The Center for Mind-Body Medicine

Fear or Trust. You Choose.

Many things have happened lately to make me fearful of others and of life itself. My world seems to be filled with people who hold unfounded grudges that baffle me and choose to say vindictive things for no other reason than spite. We’ve had deaths and serious illnesses, difficult medical prognoses. Family members whose actions are more about greed than family values. Job losses and insecurity. It’s been difficult to hold on to the trust and acceptance that got me through past challenges. I see fear peeking out of every corner, tugging at me, knocking on the door, enticing me to believe that the world is full of anger, resentment, greed and struggles. Fear is ready to haunt me, settle into my stomach and my bones. In fact, I can already feel it in my body, aching and throbbing.

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Bye Bye Butterflies

Bye-Bye Butterflies cover

Would you like to help the special children in your life cope with worry and anxiety?

We’re thrilled to announce the publication of Bye-Bye Butterflies: Seven Ways To Breathe Out Worry, written by our Mind-Body Medicine faculty member Lilita Matison, LCSW. As a K-5 children’s counselor for 5 years, Lilita became familiar with the children’s worries and creative about helping them mindfully cope. This book is a marvelous result. Publicity for the book describes it as teaching “self-regulation, stress management and mind-body techniques”, and it certainly does; but it’s really just the cutest, most empowering and practical gift you could give any young child.

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Training Haitian Healers: Father Fredy Stops By

On our first night in Port-au-Prince, while  Lee Ann and I are going over the next day’s schedule, Father Fredy appears at our table on the Plaza Hotel’s terrace.

Fredy is whippet-thin and angled slightly forward, a living emblem of his eagerness to share what he has been learning and doing even before the CMBM training begins on Tuesday. “The children who have lost their homes and parents are the ones I work with most. I have them breathe deeply to relax and then draw their biggest problem and imagine its solution – a new home, people who care for them. And then we sing together, and I ask them to imagine that place they have created.”

© CMBM

He has also worked with parents who, displaced and frantic since the earthquake, have been abusing their children – having them do dialogues with their “problem” (the abuse), and the unending frustration that seems to compel them to it. For the first time they are able to talk about what shames them, to gain a little perspective.

“They thank me,” Father Fredy says, a huge smile opening his face.

“On the anniversary of the earthquake,” he goes on, “I used an image of a river. I told  our whole congregation to imagine they were on its banks, that the river was helping to take away the memories and the sorrow. They were so happy. ‘It’s just like we are there’, they said.”

Father Fredy is still fresh but Lee Ann and I are getting tired. We do a ”dialogue with a symptom” and he realizes something that is just below the surface of his consciousness. “I know I should be tired too. I want to help, but it is too much – seven days a week, long, long hours. I am awake when I should be asleep and then I fall asleep during the day when I should be awake. My Inner Guide says I have to change that,” he says, laughing.

“You have planted a seed,” he tells us, before we all go off to bed. “Other ways, like medication and just talking, weren’t working or were too difficult, or even if good, like prayer, were not enough. But this seed is now becoming a tree and it is bearing fruit.”

We are in Port-au-Prince this week doing an Advanced Training in Mind-Body Medicine with 120 Haitian health, mental health and education professionals and caregivers. Please look for more posts in the days to come. More info on our Global Trauma Relief program in Haiti can be found here.

CMBM's Drawing Exercise Resonates in Haiti

We move during the rest of our week in Haiti from one group of health professionals and community leaders to another. It is a slow progress through the traffic jams in Port-Au-Prince’s rubble-narrowed streets, and sometimes even slower over the gorged-out, flooded dirt roads that take us to Bishop Pierre Andre Dumas’ diocese in Anse-a-Veau, three hours outside the city.

We use a variety of techniques in our workshops, including explanation of the fight-or-flight and stress responses, meditations, guided imagery, and shaking and dancing. We also do a drawing exercise that has been enormously helpful to children and adults in war, post-war, and post-disaster situations, in Kosovo, Gaza, Israel, and New Orleans, and with US military. For a while, everyone—bent over paper, crayons in hand—becomes young, earnest, playful, surprised.

The drawings allow people to tap into their intuition and imagination without effort. As a series of pictures unfolds, they find themselves creating images they’d never imagined, sketching solutions to problems that seemed insoluble.

In Haiti, we guide our groups through three drawings. The first picture is of “yourself,” the second, “you and your greatest problem,” and the third calls for “the solution to that problem.” (We modify the exercise when we use it with children: read my post about using the drawing exercise with Haitian children in the General Hospital.) Afterwards, participants share their drawings in groups of two or three, telling what they see in what they’ve created and how it makes them feel. Then they have the opportunity to share with the entire group.

As you will see, the results are often touching, and almost always surprising.

Here are a few examples and snapshots of the workshops in which they are created:

For L’Institut Haïtien pour la Doctrine Sociale Chrétienne
(Haitian Institute for the Christian Social Doctrine)

Such wonderful, accomplished people: 100 of them—physicians, architects, lawyers, police officials, business men and women. All, in this time of crisis, are renewing their commitment to the welfare of those who have suffered even more than they have. They tell us about the terrible sadness—their own, and others—and about unaccustomed irritation that surfaces at home and at work, as if, somehow, angry will could restore what has been lost.

An obstetrician/gynecologist, tall, broad-shouldered, powerful and handsome in a bright, tailored shirt, has come “for rest and peace—I have not slept since January 12th.” He says he works “always” to forget the loss of his house, the deaths in his family—his sister, nieces, nephews—as well as to care for his patients. In his second drawing (a picture of his biggest problem), he is inside a tunnel, tiny as an ant, lost, unable to touch the equally tiny figures outside. In the third (a picture of his problem’s solution), the figures are larger, recognizably human. They are dancing together and he is laughing, “for the first time since the quake.”

For Anse-a-Veau diocese—nuns, priest, lay brothers

Out in the countryside a couple days later, we are meeting with priests, nuns, and lay brothers in Bishop Dumas’ diocese. It’s like rural Africa out here: lush, green and very still, faded pastel cottages with tiny yards in which seeds, sown or thrown, produce a few vegetables and fruits. We begin and end our visit with Bishop Dumas’ blessing and simple ceremonial meals: tiny, boned, tender white fish, rice, beans, greens, fresh lemonade and thick coffee.

The religious, in straight-backed chairs, are as still and elegant as the statues in the porticos of Chartres. They are so attentive, so sweet tempered amidst the flood of suffering, homeless, city people that the earthquake has forced back to the countryside. One priest draws a scene of despair—“The Cross of Death—Good Friday without Easter Sunday,”—and then, in his third picture, much to his amazement, produces a sun that covers the page with radiant yellow. “It’s the sun of freedom. Together we can overcome.”

They dance, too—nuns, brothers, and priests together—as freely and as happily as children. Before we finish in mid-afternoon, another, older priest calls the Bishop from the next diocese. It turns out he would like us to come there.

More soon about another workshop, this time with the Haitian Red Cross staff and volunteers . . .

At School in Haiti: Andre's Story

At the end of the third class, a quiet, solemn boy asks if he can speak with me. “What,” he had wondered during class, “about memories of the lost person that come back again and again?”

While Kathy and Lynda teach the fourth class, Laurent, Cassidy and I sit with – I’ll call him “Andre” – in the only quiet, moderately private spot we can find: our vehicle.

Andre says that he has great difficulty falling asleep, and when he finally does, nightmares always come. “I feel so helpless. I cannot talk to anyone.” He grabs his throat with every other sentence. When I mention the gesture, he tells me that his “words are stuck in my throat. And I am afraid to cry. It is not manly.”

Andre tells us that on January 12th, he was supposed to pick up “my cousins who I love very much, at the University.” He called to them that he couldn’t. They stayed late, and died when the building collapsed.

These cousins, “my best friends,” lived with him and were more like sisters—“one light skinned, one dark,” he smiles with the memory. “I feel so guilty. I want to go back to the time and save them, but it is not possible. I have concluded,” he lowers his voice here, “I do not want to be left behind.”

I recognize the self-annihilating weight of this guilt, have seen it burden young and old in Kosovo, Israel, Gaza, have heard how it torments the nights of soldiers and marines returning from Iraq and Afghanistan.

“Would you,” I ask him, “be willing to meet your cousins in your imagination to talk with them and ask for their advice?”

“I have them always in my heart, but when I talk with them, it makes me cry.”

I tell him that he needs to cry—that releasing his emotions will open his throat, that perhaps his cousins have something to say to him that will help him with his guilt. He nods in agreement.

I ask him to close his eyes and breathe deeply with his belly soft, as we did in class. “Imagine that you are in a safe and comfortable place—a place where you feel good.” He does and I ask him to imagine that his cousins are there with him.

“Would you be willing,” I say, “to ask them for their advice?”

He nods his head.

After a while, his face softens and small tears appear at the outer edge of his eyes.

“Did they come?” I ask.

“Yes.”

“What was it like? What did they say?”

“I was so happy to see them. They told me to keep living my life and that I was not responsible for their death.”

“Write it down,” I say to him, after he has opened his eyes “and look at it every day. “Keep living your life. You are not responsible.”

I notice that he is breathing more deeply and no longer clutching at his throat.

Making our way back to the classroom, I feel how urgent it is to train hundreds of people to do this tender, powerful, necessary work.

We’ve just returned from our visit to Haiti today. I look forward to taking a look at what you’ve got to say on this and other posts from Haiti soon.

At School: A Place to Help Haitian Children II

We keep our sessions as simple and clear as we can: an introduction to fight-or-flight, stress, and trauma, answers to their questions, and three lessons.

Here they are:

1. Slow deep breathing with the belly soft. This, we explain, is the antidote to the flight or flight and stress response that the earthquake has inscribed in the kids’ minds and bodies. Soft belly will quiet their physiology, slow their racing thoughts, give them a little perspective on the flashbacks of dead bodies, the horror of loss and the ambush of fearful anticipation. Knowing—feeling—that they can breathe deeply and relax, they will have a small but important sense of control in world where so much—whether or not they can concentrate or sleep, where they live and how they will make a living—is, or feels, beyond their power to affect.

You can experience a relaxing guided Soft Belly meditation here, at The Center for Mind-Body Medicine’s website.

2. Later we do some shaking and dancing so they can let go of fixed patterns of physical tension and mental preoccupation; can feel their bodies moving freely; can raise their energy, lift their mood, and lower their anxiety. They clap and laugh and shout and afterwards, flop happily onto their hard seats.

3. We also explain the value of sharing here in the classroom, at home, or with a friend, the pain they feel and the fears and concerns that arise.

Many of the kids would like us to do more, to tell them where they can go to practice the techniques and talk to others. For now, I say, “you have each other and your families. We are giving you these techniques, written in French. Practice them at home and we will come back to your school. Soon we will be training many people, including some of your teachers, to do this with you.”

The story of how CMBM’s model helped Andre, a Haitian boy, overcome feelings of grief and guilt, coming soon . . .

Depression’s Upside: A One-Sided View

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.

Celebrating Hope and Healing in Haiti–Day 2

Day 2 in Haiti, Feb. 12, 2010
Dear Friends,

In Haiti three days of “memorializing the dead,” of prayer and fasting have begun.

thousands gather to memorialize the dead

thousands gather to memorialize the dead

We drive downtown, past blocks where some houses are still erect and others down, victims we are told of neglected building codes, and others where everything is flattened like discarded, half-eaten sandwiches; fragments of concrete and stone and dust are everywhere.  S.O.S. signs are chalked on walls. We pass open air congregations, gathered like human lakes in front and on the sides of tent encampments, several hundred people here a few thousand there, listening to sermons in Creole, raising their voices in song. On the radio one preacher exhorts his listeners to ask God’s forgiveness for drinking, smoking and going to voodoo priests.  Requiems for the dead are broadcast, and  reminders of God’s power to see and do all, to help us go, and live beyond death.
Haitians gather for sermons

Haitians gather for sermons

We park at the Champs du Mars. A hundred thousand people are here, or more, it is hard to tell. They fill an amphitheater where the speakers stand, flood across fields and roads, flow among the thousands of tents that have been set up, sit in the trees overhead. The Haitian people, we are told, are like those who were with Joshua at Jericho: They have no weapons but God will save them. The messages from the Haitian President as well as the preachers, are similar – have strength, have faith; we will work together for the future. Men, women and children, most in tee shirts and loose blouses, some in surprisingly neat even stylish clothes, sing and raise their arms ( a few extending bibles upward) to praise God and shout “Hallelujah”. The mood is somber and suffused with determination, but also celebratory. “We are,” one lean fortyish man with dreadlocks tells me, holding my hand and looking at me with urgent fellow feeling, “here to give thanks to God, to rejoice for our brothers and sisters who have perished, to love one another.” Drums begin to play and a breeze, as if summoned by them, blows through the noon heat. We are all clapping and dancing now. None of the Haitians,needing to remain strong, seems to be crying,  though sorrow rises like steam from their bodies; tears come to Star’s eyes and mine.
the cathedral in ruins

the cathedral in ruins

Afterwards we stop at the Cathedral. A nearby music school has disappeared, its students dying with it. The Cathedral, once one of the city’s glories, is a skeleton, its only note of celebration bright bougainvillea in what was once a garden. You can see through the great building now, from one side of the transept to the other, from the porch at the back through the nave to the chancel at the front. Across the street people too injured or tired or dispirited to attend services that require standing are camped in rubble against a wall, a few possessions piled around them, burlap for bedding. At the head of one’s pallet is an astonishing sign of faith and hope, taped to the wall: a picture of the risen Christ, emerging from a blue sky, returning victorious to earth.
great faith and hope for the future

great faith and hope for the future

Jim

Haiti Day 1, Pt. 2 of2–Visit to the Tent city

Shortly after we arrived yesterday afternoon, Star and I crossed the street and walked down the ragged line of incongruously bright new tents that front the road. An open space gives us entry, and we wander through the maze of living and cooking spaces, a large, older white man, a small, younger black woman whose “bonsoirs” are often returned with smiles.

We reach one boundary of the encampment formed by a four-story concrete building which has been crushed like a paper hat. A young woman with an infant greets us. The baby is a little thin, a little dour, a little jumpy. Her name is Miranda, and she is two months old. Miranda’s mother shows me a place on her head where the nearby building had quite literally fallen on her.  It hurts still, a month after the earthquake, and so do her neck and back.  I go into her tent to take a look. There is great tension and tenderness at the site of her injuries. I do some gentle manipulation, and she smiles with relief.  I reassure her that in time the symptoms will subside and remind myself to bring acupuncture needles next time.

Others have not been as fortunate as Miranda and her mother. One woman’s two children have been seriously injured and are still at the hospital. Another’s aunt has died. A third is missing her husband. A fourth has lost the sight in one eye. The pain from injuries received in the earthquake persist. Memories of loss and unspeakable terror seem to have attached to and continually restimulate the pain—the ever-present physical replaying of the catastrophe, the physical manifestation of psychological trauma and ongoing distress. Some “cannot remember the simplest thing,” or “make any decision.” The blind woman fears that she will not receive medicine without money to pay for it. No one sleeps well. All are fearful of further loss or injury, or—they are not quite sure what.

And, indeed, the situation is enormously stressful. The tents, which look so good, just arrived yesterday, brought by the French Red Cross. . For a month, these people have been sleeping in the open. “We have a committee,” says Wilson, Miranda’s father, “to organize ourselves.” And they are indeed cooking communally. “But we do not have toilets, or other necessary sanitation.” There are no doctors readily available to them, or medicine, or replacements for needed glasses lost, or hope for more adequate or permanent housing, or indeed, much communication with the world beyond the tent city. As we are leaving, Wilson invites us to share the rice that half a dozen families are beginning to eat.

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More in days to come.

Jim

Bringing Psychological Healing and Hope to Haiti; Day 1, Part 1 of 2–Arrival

Day 1, part 1 of 2–Arrival

There is a weight to the air; we begin to feel it at the border where we enter from the Dominical Republic. We can smell it, too, in the swirl of dust that forces some to wear masks, in the acrid edge of burned and burning building materials. It grows heavier as we bump around flanks of rubble on the outskirts of Port-au-Prince. In the city, it roughens our voices and presses tears from our eyes.

Happily, surprisingly, we have a place to stay—in the Coconut Villa, a hotel near the airport that is an undisturbed island amidst collapsed houses. Across the street, several thousand Haitians live in tents.

Rosemary Murrain, Star Myrtil, and I are here to see if our approach can help bring psychological relief to the people of Haiti—and to see if we can work with and find support from the large international agencies that are funded to bring food, housing, schools, and emergency medical care to the people. Our approach, which combines such mind-body techniques as meditation, guided imagery, biofeedback, and yoga, self-expression in words, drawings, and movement, and small group support, has made sense to and worked remarkably well with war- and disaster-traumatized populations in Kosovo, Macedonia, Israel and Gaza, in post-Katrina New Orleans, and with US military returning from Iraq and Afghanistan. It’s practical, easy to learn, and feels right to people who are trying to gain control over the thoughts, feelings, and memories that overwhelm them in the wake of catastrophe. We’ve published the only randomized controlled trial (RCT) of any invention of any intervention for war-traumatized kids. It showed an 80% decrease in symptoms of posttraumatic stress disorder in Kosovo high school students, an improvement that was maintained at three months’ follow-up. More recent studies on 1,000 children and adults in Gaza show similar sustained gains in spite of the ongoing constraints and tragedy of life there. Altogether, the several thousand clinicians, teachers, and community leaders’ we’ve trained have made our CMBM model available to hundreds of thousands of children and adults around the world.

Rosemary is CMBM’s new Director of Finance and Administration. Immensely capable, unflappable, fluent in French, she’s an MBA student who has helped to create and lead educational programs throughout Africa. She’s in charge of the logistics that brought us on our journey here, and she will help create necessary partnerships. She’s also, I say with pride, my goddaughter. Star is her friend, a Haitian living in Florida, leading women’s programs there and fluent in Creole as well as French; a human bridge for us to Haiti and to its people.

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I’ll post more this afternoon, about our visit to the tent city outside our hotel and the people we met there.

Jim

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