The Center for Mind-Body Medicine

Amazing Graces: Days Two and Three

By the second day there are actually 135 participants-almost 180 of us altogether. The ones who didn’t come to the opening are present and others from the waiting list have found a way. There are thirteen in most of our small groups.

One of the remarkable things about our trainings is how often people who at first seem utterly closed down—walled off with indifference and suspicion, sunken beneath sorrow—suddenly come alive, sharing what they have not spoken of before; discovering new worlds of feelings, possibilities, hope.

The soft belly meditation invites calm and acceptance. The drawings play to the imagination, sometimes revealing solutions to problems that have seemed intractable. Shaking and dancing loosens most of us up. And the experiences that follow in the large and small groups provoke wonder.

Regine tells me about one of the leaders of the regional police. He came to early morning yoga and scoffed, “I thought we were talking about taking care of people. This is sports.” The drawings seemed, at first, ridiculous. “This is child’s play.” He stays and later in the day she sees him sitting quietly in meditation, laughing as he shakes and dances. He’s back the next day and the day after.

The drawings of a young woman whose face is filled with rage evolve from cramped stick figures–she is fighting with her parents–to a full bodied woman standing apart from them looking at the horizon. When she does the safe place imagery she sees herself “playing hide and seek with my friends having fun as I did when I was a girl.” And then–and a smile cracks her stern face–“flying free.”

I do Mindful Eating in the large group: a third of a banana for each participant. Almost two hundred people feel, smell, taste, and slowly chew. A fit man in his 50’s comes to the front of the room. “I have tended banana trees since I was a child. I know everything about the fruit and the tree and the soil and the bugs that come around. I sell bananas and give them away to the poor and have done so for many years. I eat them every day. And yet, I have to tell you, this is the first time I have truly eaten a banana.” The room swells with laughter as everyone gets the message: It really is possible to come to any experience, including eating an everyday banana, with an open mind and an open heart, as if for the first time.

James S. Gordon MD, a psychiatrist, is the author of Unstuck: Your Guide to the Seven Stage Journey Out of Depression and the Founder, Director of the Center for Mind-Body Medicine in Washington, DC, and Dean of the College of Mind-Body Medicine with Saybrook University.

Mind-Body Medicine is “How to Heal Psychological Trauma”

Dear Friends,

On a recent trip to London, I was interviewed during Depression Awareness Week about my book Unstuck’s UK release by The Guardian newspaper. The reporter was particularly interested in CMBM’s Global Trauma Relief program and our work to bring population-wide psychological healing to places around the world that are afflicted by war and natural disaster. You can read the piece here:

THE GUARDIAN: How to Heal Psychological Trauma: From Haiti to Gaza, psychiatrist James Gordon counsels survivors of disasters around the world

I’m certainly pleased that the author recognizes CMBM’s groundbreaking efforts to teach and support hundreds of thousands of people in Kosovo, Israel, Gaza, Haiti, Southern Louisiana, as well as US military returning from Iraq and Afghanistan. It’s a shame, however, that his tone is so dismissive of integrative medicine and that he fails to recognize the fundamental importance of self-care for psychological and physical healing.

Please note that as of this writing, corrections are being made online for several factual errors, including the following:

-          In Gaza, we trained 90 clinicians initially, only a few of these were “educators” (as the article states)

-          CMBM now has 160 groups meeting in Gaza each week, not 48, as reported.

Beyond factual errors, though, I’m disappointed in the tone of the article. I want to emphasize that our approach to psychological trauma relief is not about “belief,” as the article repeatedly implies. It is based on hard evidence that is just as rigorous – actually more so – than most of that provided by the drug companies he seems to accept as the standard.

It is a common misconception (and prejudice) that psychological and nonpharmaceutical research is less stringent and reliable than clinical drug trials. Each of the approaches that we use, including meditation, guided imagery, biofeedback, autogenic training, yoga, self-expression in words and drawings, and movement and exercise, has a significant research base, one which demonstrates decreases in stress levels and improvement in mood. The CMBM approach combines these into a comprehensive program, and The Center for Mind-Body Medicine takes great care in scientifically researching, documenting, and publishing our findings of our approach in peer-reviewed journals. We recently published a randomized controlled trial (RCT) on our work with war traumatized children in Kosovo that shows an 80% decrease in symptoms of PTSD (read the abstract here).

This was the first RCT of any intervention with war-traumatized children, and sometime in the next few months, we will be publishing a study (in the International Journal of Stress Management) that shows similar results—80% decrease in PTSD symptoms, significant decreases in depression and hopelessness—in war-traumatized youth in Gaza. This study is particularly important because the gains that were achieved over ten weeks of once-weekly group sessions were largely maintained at seven months’ follow-up—in spite of ongoing conflict and severe economic hardship.

The point is that this approach is not alternative. It is fundamental. It makes human and scientific sense. We have an approach that works with large groups of people in developed countries as well as those ridden by disaster. It is flexible, inclusive, and culturally acceptable. And the groups in which we train caregivers can be led by anyone—teachers, and religious and community leaders, as well as health professionals; and the scientific evidence for its effectiveness continues to accumulate. And as the article states, CMBM will continue to be there to provide our program of mind-body medicine for people suffering from psychological trauma, to teach them, and help them help themselves.

In Haiti, Faces of Change: Mercedes' Transformation

Yesterday I told you about James (from the National Police), Ty Rose (an anesthesiologist and teacher), and Marilyn (a pediatrician).  (Here is the link, if you missed it.) Now, here is Mercedes’ story.

We go around the circle to “check in” about our emotions and what’s happening right now, this moment. It is Mercedes’ time to ‘partager,’ or share. “Most of you,” she begins, “have seen how I was last time,” and I remember – and imagine that all the others remember as well – how at the very first training, in December, she sat erect in clothes that hung like armor, her face as immobile and solemn as the great statues on Easter Island, speaking occasionally and telegraphically about the death of her husband and her daughters, and her own despair.

Mercedes now opens her hands and, amazingly, grins. “I have found calm,” she begins, “doing the deep breathing and the shaking and dancing every day,” (she is emphasizing now). “And I have found much more as well.”

by Mark Silverberg for CMBM

“On the anniversary, January 12th, my daughter and I and our whole community were in Church. And everyone was so sad, but tense also and unable to express the sadness. And I let myself cry. And then my daughter was able to cry too. And in my crying I found strength. And I asked myself ‘what have I learned in the Mind-Body program and how can I use it to help everyone in this Church?’ And I began to sing a song – I have never done this before. And my voice grew stronger, and I asked everyone to lift their arms and glorify God. And they all began to sing and lift their arms, and cry. And I sang three songs and then we opened our eyes and we were all calm.”

She concludes, “you know I work as a teacher. But my students no longer call me teacher,” she says, wagging her finger and pausing with what I cannot help but think is a mischievous grin. “now,” she goes on, “they call me ‘mommy’.”

Thank you for reading my accounts of CMBM’s trainings in Haiti, and these stories from our trainees. I hope you are finding the people as amazing and their stories as touching as I do.

Now that the first 120 Haitian professionals have completed our Initial and Advanced Trainings in Mind-Body Medicine, they will begin to offer Mind-Body Skills Groups to their family, friends, community, and at their institutions, and I will be sharing more of their stories here as they teach and share with others, and learn and grow themselves.

Jim

Trauma Healing for Haitian Nursing Students

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.”

Trauma Healing for Haitian Red Cross Staff and Volunteers (Croix Rouge Haitien)

Already at 9am, the air is hot and heavy in the workshop tent. Fifty or sixty people are present, most of them quite young, taking notes, wonderfully attentive and responsive. They are a bit shy at first, but as we all introduce ourselves, they offer stories of trembling bodies, panicked hearts, of sights beyond endurance—watching family members crushed under falling concrete.

We teach them slow breathing to quiet the mind and body and relieve stress. They participate with eagerness and enthusiasm. Afterwards they clamor eager to “partager,” to share: “A feeling of calm for the first time since January 12th;” “a letting go in the shoulders;” “this is the first time also,” one adds, “that we’ve had an opportunity to learn about our own psychology, to share our feelings, to look at what stress causes in the body and to feel relief from it.”

After a mid-morning break, 30 or 40 more people join. “We have spread the word,” one of the young men says with a grin. After we do drawings (of “yourself,” “your greatest problem,” and “the solution to that problem”), the HRC staff and volunteers share them in animated groups of three. “There is hope here,” say several, of their third drawings.

They are filled with sunlight after darkness of the second drawing; with music—drums and guitar—and dance and movement, after “the biggest problem” of buried and walled off emotions, broken bodies and silence: “It gives me direction,” says one young woman, and others agree. Several stand to show their drawings to the whole group; many more want to.

Then we push back the chairs and stand together, shaking our bodies and releasing tension. When the music changes, the young people sing together, clapping their hands. Afterwards, no one seems to want to leave. Little groups form around each of our faculty and staff.

Twenty-five or thirty of the Red Cross volunteers and staff write notes of appreciation. Most are translated from Creole and French by our interpreters, and a couple are in English. Here, in English, are a few:

“Today I have found the means to comfort myself when I have a problem, to change my way of thinking and looking at things in other people and in myself.” Jeanty

“I feel so good. If everywhere they could have someone learn these exercises and teach them in their neighborhood, everything would be okay for everybody, and accept life as it is. Thank you so much to teach us. May God bless you and protect you.” Myrka

Many of the young people say spontaneously that the experience, has, in the words of one, “taught me how to face the dangers that present themselves to me instead of flying from them.” Another adds, “I’m very happy with the information that I learned today. Now I know how to confront my fears. I would like to be a part of another one of your workshops. Thanks a lot. I’ll never forget you. We needed it.”

“I’m Elder,” writes a third, “I’d like to say I’m very happy and I say to you a big thanks to you for that. You’ve made me a messenger to a lot of people in the world. Thank you so much for your encouragement and the hope of living you bring to me. I love you very much.”

Many, many of the HRC volunteers and staff tell us how much they appreciated the copies of the exercises that we gave them, as well as the workshop, and that they plan to share what they have learned with others. But still, “we want to learn more.” A number invite us to come to visit with them, to bring “workshops of healing” to family members and friends in schools, tent camps, and churches in Port-Au-Prince and beyond.

These idealistic, committed, bright young people (some Red Cross staff, most volunteering), are such an important resource for Haiti’s future. They have a tremendous appetite for learning about themselves and the world, and for helping others. I would very much like to do a full professional training for them.

CMBM's Drawing Exercise Resonates in Haiti

We move during the rest of our week in Haiti from one group of health professionals and community leaders to another. It is a slow progress through the traffic jams in Port-Au-Prince’s rubble-narrowed streets, and sometimes even slower over the gorged-out, flooded dirt roads that take us to Bishop Pierre Andre Dumas’ diocese in Anse-a-Veau, three hours outside the city.

We use a variety of techniques in our workshops, including explanation of the fight-or-flight and stress responses, meditations, guided imagery, and shaking and dancing. We also do a drawing exercise that has been enormously helpful to children and adults in war, post-war, and post-disaster situations, in Kosovo, Gaza, Israel, and New Orleans, and with US military. For a while, everyone—bent over paper, crayons in hand—becomes young, earnest, playful, surprised.

The drawings allow people to tap into their intuition and imagination without effort. As a series of pictures unfolds, they find themselves creating images they’d never imagined, sketching solutions to problems that seemed insoluble.

In Haiti, we guide our groups through three drawings. The first picture is of “yourself,” the second, “you and your greatest problem,” and the third calls for “the solution to that problem.” (We modify the exercise when we use it with children: read my post about using the drawing exercise with Haitian children in the General Hospital.) Afterwards, participants share their drawings in groups of two or three, telling what they see in what they’ve created and how it makes them feel. Then they have the opportunity to share with the entire group.

As you will see, the results are often touching, and almost always surprising.

Here are a few examples and snapshots of the workshops in which they are created:

For L’Institut Haïtien pour la Doctrine Sociale Chrétienne
(Haitian Institute for the Christian Social Doctrine)

Such wonderful, accomplished people: 100 of them—physicians, architects, lawyers, police officials, business men and women. All, in this time of crisis, are renewing their commitment to the welfare of those who have suffered even more than they have. They tell us about the terrible sadness—their own, and others—and about unaccustomed irritation that surfaces at home and at work, as if, somehow, angry will could restore what has been lost.

An obstetrician/gynecologist, tall, broad-shouldered, powerful and handsome in a bright, tailored shirt, has come “for rest and peace—I have not slept since January 12th.” He says he works “always” to forget the loss of his house, the deaths in his family—his sister, nieces, nephews—as well as to care for his patients. In his second drawing (a picture of his biggest problem), he is inside a tunnel, tiny as an ant, lost, unable to touch the equally tiny figures outside. In the third (a picture of his problem’s solution), the figures are larger, recognizably human. They are dancing together and he is laughing, “for the first time since the quake.”

For Anse-a-Veau diocese—nuns, priest, lay brothers

Out in the countryside a couple days later, we are meeting with priests, nuns, and lay brothers in Bishop Dumas’ diocese. It’s like rural Africa out here: lush, green and very still, faded pastel cottages with tiny yards in which seeds, sown or thrown, produce a few vegetables and fruits. We begin and end our visit with Bishop Dumas’ blessing and simple ceremonial meals: tiny, boned, tender white fish, rice, beans, greens, fresh lemonade and thick coffee.

The religious, in straight-backed chairs, are as still and elegant as the statues in the porticos of Chartres. They are so attentive, so sweet tempered amidst the flood of suffering, homeless, city people that the earthquake has forced back to the countryside. One priest draws a scene of despair—“The Cross of Death—Good Friday without Easter Sunday,”—and then, in his third picture, much to his amazement, produces a sun that covers the page with radiant yellow. “It’s the sun of freedom. Together we can overcome.”

They dance, too—nuns, brothers, and priests together—as freely and as happily as children. Before we finish in mid-afternoon, another, older priest calls the Bishop from the next diocese. It turns out he would like us to come there.

More soon about another workshop, this time with the Haitian Red Cross staff and volunteers . . .

At School: A Place to Help Haitian Children II

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 . . .

At School: A Place to Help Haitian Children

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 . . . .

Meetings with Remarkable Haitians—Dr. Jean Hugues Henrys and Dr. Alex Larsen

Our last full day in Haiti brought us another unexpected and auspicious meeting. On our first visit to Haiti the month before, Rosemary and I had met with Dr. Claude Surena, an internist who is head of the Haitian Medical Association and principal advisor to the Ministry of Health. Dr. Surena was extremely enthusiastic about working with us. This time Dr. Surena was out of the country, and he suggested we meet with his colleague, Dr Jean Hugues Henrys.

The problem was that we could no more find Dr. Henrys — housed in temporary quarters and mostly out working in the clinics and hospitals — than we could Drs. Guiteau and Amedee-Gedeon. Lee-Ann called and called, and finally—“just one more time.” We reached him, and set an appointment for the last hour of our last day in Port-au-Prince.

It turned out Dr. Henrys, a genial host, was as happy to see us as we him, and was particularly eager for us to work with Ministry of Health employees. Their building had been destroyed, many of their colleagues were dead, and the ones who remained were carrying grief for lost friends as they dealt with the enormous needs of the population.

And then, as the meeting was winding down, another man entered the room. It turned out to be the Minister of Health, Dr. Alex Larsen. Dr. Henrys filled him in on our work and what we had been talking about and went on to make a suggestion. “It says in your proposal,” Dr. Henrys–a quick study– reminded us, “that you want to have a ‘Haitian leadership team.’ It is important that you work with the future leaders too, with medical students, and others concerned with the social sciences.”

“Yes,” I say, “we do that in the US. That would make me very happy.”

“Perhaps he has not told you,” Dr. Larsen interjected, smiling, “but Dr. Henrys is the Dean of our Medical School.”

Next post: the very successful workshop we offered to American Red Cross workers during our visit.

Celebrating Hope and Healing in Haiti–Day 2

Day 2 in Haiti, Feb. 12, 2010
Dear Friends,

In Haiti three days of “memorializing the dead,” of prayer and fasting have begun.

thousands gather to memorialize the dead

thousands gather to memorialize the dead

We drive downtown, past blocks where some houses are still erect and others down, victims we are told of neglected building codes, and others where everything is flattened like discarded, half-eaten sandwiches; fragments of concrete and stone and dust are everywhere.  S.O.S. signs are chalked on walls. We pass open air congregations, gathered like human lakes in front and on the sides of tent encampments, several hundred people here a few thousand there, listening to sermons in Creole, raising their voices in song. On the radio one preacher exhorts his listeners to ask God’s forgiveness for drinking, smoking and going to voodoo priests.  Requiems for the dead are broadcast, and  reminders of God’s power to see and do all, to help us go, and live beyond death.
Haitians gather for sermons

Haitians gather for sermons

We park at the Champs du Mars. A hundred thousand people are here, or more, it is hard to tell. They fill an amphitheater where the speakers stand, flood across fields and roads, flow among the thousands of tents that have been set up, sit in the trees overhead. The Haitian people, we are told, are like those who were with Joshua at Jericho: They have no weapons but God will save them. The messages from the Haitian President as well as the preachers, are similar – have strength, have faith; we will work together for the future. Men, women and children, most in tee shirts and loose blouses, some in surprisingly neat even stylish clothes, sing and raise their arms ( a few extending bibles upward) to praise God and shout “Hallelujah”. The mood is somber and suffused with determination, but also celebratory. “We are,” one lean fortyish man with dreadlocks tells me, holding my hand and looking at me with urgent fellow feeling, “here to give thanks to God, to rejoice for our brothers and sisters who have perished, to love one another.” Drums begin to play and a breeze, as if summoned by them, blows through the noon heat. We are all clapping and dancing now. None of the Haitians,needing to remain strong, seems to be crying,  though sorrow rises like steam from their bodies; tears come to Star’s eyes and mine.
the cathedral in ruins

the cathedral in ruins

Afterwards we stop at the Cathedral. A nearby music school has disappeared, its students dying with it. The Cathedral, once one of the city’s glories, is a skeleton, its only note of celebration bright bougainvillea in what was once a garden. You can see through the great building now, from one side of the transept to the other, from the porch at the back through the nave to the chancel at the front. Across the street people too injured or tired or dispirited to attend services that require standing are camped in rubble against a wall, a few possessions piled around them, burlap for bedding. At the head of one’s pallet is an astonishing sign of faith and hope, taped to the wall: a picture of the risen Christ, emerging from a blue sky, returning victorious to earth.
great faith and hope for the future

great faith and hope for the future

Jim
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