"This is basic to all medicine" - an interview with James Gordon, M.D.
The Dean of Saybrook’s College of Mind-Body Medicine, Dr. James Gordon, is one of the leading global voices calling for a change in the way medicine is practiced.
The Founder and Director of The Center for Mind-Body Medicine and a Clinical Professor in the Departments of Psychiatry and Family Medicine at Georgetown Medical School, he recently served as Chairman of the White House Commission on Complementary and Alternative Medicine Policy. He also served as the first Chair of the Program Advisory Council of the National Institutes of Health’s Office of Alternative Medicine and is a former member of the Cancer Advisory Panel on Complementary and Alternative Medicine of the NIH.
The Saybrook Forum asked Dr. Gordon to talk with us about the changes he sees in medicine as a field, and his recent book Unstuck: Your Guide to the Seven Stage Journey Out of Depression (Penguin Press).
Forum: Are there myths about depression that most Americans hold?
James Gordon: “Basically we’ve decided, with the fervent urging of the pharmaceutical companies and the sometimes active participation of the medical community, that depression is a disease and that it’s best treated with medications we call ‘anti-depressant’ drugs.
This is a misunderstanding, this is a myth, and it goes against the scientific grain as well as the experience of many, many, people.
Depression is a very painful experience, but it’s not the same as diabetes or coronary artery occlusion. There’s no consistent chemical abnormality. Depression is a state of being that we get into when we’re out of balance. Sometimes physically out of balance, to be sure, but also socially, spiritually, emotionally. It has many causes, but the causes are not Prozac deficiency, or even serotonin deficiency. These are often results, rather than causes. So what I’m doing in Unstuck is saying let’s look at the evidence, and the evidence is quite clear that depression is not a disease like these other entities are, that there is no simple biochemical abnormality, and that when you look at the so-called magic bullets that are supposed to wipe out depression, the research shows that they are little better than placebo, than sugar pills. When you look at the history of the research, the published studies make them look like they’re very effective therapeutic agents, but when you put these together with the unpublished studies, you see that they’re of very little use.
It’s an emperor’s new clothes situation. We’ve developed and marketed a cure that doesn’t really work very well.”
Forum: What should we do differently?
James Gordon: “We have to take a step back and look at the reasons why we’re depressed, we have to look at how we’ve gotten out of balance, and what the causes are – the drugs just address the symptoms, and they should be seen as a last resort rather than a first choice.
When we experience the signs and symptoms of depression, it’s not the end point of a disease process, it’s a wake-up call that change is necessary, and we need to move on a healing journey.
I wrote Unstuck because I wanted people to have a guidebook that would give them a comprehensive way to address depression, show them that it’s grounded in science, and give them a variety of experiential techniques to heal themselves.”
Forum: Do the myths about depression apply to medicine generally?
James Gordon: “I think that’s the tendency, to pathologize behavior, and we focus on these diagnostic tendencies in medicine, and it’s increasingly looking like that’s not the right way to go. It’s clear that even in cases that have clear pathologies, that we need to be looking at underlying processes, not the symptoms. For example: inflammation is an underlying cause in many disease conditions. We should be asking: what are we doing in the world, what we eat, the way we live, that causes so much inflammation. Instead we’re developing more anti-inflammatories. Once we give it a name – this is heart disease, this is cancer, this is asthma – then we’re always looking for the magic bullet to annihilate it.”
Forum: Is alternative medicine an answer?
James Gordon: “I don’t see the things that we’re talking about as “complementary” or “alternative” – they’re fundamental to health care. And the research on approaches like meditation for treating pain is as good or better than pharmaceuticals. The question isn’t ‘what label have we put on this technique.’ The question is: what does it do, how does it do it, and how effective is it? Saying ‘this is alternative, so it doesn’t work,’ isn’t science. But I don’t think of Mind-Body Medicine as alternative or complementary: it’s critical to self-care, and to the treatment of the chronic problems that most of us have--almost all of which are related to exercise, nutrition, social support … things like that. Something like acupuncture? That’s a whole different system. But self-care—stress management, nutrition, exercise—and group support is basic to all medicine, and people should know that and be using this approach as their true “primary care”.”
Forum: Is the word getting out? Is a transformation happening?
James Gordon: “You know, that’s interesting. Somebody yesterday told me ‘it’s going to take so long for all this to happen,’ and I started to think about everything that’s happened in the last 40 years, how much has changed since I started to get interested in Mind-Body Medicine.
In 1970 it was not even on the map, it was like another planet. But now everybody understands the importance of stress, everybody has some grasp of the idea that techniques like meditation are helpful. They might argue about specific evidence, but this is an enormous change.
And the poor state of health care in the United States is just crying out for another approach, an approach that really addresses the root causes. How we eat, how we deal with stress, how we exercise or don’t exercise, whether or not we have social support, and the environment in which we live. Unless we address those, there’s no hope of addressing the chronic conditions that so many of us have. So I see that the change will come. There are times when I’m impatient, and times when I’m less so.
I do think we keep missing opportunities to move things ahead further. 10 years ago or so there was a huge focus on the Medicare Prescription Drug Bill, at a cost of $800 billion over 10 years. Now sometimes you need a prescription drug and can’t afford it, so that’s good, but most of the research shows that most people over 65 are already on two-to-three times as many prescription drugs as they need. So for that kind of money, why not ask family physicians and nurse practitioners to work with people over 65 and review their medications to see what they actually need to be on and to weed out what they don’t. But instead we just give them the ability to get more drugs. Same thing with health care reform: it does include some money for a better approach, one that emphasizes self-care, but it’s a small amount in the total cost of what we’re doing.”
The good news is that the research is there, and even the cost-effectiveness studies of Mind-Body Medicine are starting to appear as well.”
Forum: If someone wants to look after their own health, what should they do?
James Gordon: “I think the first thing is to realize that it’s possible, that you can make a difference in your own health. The tools to do that are accessible to everyone. One of the things that we provide for all of our students in (Saybrook’s Graduate College of ) Mind-Body Medicine is exposure to the basic techniques, study of the research literature, exposure to critical thinking that will enable them to evaluate its importance. So that is important.
Now, prescriptively for the population … if you know that self-care is possible and effective, that opens the door. Then other things follow. Read a book, maybe Unstuck or something by Dean Ornish or Mark Hyman … all of which will give you a sense of what you can do to improve your health. There are many things you can do on your own. On the other hand, we often also need people to help us, and it’s a question of finding a practitioner who’s willing to work with you and be with you step by step on this journey towards healing and wholeness. In Unstuck I provide basic guidance and also give a resource guide to find these practitioners in their communities. So I would say that most often you’re going to need someone to help you on this journey, as well as have a sense of what you can do for yourself.
The third piece that’s often very helpful is to join a group. All of the people in our program learn how to lead these groups. Groups are extremely important for people as they learn how to make these often difficult changes. I was talking with a patient about her diet, and I said: ‘it’s simple,’ and she said ‘no, it’s very hard.’ And I said ‘I didn’t say it’s easy, I said it’s simple.’ But as you’re doing this it is often very good to have a group who are making changes along with you, and can help you, as you help them, as you go through this process.”
Forum: Two of these three things involve reaching out to people, forming community in some sense.
James Gordon: “Yes. There’s a great deal of research showing that people who are connected to other people are less susceptible to disease and recover better if they are ill. So if we need the evidence of what has been apparent to human beings for thousands of years, we now have it. I often work in less developed countries, and there are usually much better social support mechanisms then there are here in the United States. There are people you can talk to, people you can connect to, people you can go to when you’re having a hard time. There’s much more natural support, and it hasn’t been destroyed the way we have destroyed it in the United States. Not deliberately so, but by leaving our communities of origin, going after the next better thing. People fly in, people fly out, and no one’s there on a consistent basis. Most of us here in the U.S. don’t have that kind of support. That’s another reason that these groups are so important, they’re another structure you can depend on and that can support you.
It’s a very stressful life that we live. It’s out of harmony with our genetic programming. We’re really programmed to be connected to many people, to move our bodies a great deal, not to stress so much, and to eat whole foods. We’re out of whack on every score. It’s bound to take a toll. There are always some people who are built to be solitary, but for most of us that’s not true and we tend to live lives that are cut off from the support that we need and that we thrive on.”
Forum: What’s the next goal for MBM in the US?
James Gordon: “I think the next goal is to make the teaching of Mind-Body Medicine an integral part in the graduate education of all health professionals, and a required part of the education of our children. That’s the next big hurdle. That’s where the changes are going to come. The health professionals still have a lot of authority in our society, and if they experience the benefits of this approach in their own lives they will communicate it to their patients and clients. Kids are open, and if you start teaching them these things early on it will become a foundation for their lives.”
Forum: Many primary school systems are in such a shambles right now, raising class sizes and cutting anything that isn’t nailed to the floor.
James Gordon: “It’s a question of pointing out to the school systems, with evidence, that what they’re doing now is not working. A huge number of kids are obese. That’s correlated with depression, with worse academic performance, and with chronic illness later in life. I think we have to take a step back from the emphasis on testing and look at what we’re doing. Schools are for children, not standardized tests. Right now it’s as if the children are in service to the tests. We need to look instead at what is best for the kids. What’s the best way to turn out kids who are going to be creative and intelligent and open to new avenues for the future. There’s lots of research that shows that kids who are happy and relaxed will do that. 10 minutes a day of extra math problems won’t make a real difference, but 10 minutes a day for their health might.”
But really medical schools are the same thing! Medical professionals are interested, but in medical schools it’s pushed aside. It’s marginalized. Our Mind-Body Groups are being used in 17 or 18 medical schools, but it’s very hard to get faculty paid to lead these groups. It’s very short sighted.”
Forum: You recently returned from a trip to set up a mental health care system for disaster victims in Haiti. What was that experience like?
James Gordon: “We’ve done workshops for probably 1,000 people and we’re training 120 people to lead groups and work with individuals and families, and I would say that the Haitian people are very open. They’re in a situation where they’ve been so overwhelmed by what’s happened to them since Jan. 12, 2010, against a background of what’s happened to them over 500 years. They’ve been so frozen in this mode of trauma, and what we see (to shift metaphors) is that everything is dried up inside them; we’re the water they need; and they drink in what we have to teach them and they start using it and growing from it immediately. They sit in a group or a lecture and they learn a slow, deep breathing technique, and they do it, and they go home and teach it to their family, and half the family sleeps through the night for the first time in a year. They share everything they learn from us.
They’re dealing with huge obstacles, but they’re a joy to work with. Everybody we’re working with is really interested in what we have to offer, and there’s a sense of such enormous gratitude. People say is ‘you care enough to be here, you keep coming back, you’re giving us something that we can use to help ourselves.’ And they love it, and they want to learn it, and they want to teach it to others. It’s happening. I feel like we’re at the first stages of what I hope will be the creation of a national program of mental health care, based on self-care and mutual help, in Haiti. I hope we’ll train two thousand people, and that our approach will be nationally available to everyone. We have the cooperation of the Ministry of Health and all the major health, educational, relief and institutions.
Forum: What about at Saybrook?
James Gordon: I would say thatin (Saybrook’s Graduate) College of Mind-Body medicine we are creating a healing community, and training healer scholars. The response that we’ve seen from students and the faculty has been so beautiful. People are happy with what we’re doing, not just because of what they’re learning but because they’re being heard. So it’s a genuine dialogue that’s going on among faculty, students, administrators, and mentors, and it’s personal as well as professional. You can see it in the student satisfaction survey. Just about 100% feel that we are paying attention to what they want and need and helping them move towards their goals. Yes, the academic excellence is crucial, but education is something beyond that. We’re creating a model for what should be happening in all health professional schools.”
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