Haiti's Earthquake Anniversary: Building Blocks
© Mark Silverberg for CMBM
As the anniversary of Haiti’s catastrophic January 12, 2010, earthquake approaches, physical and emotional symptoms that were ebbing or had disappeared, are rising. We hear it everywhere as we– Linda Metayer, our Haiti program director, and I–move through a day of visits and talks with staff at the General Hospital and the Ministry of Health, as well as with kids and adults in tent camps in Petionville, a suburb of Port-au-Prince that is a city of half a million.
Headaches have intensified, and sleep is ever more disturbed by sudden awakenings and half remembered nightmares. Irritability and anger sweep people away in rage at children, who are themselves agitated by neighbors who are too close and too ever-present, too troubled and helpless, too painfully mirroring their own suffering.
Everyone knows in their bodies, as well as from the calendar, that the anniversary is coming, but there is little plan for public ceremony that might make remembrance and mourning easier, and bring hope for a happier future. The program that Linda Metayer and Rene Domercant (a Ministry of Health official who attended our first training in December) have organized at the General Hospital is a happy exception.
After an introduction by Dr Jocelyn Pierre-Louis, one of the Ministry of Health’s leaders and a strong supporter of CMBM’s program, Linda, Rene and I speak. Our talks are nicely paired: Linda and I discuss the extent of psychological trauma and the practical steps people can take to heal themselves and their communities psychologically, and I teach slow, relaxing soft belly breathing and get everyone to move their body. A number of these professionals appreciate the immediate effectiveness and ease of the techniques – “I feel so calm,” says one; “So calm I went to sleep,” adds another, and everyone laughs, recognizing the tension that keeps them awake and the need for rest. “I felt tears come,” another woman adds – all the emotion that needs to be released, I suggest, and she nods.
Afterwards Rene, who is an engineer as well as a psychologist, shows slides from a manual for safe rebuilding: foundations propped and buttressed so they are no longer unbalanced and unstable, second stories supported by first floors that have sustaining walls. Each slide is paired a “Don’t” in red which can lead to collapse in a future earthquake, a “Do” in green – the safe way to sustain a dwelling and save lives. These slides will be shown everywhere in Haiti and distributed in booklets, Rene tells us.
What a pleasantly surprising symmetry and pairing: principles and building blocks for new safe houses, and for emotional and physical self-care–a hopeful beginning for the new year.
© Mark Silverberg for CMBM
To be continued tomorrow–the anniversary of the Haiti earthquake . . .
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.”
Meetings with Remarkable Haitians: Pierre Andre DuMas
Haiti is often criticized, even derided for its lack of leadership, or alternately or in addition, for the corruption and cruelty of its leaders. And there is, no question, a long legacy, during and after slavery, of oppression; and of political, social, economic, and spiritual hopes raised and devastatingly betrayed.
On the other hand — and there is definitely another hand — the Haitian people are blessed, at least within the fields I’m coming to know best (medicine, mental health, and public health) by a leadership group that is knowledgeable, thoughtful, and skillful, as deeply committed to the welfare of its people and as open-minded as any I’ve found anywhere in the world. These Haitian leaders seem at this crucial moment in history far less encumbered with the self-importance and pride that afflicts many national and, indeed, professional leaders I have known. Their commitment to the welfare of their people and their compassion trump received truths and narrow professional prerogatives.
Here’s a pic of Haiti streets finally looking a little more alive:
Already you’ve met two of these remarkable people: Alix Lassegue, the physician who directs the University Hospital, and Marlaine Thompson, the nurse who works closely with him. Together, they embrace the flood of people who overwhelm the hospital. They shape the comprehensive services for the complex problems that their patients, overwhelmed by the earthquake as well as the ordinary calamities of Port-au-Prince daily life, bring to them. In the next few blog entries I’ll introduce you to several other of these remarkable men and women, the welcoming leaders and kind teachers with whom we hope to be working closely in the months and years ahead.
Monseigneur Pierre Andre DuMas
There are certain people, who upon entering a room, fill and light it up. Monseigneur Pierre Andre Dumas, bishop of the Diocese Anse-a-veau/Miragoane and president of the Catholic Church’s service arm, Caritas, and Dr. Emmanuel Justima, a psychologist who is a leader in shaping the Haitian national mental health plan (whom you’ll meet next installment) are two.
Pierre Andre DuMas is tall, supple, gray-haired, and dressed in gray vestments. Sitting with him I feel myself warmed by his abundant energy and his generous sweet nature. Though I have never met him before, I somehow feel that I know him. Like my old close friends, we simply share what is most important to us, find ourselves embellishing each others’ narratives, and quickly invite each other into our unfolding lives.
I tell Pierre Andre a little bit about our work and where we have done it, and he smiles with recognition. He invites me to present our way of healing trauma to Haiti’s religious leaders, “as soon as we can arrange it.” It is part of his job, he tells us, to bring together Protestants as well as Catholics, Jews, Muslims and Voudoun practitioners.
He tells us about the thousands who have returned from Port-au-Prince to his rural diocese and the dislocation and suffering they bring with them. On Good Friday, he hiked up a nearby mountain with 6000 people from his diocese. “We sat by a waterfall and breathed deeply, relaxed — Like your work, no? Some of us swam. All of us needed a catharsis.”
When I give him a copy of my book Unstuck, I assure him that he will enjoy it even though he’s not depressed. “I know that you know that I am not,” he says. “If you are still alive,” he adds, opening his hands, “you have to stand up and give hope.”
Next installment, meet Emmanuel Justima, a psychologist working on Haiti’s National Mental Health Plan
Haiti Day 1, Pt. 2 of2–Visit to the Tent city
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.
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More in days to come.
Jim
On Our Way to Haiti
Dear friends,
We’re on our way to Haiti now, via the circuitous route that the damaged Haitian airport and the daunting US weather demand. We’ll be arriving on Thursday to begin working with people on the ground and exploring partnerships with the Haitian government and local and international NGO’s, churches, schools, and other community groups. I’m going with Rosemary Murrain, our Director of Administration and Finance, who has worked in Haiti, and Star Myrtil, a young Haitian woman who has been a Program Manager for NGO’s and speaks Creole as well as French.
We’ll let you know more when we’re on the ground; meanwhile, here’s a brief description of the work we hope to be doing.
All my best,
Jim
Open Minds, and Warm but Troubled Hearts in Closed Gaza
Gaza City, December 16, 2009
Day 5
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.
We Must Consider CAM for Depression
Dear Readers,
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.
Jim
Good News, Bad News, Better News
This week’s Journal of the American Medical Association reports on the successful use of Viagra by women whose sexual desire and orgasmic capacity have been diminished by the antidepressant drugs they’ve been taking. The data on the benefits of Viagra (which does not ordinarily enhance desire or improve sexual function in women), when compared to an inert placebo pill, are statistically significant. The article is hopeful. Relief is at hand.
That’s the apparent good news. But so far as I’m concerned, it’s overwhelmed by two large, unanswered bad news issues. Viagra may be significantly better than placebo at dealing with the symptoms of sexual dysfunction, but it’s not at all clear that the antidepressant drugs, whose side effects they’re addressing, are better than placebo for improving the symptoms of depression. Two recent reviews of the literature, including one in the prestigious New England Journal of Medicine, show that when all the studies – the negative ones the drug companies file away, as well as the positive ones they rush to publish – are put together, the drugs are far less useful than physicians and the public have long been led to believe.
A reasonable person has to ask, why then are women (and men) in such large numbers (more than 200 million US prescriptions in 2007) taking drugs to improve their mood which appear not to work very well, and so often (in up to 70% of cases) have negative sexual side effects? And ask as well, why researchers are reporting so cheerfully about the use of Viagra, a drug with its own side effects, to counteract the side effects of antidepressant drugs that may only be marginally helpful?
It’s time to step back from this cycle of promiscuous prescription and unpleasant side effects, to look for better news in an approach that is likely improve mood and perhaps even enhance sexual functioning without the negative consequences – and the expense –the drugs bring. This approach which I describe in my new book, Unstuck: Your Guide to the Seven Stage Journey Out of Depression, details a variety of therapeutic techniques including exercise, meditation, nutrition, and psychotherapy. Each is as likely to improve mood as antidepressants. Used together they may also have positive sexual and emotional “side benefits” – improved energy, greater calm, enhanced body image, self-esteem and self-control, and maybe even more interest in and compassion and love for one’s partner.
Coming up soon: More Responses to A Readers’ Question about Depression and Posttraumatic Stress
