The Center for Mind-Body Medicine

Meeting Martelly: A New President for Haiti is Inaugurated

On the night before his inauguration, Haitian president-elect Michel Martelly  came to the Hotel Karibe, where our US team and our Haitian program director Linda Metayer were staying. He sat outdoors among us as the band began to play. There were watchful bodyguards, but also a feeling of welcome, of fraternity.

The people I spoke with were happy, excited; not just the tent-camp organizers who had always been solidly behind “Sweet Micky”, the popular singer, as President Martelly was known, but also wealthy people and the intelligentsia. There had been a shift in the weeks since the election, a sense of possibility that, freed from narrow, self-serving needs—he’d already had plenty of fame, adulation, and devotion, and had made plenty of money—he might really mean what he’d said: about rebuilding the infrastructure and making, for the first time, education available to all.

It felt important to talk to him, to tell him how hopeful we were as well as what we were doing. And so, Linda and I arrived at his table. She explained in Creole—the people’s language here in Haiti—about the Center’s work and our hopes for establishing a National Program of Self-Care and Mutual Help.  “Thank you,” he said to us in English, “for everything you are doing for Haiti.” He gave us names and contact information for key advisors and the next Minister of Health, embraced us with a kind of warmth and ease that is rare in politicians.

In the background, the guitarist, Belo, was joined by backup singers and other musicians—two, three, five, ten of them. The music, a kind of joyful Haitian reggae, had us smiling and dancing. I wish you all could’ve been there. The president stayed at his table for awhile, happily greeting supporters, many of whom had returned from the Haitian diaspora, enjoying his evening and everyone’s music.

Mind-Body Medicine is “How to Heal Psychological Trauma”

Dear Friends,

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:

THE GUARDIAN: How to Heal Psychological Trauma: From Haiti to Gaza, psychiatrist James Gordon counsels survivors of disasters around the world

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.

Does "Fighting Spirit" Affect Health?

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.

Sweat Lodges and Spirituality: I'm on Talk of the Nation

Dear Friends,

I wanted to let you know that I am going to be on “Talk of the Nation” on National Public Radio tomorrow, Thursday, October 22nd from 2:06-2:40pm EDT.  I will be talking about Americans and the search for healing and meaning, the promise and the perils of the spiritual path.

I hope you will tune in if you’re able! Please enjoy the show, and I will be in touch soon again.

Jim

Stress and the Economy: My Washington Post Article

Dear readers,

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 health@washpost.com.  (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.

Jim

Obama: Addressing the Healing Crisis

Dear President Obama,

Before you even took office you asked us Americans to share our ideas about healthcare reform with your new Administration. Thousands of us, thrilled to be invited to participate, gathered in small groups and offered our vision to you. Now, tonight, as you address us, it’s time for you to give us back our vision, enhanced by your broader perspective, enriched by detail, unencumbered by fear.

(c) Dreamstime.com

Americans for Healthcare Reform © Dreamstime.com

I’m sure you and your advisors have seen the polls that have repeatedly shown that the vast majority of Americans (up to 85%) believe that our healthcare system needs to be “fundamentally changed and completely rebuilt,” and that almost equal numbers are concerned that “access to medical tests and treatment would be more limited” as a consequence of healthcare reform. The polls tell us that Americans know that our far more expensive healthcare system is significantly less effective and efficient than that of other developed countries, and that, in general, we like the doctors who care for us.

These apparent contradictions are best understood as Zen koans, paradoxes that work to boggle our minds prior to opening them to new ways of seeing and thinking. I hope tonight you will invite us to look at healthcare reform in such a new way;  help us to find, beyond the fears that have been evoked, and the mind-numbing horse-trading and compromise of the legislative process, the vision that continues to animate your commitment to the health and wellbeing of all Americans.

The vast majority of Americans-not just “Democrats” or “progressives,” but all of us – are decent, compassionate people who really want all our fellow citizens to have the healthcare they need. We know that change is necessary, but we don’t know yet what’s actually being proposed, and we fear that the change that comes may take away the surety of care and the security of our relationship with our doctors.

Fear is an enormously powerful emotion-deeply embedded in our evolutionary heritage and in our central nervous system. It signals danger, mobilizes the fight or flight response and all the psychobiological mechanisms of survival. Fear, as this summer’s town halls illustrate, overwhelms our capacity for nuanced observation or even rational thought. The very thought of going to the doctor makes many people tremble. The possibility of failing health, or of a vulnerable old age, or a change in access to those who are supposed to care for us makes us deeply uneasy. When opponents of healthcare reform have used evocative and provocative words to summon up these specters, the fear factor has obviously jumped off the chart.

To our agitated minds, “rationing” means that we will likely lose the diagnostic tests which we hope will clear away threatening uncertainties, the treatments that may restore us to health, and the doctors whom we have literally trusted with our lives. “Death panels” signify that anonymous others will, in the name of some impersonal, financially motivated calculus, shorten our lives.

Outrage, reassurance, and careful reference to the actual texts of proposed legislation-the principal defensive strategies of healthcare reform proponents to date-only take the edge off our collective apprehension. Relaxed, even meditative, clear-eyed assessment of healthcare realities, active engagement of each person in responding to them, and a call to transcendent and common purpose are what will ultimately make it possible for us-individually and collectively- to move through and beyond the fears that have been dominating the discussion. We are an energetic, inventive people and once we know it is possible and even necessary, we will want to be actively, effectively engaged in our care, and in determining our destiny.

Think of the “terminally ill” mother, who “somehow” lives to see her daughter’s wedding, the firefighter who enters a burning building to save an endangered child, the soldiers who brave bullets to protect one another. Think too, of people with life-threatening or life burdening illnesses (coronary heart disease, diabetes and cancer, clinical depression and post traumatic stress disorder), who, in the therapeutic programs many of us have created around the country, are healing themselves: sharing their fears and developing strategies for dealing with the threats to their lives; regarding illness more as a challenge than a disaster; eating and exercising in more healthy ways; learning from and supporting one another. William James coined the phrase, “The moral equivalent of war.” Caring for ourselves individually and collectively is such an equivalent.

I’m asking you, really, all of us are asking you, to mobilize and inspire us to participate actively in our own healthcare; to insist that those professionals who are supposed to help us treat us respectfully, even lovingly, as active partners, not passive patients.

We don’t, for the most part, need more drugs or procedures, but rather doctors and other healthcare professionals who will spend adequate time with each of us, listening and creating partnerships, as well as writing orders and prescriptions. The powerful therapeutic effects – and cost effectiveness – of such instruction in self-care, of what some are calling “lifestyle medicine,” on outcomes of chronic illness have been repeatedly documented.

If every older person were guaranteed a physician with time to talk about life and ways to live it more fully, as well as to discuss the best ways to deal with the inevitability of death, debates about “death panels” would wither from lack of fearful fuel. If doctors spent more time looking at the excess of often clashing and contraindicated medications that older people take, much of the unnecessary suffering and fear that accompanies care in old age would disappear. As we actually learn what combinations of self-care and physician-administered therapies are most effective, for which condition, most concerns about rationing-raised now almost entirely by drug companies, which fear that their products’ flaws will be revealed- will dissolve. We need to hear clearly from you that all those individuals and institutions that profit from our pain – hospitals, insurance and pharmaceutical companies, and those of us who are doctors too – can be justified and supported only as long as they serve all of us.

Finally, you must assure all of us, left, right and center, that you and your Administration will continue to give us and our health care the careful consideration we deserve, that this present effort is only the first stage of healthcare reform; the beginning of a process of national education; and a framework for the more profound and pervasive changes that we want but are not yet sure how to achieve. Tonight, we need you again to inspire us, to give us a vision not only of how we can all be safely and effectively treated, but how we can thoughtfully, lovingly, energetically, even joyously, learn to better care for ourselves and one another.

A Better Litmus Test for Healthcare Reform

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.

In the Science Times

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.

CMBM and Saybrook University

Dear Friends,

It’s stunningly, suddenly it seems to me, green here in Washington. It feels like the season and its recent holy days match the message and the mood of our work – change and hope, new growth and greater freedom, leavened by compassion and forgiveness and, for me as well, gratitude for who you are and all we’ve done together and will continue to do. “Old things are passed away…all things are new” is what it says in the New Testament. Thank you.

Some very happy news for us: we’re now partners with Saybrook University, a wonderful cutting-edge program in psychology.Read about it here.

Dennis Jaffe, my old friend who is both a CMBM and a Saybrook Board member, got things started, and Lorne Buchman, the Saybrook President, has embraced our vision from the beginning and made sure that it infuses our partnership. The negotiations were long but we’re all happy now. I am going to be the Dean of Saybrook’s new Graduate College of Mind-Body Medicine and our program (Professional & Advanced Training Programs in Mind-Body Medicine, Supervision by faculty, plus Food As Medicine Training) is going to be required and central to the core curriculum for both Saybrook Masters and PhD degrees in Mind-Body Medicine.

This means a wonderful opportunity for CMBM to reach and teach more bright, eager, and idealistic participants, for those who want our work to be central to an advanced degree to have that opportunity, and for me (and our faculty) to help shape a graduate curriculum which will be exciting, attractive, and fun too. We’ll be getting the word out about the Saybrook degree and they’ll be telling people about Center programs. Dan Sterenchuk, our Director of Finance and Administration, is going to be working closely with me on all this. He’s thrilled and of course so am I; Dan does such an amazing job, makes everything easier and better for everyone he works with, and we enjoy our adventures together. Everyone else at The Center is really excited too.

With love,

Jim

Health care reform cannot wait, must not wait, and will not wait

Dear Friends,

 I spent Monday afternoon, February 23, 2009, testifying on the strengths of integrative healthcare and our hope for healthcare reform at the hearing, “Principles of Integrative Health: A Path to Health Care Reform” by the Senate Committee on Health, Education, Labor, and Pensions (HELP). The video is comprehensive—click to read shorter coverage in the Huffington Post.

 My colleagues (including Wayne Jonas, M.D. of the Samueli Institute, Robert Duggan, M.A., M.Ac. (UK), Dipl.Ac. (NCCA), of Tai Sophia, and others from institutions and the private sector) and I sincerely hope the time has come to change from a “disease-care” system to one truly centered on the patient and our wellness as a nation. Our current system is expensive, and ineffective at keeping us healthy. Turning to costly drugs ridden with side effects before trying natural approaches and wellness techniques is bankrupting our treasury and our health as a nation.

 More to come—check out the video, and check back here for updates. It’s a very busy time for us here at the Center!

 Best,

Jim

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