Some thoughts on Jonah Lehrer’s article from The New York Times Magazine, February 25, 2010.
In his article on the possible evolutionary purpose of sadness, Jonah Lehrer, a talented writer and knowledgeable scientists confuses an adaptive mechanism –the capacity for greater focus that the rumination of depression may afford – with a therapeutic one. Even more important, he does not address the causes of depression and, in accordance with his emphasis on enhanced problem solving, limits his discussion of therapeutic efforts to cognitive change.
Work with many hundreds of depressed people in my psychiatric practice and tens of thousands more in war, post-war and disaster situations around the world gives me a very different perspective and leads me to different conclusions. So many of us are depressed because we are living at variance with both our genetic programming and our need for meaning and purpose. We are affected so dramatically by losses of relationships, jobs, etc. because we are not sustained by the adequate social support that is a hallmark of traditional societies. We are subject to an unprecedented level of stress and overstimulation in our environment, to toxic food, and sedentary ways of living that are anathema to our evolutionary development and detrimental to our mood. Many of us lack a sense of purpose in our lives, a connection to something greater than ourselves that gives human life meaning, and can give us hope in difficult times.
The symptoms of depression – both the rumination on what went wrong and why that Lehrer focuses on, and the lethargy, hopelessness, decreased interest in sex and food that go along with it – are best understood and responded to not as an evolutionary advantage but as a wake-up call. They let us know that it is time to address the conditions that are creating the imbalances in our lives; to use food and exercise, meditation and imagination to improve our biology and enlarge our perspective, and to reach out to others—therapists, clergy, family and friends—who can help us. The true purpose and challenge of our depression is to wake us up to what is wrong in the way we live, to point us toward ways to become more fully human.
Gaza City, December 12, 2009
Hello Friends, Many of you have asked and many more wondered, what goes on when you guys are over there in the Middle East, in Israel, and especially in Gaza, a strip of land that most of the world, including those parts of it that are closest, ignore or misunderstand, a shabby, beleaguered, always surprising territory where we have been working for more than seven years. What’s it really like? So here goes, with the first of what I hope will be communications every day or two until just before Christmas.
My room in Gaza City’s Commodore Hotel looks out on the Mediterranean, its small waves, falling coolly, brightly, and predictably this early morning. On the spit of land that points toward the open sea where Israeli Navy, vigilant for errant or desperate Palestinian boats, patrol, a dozen Hamas security men, are drilling – lining up in formation, jogging. Tomorrow our Gaza leadership team – sixteen health and mental health professionals of considerable, hard earned skill, sweet dispositions, wry humor and luminous goodwill – will gather downstairs for the faculty preparation that precedes the “Advanced Training” in Mind-Body Medicine of 150 more clinicians.
It’s our first day in Gaza after one in Israel – for me and our US team a long evening filled with meetings with Naftali Halberstadt the psychologist who directs our program there, Rhonda Adessky, the Hadassah Hospital researcher who is our clinical director, Smadar Shmuel our administrator, Danny Grossman the retired Israeli fighter pilot who supports all our healing efforts in the region, and the rest of our Israeli Board.
We’ve trained 300 clinicians, educators and community leaders in Israel – from heads of departments of psychiatry and leading academic psychologists to family physicians, police and the Zaka, the stalwart Orthodox men who gather the body parts of victims of violence for burial, and inform their families of their deaths. The mental health and health professionals use our model – of self-awareness and self-care, of mind-body skills like meditation, guided imagery and biofeedback; of self-expression in words, drawings and movement; and small group support – in hospitals, clinics and universities. The Zaka now bring our meditation techniques and our teachings of awareness and acceptance to the scenes of bombings and car accidents and into the living rooms of overwhelmed, suddenly bereaved families.
Over 120 Israeli school psychologists and school counselors have graduated from our program. They are using our model in schools everywhere, but especially with kids traumatized by shelling in and around Sderot in the South and in the North where Hezbollah’s missiles fell. A third of our Israeli trainees are Arabs, many of whom identify themselves as “Palestinians.” At our meetings in Jerusalem we discuss expanding our work in the South, developing more joint programs for Israeli Jews and Arabs (co-led by our Arab and Jewish graduates) and working with disabled military veterans. We’ll continue the planning when we return from Gaza.
Right now we’re “checking in “in my room at the Commodore, catching up on the time since we and our Palestinian colleagues began, last March, to train this committed and enthusiastic cohort of Gaza clinicians, sharing our feelings of gratitude for the opportunity to be here in Gaza, once again, in what its inhabitants call “the world’s largest open air prison.”
We are enjoying being in Gaza. You may wonder about that word “enjoy.” Actually, the feeling is much rounder and more robust, and, of course, more complex as well. Gaza is, in spite of some much needed UN sponsored cleanup of rubble from the Israeli attacks of last winter, a bleak place, terribly diminished by the severe restrictions on material coming in and exports (chiefly food and flowers) leaving, by overwhelming population density and pervasive poverty, and by the widespread – and still unrepaired – destruction of farms, fields and factories, of mosques, public buildings, and private homes. And yet Gaza is to me and to our team a place that is at least as blessed by its people as it is cursed by conflict.
As we sit in a circle each of us recalls, along with the terror of times past – days training our Palestinian colleagues in 2007 while Hamas and Fatah fought in the streets not far from our hotel, nights of Israeli planes’ building shaking, glass breaking sonic booms, the bodies of children lying in the streets – a sense of satisfaction, and, yes, love, that far outweighs it and draws us back over and over. Amy Shinal our clinical director, Afrim Blyta and Yusuf Ulaj, Kosovo psychiatrists I began to work with ten years ago during the war there, Dan Sterenchuk and Lee-Ann Gallarano, our administrative team, and I all feel it and say it each in his or her own accents: Our Gaza team feel like our family, instantly recognizable and available, and accepting and caring in a way that recalls the embrace of those bound to us by biology. We are there to teach them – about mind-body skills, and being aware of the thoughts and feelings that arise each moment, and the uses of the imagination, and about skillfully leading groups – and they inevitable teach us so much more, about generosity arising in the midst of the greatest tragedy, openheartedness to strangers, the power of community and of love for one another, the possibility of hope in the darkest of times, endurance, patience, tolerance, humor.
At lunch we eat a meal of seafood on the terrace – it is late spring warm, if breezy on this December day- of the Lighthouse restaurant with our Gaza coordinator psychologist Jamil Abdel Atti. We toast – with lemonade in dry Gaza – Chuck Feeney the Chairman of The Atlantic Philanthropies who has funded our work for five years and Don de Laski my always generous US Board member: The sufferings of Gazans, and first the promise and later the effectiveness of our work have touched them deeply. On the coast road cars and motorbikes flying green flags chug by celebrating Hamas’ birthday. We have coffee and ready ourselves for the training to come.
(Film to follow in days ahead.)
Dear President Obama,
Before you even took office you asked us Americans to share our ideas about healthcare reform with your new Administration. Thousands of us, thrilled to be invited to participate, gathered in small groups and offered our vision to you. Now, tonight, as you address us, it’s time for you to give us back our vision, enhanced by your broader perspective, enriched by detail, unencumbered by fear.
I’m sure you and your advisors have seen the polls that have repeatedly shown that the vast majority of Americans (up to 85%) believe that our healthcare system needs to be “fundamentally changed and completely rebuilt,” and that almost equal numbers are concerned that “access to medical tests and treatment would be more limited” as a consequence of healthcare reform. The polls tell us that Americans know that our far more expensive healthcare system is significantly less effective and efficient than that of other developed countries, and that, in general, we like the doctors who care for us.
These apparent contradictions are best understood as Zen koans, paradoxes that work to boggle our minds prior to opening them to new ways of seeing and thinking. I hope tonight you will invite us to look at healthcare reform in such a new way; help us to find, beyond the fears that have been evoked, and the mind-numbing horse-trading and compromise of the legislative process, the vision that continues to animate your commitment to the health and wellbeing of all Americans.
The vast majority of Americans-not just “Democrats” or “progressives,” but all of us – are decent, compassionate people who really want all our fellow citizens to have the healthcare they need. We know that change is necessary, but we don’t know yet what’s actually being proposed, and we fear that the change that comes may take away the surety of care and the security of our relationship with our doctors.
Fear is an enormously powerful emotion-deeply embedded in our evolutionary heritage and in our central nervous system. It signals danger, mobilizes the fight or flight response and all the psychobiological mechanisms of survival. Fear, as this summer’s town halls illustrate, overwhelms our capacity for nuanced observation or even rational thought. The very thought of going to the doctor makes many people tremble. The possibility of failing health, or of a vulnerable old age, or a change in access to those who are supposed to care for us makes us deeply uneasy. When opponents of healthcare reform have used evocative and provocative words to summon up these specters, the fear factor has obviously jumped off the chart.
To our agitated minds, “rationing” means that we will likely lose the diagnostic tests which we hope will clear away threatening uncertainties, the treatments that may restore us to health, and the doctors whom we have literally trusted with our lives. “Death panels” signify that anonymous others will, in the name of some impersonal, financially motivated calculus, shorten our lives.
Outrage, reassurance, and careful reference to the actual texts of proposed legislation-the principal defensive strategies of healthcare reform proponents to date-only take the edge off our collective apprehension. Relaxed, even meditative, clear-eyed assessment of healthcare realities, active engagement of each person in responding to them, and a call to transcendent and common purpose are what will ultimately make it possible for us-individually and collectively- to move through and beyond the fears that have been dominating the discussion. We are an energetic, inventive people and once we know it is possible and even necessary, we will want to be actively, effectively engaged in our care, and in determining our destiny.
Think of the “terminally ill” mother, who “somehow” lives to see her daughter’s wedding, the firefighter who enters a burning building to save an endangered child, the soldiers who brave bullets to protect one another. Think too, of people with life-threatening or life burdening illnesses (coronary heart disease, diabetes and cancer, clinical depression and post traumatic stress disorder), who, in the therapeutic programs many of us have created around the country, are healing themselves: sharing their fears and developing strategies for dealing with the threats to their lives; regarding illness more as a challenge than a disaster; eating and exercising in more healthy ways; learning from and supporting one another. William James coined the phrase, “The moral equivalent of war.” Caring for ourselves individually and collectively is such an equivalent.
I’m asking you, really, all of us are asking you, to mobilize and inspire us to participate actively in our own healthcare; to insist that those professionals who are supposed to help us treat us respectfully, even lovingly, as active partners, not passive patients.
We don’t, for the most part, need more drugs or procedures, but rather doctors and other healthcare professionals who will spend adequate time with each of us, listening and creating partnerships, as well as writing orders and prescriptions. The powerful therapeutic effects – and cost effectiveness – of such instruction in self-care, of what some are calling “lifestyle medicine,” on outcomes of chronic illness have been repeatedly documented.
If every older person were guaranteed a physician with time to talk about life and ways to live it more fully, as well as to discuss the best ways to deal with the inevitability of death, debates about “death panels” would wither from lack of fearful fuel. If doctors spent more time looking at the excess of often clashing and contraindicated medications that older people take, much of the unnecessary suffering and fear that accompanies care in old age would disappear. As we actually learn what combinations of self-care and physician-administered therapies are most effective, for which condition, most concerns about rationing-raised now almost entirely by drug companies, which fear that their products’ flaws will be revealed- will dissolve. We need to hear clearly from you that all those individuals and institutions that profit from our pain – hospitals, insurance and pharmaceutical companies, and those of us who are doctors too – can be justified and supported only as long as they serve all of us.
Finally, you must assure all of us, left, right and center, that you and your Administration will continue to give us and our health care the careful consideration we deserve, that this present effort is only the first stage of healthcare reform; the beginning of a process of national education; and a framework for the more profound and pervasive changes that we want but are not yet sure how to achieve. Tonight, we need you again to inspire us, to give us a vision not only of how we can all be safely and effectively treated, but how we can thoughtfully, lovingly, energetically, even joyously, learn to better care for ourselves and one another.
Hey, I know I’m a little late, but I was a little late to Woodstock too. I hadn’t planned on going, but then another doctor as young as I was then called me up, desperate–actually, crazed. “You’ve got to get up here, man. They’ve got hundreds of thousands of people coming, and there’s no food, no place to stay, nobody to take care of them.”
“I saw on television that the roads were jammed.”
“Forget about it, man—we’ll send a helicopter.”
And he did.
And that’s how my girlfriend Sharon and I–veterans of the civil rights and anti-war movements, former residents of the Haight-Ashbury and Berkeley, and passionately committed to “health care for all”–found ourselves on the way to Bethel, New York.
Looking back this week on Woodstock, forty years later, wondering if there was anything I had to add to everything that everyone who was or wasn’t there has had to say, I realized I had actually learned a lot in those three days and that the lessons might be worth sharing.
Here they are, in the order they came to me.
* Always be ready to help. When someone asks with real need, you have to pay attention. Inconvenience–dicey travel plans, the loss of a precious few days of a psychiatric resident’s vacation—is really a small deal. Utter lack of knowledge about the conditions we were walking into or the support available to us once we got there—let it be, see what happens. Bottom line: if it feels right and necessary, do it.
* If you’re meant to do something, it’s likely, in spite of all improbabilities, that it will happen. I know, I know, this sounds hopelessly hippie-ish and “New Age,” but what am I going to do? Jung gave this acausal connection between internal intention and external events the more dignified name of “synchronicity.” Let’s call it that.
A helicopter did indeed take us from LaGuardia to a field near Bethel. It landed to pick up some performers. Questions were raised about whether we should be debarked so that Joan Baez’s mother could accompany her. “We can all go,” Sharon said cheerfully, but highly insistently. “We’re all needed.” And indeed, we did—Joan, her mother, and the two of us.
* Be patient, if it’s necessary, even when you really don’t want to be. This, I have to admit, is a lesson I’ve had to keep re-learning many times these last forty years, but Woodstock gave me a clear, undeniable glimpse of its usefulness.
Everyone was helpful, but no one actually knew how to find our friend, the doc who called. “He’s here” . . . “there” . . . “behind the stage” . . . “over by those tents.” Hopelessly lost half a dozen times, we picked our way among hundreds of thousands of bodies and got righteously irritated that no one seemed to know our friend or where we should go or where supplies could be found, or who else might be in charge—“Listen, you guys flew us up here to do this job. There are already kids all over the place with cut feet, sore throats, and bad trips. It’s starting to rain, and it’s gonna get worse.”
“Oh, wow, man,” they said. “That’s far out. Would you like some food, booze, hash, acid? Would you like a hug?” We had to laugh.
* If you build it—and they really need it—lots of people will come. Without supplies or shelter, we set up at the edge of the huge bowl where the bands were playing, Our spot was marked only by a sign, “First Aid.”
People started lining up immediately. An hour or so later, miraculously, antiseptics and bandages, sutures, and antibiotics started arriving, Wavy Gravy, the prince of hippie self-help, sent some guys with a tent.
* Opposition will come your way. The line is from reggae musician Jimmy Cliff (he wasn’t at Woodstock) but the truth is universal. By the second evening of the festival, more than 100 people were regularly in line outside our little tent. Some needed sutures—Sharon reminded me the other day how impressed she was with my one-hand surgical ties, and I am too, though I honestly don’t remember them. Others had respiratory infections and were working on pneumonias. And a very large number, quite young even to my 27-year-old eyes, had taken improbable quantities of unnamed and perhaps unnameable substances, and were deeply distressed. I went down the line triaging, and discovered about fifty of them.
“We need a bigger tent,” I told a guy who’d shown up with a two-way radio, “a real big one for 50-100 people.” The big tent arrived and I invited all the mentally, emotionally and psychically challenged to come inside. I spent time going from one to the other and realized the mission was truly impossible. There were simply too many, and despite Sharon’s best efforts the line outside our little tent was growing long.
* Self-care and mutual help are fundamental tools of all healing. This is a lesson I’ve been learning ever since my first days as a student on hospital wards, and it’s one that I’ve devoted much of my professional life to exploring and teaching to others. The couple of days in the big tent at Woodstock highlighted it luminously. Absolutely unable to care for all these people myself, and with only a couple of untutored volunteers available, I came up with a game plan. I asked all those who had taken too many ‘uppers’—amphetamines, cocaine, and the like—and were fidgety, agitated, and utterly at a loss to know what to do—to walk around vigorously, insistently holding, leading, urging on all those who had overdosed on ‘downers’ like heroin, barbiturates, quaaludes, and liquor. I asked the remaining kids, who were lost in the dark forests of psychedelia to sit on the floor of the tent in pairs or threesomes or fours. “Hold each other,” I instructed, “listen to each other. Take care of your brothers and sisters.” I told the volunteers to keep their eyes open and to get me in case of crisis. Every half hour or so I checked in.
The walking, holding, and hugging went on all night. The next morning, some of the young people, happy and calm enough, dropped by to thank me; others simply sat listening to the music.
* Nothing is perfect. Woodstock was a triumph of peace, love, and community, says just about everybody who was there. Millions of people now regard it as a touchstone, an example of what’s possible when you set aside fear and prejudice and promote love and peace. Yes. Woodstock was a self-indulgent mess, say some others, skeptical and cynical perhaps, and maybe scared of the unleashed id of the experience. And there’s some truth there too.
But there were other issues. I was, amidst the pleasure of the celebration, the impressive kindness and sharing, troubled by something else I saw and felt, a certain kind of dislocation and sadness in some of the young people.
They said they were disoriented by the crowds and uneasy being away from the cities and suburbs which were their homes. These feelings, of course, had been amplified by quantities of drugs consumed, but we heard and felt it in others who seemed more or less sober—an uneasiness and loneliness that camaraderie and crowds could not assuage. I heard it, too, in the months after Woodstock, from people who felt let down by the lack of fellow feeling in the world they returned to, by the absence of the indomitable hope that seemed to them to suffuse Bethel.
* You never know who your friends and teachers will be. I was already learning this during several years of psychotherapy and meditation and from time spent ministering to the so-called “mentally ill“—as well as hippies. It was possible, I was finding, to find solace, friendship, and even wisdom in unlikely places and with unexpected people. Woodstock reinforced this mightily.
During the three days of the festival I met apparently hapless kids with remarkable skills in erecting shelters, scrounging and preparing food, and tending to the ill and crazed. I was impressed over and over again by the exuberant effectiveness of Wavy Gravy’s Hog Farm tribe, the courtesy of celebrities like Joan Baez who really did believe in “power to the people,” the kindness and good sense of those who volunteered to help out.
It all came home to me, appropriately enough, on the way back home, in a small plane that Sharon and I shared with the chief of police of Beverly Hills, who had come to supervise security. “Great kids,” he said. “Great festival. Great view,” he added as he gestured toward the Manhattan skyscrapers over which we were flying. “People will be talking about this for a long time.”
David Leonhardt’s “prostate cancer test” (The New York Times, July 8, 2009) is a good but incomplete one for healthcare reform.
In addition to removing financial incentives for high tech intervention, we need to educate clinicians in the impartial, critical analysis of all therapeutic options, and in supporting their patients as they act on the choices they make. For 10 years, The Center for Mind-Body Medicine has trained health professionals and patient advocates to do precisely this, as “CancerGuides®.”
We need as well to realize that expensive, Draconian treatment and “watchful waiting” are not our only choices. There is, as Dean Ornish is showing with peer-reviewed studies on prostate cancer - and a number of us are doing with heart disease, diabetes, chronic pain, depression and post traumatic stress disorder – a far more promising third way. It is grounded in techniques of self-care – dietary modification, physical exercise, and mind-body approaches like meditation and yoga – and in group education and support.
This approach holds great promise for treating and preventing chronic illness of all kinds and for saving large sums of money. It should be central to healthcare reform.
A shortened version of this was published in the New York Times online Letters section on July 21, 2009.
I 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,
I spent Monday afternoon, February 23, 2009, testifying on the strengths of integrative healthcare and our hope for healthcare reform at the hearing, “Principles of Integrative Health: A Path to Health Care Reform” by the Senate Committee on Health, Education, Labor, and Pensions (HELP). The video is comprehensive—click to read shorter coverage in the Huffington Post.
My colleagues (including Wayne Jonas, M.D. of the Samueli Institute, Robert Duggan, M.A., M.Ac. (UK), Dipl.Ac. (NCCA), of Tai Sophia, and others from institutions and the private sector) and I sincerely hope the time has come to change from a “disease-care” system to one truly centered on the patient and our wellness as a nation. Our current system is expensive, and ineffective at keeping us healthy. Turning to costly drugs ridden with side effects before trying natural approaches and wellness techniques is bankrupting our treasury and our health as a nation.
More to come—check out the video, and check back here for updates. It’s a very busy time for us here at the Center!