Theatrical expression is an ancient tradition and has taken on countless forms and purposes throughout history. The purpose of this Open Forum is to outline how theatrical activities can serve as a catalyst for positive personal and social change for people living with psychiatric disabilities. Given the lack of previous research in this area, this Open Forum essay is intended to provide an initial framework upon which future discussion and study can be based. We begin with a summary of ways in which the theatrical and mental health arenas have historically overlapped, particularly in community-based theater settings. Next, we highlight a set of key elements of theater that can serve to improve the lives of people with psychiatric disabilities. We conclude with a set of recommendations for future theory and research.
The union of theatrical expression and clinical psychology is perhaps best known in the context of the traditions of psychodrama and drama therapy (1). Drama therapy has theoretical roots spanning a wide array of psychological and sociological orientations, including psychoanalysis, developmental psychology, object relations theory, symbolic interaction theory, and humanistic approaches (1). In psychotherapy, drama is used as a way to enhance self-esteem and self-knowledge, explore and process traumatic events, bolster creative problem-solving skills, and treat personality disorders and mood disorders (2,3). However, the power of theater may also manifest in its ability to challenge stereotypes about mental illness and to provide valued social roles to individuals coping with psychiatric disabilities.
One of the ways that citizens with a variety of marginalized social identities come together to be heard and influence their communities is through "applied," or what we classify as "community-based," theater (4,5). An important distinction exists between what is commonly known as "community" or "amateur" theater within the United States, and theatrical settings that can be classified as "community-based theater." Both of these settings may include amateur actors, but "community-based theater" is a form of grassroots theater that specifically promotes a political or social discourse based on issues relevant to the local community or society at large. In contrast "amateur," "community," or "regional" theater companies generally mimic professional theater settings, offer performance and technical theater opportunities for nonprofessional artists, tend to produce established and well-known plays, and are primarily focused on entertainment value and financial sustainability.
Community-based theater is a form of sociopolitical theater that takes a critical position toward social issues, often focuses on creating original works, aims to raise awareness, and works to alleviate social frustrations and conflict. This form of theater functions from a community-citizen empowerment and social justice perspective and is designed to be inclusive (4). Community-based theater activities often exist outside mainstream theater institutions and are intended to benefit not only individual participants but also communities and societies (5). These are interdisciplinary and hybrid practices based within a wide variety of contexts around the world. Community-based theater projects emphasize the dialogical nature and ongoing process of creating empowering workshops and performances. These are often grounded in established theoretical or logistical structures, such as Playback Theater, Sociodrama, Theatre of the Oppressed, or Agit-Prop Theater.
Community-based theater programs are sometimes found in traditional "playhouse" settings but can also be associated with community arts initiatives, public health programs, or established social service programs. Community-based theater initiatives take many forms. Some are focused on organizing and maintaining a troupe of actors and writers who remain together for several years. Other initiatives may be more time limited and culminate in a single performance for the local community, an agency, community group, or specific population. Mental health issues, poverty, HIV or drug-use prevention, domestic violence, women's rights, disability rights, and war veteran readjustment are just a few of the issues that community-based theater projects have addressed around the world.
One burgeoning community-based theater setting involves people living with psychiatric disabilities. For example, people with psychiatric disabilities are currently involved in community partnerships between local theater companies and psychosocial rehabilitation clubhouses. In one model of such a partnership, members of a clubhouse can participate in a theater troupe that creates original scripted performances designed to educate audiences about mental health issues and fight stigma surrounding mental illness (6). The artistic and managing directors of these troupes are often trained, paid staff of a mental heath organization or local theater company; however, troupe members are involved in all aspects of script writing, performing, and production. Rehearsal and performance space may be offered by a mental health service agency partner, a local amateur or professional theater company, or a city or state human services agency. Fiscal support for community-based theater is at times funded by a grant or an agency, but many groups are self-supported through donations or ticket sales.
Community-based theater activities involving people living with psychiatric disabilities exist along a spectrum—at one end the activities are completely organized, maintained, and financed within a mental health service agency or psychiatric rehabilitation program; at the other they exist completely independently from a mental health agency. Although there is little systematic understanding of the impact of community-based theater for this population, research has highlighted positive psychological and social outcomes of theater projects in nontreatment settings with such groups as marginalized women (5) and students (7). Previous research with both directors and actors in community-based theater groups involving people living with mental illness has identified several critical themes. These themes include the development of a sense of empowerment and personal gains among troupe members, challenges to sustainability of the troupe, relationships between agency or community gatekeepers and troupe members, and development of autonomy and ownership by troupe members with psychiatric disabilities (8).
After reviewing the literature addressing recovery processes, mutual support, and community integration, we found several core components of theater that can contribute to positive change for people with psychiatric disabilities at both personal and community levels. These core elements of theater include processes of group cohesion and affiliation, common goals, common experiences, setting characteristics of openness and inclusion, opportunities for community connections and integration, flexibility, and ownership.
Community-based theater involves a sense of group cohesion and affiliation, and it can offer opportunities for actors living with psychiatric disabilities to feel that they are valued members of a group. Group work in theater involves various socially cohesive forces, including trust, risk taking, safety, and teamwork (4). As the group works together creatively, individual members may feel growth in their identity as a creative person and discover that they are capable of helping other members succeed. Theater thus creates an opportunity to play a valued social role in helping others. Valued roles can be especially powerful for adults with psychiatric disabilities, because they are generally marginalized and often face constant implicit and explicit reminders that they are not part of community life. Group membership and a sense of affiliation contribute to growth processes in the lives of people with psychiatric disabilities. Furthermore, group involvement can lead to decreased isolation and increased social cohesion and has been found to have a positive impact on recovery from mental illness (9).
Another fundamental element of theatrical activities is a sense of common goals, whether the dramatic activities are structured (such as rehearsal and performance of a scripted play) or are more improvisational and unstructured. In a more structured context, the common goal may be making a high-quality presentation for an audience by the opening night of performance. In unstructured contexts, with a focus on play and exploration, the common goal may be openness to the creative moment (4) or challenging the other actors on stage. Previous research on group empowerment processes for people living with mental illness have highlighted the importance of having common goals and visions of the future (10).
Another powerful component of community-based theater is the sharing of common experiences. Theater groups focused on examining social issues through their works often share common experiences in their day-to-day lives that relate to these issues. Theatrical endeavors may address the participants' common experiences in regard to such issues as stigma, hospitalization, and navigating mental health services. The commonalities in the lived experience of actors with psychiatric disabilities may serve a mutually supportive function, creating an environment where personal change processes can occur and group empowerment is enhanced.
Theatrical settings may also foster an expanded sense of self for participants when those settings are focused on openness and inclusion. Many grassroots and community-based theater initiatives are fundamentally designed to be inclusive and accessible to community members. Research on recovery processes highlights how sense of self can be affected by the situational opportunities that help one activate and acknowledge personal strengths (11). Here, theater offers a bridge between personal development and community integration for people with psychiatric disabilities. The inclusive nature of the setting connects person to community, and personal identity to community identity.
Dramatic exploration is naturally flexible. As an actor develops a character or as the physical movements of the actors in a scene are blocked out, a process of trial and error occurs. This process offers opportunities to develop problem-solving skills and creates an atmosphere where it is safe and acceptable to make mistakes. Mental health challenges have a tendency to interrupt the flow of daily living. Thus many people with severe mental difficulties have trouble finding settings where structural flexibility exists and where their efforts are adequately supported. Previous studies of people with psychiatric disabilities in academic and employment settings have emphasized the importance of structural flexibility. Community-based theater can act as a unique setting that offers actors with disabilities critical accommodation and flexibility.
Finally, the issue of ownership in theatrical activities relates to both personal and social change processes. An actor who copes with psychiatric disabilities may feel a sense of personal ownership in dramatic activities at several levels—in the particular character she or he is playing on stage and at a broader organizational level, toward the theater troupe of which she or he is a member. This sense of personal ownership may enhance self-efficacy and pride in the creative activities. To the extent that a theatrical group involving people with psychiatric disabilities is situated in a larger community context, the group ownership of the troupe may enhance a feeling of community integration as well.
When studying the outcomes and impact of theatrical activities involving people with psychiatric disabilities, researchers would do well to consider the lived experiences of the actors and the varied contexts of the settings. Both quantitative and qualitative studies could focus on the influence of theatrical expression on outcome variables such as sense of self, community integration, and quality of life. In addition, employment status, membership in other mutual-aid groups, and involvement with mental health services could be incorporated into research on community-based theater settings involving this population. Moreover, studies of community-based theater settings need to go beyond the investigation of individual outcomes and investigate the impact of activities and performances at the community level as well.
Public attitudes about mental illness are often shaped by negative, stereotypical, and unrealistic portrayals in popular media. Theatrical arts involving people with psychiatric disabilities may offer communities a more balanced and realistic portrait of mental illness. Audience members are offered the opportunity to have personal contact with the actors and view them in a valued social role, which can decrease stigmatizing attitudes. A decrease in stigmatizing attitudes after witnessing theatrical performance by and about people with psychiatric disabilities has been demonstrated in the case of college student audiences (6). Future research could help elucidate complexities of local factors related to theatrical initiatives, shed light on setting and organizational constraints, and help facilitators tailor future initiatives more adroitly.
The core ingredients of theatrical activities highlighted here offer exciting opportunities for personal growth, as well as community integration and advocacy for citizens with psychiatric disabilities. As therapeutic services in community-action settings expand, collaboration among consumers, artists, and mental health professionals can harness the power of theater to enhance both personal growth and societal change.