Our signature mind-body medicine technique is something Founder and Director James Gordon, MD calls “Soft Belly”, by way of encouraging each of us to relax — which few of us instinctively do these days.
We sit quietly, breathing in through our nose and out through our mouth, which both calms the sympathetic nervous system and awakens the parasympathetic nervous system, creating a feeling of relaxation in the mind and body. Dr. Gordon suggests we think “soft” as we breathe in and “belly” as we breathe out, reminding ourselves to relax our belly so we can take in full, healing breaths rather than shallow, tense ones.
Since my first Mind-Body Medicine Professional Training Program in 2006, there have been so many moments in which I have given quiet thanks for all that I have learned and experienced with the Center. The moment captured in this photo is but one of many. Having facilitated mind-body skills groups in all kinds of places with all kinds of people, young and old, I have noticed so many common themes, including one I’ve heard Jim refer to as the “equal opportunity group experience.”
On a recent trip to London, I was interviewed during Depression Awareness Week about my book Unstuck’s UK release by The Guardian newspaper. The reporter was particularly interested in CMBM’s Global Trauma Relief program and our work to bring population-wide psychological healing to places around the world that are afflicted by war and natural disaster. You can read the piece here:
I’m certainly pleased that the author recognizes CMBM’s groundbreaking efforts to teach and support hundreds of thousands of people in Kosovo, Israel, Gaza, Haiti, Southern Louisiana, as well as US military returning from Iraq and Afghanistan. It’s a shame, however, that his tone is so dismissive of integrative medicine and that he fails to recognize the fundamental importance of self-care for psychological and physical healing.
Please note that as of this writing, corrections are being made online for several factual errors, including the following:
- In Gaza, we trained 90 clinicians initially, only a few of these were “educators” (as the article states)
- CMBM now has 160 groups meeting in Gaza each week, not 48, as reported.
Beyond factual errors, though, I’m disappointed in the tone of the article. I want to emphasize that our approach to psychological trauma relief is not about “belief,” as the article repeatedly implies. It is based on hard evidence that is just as rigorous – actually more so – than most of that provided by the drug companies he seems to accept as the standard.
It is a common misconception (and prejudice) that psychological and nonpharmaceutical research is less stringent and reliable than clinical drug trials. Each of the approaches that we use, including meditation, guided imagery, biofeedback, autogenic training, yoga, self-expression in words and drawings, and movement and exercise, has a significant research base, one which demonstrates decreases in stress levels and improvement in mood. The CMBM approach combines these into a comprehensive program, and The Center for Mind-Body Medicine takes great care in scientifically researching, documenting, and publishing our findings of our approach in peer-reviewed journals. We recently published a randomized controlled trial (RCT) on our work with war traumatized children in Kosovo that shows an 80% decrease in symptoms of PTSD (read the abstract here).
This was the first RCT of any intervention with war-traumatized children, and sometime in the next few months, we will be publishing a study (in the International Journal of Stress Management) that shows similar results—80% decrease in PTSD symptoms, significant decreases in depression and hopelessness—in war-traumatized youth in Gaza. This study is particularly important because the gains that were achieved over ten weeks of once-weekly group sessions were largely maintained at seven months’ follow-up—in spite of ongoing conflict and severe economic hardship.
The point is that this approach is not alternative. It is fundamental. It makes human and scientific sense. We have an approach that works with large groups of people in developed countries as well as those ridden by disaster. It is flexible, inclusive, and culturally acceptable. And the groups in which we train caregivers can be led by anyone—teachers, and religious and community leaders, as well as health professionals; and the scientific evidence for its effectiveness continues to accumulate. And as the article states, CMBM will continue to be there to provide our program of mind-body medicine for people suffering from psychological trauma, to teach them, and help them help themselves.
Yesterday I told you about James (from the National Police), Ty Rose (an anesthesiologist and teacher), and Marilyn (a pediatrician). (Here is the link, if you missed it.) Now, here is Mercedes’ story.
We go around the circle to “check in” about our emotions and what’s happening right now, this moment. It is Mercedes’ time to ‘partager,’ or share. “Most of you,” she begins, “have seen how I was last time,” and I remember – and imagine that all the others remember as well – how at the very first training, in December, she sat erect in clothes that hung like armor, her face as immobile and solemn as the great statues on Easter Island, speaking occasionally and telegraphically about the death of her husband and her daughters, and her own despair.
Mercedes now opens her hands and, amazingly, grins. “I have found calm,” she begins, “doing the deep breathing and the shaking and dancing every day,” (she is emphasizing now). “And I have found much more as well.”
“On the anniversary, January 12th, my daughter and I and our whole community were in Church. And everyone was so sad, but tense also and unable to express the sadness. And I let myself cry. And then my daughter was able to cry too. And in my crying I found strength. And I asked myself ‘what have I learned in the Mind-Body program and how can I use it to help everyone in this Church?’ And I began to sing a song – I have never done this before. And my voice grew stronger, and I asked everyone to lift their arms and glorify God. And they all began to sing and lift their arms, and cry. And I sang three songs and then we opened our eyes and we were all calm.”
She concludes, “you know I work as a teacher. But my students no longer call me teacher,” she says, wagging her finger and pausing with what I cannot help but think is a mischievous grin. “now,” she goes on, “they call me ‘mommy’.”
Thank you for reading my accounts of CMBM’s trainings in Haiti, and these stories from our trainees. I hope you are finding the people as amazing and their stories as touching as I do.
Now that the first 120 Haitian professionals have completed our Initial and Advanced Trainings in Mind-Body Medicine, they will begin to offer Mind-Body Skills Groups to their family, friends, community, and at their institutions, and I will be sharing more of their stories here as they teach and share with others, and learn and grow themselves.
I’m not quite sure when or even how it happened but Haiti is starting to feel like home. Not in the sense that I have my family with me, or know where to do grocery shopping, or can lay my hands on the books I love most.
It’s something else, an ease with people, a sense of words and actions contributing to something really good – right now and for the future — a welcome, even an embrace that keeps expanding. It swells from the team around me, and from the 120 people — doctors, psychologists, nurses, midwives, teachers, priests and nuns and voudoun healers — who come to our training with great fidelity and teach the techniques they are learning from us to friends, family, and patients as soon as it is humanly possible. “In order to keep the training inside me always, I have to share it with others,” one young teacher announced this morning.
In the days after Yehlie’s first communion we complete the training we began in December. My ‘small group’ of participants, gathered together again, begins as always with a few minutes of soft belly meditation – slow deep breathing, in through the nose, out through the mouth, with the belly soft and relaxed — quieting our nervous systems, our minds and bodies. And then we “check in”, tell each other what has happened since we last saw each other and share what we are feeling “right now.” Already it is becoming a commonplace for us, a way to regularly connect with those around us, outside as well as within the training. “Check in,” laughs one priest, “is almost now a second religion.”
There are still major problems and issues – almost half of our group is still not living in their homes, and there is abiding sadness for those who have died, but there is more energy for understanding and meeting current challenges.
We discuss the short term memory loss that bedevils several people and makes them apprehensive, even in their thirties or forties, about Alzheimer’s disease. I say it is highly unlikely, that trauma has long been known to obscure memory. And one of the other doctors in the group assures us that her memory – devastated amidst the loss of her brother and her husband — has begun slowly to return: “Sharing my emotions, accepting help from others, permitting my own tears – it as if the memory flows back with them.”
This doctor’s face is no longer constricted in pain as on our last visit, but open, changeable, easy with laughter as well as tears. Many of the faces I see are equally changed. James, who is head of psychology for the National Police, scrupulously kind, but painfully thin and equally serious in December, is ten pounds heavier, relaxed, expansive. And the woman I think of as “the Teacher,” as immobile and expressionless as mahogany in devastated grief at the loss of husband and home two months ago, is now a river of feeling and words.
One participant says, “The earthquake brought us so much pain, but also we are seeing it brings good things to the people who survive. Psychology [i.e. traditional therapy] was useless to me and my community – no one could go because it meant you were crazy. Now with CMBM approach I am helping myself and others too.”
Says another, “On January 12th, the anniversary, when everyone in my church was so tense, I taught them the breathing. And as I relaxed I let myself cry, and found my strength, and then we cried together, my children and my friends. And then I sang a song – I have never led a song any time – and I asked everyone to sing with me and praise god. And we did, three songs, and then we all felt more calm.”
It is so encouraging to see the positive changes in our trainees, and to hear that our participants are taking the techniques back to their homes, churches, workplaces. Giving the people of Haiti practical tools for their own emotional healing, and empowering them to teach these tools to everyone they meet, will, we hope, help the Haitian people heal themselves.
Sometimes, on this first anniversary of the earthquake, it feels like very large, steady hands are needed to pull together the two sides of the gaping wound that is Haiti, hands that Michelangelo might fashion for this purpose.
I find myself looking around as we circulate through tent camps with little food and water, no health care or education or employment for the tens of thousands of people I see, for the hundreds of thousands who still live like this all across the region. “How can this be?” I shout – but only inside my head – how can we, Americans, the world community, all of us, let this continue? Our hearts were touched a year ago. Politicians said the right things, famous people answered phones on television and lent their shine to the pleas for help. Billions of dollars were pledged. Where are they? Why is there scant organization, no plan, so little mercy and fellow feeling?
It worries me, as much for ourselves–the privileged, literate, and apparently protected– as for those who live exposed to heat and rain and hurt.
In one of our workshops on January 11, 2011, the day before the anniversary, two men – a priest who tends a devastated parish and an accountant who has left his paying job to bring whatever order he can to two tent camps– share their drawings. (Read more about CMBM’s drawing exercise in this earlier Haiti entry.)
The accountant, a large serious man, sees himself planted in the midst of a quilted crop of families, cooking fires and plastic sheeting; the priest’s drawing of his slim black-clad figure is bright with God’s light refracted through a mirror framed in rainbow colors. The drawings of their “biggest problems” are, with no other guidance, no consultation, virtually identical. One side of the pages shows effort – to salvage and succor, hands reaching out, shovels in the earth – and a row of disconnected figures: “the ones who could help but don’t” “the rich and powerful who do not care.” They are barely sketched, drained of color. On the other side of the page, the people in the camps are suffering, but they do have bodies and expressions.
We need to offer them help, ourselves, in order to be human; and we need this at least as much as they need our help. That is the key to a happier future anniversary.
Fire on the Streets, Peace in Our Circle
CMBM Training, Day Five
25 participants come today, making their way to the hotel around barricades and tire fires in the streets avoiding the demonstrators armed more and more now with guns as well as machetes. Just outside the hotel several men, apparently from one political party, have opened fire on others. Three are dead.
The tent camp on the Champ de Mars is uneasy. People are moving away from the street, ahead of rumors of revenge for political sympathies that some feel are unacceptable. Inside the hotel, its gates locked, its security guards on alert, we feel pretty safe. We’re sitting in a large circle answering questions, sharing what we have learned and are learning. “Is it helpful?” a psychologist asks, “to talk about what makes us afraid? Shouldn’t we use images to make it go away?”
“We cannot force away our fear,” I say. “It doesn’t seem to work. The fear will return.” Heads nod in agreement.
“But isn’t it possible to relax with your fears?” a teacher asks.
“Yes,” I respond, happy at an apt pupil, “that is exactly what we teach.”
“Well,” grinning now, he says, “Let me tell you about yesterday. I was at my school and there was shooting outside between political parties and everyone was upset and very scared. I said, ‘I’ve been in a training and I’ve learned a technique for relaxing even in such difficult situations.’ So, I taught them the safe place images. We sat for ten minutes or so, and afterwards the shooting was still going, but we were smiling and talking with each other, and even singing together.”
And so it goes for the rest of the day, stories of finding a little calm in the chaos, our participants’ eagerness to take what they are learning into their homes, classrooms and clinics.
“My bishop,” a priest tells me, “wants everyone in the parish to learn what you are teaching.” The dean of the midwifery school says she will begin tomorrow to bring our work into the delivery room, to all “sage femmes” who will attend the births of the next generation.
CMBM Training, Days 2-3, continued
During the training, we do a drawings exercise, a sequence of three pages: one of “one’s self,” “one’s biggest problem” and “the solution to the problem”- and they are as always a revelation. They display what is inside each person and the images of one participant so often are a mirror for those of others.
The biggest problem of one physician here is shown as a clot of black guilt and fear and shame, of inhibited action and feeling buried under a mountain. She is straining for faith, toward a distant Jesus, and to do what must be done. But she feels unable to move or believe. In the third drawing all the conflicted colors of the mountain are striped in an arc du ciel, a rainbow. “ I was buried,” she says, “and now in this drawing I can see myself free, imagine myself again with my God.” (To learn more about our drawing exercises, read this post, “CMBM’s Drawing Exercise Resonates in Haiti,” when we introduced it in June.)
“I have in my drawings,” says Linda, the psychologist who coordinates our Haiti program, “dropped the mask of sunny happiness that I felt I had to put on. I have allowed myself to feel the loss of my father last week. And dancing and crying,” she adds, pointing to her third drawing, “I have found the authentic happiness inside myself.”
Checking in emotionally on the second day, my group members find their own choked-off voices- amazing how many cough and clear their throats and say they have forgotten how to say how they feel. They speak and are heard, listened, and they recognize that they are actually here with others who care and not alone. A nun and teacher who at first had felt so lonely as the only religious (woman) in the group realizes that she is not alone at all, “My images of pain and sadness are so similar to those of others. Showing you my drawings, telling you about them, I feel you are my sisters, and my brothers too.”
After the first day our participants are already using what they have learned. Several speak of “traffic meditation,” pulling over to the curb amidst Port-au-Prince’s daily madness, soft belly breathing (click here for a short guided meditation) until they are “calme” and “douce,” peaceful, soft and amazingly unhurried. A psychologist at odds with her teenage son reports asking him to breathe deeply with her and dissolving the tension that had led to fights, “…every night since the earthquake.” Several say that deep breathing and shaking and dancing had allowed them to sleep peacefully for the first time ever since January 12th.
Here is a short video of Linda Metayer, our Haiti Clinical/Program Director, describing what she feels Haitian trainees are gaining here:
(video by Mark Silverberg for CMBM)
The Training Begins– Day Two & Three
Tears are everywhere. Like high water behind a dam, you can see them swelling, pressing for release in the stiff bodies and taut faces of men and women who gather for the first day of our training.
We’ve selected 120 clinicians, educators and religious leaders. About that many crowd the registration desk and fill the chairs in our lecture hall. But they aren’t exactly the 120 that we invited.
This is the beginning of our Haiti training, but before I tell you about these new colleagues of ours and about what we are learning together, I have to jump to Wednesday morning—Day Four– and to the hours last night, after the election results were in. Demonstrators filled the streets outside our hotel in front of the Champs De Mars, angry thousands protesting results which certified President Preval’s son-in-law in-waiting, Jude Celestin, as a participant in a run-off election. Last night our team heard the pop of gunshots as a counterpoint to the rhythm of music from the hotel band. This morning, smoke from fires fills the air as demonstrators march toward, and, we are told, destroy Celestin’s headquarters.
Everyone we meet believes Mrs. Mirlande Manigat was indeed the legitimate top vote getter, and they are convinced that another candidate, Michel “Sweet Mickey” Martelly, the pop singer, had more votes than Celestin and if he didn’t, someone else certainly did.
The election results seem to the Haitians only the most recent insult, the latest dismissal of their sovereignty, indeed of their humanity- -once again the big man appoints his successor. All the frustration of all of their months since the earthquake and all the years before, all the pain we’ve seen in the tent dwellers on the Champ de Mars and in the faces of the men and women we are training is erupting- moving this afternoon uphill towards Celestin’s headquarters, and the homes of the rich and powerful.
On this day of anger and danger, only half a dozen of our participants have made their way through large, angry, often armed mobs and small fires. The rest however, have been on the phone, “Tomorrow?” “Don’t do too much today; we don’t want to miss anything.” “Can your international team stay another day?”
Back to the Beginning-Training, Day 2
On Day Two some of our invited participants were kept away by the urgent demands of cholera care, and by fears of the demonstrations that had not yet occurred. But others arrived from the Ministry of Health, the universities, the schools and churches to take their place. By the second day these eager volunteers and the original invitees were joined by the latecomers and by some who have somehow heard stories about unexpected relaxation and education, welcome, and safety. At lunch we feed 145.
The small groups which are central to this adventure in self discovery and self-care- so supportive and inviting for men and women who have held back personal feeling in favor of continual service to others- have swollen in size.
12 or 14 men and women sit in circles meditating, breathing in through their nose and out through their mouth, allowing their bellies to relax, expand, become soft. After they open their eyes they share who they are, what they do, and why they took five days from over burdened schedules to be with us. They speak in turn about the first morning’s large group lectures and “experiential exercises.”
“After the shaking and dancing,” an anesthesiologist begins, “I felt freer. There are not many people in my profession and after the earthquake we did amputations all the time. It was painful. I lost my spontaneity. I think we all have. It was good to dance.” (Read more about the shaking and dancing we used in Haitian schools here)
As we go around the circle the possibility of sitting peacefully, of relaxing at the end of the day, rises on horizons dimmed by almost unimaginable loss, “I have tried,” another physician says, “to bury myself in work so that I do not think of all of those who have died and are buried in the ground.”
“Or are still buried under piles of concrete,” another adds with grim precision.
To be continued tomorrow–check back to learn about how CMBM’s healing drawing exercises and what the participants appreciate about the training.
CMBM Training in Port-au-Prince
Our team has been gathering for the last two days, long flights and sometimes long delays as well.
Jamil Atti is in from Gaza, Afrim Blyta and Jusuf Ulaj from Kosovo, and Naftali Halberstadt from Jerusalem- psychiatrists and psychologists who have lived through war and terrorism themselves, leaders of our program in their country, friends and brothers. From the US, Amy Shinal (our Clinical Director) Lynda Richtsmeier Cyr, Kathy Farah, Lora Matz and Jerrol Kimmel, physicians and psychotherapists–long time friends of 10 to 15 years, talented, adventurous, deeply committed to this international work.
Linda Metayer is our Haitian Program Coordinator, a psychologist with a degree in public health, as brave and courteous as she is smart and competent. Lee-Ann Gallarano, who organizes all of our work with trauma around the world, was working with Linda before we arrived with Jesse Harding, our newest staff member, who several years before worked with Lee-Ann when they were Peace Corps Volunteers in Mali. Tod and “B”, gifted documentarians, are filming us, and Mark, who has volunteered his time, is taking most of the still photos you’ll see on this blog.
We spend this first day “checking-in”, hugging, laughing, sometimes crying, as we tell the stories of our first meetings, recalling the power of soft belly breathing to help us relax in the middle of fire fights, of Afrim informing us in Gaza City that the 3AM earth shaking noises were in fact sonic booms. And everyone is speaking of the realization, growing over the years that, “You are my people,” “This is the work I want to do,” “I am at home.”
In the early evening Linda, Amy, Jesse and I walk with our camera crews into the sprawling tent camp across from our hotel- 10,000 people in the Champs de Mars. We had been told that “from the outside things look better.” There were fewer tents, less crowding. Up close the opposite turns out to be true- some people have indeed left, clearing out in terror of cholera, but everyone doubts they have found places much better. Meanwhile, moving from one clump of canvas, plywood, plastic and corrugated metal– one collection of shelters to another — we hear similar disturbing, dispirited stories: there is actually less food and water than there was four months ago and far more violence. Women, and muscular men as well, tell us that if and when they are able to sleep, it is with one eye open, alert to robbers who are often armed, and to rapists. The jobs cleaning rubble that once helped sustain these encampments have moved on, though no one knows exactly where.
Though some people are shy and wary, virtually everyone is gracious and within a few moments, eager to talk to us. Mothers tell us that so many of the children are “hyper” since the earthquake. We see them shuffling from foot to foot, eyes shifting with their bodies. The mothers say they have lost weight. When I ask about emotional problems everyone- men, women, teenagers- says they are angry. “What do you do?” I say. “I pray to God,” several say. “I take this medicine,” says a man raising a small bottle of homebrew. A woman says, troubled, but resigned, “I beat my children.” Several others nod.
As we move from one section of the camp to the other, two teenagers run past and jostle Linda. A moment later we see that her necklace is gone. She is a bit shaken, but philosophical, “They do it to eat,” she says. Other camps are likely to be somewhat better, but some are not and there are 10,000 people here. Walking back to our hotel I feel the weight of life here in Haiti, people stretched and pushed beyond breaking. I think of how much our work is needed, and I feel frustration along with everyone else. “Where is the organization?” I ask rhetorically, “The benefits of all the money the international community has committed?”