In an art therapy session four years ago, Chris Stowe was given a blank mask and was encouraged to paint, cut, or add to it to create "a story about what I felt inside."
Stowe sustained a traumatic brain injury during his deployment in Iraq from 2003 to 2005 as an explosive ordnance disposal technician in the Marine Corps. He was hit by shards of glass from explosions.
"I was having anger outbursts," said the 43-year-old from Warren, Ohio. "I was having a hard time with my speech and balance because of the TBI."
In 2014, he participated in an art therapy class and created a mask that represented a person divided. Half is "just a normal person that may be sad sometimes," and the other half shows a demon-like face with bees poking out of the eye and mouth.
"The best way I've been able to explain [the feeling of PTSD] is like someone took the world's biggest beehive and put it in my chest," Stowe said. "Sometimes it's quiet. But if someone bumps into it, it becomes active and buzzing."
Stowe is among the 1,500 active-duty service members who participated in an eight-year study that sought to identify service members' mental health conditions through art therapy.
The study, published in June, was led by Girija Kaimal, an assistant professor at Drexel University's College of Nursing and Health Professions, and Melissa Walker, healing arts program coordinator at the Walter Reed National Military Medical Center's National Intrepid Center of Excellence (NICoE) in Maryland.
The four-week intensive outpatient program at NICoE, which included art therapy, psychiatry, and physical therapy, began in 2010. During the first week of the program, the service members complete a survey about their mental health and then are asked to create masks that represent their feelings.
"Art therapy has helped many populations address their struggles through self-expression," Kaimal said. "It is a form of psychotherapy applicable to anyone facing psychosocial struggles and/or seeking ways to enhance health and well-being."
Kaimal and her team of researchers analyzed the symbolism and imagery of 370 masks. Over a quarter of the service members who made masks reflecting psychological injury — such as being unable to speak — reported suffering from severe PTSD. Service members whose masks showed fragmented military symbols — like a torn American flag — reported higher anxiety.
For example, in Stowe's mask, researchers identified "two aspects of self, representations of sadness, and injuries — physical and psychological," Kaimal said.
However, masks with images of military unit identity — such as including the crab-like symbol of the explosive ordnance disposal badge — or nature-related imagery correlated with lower levels of PTSD and depression.
At the end of the first week, clinical notes by the art therapist reflected that at least a third of the participants enjoyed the art therapy, 19 percent said it helped with focus, and 14 percent said it allowed them to relax.
One in five participants said art therapy helped them to socialize and open up about their injuries, treatment, and other difficulties.
"What the artwork created in art therapy helps with is putting a visual representation to the inner struggles of recovering service members — humanizing and helping us 'see' their experiences," Kaimal said. "Being able to express, communicate, and share their authentic experiences is an important component of getting appropriate treatment and clinical care."
"I think that's what makes it intimidating for a lot of people," Stowe said. "It's super intimate and kind of scary."
Stowe, who retired from the Marine Corps in 2016, now lives in Tampa, Fla., and works as the director of school safety for a county school system.
On Sundays, he leads a four-hour glassblowing workshop for service members and veterans. He finds that often, those hesitant to try other forms of art therapy enjoy glassblowing.
It's "molten glass at the end of a rod," he said. "It's heavy; it's loud. They don't realize they're doing art."
Stowe hopes his work will lessen the stigma active-duty service members face when seeking mental health help.
He was diagnosed with post-traumatic stress disorder, anxiety, and depression in 2007, but didn't seek treatment until two years later.
Service members "don't like to see when someone's hurt," Stowe said. "If they don't go on a deployment because they're getting treatment, it could mess up promotions."
That's why he is focusing on helping himself and other soldiers heal through art therapy.