Coming Together to Heal
The terrible deaths of school children and those who care for them in Connecticut are bound to touch all of our children and, indeed, all of us. I’ve learned, over 15 years of work with populations traumatized by violence and natural disaster, that we must pay attention to whole populations as well as to the people most affected. All of us, certainly those who have lost family members and all of those living in Newtown need a way to come together to share their grief and anger, bewilderment, and, yes, despair. And they need, as well, ways to help them to deal with the fear and mistrust, the rage and the emotional numbing, that may persist along with the grief and the loss.
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.
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.
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
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 . . .
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:
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.
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.
In the days after Yehlie’s first communion we complete the training we began in December. My ‘small group’ of participants, gathered together again, begins as always with a few minutes of soft belly meditation – slow deep breathing, in through the nose, out through the mouth, with the belly soft and relaxed — quieting our nervous systems, our minds and bodies. And then we “check in”, tell each other what has happened since we last saw each other and share what we are feeling “right now.” Already it is becoming a commonplace for us, a way to regularly connect with those around us, outside as well as within the training. “Check in,” laughs one priest, “is almost now a second religion.”
photo by Mark Silverberg for CMBM
There are still major problems and issues – almost half of our group is still not living in their homes, and there is abiding sadness for those who have died, but there is more energy for understanding and meeting current challenges.
We discuss the short term memory loss that bedevils several people and makes them apprehensive, even in their thirties or forties, about Alzheimer’s disease. I say it is highly unlikely, that trauma has long been known to obscure memory. And one of the other doctors in the group assures us that her memory – devastated amidst the loss of her brother and her husband — has begun slowly to return: “Sharing my emotions, accepting help from others, permitting my own tears – it as if the memory flows back with them.”
This doctor’s face is no longer constricted in pain as on our last visit, but open, changeable, easy with laughter as well as tears. Many of the faces I see are equally changed. James, who is head of psychology for the National Police, scrupulously kind, but painfully thin and equally serious in December, is ten pounds heavier, relaxed, expansive. And the woman I think of as “the Teacher,” as immobile and expressionless as mahogany in devastated grief at the loss of husband and home two months ago, is now a river of feeling and words.
One participant says, “The earthquake brought us so much pain, but also we are seeing it brings good things to the people who survive. Psychology [i.e. traditional therapy] was useless to me and my community – no one could go because it meant you were crazy. Now with CMBM approach I am helping myself and others too.”
Says another, “On January 12th, the anniversary, when everyone in my church was so tense, I taught them the breathing. And as I relaxed I let myself cry, and found my strength, and then we cried together, my children and my friends. And then I sang a song – I have never led a song any time – and I asked everyone to sing with me and praise god. And we did, three songs, and then we all felt more calm.”
It is so encouraging to see the positive changes in our trainees, and to hear that our participants are taking the techniques back to their homes, churches, workplaces. Giving the people of Haiti practical tools for their own emotional healing, and empowering them to teach these tools to everyone they meet, will, we hope, help the Haitian people heal themselves.
Photo by Mark Silverberg for CMBM
Training Haitian Healers: Father Fredy Stops By
© CMBM
“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.
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.
Haiti's Earthquake Anniversary: Building Blocks
© Mark Silverberg for CMBM
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– Linda Metayer, our Haiti program director, and I–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, a suburb of Port-au-Prince that is a city of half a million.
Headaches have intensified, and sleep is ever more disturbed by sudden awakenings and half remembered nightmares. Irritability and anger sweep people away in rage at children, who are themselves agitated by neighbors who are too close and too ever-present, too troubled and helpless, too painfully mirroring their own suffering.
Everyone knows in their bodies, as well as from the calendar, that the anniversary is coming, but there is little plan for public ceremony that might make remembrance and mourning easier, and bring hope for a happier future. The program that Linda Metayer and Rene Domercant (a Ministry of Health official who attended our first training in December) have organized at the General Hospital is a happy exception.
After an introduction by Dr Jocelyn Pierre-Louis, one of the Ministry of Health’s leaders and a strong supporter of CMBM’s program, Linda, Rene and I speak. Our talks are nicely paired: Linda and I discuss the extent of psychological trauma and the practical steps people can take to heal themselves and their communities psychologically, and I teach slow, relaxing soft belly breathing and get everyone to move their body. A number of these professionals appreciate the immediate effectiveness and ease of the techniques – “I feel so calm,” says one; “So calm I went to sleep,” adds another, and everyone laughs, recognizing the tension that keeps them awake and the need for rest. “I felt tears come,” another woman adds – all the emotion that needs to be released, I suggest, and she nods.
Afterwards Rene, who is an engineer as well as a psychologist, shows slides from a manual for safe rebuilding: foundations propped and buttressed so they are no longer unbalanced and unstable, second stories supported by first floors that have sustaining walls. Each slide is paired a “Don’t” in red which can lead to collapse in a future earthquake, a “Do” in green – the safe way to sustain a dwelling and save lives. These slides will be shown everywhere in Haiti and distributed in booklets, Rene tells us.
What a pleasantly surprising symmetry and pairing: principles and building blocks for new safe houses, and for emotional and physical self-care–a hopeful beginning for the new year.
© Mark Silverberg for CMBM
To be continued tomorrow–the anniversary of the Haiti earthquake . . .
