Qi Unity Report interviews James Gordon, MD

Dr. Gordon is the founder of The Center for Mind-Body Medicine and author of Unstuck: Your Guide To A Seven Stage Journey Out of Depression.

QUR: First of all, how are you?

I'm fine. Ridiculously busy, but fine. Just had a wonderful-and-tragic trip to Gaza; I'm back and now trying to relate to health-care reform and our upcoming trainings—cancer guides and Buddhist medicine training—just moving along.

QUR: There's so much to do, isn't there?

There is. It's a good time, so it's fine; you just have to be careful what you wish for. . .

QUR: Right! I’m going to launch into these questions that I’ve prepared. There's a call-to-service aspect to your personal history, given your work with runaway kids, your dissatisfaction with conventional allopathic approaches to depression and your current work with the Center for Mind and Body Medicine. Can you relate some of your personal history and explain how it evolved such that you have become the bridge-building person you are now?

It's a great question. First, I hope that the call to service is what animates all of us who go into what we somewhat limply call “the helping professions.” I mean, that's why we're doing this work—to service people; and if there's any other primary reason, we've got to look at ourselves and sort it out. That's got to be crucial, because that's what makes it all a joy, and what also makes it all continually interesting. In my case what lead me to do the things that I do was that I got interested in allopathic medicine—I became a doctor to be of help to other people and also to make a living while I did it—to be with people in times that are difficult, challenging and sometimes joyous in their lives, alongside them, helping as best as I could. I was always interested in people's stories, and how listening to stories could be helpful to people…whether it was my friends, my family members or homeless people I met on the New York subway who wanted to tell me about their lives-and, indeed, about the secret of life! It seemed to be useful to them, and for me, to listen to them and be there with them. That was the motivating force.

Many of the interactions that went on in the hospitals where I was trained seemed to me unhelpful, sometimes even demeaning and counter-productive. I looked for other ways to relate to people, but as I paid closer attention to what was missing in the treatment—for other systems of healing and health care that might be helpful where Western medicine was not. That sort of inevitably led me to adapt an approach that seemed ultimately (depending on who was looking at it) either open-minded or crazy-minded.

I was young...I got interested in Chinese medicine in 1964, initially through macrobiotics. I was in medical school and had taken time out to do research, doing a pathology fellowship in New York City at Cornell, and there was the first macrobiotic restaurant in the United States, on the Lower East Side, called “The Paradox.” I would go there, and first of all I noticed that I felt better after eating brown rice and vegetables and fish. I cooked very fresh—the way they did—and thought, hmmm, that feels really good! I felt light, my mind was clear, and I didn't feel that kind of sleepy feeling I sometimes get after heavy American meals. Then I began to look at some of the literature they had on Chinese medicine, which is the basis, ultimately, of macrobiotics. I thought, my God, here's this system, several thousand years old and a whole other way of looking at the world than we do in Western medicine. People continue to use it, and this food based on this system seems very healthy and very good for me, so I should pay attention. That's how my interest in Chinese medicine started.

QUR: You describe cultural factors that lead people to seek medication as the "quick fix" for depression. Do you have any thoughts on how acupuncture and Oriental medicine practitioners can best communicate alternatives to the pharmacological fix that is so popular now? And how many prescriptions in a year of antidepressants are written?

Since I published Unstuck, in 2008, new figures have come out. In 2007, there were some 220 million prescriptions written for antidepressants in the United States, which is staggering. There are about 30 million people in the United States who are on antidepressants, and someone who's looking at the statistics might say, "Well, you know it looks like there are about 20 million people who are diagnosed with clinical depression in the United States; how do 30 million people get on antidepressants at one time or another during the year?"

QUR: That's 10% of the population.

Not only are many of those 20 million people being prescribed antidepressants; a whole host of other people who are anxious, shy, sometimes unhappy, not assertive; women who have premenstrual syndrome and others are prescribed these antidepressants, as a kind of panacea. One of the most important things [for] practitioners of acupuncture or Oriental medicine [to know] is that some of the research literature that I summarize in Unstuck essentially says: First of all, there's no evidence that depression is a disease in the same way that insulin-dependant diabetes, [to] which it is often compared, is a disease. There are no consistent physiological or anatomical changes, no post-mortem findings see[n] regularly, no strong genetic correlations, and on top of that [there are] no simple pharmaceutical answers, like the way insulin is for people whose pancreases don't function-for depression. So the evidence for depression being a disease is rather slender.

Secondly, the anti-depressant drugs which are mostly now [used], the selective serotonin re-uptake inhibitors (SSRIs), don't work very well. They work in a very crude way, by increasing, perhaps improving, our response to stress, by increasing levels of serotonin, or in the case of selective uptake inhibitors, by increasing levels of norepinephrine, but there's no evidence that most people with depression have low levels of norepinephrine or serotonin. Some do, but there's no evidence that most people do.

Furthermore, when you look at the research literature carefully—(I really suggest that people who are practicing acupuncture and Oriental medicine at least they read the summary I have in Unstuck, and ideally look at some of the papers)—you’ll find that for many years it was said that antidepressants were 60% better than placebos, i.e., sugar pills, if you looked at the published studies on relieving the symptoms of depression. Now, there are many problems with the published studies. Even though they were supposed to be double-blind studies, they were un-blinded by the fact that almost all of the patients knew they were taking antidepressant drugs, because of the side effects. They did not use active placebos; and the researchers knew as well—so these were not double-blind studies at all.

There were other problems with the way the studies were set up, but even leaving that aside you’d think, "Well, these seem to have some benefit." But when you take a look, as researchers have begun to over the last couple of years, at the unpublished studies, as well as the published studies, you find a very different picture: the drug companies published virtually every favorable study, and published only a tiny number—maybe a quarter—of the unfavorable studies. When you put together the unpublished as well as the published studies (they're all available from the Food and Drug Administration, and several investigators have done this), what you find is that antidepressant drugs are little better than placebos. That doesn't mean that they may not be helpful to some people with depression; it means that if you're looking at this issue scientifically, what you see is that they are little, if at all, better than a sugar pill for depression.

Not only that, but they have significant side effects. 15-20% of people become more agitated; even more have GI upset; 60-70% have some kind of sexual dysfunction; there's weight gain. There are long term neurological consequences which can be very severe, including the same kind of dyskenesia that you get with antipsychotic medications. We don't know how many people have these; it's a small percentage, but it may be irreversible. Also, antidepressant drugs are, indeed, habituating. When you stop taking them you have withdrawal symptoms. So, I think the first thing AOM practitioners need to know is that these drugs don't work very well, the evidence is not there for their efficacy, so they should be used as a last resort rather than a first choice.

Beyond that, I think what they could communicate to their patients is that we have another approach, that we believe is working with some of the underlying sort of psycho-physiological issues that are present in depression, that has some evidence for its efficacy. Studies have been done in China, especially with electro-acupuncture; studies that have been done at the University of Arizona of the use of acupuncture, and that it is likely that by combining acupuncture and herbal therapies and other aspects of Chinese medicine, we are going to get an outcome that is at least as good as antidepressants— maybe far better—with no negative side effects, and with other side benefits of general health. I think we can approach it with a hopeful, optimistic attitude, not promising that it would cure your depression, but saying that based not only on clinical experience, but on research evidence, Chinese medicine has a very good chance of being helpful to you.

QUR: I think Rahm Emmanuel recently said that "America has never wasted a crisis." That brings me as a sort of transition to next question, which is a fascinating quote I pulled from your website. You wrote: "In the case of depression and life's other challenges, we've also lost the understanding that our suffering is sometimes both a necessary teacher and a prelude to profound life-enhancing change." So given that you challenge the status of depression as a bona-fide disease, can people redefine their relationship to depression and to that suffering, and consider it a meaningful step toward healing?

I think they have everything to gain by redefining their relationship to depression, and nothing to lose. That is, if you define it that way, as an opportunity to learn what you need to learn, and to make the changes that you need to make, then something that appears to be a negative experience has a distinctly positive cast as well. That is, "this is happening, because your life is out of balance." You need to put your life— psychologically, biologically, socially, spiritually, and ecologically—back into balance. So this is an opportunity, and what that gives people a sense of being able to value an experience that, until then, has seemed to them (or may have seemed to them) totally devoid of any value and simply negative.

Second, it says that there is hope. One of the hallmarks of depression is feelings of hopelessness and helplessness, and looking at it in this way, as a wakeup call rather than an endpoint of a disease process, gives you the sense that "OK, now there's something that I can do," and that in itself, aside from whatever measure you take, is therapeutic.

Also, I’d just like to say that this is very much in harmony with all traditional systems of healing, which understood the notion of and the experience of a healing crisis—and this is a kind of healing crisis. It's an opportunity for profound healing to come if the crisis is looked at appropriately. I think that AOM practitioners are predisposed by training in Chinese medicine to look at it this way, and I think it's important to have the courage not only of conviction but the courage of the research that shows that other ways of looking at it, other ways of treating it are simply not very good.

QUR: It seems to me, if I'm listening properly, that you're re-positioning the problem. Which is to say that the problem of depression has traditionally been presented to a patient is "You're sick; we, the doctors, are going to give you something that's going to fix it." And it sounds to me like what you're saying is that "Wait a second, you're not just the patient, you're the person who still has control over your life." And as a result, you can look toward various tools that you have available as a person, as a human being, to look into how you can restore balance and learn from this experience."

That's exactly right.

QUR: Rather than casting it as a negative, we're looking at the problem systemically from a different position of a patient's control over his own health.

Exactly, and that's both a philosophical position and it's also a necessity. There are no magic bullets for depression, nor in a sense should there be, because it's not about magic bullets; it's about lives that are not...that doesn't mean there can't occasionally be people deficient in B12 or vitamin D—you give it to them and they're fine; that does happen on occasion, and everything else sort of irons out, but again, that's the role a physician of any kind can play. But for most people that's not the whole story. Those are important measures, but they're not comprehensive measures. And so I say right from the beginning, as you suggested, that this is something (and I say this in Unstuck, I say this to people on the phone, “you're going to have to be actively involved in understanding yourself better and in caring for yourself, and that this is the way that together, we will help you to heal yourself.”)

QUR: And in this way of presenting the problem, the patient certainly has an active role in his or her own health.

Absolutely. It's absolutely crucial, and it's deeply therapeutic, regardless of the modalities they're using. In addition, there are many specific modalities which I use with that: meditation, exercise, dietary change, supplements, herbs, spiritual practice of different kinds, Chinese medicine: all of these are part of what I’m using and teaching to people. But whichever ones I’m using, I'm engaging people actively in their own care.

QUR: I want to move on now to discussing your work in Gaza. You have advocated the need to be able to relax even when confronting fear and uncertainty. What habits, specifically, can people adopt to cope with extreme stress? How have you seen this play out in your work in Gaza?

At the Center for Mind-Body Medicine, we developed a training program which has been going on for about 15 years, and it's our professional training program in Mind-Body Medicine. We train conventional health and mental health clinicians. We train acupuncturists, herbalists, and chiropractors. We train educators including teachers. We train community organizers, religious leaders—and every once in a while a political leader as well. The work begins with two 5 day training sessions, and a process of supervision that follows the second 5-day training. At the first training we teach all the people who come—up to 250 people at a time—we teach them the fundamentals of mind-body medicine. This includes how to work with a variety of techniques—several different forms of relaxation, meditation, concentrative meditation, simply breathing deeply and relaxing, soft belly meditation, mindfulness meditation-becoming more mindful of your activity, when you're sitting or walking; and expressive meditation: meditation involving movement and expression. We work with guided imagery, we work with several forms of guided imagery, we work with biofeedback, we have autogenic training, which is using a series of phrases to balance the fight-or-flight stress response with relaxation, using the autonomic nervous system; we work with drawings, movement, dance; we work with genotypes, (family trees) to help people look not only at the difficulties that run in the family but also where they get their strengths.

The first part of the training is done in a large- and small-group format, so that people experience these techniques and they use them on themselves. And they work with their own issues, whatever they may be. Anxiety, depression, difficulty making decisions, problems at home, problems dealing with the world, at work, whatever it might be. . .

The second part of the training we coach and cajole and give people the opportunity to lead the same kind of small group they were in the first place. Then, in the third phase, for those who are interested we provide ongoing supervision as they take our model out into the world, using it with individuals, in small groups and classroom settings. For the last 13 years we've been working in warzones and post-war situations in various places around the world.

Training people to use this model themselves, and then working with them to make it part of the health and mental health system in the societies in which they live. Our major pilot program was in Kosovo, where we began to work during the conflict between Serbs and Albanians in 1998, and since then working during the conflict in Kosovo and during the NATO bombing in Macedonia, and afterwards back in Kosovo we trained 600 people, including all of the professionals who work in the community mental health system. Our work was modeled on mind-body medicine of self-care that I teach. I use this approach in my private practice and found it central to the health and mental health model that's being used in Kosovo. Subsequently, we have a faculty in Kosovo, a Kosovar faculty whom we've trained to continue this work and to continue to train and supervise people there. Subsequently we've been working with Israelis and Palestinians, and in fact just got back from Gaza, where we have been working intensively for the last four years.

We trained a local group of people; some of them we select to become faculty. Most recently, when we were in Gaza just after the recent Israeli invasion of Gaza, our Palestinian faculty in Gaza led the training of 150 health and mental-health professionals in Gaza to add to the 90 we had already trained. What happened is that during this most recent Israeli invasion, while bombs were falling, and troops were shooting at nearby houses, the people we trained were leading groups. Sometimes with their faculties, sometimes in their shelters set up by the schools or by the UN, and they were using exactly the same kind of techniques of deep breathing to help people relax and deal with the stress as much as possible, drawings to help them express and share the terror that they were experiencing. It was a small-group structure, so that people could share what was going on with them with others, with others in their family or others of their workplace, wherever they happened to be. What people told us is that our work—this model—helped them to maintain their own sanity during this overwhelmingly terrifying experience: 22 days of pretty much all-out war on the people of Gaza. If you go there, as I did, you'll see destruction everywhere: really, no neighborhood spared. And fear was everywhere. So these are techniques that can be and are being used in the middle of conflict to deal with what you might call "ongoing traumatic stress disorder," as well as after conflict.

Our international faculty was in Gaza doing the training during the civil war between Baath and Hamas (the two major political parties) in the summer of 2007. We didn't intend to go in during a civil war, but it began the day after we arrived. So we did a training, and, fascinatingly, the 50 people comprising our core leadership group in Gaza came to every session, in spite of the fact that there was fighting in the streets! They had to go around, or through, barricades that were manned by armed, masked men; or they had to go around firefights, but they all got there with the exception of one person who couldn't get in from Egypt and another who was simply not allowed to leave his neighborhood; but 47 out of 49 people were there every day, and pretty much there on time. This was amazing in itself.

QUR: They're risking their lives for the principle of health. Risking their lives to assert the importance of sanity...

On the last day of training, we had security guards, eight security guards around the clock—but they fled, because anyone in a uniform was a target at that point. So there was fighting going on in the street outside, we could hear the gunfire outside the hotel. Our security guards had gone; the training was coming to an end, and it was time for us to leave. At the same time, we had no idea how we could leave. We were all getting pretty agitated, pretty antsy, a little crabby with each other.

Then my Palestinian coordinator, Jumea, and I were having lunch in the basement of the hotel watching all the gunfire going on outside, and Jumea looks at me and says, “Well Jim, now we have a chance to practice all those things you came here to teach us.”

So we did that! After some soft-belly meditation we formed a plan, waited until the right time and got out of there without incident.

Most of the training in Gaza was done in 10 week long small groups. And the rest either in individual sessions, family meetings, or groups that met once or twice. So we're having a very significant effect on the culture in Gaza, as well as on individual mental health. And when we did this last training in Gaza, there were places for 150 people; about 500 wanted to come and be part of the training. The training now we're offering is being very eagerly sought after by U.S. military. . .health and mental-health professionals in the military, who are interested in using this for troops returning from Iraq and Afghanistan, and with their families.

QUR: Well, it sounds like people are attracted to this work because it's practical and actually serves them.

Exactly, you got it. That's why the people who we train are attracted, and we would be very much interested in training more people who practice acupuncture and Oriental medicine. It can be a very important part of their work. It's very practical, it's very easily integrated into any practice that you have, and I think one of the reasons why people are so responsive is because the professionals we train get so much out of it and find it, as you say, practical and useful. They convey that very clearly to the people in their practice and the people in their communities.

QUR: I feel that you may already have covered this question in many respects, but I'm going to ask because it's such a major problem these days in society, and that's to ask, how focused is your work on confronting stress?

I think the research is showing, increasingly, that stress is the major issue. The question is how we deal with stress. The people who are likely to be vulnerable to depression are more likely to be vulnerable to stress. There's a whole discussion I have of a very wellknown study that attempted to examine the genetics of depression and genetic factors of depression, looking at one of the genes that regulates serotonin metabolism; but what they found is that that gene actually mediates the way we respond to stress, rather than as a one-to-one correlation with depression.

Stress is also the fundamental factor in some of the anatomical changes that have been seen in the brains of people who have been severely depressed, traumatized when they were young or chronically depressed, which is a decrease in cells in the hippocampus. Again, stress is the primary factor in depression. So I say that it's absolutely crucial for people who either are depressed, or who don't want to be depressed, to learn how to deal with stress in a more productive, creative way. I think that if we can teach people to do that, depression is much less likely to come in their lives and if it comes, they're far more likely to deal with it successfully.

QUR: So if I’m listening right, there are two aspects to this fundamentally, if I can break this down simply. One is to try to provide a physiological environment in which one can cope with stress more centrally as it comes and depression and things that happen to a person experientially, and then the second aspect, beyond physiology, is to gather tools that one can use to cope with whatever does come. The physiologically inevitability of stressful experience one doesn’t choose and can’t change, but tools exist to countermand the effects of those experiences.

I agree completely with that, and I would add that having loving connections with other people is absolutely crucial in dealing with stress and depression. Both preventively, if you will, and also therapeutically.

QUR: Well, Jim, it's been wonderful to talk with you.

It's good to talk with you. I think one of the things that people who are so focused on a specific and beneficial practice like acupuncture and Chinese medicine wonder about is how they can integrate this approach to their own work. I would say that it integrates extremely well. It's completely in harmony with those fundamental and philosophical perspectives of Chinese medicine; it also gives you tools that complement everything that you're doing with acupuncture and with herbal therapies. I hope that when these tools are there—whether it's meditation, movement or massage—that all are very much a part of that tradition. Whether you're using the traditional Chinese forms or forms that are taken from other cultures, and I really use forms from many cultures, you can create your own program.

The other thing I encourage people to do (I’m thinking right now of an anesthesiologist who practices Chinese medicine named Dan Avery,) is to set up groups. Groups are a wonderful way to support the work that you’re doing with people to balance them physiologically and energetically and bio-chemically, and the work that you're doing teaching them how to help themselves. Groups are by far the best way, in my experience, to teach self-care. Also if you give people a chance to talk about what’s going on, what they're learning and the difficulties they're having, they provide an unparalleled support as they make changes in their lives.

One other thing: your readers who are interested should take a look at our website, www.cmbm.org. They can look at the work we're doing and at the research papers we've published on the use of our model with people who are anxious, depressed, or stressed out, as well as health professionals and medical students.