By Cinder Hypki with Rhonda S. Cooper and Louise Knight

Introduction

As a community artist and activist living in Baltimore, Maryland, I have struggled with the undeniable fact that many of the youth I have worked with over the years in marginalized inner-city neighborhoods have experienced the loss of a loved one due to violence—much of it drug-related, sudden and random. From East Baltimore to West Baltimore, from McElderry Park to Harlem Park children have shared a litany of loss: "my uncle," "my brother," "my cousin," "my boo"…. In the 24 years that I have lived in Baltimore the political winds have carried ever-changing law-enforcement strategies for reducing violent crime—with little effect.

Throughout the City, organized responses to the homicide rate vary. The faith community is the leading force behind prayer vigils marking the site of murders and other efforts to end the violence, like the United Methodist Congregation's Hope for the City initiative. Current efforts like the Health Department's Safe Streets campaign aim to galvanize citizen participation within neighborhoods suffering the most by targeting at-risk youth ages 14-25 with messages like "Stop Shooting, Start Living." Baltimoreans United in Leadership Development's (BUILD) new Raise Our City/Raise Our Youth organizing campaign calls on city leaders and citizens to invest equally in both "downtown" and "uptown." By creating better schools, recreation and job opportunities for young people, proponents reason that youth will have real alternatives to the powerful cycle of violence on the streets.

After 18 years of a community arts practice that has served many community issues, I have begun to explore the potential of ritual and the power of collaborative art making as a response to violence. In providing aesthetic and spiritual tools for transcending loss, art offers a collective means for healing, celebrating the lives of those lost and strengthening individual and community resolve to keep living fully and working to prevent future violence. Poetry and visual art have become the tiles that I bring to the collective mosaic of empowering change.

It is from this frame of reference that I was intrigued by and accepted the invitation of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins to create an artistic "focal point" for a service of remembrance serving the family members of cancer patients who had died of their disease, either in the hospital or after their discharge to home or hospice. My work with the staff, including collaborators Rhonda Cooper, the Cancer Center's Chaplain, and Louise Knight, the Center's Director of The Harry J. Duffey Family Patient and Family Services Program, began with a shared exploration into the meaning and dynamics of ritual. It culminated in a collaboration that resulted in the design and implementation of the inaugural Service of Remembrance on May 20, 2010.

I entered the collaboration keen to explore the contributions I might make as part of an interdisciplinary team that was designing ritual elements for the Service. The work itself also engendered my intense interest in learning more about the many possible uses of ritual in individual and community grieving experiences. Ultimately, the authors held a re-staging of the Ritual of Remembrance at the Community Arts Convening held in Baltimore, March 2011, at the Maryland Institute College of Art. Each experience built upon the one before, illuminating the path forward and leading me to a host of lessons learned.

During the Convening, I also presented a related project looking at community-level healing with Sandi McFadden, a community leader, educator and activist from the Mid-Govans neighborhood of Baltimore. Sandi had requested my help creating a Memorial Garden in honor of a beloved City Councilman, Kenneth Harris, who was slain in a random act of violence in September 2008. My goal was to bring the collective wisdom and experience of community cultural workers from across the country to bear both on the creation of the Mid-Govans memorial space and as an interactive case study addressing the "global" importance of ritual in community.

The confluence of these two endeavors and the coming together of four professionals in fields as varied as chaplaincy/spiritual counseling, social work, community/youth development and community art did not strike me as a "coincidence" but as an opportunity to shine a light on the following questions: How might collaborative art making within the context of meaningful ritual assist bereaved individuals and groups to heal from their individual and collective loss? What elements might be common to the loss of a loved one after a struggle with cancer and a loss due to sudden violent circumstances? Do rituals of remembrance and healing have the potential to both support individuals and empower groups to strengthen their resolve to carry on in the aftermath of loss and to ensure against future losses? Are rituals essential catalysts for individual and community change? What are some "best practices" that a community cultural worker might incorporate into their ritual practices in community?

This paper considers these questions by examining the use of ritual in grieving and healing processes through different perspectives from the fields of my co-authors and myself. My growing interest in exploring collaborative art-based projects as part of communal healing practices responding to violence provides the point of departure for our inquiry. I locate this investigation within the broad context of rituals used by other practitioners, in varied forms of practice in the U.S. and elsewhere, for healing, grieving and raising awareness of social-justice issues surrounding loss.

The writing of the paper was truly a collaborative effort of the authors, with each contributing significant parts of the story. For this publication, we highlight the contributions of the artist (myself) so that much of the story will be told largely through my eyes and therefore in first person. For the case presentation and section on additional perspectives from the other two authors' fields, i.e., chaplaincy and social work, the third person is used.

The case study presents my practice in designing specific aspects of the Service of Remembrance, a healing ritual, in collaboration with the Cancer Center staff. Following the case presentation, I speak as the artist about the design and implementation of these elements. For the conclusion, although again, a truly collaborative effort, the tense is first person, as through the eyes of an artist, the primary readership of this publication.

Perspectives on Ritual and Loss in Community Arts

…ritual is called for because our soul communicates things to us that the body translates as need, or want, or absence. So we enter ritual to respond to the call of the soul. —Malidoma Patrice Somé

Ritual is commonly defined as "a religious or solemn ceremony consisting of a series of actions performed according to a prescribed order" (Oxford American Dictionary, online edition). I will use the armature of this definition to distinguish my investigation from quotidian practices like brushing one's teeth or taking a walk each morning—noting that solemnity may sometimes be replaced with joyful acts depending on the occasion. On this armature, I will add Somé's concept of a spiritual impetus for ritual that stems from his West African roots.

As a "response to the call of the soul," ritual can help to fulfill the desire to grieve and to make meaning of loss. "Rituals empower people emotionally, mentally and spiritually" (Zulli 261). Ritual provides the intentionality of a thoughtfully designed "space," "moment" or "practice" in which to galvanize a resolve to transform ourselves and our community in the face of violence that creates "need, want or absence." The physical manifestations of the ritual possess an artistic/aesthetic component that is intimately linked to a commonality found within a group of people. However diverse this group may be, it may be considered a "community" for this period of time. Within this tangible or metaphorical community can be found a power, a unity from which individuals may derive comfort and strength. In speaking of funeral rituals, for example, Kollar states: "The community…should find its deeply felt grief and desire to help engrained in the ritual action" (273).

The powerful symbolic and metaphorical nature of ritual is a compelling "medium" unto itself for community artists and cultural workers. "Performance artists" and artist-activists often use elements of ritual to engage and involve audiences or groups in ways that are meaningful, provocative, motivational and even life-changing. But unlike the individualistic, self-referential practices of many "high art" artists, community-based, arts-based ritual is at its most powerful when it emerges from or is designed to reflect the history, traditions, culture or struggles, goals and aspirations of specific groups of people. Ritual both builds and presupposes community; its symbols have the ability to bring the members of the group together in a shared experience (Kollar). "Healing rituals empower the dying and the bereaved to move from the fragmented, alienating and disorienting consequences of change to a renewed sense of wholeness" (Zulli 262).

A search for examples of rituals using art for healing led to research about and interviews with community arts colleagues. My request for examples was met with an overwhelmingly positive response. I can only conjecture that artists who have found power, comfort, joy and healing in the creative process are eager to share with others. Consider a few examples drawn from an expansive body of practice:

• Joan Gaither, professor emeritus at the Maryland Institute College of Art, pieces together "healing acts" one stitch at a time, leading family and community quilt-making sessions rooted in her African-American ancestry. Gaither's quilts incorporate keepsakes, mementos and other artifacts of lives and lifestyles that are past or vanishing -- redefining community unity and pride for both celebration and healing. Drawing on traditions that echo back to the days of slavery, Gaither's work references historical rituals of collaborative art-making that summon community cohesion in the face of unspeakable hardship and loss. These quilts are also stunningly beautiful!
• Community arts elder Amalia Mesa-Bains draws on her Mexicana/Latina heritage in her work of creating ofrendas/altars/offerings and other installations to memorialize loved ones and to re-create Day of the Dead rituals in ways that explore and reinvigorate rich cultural traditions and the long history of creative resistance to colonization and oppression. "The central quality of Day of the Dead is the act of remembrance. It is a reenactment of the most cherished memories and love that you felt" (Mesa-Bains, 2009).
  
  Mesa-Bains' creation of "memorial spaces" in ritual work teaches new generations of community artists to understand their pasts through traditional bereavement rituals. Simultaneously, she models the use of contemporary art making to both personalize the grieving process and to question current injustices and challenges faced by the Latino/a community. Like Gaither, her installations open the way for the consideration of the spiritual within community cultural work (Mesa-Bains, 1998, 1993).
• Brazilian artist Rivane Neuenschwander's social sculpture installation I Wish Your Wish" at the New Museum in New York in June of 2010, while not directly aimed at the bereaved, invites strangers entering a traditional art gallery to be inspired by and become the keeper of another's dreams and hopes. This elegant exchange between strangers centers on a set of wishes solicited from the public online and at earlier exhibitions, printed on multicolored ribbons and hung by the thousands on the gallery walls. Participants were asked to take a wish that they found compelling, replace it with their own wish jotted on a piece of paper, and wear it on their wrist until it fell off, at which time their unseen "partner's" wish would be granted. In essence, this ritual involves the keeping of a stranger's dream, taking responsibility for a member of the community, becoming an ally in their longing, protecting their wounded place and, depending on the content, sharing a place where one is also wounded or broken (Boyd).
• The "Arlington West," Veterans for Peace's ritual involving the placement of crosses on a Santa Monica, California, beach each Sunday from sunrise to sunset, is a temporary memorial honoring those killed in the United States' various arenas of war. The Arlington West mission statement is "to honor the fallen and wounded; to provide a place to grieve; to acknowledge the human cost of war; to encourage dialogue among people with varied points of view; and to educate the public about the needs of those returning from war." The spare, simple beauty of the installation of crosses and coffins is a work of art that powerfully fulfills the multifaceted mission of Veterans for Peace and is indicative of the complexity and depth that ritual can encompass.

Other examples of rituals for grieving include white, flower-adorned "ghost bikes" marking the spot where bicyclists have died in major U.S. cities; R.I.P. tags, bottles, balloons, stuffed animals and other mementos honoring murder victims on street corners in Baltimore's neighborhoods; small backyard altars created with symbolic objects to memorialize a friend's passing; the planting of trees and calling of names in honor of transgendered individuals who have met violent deaths in cities throughout the country; the participatory creation of vast piles of shoes marking the loss of lives and limbs due to landmines that has travelled to public spaces in European cities like Paris to aid the international movement to ban land mines. In each of these varied examples, the visual or poetic element is used symbolically to enhance the experience of ritual – both individually and collectively.

Participation in rituals like these helps us to experience feelings of transcendence, which moves us to a higher level of consciousness. As artist, activist and ritual designer Andrew Boyd states:

If it takes us outside of ourselves, then it manifests community. Lots of lip service is paid to "[creating] community," but it is hard to really experience it. When everyone [involved in a ritual] takes that risk together and moves out of their comfort zone, it's …powerful, we…feel lifted, transcendent; we feel ourselves part of "a wider circle of connection, a larger circle of concern" (Boyd).

In this sense, the use of ritual places us in a realm of experience that we could not enter alone.

Arts-based collaboration extends the ritual experience, sustaining group cohesiveness and further elevating the unity of purpose of the individuals involved. Art involves people in a hands-on experience, made more compelling by its participatory nature. It leaves behind a tangible artifact that may literally or figuratively be carried away from the event.

In an attempt to draw from the well of community artists' experience with ritual and to explore its connection to the spiritual aspects of community arts practice, I composed the following poem from my research. Many lines were taken verbatim from telephone interviews, written communications and the photographic contributions of 24 individuals and organizations with whom I communicated.

Walking Alongside

We enter ritual to respond to the call of the soul¹: To heal ourselves, To pay our tribute To honor our ancestors, our fallen warriors, our soft spoken heroes, To encircle our children with love and hope for a future, To stitch our neighborhoods together one honest connection at a time. As artists and teachers and activists, As would-be and sometimes wounded healers: When summoned, we walk alongside, in humility, Open ourselves to hear deeply, Enter in to core matters of the heart.² We tip the soul's basket onto the table, Offer possibilities for mutual healing, bring into being acts of resilience and resistance. So we build our ofrendas³ of rose petal and rosemary, Mexican marigold and store-bought mums. We pour our libations on the earth or the pavement - From the waters of West Africa to the streets of Baltimore. We paddle out into an ocean of grief, Place a sea of flowers at the gate, We spray the bike white, Wrap a teddy bear tight around a pole. Write a name in the sand, or R.I.P. Brotherman On the wall of the rowhouse next door. We sing a song they loved, draw a dove on their photo, We sing and dance and eat and carry on, Long, long after they are gone. Art for remembering in a time of forgetting, Art for asking: What is needed here? Art for mending a broken heart Finding our voice, our resolve, a new start. Hush now, listen, and call their name. Widen the circle; welcome them in.

Composed from research and interviews with community artists and activists by Cinder Hypki, 2011.
1 Quote by Malidoma Patrice Somé in Ritual: Power, Healing, and Community 1993.
2 Quote by Andrew Boyd, personal communication 2011.
3 Spanish: "altar," "offering"

Additional Perspectives on Ritual and Loss in Pastoral Care and Social Work

Bereavement is a multidimensional experience that takes those "left behind" on a journey from "a relationship of presence … to a relationship of memory" with the one who has died (Irion, "The Funeral and the Bereaved" 32). Grieving often begins before the death of the loved one as an anticipated loss and continues indefinitely, rather than having an identifiable end point. Although the intensity of feeling may wax and wane, grieving is a process that occurs over time rather than comprising a singular episode. Whether the death is anticipated, as from a disease like cancer, or sudden and violent, as of a young person caught in the crossfire of rage in the inner city, grief is a peculiar and poignant experience for the bereaved as well as those who attempt to temper the anguish of the mourner.

The experience of grieving is multi-layered and includes for many people the unrelenting and intense experience of emotional and spiritual pain and suffering as well as experiences such as comfort, connection and celebration, especially in the context of community support. The task of grieving is not only about "saying good-bye" but includes the work of discerning and claiming a psychic or spiritual connection with the deceased. If this "connection" aspect of bereavement is not acknowledged or supported, the mourner may not be able to face his/her ongoing life in a healthy, life-affirming manner (Romanoff and Terenzio).

The family member of a cancer patient often has time to prepare for the loss, while death from sudden, unexpected circumstances such as accidents, suicide or murder, may produce more severe, exaggerated or complicated reactions. The mourner's capacity to use adaptive coping mechanisms is overwhelmed, producing responses that range from emotional withdrawal to murderous rage (Redmond). The caregivers in the community, including family, friends, clergy, artists and community organizers, may assist in the healing of these wounds. Through their presence and compassionate support the bereaved may be assisted to symbolically express their grief through ritual and re-connect to the land of the living.

In the practice of pastoral care and social work, rituals are considered to be "cultural devices that facilitate the preservation of social order and provide ways to comprehend the complex and contradictory aspects of human existence within a given societal context" (Romanoff & Terenzio 698). Ritual becomes the means by which persons make meaning and cope with the reality of loss. Rituals enlist group support through participation, and act as a "container" for the expression of strong feelings and emotions. In the case of a death, the enacted rituals assist the individual and the community to apprehend life and death in relationship with the transcendent (Irion, The Funeral: Vestige or Value?). These functions of ritual clearly point to the healing properties of rituals that are designed and enacted reverently and with the context, needs, beliefs and values of the bereaved in mind.

By definition, a memorial service, whether religious or secular, is a personalized service during which the deceased is remembered and "laid to rest" by the community, while affirming the spiritual beliefs of the bereaved. While there are other important mourning rituals, the funeral was the most germane in the Cancer Center's endeavor to plan and implement what would properly be termed a "post-funeral" service for family members and staff. The complementary elements of personalization, community solidarity, experience of transcendence, meaning-making and the use of symbol and metaphor in a "performance framework" (Romanoff & Terenzio) are all relevant.

We, the co-authors, entered into this collaboration in response to the call of our own souls, and on behalf of the bereaved of our respective communities, that "gain might come out of loss." With this singleness of purpose in mind, the following is a case presentation outlining the design and implementation of the inaugural Service of Remembrance. This analysis emphasizes the role of the arts as the vehicle for a transformative and profoundly spiritual experience that promotes connection and celebration, meaning-making and resolve, in the wake of unspeakable loss.

Case Study: The Service of Remembrance at the Kimmel Cancer Center

The Kimmel Cancer Center at Johns Hopkins recognized that bereaved families needed more than they were receiving from the Center. When patients die from cancer, surviving family members experience the life-changing loss of their loved ones, who had been cared for through treatment, followup and then the recurrence of disease over a period of years. These family members also experience the corollary losses of the all-important relationship with the health care team, the frequent visits to the Cancer Center, and their identity as caregivers. Whether the individual is a patient for weeks or for years, the feelings of bereaved survivors are complex.

The patients and their familial caregivers hope for healing when they come to the Center, and their feelings of vulnerability are often acute. Both the patients and their family members are asked to trust their practitioners, including the nurses, doctors, social workers and chaplains, in an effort to realize the optimal outcome of the medical interventions provided. The patients may have daily contact with their nurses and other members of the team for months during treatment, and staff members become the trusted intimates of their cancer experience. Conversely, the staff members connect deeply with their patients, learning about them as people with hopes, dreams, interests, talents, careers and family priorities beyond the world of cancer.

Because of the deep relationships that often are forged with the staff, outreach to the bereaved families on the part of the Center is appropriate and meaningful after the death of the patient. For both the family members and the staff, the contact presents the opportunity for each to acknowledge the other's value during that part of their shared life. The contact effectively provides an opportunity for closure in terms of the caregiving relationship. Each may affirm the other with, "You cared well for the patient, even though the outcome was not the desired one." The caring on the part of staff is communicated to go beyond merely medical. The benefits are apparent for all involved: for the family member who feels valued by the Center and for the staff member who has "lost" the patient despite enormous investment of effort and care. In the shared loss, though felt more acutely by the family, each may draw solace from the care of the other.

While oncology staff members reach out to grieving families in a variety of ways, for example, through calls, cards or attendance at funerals, many staff members have reported that they would appreciate a more formal way to acknowledge and honor patients lost to death. Through the vision of the Oncology Chaplain, a carefully crafted Service of Remembrance was proposed that would provide an opportunity for family members to re-connect with staff in a joint honoring of the patients who had died. Additionally, the staff would have an opportunity to honor and affirm the family members and friends who served as caregivers. The family members could share their loss as well as their gratitude for the care provided to their loved one, in the company of family, friends and staff who understand their pain.

The spiritual lodestar for the process was the belief that grief is a journey "that searches for meaning and … for a place in the lives and relationships that it touches" (Moules 161). Meaning-making is rarely a solitary enterprise and is best accomplished in relationship with others. In the Cancer Center context, the professional caregiver is more than a technician, for the possibility of healing body and spirit lies within the interaction between patient and caregiver. Healing is dependent on the relationships formed as well as the medical interventions provided. The person, whether a patient, family member or medical team member, is greater than his or her utility to the other. Personhood transcends illness and infirmity. Personhood encompasses the capacity for profound trust, on the patient's part, in the caregiver who is well aware of his or her profound capacity to harm or heal. What better context than a cancer center to hold a ritual of remembrance in light of the shared journey of all persons involved.

A number of cancer centers and hospitals sponsor memorial services. For example, the Johns Hopkins Children's Center has held for over 20 years an Annual Tribute Service to honor pediatric patients who have died, and both staff and family attend the well-supported program. The precedent of other medical centers, including the Children's Center, was helpful in determining the substance and format of the Kimmel Cancer Center program. Additionally, the administrative leaders and staff of the Cancer Center were engaged in the planning process, as this has been shown to be a critical component in the success of such a program in other health care settings (Burke, 1994).

The challenges associated with planning the program were considerable. However, the sponsorship of the Service of Remembrance by the Cancer Center signaled a willingness to begin the process of incorporating bereavement into the fabric of care, not for one event only but in an ongoing way. This was a momentous change in the institutional culture, which historically had not acknowledged the death of patients and the loss of relationships formed with patients and their family members. The Service also would be a break from tradition in that it would be a formalized spiritual program for the public in the Cancer Center, a secular institution.

Although many of the staff members are adherents to a faith tradition or consider themselves to be spiritual persons, the focus of the Cancer Center's research and treatment is clearly empirical and scientific in nature. With this in mind, it was determined that the annual Service of Remembrance would become a program by the Cancer Center as a whole rather than that of a singular discipline, department or staff member. Rather than remaining a discrete "localized" effort to address a particular constituency's bereavement needs, the program would become a vehicle for a greater culture shift within the institution. In short, the Service would promote institutional change in a manner that was both practical and manageable without posing a threat to the institution.

The Cancer Center's institutional core value is respect for the culture and beliefs of all patients and staff. Therefore, the Service of Remembrance, while being deeply spiritual in character, would be nonsectarian, i.e., not limited to a singular religious tradition. In line with the hospital's mandate to protect the privacy of patients, the Service would be personalized while being conscious of these issues. The Service would necessarily be respectful of the many ethnic, religious and socio-economic constituencies served by the Center. By intent, the Cancer Center's Service would include ritual elements from various religious traditions, the substance of which would be sensitively and thoughtfully designed to uphold meaning-making and the feeling of transcendence, that which goes beyond the ordinary range of perception. The Service would also function as a worthy container of strong feelings related to loss.

Health care professionals in the field of oncology are drawn to the work to make a difference, find a cure, ease pain and discomfort, comfort the soul and support the emotional spirit. When a beloved staff member in the Cancer Center died of cancer the collective heart of the entire staff was broken. The staff became the surviving caregivers in the "Cancer Center family." This colleague's death brought to mind the unacknowledged loss of many beloved patients and the sadness that was engendered. Unconsciously perhaps, this deeply felt loss allowed the Cancer Center in its vulnerability and grief to have an intellectual and spiritual openness to the idea of a Service of Remembrance for the family members and staff who had cared for all the patients.

The chaplain was not new to the institution and had established a reputation of reliability and credibility, which set the stage for subsequent dialogue with Cancer Center leadership. She intentionally solicited suggestions from Cancer Center leadership members, who naturally were concerned with the manner and means by which the Service would be planned and accomplished. Through this process of listening and learning the chaplain became ever more articulate in stating the need, intervention and outcome/benefit for not only the family members but also for the Center itself. She also found a staunch ally in the director of the Harry J. Duffey Patient and Family Services Program, which included social work, pastoral care, cancer counseling and other support services.

The conversations with these leaders informed the chaplain's understanding of the institutional culture: How decisions were made and by whom, protocol and parameters and power dynamics, as well as the hopes and fears of the institution for programming of this type. The barriers and challenges for the particular setting were also identified, primarily around funding issues along with a historical concern that drawing attention to the deaths might be distracting from the mission of the Cancer Center ("to cure cancer") or demoralizing for the staff. While developing this operational understanding of the culture of the Cancer Center, the chaplain also cultivated broad-based buy-in from the administration.

The chaplain formulated the Service to include the elements of gathering and welcome, music, invocation, reflection, responsive reading and a time for the deceased to be recognized in a personalized way by the family members and staff. The chaplain also envisioned an opportunity for family members and staff to participate in creating an art piece, a place to "leave their mark," that would function as a transitional experience to move the participants from the world of the Cancer Center to their own homes following the Service.

The planning of the Service embraced full and meaningful participation by staff members. Volunteers were recruited for specific tasks: greeters, reception servers, hosts for guest participants, parking validation, ushers, guides in the Sculpture area. Other staff members met and selected a traditional Jewish litany, "We Remember Them," as the responsive reading. An experienced community artist and organizer, co-author of this paper, was engaged as an integral member of the creative planning process; she had facilitated a large-scale collaborative art project at the Johns Hopkins University's Interfaith Center, and was identified by the chaplain as a trusted guide. Her role included consultation on various aspects of the Service, the design and co-creation of the art piece — an interactive Sculpture of Remembrance, and facilitation of a mandala/poetry workshop with the planning committee.

A printed program for the Service was designed, and a yellow satin ribbon printed with "We Remember Them" was attached to the cover by staff volunteers with removable tape as a keepsake for participants. The ribbon not only allowed the holder to recall the Service, it also allowed for the recall of the loved one within the context of the evening's spirit, love and support. The ribbon functioned as a transitional object connecting the loved one to the Service, to the heartfelt support and finally to the present day. The object (in this case a yellow ribbon) had the potential to mentally and emotionally return the holder to the specific point in time and allow them to physically hold the power of the Service in the palm of a hand.

On the evening of the Service in mid-May, family members parked in the same garage in the Cancer Center that they had used when accompanying or visiting their family members during their treatment. Many of them came somewhat hesitantly into the lobby from the garage, a bit unsure what to expect from their first visit back since the death of their loved ones. Everyone was greeted by staff members who kept an eye out for those whose emotions caught them unaware at being back in the setting that had held so many painful memories. Administrative leaders from among the primary stakeholder constituencies took part in the Service as leaders of readings and portions of the Service. By the beginning of the 7 p.m. service the 300+ chairs were filled, with many staff members standing.

The highlight of the 45-minute Service was the calling of the names of the deceased by their family members, which personalized the Service and protected the privacy of guests and patients. One by one, in response to the simple invitation of the leader of this portion of the Service, the Cancer Center's Director of Patient and Family Services, individuals and families with linked arms stood and called the names of their loved ones. Some held photos aloft. All around the vast hall, people stood and the deceased were honored thusly. The effect was both extremely moving and celebratory in nature. Those who had passed were once again present.

The cantor, who provided the music during the Service along with a harpist and guitarist, closed the Service with "Turn, Turn, Turn," originally written and recorded by Pete Seeger. Its lyrics were apropos to the occasion: "To everything, turn, turn, turn, there is a season, turn, turn, turn, and a time for every purpose under heaven. A time to be born, a time to die…." Spontaneously and with no prompting, the audience joined in. After a brief blessing by the chaplain, family members sought out staff members to shake hands, embrace and share words of appreciation. The Service had provided opportunities for participants to speak out and to join in, and prepared them for a furthering of the ritual process.

At the end of the Service, the director of the Center invited the guests to write a message on a strip of cloth to weave into the Sculpture of Remembrance. The invitation represented yet another opportunity for the family members and staff to share their voices – this time in writing. Of note was the nature of this open-ended invitation: described as a wish, a message, a prayer or remembrance. These gentle instructions provided encouragement and the freedom for all the participants to express freely during this part of the program, a ritual within the larger Service.

The setup for the Sculpture supported the interaction of large numbers of people in a relatively short span of time. As the initial group of guests gathered around tables heaped with strips of muslin cloth and markers, those behind politely stood and waited their turn. People were relaxed and chatted quietly as they waited. They watched and sometimes helped others with their weaving as needed. Once the process had begun, it quickly became evident that this interactive, mutually supportive activity (a ritual in the purest sense) was truly worthy of everyone's investment.

The majority of people participating in the message-writing exhibited no hesitation whatsoever. They most often expressed themselves quickly. Some wrote names and dates only. Others wrote detailed messages. Some wrote memories of cherished moments with the beloved. While most messages were text, some included symbols such as hearts, animals, faces and figures. Many people wrote their messages alone, but others consulted with family members. In some cases, entire families or groups of people collaborated by weaving their strips of cloth together, in a specific place and a specific direction. Some younger people wove strips for older participants; some parents wove strips for young children. There was great variation in the expression of voice, both individually and collectively.

Elsewhere in the lobby, tables with refreshments beckoned, but for more than an hour, an estimated 30 or 40 people were standing and steadfastly waiting for their turn to write a message. The majority of the guests participated; 271 strips were woven into the Sculpture. The planners of the Service stayed in the area of the Sculpture the entire time and noted the power of this shared experience as a tangible force in the room. Guests lingered longer than expected, even as darkness descended.

Design of a Healing Arts Workshop for Caregivers Prior to the Service

A major focus of my work as the artist was consultation with the Cancer Center on how visual art and poetry might be incorporated into the Service. As I worked to understand how art was needed on the part of staff and the families of patients, I realized that the staff members themselves would benefit from the healing properties of artistic expression. In conversation with the chaplain, I understood that "compassion fatigue" is a very real phenomenon for those who work long-term with the terminally ill, and that limited opportunities existed within the institution for staff to reflect on their work and rejuvenate their own spiritual wellness. I therefore designed an hour-long art-making workshop for ten members of the planning committee, which included nursing, pastoral care, social work and medical staff.

The goals of the workshop were threefold: to allow participants to experience an enjoyable and reflective moment through art, and gain perspective on their own professional work; to create an environment that enabled both personal introspection and collaborative creativity among colleagues; and to stimulate/inspire the writing of a collective poem about caregiving for the Service. Among the immediate outcomes of this planning activity was the creation of personal mandala drawings that provided a touchstone for a group discussion about the nature of the participants' work as caregivers.

A mandala, from the Sanskrit word meaning "circle" is a representation of wholeness; a mandala design is, very simply, a drawing or painting that is created within a circular shape with a center radiating both inwardly and outwardly. The circular shape mirrors many basic forms in nature throughout the universe, from the circles within circles of the solar system to the concentric rings of trees, from flowers to spider webs. "A mandala can be seen as a model for the organizational structure of life itself – a cosmic diagram that reminds us of our relation to the infinite, the world that extends both beyond and within our bodies and minds" (Cunningham 12).

Used for millennia in both the Hindu and Buddhist traditions as a form of meditation and connection, and more recently in the psychosocial fields as a calming and healing means to tap in to one's unconscious mind, mandalas offer a snapshot of our deeper selves at a given moment in time. I first learned about mandala art as a form of healing from an art therapist with whom I was working in a homeless shelter, and I witnessed firsthand even the most agitated, fraught and confused individuals respond in a remarkably positive way to creating mandalas. Since then, I have very successfully used the creation of mandala designs with very diverse groups of people in my community art practice, modifying the approach and simple technique to fit specific needs and circumstances.

I chose to use mandala-making with staff at the Cancer Center because it creates a nonthreatening "way in" to self-expression and contemplation for those who do not identify as artists. Individuals who may worry that they are unable to draw in a representational or "realistic" way need not fear. There are no rules other than responding to the circle shape in front of them; they simply choose colors among art supplies that appeal to them, take a few deep breaths, and trust that whatever emerges will be exactly what needed to appear. In facilitating mandala-making with groups, I have never failed to witness a "moment" in which the noise level in a room sinks into a whisper, and the intensity of energy deepens, faces reflecting intense concentration. It is akin to something mysterious that clicks or falls into place, into rightness; I can only describe this moment as having a spiritual quality.

I believe that mandalas are able to tap into a wellspring of creativity and a connection to our deepest selves. Therefore when finished, I ask participants to share any words that they recall going through their minds as they were drawing. The words and phrases that emerge never cease to amaze me in their depth and insight. Consequently, I asked the caregivers of the planning committee for the Service to jot any words they remembered while making their mandalas. Participants generated written phrases such as: "layers of touch and presence," "when the darkness around us is deep," "harmonious," "steady," "flame." The participants and I wove these phrases together into a poem that was to become the caregiver reading for the Service. Subsequent interviews with participants allowed me to create a final reading entitled "We are Caregivers, All of Us." The utilization of staff's own words in the process of creating a collective poem allowed for a deeper level of involvement in the event. The following is the final version of the poem.

We Are, All of Us, Caregivers

We are, all of us, Caregivers. Husband. Brother. Mother. Father. Child. Sister. Healthcare provider. Grandparent. Partner. Confidante. Nurturer. Supporter. Wife. Friend… We are all Caregivers from beginning to end. We have strived to be Steady Present Kind. We have strived to create a wordless place that is Peaceful Harmonious Calm. We are all Caregivers, Attending to Mind and Body and Spirit. When the darkness around us is deep, * We have strived to be Energy Flame Light. We have strived to create a loving web of support and connection, Layers of touch and presence, A hand to hold, A smile to keep, An ear to listen. We are all Caregivers, Privileged to serve, to shape lives – others' and our own To always remind that we are not our illness; we are our souls. We thank those for whom we care for teaching us That our truest gift is always the act of simply being there – Steady, steady, steady. Present. And kind.

Created by Kimmel Cancer Center staff and composed by Cinder Hypki.
*From A Ritual to Read to Each Other" by poet William Stafford.

The mandala workshop for planning-committee members prior to the event provided staff members a glimpse into their colleagues' jobs and duties at the Center. They gained appreciation for each other's work and were given the opportunity to develop deeper personal and professional relationships with and insights about each other. One participant said that the experience helped "create a community out of a disparate group… that was spiritual in the sense that there was a sense of awe, wonder and amazement at what the group created and individuals [within the group] created." In an interview with the artist, Sharon Krumm, Director of Nursing for Oncology, continued,

The aspect of the mandala workshop that was really wonderful was that it engaged people from different backgrounds and groups who never have an opportunity to participate in that kind of work: Doctors, nurses, administrative staff, social workers, etc., in a creative process. …it created a real sense of appreciation for individuals and fostered a bond … and provided some wonderful insights into people that you just wouldn't have had otherwise.

Design Considerations for the Interactive Sculpture

My process of designing a meaningful and inviting Sculpture of Remembrance mirrored the design process of the Service itself. For example, I was guided by the principle that a collaboratively made piece of artwork simultaneously calls forth participation on two levels -- individual as well as communal. My goal was to create a process and an artifact that would resonate with the community, i.e., the participants at the Service, and call forth healing, celebration and resolve.

In designing the vessel or container for such a multi-faceted, layered interactive experience, I took into account several important principles drawn from past collaborative efforts; including "guiding principles" and aesthetic points of departure. First, the physical experience of the ritual and related art making must be as non-threatening to participants as possible. What they see, what they do, and the vessel or method by which they do it must resonate as emotionally safe and secure. The art-making process and the envisioned final artwork must call to them as familiar, comfortable or enticing in some way. Within this environment, they are then free to consider sharing their personal pain and anguish amidst a group that may be strangers. As the act of sharing unfolds, the space is then opened for a spiritual experience. "Good art …transports you to another place, and this other place is a spiritual one" (Dene 24).

Because so many people relegate "art" to the purview of a few talented professional artists, it is important that the art-making process utilized be one that is accessible to as many people of limited artistic skills and experience as possible. As artist, activist and ritual designer Andrew Boyd states:

Ritual is familiar….that's what's interesting. We feel like we're in a container that we know, and within that container we take risks. Without the right container, you fall…it has to [resonate with] your instinctive emotional landscape.

Taking Boyd's notion of a familiar "container" into account, the design and related process for creating the Sculpture of Remembrance was kept deliberatively simple on three levels: in its fabrication, visual appearance and process for participant interaction. The simplicity of the Sculpture's design would provide a sense of a tabula rasa, a "blank slate," so that it would be viewed as non-threatening, welcoming and inviting. A wooden frame, six feet long by three feet high, provided the armature for draping cloth in long swooping folds within it.

A gauzy white scrim cloth and shimmering honey-colored organza fabric represented the spiritual mystery of human experience, the life force itself. Layered on top of the fabric was bronzed hardware cloth with hexagonal shaped holes, which functioned as a loom and allowed for the weaving of strips of white muslin fabric through the wire. The fabric strips would contain the ritual participants' handwritten personal messages to their loved ones. The wire added another layer of delicate visual complexity to the piece, which was illuminated from behind, thereby emanating a warm glow.

Collaborative art-making must strive to help lift up the voice of those wishing to be heard, in this case, the bereaved and staff of the Cancer Center. It was important to all the collaborators that participants have an opportunity for visual and written expression – thereby addressing their desire and longing to be connected to their loved ones who had died. That which the community artist asks of the group members must have real meaning; it must translate as worthy of each person's interest, time and energy. Participants should not feel like they are going through the motions, but rather like they are "going into emotion."

Meaning-making and the desire for relatedness to the other, whether human or divine, are the purest expressions of spirituality. The goal of community arts is to help people make meaning out of the substance of their lives and to forge real connections with each other. At heart, spirituality is the basis of all art making, for art (including the art of ritual) is the means by which we both apprehend and experience transcendence. Art is the way we proclaim, "There's more to life than meets the eye!" The collaborative, creative experience serves as a door leading to the co-creation of new meaning, understanding and resolve.

Creative tasks beckon people to enter into a collaborative space. The religious rituals of bereavement are at heart collaborative, for they are rooted in the communal life of the mourner and the belief that "where one suffers all suffer" (I Corinthians 12.26). Within the context of community we are gently reminded of the beliefs and values that motivate us to "press on" in spite of loss. The process of art making, as of mourning itself, must engender participation from all members of the community such that individual contributions build upon each other and into shared existence, communion and meaning making.

Evaluation and Discussion

The ability of ritual to concretize the intangible is well accepted, although the effects are not always explainable by participants (Rando). In a debriefing session the day after the Service of Remembrance, this axiom was affirmed when staff members spoke of being moved in undeniable ways that they did not totally understand. Stories were shared about the active engagement of the guests during the Service, especially the calling of names, the music and the "completing" of the Sculpture by 271 persons, about 83% of the attendees. Staff members were deeply touched and surprised by the unreserved expressions of gratitude by family members for staff members.

A number of the guests that evening also visited the nursing units where their loved ones had been patients, some for the first time since the loved one's death. They sought out staff members who had cared for them (patient and family). Guests were overheard to say to their companions, "This is where we waited to see our doctor." "This is where we got our prescriptions filled." "This is the elevator we always took." "I always parked on the 3rd level." The Cancer Center was the place that held part of the life of their beloved ones. The seemingly mundane had been imbued with a significance that was sacred to the bereaved.

Staff members at the debriefing also were impressed at the number of family members who responded to the Service invitation; more than 300 guests made a reservation to attend, out of the 700 families who had been invited. Although this speaks primarily to the need of the family members, the number of attendees who waited patiently to add their message to the Sculpture points to active, invested engagement during the program itself. Based on the attendance, feedback of the staff, interest and engagement of the attendees and comments from guests "after the fact" in the form of correspondence and e-mails, the decision was made without hesitation by the Cancer Center to schedule a second annual Service for next year.

My goals as a community artist were fully realized. For example, many people took out their cell phones and photographed their message on the strip of cloth. These participants wanted to document something concrete that they had created in order to share the memory of deceased loved ones with others. In effect, to take a photo and text it, e-mail it, post it on social networking sites, or save it, was to affirm: "I was here, I did this thing that was important to me and it was a part of something much larger that validates me and our collective coming together."

As participants dispersed, whole groups of people were asking to be photographed in front of the Sculpture — something I had not anticipated. As a whole, the Sculpture functioned as a transitional object, a tablet etched with the voices of loved ones present and deceased. That hundreds of attendees chose to participate in the art making underscored the meaning with which they imbued the Sculpture. Further evidence of this fact was provided by the many questions about the fate of the Sculpture: "What will happen to the sculpture? Will it remain at the Center? Will it be on display? Can we come back to see it?"

The Service was a social event in which the bereaved were embraced by a group of individuals who shared a deep and profound understanding of their loss. As Irion states, a funeral marks "the end of a relationship of presence with dignity" ("The Funeral and the Bereaved" 32). The Service of Remembrance gave family and staff members the opportunity to convene at the Cancer Center as part of a dignified, reverent occasion in pursuit of meaningful closure and new beginnings.

Conclusion

I have found that the lessons learned from the Cancer Center experience are proving extremely helpful in my community work on projects like the design of the Mid-Govans memorial garden and a ritual ceremony for its dedication. While there may be differences in the grieving and the healing processes for the survivors of those lost to catastrophic illness, as with cancer, and those in communities suffering accumulative violence and death, there are important commonalities as well. One can apply the techniques of communal engagement and trust building, and principles for the design and creation of ritual experiences to many types of situations. Key here is the building of trust in both the personal and collective realms; of working hand in hand with community collaborators; and of vetting one's ideas with all stakeholders involved.

The need to balance the tension between private/intimate and public/collective processes related to grieving is vital regardless of the circumstances of death. The Cancer Center, for example, invited to the Service the bereaved who had at least three months to process their loss prior to participating, thus respecting individual and family needs for prior private healing. In the community, funerals and prayer services for families and loved ones act as "doorways to healing" and naturally precede community-wide rituals.

As Mesa-Bains so capably states: "The ceremonial and artistic forms that ritual takes provide symbolic meaning to allow the transformative and transcendent nature of these practices to exist in the collective setting" (personal communication). As community artists, activists and cultural workers, it is useful and important to deepen our understanding of grief and healing so as to better understand the role that art can play in these contexts. This understanding requires the same deep listening skills, the unearthing of neighborhood narratives and the lifting up of community voices that are required of us as we approach any project. In all endeavors, we must respect the remarkable human ability to move through layers of grief over time in very private and individual ways.

The interdisciplinary experience of creating a Service of Remembrance at the Cancer Center allowed my collaborators and me to draw upon each other's expertise. As we recognized one another's strengths and wisdom, we were energized by the collaboration. We also learned from each other as each person facilitated or designed specific aspects of the program according to her professional competency. Through this process I learned that ritual that ventures into the deep psychosocial realm is best undertaken by community artists in collaboration with professionals trained in art therapy, social work and/or spiritual counseling. Recognizing our limitations as community artists gives us the opportunity to embrace the richness of collaborative endeavors.

Authentic community change efforts emanate from a deep spiritual well of longing and aspiration. "It is often in the spiritual openness of the artist practitioner that the community can work to gain the place of ritual remembrance and healing" (Mesa-Bains, personal communication). As community artists, we should strive to "walk alongside" our fellow community members in roles that honor their meaning-making and acknowledge the spiritual dimension of our work together, enabling us to contribute sensitively and effectively to the change we seek.

I and the other authors welcome feedback from our peers as we continue to explore the vital role of art, spirituality and ritual in our daily lives and in the communities with which we work.

I am grateful for the words and wisdom of the artists and caregivers whose work and words informed this paper and the poem on ritual, "Walking Alongside," including Maria Gabriela Aldana, Peter Barry, Nataki Bhatti, Colleen Apostol, R.N., Sarah Blosser, Andrew Boyd, Barbara Joann Combs, Dr. Joan M. E. Gaither, Luzene Hill, Genevieve Kaplan, Amalia Mesa Bains, Rivane Neuenschwander, Benoit Pailley, Tracie Pouliot, Kristina Ralls, Nora Scheff, Meli Seval, Fran Slenbaker, R.N., Dr. Sharon Krumm, R.N., David Sloan, Sarah Tooley, Laura Vernon Russell, Veterans for Peace and Marissa Yelnick.

Cinder Hypki is a practicing community artist, activist and poet living in Baltimore, Maryland. She has taught and mentored students in the MFA and MA programs in Community Arts at the Maryland Institute College of Art since the program's inception in 2005. Through Hypki Consulting, founded in 1992, Cinder has worked to support the visions and missions of nonprofit organizations and community groups in Baltimore and beyond through art and organizational development.

Rhonda Cooper is a chaplain for patients, family and staff of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, in Baltimore, Maryland. She has been a United Methodist minister for over 30 years, and is board certified as a hospital chaplain. She chairs the planning committee for the annual Service of Remembrance in the cancer center, and has published other articles on the clinical practice of chaplains. Rhonda has been part of the Johns Hopkins community since 2005, during which time she has appreciated the rich cultural, spiritual and artistic resources in Baltimore.

Louise Knight is a licensed Maryland clinical social worker and Board Certified Oncology Social Worker. She is Director of the Harry J. Duffey Family, Patient and Family Services Program at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, in Baltimore, Maryland. She has presented nationally and internationally and published on clinical social work subjects. She has been part of the Johns Hopkins Hospital since 1989.

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