–69

Sullivan G (2001) Artistic thinking as trans-cognitive practice: Areconciliation of the process-product dichotomy. Vis Arts Res 27(1):2–12

Tal S (1980) The embroidered dress of the Bedouin women in theNegev. Bedouin Studies Magazine 30

Tal S (1995) The Bedouin women in the Negev in time of changes.Joe Alon Center for Bedouin Culture, Negev Hebrew

Thompson R (2006) Is there a psychosomatic approach. J PsychosomRes 61(3):371–429

Williamson L (1998) Eating disorders and the cultural forces behindthe drive for thinness: are African American women reallyprotected. Soc Work Health Care 28(1):61–73

Wolf M (1992) A thrice told tale. Feminism, postmodernism andethnographic responsibility. Stanford University Press, Stanford

Yamini M (1996) Feminism and Islam. Garnet, London


embodied drawings as expressions of distress among impoverished single bedouin mothers

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