Tagged stress

Day Five: Images of Our Time Together

So much happens to all of us in the Jacmel training as we go deeper, become more aware, take chances, and connect over five days.

Our faculty faces fears of not performing well, of not sleeping at night, and of missing what is muffled in translation. We take the chance of feeling our uncertainty of daily supervision and are gratified that our colleagues have at least as much compassion for us as we feel for those we are helping.

The interns are stars, setting examples of emotional risk taking and taking care of business: filling in where the translator is a bit off, pointing out what faculty may have missed, and making sure, as if they have invited all of us into their own homes, that we are well cared for in lines at lunch, during the lectures, and at the beginning and end of each day.

I see the participants grow more receptive each day, feel them more engaged with every exercise we do. Men and women who have never heard of, let alone participated in, psychotherapy are exquisitely sensitive to each others’ complex feelings and thoughts, and us. Often without words, old and young, farmers as well as physicians, create a climate of acceptance in which everyone–and I really do mean everyone–seems to feel safe.

The suspicion and rancor among religious groups–Catholics, Protestants, Vodoun Healers—is palpable in the early days. Though the saying has it that Haiti is 80% Christian and 100% Vodoun, some of the Christians seem quite fearful. “Who are these Vodoun people?” They ask with uneasily politeness. By the last day, after having sat in the same small groups, most of them seem at ease. “We are just people” says Clement, who heads the Jacmel Vodoun Healers Association. “I feel like these people are my family,” and the nuns in their habits and scripture-quoting-Protestants nod their heads.

Nature is so important. In drawing after drawing on the final day, the restoration of hope is symbolized by new trees, green and blue where there was, on the first day, only brown.

If it is possible, community is even more important. The final day’s drawings of the goal each participant would hope to reach are crowded with family, friends, and neighbors. When the groups come to the front of the grande salle to receive their certificates of completion, they sing songs to their leader and intern, and to themselves, and they call themselves “family”.

Already on the first evening many of the participants are sharing what they’ve learned with children, spouses, and parents. On the fifth and last day, they are, without being asked, pledging to take “CMBM,” this work, to their schools, churches, clinics, and to everyone in their communities. Linda has to slow them down a bit. “Sharing with your friends and family is good, but you need to practice much more. You are just learning. When we have the Advanced Training in November we will teach you how to lead groups.”

James S. Gordon MD, a psychiatrist, is the author of Unstuck: Your Guide to the Seven Stage Journey Out of Depression and the Founder, Director of the Center for Mind-Body Medicine in Washington, DC, and Dean of the College of Mind-Body Medicine with Saybrook University.

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Training Haitian Healers: Father Fredy Stops By

On our first night in Port-au-Prince, while  Lee Ann and I are going over the next day’s schedule, Father Fredy appears at our table on the Plaza Hotel’s terrace.

Fredy is whippet-thin and angled slightly forward, a living emblem of his eagerness to share what he has been learning and doing even before the CMBM training begins on Tuesday. “The children who have lost their homes and parents are the ones I work with most. I have them breathe deeply to relax and then draw their biggest problem and imagine its solution – a new home, people who care for them. And then we sing together, and I ask them to imagine that place they have created.”

© CMBM

He has also worked with parents who, displaced and frantic since the earthquake, have been abusing their children – having them do dialogues with their “problem” (the abuse), and the unending frustration that seems to compel them to it. For the first time they are able to talk about what shames them, to gain a little perspective.

“They thank me,” Father Fredy says, a huge smile opening his face.

“On the anniversary of the earthquake,” he goes on, “I used an image of a river. I told  our whole congregation to imagine they were on its banks, that the river was helping to take away the memories and the sorrow. They were so happy. ‘It’s just like we are there’, they said.”

Father Fredy is still fresh but Lee Ann and I are getting tired. We do a ”dialogue with a symptom” and he realizes something that is just below the surface of his consciousness. “I know I should be tired too. I want to help, but it is too much – seven days a week, long, long hours. I am awake when I should be asleep and then I fall asleep during the day when I should be awake. My Inner Guide says I have to change that,” he says, laughing.

“You have planted a seed,” he tells us, before we all go off to bed. “Other ways, like medication and just talking, weren’t working or were too difficult, or even if good, like prayer, were not enough. But this seed is now becoming a tree and it is bearing fruit.”

We are in Port-au-Prince this week doing an Advanced Training in Mind-Body Medicine with 120 Haitian health, mental health and education professionals and caregivers. Please look for more posts in the days to come. More info on our Global Trauma Relief program in Haiti can be found here.

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Haiti’s Earthquake Anniversary Reactions

On the anniversary of their earthquake, Haitian men, women, and children are more likely to tremble anew with fear and contend with reawakened physical, emotional and behavioral symptoms. Chronic headaches and stomachaches that had subsided over months are now returning with renewed force in those living in their own homes as well as in the more than a million demoralized tent dwellers. Sleep, increasingly restless, is more often riven with nightmares of family members buried in the rubble. Children whose beds were dry are once again wetting them.  The free-floating anger that had ebbed in many is rising, increasingly visible in family quarrels, child abuse, and street conflicts.

These phenomena, occurring at the same time as the original trauma, a year later (or indeed 5 or 10 years later) are called “anniversary reactions”. They were observed by Freud in 1895 and have been the subject of case reports ever since.

Sometimes a quite conscious understanding and anticipatory dread of the anniversary appear to set the stage: Winston Churchill dying at the same age, and on the exact same day as his father; Elvis Presley, who had announced that “my life is ended,” after his mother died at 42 in August 1958, himself dying early in August 1977, also at 42.

Often, however, the person suffering the anniversary reaction seems to be unaware of the connection. There is ample documentation of people who are surprised to learn that their unexpected anxiety attacks, nightmares, blood clotting disorders, chest pain, or heart attacks have occurred a day or two before the date a family member had died.

Some investigators have hypothesized that  “incomplete mourning” makes one more vulnerable to anniversary reactions, but it’s hard to say, especially in a situation of catastrophic loss and ongoing horrific hardship, like Haiti’s, what ‘complete mourning’ might be. Others see the reactions primarily as conditioned responses triggered by preparation for a memorial, for example, or an awareness of the coming of the season of loss, producing a variety of psychophysiological reactions.

Whatever the mechanisms, it is clear that these anniversary reactions take place on a population wide as well as an individual level. Many New Yorkers report a growing apprehension on clear days in early September that precede each 9/11, and since Hurricane Katrina, New Orleanians’ level of distress increases precipitously each August . Scientific observations confirm these reports. A study of Gulf War veterans published in the American Journal of Psychiatry in 1999 revealed a significant increase in symptoms of posttraumatic stress disorder (agitation, reliving of the traumatic experience, emotional withdrawal) in the same month that the original trauma occurred. And a 2007 study in Stress and Health, showed that a gradual decline in physical and psychological symptomatology in the months after a flood in Thailand, was followed by a marked increase in symptoms as the one-year anniversary drew near.

It is certainly possible to mitigate these anniversary reactions and indeed transform them into opportunities for mastery. The commemorative services that religious and civic groups, and governments organize often combine mourning with a shared experience of gratitude for what survivors do have. The work The Center for Mind-Body Medicine is doing in Haiti and elsewhere unites this approach to practical instruction in self-care techniques like deep breathing; self-expression in words, drawings and movement; and small group support.

Talking with children in tent camps

Still, the usefulness of commemorations and therapeutic instruction depends in part on the circumstances in which people find themselves. In Thailand, those who were still living in tents had the most severe anniversary reactions. I have observed that it is far easier for children going to rebuilt schools in postwar, independent Kosovo to move through reawakened pain than for those in Gaza, who continue to attend overcrowded, still damaged schools in a besieged and isolated territory.

Today on Haiti’s earthquake anniversary the situation is far more desperate and discouraging for many than it was in the first months after the earthquake. Some are of course putting their lives back together – kids going to school, adults back at work, many selflessly teaching and helping others. Well over 1 million, however,  are still living in tent encampments and the conditions are, if anything, less supportive than they were six or 10 months ago. Supplies of food and water are less reliable; robbery and rape seem to be more frequent. The government is in disarray and is, after the recent postelection rioting, fearful rather than welcoming of public gatherings like the helpful and cathartic day of mourning  it organized on February 12, 2010.

After the earthquake, there was an enormous, spontaneous outpouring of goodwill toward Haiti, particularly from the United States – and commitments of funds to match. Since then, the Haitian government and local and international nongovernmental organizations have done much good work, but it has often been poorly coordinated by a still devastated bureaucracy;, and only a small portion of committed funds have actually arrived.

The Anniversary brings up memories of the extraordinary pain that the entire Haitian population has suffered, that old symptoms of demoralization and despair as well as renewing emotional and physical distress. We are working, along with the Ministry of Health, Partners in Health, and other organizations to address these symptoms and mobilize the Haitian people’s resiliency and hope. Our efforts, however, depend significantly on whether the international donors and the American people will fulfill the commitment to rebuild we made a year ago –a commitment that can help transform this anniversary crisis into an opportunity for the Haitian people to recover their wholeness and celebrate their surviving community.

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Helping Haitians to Heal, Part 4

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.

(by Naftali Halberstadt for CMBM)

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.”

(by Mark Silverberg for CMBM)

“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.

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Helping Haitians to Heal, Part 3

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 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.

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Helping Haitians to Heal, part 2

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.

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Labor Day Stress Relief

Dear friends,

I wanted to share with you an article I just published on Health News Digest. I hope you’ll find it useful going into the Labor Day weekend, and that you’ll share with friends and family who may be in need of some stress relief.

Labor Day Tips for Reducing Stress by James S. Gordon, M.D. (originally posted on Health News Digest: Original Article)

Labor Day is traditionally a time of rest before the renewed activity of fall. For tens of millions of Americans who are unemployed or underemployed it is a time of high stress, a time when anxiety caused by economic insecurity and foreclosures unsettles, agitates, and casts a shadow over the unemployed and their families.

Over the years, I have worked with thousands of people who have been made anxious and depressed by economic hardship. Here are five steps drawn from my most recent book, “Unstuck: Your Guide to the Seven-Stage Journey Out of Depression,” that people can take to address the pain and insecurity that may come with today’s economic uncertainty. All of them are free and all can be easily learned and done at home.

1. Begin a simple nondenominational meditation practice: Slow, deep breathing — in through the nose, out through the mouth, with the belly soft and relaxed and the eyes closed — is a sure antidote to the stress response that uncertainty provokes. To encourage relaxation you can say, “soft” as you breathe in and “belly” as you breathe out. Begin with five minutes, two to three times a day.

2. Move your body: Physical exercise may be the single best therapy for depression. It’s very good for anxiety as well. Find any kind of movement that suits you, jog, dance, swim, or walk, it all works. You’ll see and feel some benefits after 15-20 minutes.

3. Reach out to others: Human connection — to family, friends, co-workers in the same boat — is an antidote to the sense of aimlessness and isolation that may come from job loss or unexpected economic insecurity.

4. Find someone who will listen and help you take a realistic look at your situation: Allow a trusted friend or adviser to help you look for possible solutions for any stressful situations you may be experiencing. In addition to helping you unburden your mind, body and spirit, a trusted friend or advisor can often see solutions more clearly than you and can help you find ways to put these solutions to work.

5. Let your imagination help you find healing and new meaning and purpose: After breathing deeply and relaxing for a few minutes, imagine someplace safe and comfortable, it could be a place you know and love or one that comes to you. Make yourself at home there, notice what’s around you, breathe deeply and relax. My colleagues and I at the Center for Mind-Body Medicine have used this safe place imagery successfully with New York City fire fighters after 9/11, with U.S. troops going to or returning from Iraq and Afghanistan, and with families in New Orleans in the aftermath of Hurricane Katrina. We teach it every day in our offices and like the other four steps, we use it ourselves.

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CMBM’s Drawing Exercise Resonates in Haiti

We do a drawing exercise that has been enormously helpful to children and adults in war, post-war, and post-disaster situations, in Kosovo, Gaza, Israel, and New Orleans, and with US military. For a while, everyone—bent over paper, crayons in hand—becomes young, earnest, playful, surprised. The drawings allow people to tap into their intuition and imagination without effort. As a series of pictures unfolds, they find themselves creating images they’d never imagined . . . .

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