© Cleveland Chiropractic College – Kansas City and Los Angeles
James S. Gordon, MD, is the founder and director of The Center for Mind-Body Medicine and is also one of the founders of contemporary holistic medicine. A practitioner, researcher and educator, he pioneered integrative medical education at the Georgetown University School of Medicine in Washington, DC, where he is Clinical Professor in the Departments of Psychiatry and Family Medicine. Gordon was named by President Clinton to chair the White House Commission on Complementary and Alternative Medicine after earlier serving as the first Program Chair for the National Institutes of Health Office of Alternative Medicine (now the National Center for Complementary and Alternative Medicine).
In addition to his new book, Unstuck: Your Guide to the Seven Stage Journey Out of Depression (Penguin, 2008), Dr. Gordon is the author of Comprehensive Cancer Care and Manifesto for a New Medicine, and has also written or edited nine other books, including the award-winning Health for the Whole Person, and more than 120 articles in professional journals and general magazines and newspapers, among them the American Journal of Psychiatry, Psychiatry, American Family Physician, Atlantic Monthly, The Washington Post, and The New York Times. His work has been featured on Good Morning America, The Today Show, CNN, CBS Sunday Morning, Fox News and National Public Radio, as well as in The Washington Post, USA Today, Newsweek, People, Town and Country, Hippocrates, Psychology Today, Vegetarian Times, Natural Health, Health and Prevention.
A graduate of Harvard University and Harvard Medical School, he was for ten years a research psychiatrist at the National Institute of Mental Health. There he developed the first national program for runaway and homeless youth, edited the first comprehensive studies of alternative and holistic medicine, directed the Special Study on Alternative Services for President Carter's Commission on Mental Health, and created a nationwide preceptorship program for medical students. Through the Center for Mind-Body Medicine, Dr. Gordon has created ground-breaking programs of comprehensive mind-body healing for physicians, medical students and other health professionals; for people with cancer, depression and other chronic illnesses; and for traumatized children and families, and those who serve them, in Bosnia, Kosovo, Israel, Gaza, post-9/11 New York City, and post-Katrina southern Louisiana.
Unstuck, Dr. Gordon’s newest book, focuses on his holistic, non-drug based model for helping people with depression, who Gordon believes have been ill-served by conventional medicine. He is critical of the tendency of many doctors to quickly prescribe antidepressant medications while devoting little or no time to exploring the life events that led to the depression. He feels strongly that doctors need to engender hope and empowerment in patients to help them to move through and out of depression. He offers Unstuck as a manual for implementing these goals.
In this interview with Dr. Daniel Redwood, Dr. Gordon explains the limitations of viewing depression as a disease, describes the various aspects of his program, tells the story of a patient’s dramatic positive response, explains the importance of physical exercise for depressed people, and discusses a variety of circumstances in which he has applied his methods, including his work in Kosovo during and after the 1999 war there.
The current conventional medical model asserts that depression is a disease that can be treated effectively with medications. A central theme in your book is that depression is not a disease but a call to change something in one’s life. Please begin at the beginning and explain how you reached this opinion.
The beginning for me was when I was in medical school. I was working on a psychiatric ward and it just hit me that the folks on the psychiatric ward didn’t look much like the folks on the medical ward or the surgical ward. They didn’t look sick, just more or less like me and the other people who worked on the ward. And yet they were being put in pajamas (which is what they used to do in psychiatric wards). I thought to myself, this is very strange.
The question came to me: in what way do these people have a disease? Certainly not in the way that someone going to the hospital in a diabetic coma has a disease, or someone who has cancer or who has had a heart attack. It’s just not the same kind of experience. So I began to question how this was a disease and the answers I got were not terribly satisfactory. Also, as I read about it, I didn’t see that there was any evidence of anatomical lesions. I had worked in pathology, I had done autopsies, and I knew that there were anatomical lesions for disease states. But there weren’t any for depression. I also discovered that people could move through it. They were depressed for a period of time and then they stopped being depressed, sometimes without any particular kind of treatment. And I wondered, what kind of disease exactly is that? There’s no pathogen that’s been discovered, there’s no anatomical lesion, there’s no fixed biochemical abnormality, there’s no particular downhill course for this condition. What makes it a disease?
I wanted to understand the experience of people who were diagnosed as being depressed so I began to talk with them and to hear their experiences. Some of these people had what we then called “endogenous” depressions, which at the time were considered distinct from the “reactive” depressions when you became depressed, had all the signs and symptoms, the weight loss or weight gain, lack of pleasure in life, a sense of hopelessness, fear about the future, discouragement and sometimes suicidal feelings. There were some people who experienced these things clearly as a reaction to events in their lives, but there were other people for whom these signs and symptoms just appeared, who were said to have an endogenous depression.
But when I talked with those people at length, I found that in their lives, too, things had gone on that made them significantly more depressed now than they were six weeks or six months before. And I began to read the psychological literature, Freud and Abraham, and to think about some of the theories about depression. And it just didn’t seem to be a disease. When I found myself depressed, at times it felt overwhelming in the way an illness did, but there was no illness. I realized these were ways I was looking at the world, things I was feeling. Primarily a sense of loss and a sense of confusion after losing a relationship.
In Unstuck, you quote Freud as writing that replacing neurosis with ordinary unhappiness is a worthy goal. You also point out that many psychopharmacologists praise the restoration of the “pre-morbid personality.” I was struck by how low the bar can be set. How realistic is it to set it higher?
If you think about those phrases, they’re pretty discouraging. [Laughter]. The bar is set extremely low. My own experience is that depression is the beginning. They’re talking about a state or a terrible condition. Their model is that it’s sort of like an infection, where you may have pneumonia now, and we’ll give you antibiotics for it, and your lungs will come back to what they were before. That’s the “restoring the pre-morbid personality.”
But depression is part of life. It’s not a particular disease state and there are lessons that it is bringing to us. If we can learn those lessons, then we can move ahead with our lives in ways that may be very different from the way we’ve lived before. For me, it’s entirely reasonable to set the bar far higher, to see that this is a wake-up call. Depression was a wake-up call for me and it is for the patients and people I see. If you view it as a disease state, then you’ll be perfectly happy to restore the pre-morbid personality. If you view it as a sign that something needs to change, then what you’re going to want to do is work for that change. To ask what needs to change, and what can I do as a person who is depressed. Or what can I do as a clinician to help promote that change.
In your book, you tell the stories of patients you’ve seen who worked their way through depression, some of them slowly and others surprisingly quickly. The story that moved me most was that of a man you called Milton, who came to you after two years of suffering through the breakup of his marriage and the fact that his wife moved with his son to California, 3000 miles from Washington, DC, where he lived. Please tell us that story.
Milton was an amazing story. With all the people I write about, I disguise them enough so that no one is likely to recognize them, except perhaps they will recognize themselves. Milton came into my office and he was depressed, he was angry and he was very strong. He had been a sergeant in the Air Force, kind of a ramrod straight guy. He was an airplane mechanic and one of the people whose planes he was servicing, a neurosurgeon, had seen how upset he was and had referred him to me. He was angry at his ex-wife, he was angry at his kid, he was angry at the doctors who had prescribed antidepressants, he was angry at himself, he was angry at his boss, he was angry at everybody. And he wasn’t sure what he was doing there [in a psychiatrist’s office] but nothing else had worked for him.
I took a history and found out what had happened. He and his wife had had a very nasty breakup and she moved to California. He got more and more upset about his son being so far away from him. And he found himself getting more and more angry at his son, and I think that’s really what brought him to see me ultimately, because that was so distressing to him, that this anger and this sense of hurt was so uncontrolled. Meanwhile, all of his life had lost its savor for him; there was nothing he really enjoyed any more. He was still perfectly good at his job but it didn’t give him any real pleasure.
After we talked for some time, I taught him the very simple relaxation technique that I teach in the beginning of the book, which I teach many of my patients and also in our training programs at The Center for Mind-Body Medicine. It’s called Soft Belly. And what I said to him was to just sit in your chair and let your breathing deepen. Breathe in through your nose and out through your mouth (which is a particularly relaxing way to breathe) and allow your belly to be soft. If you breathe this way the breath tends to go deeper into the lungs, there’s better exchange of oxygen. The vagus nerve will start working to produce relaxation to balance out the tension, the fight-or-flight response that Milton was in. I told him that if you relax your belly, all the other muscles of your body will begin to relax.
And you did this along with him. You were a participant, a partner, as well as an observer.
Yes. We did this together for some minutes. When he opened his eyes, I could see that there was some relaxation in his muscles. He felt a little bit better, a little calmer. I felt a connection with him. I always give people things that they can do for themselves—this is so crucial to working with people who are depressed, or with anybody. Because part of being depressed is not only that you feel hopeless, but you feel helpless. So if you give people techniques and approaches and ways of looking at things that are practical strategies that they can use to help themselves, you’re beginning to overcome that sense of helplessness. And if you have an experience, like Milton did, of relaxing, then you start having a little hope that things can be different. So that was a very good experience for him. And I told him I wanted him to do this Soft Belly deep breathing several times a day, for several minutes at a time. I thought it would help to relax him so that he would feel better and wouldn’t be quite so angry or quite so tense in the muscles in his jaw and his shoulders.
Then, as he was getting ready to leave, I asked him to read the Tao Te Ching [a short Taoist text, written by Lao Tzu in China in the 6th century B.C., that has achieved great popularity in the West].
You said in Unstuck that this idea just came to you, that you had never recommended that book to anyone before.