On a recent trip to London, I was interviewed during Depression Awareness Week about my book Unstuck’s UK release by The Guardian newspaper. The reporter was particularly interested in CMBM’s Global Trauma Relief program and our work to bring population-wide psychological healing to places around the world that are afflicted by war and natural disaster. You can read the piece here:
I’m certainly pleased that the author recognizes CMBM’s groundbreaking efforts to teach and support hundreds of thousands of people in Kosovo, Israel, Gaza, Haiti, Southern Louisiana, as well as US military returning from Iraq and Afghanistan. It’s a shame, however, that his tone is so dismissive of integrative medicine and that he fails to recognize the fundamental importance of self-care for psychological and physical healing.
Please note that as of this writing, corrections are being made online for several factual errors, including the following:
- In Gaza, we trained 90 clinicians initially, only a few of these were “educators” (as the article states)
- CMBM now has 160 groups meeting in Gaza each week, not 48, as reported.
Beyond factual errors, though, I’m disappointed in the tone of the article. I want to emphasize that our approach to psychological trauma relief is not about “belief,” as the article repeatedly implies. It is based on hard evidence that is just as rigorous – actually more so – than most of that provided by the drug companies he seems to accept as the standard.
It is a common misconception (and prejudice) that psychological and nonpharmaceutical research is less stringent and reliable than clinical drug trials. Each of the approaches that we use, including meditation, guided imagery, biofeedback, autogenic training, yoga, self-expression in words and drawings, and movement and exercise, has a significant research base, one which demonstrates decreases in stress levels and improvement in mood. The CMBM approach combines these into a comprehensive program, and The Center for Mind-Body Medicine takes great care in scientifically researching, documenting, and publishing our findings of our approach in peer-reviewed journals. We recently published a randomized controlled trial (RCT) on our work with war traumatized children in Kosovo that shows an 80% decrease in symptoms of PTSD (read the abstract here).
This was the first RCT of any intervention with war-traumatized children, and sometime in the next few months, we will be publishing a study (in the International Journal of Stress Management) that shows similar results—80% decrease in PTSD symptoms, significant decreases in depression and hopelessness—in war-traumatized youth in Gaza. This study is particularly important because the gains that were achieved over ten weeks of once-weekly group sessions were largely maintained at seven months’ follow-up—in spite of ongoing conflict and severe economic hardship.
The point is that this approach is not alternative. It is fundamental. It makes human and scientific sense. We have an approach that works with large groups of people in developed countries as well as those ridden by disaster. It is flexible, inclusive, and culturally acceptable. And the groups in which we train caregivers can be led by anyone—teachers, and religious and community leaders, as well as health professionals; and the scientific evidence for its effectiveness continues to accumulate. And as the article states, CMBM will continue to be there to provide our program of mind-body medicine for people suffering from psychological trauma, to teach them, and help them help themselves.
Richard Sloan’s op-ed in the New York Times (“A fighting spirit won’t save your life”, January 25, 2011) is guilty of precisely the faults he attributes to those who believe that attitude can affect health – smug, self-righteous, and short on scientific evidence.
Prof. Sloan is of course correct when he takes to task those who believe that “requests to the universe” ensure good health, or that good people always receive good prognoses. But these are extremes, rhetorical straw men. There have in fact been years of important scientific investigations on the very real benefits of hopefulness and positive expectation.
Here are several examples: a 15 year follow-up of Steven Greer’s landmark study showed that a fighting spirit didn’t, over the long haul, enhance survival for women with advanced breast cancer; on the other hand, the follow-up did demonstrate that feelings of helplessness and hopelessness significantly decreased longevity. Contrary to what Prof. Sloan suggests, the pioneering work of Redford Williams and others has clearly shown connections between hostility and heart disease. And a number of investigations over 20 years have demonstrated that people with lung cancer who are more optimistic actually have better prognoses than those with a similar stage of disease and physical findings who are less sanguine.
Prof. Sloan does a disservice to readers and to the truth when he categorically denies the power of hope in healing.
I wanted to share with you an article I just published on Health News Digest. I hope you’ll find it useful going into the Labor Day weekend, and that you’ll share with friends and family who may be in need of some stress relief.
Labor Day Tips for Reducing Stress by James S. Gordon, M.D. (originally posted on Health News Digest: Original Article)
Labor Day is traditionally a time of rest before the renewed activity of fall. For tens of millions of Americans who are unemployed or underemployed it is a time of high stress, a time when anxiety caused by economic insecurity and foreclosures unsettles, agitates, and casts a shadow over the unemployed and their families.
Over the years, I have worked with thousands of people who have been made anxious and depressed by economic hardship. Here are five steps drawn from my most recent book, “Unstuck: Your Guide to the Seven-Stage Journey Out of Depression,” that people can take to address the pain and insecurity that may come with today’s economic uncertainty. All of them are free and all can be easily learned and done at home.
1. Begin a simple nondenominational meditation practice: Slow, deep breathing — in through the nose, out through the mouth, with the belly soft and relaxed and the eyes closed — is a sure antidote to the stress response that uncertainty provokes. To encourage relaxation you can say, “soft” as you breathe in and “belly” as you breathe out. Begin with five minutes, two to three times a day.
2. Move your body: Physical exercise may be the single best therapy for depression. It’s very good for anxiety as well. Find any kind of movement that suits you, jog, dance, swim, or walk, it all works. You’ll see and feel some benefits after 15-20 minutes.
3. Reach out to others: Human connection — to family, friends, co-workers in the same boat — is an antidote to the sense of aimlessness and isolation that may come from job loss or unexpected economic insecurity.
4. Find someone who will listen and help you take a realistic look at your situation: Allow a trusted friend or adviser to help you look for possible solutions for any stressful situations you may be experiencing. In addition to helping you unburden your mind, body and spirit, a trusted friend or advisor can often see solutions more clearly than you and can help you find ways to put these solutions to work.
5. Let your imagination help you find healing and new meaning and purpose: After breathing deeply and relaxing for a few minutes, imagine someplace safe and comfortable, it could be a place you know and love or one that comes to you. Make yourself at home there, notice what’s around you, breathe deeply and relax. My colleagues and I at the Center for Mind-Body Medicine have used this safe place imagery successfully with New York City fire fighters after 9/11, with U.S. troops going to or returning from Iraq and Afghanistan, and with families in New Orleans in the aftermath of Hurricane Katrina. We teach it every day in our offices and like the other four steps, we use it ourselves.
Some thoughts on Jonah Lehrer’s article from The New York Times Magazine, February 25, 2010.
In his article on the possible evolutionary purpose of sadness, Jonah Lehrer, a talented writer and knowledgeable scientists confuses an adaptive mechanism –the capacity for greater focus that the rumination of depression may afford – with a therapeutic one. Even more important, he does not address the causes of depression and, in accordance with his emphasis on enhanced problem solving, limits his discussion of therapeutic efforts to cognitive change.
Work with many hundreds of depressed people in my psychiatric practice and tens of thousands more in war, post-war and disaster situations around the world gives me a very different perspective and leads me to different conclusions. So many of us are depressed because we are living at variance with both our genetic programming and our need for meaning and purpose. We are affected so dramatically by losses of relationships, jobs, etc. because we are not sustained by the adequate social support that is a hallmark of traditional societies. We are subject to an unprecedented level of stress and overstimulation in our environment, to toxic food, and sedentary ways of living that are anathema to our evolutionary development and detrimental to our mood. Many of us lack a sense of purpose in our lives, a connection to something greater than ourselves that gives human life meaning, and can give us hope in difficult times.
The symptoms of depression – both the rumination on what went wrong and why that Lehrer focuses on, and the lethargy, hopelessness, decreased interest in sex and food that go along with it – are best understood and responded to not as an evolutionary advantage but as a wake-up call. They let us know that it is time to address the conditions that are creating the imbalances in our lives; to use food and exercise, meditation and imagination to improve our biology and enlarge our perspective, and to reach out to others—therapists, clergy, family and friends—who can help us. The true purpose and challenge of our depression is to wake us up to what is wrong in the way we live, to point us toward ways to become more fully human.
I’m pleased to announce that my PBS special based on Unstuck: Your Guide to the Seven-Stage Journey Out of Depression has been picked up on so many stations, that we had to make a new calendar available! (I announced in my last post that the dates were in my web calendar here.)
I’m so excited for you to see the great show the crew at PBS put together, and for you to learn the basic biology of stress and its effect on your body and mind, and I hope you get some wonderful relief (which you and/or your family probably need, right now) through the simple mind-body techniques which I will teach you on the air.
SO–please note, the list of my PBS “Unstuck” Special dates on the calendar here is not complete. Find a more complete list here in PDF form, and now there’s also a partial list available at the KPBS website.
More dates are being announced every day, so check your local listings for the most up-to-date information, and support your local PBS station this year for all their great programming!
Here’s a letter to the editor published in the New York Times:
To the Editor:
Re “Fellow Inmates Ease Pain of Dying in Jail, and Glimpse New Life” (“Months to Live” series, front page, Oct. 18):
What a tender, important story. Prisoners who commit generous acts toward dying fellow inmates awaken to their own capacity for love and, in the process, come to feel regret and compassion for those they have harmed.
I have seen this again and again in groups my colleagues and I lead overseas for war-traumatized children and adults and here at home for American troops who have been maimed and bereaved by combat. Fantasies of revenge dissolve, knots of resentment loosen.
These inmates’ stories tell us that we must make such opportunities for change available to prisoners whom we have abandoned as irredeemable. The lessons these transformations teach us are priceless.
James S. Gordon
Washington, Oct. 20, 2009
The writer is a psychiatrist and the founder and director of the Center for Mind-Body Medicine.
Take a look at my calendar (right column) to see if your local station will be carrying it. More dates & stations will be added. We’ll get you more information soon! (If you’re on our mailing lists, it will be delivered to your inbox–signup box is also in the right column.)
We hope you’ll tune in and support your local Public Broadcasting Station and all their wonderful programming by calling in and pledging during your local run.
My piece, “Some Simple Steps for the Stressed-Out: Psychiatrist Offers Simple Steps for Coping with Uncertainty,” on dealing with stress from the economic downturn, appeared on the front page of the Washington Post Health Section today.
A middle-aged, working-class woman recently came to my medical office complaining that her back had “seized up.” Her husband had lost both his jobs and was feeling quite disheartened; not long after, her blood pressure had “jumped though the ceiling” and she began sleeping poorly.
Another patient came to see me suffering from crippling anxiety attacks. He had lost the better part of his considerable fortune in the economic collapse. Now he was waking in the middle of each night feeling his chest crushed, unable to breathe, half fearing and half wishing he would die.
I have been practicing psychiatry for 40 years, but I’ve never seen this much stress and worry about economic well-being and the future. There is a sense that the ground is no longer solid, that a system we all thought would sustain us no longer works as we were told it would. In the past, when patients reported job-related stress, it was from unfulfilling work and the anxiety of making choices. “Should I stay in this job that I can’t stand and keep feeling so unhappy?” they would say. Now, I hear about unmeetable mortgages, months without work, fears of ending life in a low-paying, entry-level job. “What went wrong?” my patients say. “What could I have done?” “How can I manage?”
In this uncertain time, symptoms of chronic illnesses — hypertension, back pain, diabetes — that were controlled or dormant are erupting. Low-level depression, whose hallmarks are feelings of helplessness and hopelessness, is endemic.
Large numbers of people across the country are trying to quiet their apprehension with drugs or drink, or have turned to antidepressants, anti-anxiety medications and sleeping pills. But after decades working not only in Washington but also with war-traumatized populations overseas, I’ve found there are simple strategies for helping people cope that are easy to learn, practice at home and, in these stressful times, free.
1.Begin a simple meditation practice. Loss — of jobs or economic security, as well as of a beloved person — is perhaps the greatest and most common of stressors, and the most frequent cause of anxiety and depression. Slow, deep breathing — in through the nose, out through the mouth, with the belly relaxed and soft, and the eyes closed — is a sure “evidence-based” antidote to the stress response that uncertainty provokes. Practicing this “soft belly” technique several times a day for several minutes each time quiets the “fight-or-flight” response that makes people anxious and agitated, and brings us what cardiologist Herbert Benson famously called “the relaxation response.” Financial advisers, child-care workers and soldiers back from a second tour in Iraq with whom I’ve worked have all found, in this simple practice, a source of calm.
2.Move your body. With the possible exception of talking with a sympathetic, skilled human being, physical exercise may be the single best therapy for depression. It’s very good for anxiety as well. Exercise has been shown in animal studies to increase cells in the hippocampus, a region of the brain concerned with memory and emotion, which can be depleted by significant psychological trauma (and financial stress is one of the most significant traumas) or chronic depression. Exercise increases mood-enhancing neurotransmitters in our brains, and decreases the levels of stress hormones that exacerbate chronic illness.
It may not be easy to get moving when you’re feeling defeated, but every step you take, literally as well as figuratively, will encourage you to take the next one. Make sure you do something physical that you enjoy or once did enjoy. Aerobics or yoga classes may feel overwhelming or too expensive. Don’t worry: Dancing at home by yourself works just as well, and so does walking. Exercise is often the first item on my prescription pad.
3.Reach out to others. Human connection — to family, friends, co-workers in the same boat — is an antidote to the sense of aimlessness and isolation that may come from job loss or unexpected economic insecurity. Social connection also helps prevent the chronic illness that can often follow prolonged stress. I see the healing power of group membership every day in mind-body skills groups that colleagues and I organize, when a group member, demoralized and humiliated by job loss, realizes he or she is not the only one. Acknowledging and sharing (but not indulging) this sense of grief and pain is a remarkable source of strength for many people.
4.Find someone who will listen and help you take a realistic look at your situation. When the middle-aged woman with the “seized-up” back came to see me, we discussed her finances as well as her feelings. Although her husband had lost his jobs, her own job, in the health-care industry, was still secure. She and her husband would have to give up some of the “little luxuries” to which they’d been accustomed, but it was clear they could still manage. She needed to relax (using the soft-belly technique), recognize what she could and couldn’t do, give her husband a fair share of the household chores while he looked for another job, and generally unburden her mind, body and spirit. This simple exploratory conversation — and a subsequent heart-to-heart with her husband — allowed her to turn aside the cascade of anxious emotions. Her body began to repair itself.
5.Let your imagination help you find healing — and new meaning and purpose. The wealthy man who came to see me last winter paralyzed by anxiety attacks after losing much of his fortune was able to put his own trauma in perspective by using his imagination.
Though he still was, by most standards, wealthy, his sense of himself as a wise, sure-footed investor had been shattered. He did soft belly breathing to relax and began to cut out and copy pictures from magazines that seemed to him somehow hopeful. He spent days, he told me, copying a photo of a man his age, a grandfather apparently, standing with his arm around a young boy on the verge of the hole where the World Trade Center had been. “The tragedy in the picture is so much greater than my own,” he said, “and I realized that what’s really important is the connection between this man and boy, the hope for the future. I drew it, and I really started looking for this connection in my own life — a connection with meaning now, not money.”
Other patients find relief and assistance from imagining themselves in a safe place and consulting their inner “wise guide” to help them find peace, direction and meaning. This may seem kind of strange at first, but it’s an ancient process used in many indigenous cultures and is actually pretty easy.
First, after breathing deeply and relaxing, imagine someplace safe and comfortable, one you know or one that just arises at the moment in your imagination. As you sit there, you allow your “guide” to appear. Accept whatever image appears — a wise old man or woman, a relative, a figure from scripture or literature, or even an animal. Mentally introduce yourself, and ask this guide a question about what’s troubling you, and then “listen” to the response that comes into your mind. Let the dialogue with you and this guide continue. Often helpful guidance will emerge from your own intuitive understanding.
6.Speak and act on your own behalf. Sometimes this produces rapid and even material benefits: One patient, a financial analyst, talked to her colleague about impending cutbacks; they forestalled a layoff by offering their supervisor a job-share alternative. Often speaking up for yourself produces valuable information and greater peace of mind and clarity: An anxious nanny finally asked her employer, who was herself experiencing a significant decrease in income, if her own job was secure and discovered it was; an IT consultant, asking his boss for a straightforward response, discovered his job was likely to be eliminated and began the search for another job, early, unsurprised and still employed.
There are two common denominators to these six strategies for dealing with and healing from financial setbacks and the unnerving feeling that the ground has shifted. All of them remind us, in times when the economy has made us feel powerless, that there are things we can do to help ourselves. And none of them costs money.
You can read the original article here.
If you like what you read, please make a comment; it’s always great to hear from you here, but it also helps if you leave one on the Washington Post article so that they know you like reading articles with a focus on prevention, wellness, and self-care. You can either do this through their website form (if you login) or by emailing firstname.lastname@example.org. (I’m really enjoying the comments that are already there.) And for those of you who participate in social bookmarking, I also appreciate submissions to Digg, Deli.cio.us, Reddit, and other bookmarking sites.
Thanks for reading, and I hope the techniques in the article will be useful to you and to everyone in these difficult times.
David Leonhardt’s “prostate cancer test” (The New York Times, July 8, 2009) is a good but incomplete one for healthcare reform.
In addition to removing financial incentives for high tech intervention, we need to educate clinicians in the impartial, critical analysis of all therapeutic options, and in supporting their patients as they act on the choices they make. For 10 years, The Center for Mind-Body Medicine has trained health professionals and patient advocates to do precisely this, as “CancerGuides®.”
We need as well to realize that expensive, Draconian treatment and “watchful waiting” are not our only choices. There is, as Dean Ornish is showing with peer-reviewed studies on prostate cancer - and a number of us are doing with heart disease, diabetes, chronic pain, depression and post traumatic stress disorder – a far more promising third way. It is grounded in techniques of self-care – dietary modification, physical exercise, and mind-body approaches like meditation and yoga – and in group education and support.
This approach holds great promise for treating and preventing chronic illness of all kinds and for saving large sums of money. It should be central to healthcare reform.
A shortened version of this was published in the New York Times online Letters section on July 21, 2009.
I just returned from another trip to Israel and Gaza to visit our programs there and to plan for the future. I’ll tell you about what happened sometime soon. Right now, I wanted to share with you some testimonials from health and mental health professionals who participated in our most recent professional training in Gaza (March 7-11, 2009). It was, as you’ll see, an extraordinary five-day experience. Jamil Abdel-Atti and his Palestinian team gave just about all the lectures (I filled in some) and led all the small groups. Amy Shinal, our CMBM clinical director, and Afrim Blyta and Yusuf Ulaj, Kosovo psychiatrists and dear brothers with whom I’ve worked for ten years and I provided consultation and supervision; and Dan Sterenchuk and Lee-Ann Gallarano, from our DC office, offered invaluable administrative support. But the training and the beautiful spirit came with our wonderful Gaza team.
Here, then, is what some of our participants had to say:
The information, the relaxation techniques, meditation, and deep breathing. I deeply discovered myself and how to take care of myself. I discovered my neglected body and promised to be taken care of. I forgave my friends and relatives I have neglected and lived far from. Spirituality, I had neglected that part for so long, but realize how important it is for my healing. Grateful for the ability to apply these new techniques in my work. I met new friends. The family tree gave me a very good space to think of my relationships that I’ve ignored.
• Ensherah Zqoot
Gaza for Psychological Health Program
First, I want to express my feelings. I’m happy and feel like I own the world. The training was wonderful and excellent. I felt changes in my physical, psychological and mental status. The techniques were great and worth teaching and sharing in such a training. For the first time I feel involved in a training for myself. I feel safe and comfortable with the team and the facilitator Jamil, who shared his feelings with us. I want to thank him but can’t find words to express my gratitude. I won’t forget the efforts of everyone who participated in this training. I just want to say I’m truly happy.
• Jabr Hussien Theibet
I benefitted a lot from this training. I debriefed lots of feelings and emotions. I truly thank the mind-body medicine team especially Dr. Jim and Jamil and the rest of the faculty. I hope I will be involved in the advanced training so I can help others like you helped me.
Mohd Abu Omirah
Psychological Support Association
I was asked by my professor in the university to participate in this training and I didn’t know anything about it. I felt sad and angry during and after the war, and I was furious about everything. Felt insecure and that all my dreams and rights have been violated on the beach of Gaza. I was thinking sometimes why live? And why continue living as long as we’re continually exposed to those violations? In the five days of this training my life has changes completely. I felt dreams could come true and might will not last long cause day is coming soon. I felt I was born again, like a new person. I felt like a loving human being, full of happiness and hope for the Gaza children. I have many things to say and deep happiness inside but I didn’t want to talk much and bore you. In the last moments I had in room 402 that I will never forget for I had sad and happy moments. I want to thank Mr. Ahmed Theibet and the small family I lived with for 5 days and for Jim, Jamil and the rest of the faculty. Thank you all.
This training provided me with the following:
1. To control my feelings when I face external stimuli
2. How to respond in a rational way and wisdom in the face of acute and difficult situations.
3. My wish that we implement this program with schools’ teachers and guidance and counseling staff at the Ministry of Education to enable them to deal with students and how to face difficult problems.
Abeer Fathi Shareef
Thanks to Jamil and his incredible team on the fabulous training. Also thanks to Dr. Jim and his team. These techniques are consistent with our Palestinian and Islamic culture and this is the secret beyond the programs success.
Gaza Mental Health Center
Training was very enjoyable in terms of changing the track of our lives and jumped with it that big leap. Therefore I have decided to change my life and to reshape my issues. I felt that the training was extremely individualized and it was directed for us as professionals, where always we are asked to care for others and in a very few occasions somebody remembered us and worked for us rather than the patients cases and clients. Thanks a lot for all of those who were behind the program.
Tawfig Abed A Hadi
This course made us realize that our hearts are like Jim’s, very beautiful and valuable. By awakening all the shine that it contains you had awakened our souls which was about to disappear in the sea of torture. We have lived moments that could be the road to the shining future.
Head of Guidance and Counseling in Ministry of Education
This letter of mine appeared in The New York Times yesterday (in somewhat shortened form), under the title, “Alternatives to New Drugs.”
To the Editor of The Science Times:
Richard Friedman (“New Drugs Have Allure, Not Track Record,” May 19, 2009) is appropriately troubled by the loss of a “larger context” by physicians who prescribe newer, aggressively marketed drugs preferentially to older, less expensive but more reliable ones. His own therapeutic context is, however, far too narrow.
In evaluating treatments for mood disorders, psychiatrists (and the comparative effectiveness studies proposed by the Obama Administration) must enlarge their perspective well beyond drug therapies. My own work over the last forty years, and my reading of the “evidence-based” scientific literature, strongly suggest that an integrative, non-pharmacological approach based on self-awareness and self-care is in many cases significantly superior to drug treatment.
This kind of integrative approach, which may include meditation, physical exercise, dietary modification and supplements, and psychotherapy has been shown to enhance biological as well as psychological functioning—decreasing stress hormones, shifting electrical patterns to portions of the brain associated with optimism, and improving neurotransmitter levels along with mood—without the negative side effects that often accompany drugs. Moreover, such an approach, carefully individualized to meet the needs of each anxious, depressed, and troubled person, significantly enhances the damaged self-esteem of patients who, using it, experience the satisfaction of helping themselves.
-James S. Gordon, M.D.
Dr. Gordon, a psychiatrist, is the author of Unstuck: Your Guide to the Seven-Stage Journey Out of Depression.