As the anniversary of Haiti’s catastrophic January 12, 2010, earthquake approaches, physical and emotional symptoms that were ebbing or had disappeared, are rising. We hear it everywhere as we– Linda Metayer, our Haiti program director, and I–move through a day of visits and talks with staff at the General Hospital and the Ministry of Health, as well as with kids and adults in tent camps in Petionville, a suburb of Port-au-Prince that is a city of half a million.
Headaches have intensified, and sleep is ever more disturbed by sudden awakenings and half remembered nightmares. Irritability and anger sweep people away in rage at children, who are themselves agitated by neighbors who are too close and too ever-present, too troubled and helpless, too painfully mirroring their own suffering.
Everyone knows in their bodies, as well as from the calendar, that the anniversary is coming, but there is little plan for public ceremony that might make remembrance and mourning easier, and bring hope for a happier future. The program that Linda Metayer and Rene Domercant (a Ministry of Health official who attended our first training in December) have organized at the General Hospital is a happy exception.
After an introduction by Dr Jocelyn Pierre-Louis, one of the Ministry of Health’s leaders and a strong supporter of CMBM’s program, Linda, Rene and I speak. Our talks are nicely paired: Linda and I discuss the extent of psychological trauma and the practical steps people can take to heal themselves and their communities psychologically, and I teach slow, relaxing soft belly breathing and get everyone to move their body. A number of these professionals appreciate the immediate effectiveness and ease of the techniques – “I feel so calm,” says one; “So calm I went to sleep,” adds another, and everyone laughs, recognizing the tension that keeps them awake and the need for rest. “I felt tears come,” another woman adds – all the emotion that needs to be released, I suggest, and she nods.
Afterwards Rene, who is an engineer as well as a psychologist, shows slides from a manual for safe rebuilding: foundations propped and buttressed so they are no longer unbalanced and unstable, second stories supported by first floors that have sustaining walls. Each slide is paired a “Don’t” in red which can lead to collapse in a future earthquake, a “Do” in green – the safe way to sustain a dwelling and save lives. These slides will be shown everywhere in Haiti and distributed in booklets, Rene tells us.
What a pleasantly surprising symmetry and pairing: principles and building blocks for new safe houses, and for emotional and physical self-care–a hopeful beginning for the new year.
To be continued tomorrow–the anniversary of the Haiti earthquake . . .
CMBM Training in Port-au-Prince
Our team has been gathering for the last two days, long flights and sometimes long delays as well.
Jamil Atti is in from Gaza, Afrim Blyta and Jusuf Ulaj from Kosovo, and Naftali Halberstadt from Jerusalem- psychiatrists and psychologists who have lived through war and terrorism themselves, leaders of our program in their country, friends and brothers. From the US, Amy Shinal (our Clinical Director) Lynda Richtsmeier Cyr, Kathy Farah, Lora Matz and Jerrol Kimmel, physicians and psychotherapists–long time friends of 10 to 15 years, talented, adventurous, deeply committed to this international work.
Linda Metayer is our Haitian Program Coordinator, a psychologist with a degree in public health, as brave and courteous as she is smart and competent. Lee-Ann Gallarano, who organizes all of our work with trauma around the world, was working with Linda before we arrived with Jesse Harding, our newest staff member, who several years before worked with Lee-Ann when they were Peace Corps Volunteers in Mali. Tod and “B”, gifted documentarians, are filming us, and Mark, who has volunteered his time, is taking most of the still photos you’ll see on this blog.
We spend this first day “checking-in”, hugging, laughing, sometimes crying, as we tell the stories of our first meetings, recalling the power of soft belly breathing to help us relax in the middle of fire fights, of Afrim informing us in Gaza City that the 3AM earth shaking noises were in fact sonic booms. And everyone is speaking of the realization, growing over the years that, “You are my people,” “This is the work I want to do,” “I am at home.”
In the early evening Linda, Amy, Jesse and I walk with our camera crews into the sprawling tent camp across from our hotel- 10,000 people in the Champs de Mars. We had been told that “from the outside things look better.” There were fewer tents, less crowding. Up close the opposite turns out to be true- some people have indeed left, clearing out in terror of cholera, but everyone doubts they have found places much better. Meanwhile, moving from one clump of canvas, plywood, plastic and corrugated metal– one collection of shelters to another — we hear similar disturbing, dispirited stories: there is actually less food and water than there was four months ago and far more violence. Women, and muscular men as well, tell us that if and when they are able to sleep, it is with one eye open, alert to robbers who are often armed, and to rapists. The jobs cleaning rubble that once helped sustain these encampments have moved on, though no one knows exactly where.
Though some people are shy and wary, virtually everyone is gracious and within a few moments, eager to talk to us. Mothers tell us that so many of the children are “hyper” since the earthquake. We see them shuffling from foot to foot, eyes shifting with their bodies. The mothers say they have lost weight. When I ask about emotional problems everyone- men, women, teenagers- says they are angry. “What do you do?” I say. “I pray to God,” several say. “I take this medicine,” says a man raising a small bottle of homebrew. A woman says, troubled, but resigned, “I beat my children.” Several others nod.
As we move from one section of the camp to the other, two teenagers run past and jostle Linda. A moment later we see that her necklace is gone. She is a bit shaken, but philosophical, “They do it to eat,” she says. Other camps are likely to be somewhat better, but some are not and there are 10,000 people here. Walking back to our hotel I feel the weight of life here in Haiti, people stretched and pushed beyond breaking. I think of how much our work is needed, and I feel frustration along with everyone else. “Where is the organization?” I ask rhetorically, “The benefits of all the money the international community has committed?”
I have wonderful news to share with you today, an amazing article on our work in Gaza from this morning’s New York Times. It gives such an accurate feeling for the touching , powerful, and effective work The Center for Mind-Body Medicine is doing in Gaza and for the spirit of healing, community and hope that I believe pervades everything that we do.
Please read this testament—so amazing to have it so well and feelingly presented in The New York Times—to the possibility of transformational change
We’re delighted that this Gaza program, which is nurtured and sustained by so many dedicated and generous people (health and mental health professionals, teachers, community and religious leaders, and our funder, the Atlantic Philanthropies) is being so positively recognized. I hope you’ll take the time to read this beautifully crafted piece and share it with friends.
I also wanted to share a few stories I’ve been saving for you from a visit to our program there in August, (the second visit within three weeks). We were moved on both visits by the ways our Gaza team is helping children and other folks—every kind of person—to relax in the midst of poverty, danger and chaos. And it was so touching and such fun to be with our dedicated, passionate, raucous, talented and tender Gaza team (you hear some of their voices in The Times article) and with Jamil, who leads them.
During our time in Gaza, we visited with some of our recent trainees –there are about 130 new ones this year. Throughout his training with us, one counselor—I’ll call him Abed—was so skeptical, so cantankerous: no question was too obscure to ask, no objection too small to raise. A couple of weeks ago, we watched him sit on the floor—sweet and solicitous and playful –with the most troubled five year old boys from the kindergarten with which he was consulting. The boys—cute, squirmy, solemn and giggly—showed us how to do “soft belly breathing” and told us how they have brought relaxation into their families — “and guided imagery too.” And, an excited five-year-old added, “I taught my brothers and sisters and my parents about the genogram.”
We saw two groups for women with breast and lung cancer. Cancer, we were told, is regarded in Gaza as a disgrace as well as a disease, a kind of plague which provokes shunning. “No one wants to know you,” we were told, “except in this group.” “I felt worthless…dead already,” said another woman. “The mind-body group relaxed me and brought me back to life.” Another woman, stout and older, proudly showed us “chaotic breathing”—flapping her arms up and down, breathing deep and fast. “I do it every day. It makes me feel so strong,” she said with a grin.
Then there was a group for kids with Down Syndrome, the boys lying on mats, imagining safe places “at a beach,” “in the garden,” or “at a sister’s beautiful wedding.” We now have 160 mind-body groups in Gaza. They meet for ten weeks and then 150 to 160 more begin. The film of all this and more will be ready soon, and we will share it with you as soon as it is. (I’ll be sure to post a link here.)
We’re growing—in many ways.
More soon. In the meantime, lots of love to all of you.
I wanted to share with you an article I just published on Health News Digest. I hope you’ll find it useful going into the Labor Day weekend, and that you’ll share with friends and family who may be in need of some stress relief.
Labor Day Tips for Reducing Stress by James S. Gordon, M.D. (originally posted on Health News Digest: Original Article)
Labor Day is traditionally a time of rest before the renewed activity of fall. For tens of millions of Americans who are unemployed or underemployed it is a time of high stress, a time when anxiety caused by economic insecurity and foreclosures unsettles, agitates, and casts a shadow over the unemployed and their families.
Over the years, I have worked with thousands of people who have been made anxious and depressed by economic hardship. Here are five steps drawn from my most recent book, “Unstuck: Your Guide to the Seven-Stage Journey Out of Depression,” that people can take to address the pain and insecurity that may come with today’s economic uncertainty. All of them are free and all can be easily learned and done at home.
1. Begin a simple nondenominational meditation practice: Slow, deep breathing — in through the nose, out through the mouth, with the belly soft and relaxed and the eyes closed — is a sure antidote to the stress response that uncertainty provokes. To encourage relaxation you can say, “soft” as you breathe in and “belly” as you breathe out. Begin with five minutes, two to three times a day.
2. Move your body: Physical exercise may be the single best therapy for depression. It’s very good for anxiety as well. Find any kind of movement that suits you, jog, dance, swim, or walk, it all works. You’ll see and feel some benefits after 15-20 minutes.
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.
4. Find someone who will listen and help you take a realistic look at your situation: Allow a trusted friend or adviser to help you look for possible solutions for any stressful situations you may be experiencing. In addition to helping you unburden your mind, body and spirit, a trusted friend or advisor can often see solutions more clearly than you and can help you find ways to put these solutions to work.
5. Let your imagination help you find healing and new meaning and purpose: After breathing deeply and relaxing for a few minutes, imagine someplace safe and comfortable, it could be a place you know and love or one that comes to you. Make yourself at home there, notice what’s around you, breathe deeply and relax. My colleagues and I at the Center for Mind-Body Medicine have used this safe place imagery successfully with New York City fire fighters after 9/11, with U.S. troops going to or returning from Iraq and Afghanistan, and with families in New Orleans in the aftermath of Hurricane Katrina. We teach it every day in our offices and like the other four steps, we use it ourselves.
A hundred nursing students come to our hotel. More than ninety of their classmates died on January 12th in their school building. The sense of sadness and loss are palpable.
They are quiet, expectant, and perhaps a little puzzled at first. What is this “mind-body medicine” all about? And then, as I begin to talk with them about fight-or-flight and stress, they become animated—calling up the unspeakable terror of the earthquake along with the biological facts and personal experience. I explain that just as trauma can produce the symptoms of ongoing stress: difficulty concentrating, sleeplessness, anger, lethargy, flashbacks of death and destruction. The techniques we are going to teach—slow deep breathing, self-expression and self-discovery in drawings, sharing one’s pain and hopes with others, and moving one’s body—can give relief; restore a sense of calmness, provide perspective, grant them a sense of control, open the door to the possibility of a future.
By the time Amy is explaining imagery and Kathy and Lynda are encouraging them in their drawings, the young women are alive with pleasure and discovery. They share first with each other, and then with the whole group. They show us pictures bisected by the barriers between the living and the dead, whom they miss so much, and third drawings that reveal the possibility of feeling, though bereaved, whole again in nature and with family and friends.
By the time we clear away the chairs and began to shake, the girls are waving their arms and laughing. When Bob Marley’s “Three Little Birds (Every Little Thing’s Gunna Be Alright)” comes on, they sing with him, and us. Some of us are still laughing, others crying in release, with gratitude as well as grief.
Afterwards, the Dean of the Nursing School speaks for a moment. “Words,” she says, herself crying, “cannot express what you have done for us today.”
“And,” I think to myself, “what you are doing and teaching to us.”
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.
“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.
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 . . .
The school is the College Canado Haitien, one of the best in Port-Au-Prince, we are told, before the earthquake and afterwards, too. The students, a few weeks after the school has reopened, are sharp in well-pressed maroon and khaki uniforms—the girls’ hair pulled through berets, the boys sideburns neatly trimmed, tout propre, I think.
Instead of the pre-earthquake concrete buildings, there are open sided wood and metal sheds. Sounds flow from one classroom to another, overlapping in a kind of reverberating clamor. Toward the end of one of our classes, when time of dancing is kept by nimble palms on desktops, the whole campus rocks.
Our equipe, our “team,” –the French is beginning to emerge from deep layers of my unconscious—includes six of us: Lee-Ann juggling logistics as before, with Cassidy, my assistant back home, here to help her and me; Amy, the social worker who is our clinical director, will come tomorrow. Today, Lynda and Kathy, psychologist and family physician, are with me. They are CMBM senior faculty who are adventurous enough to come and to commit to coming again and again. They and Amy will teach our Haitian colleagues and provide consulting and supervision as we build our program.
Today we have been invited by Frere Jacques Anthony Germeil, the principal, to College Canado Haitien. We will have an hour in each of four classrooms with eleventh and twelfth graders who have been told they will learn “lessons in dealing with stress.”
I lead the first class and the third, forty twelfth graders in each, sitting shoulder to shoulder at their desks. Lynda and Kathy, experienced with kids, but new to Haiti and to the trauma and loss that overwhelms the population, will lead the second and fourth classes.
We begin our classes lightly—a little goofily—“How do you breathe?”, I ask to general puzzlement, and then talk about babies doing it easily—naturally—their bellies rising and falling, while adults, and even high school students, cramped in chairs and on benches, barely move their chests. Laurent, my interpreter, and I act out the roles of cats in full fight or flight mode—hissing and growling at each other, and then stepping back to breathe easily. Lynda has her all-boys class—a surprise—consider Kobe Bryant, cool and relaxed, imagining his shots, inspiring the boys to imagine theirs swishing the net.
When we turn the topic to relaxation’s antipode, stress, the bravado of a few—“I’m fine, we’re all fine,” claims one boy; “it was simply a natural disaster” intones another—contends with the more complex memories of their classmates.
Soon, in each and every class, there is a rush of sharing of what happened on January 12th, of how surprise and relief yielded to horror. “I thought the shaking would be eternal. Then, it stopped, and I thought, ‘that’s not so bad, I am ok,’ and I laughed, then I saw my sister covered in dust like a ghost, and I was afraid. And then, underneath my neighbor’s house, there were twisted bodies.”
And the stories come—many, we learn, shared for the first time—and the classmates’ losses pile up: a mother gone, an older brother, “my best friend,” “almost my whole family,” We hear of bodies discovered under rubble and strewn on sidewalk, of dogs chewing on corpses.
When we ask if there are questions, a small forest of hands rises: “How do you go to sleep when these memories keep coming in nightmares?” “How can you breathe deeply to relax when the air is so bad?” “How do you deal with family members who now are arguing all the time?” “What do you do with your belief that another earthquake is coming, or as some say, ‘a tsunami’?”
More about the techniques we use to address these questions coming soon . . . .
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.
We’re on our way to Haiti now, via the circuitous route that the damaged Haitian airport and the daunting US weather demand. We’ll be arriving on Thursday to begin working with people on the ground and exploring partnerships with the Haitian government and local and international NGO’s, churches, schools, and other community groups. I’m going with Rosemary Murrain, our Director of Administration and Finance, who has worked in Haiti, and Star Myrtil, a young Haitian woman who has been a Program Manager for NGO’s and speaks Creole as well as French.
We’ll let you know more when we’re on the ground; meanwhile, here’s a brief description of the work we hope to be doing.
All my best,