From war to ward

James Gordon talks to ‘The Jerusalem Post’ about his treatment protocol that some call radical, his journeys, and why his methods are now being tested on American troops.

By LAUREN GELFOND FELDINGER
James Gordon at a training session in Haiti. (photo credit: Courtesy)
James Gordon at a training session in Haiti.
(photo credit: Courtesy)
He is not your typical psychiatrist.
James Gordon, a 69-year-old clinical professor of medicine and psychiatry at Georgetown University, darts his hands around as he describes how characters from Keats, Dante, Shakespeare, Dostoyevsky, Greek mythology and the Torah discover purpose and deal with trauma.
This Jewish, Harvard-educated scientist, who once chaired a US presidential medical commission, also finds inspiration in Chinese medicine and martial arts, Buddhist meditation, Sufi whirling and traditional Indian healing practices.
After a four-decade career, the influence of his unconventional teachings reaches today across Israel, Gaza, Bosnia, Kosovo and Haiti, as well as US medical schools, slums, homeless shelters, psychiatric and cancer wards and disaster areas from post- September 11 New York and post-Katrina New Orleans. He also worked in Louisiana after last year’s oil spill.
While the concept of integrative medicine – combining Western science with complementary worldwide practices – has become somewhat better known in recent years, Gordon is the first to integrate his teachings into a nonprofit organization that takes the approach on the road, training teachers, doctors, psychiatrists, psychologists and counselors around the world to help trauma victims help themselves.
In the most unlikely places, clinicians trained by his US-based Center for Mind- Body Medicine are teaching severely traumatized men, women and children to meditate, dance, paint, build family trees, change eating habits and use guided imagery, as self-help tools. In private consultation, he may also encourage the use of vitamins and minerals, Chinese herbs, acupuncture and yoga, long before, if ever, suggesting psychotropic drugs like Prozac for depression.
Empowering patients with self-care techniques should be fundamental to all of healthcare, he says. He outlined his approach in his 2008 book, Unstuck: Your Guide to the Seven Stage Journey Out of Depression.
Some colleagues in psychiatry and medicine call him radical; QuackWatch lists him as a doctor who exaggerates “aberrant alternative practices.”
Gordon laughs at such characterizations and pulls studies from medical journals out of his briefcase showing that patients with depression and post-traumatic stress symptoms and disorder are making significant and lasting improvements with this model.
The most recent study, published in late June by the American Psychology Association’s International Journal of Stress Management showed that 10 sessions organized by Gordon’s CMBM team in Gaza produced an 80- percent improvement in post-traumatic stress disorder symptoms and significant decreases in depressive symptoms and feelings of hopelessness. At a seven-month follow up, the improvements were largely maintained.

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Gordon's journey as an iconoclast started early, as a child in New York City. By 13, he was studying Plato and thinking, “Wow, what a great job Socrates has, asking such interesting questions and helping people to think... Does he get paid for it?”
In high school, he rode the subway from school, listening with rapt attention to the stories of the homeless whom almost everyone else around him treated as invisible. At Harvard College, reading world literature, including Dante’s Divine Comedy in the original Italian, inspired him to see a connection between the poetry of human drama and self-healing.
But as a medical student in the 1960s, he experienced an identity crisis, spending long hours doing lab work that seemed disconnected from the healing of human spirit he was hoping to effect. He fled back to New York, did research and autopsies to support himself, and looked up one of his heroes in psychiatry: Robert Coles, who spent much of his time in psychiatry doing public service, including volunteering with African-American children dealing with the South’s first school integration in New Orleans. Coles’s work as a psychiatrist, combining science with talk therapy, public service and writing, inspired him to go back to Harvard and stay on course.
After graduation in 1967, followed by a summer medical internship and volunteering at the famed San Francisco Haight Ashbury clinic, where hippies often showed up on bad acid trips, he returned to New York for his psychiatry residency. As chief resident in 1970-71, he developed his first alternative treatment model. Inspired by a program psychiatrist RD Laing had set up in London, Gordon’s program treated psychotic and severely depressed patients largely without drugs.
But with the Vietnam War draft lottery in place, he knew that doctors would be called to serve unless they resisted, left the country, could prove they were unfit or were accepted into the US Public Health Service.
“I was completely against the war and knew I was not going to enlist,” he says. “I knew I was not going to Canada, I knew I wasn’t crazy or a conscientious objector – I would fight in a just cause – so I had two choices: the Public Health Service or jail.”
Gordon was accepted into the USPHS as a research psychiatrist at the National Institute of Mental Health, working with runaway and homeless children. In his first national effort to reconsider the patientdoctor relationship, he taught the staff counselors to help children understand and take responsibility for themselves rather than label them with a disorder or consign them to the criminal justice system. He also encouraged counselors to engage parents and their children in making decisions about their future.
By the end of the 1980s, after working in private practice, writing and research, he decided to implement his ideas on a larger scale. In 1991 he founded The Center for Mind-Body Medicine to work with medical schools, hospitals and community caregivers. Eventually he started traveling to war and disaster zones, to see if his models could also help the populations there.
By 2002, during the height of the second intifada, Israeli and Palestinian psychologists who had heard about Gordon’s work in Kosovo contacted him independently and told him about the high levels of post-traumatic stress in their communities. Since then, he has been to the region at least 15 times.
On his most recent trip to Gaza and Israel last month, Gordon spent an afternoon talking with The Jerusalem Post.
You started reforming the patient-doctor relationship protocol already in the 1970s, giving patients much more control. How radical was and is that?
Quite, then, and even more now; people who are psychotic or seriously, moderately or even mildly depressed are usually given drugs right away. I thought we could help them find another way... Medication has side effects and often shuts people down emotionally. My focus is respecting people’s capacity to help themselves and facilitating this in their homes, families and communities, as well as in a hospital setting. There is a natural healing that can happen. That can be aided by meditation, exercise, yoga, tai chi, art, dance, herbalism, guided imagery and group support.
The thinking in psychiatry has been that psychological disturbances are biochemical; can biology be altered solely by behavior or talking?
The evidence that depression is purely biochemical or strongly influenced by genetics is not very robust. More importantly, the anti-depressant drugs being given in such huge quantities – to 30 million people in the US – which are presumed to correct a deficiency in the brain chemicals (neurotransmitters) serotonin and norepinephrine, are proving in most recent studies to be little if any better than placebo sugar pills. There are many ways to affect brain function and structure, and drugs are a crude one with many dangerous and damaging side effects and should be used as a last resort, not a first choice. In the case of PTSD, there is no evidence that drugs are of much use. Several good studies show that our method works as well as or better than any other.
Studies have been done on psychotherapy showing changes in the brain. If we talk and create an atmosphere of loving acceptance, there is likely to be a biological response: stress responses quiet, heart and respiratory rates go down, cortisol – the stress hormone – decreases. Areas in the frontal cortex that are associated with positive emotions are activated on an MRI and PET scans. You can see decreased activity in the amygdala, associated with fear and aggression. Psychotherapy has been shown to alter brain function in ways that are different from antidepressant drugs, and the changes in functioning have been correlated with clinical improvement.
Psychotherapy and mind-body approaches create positive changes in brain functioning and clinical status with no negative side effects, and improvements in people’s sense of control over their own lives and hopefulness. They have now been demonstrated to help with physical and psychiatric problems, from irritable bowel syndrome and migraines to high blood pressure, depression and anxiety.
You say that the approach improves people’s feelings, even their biochemistry. Can it also change their behaviors?
As you come into a more aware, relaxed meditative state, instead of reacting to stressful situations, you watch your emotions and relax with them. You become aware of and get perspective on preconceptions and prejudices and don’t take them as gospel. Teachers, for example, report that the children are less aggressive and more able to concentrate.
Who cannot be helped with your model?
Some people at the moment are not reachable – they are not open to talking or learning. But even people who are psychotic or children with Down syndrome, for example, are able to make use of these approaches.
You have worked in countries where there is a stigma about psychiatrists and psychologists or showing weakness. How do you work around that?
The process of talking is easier in groups of peers. In Kosovo, there was a 16-year-old; his family went to Albania, but he wanted to stay and fight. The Kosovo Liberation Army had told him he was too young... During the day he had to hide so the Serbian soldiers would not kill him, and at night, to help his comrades, they asked him to bury bodies of the dead.
After the war, this former A-student [was] now failing, anxious, withdrawn; his teachers asked me to talk to him. He said that at night he had dreams of mutilated bodies with hands reaching from graves and that sometimes this dream came to him during the day. He said, “I’m different than everyone else.”
I invited him to meet with a group of about 20 kids; I first taught deep breathing and then asked them to introduce themselves and, if they wanted, what happened to them during the war. The first said his house burned down and he was staying in a tent. The second said he saw his father shot by Serbian troops. The third said the paramilitary troops molested her. They went around the circle and he was last. He said, “I feel sad for all of your experiences, and excuse me for smiling, but for the first time since the war I don’t feel so weird.”
He went into one of our mind-body groups for 10 weeks. He began to sleep at night and his grades climbed back up. My experience has often been that if you can create this place where people feel safe, where they hear that others have experienced something similar and discover that nobody is going to judge, then they can share their feelings – this is powerful medicine.
How much are your theories embraced by the medical establishment?
In early days, some colleagues thought I was a pioneer, others a radical and some said I was “disturbed.” But it was clear to me from my own experience and the research literature [that] self-care should be taught by every medical school, that it should be central to everyone’s medical care and taught to every child.
There has been some shift in medicine, but the most profound change in medicine is yet to come – the shift from seeing medical and psychiatric care that experts do “to” or “for” other people to helping people help themselves. Medical students should learn the fundamentals of self-care – mind-body approaches (meditation, guided imagery, biofeedback, self-expression in words, drawings and movement), nutrition, exercise, and group support – as a basic part of their curriculum, so they can learn to help themselves and then teach this approach to their patients.
How did it go, moving from the US psychiatric/ psychological circles into war zones?
First I went to Mozambique after the revolution and civil war and met former child soldiers... I met victims of apartheid in South Africa... I went to [post-war] Bosnia where 200,000 people died and where there was ethnic strife for hundreds of years. I saw how the symptoms of war-related trauma become fixed: hypertension, insomnia, depression, PTSD... and these led to behaviors including alcoholism and off-the-charts abuse of women and children by men who never did it before. People were frustrated, angry and felt inadequate.
When the war began in Kosovo in 1998, a colleague and I began working right away; we used our techniques with people driven out of their homes by the Serbs. During the NATO bombing, the British gave us money so we could train Kosovar refugee physicians in Macedonia. After the bombing we trained 600 clinicians and teachers in Kosovo.
One of the skills you teach is guided imagery. I interviewed a former Israeli POW who described how, when tortured, he learned to separate his physical environment from his mind, to transport himself to a place away from the pain. I understand that some rape victims also do this. How common is this in trauma victims, and how hard a skill is that to teach?
This kind of dissociation is an almost automatic response to overwhelming trauma. We teach people to use this capacity consciously with guided mental imagery. This is actually a really easy skill to learn, especially for children, to use the image of a safe, quiet place where they can go when things threaten them. This creates physiological relaxation and a feeling of control. Slow, deep breathing is [also] a simple, effective way to cope in situations where there is very little you can do externally. It lowers feelings of fear and anxiety; it doesn’t make explosions go away, but removes the overwhelming feeling of terror and powerlessness. Doing these techniques with a group overcomes isolation, which is [also] so crippling.
The US Department of Defense heard about your work and gave you a grant for $400,000 to study whether your program could help traumatized war veterans from Iraq and Afghanistan. Is it different working with this population?
Veterans from all different wars have been coming to trainings and staying in the groups we run. They are practical people who appreciate learning concrete skills they can use, and they appreciate the fact that nothing goes into their record about receiving mental health care. Nobody is pushing them to come.
A RAND Corporation study found that 320,000 US military [personnel] will likely have PTSD or major depression by the time our wars in Iraq and Afghanistan are over. These are serious numbers. There will also be another 300,000 with traumatic brain injury, who are also likely to have symptoms of PTSD and depression. Many of these men and women are morose, easily moved to anger and withdrawn. This isolation is one of the reasons it is so important to work with groups.
The dynamics with US veterans are similar to those Israelis who are traumatized by shelling, or people from Gaza traumatized by the death around them, or people living with chronic and lifethreatening illness – we are raising funds for a training next summer for Israelis and Palestinians who work with people with cancer and their families.
You also work with Israeli and Palestinian trauma victims. How did that start, and how is it going?
In 2002, I got letters from Israeli and Palestinian psychologists. They said they were skilled and well-trained but were overwhelmed by the current situation, particularly the anger and distress of the children. I came to see if I could help them use our model. In 2004, we set up in Israel; we’ve now trained 400 professionals, including 100 school counselors, and we’ve worked in Sderot, Ashkelon, Ashdod and the North. Our Israeli team has done wonderful [things] in the Ministry of Education schools, in areas hit by shelling by Gaza and Hezbollah, and in hospitals and HMOs. Sadly, though, we haven’t had the kind of funding we’ve had for Gaza, so we haven’t been able to make the program as widely and easily available as we would like. The need is still great, but the progress is slow.
In Gaza, we’ve trained 230 and are now training another 180 in schools, clinics, hospitals and trauma centers. We’ve had adequate funding in Gaza, so we’ve been able to provide ongoing supervision and psychological support for everyone we’ve trained. We’ve now worked with about 40,000 kids and adults, and we’ll reach another 20,000 next year.
Initially some people wondered why an American Jew would come to Gaza, but the welcome has been incredibly warm. What’s amazing is how open everyone has been [to] what we have to offer and how quickly they learn the techniques. One day, this guy lost his home and was running around the rubble. We went to talk to him and tell him about our work; he said, “Please help me.” The Gaza team started a group two days later; about 20 members of his family showed up.
What do the people of Gaza and Israel have in common?
They are much more alike than they realize. For example, there is a myth present in both cultures that the “other side” doesn’t care about its children; this is totally untrue. Both populations are traumatized and feel like victims, both tend to be defensive and feel isolated, and both seek out help more for their children than for themselves. Also, both sides have difficulties getting beyond their preconceptions that others cannot understand what they are going through. It doesn’t always seem that way, but there is also a strong commitment to spirituality and living an ethical life in both Israel and Gaza.
Some Israelis charge that the situation of despair in Gaza is exaggerated and circulate pictures of Palestinians laughing and shopping; some Palestinians say rockets attacks on Israel are exaggerated, calling the rockets tiny, weak and misguided. Most Israelis and Palestinians in Gaza are not legally allowed to travel to each other’s territory and only know about the other through their media, which are also not reporting live from the other side. As the rare person who has spent extensive time on both sides of the border, what are your observations?
In Israel, everyone knows someone who has been injured or killed in an attack. The missiles were and are very real; I’ve seen the craters, and I’ve been shelled when I was in Sderot. Israelis are traumatized by the shelling. The missiles are badly aimed, but people have felt very much under siege and not protected. And of course there have been suicide bombers. All of this makes Israelis understandably fearful and self-protective, and it shows up in the aggressiveness of the kids. The number with diagnosable PTSD is low, but there is no question that certain symptoms of PTS, including hypervigilance and feelings of vulnerability, are widespread.
In Gaza, there is a far higher number of casualties among civilians (as well as fighters). In Gaza, however, people don’t expect their government can protect them, because it can’t. The sense of their vulnerability is all-pervasive. No one knows when the next Israeli incursion [will take] place or where. In Israel there is minimal physical destruction, and when it occurs it is quickly repaired. The damage in Gaza – destroyed homes, factories and schools, blighted fields and orchards – is everywhere, and because of restrictions and difficulty of rebuilding, the scars are ever-present reminders of loss and vulnerability.
In Gaza, of the first 500 kids and 500 adults we studied, 24 percent suffer from PTSD; 60%-70% of kids and adults know someone who was killed, and 70%-80% have seen death and destruction. Kids who come to our groups even two years after Operation Cast Lead, often cannot sleep or study well; they are often aggressive, withdrawn and wet their beds at night. There is tremendous suffering, even among the caregivers. One of our Gaza team, a social worker, was killed, and our program director’s cousin, who was not a fighter, lost a leg.
It is, of course, not like a Third World country, but it is badly overcrowded, there is massive unemployment – 45% minimum – and a great deal of suffering. Anyone who goes will see it. Yes, the people of Gaza still go to the market, drink coffee, are happy sometimes – you can see kids at the beach playing – it is a testimony to the human spirit, but not, unfortunately, a sign that life is normal. I can see and feel the vulnerability and tremendous distress of both populations.

The Center for Mind-Body Medicine's Israel and Gaza programs have been funded by The Atlantic Philanthropies, the Joint, Israel’s Education Ministry and several private American donors, with special assistance by Danny Grossman, who arranged cross-border travel permits.


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