“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
Title: Teleclass: “An Introduction to Mind-Body Health”
Description: This introductory teleclass is perfect for beginners who want to learn about mind-body health and how simple relaxation exercises can improve their health. Participants will receive a free “Mind-Body Mini Kit,” which includes a downloadable audio meditation, a video on stress, and written materials. Participants can also listen to the class on the internet.
Start Time: 08:30:00pm EST
Title: Free Webinar Lesson 4: Other Useful Techniques and Advice for Participants
Description: The last free webinar in a four-part series, “A Natural Approach to Treating Depression,” Dr. Gordon offers more resources and guidelines to help you on your journey.
Lesson 4: Other Useful Techniques and Advice for Participants
Key lessons: Dr. Gordon discusses a variety of other techniques that are effective in treating depression; he provides some final advice and words of encouragement for participants.
Download pack still available at www.mblwellness.com!
Start Time: 8:30pm EST
Date: November 24, 2008
Title: Free Webinar Lesson 3: Exercise and Movement
Description: The third free webinar in a 4-part series; tune in to hear Dr. James Gordon discuss the mental and physical benefits of exercise, and offer some easy guidelines for getting started.
Lesson 3: Exercise and Movement
Key Lessons: Physical exercise can significantly improve mood; Dr. Gordon provides advice on how to start an exercise program; Dr. Gordon shows a movement technique he has taught around the world.
The free download pack available at www.mblwellness.com includes MP3 relaxation exercises and guides to meditation!!
Start Time: 06:30:00 pm EST (note time change)
Date: November 22, 2008
Title: Free Webinar Lesson 2–Relaxation/Stress Management
Description: The second free webinar in a 4-part series, Dr. Gordon discusses relaxation and stress reduction techniques and exercises in handy video form.
Lesson 2: Relaxation/Stress Management
Key lessons: Stress and depression are connected; simple relaxation exercises can help with the symptoms of depression; Dr. Gordon teaches a relaxation exercise. (The Unstuck pack contains useful tools for this lesson.)
Don’t forget to download the free Unstuck resource pack at www.mblwellness.com!
Start Time: 8:30pm EST
Date: November 20, 2008
Title: Webinar: “A Natural Approach for Treating Depression” series: Lesson 1:
Description: A 4-part free webinar by Dr. James S. Gordon on the approaches he describes in “Unstuck: Your Guide to the Seven-Stage Journey Out of Depression.”
Lesson 1 – An Overview of Depression and How You Can Treat it Yourself with the Help of a Guide.
Key Lessons: Prescription drugs aren’t the only answer; people can use simple techniques to treat their condition; people should work with their doctor and find a guide to help them through the process; depression is not a disease, but a condition in which peoples’ lives are out of balance, or “stuck.” (Participants should read the excerpt from the Introduction of Unstuck in the Unstuck Pack, available at www.mblwellness.com.)
Start Time: 08:30:00 pm EST
Date: November 18, 2008
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.