Gaza City, December 15, 2009
The Advanced Training Program (we call it, and so do the Palestinians, “ATP”) has a complex structure that is at first a bit daunting. Our 15 Gaza faculty coach the participants in leading the same kinds of small groups that they first experienced in the initial training. The international faculty, passing from group to group provide feedback, later, in supervision, on how the Gaza faculty has helped the participants and what they could do or say more appropriately, clearly or concisely; where they could have been more sensitive to the spoken or unspoken needs of a group member; how their own reticence or preconceptions may have inhibited or biased them in their advice to a participant-leader. “Be honest with us,” our conscientious Palestinian team had repeatedly insisted. “We want to do the best job for our people. We are thirsty for learning.”
The participants lead the ATP groups in pairs; there are ten people in each group and five sessions. Hugely nervous at first, in spite of a day of reassurance and coaching, they conduct the opening meditation, and lead the check-in in which they and the other group members say how they are doing and what they are feeling at the present moment. We have encouraged participant-leaders to let go of self-conscious professional distance, to be honest about their own feelings, to be “real people as well as leaders.” Some do this with admirable courage and humility: “I am a professor at university, but at this moment I feel like I am back in grade school.” Others are more guarded. Everyone in the group speaks in turn – no interrupting, analyzing or interpreting allowed.
The participant-leaders then teach didactic material about, for example, the fight or flight and stress response that are activated by the sympathetic nervous system, and the use of slow deep breathing (which mobilizes the parasympathetic nervous system) to balance this state of hyperarousal which is so common in deeply traumatized and uneasy Gaza. Then they lead an experiential exercise – it could be guided imagery, or drawing one’s problem and its solution or quiet meditation that brings about relaxation or an active meditation of fast deep breathing or shaking and dancing, designed to raise energy in the depleted and depressed and break up fixed patterns of thought and feeling. Then they ask group members to report on their experience: “I feel like a burden is lifted” says one young, bearded school psychologist, after six or eight minutes of charged up, bellows-like arm pumping, deep breathing. “I feel free for the first time since the war to breathe the breeze from the sea.” They conclude each group with a quiet meditation. Afterwards the pair of participant-leaders say how they feel they have done and the other participants share what the experience was like for them; the Gaza faculty member concludes with his or her assessment.
This will go on for five two-hour groups over four days. It is designed to equip our participants to take our model back into their work places where they will offer it to kids and adults, the elderly and the deaf, former prisoners in Israeli jails and ambulance drivers, abused women and confused men, the anxious and angry, those bereaved by violence and those fearful they will be. In a society in which psychological problems are stigmatized and psychotherapy is often viewed, if it is considered at all, with suspicion, our model has wide appeal. It is offered as a way to develop skills and strengths, of mind as well as body, an opportunity to come together without fear of analysis or interpretation, a modern version of traditional, honored communal gathering and healing.
Each day we have a panel where Gaza faculty answer questions from the entire group of participants about the challenges of leading groups and working with individuals, about balancing the need to maintain order in the group with an openness that invites sharing, about presenting didactic material in a way that is accurate but easily comprehensible. In Gaza the questions have a special urgency and poignancy. One male psychologist, slender and graying unfolds slowly from his chair. “How do you,” he asks soberly, “deal with a situation in which during a mind-body group bombs are going off?”
“This has happened to me several times,” replies Mohammed, the psychiatrist, “You find out what is happening – I don’t want to say who is shooting,” he adds to some laughter. “You make sure your group is as safe as it can be. Then you discuss feelings so everyone can get some relief. Then do deep breathing to help everyone, including yourself, to relax. Then continue the group.”
“I was working with kids one time,” Jamil adds. “Every time there was shooting we got up and shook our bodies. Every time a bomb went off we all yelled loudly. It worked pretty well.”
“What about if you are a leader and someone says something that is very tragic and you feel like crying? Is it permitted?”
“In the war terrible things happened” responds Abdel-Hamid, “and the people come to us to talk about it: Women in my groups whose children were killed, men who saw their wives and daughters dying from burns, and I remember the things I myself saw. It is only human for us to cry as well.”
Gaza City, December 13, 2009
Our faculty gathers in a circle in high backed chairs in the ballroom of the Commodore Hotel – physicians, psychologists, a couple of social workers – 15 in all. Many of the men, who are mostly in their forties, are in suits and ties. The women, young and middle aged, all wear scarves, their heads covered as are those of ninety-five percent of adult females in Gaza; most are also in the long shape-shielding coats they wear even in the summer heat. The feelings of all of them, for one another and for us, are, however, easily visible, even palpable; the room warms with affection, hums with connection, as each one of us, in turn, “checks in.”
“My colleagues,” says Naima, a dark skinned Bedouin from Rafah at the southernmost tip of Gaza’s twenty-five mile long strip, “are not just friends but family. When the international team is here, the family is complete.” She really means it; she has returned early from her honeymoon to be with us for the training. Others have made sacrifices too. Mohammed the psychiatrist who heads up public mental health services in Gaza, made the “difficult decision” not to go to a meeting in the West Bank: “I want” as does everyone of Gaza’s penned up one and a half million people, “to get out of this prison, but I prefer to be with all of you. You are,” he adds, lightening the mood, “the best antidepressant.”
And there is more humor, as always in Gaza a crucial ingredient of the savor that makes life more than survival: A spontaneous, slightly exaggerated romantic song for Shaher who is celebrating his twentieth wedding anniversary, Abdel Hamid’s confession that “even with two wives” he is “well”, gentle teasing in untranslated Arabic of Naima about her interrupted honeymoon.
Four and a half years ago when we began the “mind-body medicine training” of 90 Gaza clinicians, most of these people didn’t know each other at all. In the time since then these “leaders,” whom Jamil has chosen, have conducted hundreds of ten week long mind body groups themselves and supervised colleagues who have led many hundreds more. Altogether 7000 children and adults of every age and social class have participated in these intensive groups and our Gaza team has worked individually, in families, and in brief groups and classroom sessions with at least 15,000 more Gazans. The research we’ve done (on 500 kids and 500 adults) shows very significant decreases in symptoms of post-traumatic stress (up to 80% in those most traumatized) improvements in mood, decreases in anger. Amidst massive Israeli attacks and civil war, in the face of pervasive, indiscriminate and violent death, poverty, isolation and confinement, we have found in those who have participated in our groups an enduring (at six months follow-up) enhancement of hope and optimism about the future.
Our team and the people they have worked with, and the changes that are so obvious to and in them, are the magnets that have drawn participants to the training that begins the next day. Eight months ago 150 of them (chosen from some 500 applicants) learned the basic techniques of our approach, and the science of stress and its reduction, and experienced the surprising comfort and intimacy of our small groups – “the one place in Gaza where everyone can take off their masks, relax and be themselves,” is the way Mohammed, who has led similar groups for professional colleagues, old men with chronic illness, war-traumatized children and patients on the psychiatric ward, describes these utterly confidential, tenderly led gatherings of 8 to 10 people.
When they check in their first small group our participants recall the experience of the first training: “I was so happy’” “It was like a vacation to me,” “It changed my personality, my life 180 degrees – I am no longer sick with colds and stomach upset. My doctor asked me what medicine I took”. During and after those five days many have begun to act differently – more assertive toward overbearing and arbitrary bosses; more sensitive to other people and, indeed to their own emotions:“it is not unmanly to cry when one witnesses the horrible suffering of our people”; more willing, even when it conflicts with cultural norms, to trust their own intuition: several young people whom I hear personally (I wonder how many more there are) have told their well-meaning parents that the bridegroom or bride selected for them was not a good match, and calm, sincere, and convinced, have prevailed.
During the intervening months they have met every four weeks with their group leaders – “strengthening our family” – to practice the meditations and the guided imagery, to do the drawings that express their feelings and summon up imaginative solutions to daily stress, to share the losses and frustrations that shadow the lives of every Gazan and to celebrate the joys – of jobs well done, and birthdays arriving and weddings to come – that persist. Still, so many of them say they have been “missing” (a word that I hear so often and that seems so apropos in locked in Gaza) us and waiting anxiously for the training.
In the lectures they bend over notebooks, eager to record information that will help them successfully lead, with our faculty’s supervision, small groups – the major task of this training. After they have finished they will offer these groups and use our model with individuals and families in the Ministries of Health, Education and Social Welfare, in the UN health and education programs, at the Red Crescent, and in hospitals, clinics, universities, and community based organizations from the Erez crossing into Israel in the North to Rafah, abutting Egypt in the South.
Lunch is grilled chicken and chicken curry, rice with almonds and raisins, the mix of mezzes – appetizers like hummus, babbaganoush, and spicy “Gaza salad” that are traditional – with fruit for dessert, a wonderful improvement over the GI challenging food of five years before. The participants – university professors and physicians who have taught some of our faculty and just graduated psychologists and social workers who are young enough to be any of our children – are clamorous with the good feelings and high spirits of reunion, old jokes and new intellectual challenges.
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.)
I just returned from another trip to Israel and Gaza to visit our programs there and to plan for the future. I’ll tell you about what happened sometime soon. Right now, I wanted to share with you some testimonials from health and mental health professionals who participated in our most recent professional training in Gaza (March 7-11, 2009). It was, as you’ll see, an extraordinary five-day experience. Jamil Abdel-Atti and his Palestinian team gave just about all the lectures (I filled in some) and led all the small groups. Amy Shinal, our CMBM clinical director, and Afrim Blyta and Yusuf Ulaj, Kosovo psychiatrists and dear brothers with whom I’ve worked for ten years and I provided consultation and supervision; and Dan Sterenchuk and Lee-Ann Gallarano, from our DC office, offered invaluable administrative support. But the training and the beautiful spirit came with our wonderful Gaza team.
Here, then, is what some of our participants had to say:
The information, the relaxation techniques, meditation, and deep breathing. I deeply discovered myself and how to take care of myself. I discovered my neglected body and promised to be taken care of. I forgave my friends and relatives I have neglected and lived far from. Spirituality, I had neglected that part for so long, but realize how important it is for my healing. Grateful for the ability to apply these new techniques in my work. I met new friends. The family tree gave me a very good space to think of my relationships that I’ve ignored.
• Ensherah Zqoot
Gaza for Psychological Health Program
First, I want to express my feelings. I’m happy and feel like I own the world. The training was wonderful and excellent. I felt changes in my physical, psychological and mental status. The techniques were great and worth teaching and sharing in such a training. For the first time I feel involved in a training for myself. I feel safe and comfortable with the team and the facilitator Jamil, who shared his feelings with us. I want to thank him but can’t find words to express my gratitude. I won’t forget the efforts of everyone who participated in this training. I just want to say I’m truly happy.
• Jabr Hussien Theibet
I benefitted a lot from this training. I debriefed lots of feelings and emotions. I truly thank the mind-body medicine team especially Dr. Jim and Jamil and the rest of the faculty. I hope I will be involved in the advanced training so I can help others like you helped me.
Mohd Abu Omirah
Psychological Support Association
I was asked by my professor in the university to participate in this training and I didn’t know anything about it. I felt sad and angry during and after the war, and I was furious about everything. Felt insecure and that all my dreams and rights have been violated on the beach of Gaza. I was thinking sometimes why live? And why continue living as long as we’re continually exposed to those violations? In the five days of this training my life has changes completely. I felt dreams could come true and might will not last long cause day is coming soon. I felt I was born again, like a new person. I felt like a loving human being, full of happiness and hope for the Gaza children. I have many things to say and deep happiness inside but I didn’t want to talk much and bore you. In the last moments I had in room 402 that I will never forget for I had sad and happy moments. I want to thank Mr. Ahmed Theibet and the small family I lived with for 5 days and for Jim, Jamil and the rest of the faculty. Thank you all.
This training provided me with the following:
1. To control my feelings when I face external stimuli
2. How to respond in a rational way and wisdom in the face of acute and difficult situations.
3. My wish that we implement this program with schools’ teachers and guidance and counseling staff at the Ministry of Education to enable them to deal with students and how to face difficult problems.
Abeer Fathi Shareef
Thanks to Jamil and his incredible team on the fabulous training. Also thanks to Dr. Jim and his team. These techniques are consistent with our Palestinian and Islamic culture and this is the secret beyond the programs success.
Gaza Mental Health Center
Training was very enjoyable in terms of changing the track of our lives and jumped with it that big leap. Therefore I have decided to change my life and to reshape my issues. I felt that the training was extremely individualized and it was directed for us as professionals, where always we are asked to care for others and in a very few occasions somebody remembered us and worked for us rather than the patients cases and clients. Thanks a lot for all of those who were behind the program.
Tawfig Abed A Hadi
This course made us realize that our hearts are like Jim’s, very beautiful and valuable. By awakening all the shine that it contains you had awakened our souls which was about to disappear in the sea of torture. We have lived moments that could be the road to the shining future.
Head of Guidance and Counseling in Ministry of Education
Check out the great AP story by Karin Laub about our Gaza training–
At the Washington Post (you may have to close an ad first to read it)
Or at Google News
It’s an great take on how our mind-body skills training is an unconventional fit, but an immense help, to people within the Palestinian culture. (Great picture of me shaking & dancing up front, too (!!!))
We’re in Israel now—flying back to the States soon. More soon.
All the best,
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!