David Leonhardt’s “prostate cancer test” (The New York Times, July 8, 2009) is a good but incomplete one for healthcare reform.
In addition to removing financial incentives for high tech intervention, we need to educate clinicians in the impartial, critical analysis of all therapeutic options, and in supporting their patients as they act on the choices they make. For 10 years, The Center for Mind-Body Medicine has trained health professionals and patient advocates to do precisely this, as “CancerGuides®.”
We need as well to realize that expensive, Draconian treatment and “watchful waiting” are not our only choices. There is, as Dean Ornish is showing with peer-reviewed studies on prostate cancer - and a number of us are doing with heart disease, diabetes, chronic pain, depression and post traumatic stress disorder – a far more promising third way. It is grounded in techniques of self-care – dietary modification, physical exercise, and mind-body approaches like meditation and yoga – and in group education and support.
This approach holds great promise for treating and preventing chronic illness of all kinds and for saving large sums of money. It should be central to healthcare reform.
A shortened version of this was published in the New York Times online Letters section on July 21, 2009.
I just returned from another trip to Israel and Gaza to visit our programs there and to plan for the future. I’ll tell you about what happened sometime soon. Right now, I wanted to share with you some testimonials from health and mental health professionals who participated in our most recent professional training in Gaza (March 7-11, 2009). It was, as you’ll see, an extraordinary five-day experience. Jamil Abdel-Atti and his Palestinian team gave just about all the lectures (I filled in some) and led all the small groups. Amy Shinal, our CMBM clinical director, and Afrim Blyta and Yusuf Ulaj, Kosovo psychiatrists and dear brothers with whom I’ve worked for ten years and I provided consultation and supervision; and Dan Sterenchuk and Lee-Ann Gallarano, from our DC office, offered invaluable administrative support. But the training and the beautiful spirit came with our wonderful Gaza team.
Here, then, is what some of our participants had to say:
The information, the relaxation techniques, meditation, and deep breathing. I deeply discovered myself and how to take care of myself. I discovered my neglected body and promised to be taken care of. I forgave my friends and relatives I have neglected and lived far from. Spirituality, I had neglected that part for so long, but realize how important it is for my healing. Grateful for the ability to apply these new techniques in my work. I met new friends. The family tree gave me a very good space to think of my relationships that I’ve ignored.
• Ensherah Zqoot
Gaza for Psychological Health Program
First, I want to express my feelings. I’m happy and feel like I own the world. The training was wonderful and excellent. I felt changes in my physical, psychological and mental status. The techniques were great and worth teaching and sharing in such a training. For the first time I feel involved in a training for myself. I feel safe and comfortable with the team and the facilitator Jamil, who shared his feelings with us. I want to thank him but can’t find words to express my gratitude. I won’t forget the efforts of everyone who participated in this training. I just want to say I’m truly happy.
• Jabr Hussien Theibet
I benefitted a lot from this training. I debriefed lots of feelings and emotions. I truly thank the mind-body medicine team especially Dr. Jim and Jamil and the rest of the faculty. I hope I will be involved in the advanced training so I can help others like you helped me.
Mohd Abu Omirah
Psychological Support Association
I was asked by my professor in the university to participate in this training and I didn’t know anything about it. I felt sad and angry during and after the war, and I was furious about everything. Felt insecure and that all my dreams and rights have been violated on the beach of Gaza. I was thinking sometimes why live? And why continue living as long as we’re continually exposed to those violations? In the five days of this training my life has changes completely. I felt dreams could come true and might will not last long cause day is coming soon. I felt I was born again, like a new person. I felt like a loving human being, full of happiness and hope for the Gaza children. I have many things to say and deep happiness inside but I didn’t want to talk much and bore you. In the last moments I had in room 402 that I will never forget for I had sad and happy moments. I want to thank Mr. Ahmed Theibet and the small family I lived with for 5 days and for Jim, Jamil and the rest of the faculty. Thank you all.
This training provided me with the following:
1. To control my feelings when I face external stimuli
2. How to respond in a rational way and wisdom in the face of acute and difficult situations.
3. My wish that we implement this program with schools’ teachers and guidance and counseling staff at the Ministry of Education to enable them to deal with students and how to face difficult problems.
Abeer Fathi Shareef
Thanks to Jamil and his incredible team on the fabulous training. Also thanks to Dr. Jim and his team. These techniques are consistent with our Palestinian and Islamic culture and this is the secret beyond the programs success.
Gaza Mental Health Center
Training was very enjoyable in terms of changing the track of our lives and jumped with it that big leap. Therefore I have decided to change my life and to reshape my issues. I felt that the training was extremely individualized and it was directed for us as professionals, where always we are asked to care for others and in a very few occasions somebody remembered us and worked for us rather than the patients cases and clients. Thanks a lot for all of those who were behind the program.
Tawfig Abed A Hadi
This course made us realize that our hearts are like Jim’s, very beautiful and valuable. By awakening all the shine that it contains you had awakened our souls which was about to disappear in the sea of torture. We have lived moments that could be the road to the shining future.
Head of Guidance and Counseling in Ministry of Education
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.
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.
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 in 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
As appeared on The Huffington Post
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.
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,
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,
I said that I would write more about our work in Israel and Gaza, but the work-and trying to find funding so that we can continue it-is taking up so much time (joyous, exciting time, to be sure) that I haven’t been able to write.
Still, I thought I would send along this very brief summary that I forwarded to our US Mind-Body Medicine faculty.
Just a couple of words from Gaza City: overwhelming, amazing, touching. That’s three words.
We (Jim, Amy, Afrim, Yusuf, Dan and Lee-Ann) had a great visit with our Israeli faculty. They are doing many interesting and exciting projects including groups that combine mind-body skills and Jewish spirituality, joint Israeli Jewish and Arab groups, and many groups for traumatized children and adults in Sderot. In fact, we made a visit to Sderot and had a chance to talk with teachers who are using mind-body skills in wonderfully creative ways with children in the SCIENCE AND RELIGION SCHOOL. The kids have experienced shelling on and off for eight years and are having all kinds of problems with concentration, bed-wetting and anger.
Naftali who heads up our Israeli program, is on the track of a major initiative in the South which will build on the work that he and his team have already done. We are working together on developing cooperative relationships and future funding.
Thanks to Danny Grossman, a friend to whom Aaron and Debbie Kaplan introduced us some years ago, (with able assists from Naftali and Smadar who handle the administrative work in Israel), we were all able to get into Gaza. It took a couple of extra days for Afrim and Yusuf, but Naftali and Tami and Ayelet from our Israeli faculty kept their spirits high while they waited. Once in Gaza, we began with visits with grieving families. There are whole sections of Gaza that have been completely destroyed and many thousands of people who are without homes. “I am very small,” one ten year old girl told us, “but the tent the 20 of us are staying in is even smaller.”
We went on for a day of meetings with our Gaza faculty. The next day, we had more site visits including one to Dr. Izzeldin Abuelaish, whose three daughters were killed. He’s an amazing man, an OBGYN who works in Israel as well as Gaza and through some miracle of wisdom and compassion, has managed to transform his suffering into a visionary project for the education of girls in Gaza-“not just so they will think, but so they will think freely”-and a mission to promote greater Israeli-Palestinian understanding.
We’re now about to start the 4th day of our PTP. Our Gaza faculty, which Jamil heads up, is doing virtually all the lectures and leading all the groups and our international team is consulting/supervising. The Gaza group is doing an absolutely wonderful job. They are so open-hearted and skillful-I’d say over the last 18 months, they’ve each lead anywhere between 6 and 20 groups and it shows.
Participants (there are over 140 of them) are speaking of issues that they have never before discussed and beginning to solve problems that have troubled them for years-not to mention finding practical ways to ease their high levels of anxiety and deal with nightmares, flashbacks, etc. All of them-faculty and participants-are so eager to learn and to share what they are learning. They are an inspiration to all of us.
There is much more to tell and I will when I have more time. For now, I send all of you my love as well as my gratitude for being with us on this and many other adventures.
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.