December 20, 2009
If Gaza is saturated with tradition, and blessed with generous impulses, it is galvanized by politics. Until several years ago, when we developed a high level of skill and firmness in directing our trainees back to their own present feelings, simple declarative statements often threatened to veer off into impassioned political narratives. The Palestinian faculty we have trained now recognizes the hazards, and has become adept at forestalling rhetoric, foreclosing budding arguments, redirecting attention inward, and calling for immediate feelings as well as the historical conditions that may have provoked them. Inevitably, however, politics and the devastating consequences of political decisions are not far from the minds and speech and feelings of Gaza’s men, women and children.
In the small groups we see and hear that the consequences of history are inscribed in our participants’ pain and fears. Remember the hurt that the young psychologists whom I described in the previous blog carry from childhoods shadowed by loss and deprivation and squeezed by self-righteous brutality. And anxiety about present safety and future survival is absolutely, understandably universal: Gaza is closed off from the rest of the world, vulnerable to unpredictable attack from Israelis who control its borders and airspace and to violent schisms and reprisals within. Inevitably there are symptoms: One stocky young male psychologist from a distinguished family of Gazan warriors admits, embarrassed but eager for help, to “panic attacks” when his toddler daughter develops a cold or returns late from a babysitting relative; several other mental health professionals speak of waking abruptly, hearts racing at innocent sounds that evoke body-memories of Israeli shells landing or Fatah and Hamas fighting under their windows.
Six months ago, Gaza, though deeply wounded, seemed far more hopeful. Crumbled buildings – large public and small private ones – punctuated the streets of Gaza City and Rafah; blasted orchards and fields torn by shells tolled a loss of innocence as well as income; memories of the 1400 who died in the fighting in December and January filled the eyes of families we visited and appeared, often briefly, modestly, but with head-shaking sadness, in conversation. Still, there was a sense that things might, even that they likely would, finally change for the better.
One of Hamas’ top officials, Deputy Foreign Minister Ahmed Yousef, spoke of the renewed faith in American idealism that Barack Obama’s election and his speech in Cairo had inspired in him and others; of his hope for reconciliation between Fatah and Hamas; and of a future in which a regional partnership “of the world’s three great monotheistic religions” would bring peace, tourism and industry to Gaza and the West Bank as well as Israel. “Soon, inshallah, (god willing)” our Gaza faculty estimated, “we will be able to go with you to Israel, the West Bank, maybe even America.”
The current “situation” – the word is an all-purpose one that Israelis as well as Palestinians regularly use – seems by contrast dispiriting, even desperate, to the Gazans I meet outside of as well as in our training. Now Ahmed Yousef reminds me that “we have not fired on Israel for a year,” and asks, sadly, rhetorically, “and what has been our reward?” Young people wonder whether a world that will not open Gaza’s borders to trade that is necessary for rebuilding or to the free passage that will overcome their punishing isolation, understands or cares about or even notices their plight. Several speak, with resignation but chilling firmness, of the inevitability, in the absence of progress, of resuming “resistance”:
I do not feel that the vast majority of Gazans whom I meet – and I have worked closely with several hundred and met many hundreds more over the last seven years – want to return to fighting; it is that they do not know what else to do, how else to lift the crushing weight of the occupation, to signal, amid what appears to them colossal indifference, if not hostility, that they are “human,” and deserve the basic rights that the rest of us assume. “Don’t the Israelis understand we are just like them” one young woman, a well educated “political independent” asks me. “I have parents and children I love. I want to help my people. Yes, I hate what the Israeli government has done to us, but I do not hate Israelis.”
There are to be sure fanatics in Gaza, people chained to an unchanging allegiance to past wounds, committed to a holy war that will wipe Israel from the landscape. They are, however, very few among the very many I have met. Hamas has been a resistance movement and has committed terrorist acts, as, I would add, have other movements in this region. However, many of its leaders and many of the young who have been drawn to it now aspire, in spite of their current distress, frustration, and discouragement, to becoming partners in leading a state, productive members of a tolerant regional and world community. A burly young man, a high ranking government functionary who speaks with resignation about the possibility of resuming resistance, sounds a few moments later exactly like an American graduate student. He is particularly glad to talk with me, he says, because he wants my advice on framing a topic for the PhD thesis he hopes to write.
The day before our training ends, I speak, at Ahmed Yousef’s invitation, at The House of Wisdom, an independent Swiss funded Gaza City “think tank” that he helped found. “Everyone has to speak English here,” he tells me. “We want to be part of the world community.” Thirty earnest young intellectuals – political scientists, environmentalists, government officials – gather on short notice: Some are affiliated with Hamas, others with Fatah; many are unaffiliated with any political party.
I sit at the intersection of long polished seminar tables – it could be Georgetown or Harvard- and talk about the work we are doing in Gaza, the research that demonstrates its efficacy in reducing stress, improving mood, and enhancing hope for the future. I discuss the resilience of the people and the community that supports them; the central role of self-care and mutual help in all health and mental health care; the necessity of knowing and caring for and changing oneself as a prelude to helping others do the same; the dangers of fixed ideological positions that force people to deny or suppress their true and changing needs; and the importance of meaning and purpose in sustaining all of us. There are nods of heads and some smiles. The questions and comments are thoughtful, balancing appreciation for and curiosity about our work – “Yes, I and others in politics could use that,” remarks one man – with reminders of the challenges to safety and survival as well as sanity that continue to confront all Gazans.
As the seminar draws to a close, the House of Wisdom executive director Mahmoud El Madhour, a wavy haired, urbane PhD engineer and MBA who has studied Greek philosophy in Greece, and is a proud independent, thanks me. He ends the afternoon with a few words of reflection: “Without communication,” he begins in easy but urgent English, “we have nothing.” He pauses for a moment. “We stand here in Gaza, with no other place to go. This is my resistance. Gaza is a lovely place. And I want you to know I do not mind sharing it.”
Here’s another video update of our 2009 Gaza Advanced Training Program (ATP)! You’ll see another technique we use, chaotic breathing, a form of very “active meditation” illustrated at minute :37. You’ll also see the introduction to the “fishbowl,” in which we demonstrate to the trainees the small group model, at 1:24. (Small mind-body skills groups meet privately, so this demonstration during training is the best way we’ve found to show the health and mental health professionals attending how to lead their own groups.)
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 make a few short announcements:
1. I hope you’ve had the chance to see my PBS special, “Unstuck with Dr. James S. Gordon.” We’ve had a good response so far, and I appreciate those of you who have written to tell me how much you’ve enjoyed it. Check your local station for any remaining listings (we’re coming to the end of its scheduled season) and if you haven’t been able to view it, because it’s a pledge show, it is available as a pledge gift (the proceeds of which go to support both PBS and The Center for Mind-Body Medicine) online at local stations’ websites or pledge call centers, or else we are hoping/planning for it to be aired again and on more stations in March 2010.
2. I wanted to let you know that my piece, “Care for the Caregivers: Preventing Future Fort Hoods” on the importance of supporting military caregivers as they care for troops pre- and post-deployment, is now featured in the Huffington Post living section–here’s an excerpt:
As we prepare to send a “surge” of 30,000 more troops to Afghanistan, we must look urgently and squarely at the mental health as well as the military and political consequences of our deployment. This means preparing American men and women to deal as effectively as they can with the fear and confusion that battle will bring and with the sometimes ambiguous life-and-death decisions . . .
Check out the whole post here! I’d love to know what you think.
3. Some of you may know I’m traveling to the Middle East this week to see the Israeli Training Center for Mind-Body Skills and to support our Gaza team as they oversee the second phase of training for 150 more clinicians, who will offer our healing model to traumatized children and adults in the Gaza strip and great expand our efforts in the region (which have already helped more than 20,000 people!).
I’m going to be blogging as often as I can during this experience, so look out for more posts this week to keep up with my travels!
All my best,