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August 12, 2008

Study Shows Mind-Body Medicine Works on PTSD

Dr-James-Gordon-MD (Just what we've been talking about, and who we've just been talking about as well.  Heh.  Love that.  So confirming...)

Read down and see how therapeutic this would be for people in rural communities, with little or no access to the VA, who are in therapy or not, for DIY types and those who prefer to access healthcare through a practitioner of one kind or another.  Just wonderful... and we knew it all along :-)

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The Washington, DC based Center for Mind-Body Medicine (CMBM) announced today the publication of a landmark study on the use of its comprehensive, non-drug model to treat posttraumatic stress disorder (PTSD) in war traumatized children. The study, “Treatment of Posttraumatic Stress Disorder in Post-War Kosovar Adolescents Using Mind-Body Skills Groups: A Randomized Controlled Trial,” which was published today online in the Journal of Clinical Psychiatry is the first randomized controlled trial (RCT) ever of any intervention with war traumatized children. It is also the first RCT of a successful, comprehensive mind-body approach with any traumatized population.

The study demonstrates that the Center’s groundbreaking model can be used to produce highly significant and lasting changes in levels of stress, flashbacks, nightmares, and symptoms of withdrawal and numbing in highly traumatized children – those who lived in an area of Kosovo where in 1999 90% of the homes were burned and bombed and 20% of the children lost one or both parents.

 The CMBM approach includes self-expression and mind-body techniques and was offered to these children over 12 sessions in an educational, supportive small group setting. Eighty-two high school students in Kosovo participated in the study. The program was conducted by teachers and included meditation, guided imagery, breathing techniques, and biofeedback as well as self-expression through words, drawings, and movement. All the students met the criteria for posttraumatic stress disorder (PTSD) which was measured using the Harvard Trauma Questionnaire. Following the program, the number of students having symptoms indicating PTSD was significantly reduced from 100% to 18%. The reduction in symptoms was maintained at a 3 month follow-up. The improvement in PTSD symptoms was significantly greater compared to a similar group of students who did not participate in the mind-body skills program. This is the same model that CMBM’s founder and director, James S. Gordon, M.D., describes in detail in his new book, Unstuck: Your Guide to the Seven Stage Journey Out of Depression.

“This RCT,” Dr. Gordon, the lead author, says, “is important because it provides scientific evidence for the efficacy of a model that has been taught to almost 3,000 health and mental health professionals and educators worldwide. We’ve used this small group model to give tens of thousands of children and adults practical tools that help them to feel better quickly, and we’ve taught them to use their intuition and imagination to solve problems that had seemed overwhelming. We help traumatized people around the world to draw on strengths they may have forgotten they have, and we offer them a ‘safe place’ in which they can share their pain with others who have suffered as they have.”

“This model is educational, non-stigmatizing, and powerfully effective. It can be easily taught and can be used by people of all ages on their own,” Dr. Gordon explains. “It’s highly acceptable to populations which do not want to be given medication, those with no access to a doctor or therapist, and those who are in psychotherapy.”

This model, which Dr. Gordon presents in a step-by-step self-help format in Unstuck, is currently being used by CMBM with war traumatized populations in Israel and Gaza as well as in post-Katrina southern Louisiana. It is widely used with anxious and depressed people and those with chronic illness in the US, and has already been incorporated as a stress reduction program for students in a dozen US medical schools.

The CMBM model is also of increasing interest to the US Department of Defense and the Veterans Administration. “The military,” Dr. Gordon says, “understands the breadth and depth of the psychological crisis (as many as 300,000 returning veterans are expected to have posttraumatic stress disorder or major depressive disorder, and another 320,000 will have been made vulnerable to these conditions by traumatic brain injury). The military’s leadership is committed to finding evidence-based approaches, like the one taught by The Center for Mind-Body Medicine, that can make a difference for the individual veteran and his/her family, an approach that can be taught to the large numbers of professionals and peer counselors who serve them.” More than 100 health and mental health professionals who work with the military are expected at the next CMBM training in mind-body medicine on October 25-29 in Minneapolis, and many more are expressing interest in learning and using the CMBM model.

For more information about the upcoming training, click here,  or to order Unstuck: Your Guide to the Seven-Stage Journey Out of Depression", please email The Center for Mind-Body Medicine (CMBM) at mindbody@cmbm.org or visit www.cmbm.org.

July 03, 2008

Find the Cost of Freedom, Buried in the Ground

Censored Truth It's an old Crosby, Stills & Nash song, by Steven Stills. Many of us who were there in the 70s still remember the words. I know I can recite them from memory: "Find the cost of freedom, buried in the ground. Mother Earth will swallow you; lay your burdens down."

Tomorrow is the Fourth of July.  Not only my favorite holiday the whole year through -- sorry, I'm a New Englander, we're just born that way -- but also another opportunity - along with Memorial Day, and Veterans Day - to stop and honor the service of those who sacrificed their lives for freedom, or at least, responded to what they saw as the call of duty that they responded to, while others did not. Those whose blood was shed on American soil -- in Lexington, Massachusetts, in the Revolutionary War -- and also, more recently, in the jungles of Vietnam, in the mountains of Afghanistan and in the sands and urban jungles of Iraq.

I'm thinking today about censorship -- and the power of an image to convey, in a single instance, what those of us who labor over our words perhaps never can.  The picture, they claim, is worth 1,000 words -- perhaps because it communicates, in an instant, across barriers of language, space and time -- what human beings instinctively understand, nonverbally.  With war: that there is a price; that it is never really glorious; that those who give their lives often do so -- as the poet W.H. Auden wrote about the famous art masterpiece, the "Fall of Icarus," by the Dutch painter, Brueghel -- in a depressingly inglorious context:

"About suffering they were never wrong,

The Old Masters; how well they understood

Its human position; how it takes place

While someone else is eating or opening a window or just walking dully along...

If you don't remember the Greek myth of Icarus you might need some refreshing.  He's the pre-Wright Brothers son of Daedalus, whose father built him a pair of wings, in order to take flight and escape from the island of Crete.  But the father glued the wing feathers in with wax, and then warned his son not to fly too close to the sun (probably without explaining actually why.)  Icarus partially succeeded in his goal -- he was able to fly, but in flying, did get too close to the sun -- at which point the sun's rays melted the wing feathers' wax and he literally dropped out of the sky, into the ocean -- having succeeded in his fabulous quest and also painfully failed, all at the same time.  That's not the parallel with the armed forces: the parallel worth drawing here is that sometimes death on a glorious "mission" turns out to be a most pedestrian thing, and the rest of us, unless we're apprised of it, don't even notice or celebrate.  On a deeper level, it brings up the question: as Americans, how exactly do we "support the troops," if we're not even really aware of what they're up against?

Unlike Vietnam, where grainy black and white news footage of U.S. soldiers fighting and dying in foreign jungles was often watched during dinner, with Walter Cronkite narrating -- in Iraq and Afghanistan, we're reduced to very little coverage and certainly not much that could "upset" our "overly tender sensibilities."  No flag-draped coffins being offloaded at Dover Air Force Base, instantly communicating that for every loss in combat there's a grieving, distraught family and a hole in the community, left by that veteran, that will never be filled.  Even those, like me, who don't exactly excel at math -- we're more than dimly aware that for every servicemember KIA -- or killed in action -- there are scores more wounded and disfigured for life -- emotionally scarred (invisibly) as well as visibly.  The human costs are staggering: those are daddies and mommies, sons and daughters, brothers and sisters, employees and employers who come home different: maybe unable to work, maybe unable to function - initially or long-term; maybe unable to take care of their families while they struggle with their own wounds of war.  This is the human cost of war: it exists whether we are personally dialed in to it and aware of it, or not.  It is, to use the words of Hedley Peach, a "generic effect of combat."

And while the news media gives scant coverage to what is happening in the conflicts in Afghanistan and Iraq, as surely as the hands of our clock tick daily the minutes and the hours, somebody's sons, daughters, brothers, sisters, fathers, and mothers are dying, and being injured -- somewhere.  We can be for or against the wars -- forget that noise for now -- but at the very least, we ought to be for the veterans.  And their families.  If what happens is fully what they signed up for: so be it.  I'll say this for myself, if no one else: They're better people than I am.  If it's not what they bargained for: even more reason to feel compassion for what they're going through.  But here's a pretty elementary principle: if we don't see it, we can't grasp it -- and we move on with our lives as though nothing were really happening.  No coffins at Dover? No bodies on the news?  I guess this war isn't really costing that much in human terms after all...it's just another blip on our radar, hardly making a difference among the rest of the pronounced concerns of our lives and welfare.  Except that it IS happening -- and men and women are dying, and being injured, often grievously -- and we're, generally speaking, like the villagers in the Icarus poem, above (read the whole thing) pretty unaware of how that affects us, or if it even does.

And THAT is where journalism comes in, and photojournalism -- to convey in a single image, what dozens of column inches can barely touch.  A single image that resourcefully, potently conveys the reality of life and death on the knife edge, on the tip of the spear -- somewhere around the globe, and challenges you, me, us -- the viewer -- to say that it matters, and that we finally understand.

Maybe that's why in every craptastic Third World-ish revolution, they always kill -- um, that would be the military who does the killing -- the intelligentsia -- the artists, the poets, the thinkers, the intellectuals -- first.  Because I guess if you even goad the populace at large to think, why, you're a highly dangerous individual, and should be stopped -- before you can do any more harm (I mean, good.)

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Want a riveting image, that "stops the presses," and conveys for all time the intrinsic truth -- or at least, one powerful truth -- about an experience?  Turn to a photojournalist.  I've read more words than I can think of in my time, but if you want to know what I remember -- it's the images, often Pulitzer Prize-winning, from the eras of our shared experience.  Vietnam? It's the naked young girl, covered in Napalm, running from her burning village.  (We dropped the Napalm, btw...) Famine in Africa?  It's the buzzard, waiting for the tiny dark baby with its protruding ribs to just "hurry up and die, wouldja?!" so the buzzard could eat it.  (The photographer who shot that amazing scene, and won a Pulitzer Prize for it, later killed himself -- perhaps because those who witness tremendous suffering, also suffer tremendously themselves.)

---

I'm not going to say who it is, because -- call me a fatalist -- I don't want to wake up tomorrow and find out that he's dead.  ESPECIALLY not on the Fourth of July -- that would be offensive in the extreme.  But the other day, some well-known and ridiculously good photojournalist blogrolled me -- stuck a link to this blog on his blog -- and I checked it out, to see what his stuff was like -- and of course it was riveting.  He's an embedded photojournalist in Iraq, or was, I should say, until the Marine brass apparently got fed up with him, and summarily pulled him out of his embedded assignment and out of the country.  His only offense, from the sounds of things?  Shooting the aftermath of a suicide blast in Ramadi -- you know, the Anbar province -- the Sunni triangle -- the previous hotbed of violence in Iraq -- which if we're to read the mainstream media, why, all that has calmed down considerably from a few years ago, and there's hardly anything brewing there at all.  Well, except for the lives of scores of people who died there, INCLUDING MARINES, in a suicide bombing just last week.  This guy documented it -- as sensitively as one could, given the horrific nature of the scene -- and he expressed the emotional toll it was taking on him, as no other experience had.  And somebody in the Marine Corps upper echelons took offense at what the rest of us call -- oh, I don't know -- the First Amendment -- and took steps to pull him out of there, on the double.

Let's HOPE the guy lives long enough to evacuate safely.  Really.  And then let's hope he still gets to show what he shot, at great personal cost -- because some of the rest of us (it's a refresher course: we're called Americans) want to actually SEE the cost of freedom -- in a way that those of us who don't serve, don't know; and those of us who do, and did -- know only too well.  It's only fair.  If we sanitize the living daylights out of these wars -- for what? -- not only will the American public not "get" the tremendous price paid by those serving AND their families; they won't be as compassionate to the same people afterwards as they need to be.  It's in all of our best interests to actively fight for, and preserve, the freedom of the press.  And that means photojournalists, who document war's horror, sufferings, and triumphs in a way no print journalist could ever begin to approximate.

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For my part, when I saw the photos in question the other day, I had myself a good, therapeutic, and instantaneous cry -- not just for the crumpled bodies of THOSE Marines on the ground -- he was subtle, nuanced and concerned enough not to show their faces, or anything else that identified them -- but for all the others I knew and knew about, who'd fought, been injured, or died there -- or returned home, not quite as intact, in body or soul, as when they'd left.  To deny us, as Americans, the chance through images like this to share the plight of those who are fighting on our behalf elsewhere in the world, is to deny us the chance to share what servicemembers are going through; and to deny them the chance to know that somewhere out there are people who "get," admire and respect the tremendous price they've paid through their service.

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The Marine Corps, which wants to sign more patriotic young sons and daughters up to fight, apparently thinks that by constraining the version of what reality is to just a portion of the whole will keep them happy and us in the dark, and people like this brave guy, the photographer, well, in complete limbo.  Little do they know that the patriots will still fight, but the rest of us could use an education course in compassion, sensitivity and yes, tenderness for those who've fought in battle, that only comes through expanding our horizons, and by facing the whole truth of what they're really going through, as combatants. Don't sugar coat the truth: everyone who goes to war comes back changed -- that's just how it is.  Let's develop a compassion and an understanding for what they go through, not sweep it under the rug.  The death and injury of those with whom they serve is often the most scarring aspect of combat there is.  Just ask those who've never been the same since.

So especially on this Fourth of July, as one extraordinarily talented photojournalist sits in limbo, let's hope still alive, ripped out of the fight for no other reason than that he was getting a little too close to home in showing us what war is really like -- I'm appalled to think that as Americans, we're not being trusted with the whole truth, when it's expressly the whole truth that we need, as Martin Luther King once said, to set us free.  We need to know the human costs of these battles we're in.  And suppressing the images of that just harms our servicemembers and their families, and cripples the compassion of us as a people.

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Until I looked it up just now, I didn't realize that Crosby, Stills and Nash song had other lyrics.  Apparently it does.  Besides the chorus (above), which I remember so well, there's another verse as well:

Daylight again, following me to bed
I think about a hundred years ago, how my fathers bled
I think I see a valley, covered with bones in blue
All the brave soldiers that cannot get older been askin' after you
Hear the past a callin', from Armegeddon's side
When everyone's talkin' and no one is listenin', how can we
decide?

On the behalf of all those "brave soldiers that cannot get older," could we at least not suppress and crush the efforts of those who are trying to get us to see the whole truth?  What truth is that, you may ask?  The very cost of freedom, buried in the ground -- in Iraq, in Afghanistan, and in Vietnam beforehand. Godspeed, Z.  You are a witness on ALL of our behalf, to the price that war really exacts, on those who serve in it.

June 15, 2008

Mind Body Medicine: Healing the Wounds of War

When I started this blog over two years ago now, I was hoping that somehow James S. Gordon, M.D., and the Center for Mind-Body Medicine which he founded in Washington, DC, would somehow get involved in the prospect of bringing mind-body medicine to the troops.  Gordon is a Harvard-trained psychiatrist, with impeccable credentials, who has a lifetime interest in expanding patient care into new areas, particularly Complementary and Alternative Medicine (CAM), and mind-body medicine in particular.  (Mind-body medicine is a shorthand way of re-combining the two "halves" of medicine perhaps unjustly sundered in an arbitrary Cartesian mind-body split.  Much of Eastern thought, rather than Western, never saw them divided at all.)  In a previous lifetime, where I interviewed luminaries in the natural medicine field, Gordon was a favorite interviewee - smart, genial and with a very forward-thinking grasp of what mind-body medicine could accomplish.  Gordon, who was featured in the Bill Moyers series on PBS, Healing and the Mind, was a frequent lecturer at the Smithsonian Institution in Washington, DC, and for years had served as the head of the White House Commission on Complementary and Alternative Medicine.  He is also a Clinical Professor in the Departments of Psychiatry and Family Medicine at Georgetown University Medical School.

But more to our purposes, when war broke out in Kosovo, he and the Center for Mind-Body Medicine (CMBM) took their methods into the region, creating a program called "Healing the Wounds of War," to help war-torn schoolchildren and their caregivers manage the trauma they had undergone, through a sustained, devastating conflict.  What I was hoping -- and I kept checking the CMBM website periodically to find out -- was that they would leapfrog off their successes with PTSD in Bosnia and Kosovo, and Israel and the Middle East, and develop something geared to PTSD in servicemembers, and the conflicts in Afghanistan and Iraq.  For years, nothing was obvious (yet), but here's some of their success with children in Kosovo.  Notice what symptoms the program helped with, how impressive the statistics are, and make the conceptual leap to how this might help with combat veterans and/or their families:

The clinical efficacy of the CMBM program with traumatized children has been repeatedly demonstrated. In a pilot study in which high school teachers in the Suhareka region of Kosovo used the CMBM model, levels of posttraumatic stress disorder in high school students were reduced from an average of 88% to 38% in only six weeks (read the research, published in Journal of Traumatic Stress, April 2004, linked here). Participants have also reported the following documented effects of CMBM trainings, including: the alleviation of their own stress and trauma; decreases in anxiety and depression; increased optimism; decreased anger; and increased capacity to help others.

You can read more about the program's specific successes, here.  Or, you can read a general overview of the program and what's involved, here.  You can also read Dr. Gordon's bio, here.

June 11, 2008

Israeli Military's Proactive Plan for Identifying and Treating Soldiers Who Have PTSD

Here in the U.S., in our usual myopic way, we can get bogged down in the news about returning servicemembers with combat trauma and PTSD and forget just how many other countries in the world have struggled with this problem as well, and often found their own solutions.  Internationally, Japan, Israel, Australia, England and Canada frequently search the Internet for news about who's doing what, and what's working, for treating PTSD worldwide -- according to data from Google's analytical trends.  Today, the Jerusalem Post has an article about how Israel's Defense Ministry is about to unveil a plan for evaluating and treating soldiers systematically who have been exposed to PTSD as part of their military service.  (The article in question is linked here.)  Their expectation is that 2,500 Israelis suffer from PTSD, in a country where military service is compulsory, and conflicts in the region frequently boil over into sustained violence. 

The significance of the Israeli announcement is that the soldiers will be treated according to a "set psychological and medical format," meaning systematically and methodically.  Their understanding is that PTSD treatment succeeds better if initiated earlier, so evaluating all soldiers soon after military service will increase the chances of favorable treatment outcomes.  According to the article, three years ago the military started thinking through how to create a protocol that would involve every soldier, and optimize chances of finding and treating PTSD.  The protocol was developed by Zeev Waisman and Dr. Dan Dolfin.

Two interesting comments from the article express a vision that the U.S. might be wise to emulate:

"A soldier who comes out of battle will immediately be evaluated and we will see what type of treatment he needs," Waisman said. "Nothing is done today in a regulated fashion and we want all treatment to be according to a protocol."

The process begins by inserting the soldier's profile into the system which will then offer several courses for treatment that could include medicines, psychological therapy, family therapy, sex therapy and others. Waisman said that the Ministry of Defense hoped to convince other organizations to adopt the new format which will be evaluated in two years.

Stateside, it's not even clear that the various branches of the Armed Forces share a similar protocol for identifying and treating PTSD -- most likely, they do not.  With far more servicemembers at risk for PTSD than the Israelis have, we could do worse than to imitate what the Israeli Defense Ministry is putting into action as a plan to deal with PTSD, and return exposed servicemembers to better mental and emotional health.

May 30, 2008

Professor Hedley G. Peach (Australia)

Hedley Peach BSc(Hons) (Wales), MBBCh (Wales) PhD(London), FFPH(UK)
University of Melbourne

(Retired) Professor, School of Public Health, Queensland University of Technology, Kelvin Grove, Queensland, AUSTRALIA.

Professor Hedley Peach is a Visiting Consultant at the Ballarat Base Hospital, and Professional Fellow at the University of Melbourne.

Professor Hedley Peach qualified as a doctor in Wales where he became interested in the social causes of illness. This interest led him to train in community medicine at the renowned St. Thomas's Hospital in London where he worked for seven years as a lecturer/senior lecturer. In 1985 he migrated to Australia where he was Foundation Professor of Tropical Health at James Cook University for three years and, subsequently, Professor of Community Medicine at Melbourne University for fourteen years. He retired earlier this year but continues as an honorary Professorial Fellow of Melbourne University. He has been interested in the nexus between religion, spirituality and health for a number of years. In 2002, he wrote the first article on this topic to appear in the Medical Journal of Australia to stimulate debate on how the medical profession should respond to research and recommendations from the USA. He has authored book chapters and papers on spirituality and women's health, the religions of rural Australians, and other topics. He has given many radio and newspaper interviews on spirituality and health. He is the author of several books, including The Epidemiology of Common Diseases and Disablement in the Community, as well as the leading author of more than 100 articles in scientific journals. He is a member of the National Heart Foundation's expert group on psychosocial causes of heart disease.

May 08, 2008

Dr. Ecstasy Will See You Now