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.
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.
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.
Title: Lecture at Urban Zen Focus on Nutrition: Nutrition in Hospitals
Location: Stephan Weiss Studio, 705 Greenwich St. NYC 10014
Description: This discussion will focus on the nutritional standards of food provided to patients in hospitals. Sadly, these standards have been notoriously weak. Malnutrition among patients has been identified in numerous studies and hospital food is frequently cited as insufficiently nourishing. This presentation will address what can be done to improve hospital food: nutrition to aid healing and improve health outcomes.
With Roberta Lee, MD.
For more info, see www.urbanzen.org/news/
Start Time: 10:45 AM EST
Date: April 17, 2009
End Time: 11:45 AM ESt
Despite a hectic schedule this January, I’m hoping to keep my blog up-to-date with the exciting events in my practice and at The Center for Mind-Body Medicine (CMBM).
A quick look at my schedule/to-do list:
I’ve just finished leading (along with Kathie Swift, MS, RD, LDN, my co-director) The Center for Mind-Body Medicine’s professional training program in nutrition, Food as Medicine, in San Francisco.
We’re also moving forward with our exciting work with the US Military training health and mental health professionals who are working with active-duty military as well as in the Veterans Administration to use mind-body techniques with vets returning from Iraq and Afghanistan with severe depression, PTSD, and traumatic brain injury. Over 100 of these professionals came to the first phase of our professional training program in mind-body medicine in Minnesota in October 2008. Here’s some data on the difference our training made to them. Most of them are returning for our advanced training–where we teach them how to lead the same kind of mind-body skills groups in which they participated in the first training—this weekend, from January 31-February 4th, once again in Minneapolis.
We’re also moving ahead with a research study funded by the Department of Defense on the use of our model with traumatized veterans and their families.
Last but not least, 30 of us–health professionals, policy makers, and just plain folks–gathered together in my home to develop a report to make recommendations for a National Health Plan to the Daschle/Obama Health and Human Services Administration. We’re continuing to explore ways for CMBM to be involved in creating a top-down support for truly universal and integrative health care for all Americans.
In other news, a recent op-ed of mine was published in the Clinical Psychiatry News, entitled “We Must Consider CAM for Depression.” You can read this succinct argument for wider use of integrative therapies, versus drug-centric treatment, here (you will have to create an account on this website to access it if you don’t already subscribe to CPN, though–sorry.) I was also published in the New York Times science section, writing about a friend and colleague of mine in Gaza going through the terrible bombings there. Read that one here.
Let me know your thoughts about what we’re doing, how we’re doing it, and how we’re bringing it out into the world! I’ll be in touch too.
The UltraMind Solution: Fix Your Broken Brain by Healing Your Body First by Mark Hyman, MD Review by James S. Gordon, MD
The UltraMind Solution: Fix Your Broken Brain by Healing Your Body First
by Mark Hyman, MD, Scribner’s: New York: 2009
Review by James S. Gordon, MD
I just finished The UltraMind Solution, a wonderful, ground breaking book that gives new and eminently practical insight into the causes and treatment of mood, behavior, and cognitive disorders. It’s a book I recommend to all of you without reservation.
The UltraMind Solution is by Mark Hyman, MD, a highly skilled, integrated Family physician who is a Center for Mind-Body Medicine Board Member, and a core faculty person in our Food As Medicine training. In The UltraMind Solution, Mark suggests that the most effective and, indeed, scientific way to address the epidemic of psychiatric disorders (affecting 1.1 billion people worldwide) is not with psychotropic drugs that treat postulated alterations in neurotransmitters, but with nutritional therapies that address the underlying biological imbalances that ultimately may disturb neurotransmitter functioning.
The UltraMind Solution is based on the principles of “functional medicine,” a systems approach to chronic disease and to the physical and emotional problems that beset our population. It is a road map for both patients and practitioners, a clear, thoughtful, guide to the ways the body can become imbalanced, and to the simple, natural methods-largely food and supplements-that can be used to restore the imbalances in the entire body, and most particularly, the brain. It’s a book that significantly deepened my own understanding of biological factors in depression. I believe, as well, it will enhance the information on biology that I present in my book Unstuck: Your Guide to the Seven Stage Journey Out of Depression.
In a series of clear, well documented chapters, Mark discusses the “7 keys” to his program, and the ways that readers can use them. These keys include optimal nutrition, hormone balancing, decreasing inflammation, improving digestion, enhancing detoxification, increasing energy metabolism, and calming the mind. In The UltraMind Solution, Mark includes more than 400 well-chosen scientific references and dozens of case studies, together with diagnostic questionnaires. He offers as well clear steps that readers can take to use this information to help and heal themselves. You can learn more about The UltraMind Solution by going to the following website: http://www.ultramindhealth.com/cmbm.
Mark is also presenting a six part webinar series for clinicians on applications of functional medicine to brain and mood disorders. In particular, he will discuss diagnostic and therapeutic approaches to ADD/ADHD, autism, dementia, and depression. Access to these webinars is complimentary for practitioners who obtain a copy of The UltraMind Solution by going to the website below.
“You don’t have to go to Gaza to treat posttraumatic stress disorder,” my friend said. “Just come to New York.”
It’s not that the mental and emotional state of the US population is indistinguishable from that of Gaza’s Palestinians — many of whom have lived with eight years of war and civil strife — thousands of lives lost and homes destroyed, and unemployment reaching 40-50 — some say 70-80– percent. Indeed, even those of us hit hardest three weeks into the worst of this unraveling financial crisis, are still technically experiencing only an “acute stress disorder.” But there are signs that each day, this growing financial crisis is traumatizing us more and more. Add to that our costly, life-claiming Middle East war, and we — like the Palenstinians in Gaza — may also be on our way to significant levels of population-wide traumatic stress.
Posttraumatic stress disorder, which by definition lasts longer than several weeks, is characterized by three sets of symptoms: “Hyperarousal,” an agitated state in which the heart may race, concentration and sleep are disturbed, startle responses are exaggerated and anger easily triggered; “Re-experiencing” the original trauma — in nightmares, intense and disturbing memories, and flashbacks; and “Avoidance” of trauma-related thoughts and feelings, coupled often with a sense of detachment and estrangement, emotional numbness and an apprehension about a bleak future.
All these are in abundant supply in those closest to the crisis — the ones who have lost jobs and pensions, older people who see their retirement savings melting away, and people of all ages who cannot keep up payment on their homes. Many who are, or were, working on Wall Street are sleeping fitfully, jiggling their knees uncontrollably in meetings, drinking and eating too much, losing their appetites, and popping antacids and tranquilizers. One broker friend is awake far into the night, worrying about her elderly clients’ inability to live on their diminished incomes and whether or not she will be able to pay her own child’s tuition. Others, like one 30-year Lehman Brothers veteran who is married to a colleague, have receded into states of frozen denial; acting as if somehow everything were still as it was. He dresses as meticulously as he always did and sits for hours at a computer which no longer registers his trades.
And the symptoms are also present with more or less intensity in many of the rest of us who feel the financial foundations crumbling under our feet. I have been hearing from retirees who are waking up in the middle of the night, panicked, to pore over diminished budgets, then fall asleep worrying that their fixed incomes will no longer permit them to live in the houses they saved a lifetime to buy. A colleague out West tells me her psychiatric inpatient service is overflowing with people whose loss of homes and jobs has undermined their precarious emotional, as well as economic, security. Meanwhile, anxious and depressed people, unable to afford gas for the long trip to the outpatient clinic, call in for more prescriptions for tranquilizers, antidepressants, and sleeping pills. And children may be just as deeply affected as their parents; according to The Washington Post, a recent national survey of 500 teenagers found that already, “70% fear ‘an immediate negative impact’ on the security of their families.”
Former senator Phil Gramm’s infamously dismissive comment declaring the US in the midst of a “mental recession” is likely to turn out to be true in a way he never intended. Financial irresponsibility and lack of oversight are indeed creating the conditions for “mental” disturbance. The associated loss of confidence and hope further threatens the trust upon which credit and the financial markets depend.
Even when trauma is reliably over, the feelings of being overwhelmed and stuck persist. Five years after the war in Kosovo, we found that 44% of all high school seniors in the Suhareka region still had symptoms of PTSD. And when stress is ongoing, its symptoms and the accompanying depression are continually reinforced. Some Americans will never recover financially or emotionally from the loss of jobs and homes and savings. Others will be long unemployed, and their misfortune and lack of income — and the emotional distress both bring — will affect businesses in their communities as well as in their own families and friends. Meanwhile, vast numbers, perhaps our entire population, will likely feel the uncertainty and vulnerability that the ongoing and deepening financial crisis is provoking — feelings that still bedevil so many who lived through the Great Depression. One recent landmark study on the influence of genetics and “life stress” showed that of all possible causes, financial setbacks were most likely to contribute to depression.
In Gaza and Israel — where the consequences and threats of terrorist bombings are ever-present — and in Kosovo and New Orleans, my colleagues and I have helped tens of thousands of fearful and vulnerable people in the midst of chaos. We teach them meditation, deep breathing and movement techniques, mental images, and exercise. Learning these techniques, they find places of calm and control within themselves, discover solutions to problems that had seemed unsolvable, and raise their depleted physical and emotional energy. Acting to help themselves, they find antidotes to the helplessness and hopelessness that are the hallmarks of depression and traumatic stress. Learning together they discover mutual support and a renewed sense of community.
In Gaza, in the most vulnerable parts of Israel, and in New Orleans, there is another factor that makes people’s stress and depression — and, yes, their anger as well — so much worse. This is the sense of being dismissed and neglected by the larger world on which they had once depended.
These feelings of neglect, deception, and disrespect are only increasing as the financial crisis deepens here and expands overseas. They must be addressed. The various bailouts are initial investments in confidence as well as credit, the first signs of a public assumption of responsibility. But they are only a down payment on the far more comprehensive measures that must follow, and should only be the first step in the government’s effort to regain the trust that is necessary to real recovery.
As a country, we must honestly admit to and address the causes of our crisis — greed, arrogance, and indifference. Then we must begin to pay honest, ongoing attention to the concerns of a population that feels betrayed, vulnerable, and abandoned. These steps will promote stress reduction as well as provide fiscal reassurance. Meanwhile, we have to learn, quite literally, to breathe deeply, to relax in the midst of fear and uncertainty, to trust that we, like the Israelis and Palestinians and New Orleanians, can grow and change through adversity. We cannot avoid the fear and the stress in the world in these troubled times. We can however, learn to live more peacefully with them.
Republished with permission from The Huffington Post
First published October 23, 2008, 10:52 AM EST at
NEWS RELEASE: "Landmark CMBM Randomized Controlled Trial Treating PTSD in Children Published in Journal of Clinical Psychiatry"
The Washington, DC based Center for Mind-Body Medicine (CMBM) announced today the publication of a landmark study on the use of its comprehensive, non-drug model to treat posttraumatic stress disorder (PTSD) in war traumatized children. The study, “Treatment of Posttraumatic Stress Disorder in Post-War Kosovar Adolescents Using Mind-Body Skills Groups: A Randomized Controlled Trial,” which was published today online in the Journal of Clinical Psychiatry is the first randomized controlled trial (RCT) ever of any intervention with war traumatized children. It is also the first RCT of a successful, comprehensive mind-body approach with any traumatized population.
The study demonstrates that the Center’s groundbreaking model can be used to produce highly significant and lasting changes in levels of stress, flashbacks, nightmares, and symptoms of withdrawal and numbing in highly traumatized children – those who lived in an area of Kosovo where in 1999 90% of the homes were burned and bombed and 20% of the children lost one or both parents.
The CMBM approach includes self-expression in words, drawings, and movement and mind-body techniques (including meditation, guided imagery, biofeedback and yoga) was offered to these children over 12 sessions in an educational, supportive small group setting. This intervention produced an approximate 80% reduction in PTSD in the treatment groups, much of which was maintained at 3 month follow-up. This is the same model that CMBM’s founder and director, James S. Gordon, MD, describes in detail in his new book, Unstuck: Your Guide to the Seven Stage Journey Out of Depression.
“This RCT,” Dr. Gordon, the lead author, says, “is important because it provides scientific evidence for the efficacy of a model that has been taught to almost 3,000 health and mental health professionals and educators worldwide. We’ve used this small group model to give tens of thousands of children and adults practical tools that help them to feel better quickly, and we’ve taught them to use their intuition and imagination to solve problems that had seemed overwhelming. We help traumatized people around the world to draw on strengths they may have forgotten they have and we offer them a ‘safe place’ in which they can share their pain with others who have suffered as they have.”
“This model is educational, non-stigmatizing, and powerfully effective. It can be easily taught and can be used by people of all ages on their own,” Dr. Gordon explains. “It’s highly acceptable to populations which do not want to be given medication, those without access to a doctor or therapist, and those who are in psychotherapy.”
This model, which Dr. Gordon presents in a step-by-step self-help format in Unstuck, is currently being used by CMBM with war traumatized populations in Israel and Gaza as well as in post-Katrina southern Louisiana. It is widely used with anxious and depressed people and those with chronic illness in the US, and has already been incorporated as a stress reduction program for students in a dozen US medical schools.
The CMBM model is also of increasing interest to the US Department of Defense and the Veterans Administration. “The military,” Dr. Gordon says, “understands the breadth and depth of the psychological crisis (as many as 300,000 returning veterans are expected to have posttraumatic stress disorder or major depressive disorder, and another 320,000 will have been made vulnerable to these conditions by traumatic brain injury). The military’s leadership is committed to finding evidence-based approaches, like the one taught by The Center for Mind-Body Medicine, that can make a difference for the individual veteran and his/her family, an approach that can be taught to the large numbers of professionals and peer counselors who serve them.” More than 100 health and mental health professionals who work with the military are expected at the next CMBM training in mind-body medicine on October 25-29 in Minneapolis, and many more are expressing interest in learning and using the CMBM model.
I did an interview recently about depression, the work that I do through The Center for Mind-Body Medicine, and my book, Unstuck: Your Guide to the Seven Stage Journey Out of Depression. Hopefully you will find it not only informative, but helpful as well.
Speaking with James Gordon, MD
Your book begins with the assertion, “Depression is not a disease.” How did you come to this conclusion?
It always seemed strange to me that anyone would describe depression as a disease. In medical school, I learned that diseases were characterized by specific physiological and biochemical abnormalities and physical changes. When I was doing autopsies and I looked at the organs of people who had diseases, I could see cancer cells, or blood clots in the arteries, or obvious changes in the pancreas of someone with insulin dependent diabetes. So far as I could tell then, and so far as I know now, this is not the case with depression. Depression, it seems to me, is a way of feeling and a set of attitudes that people develop toward the world, influenced certainly by heredity but, much more importantly, a result of their entire life experience. It is certainly not the consequence of a bacterial invasion or a specific genetic abnormality.
I found, too, that when I spent time with depressed people and helped them understand and experience the world differently that they tended to become less depressed. Their depression was a human experience and when that experience changed, their depression lifted. They were having a change of mind and a change of heart. When I myself became clinically depressed while I was in medical school, my body felt weighed down, my mind was preoccupied with guilt, and my heart was heavy. But it was clear to me that the events in my life―the end of a romantic relationship and my very mixed feelings about medical school―not some disease process was responsible for what I was feeling.
If you look at depression as a disease, you can treat it that way―and the pharmaceutical companies definitely encourage doctors to do so. But this seems, to me, an ill-considered choice. If you look at depression as a human experience from which you can learn, the possibilities are infinitely greater and, in my experience, the prognosis is far better.
You point out that there is little evidence that antidepressants are more effective in treating depression than many other, less potentially toxic approaches. Interestingly, in January the New England Journal of Medicine (NEJM) published a report that stated that doctors and patients are getting a distorted view of the effectiveness of antidepressant medications because of pharmaceutical manufacturers’ suppression of negative results. And yet antidepressants are being prescribed and taken at an alarming rate. Why do you think the medical establishment continues to prescribe these drugs so commonly?
200 million prescriptions will be written in the US this year. This widespread, even epidemic use of antidepressants reminds me of the Hans Christian Andersen story of The Emperor’s New Clothes. We are all, like the Emperor, his courtiers, and his subjects, in a state of collective hypnosis. The science that demonstrates the biological consequences of depression in some people and the benefit of drugs for others is the small piece of reality at the core of this illusion. It has been augmented by the desire of physicians to be of help to their patients, and relentlessly inflated by the pharmaceutical companies that profit so hugely from these drugs, and the insurance companies who realize larger financial gains by prescribing pills rather than personal counseling.
When you take a close look at the biological claims which set the stage for this mass hypnosis, another picture emerges. There are biological changes in depression―as indeed there are in joy―but these changes are inconsistent and, in any case, are far more likely the result of feelings of loss, hopelessness, and helplessness, than their cause.
The NEJM study, which actually confirms several earlier ones, is the voice of the little boy pointing out the Emperor’s nakedness. When the drugs are looked at fairly―that is when the negative studies that the drug companies did not publish are counted as well as the positive ones they did publish―it turns out that antidepressant drugs do not, on average, make very much difference. In the Andersen story, after the little boy speaks up, everyone starts laughing and the scamming tailors are run out of town. But because the idea of drugs as a “quick fix” is so seductive and the pharmaceutical and insurance companies are financially motivated to continue to promote the use of antidepressants, I think it’s going to take us a while longer to find our own happy ending.
Our culture does seem to be easily sold on promises of a quick fix.
Depression is incredibly painful. It’s certainly understandable that we want to feel better as fast as possible. And it is a part of our culture to believe we should be able to have a quick solution and there’s got to be a pill to make it happen. Some pills are fabulously useful―antibiotics for bacterial infections, for example―and they encourage us to have this belief. Still if we were paying attention for the last half century, we would have learned that those quick fixes are very often an illusion. Many so called miracle drugs―Vioxx and the FenPhen diet pills, for example―have turned out to have terrible, even life-threatening, side effects. But it’s not just drugs that are problematic here. We want to be able to have it all now. And in our demand and greed, we’ve lost the wisdom that helps us comprehend the consequences of our actions. In the case of depression and life’s other challenges, we’ve also lost the understanding that our suffering is sometimes both a necessary teacher and a prelude to profound, life enhancing change.
Your book explains the seven stages of your approach to healing depression without the use of antidepressants and gives a hands-on program of practices, exercises and suggestions that will relieve depression’s symptoms. How did you come to develop this program?
The techniques that I use and describe in Unstuck are ones that I first learned and tested on myself. Each of them is designed to address different parts of the picture that we describe as depression: quiet breathing techniques that are an antidote to the ongoing stress response that plays such a large part in precipitating depression and making it chronic; the use of guided imagery, written exercises and drawings to open depressed people up to their intuition and to possibilities for change that had seemed beyond them; experiments with movement and exercise that break up the fixed patterns of thought and feeling that characterize depression and raise the energy of depleted and discouraged people. All of these approaches make it possible for depressed people―and those who are ordinarily confused, anxious, and troubled―to realize that they do not need to be helpless and hopeless. As you do each of these techniques, you can see and feel the change. Usually right away. Over the years, I’ve created clear instructions and a logical sequence for these techniques, both of which I present in Unstuck. What I do in my office, and in the book, is to give people a step-by-step experience of these approaches and of their benefits.
How do you encourage people to shift their thinking and take an active, effective role in their own healing?
My experience is that if you offer them the opportunity, most people want to take an active part in their own healing. This is particularly true after they’ve seen that what they’ve been doing isn’t working so well. We’ve created a social belief that the power to heal lies in the hands of the experts, the doctors. In the case of depression, and indeed of many chronic conditions, this is simply not true. Silver bullets are very rare. I find that the people I work with are first amazed, and then deeply satisfied, when I tell them they have the capacity to help themselves―especially when they actually experience the positive changes they can make. I know it’s very hard when you’re really depressed―I’ve been there―but I also know that the small changes in belief or action (breathing more slowly and deeply, going for a brief walk, etc,) can brighten your outlook and be the basis for ever-more significant and broader changes. I think one of the most important things I do in Unstuck is to say it is possible to change―and then show how people just like the reader, and in many cases far worse off than the reader, have accomplished just that.
Would you explain the concept behind integrative medicine?
Perhaps the most important, and often neglected, aspect of integrative medicine is its emphasis on the wholeness, the integrity, of each person. This is fundamental to all great systems of healing, including, of course, our Western medicine, but it has unfortunately been neglected. We have tended to focus too much on the particular biological abnormalities, on the parts. We have neglected to appreciate how all those parts are connected in each of us, in the thinking, feeling, acting human being who is far greater than the sum of his parts.
Integrative medicine is an approach that includes all of the world’s healing traditions and combines and carefully individualizes them to the person who is coming for help. The approach that I describe in Unstuck, for example, integrates meditation techniques from several cultures with modern ways of expressing emotions; Chinese medical therapies that are thousands of years old with the latest information on the use of vitamins, minerals, and other supplements; and a group approach that combines ancient tribal wisdom with the modern, democratic emphasis on each person’s capacity to help and understand herself.
You are a Harvard-trained psychiatrist. How did you first become involved in integrative medicine?
My involvement began 45 years ago during the first months of that Harvard training. I deeply respected the expertise of our faculty, but I was also troubled by the way that many of them treated patients. I felt they focused too exclusively on the patients’ laboratory values and physical findings and was troubled by their apparent indifference to the human beings who were lying on the beds around which we stood. I found that I was at least as interested in who my patients were as in the diagnoses they had been given.
As a third year medical student, I was actively questioning the disease model of depression and other psychiatric conditions, and began to explore ways to help my patients to understand and help themselves. By the time I finished my psychiatric residency and began work as a researcher at the National Institute Mental Health in 1971, I was already exploring meditation, yoga, nutrition, and Chinese medicine―for myself, then, as time went on, I began to use these techniques with other people. For a couple of years, I had a weekly free clinic in my home. After awhile, I began to integrate these approaches into everything that I was doing―working with troubled teenagers and their families at NIMH as well as in my private practice.
You’ve helped many thousands of people who’ve been depressed and traumatized by war and disaster in places such as Kosovo, Israel, Gaza, and post-9/11 New York City and post-Katrina New Orleans. How is this work related to the program you describe in Unstuck?
The program The Center for Mind-Body Medicine uses for people traumatized by war and other disasters is very much the same as the one I describe in Unstuck. As a matter of fact, I’m giving the first few copies of Unstuck to the leaders of our programs in Israel, Gaza, Kosovo and New Orleans. I’m so pleased with Unstuck because I’ve been able to gather so many of the techniques I use, together with stories which show how people successfully use these techniques, as well as a Resources section to support readers on their journey, all together in one book for the first time.
One of the things about this approach is how well it translates across cultures, ages, and economic groups, both here in the US and overseas. I believe that in Unstuck, I’m speaking a universal language of self-discovery and self-healing that just about anybody can understand and benefit from.
Is your approach only for those who are diagnosed as clinically depressed?
It was very important to me to write a book for people who are feeling the helplessness and hopelessness of clinical depression. Though there are certainly other self-help books, it seemed to me that one was needed that was both practical and inspirational, as well as authoritative and scientifically grounded. I wanted people who were feeling overwhelmed and lonely to have a friendly guide on whom they could lean at every step as they moved on their journey through and beyond depression.
At the same time, I was aware as I was writing Unstuck, that it was also a guide for anyone who wanted to learn from the challenges that inevitably arise in all our lives, a guide that could help each of us to find our way to greater wholeness and happiness. This book is also for people who do not consider themselves depressed but are simply sad or dissatisfied with their lives. Many thousands of people who were not depressed―health professionals, medical students, people with physical problems, and spiritual seekers among them―have used the Unstuck approach happily and successfully.