Shortly after we arrived yesterday afternoon, Star and I crossed the street and walked down the ragged line of incongruously bright new tents that front the road. An open space gives us entry, and we wander through the maze of living and cooking spaces, a large, older white man, a small, younger black woman whose “bonsoirs” are often returned with smiles.
We reach one boundary of the encampment formed by a four-story concrete building which has been crushed like a paper hat. A young woman with an infant greets us. The baby is a little thin, a little dour, a little jumpy. Her name is Miranda, and she is two months old. Miranda’s mother shows me a place on her head where the nearby building had quite literally fallen on her. It hurts still, a month after the earthquake, and so do her neck and back. I go into her tent to take a look. There is great tension and tenderness at the site of her injuries. I do some gentle manipulation, and she smiles with relief. I reassure her that in time the symptoms will subside and remind myself to bring acupuncture needles next time.
Others have not been as fortunate as Miranda and her mother. One woman’s two children have been seriously injured and are still at the hospital. Another’s aunt has died. A third is missing her husband. A fourth has lost the sight in one eye. The pain from injuries received in the earthquake persist. Memories of loss and unspeakable terror seem to have attached to and continually restimulate the pain—the ever-present physical replaying of the catastrophe, the physical manifestation of psychological trauma and ongoing distress. Some “cannot remember the simplest thing,” or “make any decision.” The blind woman fears that she will not receive medicine without money to pay for it. No one sleeps well. All are fearful of further loss or injury, or—they are not quite sure what.
And, indeed, the situation is enormously stressful. The tents, which look so good, just arrived yesterday, brought by the French Red Cross. . For a month, these people have been sleeping in the open. “We have a committee,” says Wilson, Miranda’s father, “to organize ourselves.” And they are indeed cooking communally. “But we do not have toilets, or other necessary sanitation.” There are no doctors readily available to them, or medicine, or replacements for needed glasses lost, or hope for more adequate or permanent housing, or indeed, much communication with the world beyond the tent city. As we are leaving, Wilson invites us to share the rice that half a dozen families are beginning to eat.
More in days to come.
Day 1, part 1 of 2–Arrival
There is a weight to the air; we begin to feel it at the border where we enter from the Dominical Republic. We can smell it, too, in the swirl of dust that forces some to wear masks, in the acrid edge of burned and burning building materials. It grows heavier as we bump around flanks of rubble on the outskirts of Port-au-Prince. In the city, it roughens our voices and presses tears from our eyes.
Happily, surprisingly, we have a place to stay—in the Coconut Villa, a hotel near the airport that is an undisturbed island amidst collapsed houses. Across the street, several thousand Haitians live in tents.
Rosemary Murrain, Star Myrtil, and I are here to see if our approach can help bring psychological relief to the people of Haiti—and to see if we can work with and find support from the large international agencies that are funded to bring food, housing, schools, and emergency medical care to the people. Our approach, which combines such mind-body techniques as meditation, guided imagery, biofeedback, and yoga, self-expression in words, drawings, and movement, and small group support, has made sense to and worked remarkably well with war- and disaster-traumatized populations in Kosovo, Macedonia, Israel and Gaza, in post-Katrina New Orleans, and with US military returning from Iraq and Afghanistan. It’s practical, easy to learn, and feels right to people who are trying to gain control over the thoughts, feelings, and memories that overwhelm them in the wake of catastrophe. We’ve published the only randomized controlled trial (RCT) of any invention of any intervention for war-traumatized kids. It showed an 80% decrease in symptoms of posttraumatic stress disorder in Kosovo high school students, an improvement that was maintained at three months’ follow-up. More recent studies on 1,000 children and adults in Gaza show similar sustained gains in spite of the ongoing constraints and tragedy of life there. Altogether, the several thousand clinicians, teachers, and community leaders’ we’ve trained have made our CMBM model available to hundreds of thousands of children and adults around the world.
Rosemary is CMBM’s new Director of Finance and Administration. Immensely capable, unflappable, fluent in French, she’s an MBA student who has helped to create and lead educational programs throughout Africa. She’s in charge of the logistics that brought us on our journey here, and she will help create necessary partnerships. She’s also, I say with pride, my goddaughter. Star is her friend, a Haitian living in Florida, leading women’s programs there and fluent in Creole as well as French; a human bridge for us to Haiti and to its people.
I’ll post more this afternoon, about our visit to the tent city outside our hotel and the people we met there.
December 20, 2009
If Gaza is saturated with tradition, and blessed with generous impulses, it is galvanized by politics. Until several years ago, when we developed a high level of skill and firmness in directing our trainees back to their own present feelings, simple declarative statements often threatened to veer off into impassioned political narratives. The Palestinian faculty we have trained now recognizes the hazards, and has become adept at forestalling rhetoric, foreclosing budding arguments, redirecting attention inward, and calling for immediate feelings as well as the historical conditions that may have provoked them. Inevitably, however, politics and the devastating consequences of political decisions are not far from the minds and speech and feelings of Gaza’s men, women and children.
In the small groups we see and hear that the consequences of history are inscribed in our participants’ pain and fears. Remember the hurt that the young psychologists whom I described in the previous blog carry from childhoods shadowed by loss and deprivation and squeezed by self-righteous brutality. And anxiety about present safety and future survival is absolutely, understandably universal: Gaza is closed off from the rest of the world, vulnerable to unpredictable attack from Israelis who control its borders and airspace and to violent schisms and reprisals within. Inevitably there are symptoms: One stocky young male psychologist from a distinguished family of Gazan warriors admits, embarrassed but eager for help, to “panic attacks” when his toddler daughter develops a cold or returns late from a babysitting relative; several other mental health professionals speak of waking abruptly, hearts racing at innocent sounds that evoke body-memories of Israeli shells landing or Fatah and Hamas fighting under their windows.
Six months ago, Gaza, though deeply wounded, seemed far more hopeful. Crumbled buildings – large public and small private ones – punctuated the streets of Gaza City and Rafah; blasted orchards and fields torn by shells tolled a loss of innocence as well as income; memories of the 1400 who died in the fighting in December and January filled the eyes of families we visited and appeared, often briefly, modestly, but with head-shaking sadness, in conversation. Still, there was a sense that things might, even that they likely would, finally change for the better.
One of Hamas’ top officials, Deputy Foreign Minister Ahmed Yousef, spoke of the renewed faith in American idealism that Barack Obama’s election and his speech in Cairo had inspired in him and others; of his hope for reconciliation between Fatah and Hamas; and of a future in which a regional partnership “of the world’s three great monotheistic religions” would bring peace, tourism and industry to Gaza and the West Bank as well as Israel. “Soon, inshallah, (god willing)” our Gaza faculty estimated, “we will be able to go with you to Israel, the West Bank, maybe even America.”
The current “situation” – the word is an all-purpose one that Israelis as well as Palestinians regularly use – seems by contrast dispiriting, even desperate, to the Gazans I meet outside of as well as in our training. Now Ahmed Yousef reminds me that “we have not fired on Israel for a year,” and asks, sadly, rhetorically, “and what has been our reward?” Young people wonder whether a world that will not open Gaza’s borders to trade that is necessary for rebuilding or to the free passage that will overcome their punishing isolation, understands or cares about or even notices their plight. Several speak, with resignation but chilling firmness, of the inevitability, in the absence of progress, of resuming “resistance”:
I do not feel that the vast majority of Gazans whom I meet – and I have worked closely with several hundred and met many hundreds more over the last seven years – want to return to fighting; it is that they do not know what else to do, how else to lift the crushing weight of the occupation, to signal, amid what appears to them colossal indifference, if not hostility, that they are “human,” and deserve the basic rights that the rest of us assume. “Don’t the Israelis understand we are just like them” one young woman, a well educated “political independent” asks me. “I have parents and children I love. I want to help my people. Yes, I hate what the Israeli government has done to us, but I do not hate Israelis.”
There are to be sure fanatics in Gaza, people chained to an unchanging allegiance to past wounds, committed to a holy war that will wipe Israel from the landscape. They are, however, very few among the very many I have met. Hamas has been a resistance movement and has committed terrorist acts, as, I would add, have other movements in this region. However, many of its leaders and many of the young who have been drawn to it now aspire, in spite of their current distress, frustration, and discouragement, to becoming partners in leading a state, productive members of a tolerant regional and world community. A burly young man, a high ranking government functionary who speaks with resignation about the possibility of resuming resistance, sounds a few moments later exactly like an American graduate student. He is particularly glad to talk with me, he says, because he wants my advice on framing a topic for the PhD thesis he hopes to write.
The day before our training ends, I speak, at Ahmed Yousef’s invitation, at The House of Wisdom, an independent Swiss funded Gaza City “think tank” that he helped found. “Everyone has to speak English here,” he tells me. “We want to be part of the world community.” Thirty earnest young intellectuals – political scientists, environmentalists, government officials – gather on short notice: Some are affiliated with Hamas, others with Fatah; many are unaffiliated with any political party.
I sit at the intersection of long polished seminar tables – it could be Georgetown or Harvard- and talk about the work we are doing in Gaza, the research that demonstrates its efficacy in reducing stress, improving mood, and enhancing hope for the future. I discuss the resilience of the people and the community that supports them; the central role of self-care and mutual help in all health and mental health care; the necessity of knowing and caring for and changing oneself as a prelude to helping others do the same; the dangers of fixed ideological positions that force people to deny or suppress their true and changing needs; and the importance of meaning and purpose in sustaining all of us. There are nods of heads and some smiles. The questions and comments are thoughtful, balancing appreciation for and curiosity about our work – “Yes, I and others in politics could use that,” remarks one man – with reminders of the challenges to safety and survival as well as sanity that continue to confront all Gazans.
As the seminar draws to a close, the House of Wisdom executive director Mahmoud El Madhour, a wavy haired, urbane PhD engineer and MBA who has studied Greek philosophy in Greece, and is a proud independent, thanks me. He ends the afternoon with a few words of reflection: “Without communication,” he begins in easy but urgent English, “we have nothing.” He pauses for a moment. “We stand here in Gaza, with no other place to go. This is my resistance. Gaza is a lovely place. And I want you to know I do not mind sharing it.”
Gaza City, December 16, 2009
As the days pass, our participants discover and discuss new possibilities of psychophysiological self-regulation – breathing deeply to relax in spite of the anxious anticipation of leading a group for the first time, or to find a calm place from which to encounter memories of family members “martyred” by violence. They find in the creative imagination of guided imagery unexpected ease: “When I go to my imaginary ‘safe place’ I discover it is my home – I would not have believed it because we are close to the border and have often been shelled – and I thank God for my family and for seeing the green of the trees every day.”
Sitting in the circles of our small groups we move more deeply into each others’ minds and hearts. Experiences and feelings that are rarely if ever publicly revealed in tradition-saturated Gaza are shared; long suppressed emotions and conflicts emerge.
We hear about the ways that the frustrations of men, deprived in the Nakba – the “catastrophic” loss of homes and villages of 1948 – of their patrimony, unable to maintain their self-respect without jobs or freedom, have manifested in the self-righteous abuse of women and children. Her late arrival after difficulty navigating the streets during a Hamas demonstration reminds one young psychologist – gentle, always smiling, pale in her long black coat – of her father’s fury at an elder brother when one evening years ago he came home late: The old man burned the boy’s arm with a stick glowing with red heat, and turned the instrument on his wife when she pleaded for mercy. The girl watched. A university professor cries with shock and pain for her young colleague, and recalls her own father’s contrasting kindness. Then it is the turn of a large young man, a gentle giant I think, who is also a psychologist. “I have not spoken of this before,” he begins. When he and his brother were six and five, their father forced them, out of, the psychologist now believes, some warped idea of discipline and manliness, to walk 10 kilometers to school each morning before dawn; the young man remembers, his face softening in hurt, his hands opening in incomprehension, how furious his father became when one day, attacked by dogs, the boys ran home. The participant who is leading the group today suggests we stand and hold hands. He asks us, so wisely I think, to “Feel the support of the group,” The pale young woman, quietly tearful, nods with relief and release; the young man thanks us – “Shukran” – and tells us he has vowed always to understand and be kind to his own children.
The ways of Gaza are ancient, sometimes painfully problematic, but also rich and in many ways still sustaining. The closeness to families that can under pressure constrict can also hold up people who should by all ordinary reckoning have collapsed. Mothers, fathers and especially grandparents appear in another imagery exercise – the summoning of a “wise” or “inner guide” with a frequency I have seen nowhere in the Western world. “My grandmother was strong and kind” one young woman announces, emphasizing the conjunction. “she was always there for me.” Another says his long dead, imagined grandfather counseled him not to throw stones at Israeli tanks; “It is a waste, he says to me. True courage will be in caring for your children and your wife.” When a young psychologist – unusually lithe and natty, a “dead ringer” I am told for a Turkish movie star – tells me I remind him of his grandfather. I’m at first taken aback, ready to protest – “I’m much too young,” I think. When I look again and see the sweetness of his face, the tears in his eyes, I am aware of the foolishness of my reaction, and accept the honor he is giving me.
Each day the nature that remains free from overcrowding, the destruction of artillery shells and fear of Israeli patrols appears, vital and hopeful, in mental imagery, check-ins and reminiscences. In the drawings participants make of “how I want to be” and “how I will achieve it,” there are palm trees with ladders- steps to a more hopeful future- leading upward; small patches of green issue gracious invitations; many colored flowers represent “all the brightness of experience;” birds of free thought and feeling fly at the top of pages; the sun warms tired heads and softens hunched, burdened shoulders. Often the sea that borders Gaza appears, deep and ever present, calming troubled minds.
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
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.
Despite a hectic schedule this January, I’m hoping to keep my blog up-to-date with the exciting events in my practice and at The Center for Mind-Body Medicine (CMBM).
A quick look at my schedule/to-do list:
I’ve just finished leading (along with Kathie Swift, MS, RD, LDN, my co-director) The Center for Mind-Body Medicine’s professional training program in nutrition, Food as Medicine, in San Francisco.
We’re also moving forward with our exciting work with the US Military training health and mental health professionals who are working with active-duty military as well as in the Veterans Administration to use mind-body techniques with vets returning from Iraq and Afghanistan with severe depression, PTSD, and traumatic brain injury. Over 100 of these professionals came to the first phase of our professional training program in mind-body medicine in Minnesota in October 2008. Here’s some data on the difference our training made to them. Most of them are returning for our advanced training–where we teach them how to lead the same kind of mind-body skills groups in which they participated in the first training—this weekend, from January 31-February 4th, once again in Minneapolis.
We’re also moving ahead with a research study funded by the Department of Defense on the use of our model with traumatized veterans and their families.
Last but not least, 30 of us–health professionals, policy makers, and just plain folks–gathered together in my home to develop a report to make recommendations for a National Health Plan to the Daschle/Obama Health and Human Services Administration. We’re continuing to explore ways for CMBM to be involved in creating a top-down support for truly universal and integrative health care for all Americans.
In other news, a recent op-ed of mine was published in the Clinical Psychiatry News, entitled “We Must Consider CAM for Depression.” You can read this succinct argument for wider use of integrative therapies, versus drug-centric treatment, here (you will have to create an account on this website to access it if you don’t already subscribe to CPN, though–sorry.) I was also published in the New York Times science section, writing about a friend and colleague of mine in Gaza going through the terrible bombings there. Read that one here.
Let me know your thoughts about what we’re doing, how we’re doing it, and how we’re bringing it out into the world! I’ll be in touch too.
The UltraMind Solution: Fix Your Broken Brain by Healing Your Body First by Mark Hyman, MD Review by James S. Gordon, MD
The UltraMind Solution: Fix Your Broken Brain by Healing Your Body First
by Mark Hyman, MD, Scribner’s: New York: 2009
Review by James S. Gordon, MD
I just finished The UltraMind Solution, a wonderful, ground breaking book that gives new and eminently practical insight into the causes and treatment of mood, behavior, and cognitive disorders. It’s a book I recommend to all of you without reservation.
The UltraMind Solution is by Mark Hyman, MD, a highly skilled, integrated Family physician who is a Center for Mind-Body Medicine Board Member, and a core faculty person in our Food As Medicine training. In The UltraMind Solution, Mark suggests that the most effective and, indeed, scientific way to address the epidemic of psychiatric disorders (affecting 1.1 billion people worldwide) is not with psychotropic drugs that treat postulated alterations in neurotransmitters, but with nutritional therapies that address the underlying biological imbalances that ultimately may disturb neurotransmitter functioning.
The UltraMind Solution is based on the principles of “functional medicine,” a systems approach to chronic disease and to the physical and emotional problems that beset our population. It is a road map for both patients and practitioners, a clear, thoughtful, guide to the ways the body can become imbalanced, and to the simple, natural methods-largely food and supplements-that can be used to restore the imbalances in the entire body, and most particularly, the brain. It’s a book that significantly deepened my own understanding of biological factors in depression. I believe, as well, it will enhance the information on biology that I present in my book Unstuck: Your Guide to the Seven Stage Journey Out of Depression.
In a series of clear, well documented chapters, Mark discusses the “7 keys” to his program, and the ways that readers can use them. These keys include optimal nutrition, hormone balancing, decreasing inflammation, improving digestion, enhancing detoxification, increasing energy metabolism, and calming the mind. In The UltraMind Solution, Mark includes more than 400 well-chosen scientific references and dozens of case studies, together with diagnostic questionnaires. He offers as well clear steps that readers can take to use this information to help and heal themselves. You can learn more about The UltraMind Solution by going to the following website: http://www.ultramindhealth.com/cmbm.
Mark is also presenting a six part webinar series for clinicians on applications of functional medicine to brain and mood disorders. In particular, he will discuss diagnostic and therapeutic approaches to ADD/ADHD, autism, dementia, and depression. Access to these webinars is complimentary for practitioners who obtain a copy of The UltraMind Solution by going to the website below.