Tagged Trauma

Letters The New York Times Chose Not to Print: Occasional Postings

Like many people I know, I’ve long been in continual dialogue with The New York Times, my breakfast companion for over 60 years. Often I’ve nodded my head with appreciation when The Times reporters have brought back news from far away or previously ignored places, or its columnists have set out a position with which I agreed or one I was groping toward. Sometimes I’ve been stumped, particularly by the arcana of financial reporting. And on occasion—coverage of the run-up to the war in Iraq comes to mind—I’ve found myself shouting at the folded paper, even shaking my fist.

I’ve written for The Times occasionally, over more than 40 years, mostly for The Book Review but also for the Science section. The Times has also written about me and my work, mostly quite favorably. And I’ve also written letters. A couple have been published, and a number of them have been rejected. Or is “ignored” the better word?

Perhaps it’s vanity or the infirmity that comes with age—or maybe it’s just experience and conviction—that makes me feel I have something to say that others should attend to. In any case, I decided that I’m going to share with you what doesn’t appear in The Times to let opinions and words that may have seemed peripheral, tendentious, or perhaps too challenging to The Times staff, find a more welcoming home.

What I’m going to do is publish the letter I wrote here with a link to the original article and another to the letters The Times did choose to publish. I hope you’ll find this experiment interesting and that it will also inspire you to let your own voices be heard. In any case, please let me know what you think.

This first posting, below, concerns a column by Nicholas Kristof “A Veteran’s Death, The Nation’s Shame,” which I admired, which appeared on April 15th, together with the letters that were in the paper today, April 20th.

Preventing Military Suicide with Self-Care

James S. Gordon, M.D.

In his poignant piece on escalating post-deployment military suicides (NYT, April 15), Nicholas Kristof writes that “we refurbish tanks after time in combat, but don’t much help men and women exorcise the demons of war.”

There are in fact programs that do address these demons successfully and in ways that are stigma free and widely acceptable to the military and their families. Unfortunately they are not yet widely available.

These programs are based on the understanding that persistent stress and trauma may come to all who are in combat; and that practical self-care skills like meditation, guided imagery and movement can provide prospective on and address the agitation and aggression, the overwhelming memories, isolation, despair, and suicidal feelings—the symptoms of post traumatic stress disorder (PTSD)—that may come in its wake.

At The Center for Mind-Body Medicine we have used this approach to reduce symptoms of war-related PTSD by 80%-in Kosovo and Gaza. The 300 US military and VA clinicians whom we have trained and the active duty, veterans, and family members with whom they work, appreciate the stress-reducing, mood enhancing practicality of our “mind-body” program. They embrace the opportunity to express themselves without fear of censure, or career foreclosure, in small groups whose support is reminiscent of combat units.

We are currently undertaking a Department of Defense funded randomized controlled trial of this method with war-traumatized US vets. Others are doing similar studies with similar approaches. Our preliminary results are promising, but research is slow and the time for many vets, like Ryan and Michael, is short. The Defense Department and the VA need to move ahead swiftly to offer this program and others to the hundreds of thousands who can make good, perhaps life-saving use of them.

“A Veteran’s Death, The Nation’s Shame”

“Letters to the Editor, April 20th, 2012″

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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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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Who Will Lead Haiti’s Mental Health Recovery?

We did a workshop for our team while we were in Haiti last week– at a church retreat center, a little, open, green place at the bottom of a hill in the middle of Petionville, bird-filled flowering trees, some fresh, if very warm air—an oasis.

More than 60 of those who completed our Advanced Training in Mind-Body Medicine came for the day—from Port-au-Prince, Petionville, Leogane, and even from further out in the countryside.

They were quiet at first, then fairly bursting with stories about the work they’d done, with children in schools; with patients in hospitals; with Catholic, Protestant, and Voudoun parishioners; with students and colleagues at universities and professional schools; and family members, friends, and neighbors.

Many people who have come to these groups are, we hear, sleeping well for the first time; chronic pains are receding; kids who’ve lost parents and homes are able to focus. The need to talk about what has happened, to share the feelings that continue to well up, is everywhere. The groups have become a place to go—to get relief, to “be at home,” to learn “something that works”.

Amy, Linda, JJ, and I all teach and answer questions–stretching mind and body; how to deal with someone who is, or may be suicidal; how to stay “present” and empathetic without being overwhelmed by needs that cannot be met.

Linda Metayer presides with grace and clarity, gives a lecture on biofeedback and autogenic training that is a model of economy. It’s a pleasure to watch her and to listen as she explains the next steps we will take together—the ongoing supervision, the site visits that we’ll make to our trainees’ groups, the workshops we’ll all be offering in the community.

We also outline our plans to develop a leadership team that will work closely with our international faculty in providing supervision and in training hundreds, perhaps thousands, more Haitians to use our work with hundreds of thousands.

The next morning, we meet with the first nine members of that leadership team: highly energetic, talented people who have deeply been moved by our approach and have begun to lead groups in hospitals, churches, school, and tent camps. Among them are a child psychiatrist, a pediatrician and neonatologist, and a medical student; several psychologists, a consultant to the Ministry of Health who is a professor as well; and an accountant who has left his practice for the more-than-full-time job of leading a tent camp and teaching mind-body medicine. I’ll tell you much more about them in future entries.

In the meantime, here’s a picture of our crew—Haitians and Americans together.

From left: 4th row: Lee-Ann Gallarano, Spencer Aimable; 3rd row: Caroline D. Coicou, Lynda Richtsmeier Cyr; 2nd row:Junie Delmont Fortuné, Linda Delmont Métayer, Amy Shinal, Anne-Kary Perrault, René Domersant; 1st row: Fornia Cenezir, Clairetida Cassamajor, Jim Gordon, Jesse Harding, Marie Ange Octena

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Visiting Leogane: Earthquake Epicenter to become Center of Healing

Visiting Leogane the day after the inauguration, we are plunged into the canyon between the promise and its fulfillment.  The city,  which was the epicenter of the earthquake, is desolate, a combination of “the hour before the shootout” in the Westerns, and a scene from after the Apocalypse. There are empty lots where once there were buildings; rubbish is thrown on top of rubble; motorcycles buzz around, but their riders are solemn.

We stop to buy Haitian CD’s and talk with a 30-ish man whose face looks frozen, who is standing near the rack. “Is this your store?”  I ask, of the tiny cabin.

“It is not mine,” he says, “but I built it.”

“What about your house?” I ask.

“My house was destroyed,” he replies.

“Did you lose family?” I ask.

“Yes,” he says, and slowly, deliberately, names them. “My brother, my other brother, my sister, my mother.”

Around us, other young men stand like statues. Only when the music from the CD begins does anyone move. The young man who actually owns the store shuffles his feet and smiles a little. A couple of the other guys sing along with Belo.

We know we will be coming back to Leogane and working there.

To be continued tomorrow . . .

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Mind-Body Medicine is “How to Heal Psychological Trauma”

Dear Friends,

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:

THE GUARDIAN: How to Heal Psychological Trauma: From Haiti to Gaza, psychiatrist James Gordon counsels survivors of disasters around the world

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.

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In Haiti: Signs of Healing

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.

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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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Our Work, Alive in Haiti

This weekend I’ll be headed back to Haiti with my team of international faculty, to continue training Haitian caregivers in Mind-Body Skills that they can bring to their traumatized families, the more than 1 million who still live in tent camps, colleagues, patients, and students at their workplaces. This is the next step as we create a nation-wide program of psychological self-care for Haiti. I can’t wait to be back in Port-au-Prince with our faculty, and the wonderful, caring group of Haitian professionals we’re gathering together and training to be the nucleus of society-wide change.

Haitian caregivers in our training, at our Port-au-Prince Office. © CMBM

You may remember our first training in December 2010, which was cut short by election riots. Here are a couple of moving testimonials from attendees who are practicing what they learned . . . Saint-Juste Desir, Teacher at the Public school in Raymond and at the Family Care Program for Better Future International, in Cayes-Jacmel, Haiti, writes:

At the end of December, I lost one of my cousins who was about 30. I was really shocked because she was not sick. So hearing the news shocked me very hard. After that I could not sleep at night, I also had headache. By chance, I recalled the CMBM training and I decided to try it so I could sleep. I tried the “soft belly technique” and I slept all night. Since then, I use it every night before going to bed.

As I am a teacher, after the training in December, I was teaching math to my students. I realized that they were tired and could not concentrate. I asked them if they would like to experience some relaxation techniques. They agreed. I put music, I asked them to stand up and we did some “shaking and dancing” for about 5 to 10 minutes. After that we continued working with no problem. They were relaxed and they asked me why I didn’t do that with them before. They loved it.

I expect to know more techniques during the Advanced Training so I can help myself better and also help my students.

Jacques Africot, Project director, Better Future International, from Jacmel, Haiti, writes:

The technique I use the most is the “soft belly”. It can be practiced anywhere, any moment. It is the easiest technique for me to calm down my nerves, reduce my stress. Any time, I feel stressed or depressed I use it.

An Experience that surprised me:  I was talking to a friend and she was suffering in her breast. I asked her if she wanted to make an experience. She said yes. I put a soft music and I asked her to close her eyes. After some deep breathing, I started to guide her slowly with the “body scan technique.” After finishing, she was smiling: Her pain was completely gone. I was myself surprised.

I practiced different CMBM techniques with my children: soft belly, shake and dance, drawing, imagery.  I realized that after practicing those techniques they sleep better. Less nightmares, no headache if someone had one before we practiced it. And they sometimes ask me to practice with them.

I expect that the advanced training will give me more techniques to guide others.

By the time our training is finished—the end of February– these Haitian caregivers will all be taking the CMBM model out into the wider world and leading “small groups.” Each person will begin helping others manage their own stress and anxiety (still lingering from the January 12th 2010 earthquake, cholera outbreaks, and continued hardship and displacement).  If each caregiver leads 1 group of 10 Haitians, that means the 120 caregivers we’re training will immediately be able to reach a minimum of 1200 Haitians in rural areas as well as cities; and that number will grow as our trainees continue to use these skills with the individuals and in classrooms and with additional small groups.

Making Haiti a community of healers—that is our goal. “This program,” as our Haitian Program Director Linda Métayer has said, “is a gift to the Haitian people.

Haitian Participants at CMBM Training © Mark Silverberg for CMBM

If you’d like to support us as we bring this gift to the Haitian people, please click here.

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Haiti’s Earthquake Anniversary: Building Blocks

As the anniversary of Haiti's catastrophic January 12, 2010, earthquake approaches, physical and emotional symptoms that were ebbing or had disappeared, are rising. We hear it everywhere as we move through a day of visits and talks with staff at the General Hospital and the Ministry of Health, as well as with kids and adults in tent camps in Petionville . . .

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