An unfamiliar mixed emotion overtook my nine year old son, Gabriel, and me as we watched the New York Giants close out the San Francisco 49ers.
For almost four hours, we’d been sitting in a San Francisco home—lone Giants fans happily slapping palms and shouting encouragement surrounded by three generations of equally fervent Niner supporters. And then, after a moment of unalloyed glee, as Giant’s holder Steve Weatherford recovered a bad snap and Lawrence Tyner nailed the winning field goal, Gabe and I fell silent.
We were, it turned out, both thinking of Kyle Williams, the Niners kick return guy who had lost the ball that opened the door to the Giants’ winning field goal, after he had earlier, inadvertently kicked away a punt. The TV camera had found him on the bench pushing his mouthpiece around with his tongue. How, Gabe and I wondered, was he going to make it through the night carrying all the burdens of his unfulfilled responsibility, and through all the nights ahead?
Perhaps it’s because Gabe earnestly loves to play ball, and I feel so intimately the pain that comes with his inevitable share of mistakes; perhaps it’s because I am a psychiatrist and older and more aware of my own blunders and their consequences, that I find myself ever more interested in the quality of the play and the feelings of the players- and less preoccupied with the identity of the winner.
I think, too, that journalists—especially the old fashioned ones who write for papers- have helped to sensitize me. Over the last few years, I’ve become aware of how much and how subtly they attend to the psychology of their subjects—players, coaches, managers, and even owners. Anticipating meeting real people- as well as the drama of the game and its results- now brings me to the sports pages with a pleasure I haven’t had since I was Gabe’s age, devouring box scores and aping batting stances.
I also cannot help but contrast this attention to what “hard news” counterparts usually offer in our papers’ front sections. I feel I know and have more fellow-feeling for the emotions and egos, the idealism, attentiveness, self-deception, and fatuousness, of Shaq, Kobe, and Dirk, of Pac Man and Kim Clijsters and Martina, than I do for Barack, Hillary, and Mitt, Bibi Netanyahu, Mahmoud Abbas, and Hamid Karzai.
The omission of this psychological, this human attention, handicaps my understanding of political players and the weighty moves they make. It also tends, I believe to make us readers less sensitive to the negative consequences- collateral damage it is sometimes called- of their actions. The presence of this sensibility in the sports pages, on the other hand, helps me to feel far more connected to the men and women who populate our playing fields and courts.
So I’m glad that the sportswriters and I can feel for and with Kyle Williams, even as I root against him, and with Billy Cundiff, who missed the Ravens’ game-tying kick, and everyone else who can’t step up or who falls down. And because I can, feel for them I can tell my son that I hope Kyle Williams will be able to accept responsibility without being devastated by self-blame; that he will, as I hope Gabe and his friends would, talk with his teammates and family and friends. And as I do so, I know that I’m at least as grateful for the opportunity to learn and share this lesson in compassion as I am for the Giants hard earned win.
James S. Gordon, a psychiatrist, is the author of Unstuck: Your Guide to the Seven Stage Journey Out of Depression and the Founder and Director of the Center for Mind-Body Medicine in Washington, DC.
We keep our sessions as simple and clear as we can: an introduction to fight-or-flight, stress, and trauma, answers to their questions, and three lessons.
Here they are:
1. Slow deep breathing with the belly soft. This, we explain, is the antidote to the flight or flight and stress response that the earthquake has inscribed in the kids’ minds and bodies. Soft belly will quiet their physiology, slow their racing thoughts, give them a little perspective on the flashbacks of dead bodies, the horror of loss and the ambush of fearful anticipation. Knowing—feeling—that they can breathe deeply and relax, they will have a small but important sense of control in world where so much—whether or not they can concentrate or sleep, where they live and how they will make a living—is, or feels, beyond their power to affect.
You can experience a relaxing guided Soft Belly meditation here, at The Center for Mind-Body Medicine’s website.
2. Later we do some shaking and dancing so they can let go of fixed patterns of physical tension and mental preoccupation; can feel their bodies moving freely; can raise their energy, lift their mood, and lower their anxiety. They clap and laugh and shout and afterwards, flop happily onto their hard seats.
3. We also explain the value of sharing here in the classroom, at home, or with a friend, the pain they feel and the fears and concerns that arise.
Many of the kids would like us to do more, to tell them where they can go to practice the techniques and talk to others. For now, I say, “you have each other and your families. We are giving you these techniques, written in French. Practice them at home and we will come back to your school. Soon we will be training many people, including some of your teachers, to do this with you.”
The story of how CMBM’s model helped Andre, a Haitian boy, overcome feelings of grief and guilt, coming soon . . .
The school is the College Canado Haitien, one of the best in Port-Au-Prince, we are told, before the earthquake and afterwards, too. The students, a few weeks after the school has reopened, are sharp in well-pressed maroon and khaki uniforms—the girls’ hair pulled through berets, the boys sideburns neatly trimmed, tout propre, I think.
Instead of the pre-earthquake concrete buildings, there are open sided wood and metal sheds. Sounds flow from one classroom to another, overlapping in a kind of reverberating clamor. Toward the end of one of our classes, when time of dancing is kept by nimble palms on desktops, the whole campus rocks.
Our equipe, our “team,” –the French is beginning to emerge from deep layers of my unconscious—includes six of us: Lee-Ann juggling logistics as before, with Cassidy, my assistant back home, here to help her and me; Amy, the social worker who is our clinical director, will come tomorrow. Today, Lynda and Kathy, psychologist and family physician, are with me. They are CMBM senior faculty who are adventurous enough to come and to commit to coming again and again. They and Amy will teach our Haitian colleagues and provide consulting and supervision as we build our program.
Today we have been invited by Frere Jacques Anthony Germeil, the principal, to College Canado Haitien. We will have an hour in each of four classrooms with eleventh and twelfth graders who have been told they will learn “lessons in dealing with stress.”
I lead the first class and the third, forty twelfth graders in each, sitting shoulder to shoulder at their desks. Lynda and Kathy, experienced with kids, but new to Haiti and to the trauma and loss that overwhelms the population, will lead the second and fourth classes.
We begin our classes lightly—a little goofily—“How do you breathe?”, I ask to general puzzlement, and then talk about babies doing it easily—naturally—their bellies rising and falling, while adults, and even high school students, cramped in chairs and on benches, barely move their chests. Laurent, my interpreter, and I act out the roles of cats in full fight or flight mode—hissing and growling at each other, and then stepping back to breathe easily. Lynda has her all-boys class—a surprise—consider Kobe Bryant, cool and relaxed, imagining his shots, inspiring the boys to imagine theirs swishing the net.
When we turn the topic to relaxation’s antipode, stress, the bravado of a few—“I’m fine, we’re all fine,” claims one boy; “it was simply a natural disaster” intones another—contends with the more complex memories of their classmates.
Soon, in each and every class, there is a rush of sharing of what happened on January 12th, of how surprise and relief yielded to horror. “I thought the shaking would be eternal. Then, it stopped, and I thought, ‘that’s not so bad, I am ok,’ and I laughed, then I saw my sister covered in dust like a ghost, and I was afraid. And then, underneath my neighbor’s house, there were twisted bodies.”
And the stories come—many, we learn, shared for the first time—and the classmates’ losses pile up: a mother gone, an older brother, “my best friend,” “almost my whole family,” We hear of bodies discovered under rubble and strewn on sidewalk, of dogs chewing on corpses.
When we ask if there are questions, a small forest of hands rises: “How do you go to sleep when these memories keep coming in nightmares?” “How can you breathe deeply to relax when the air is so bad?” “How do you deal with family members who now are arguing all the time?” “What do you do with your belief that another earthquake is coming, or as some say, ‘a tsunami’?”
More about the techniques we use to address these questions coming soon . . . .
“We have been on a journey,” says the psychologist who is leading the final session of Mohammed’s group. She sits comfortably cross-legged on the floor, in her long coat and headscarf, next to the young man who is her partner on this last day. “We have come to know each other in a way that is not usual here in Gaza,” she goes on. “men and women speaking together from their hearts, all of us finding new friends.”
This is our last group and, as we check-in, and while my translator summons up her English, I find myself pondering old mysteries and contemplating new wonders. The dress of the woman’s co-leader: He is wearing a sport jacket and slacks, neatly pressed, and a tie, secured with a Windsor knot, a professional code of dress that many of the men favor. How much effort, I wonder, does it take to maintain such self-respect amid Gaza’s crushing, demoralizing constraints? And how does he do it with the dearth of dry cleaning facilities and the scarcity of solvents? I am impressed once again by the intelligence, dignity and, yes, elegance of a woman who, except for a tiny slit for her eyes is completely covered. Her assessment of herself this last day is so open, unsparing, witty – “I want to thank all of you,” she begins, “I realize now I have been too rigid, and often wrong, in my judgments; and I have been unnecessarily covering my feelings, not just my body.” I too realize once again – what a grace of these groups – that I have much to learn about my own preconceptions and judgments.
In this session we do drawings similar to the ones we do on the first day of the first training, pictures that often show us how much – sometimes how stunningly, satisfyingly much – we have changed since that opening group. The wires of a cage that contained an irritable, frustrated physician have turned into steps on a ladder which will bring him to a place of peace, among trees in his yard and within himself; a psychologist’s family members scattered across the landscape by misunderstanding in day one’s picture are now gathered in a comforting circle in which they are, like members of the mind-body group she is addressing, “sharing their feelings.”
Our leader has brought us candies wrapped in red foil, to celebrate our time together, and to mark its end. “I Love You” is written across them in silver. Another woman has brought us all pens “to remember this group when you write.” A third has baked a cheesecake, its top speckled with many colored candied glitter, with a single candle. “This is,” she announces, “to celebrate our journey and also,” she adds, “the Prophet Mohammed’s hijra,” his journey from Mecca to Medina in 622, “whose anniversary falls on this day.”
It was in Medina, I remember, that Mohammed created the umma, the spiritual community that is the model for Islamic society. It provides Muslims with the opportunity to gratefully practice the prayers and manifest the precepts and the code of conduct that Mohammed brought to them.
As our leader carefully divides the cake in squares I hear, as clearly as if he were once again standing in front of me, the closing comment of a young psychologist in our previous training nine months before. A tough, pale, earnest, bearded young man, he had spoken with some formality: “I did not know what to expect when I came; these techniques, it seemed to me, were foreign to Gaza. But as I have been here these days I have been so impressed. You and your faculty are so knowledgeable and such good teachers, and I have learned so much about myself as well as psychology. But even more important” – I can hear again his voice lowering, more intimate now – “you have all been so kind to me and all the participants, have made us feel so much at ease. I believe,” – I knew he was getting ready to conclude, but never could have imagined what he would say – “that this is what it must have been like in the time of the Prophet Mohammed.”
Our leader hands us plates, and we eat our cake and savor each other’s company. There is general sadness at “concluding this blessed vacation with ourselves,” as one woman observes, to general agreement. But there are also commitments to “meditate daily” and “shake and dance with my children when we are feeling overwhelmed, or stressed.” Everyone expects to “start mind-body groups for patients on the first of the year.” There are promises all around to be in touch in the months ahead – in the supervision groups that Mohammed and the rest of our faculty will be leading every week throughout Gaza, and less formally too. Phone numbers are exchanged and a paper passed around for email addresses.
And then our leader in her long coat and head scarf reaches over and turns on the CD player and stands and claps, and sways a little, while her young colleague in the sports coat, his collar open and tie now loosened, rises and steps to his right toward Mohammed and the other men, and begins the steps that will take them and me too, our arms on each others’ shoulders, in a small happy circle, around our room.
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.
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.
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,