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.
I’m delighted–NBC Washington online just posted a wonderful profile of our work in Haiti. Read about our program and the many people it is helping here.
“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.
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.
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.
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?”
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.
We move during the rest of our week in Haiti from one group of health professionals and community leaders to another. It is a slow progress through the traffic jams in Port-Au-Prince’s rubble-narrowed streets, and sometimes even slower over the gorged-out, flooded dirt roads that take us to Bishop Pierre Andre Dumas’ diocese in Anse-a-Veau, three hours outside the city.
We use a variety of techniques in our workshops, including explanation of the fight-or-flight and stress responses, meditations, guided imagery, and shaking and dancing. We also 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, sketching solutions to problems that seemed insoluble.
In Haiti, we guide our groups through three drawings. The first picture is of “yourself,” the second, “you and your greatest problem,” and the third calls for “the solution to that problem.” (We modify the exercise when we use it with children: read my post about using the drawing exercise with Haitian children in the General Hospital.) Afterwards, participants share their drawings in groups of two or three, telling what they see in what they’ve created and how it makes them feel. Then they have the opportunity to share with the entire group.
As you will see, the results are often touching, and almost always surprising.
Here are a few examples and snapshots of the workshops in which they are created:
For L’Institut Haïtien pour la Doctrine Sociale Chrétienne (Haitian Institute for the Christian Social Doctrine)
Such wonderful, accomplished people: 100 of them—physicians, architects, lawyers, police officials, business men and women. All, in this time of crisis, are renewing their commitment to the welfare of those who have suffered even more than they have. They tell us about the terrible sadness—their own, and others—and about unaccustomed irritation that surfaces at home and at work, as if, somehow, angry will could restore what has been lost.
An obstetrician/gynecologist, tall, broad-shouldered, powerful and handsome in a bright, tailored shirt, has come “for rest and peace—I have not slept since January 12th.” He says he works “always” to forget the loss of his house, the deaths in his family—his sister, nieces, nephews—as well as to care for his patients. In his second drawing (a picture of his biggest problem), he is inside a tunnel, tiny as an ant, lost, unable to touch the equally tiny figures outside. In the third (a picture of his problem’s solution), the figures are larger, recognizably human. They are dancing together and he is laughing, “for the first time since the quake.”
For Anse-a-Veau diocese—nuns, priest, lay brothers
Out in the countryside a couple days later, we are meeting with priests, nuns, and lay brothers in Bishop Dumas’ diocese. It’s like rural Africa out here: lush, green and very still, faded pastel cottages with tiny yards in which seeds, sown or thrown, produce a few vegetables and fruits. We begin and end our visit with Bishop Dumas’ blessing and simple ceremonial meals: tiny, boned, tender white fish, rice, beans, greens, fresh lemonade and thick coffee.
The religious, in straight-backed chairs, are as still and elegant as the statues in the porticos of Chartres. They are so attentive, so sweet tempered amidst the flood of suffering, homeless, city people that the earthquake has forced back to the countryside. One priest draws a scene of despair—“The Cross of Death—Good Friday without Easter Sunday,”—and then, in his third picture, much to his amazement, produces a sun that covers the page with radiant yellow. “It’s the sun of freedom. Together we can overcome.”
They dance, too—nuns, brothers, and priests together—as freely and as happily as children. Before we finish in mid-afternoon, another, older priest calls the Bishop from the next diocese. It turns out he would like us to come there.
More soon about another workshop, this time with the Haitian Red Cross staff and volunteers . . .