On a recent trip to London, I was interviewed during Depression Awareness Week about my book Unstuck’s UK release by The Guardian newspaper. The reporter was particularly interested in CMBM’s Global Trauma Relief program and our work to bring population-wide psychological healing to places around the world that are afflicted by war and natural disaster. You can read the piece here:
I’m certainly pleased that the author recognizes CMBM’s groundbreaking efforts to teach and support hundreds of thousands of people in Kosovo, Israel, Gaza, Haiti, Southern Louisiana, as well as US military returning from Iraq and Afghanistan. It’s a shame, however, that his tone is so dismissive of integrative medicine and that he fails to recognize the fundamental importance of self-care for psychological and physical healing.
Please note that as of this writing, corrections are being made online for several factual errors, including the following:
- In Gaza, we trained 90 clinicians initially, only a few of these were “educators” (as the article states)
- CMBM now has 160 groups meeting in Gaza each week, not 48, as reported.
Beyond factual errors, though, I’m disappointed in the tone of the article. I want to emphasize that our approach to psychological trauma relief is not about “belief,” as the article repeatedly implies. It is based on hard evidence that is just as rigorous – actually more so – than most of that provided by the drug companies he seems to accept as the standard.
It is a common misconception (and prejudice) that psychological and nonpharmaceutical research is less stringent and reliable than clinical drug trials. Each of the approaches that we use, including meditation, guided imagery, biofeedback, autogenic training, yoga, self-expression in words and drawings, and movement and exercise, has a significant research base, one which demonstrates decreases in stress levels and improvement in mood. The CMBM approach combines these into a comprehensive program, and The Center for Mind-Body Medicine takes great care in scientifically researching, documenting, and publishing our findings of our approach in peer-reviewed journals. We recently published a randomized controlled trial (RCT) on our work with war traumatized children in Kosovo that shows an 80% decrease in symptoms of PTSD (read the abstract here).
This was the first RCT of any intervention with war-traumatized children, and sometime in the next few months, we will be publishing a study (in the International Journal of Stress Management) that shows similar results—80% decrease in PTSD symptoms, significant decreases in depression and hopelessness—in war-traumatized youth in Gaza. This study is particularly important because the gains that were achieved over ten weeks of once-weekly group sessions were largely maintained at seven months’ follow-up—in spite of ongoing conflict and severe economic hardship.
The point is that this approach is not alternative. It is fundamental. It makes human and scientific sense. We have an approach that works with large groups of people in developed countries as well as those ridden by disaster. It is flexible, inclusive, and culturally acceptable. And the groups in which we train caregivers can be led by anyone—teachers, and religious and community leaders, as well as health professionals; and the scientific evidence for its effectiveness continues to accumulate. And as the article states, CMBM will continue to be there to provide our program of mind-body medicine for people suffering from psychological trauma, to teach them, and help them help themselves.
“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.
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.
Gaza City, December 15, 2009
The Advanced Training Program (we call it, and so do the Palestinians, “ATP”) has a complex structure that is at first a bit daunting. Our 15 Gaza faculty coach the participants in leading the same kinds of small groups that they first experienced in the initial training. The international faculty, passing from group to group provide feedback, later, in supervision, on how the Gaza faculty has helped the participants and what they could do or say more appropriately, clearly or concisely; where they could have been more sensitive to the spoken or unspoken needs of a group member; how their own reticence or preconceptions may have inhibited or biased them in their advice to a participant-leader. “Be honest with us,” our conscientious Palestinian team had repeatedly insisted. “We want to do the best job for our people. We are thirsty for learning.”
The participants lead the ATP groups in pairs; there are ten people in each group and five sessions. Hugely nervous at first, in spite of a day of reassurance and coaching, they conduct the opening meditation, and lead the check-in in which they and the other group members say how they are doing and what they are feeling at the present moment. We have encouraged participant-leaders to let go of self-conscious professional distance, to be honest about their own feelings, to be “real people as well as leaders.” Some do this with admirable courage and humility: “I am a professor at university, but at this moment I feel like I am back in grade school.” Others are more guarded. Everyone in the group speaks in turn – no interrupting, analyzing or interpreting allowed.
The participant-leaders then teach didactic material about, for example, the fight or flight and stress response that are activated by the sympathetic nervous system, and the use of slow deep breathing (which mobilizes the parasympathetic nervous system) to balance this state of hyperarousal which is so common in deeply traumatized and uneasy Gaza. Then they lead an experiential exercise – it could be guided imagery, or drawing one’s problem and its solution or quiet meditation that brings about relaxation or an active meditation of fast deep breathing or shaking and dancing, designed to raise energy in the depleted and depressed and break up fixed patterns of thought and feeling. Then they ask group members to report on their experience: “I feel like a burden is lifted” says one young, bearded school psychologist, after six or eight minutes of charged up, bellows-like arm pumping, deep breathing. “I feel free for the first time since the war to breathe the breeze from the sea.” They conclude each group with a quiet meditation. Afterwards the pair of participant-leaders say how they feel they have done and the other participants share what the experience was like for them; the Gaza faculty member concludes with his or her assessment.
This will go on for five two-hour groups over four days. It is designed to equip our participants to take our model back into their work places where they will offer it to kids and adults, the elderly and the deaf, former prisoners in Israeli jails and ambulance drivers, abused women and confused men, the anxious and angry, those bereaved by violence and those fearful they will be. In a society in which psychological problems are stigmatized and psychotherapy is often viewed, if it is considered at all, with suspicion, our model has wide appeal. It is offered as a way to develop skills and strengths, of mind as well as body, an opportunity to come together without fear of analysis or interpretation, a modern version of traditional, honored communal gathering and healing.
Each day we have a panel where Gaza faculty answer questions from the entire group of participants about the challenges of leading groups and working with individuals, about balancing the need to maintain order in the group with an openness that invites sharing, about presenting didactic material in a way that is accurate but easily comprehensible. In Gaza the questions have a special urgency and poignancy. One male psychologist, slender and graying unfolds slowly from his chair. “How do you,” he asks soberly, “deal with a situation in which during a mind-body group bombs are going off?”
“This has happened to me several times,” replies Mohammed, the psychiatrist, “You find out what is happening – I don’t want to say who is shooting,” he adds to some laughter. “You make sure your group is as safe as it can be. Then you discuss feelings so everyone can get some relief. Then do deep breathing to help everyone, including yourself, to relax. Then continue the group.”
“I was working with kids one time,” Jamil adds. “Every time there was shooting we got up and shook our bodies. Every time a bomb went off we all yelled loudly. It worked pretty well.”
“What about if you are a leader and someone says something that is very tragic and you feel like crying? Is it permitted?”
“In the war terrible things happened” responds Abdel-Hamid, “and the people come to us to talk about it: Women in my groups whose children were killed, men who saw their wives and daughters dying from burns, and I remember the things I myself saw. It is only human for us to cry as well.”
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.
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.
Memoirs of depression like Daphne Merkin’s in The Sunday Times (May 10, 2009), and for that matter like William Styron’s Darkness Visible, make me sad. Of course I feel sadness for the writers’ dense and burdened suffering, set off so strikingly against their lucid, often spritely, prose. But more important, and far more troubling, I feel sad for the inadequacy of the therapeutic approaches they use, for the lack of understanding their suffering yields them, and, especially, for the fact that inadequate approaches and limited understanding are offered to readers as “state of the art.”
Daphne Merkin and her doctors seem to have concluded that depression is a disease characterized by inadequacies in brain chemistry and best treated by drugs that raise the levels of neurotransmitters like serotonin and/or norepinephrine. In fact, the evidence that depression is a disease is mixed at best, and the weight of the research evidence-negative studies on antidepressant drugs have notoriously been unpublished-suggests that antidepressants are little, if any, better than simple placebos.
What is absent from Merkin’s account, and, most sadly, from her experience, is an effort to address the fundamental biological, psychological and social processes that may precipitate depression and contribute to its persistence: the severely impaired response to stress that may indeed be the consequence of the kind of prolonged early life deprivation and trauma Merkin describes; nutritional deficiencies (apparently untested in Merkin’s case) that can cause or contribute even to the most severe depression; and the need for the healing power of sustained and sustaining support and intimacy that may have been absent in early life.
Nor do her therapists suggest other powerful, non-pharmacological modalities that are proving effective in significantly improving mood; for example, exercise, which is at least as effective as antidepressant drugs (it appears among other benefits to stimulate neuron growth in areas of the brain where cells have been destroyed by chronic stress and depression); and meditation which enlarges our perspective on the role of suffering in our lives and shifts brain activity from cortical areas connected with pessimism and depression to those associated with happiness and optimism.
Finally, the saddest thing about Merkin’s account is the passive role she assumed, one which it appears was acquiesced in, if not encouraged, by her therapists. “Do what we say; take the pills we tell you to,” they seemed to have said, “and all will be well.” In fact, therapeutic interventions in which we actively participate are doubly powerful. They have the kinds of inherent benefits I suggested above. Equally important, acting on our own behalf, working in concert with physicians and therapists who value our efforts, we overcome the helplessness and hopelessness that are the hallmarks of depression. Moving forward, as Merkin finally and unexpectedly does, we discover the possibility of change, to see, perhaps for the first time, light in the darkness which had seemed to surround us.
Our exciting training program, CancerGuides® II will be offered June 11-14, here in DC (along with Food As Medicine). You can help us as we offer our groundbreaking, integrative trainings by telling everyone you know about the programs, posting the fliers in your offices and clinics, handing them out on the street, etc. etc. Download a flier here.
A quick note: CancerGuides II is absolutely appropriate and accessible for cancer survivors and their families, not only for professionals. Everyone will have the opportunity to meet leaders in the field of integrative care, and to get the most up-to-date practical information–about nutrition, yoga, massage, Chinese medicine, and cutting-edge alternative therapies among many other topics. We would love to see you there, and there are generous partial scholarships available. Check out the website (see above) to learn more.
I hope you understand that you all – staff and faculty, along with our Board, and all those who support and participate in our programs – are the foundation for all we do, the juice that keeps nourishing our work, nourishing me, and helping us to grow. I’m so eager to hear from you and to see you soon, or to meet you for the first time at one of our exciting upcoming trainings.
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.