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.
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.
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.
For two years whenever the teacher closes her eyes to sleep or rest she sees “only all darkness.” After a while of doing Soft Belly, it changes. By the second day she is “seeing colors” and pronounces herself “very satisfied.” That first night she returned home and, just as we had done in the training, she shook and danced with her surviving son. The next night, after we had used imagery, she tells him to “close your eyes and say what you see.” “A house and a sailboat,” he tells her. She is amazed. This is exactly what she had drawn in the picture of how she would be without her biggest problem. On the third day she tells her group, “My smile is back.” She brings her son to a party and we kid around and dance a bit. Her smile lights up the restaurant.
Then, on the fourth day, when I give my talk on Trauma and Transformation she finds herself, like so many others, remembering and crying. “I am afraid the crying will never stop,” she confides. That she will never again locate the smile which has so remarkably reappeared. Toni tells her that smiles and sorrows can live alongside one another in the same person, that she felt that way when she did our training after Katrina destroyed so much in her own state. She and I and our whole team have seen it in Kosovo, Israel, and Gaza, and indeed everywhere we’ve gone.
When people are frozen in shock and grief all the emotions are deadened. As our work unfolds, they recover what they have lost. Years ago, I remember teenage Kosovan girls in a refugee camp in Macedonia. When they shook and danced the tears they had held back finally came, tears for the loss of fathers and brothers dead, imprisoned, or fighting. Only after they cried could they laugh with the ordinary joy of girls.
On the fourth night, the teacher returns. She is going to partage, to share, everything she is learning with her husband.
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.
The loss of life here in Jacmel is far less than in Port-au-Prince but the burden is still heavy. There are of course the ordinary deaths that come with age, and the losses of younger people cut down by accident, sudden illness, or murder. And in the background for everyone in this coastal city, and all the surrounding communities, as well as in Port-au-Prince, is the tide of losses that came with the January 2010 earthquake. The deaths of children seem the hardest to bear.
Toni, a clinical social worker from Baton Rouge, tells me about a woman in her group–a school teacher. Her six-year-old twin sons were buried under the rubble with their father. He struggled to carry both out, but one fell under a collapsing ceiling. The father suffered a serious head injury as he carried the first boy to safety. Still, he returned to dig frantically for the fallen twin, but to no avail. By the time he reached him, his second son was no longer moving or breathing. Two years later the family is still frozen in grief. The surviving twin is furious. “Why are you alive?” he shouts, when family tension rises, at his father. “And why is my brother not? He should be alive, and you dead.” Toni and I both suspect that the boy feels guilty that he could as easily be angry at himself.
After her son died, his mother “lost my smile. When I smile now,” she goes on, “it feels”–and here she grimaces, all teeth–“like this.”
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.
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
We spend the morning at the Cardinal Leger Hospital, destroyed in the earthquake and quickly rebuilt. Haiti’s lepers come here, older people without legs , or with fingers and toes amputated by the disease; brothers 8 and 12 years old whose noses have collapsed and whose faces and hands already bear the scars of the condition.
The kindly and concerned Sisters and lay nurses who are in charge have been overwhelmed by the suffering around them—staff, friends and family killed in the earthquake, as well as by the weight of sadness their patients bring. Out in the country, living with people whose illness has wasted them, meeting acute care needs, they are clearly stretched thin.
Little by little, they brighten during our workshop, appreciating the relaxation of Soft Belly, laughing with the shaking and dancing—“The first time laughing since last January 12th,” notes one sister.
Here’s a quick video we took of participants dancing at a Port-au-Prince workshop—
Sharing their drawings, One sister notes how rigid her body is in the drawing of her “biggest problem”, and how the flower that she draws in the third picture (“the solution to the problem”), bending gracefully toward the sun, is a “lesson to remember.” Before we close, JJ teaches us all to stretch in our chairs.
Afterwards, outside, the Sisters show us the bushes blooming red, yellow, white, and orange, and reach up with a net to fetch us mangos for the road. “We will use what you have taught us, ourselves,” says Sister Yolande, the Director, “and we will teach our patients too.”
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.
On the night before his inauguration, Haitian president-elect Michel Martelly came to the Hotel Karibe, where our US team and our Haitian program director Linda Metayer were staying. He sat outdoors among us as the band began to play. There were watchful bodyguards, but also a feeling of welcome, of fraternity.
The people I spoke with were happy, excited; not just the tent-camp organizers who had always been solidly behind “Sweet Micky”, the popular singer, as President Martelly was known, but also wealthy people and the intelligentsia. There had been a shift in the weeks since the election, a sense of possibility that, freed from narrow, self-serving needs—he’d already had plenty of fame, adulation, and devotion, and had made plenty of money—he might really mean what he’d said: about rebuilding the infrastructure and making, for the first time, education available to all.
It felt important to talk to him, to tell him how hopeful we were as well as what we were doing. And so, Linda and I arrived at his table. She explained in Creole—the people’s language here in Haiti—about the Center’s work and our hopes for establishing a National Program of Self-Care and Mutual Help. “Thank you,” he said to us in English, “for everything you are doing for Haiti.” He gave us names and contact information for key advisors and the next Minister of Health, embraced us with a kind of warmth and ease that is rare in politicians.
In the background, the guitarist, Belo, was joined by backup singers and other musicians—two, three, five, ten of them. The music, a kind of joyful Haitian reggae, had us smiling and dancing. I wish you all could’ve been there. The president stayed at his table for awhile, happily greeting supporters, many of whom had returned from the Haitian diaspora, enjoying his evening and everyone’s music.
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.
Mark Silverberg is a welcome guest blogger. He is an Ohio businessman who read about our work in Gaza (in the NY Times) and got in touch. “I want to volunteer and help,” he said. “I can take pictures.” He came with us to Haiti–we saw the pictures, felt Mark’s heart, and now he is a dear part of our team. He sent us this account of his time in the tent camps.
Enjoy his story.
Jim
We hiked to three tent camps on the side of a mountain today, Thursday morning. Hot as heck. What I saw cannot be described– 13,000 people live in one camp alone. The pictures and videos only begin to tell the story. We were given a tour through the camps by the residents who are elected to help coordinate running the camps, so a school and homes were opened to us. The camp organizers kept introducing us to people and children with problems and asking us how they can help them. We suggested they apply to take the CMBM training. [Note: if this is your first time to the blog, you can read other postsabout CMBM's Haiti trainings to help Haitian caregivers help these kids & families].The visit was a very humbling experience.
An extraordinary experience on Friday morning. I went to the Champ de Mars tent camp across the street from where the CMBM training program was held at to take printed pictures to the kids and families I photographed during the CMBM training in December 2010. Laurent Sheineder helped me find all of the kids and adults in the pictures. They were very surprised to see their pictures and of course posed for many more! They told Laurent and I that of all of the people who had taken their pictures I am the only one to bring them copies. I think they must feel invisible.
by Mark Silverberg for CMBM
Then at lunchtime the organizers of another nonprofit, Zanmi Lakay (ZM) from Oakland, CA picked me up and we went to Cite Soleil. It’s the worst slum in the poorest city in the hemisphere. And we weren’t in the BAD part of the slum. This was big time scary.
ZM organizes basic needs (food, clothing, shelter, medical care, education) for homeless children in Port au Prince. Before the earthquake they had a home and facilities for many children, but the earthquake destroyed the house so the kids are spread out in three clusters in Cite Soleil and Jacmel. The kids also receive documentary photography cameras and training in their care so they can document their lives, tell their stories and express their hopes and aspirations. There have been 5 gallery shows across the US (SF, NYC, DC, Florida) to raise awareness and funds. The kids’ pictures are sold to benefit the organization that helps care for them.
So I was able to be at the first gallery show in Port au Prince, at a cyber cafe in Cite Soleil today. Forget what you think about a cyber cafe. Small, dark, a few folding chairs – but still a space for their pictures, which were taped to the wall with packaging tape. The original location where the show was to open had too many shootings, so it had to move to this new location.
by Mark Silverberg for CMBM
The kids got to see their pictures on the wall, to hear about the gallery shows in the US and the great reviews they got, received certificates for completion of their photography training–I donated items and foodstuffs from CMBM faculty and staff. They asked me to speak, and I told them about teaching photography to kids their age in a poor inner-city Cleveland neighborhood nearly 40 years ago. I encouraged them to continue using photography to express themselves and to clarify their dream, since their dream will keep them going through hard times. It was a gift to be present for the recognition of their struggles and accomplishments.
After leaving Haiti the memories of those two days kept echoing in my mind. I recalled that when I was leaving the school in the mountainside tent camp on Thursday, one of the kids said repeatedly, “We are waiting for you,”–meaning, “waiting for you to return.” On the following day when I brought the pictures to the kids and families in the Champ de Mars tent camp, their reaction was often puzzlement. I later realized it was because their expectation was for people to not come back, to not remember them or be touched by what they saw; to return to their normal lives, unmoved and unchanged.
Welcome--I hope you enjoy these stories of healing through mind-body medicine from our programs around the world. 
