Tagged meditation

In the Science 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.

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When Depression is Treated as a Disease

Memoirs of depression like Daphne Merkin’s in The Sunday Times (May 10, 2009), and for that matter like William Styron’s Darkness Visible, make me sad. Of course I feel sadness for the writers’ dense and burdened suffering, set off so strikingly against their lucid, often spritely, prose. But more important, and far more troubling, I feel sad for the inadequacy of the therapeutic approaches they use, for the lack of understanding their suffering yields them, and, especially, for the fact that inadequate approaches and limited understanding are offered to readers as “state of the art.”

Daphne Merkin and her doctors seem to have concluded that depression is a disease characterized by inadequacies in brain chemistry and best treated by drugs that raise the levels of neurotransmitters like serotonin and/or norepinephrine. In fact, the evidence that depression is a disease is mixed at best, and the weight of the research evidence-negative studies on antidepressant drugs have notoriously been unpublished-suggests that antidepressants are little, if any, better than simple placebos.

What is absent from Merkin’s account, and, most sadly, from her experience, is an effort to address the fundamental biological, psychological and social processes that may precipitate depression and contribute to its persistence: the severely impaired response to stress that may indeed be the consequence of the kind of prolonged early life deprivation and trauma Merkin describes; nutritional deficiencies (apparently untested in Merkin’s case) that can cause or contribute even to the most severe depression; and the need for the healing power of sustained and sustaining support and intimacy that may have been absent in early life.

Nor do her therapists suggest other powerful, non-pharmacological modalities that are proving effective in significantly improving mood; for example, exercise, which is at least as effective as antidepressant drugs (it appears among other benefits to stimulate neuron growth in areas of the brain where cells have been destroyed by chronic stress and depression); and meditation which enlarges our perspective on the role of suffering in our lives and shifts brain activity from cortical areas connected with pessimism and depression to those associated with happiness and optimism.

Finally, the saddest thing about Merkin’s account is the passive role she assumed, one which it appears was acquiesced in, if not encouraged, by her therapists. “Do what we say; take the pills we tell you to,” they seemed to have said, “and all will be well.” In fact, therapeutic interventions in which we actively participate are doubly powerful. They have the kinds of inherent benefits I suggested above. Equally important, acting on our own behalf, working in concert with physicians and therapists who value our efforts, we overcome the helplessness and hopelessness that are the hallmarks of depression. Moving forward, as Merkin finally and unexpectedly does, we discover the possibility of change, to see, perhaps for the first time, light in the darkness which had seemed to surround us.

Warmly,

Jim

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Advances in Cancer Care You Can Count On

Gina Kolata’s April 24, 2009 front page New York Times story (“Advances Elusive in the Drive to Cure Cancer“) on the significant failure of our near-forty-year “war on cancer” provided a sobering and necessary corrective to inflated claims about cures already arrived or just around the corner. Kolata rightly chides those in the pharmaceutical, medical, and health food industries who claim that their approach promises a cure and notes our national failure to fund and launch truly innovative studies. She appropriately takes to task clinicians who use deceptive prognostic terminology: “progression free survival” does not, to the dismay of people who are so labeled, mean longer survival. On the other hand, Kolata’s actual or implied dismissal of the potent preventive and therapeutic power of diet and exercise, and of the role that attitude, mood, and social support can play in enhancing quality of life and perhaps prolonging survival, is ill-informed and potentially dangerous.

Though there is indeed some disagreement about the value of “high-fiber or low-fat” [my underlining] diets woman flexes armin preventing cancers of various kinds, there is a general consensus, shared by the National Cancer Institute, that diet plays a significant role in at least 35-40% of all cancers. In recent years it has become abundantly clear, for example, that obesity has an important role in making us vulnerable to cancer and to its recurrence. And there is considerable evidence that certain kinds of diet can have significant anti-cancer properties and effects: epidemiological studies show that populations with diets high in the omega-3 fats that are present in fish oil have a lower incidence of several cancers; one study published in the Journal of The National Cancer Institute in 2006 shows that reducing dietary fat may increase survival time for women with breast cancer. And then there is the data on specific foods: cruciferous vegetables (broccoli, cauliflower, cabbage, etc.) have significant, repeatedly observed anticancer effects; tomatoes may help prevent prostate cancer; and soy may be useful for the prevention of breast cancer in premenopausal women.

Kolata does not, curiously, discuss exercise, but appears to marginalize it along with nutrition, as she presents the case of a fit vegetarian woman, Phyllis Kutt, whose breast cancer has recurred. Exercise is not of course a panacea, but it does appear to be a powerful tool in both preventing cancer and forestalling its recurrence. One important study, published in 2005 in The Journal of The American Medical Association , showed that 3-5 hours of walking per week significantly reduced the rate of breast cancer recurrence.

Stress, which Kolata also chooses to ignore, appears to be another important and perhaps remediable factor in hastening recurrence. Though the evidence is still weak that stress causes cancer (the exception may be overwhelming stress, as in bereavement, divorce, or massive trauma), studies are accumulating which show that chronic stress may speed up recurrences. In particular, it appears that high levels of hormones like cortisol that stress produces can inhibit enzymes that would otherwise help protect us against cancer.

Finally, group support, which has also been shown to be so helpful in improving quality of life, though not necessarily (here the data is mixed) extending life, is also given short shrift. Kolata tells a horror story of a support group whose members, apparently unable to deal with their own fears, rejected Kutt and forced her out of the group after her cancer had recurred.

For more than ten years my colleagues and I at The Center for Mind-Body Medicine have accepted the challenge of exploring and clarifying the limitations, as well as the benefits, of conventional cancer care and of bringing an open-minded but critical perspective to therapies that are said to complement or be alternatives to them. We have been training what we call CancerGuides(R)–health and mental health professionals and patient advocates who can provide informed and compassionate guidance to people with cancer and their families as they navigate among the bewildering array of therapeutic options and professional opinions. Our CancerGuides learn to cut through the hype about conventional care as well as complementary and alternative approaches. They work collaboratively with people with cancer and their families to create comprehensive programs of care which include evidence-based nutritional and herbal approaches, exercise, massage, acupuncture, and stress-reducing mind-body techniques as well as appropriate conventional therapies. They learn to help people with cancer put all therapeutic and preventive studies on a “level playing field” in which evidence for every approach, whether called “conventional” or “alternative,” is looked at with the same thoughtful, critical gaze.

The oncology professionals and patient advocates we train (sometimes nonprofessionals who have themselves faced the challenges of cancer and its treatment can be the most discriminating and skillful of guides) help those they are guiding to ask the right, and often hard, questions of their oncologists. We also help these CancerGuides to develop the sensitivity that is necessary to encourage and support each person with cancer to make choices that are appropriate to his or her unique situation.

We teach our trainees mind-body approaches (guided imagery, meditation, biofeedback, yoga, etc.) and expressive therapies (written exercises, drawings, and movement) that are so helpful in reducing chronic stress (and levels of stress hormones) and in dealing with the difficult choices and challenges that cancer and its treatment presents. Finally, over time, we train these CancerGuides to lead groups that are genuinely supportive, groups that help people with cancer come to terms with their fears rather than (like Ms. Kutt’s group members) shun those who provoke them, groups where true compassion trumps emotional convenience.

We as a nation have certainly not won the war on cancer. But we have learned over the last forty years that there are things each of us can do to reduce the risk of cancer and, in some instances, slow or forestall its recurrence. We have learned also that acting on our own behalf to create programs in which self-care is integral is, itself, stress-reducing and therapeutic, helping people with cancer to overcome the feelings of helplessness and hopelessness that so often debilitate them. And we have found too, as so many people with cancer would testify, that such efforts often become an opening to remarkable self-discovery and psychological and spiritual growth.

There is no silver bullet for most cancers, or sure cure for those whose cancers have advanced. But creating a comprehensive program that includes diet, exercise, stress management, and genuine support, a full array of options critically examined, may offer a measure of scientifically grounded common-sense help from which all of us can take heart.

James S. Gordon, M.D., a psychiatrist, is creator of the CancerGuides(R) training program and Founder and Director of The Center for Mind-Body Medicine. He is the author, with Sharon Curtin, of Comprehensive Cancer Care: The Integrating Alternative, Complementary, and Conventional Therapies and of Unstuck: Your Guide to the Seven-Stage Journey Out of Depression.

Read more about the upcoming CancerGuides training, June 11-14th in Washington DC

New York Times Article by Kolata
2006 NCI Report on Dietary Fat & Cancer
2005 JAMA study on Exercise and Cancer
2008 Study, Stress Hormones Inhibit Tumor Suppression

As appeared on The Huffington Post

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CancerGuides Training in DC in June

Dear Friends,

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.

CancerGuidesA 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.

With love,
Jim

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“Unstuck” E-book release!

Dear friends,

I have some exciting news—thanks to numerous requests, my latest book, Unstuck: Your Guide to the Seven-Stage Journey Out of Depression is being released as an e-book! In my publisher’s own words:

your e-book will be with retailers tomorrow; it should be on sale within 48 hours on Amazon and by the end of next week everywhere.”

“Unstuck” is on Kindle at Amazon.com here (or will be soon).

A warm thank you to everyone who helped by requesting this format. I hope this additional release will allow me, through Unstuck, to help many more people struggling through depression and anxiety (and perhaps, antidepressants) to move toward health and wholeness.

All my best,

Jim

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Gaza Mind-Body Training in the News

Dear Friends,

Check out the great AP story by Karin Laub about our Gaza training–

At the Washington Post (you may have to close an ad first to read it)

Or at Google News

It’s an great take on how our mind-body skills training is an unconventional fit, but an immense help, to people within the Palestinian culture. (Great picture of me shaking & dancing up front, too (!!!))

We’re in Israel now—flying back to the States soon. More soon.

All the best,

Jim

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Healing in Israel

March 2, 2009

I’m returning to the Middle East after 9 months away, in the wake of the War in Gaza and the ongoing shelling of the south of Israel by Hamas. Read about our mission here.

Our team is in Israel for 4 days: Amy, who runs our program of clinical supervision for our Israeli and Palestinian faculty. Dan and Lee-Ann, who coordinate both programs on the US side and Afrim and Jusuf, psychiatrists from Kosovo, whom I first met when they we’re refugees in Macedonia during the 1999 NATO bombing of Kosovo. Amy and I have worked together for 10 years. Afrim and Jusuf are like brothers. It seems that Dan and I have been everywhere together, and Lee-Ann, our newest member, has done a fabulous job with logistics for the trip.

We hit the ground running, heading to Sderot, which has been shelled from Gaza for 8 years, as soon as we wake up on the first morning after our arrival. Naftali, our Israel program director, (we’ve trained some 300 health and mental health professionals in Israel over the last 5 years), is doing the driving, and will be introducing us to colleagues who are dealing with the ongoing trauma in Israel’s south.

First stop: the SCIENCE AND RELIGIOUS ELEMENTARY SCHOOL, a meeting with the principal, Dina Chouri as well as Miri Asoulin, a teacher who has come through part of our training program and heads up the “Havens of Calm” program. “Havens of Calm” is a room apart from the school with bean bag chairs, crayons, games, a place for kids to come express their feelings and simply hang out when they need to. Miri is exactly the kind of teacher you wish your children had-or wish you might have had yourself. She has the kind of smile that erases all the doubts you have about your own worthiness, that makes you feel that everything you do is not just alright, but really really interesting.

Over the last 7 years, while shells fell in and around Sderot, perhaps 60 percent of the kids used the “Havens of Calm” room. During the recent war, and in its aftermath, everyone does.”

“For a long time,” Miri tells us, “the children have been nervous and angry; they have trouble sleeping and are wetting their beds. Now, from the time the war began, there are new symptoms. Now the children tend to find scapegoats. One class had an election for what classmate they wanted to most to be dead. They cannot fight against the rockets, so the anger has to go somewhere,” she says.

“In the beginning,” a psychologist who consults with the school, added, “the children were crying and anxious. Now, sometimes, they go into a total freeze when the red alert (the signal that a Qassam rocket is about to fall). One eight year old girl’s body was like a stone. She couldn’t move her hands or feet for four hours.”

Miri and a number of the other teachers and counselors in this and other Sderot schools find the techniques they learned from The Center for Mind-Body Medicine to be enormously helpful for themselves-for they too work, and often live, amidst the falling rockets-and for the kids. She shows us pictures that the children have done of huge rockets falling on their town and of Gaza burning.

The children seem more hopeful, but their parents are not. In Sderot, and in nearby Shaar Ha Negev, we hear voices of distress and disillusionment. “The people felt strong during the war,” one psychologist tells us. “They thought the rocket attacks from Gaza would be over. But now the war is finished, and still we have Qassams almost every day. What was the point?”

More to come.

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Going to Israel and Gaza

Dear Friends,

I’m getting ready to get on the plane for Tel Aviv, and begin this round of work in Israel and Gaza. (Read about our current work in the middle east here.)  You can get more info on the work we’ve done in psychological trauma relief in Kosovo, Israel, Gaza, and in the US here.

We plan to spend a few days working in Israel with our team of CMBM-trained professionals there, then (hopefully) make our way into Gaza to train 150 more professionals (on top of the 90 already trained) in mind-body skills that will help them to help heal the widespread terrible anxiety, anger, depression, posttraumatic stress disorder, and grief resulting from the latest conflict. We believe this work will eventually reach hundreds of thousands of people in Gaza, not to mention Israel–we believe we’re the only program working in both Israel and Gaza.

Right now, we’re just hoping to get in and start making a difference to the people who have suffered so much from this conflict.  This work is so difficult, and so necessary. We hope you’ll hold the safety of our team and the success of our mission in your minds and hearts— 

Sending all my best,

Jim

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Health care reform cannot wait, must not wait, and will not wait

Dear Friends,

 I spent Monday afternoon, February 23, 2009, testifying on the strengths of integrative healthcare and our hope for healthcare reform at the hearing, “Principles of Integrative Health: A Path to Health Care Reform” by the Senate Committee on Health, Education, Labor, and Pensions (HELP). The video is comprehensive—click to read shorter coverage in the Huffington Post.

 My colleagues (including Wayne Jonas, M.D. of the Samueli Institute, Robert Duggan, M.A., M.Ac. (UK), Dipl.Ac. (NCCA), of Tai Sophia, and others from institutions and the private sector) and I sincerely hope the time has come to change from a “disease-care” system to one truly centered on the patient and our wellness as a nation. Our current system is expensive, and ineffective at keeping us healthy. Turning to costly drugs ridden with side effects before trying natural approaches and wellness techniques is bankrupting our treasury and our health as a nation.

 More to come—check out the video, and check back here for updates. It’s a very busy time for us here at the Center!

 Best,

Jim

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