“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.
This weekend I’ll be headed back to Haiti with my team of international faculty, to continue training Haitian caregivers in Mind-Body Skills that they can bring to their traumatized families, the more than 1 million who still live in tent camps, colleagues, patients, and students at their workplaces. This is the next step as we create a nation-wide program of psychological self-care for Haiti. I can’t wait to be back in Port-au-Prince with our faculty, and the wonderful, caring group of Haitian professionals we’re gathering together and training to be the nucleus of society-wide change.
You may remember our first training in December 2010, which was cut short by election riots. Here are a couple of moving testimonials from attendees who are practicing what they learned . . . Saint-Juste Desir, Teacher at the Public school in Raymond and at the Family Care Program for Better Future International, in Cayes-Jacmel, Haiti, writes:
At the end of December, I lost one of my cousins who was about 30. I was really shocked because she was not sick. So hearing the news shocked me very hard. After that I could not sleep at night, I also had headache. By chance, I recalled the CMBM training and I decided to try it so I could sleep. I tried the “soft belly technique” and I slept all night. Since then, I use it every night before going to bed.
As I am a teacher, after the training in December, I was teaching math to my students. I realized that they were tired and could not concentrate. I asked them if they would like to experience some relaxation techniques. They agreed. I put music, I asked them to stand up and we did some “shaking and dancing” for about 5 to 10 minutes. After that we continued working with no problem. They were relaxed and they asked me why I didn’t do that with them before. They loved it.
I expect to know more techniques during the Advanced Training so I can help myself better and also help my students.
Jacques Africot, Project director, Better Future International, from Jacmel, Haiti, writes:
The technique I use the most is the “soft belly”. It can be practiced anywhere, any moment. It is the easiest technique for me to calm down my nerves, reduce my stress. Any time, I feel stressed or depressed I use it.
An Experience that surprised me: I was talking to a friend and she was suffering in her breast. I asked her if she wanted to make an experience. She said yes. I put a soft music and I asked her to close her eyes. After some deep breathing, I started to guide her slowly with the “body scan technique.” After finishing, she was smiling: Her pain was completely gone. I was myself surprised.
I practiced different CMBM techniques with my children: soft belly, shake and dance, drawing, imagery. I realized that after practicing those techniques they sleep better. Less nightmares, no headache if someone had one before we practiced it. And they sometimes ask me to practice with them.
I expect that the advanced training will give me more techniques to guide others.
By the time our training is finished—the end of February– these Haitian caregivers will all be taking the CMBM model out into the wider world and leading “small groups.” Each person will begin helping others manage their own stress and anxiety (still lingering from the January 12th 2010 earthquake, cholera outbreaks, and continued hardship and displacement). If each caregiver leads 1 group of 10 Haitians, that means the 120 caregivers we’re training will immediately be able to reach a minimum of 1200 Haitians in rural areas as well as cities; and that number will grow as our trainees continue to use these skills with the individuals and in classrooms and with additional small groups.
Making Haiti a community of healers—that is our goal. “This program,” as our Haitian Program Director Linda Métayer has said, “is a gift to the Haitian people.”
If you’d like to support us as we bring this gift to the Haitian people, please click here.
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 . . .
Gaza City, December 13, 2009
Our faculty gathers in a circle in high backed chairs in the ballroom of the Commodore Hotel – physicians, psychologists, a couple of social workers – 15 in all. Many of the men, who are mostly in their forties, are in suits and ties. The women, young and middle aged, all wear scarves, their heads covered as are those of ninety-five percent of adult females in Gaza; most are also in the long shape-shielding coats they wear even in the summer heat. The feelings of all of them, for one another and for us, are, however, easily visible, even palpable; the room warms with affection, hums with connection, as each one of us, in turn, “checks in.”
“My colleagues,” says Naima, a dark skinned Bedouin from Rafah at the southernmost tip of Gaza’s twenty-five mile long strip, “are not just friends but family. When the international team is here, the family is complete.” She really means it; she has returned early from her honeymoon to be with us for the training. Others have made sacrifices too. Mohammed the psychiatrist who heads up public mental health services in Gaza, made the “difficult decision” not to go to a meeting in the West Bank: “I want” as does everyone of Gaza’s penned up one and a half million people, “to get out of this prison, but I prefer to be with all of you. You are,” he adds, lightening the mood, “the best antidepressant.”
And there is more humor, as always in Gaza a crucial ingredient of the savor that makes life more than survival: A spontaneous, slightly exaggerated romantic song for Shaher who is celebrating his twentieth wedding anniversary, Abdel Hamid’s confession that “even with two wives” he is “well”, gentle teasing in untranslated Arabic of Naima about her interrupted honeymoon.
Four and a half years ago when we began the “mind-body medicine training” of 90 Gaza clinicians, most of these people didn’t know each other at all. In the time since then these “leaders,” whom Jamil has chosen, have conducted hundreds of ten week long mind body groups themselves and supervised colleagues who have led many hundreds more. Altogether 7000 children and adults of every age and social class have participated in these intensive groups and our Gaza team has worked individually, in families, and in brief groups and classroom sessions with at least 15,000 more Gazans. The research we’ve done (on 500 kids and 500 adults) shows very significant decreases in symptoms of post-traumatic stress (up to 80% in those most traumatized) improvements in mood, decreases in anger. Amidst massive Israeli attacks and civil war, in the face of pervasive, indiscriminate and violent death, poverty, isolation and confinement, we have found in those who have participated in our groups an enduring (at six months follow-up) enhancement of hope and optimism about the future.
Our team and the people they have worked with, and the changes that are so obvious to and in them, are the magnets that have drawn participants to the training that begins the next day. Eight months ago 150 of them (chosen from some 500 applicants) learned the basic techniques of our approach, and the science of stress and its reduction, and experienced the surprising comfort and intimacy of our small groups – “the one place in Gaza where everyone can take off their masks, relax and be themselves,” is the way Mohammed, who has led similar groups for professional colleagues, old men with chronic illness, war-traumatized children and patients on the psychiatric ward, describes these utterly confidential, tenderly led gatherings of 8 to 10 people.
When they check in their first small group our participants recall the experience of the first training: “I was so happy’” “It was like a vacation to me,” “It changed my personality, my life 180 degrees – I am no longer sick with colds and stomach upset. My doctor asked me what medicine I took”. During and after those five days many have begun to act differently – more assertive toward overbearing and arbitrary bosses; more sensitive to other people and, indeed to their own emotions:“it is not unmanly to cry when one witnesses the horrible suffering of our people”; more willing, even when it conflicts with cultural norms, to trust their own intuition: several young people whom I hear personally (I wonder how many more there are) have told their well-meaning parents that the bridegroom or bride selected for them was not a good match, and calm, sincere, and convinced, have prevailed.
During the intervening months they have met every four weeks with their group leaders – “strengthening our family” – to practice the meditations and the guided imagery, to do the drawings that express their feelings and summon up imaginative solutions to daily stress, to share the losses and frustrations that shadow the lives of every Gazan and to celebrate the joys – of jobs well done, and birthdays arriving and weddings to come – that persist. Still, so many of them say they have been “missing” (a word that I hear so often and that seems so apropos in locked in Gaza) us and waiting anxiously for the training.
In the lectures they bend over notebooks, eager to record information that will help them successfully lead, with our faculty’s supervision, small groups – the major task of this training. After they have finished they will offer these groups and use our model with individuals and families in the Ministries of Health, Education and Social Welfare, in the UN health and education programs, at the Red Crescent, and in hospitals, clinics, universities, and community based organizations from the Erez crossing into Israel in the North to Rafah, abutting Egypt in the South.
Lunch is grilled chicken and chicken curry, rice with almonds and raisins, the mix of mezzes – appetizers like hummus, babbaganoush, and spicy “Gaza salad” that are traditional – with fruit for dessert, a wonderful improvement over the GI challenging food of five years before. The participants – university professors and physicians who have taught some of our faculty and just graduated psychologists and social workers who are young enough to be any of our children – are clamorous with the good feelings and high spirits of reunion, old jokes and new intellectual challenges.
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.
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.
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.