Talking Through Pandemic Anxiety With a Pioneer of Mind-Body Medicine

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This transcript has been edited for clarity.

Andrew N. Wilner, MD: Welcome to Medscape. I'm Dr Andrew Wilner. Today I have a special guest, Dr James Gordon, founder and executive director of the Center for Mind-Body Medicine. Welcome, Dr Gordon.

James S. Gordon, MD: Thank you very much. It's good to be with you.

Wilner: Thanks for joining us. We are recording this in late May 2020, in the midst of the coronavirus pandemic. Millions of people have been infected. Hundreds of thousands have died. Millions have lost their jobs. I think it's fair to say that people are under a greater degree of stress than to which they're normally accustomed. Would you agree with that?

Gordon: I think it's more than fair to say that everybody in the United States, and actually pretty much everyone in the world, is under extreme stress. And that compounds any stresses that they've experienced before in their lives. Everyone is affected.

Wilner: The mind-body medicine concept is one that that you've pursued for decades. Tell us a little bit about the Center for Mind-Body Medicine and how that's led to the program that you have to help us deal with the coronavirus.

Gordon: I started the Center for Mind-Body Medicine about 30 years ago. I'd been a researcher at the National Institute of Mental Health for a number of years, in private practice, and a professor at Georgetown Medical School. But I wanted to really focus on how to change and enrich medicine by making self-care, self-awareness, and group support central to all healthcare.

Western medicine is enormously powerful in certain situations, such as physical trauma, high levels of infection, congenital anomalies. But we're not so good at working with chronic physical or psychological problems. Those are much more complex.

We've been discovering that what is going to make the long-term difference in conditions like type 2 diabetes, pain syndromes, hypertension, depression, and anxiety are those approaches that we can learn to do for ourselves. These are changes we can make in how we deal with stress, eat, exercise, relate to other people, and whether we find meaning and purpose in our lives.

For the past 25 years, the major part of our focus has been on whole populations that have been psychologically traumatized by wars, climate-related disasters, the opioid epidemic, chronic poverty, historical trauma. We do a lot of work with indigenous people here in North America. We've worked in a number of communities where school shootings have traumatized everyone.

What we've learned over these past 25 years, and what interested me professionally as well as personally over the past 50 years, is what we're now bringing out on an even larger scale. The kind of approaches that we've developed, studied, and published research on are exactly what everyone needs to include and incorporate in their daily life, as well as in their medical and healthcare, from now on.

Wilner: Do you have a program that's specifically for healthcare providers?

Gordon: Yes. The Center for Mind-Body Medicine is primarily an educational organization rather than a service organization. Since the beginning, I've been focused on training health professionals. My first passion was for training physicians — I'm a physician, so there's a feeling of fellowship there — but also healthcare workers and mental health professionals of every kind.

We teach health professionals a whole system, a comprehensive program of techniques of self-awareness and self-care. We teach them so that they can practice on themselves and study the underlying science, so they can then teach what they've learned to the patients or clients they work with. They integrate it into what they're already doing, regardless of their specialty. At times we also offer some of the same kinds of mind-body skills groups that are the fundamental part of our training as a stand-alone intervention. You can't really teach other people how to take care of themselves unless you're also doing it yourself. Otherwise, it's just a theory.

Wilner: As a neurologist, I'm interested in the mind-body system. You are a psychiatrist and understand that it's a lot more difficult to objectify certain things. What is stress? What is happiness? What is sadness? It's very hard to measure. You can have scales, but it requires insight on the part of the individual. So I think it's certainly an ambitious project.

Gordon: You're absolutely right. It requires insight. And one of the shortcomings of our medical education is that it doesn't encourage us to look inside ourselves enough. There's so much focus on objectivity and on data, that we've lost some of the subjective art of medicine.

My experience with myself, as well as with the thousands of people we've trained here in the United States and around the world, and the many hundreds of thousands with whom they've worked, is that all of us have a greater capacity to understand and help ourselves than we ordinarily think, or than most of us learn about in our medical education.

This work is saying to people to take a little bit of time and relax a little, in order to allow yourself to come into a meditative state. And I don't mean anything fancy by that. Meditation is just being relaxed. Moment-to-moment awareness doesn't have to do with any particular religion or spiritual practice. It's part of all of them. If you can get into that state, then you can begin to say, "Oh, that's what's going on with me. That's why my pain is worse."

For example, you often wonder in people with peripheral neuropathy why it becomes worse or better at certain points. I would encourage neurologists and other physicians to ask your patients, "Why do you think it's worse?" They may say, "I don't know, doc; that's why I'm here." But I would ask them to take a couple of minutes to let me know. They could think it has something to do with the fact that they had a big fight with their wife that morning, they don't want to go to work, or whatever it is. This is part of the lost art that we need to bring back into medicine for ourselves and especially for our patients.

Wilner: Can you give me an example of some of the exercises you'd do in a class?

Gordon: All of the exercises and our entire program that we teach at the Center for Mind-Body Medicine is in this new book of mine, The Transformation: Discovering Wholeness and Healing After Trauma. It's really the distillation of not just the past 25 or 30 years, but really 50 years of work.

The techniques are all pretty simple and, as we say, evidence based. There is evidence that shows how they work on us physiologically as well as psychologically. And they're all pretty easy to teach to anyone.

Myself and about 60 or 70 of our faculty at the Center for Mind-Body Medicine are currently leading online groups. Then several hundred of the other people we've trained are also leading these groups. We're still counting it up, but we probably have between 700 and 1000 groups going around the world, led by our faculty and by people we've trained.

We teach a different technique every week in these online groups. Last week, after getting people energized and focused, we did a written dialogue with an emotion. You put down the initial of your name — in my case, "J" for Jim — and create a dialogue with an emotion, such as sadness. I would write it as fast as I can.

I would say, "OK, Sadness. Why are you here? What are you doing? I don't enjoy having you around." And Sadness writes back to me, "But you need me." And J says, "What do you mean I need you?" And Sadness says, "Well, your brother died 7 weeks ago, didn't he?" And I say, "Yes, he did." And Sadness says, "Aren't you sad?" I say, "Yes. I'm terribly sad and grieving all the time. But I wasn't thinking about him at this moment." And Sadness says, "But he's there with you all the time and that sadness is in you." And I say, "You mean it's in me even here, now, as I'm talking with Andrew in this interview?" And Sadness says, "Yes. You can talk about your work. But in between the words, as you take a breath, don't you feel it in your chest?" That's the way the dialogue goes.

Wilner: What about specifically with the coronavirus? Fear is certainly an emotion. Nobody wants to get sick and die. Nobody wants to bring this disease home to their family. People are reluctant to even go outside and you can't shake someone's hand. Are there precedents for this?

Gordon: There are precedents, but only relatively small groups were affected before by, for example, severe acute respiratory syndrome or H1N1, at least in the United States. But we haven't seen a global pandemic like this since 1918. None of us was around then — or I certainly wasn't around. So for most everyone, not only has it not happened before, but we've never been so globally aware of everything that's going on and how different groups are reacting.

I've been reading Daniel Defoe's A Journal of the Plague Year. It's really very interesting. It's about the bubonic plague in 1665 London, although he wrote it in the 1720s. Some of the same things were going on then: the enormous fear, the isolation; rich people being able to escape, poor people having nowhere to go; conspiracy theories of one kind or another, about where the plague came from or blaming a group of people for it; magical thinking that it's just going to go away. All of those things that happened several hundred years ago are going on now.

And we're all simultaneously aware of all those things. There's not only the fear, which should be universal because it's a reasonable response to this situation, but also the terrible confusion about what to do. The President is saying one thing, governors something else; Anthony Fauci is saying something else, and Deborah Birx is saying something a little bit different. There's this tremendous confusion that overlays the fear, and I think everybody is more or less feeling these things.

So, yes, a dialogue with fear is a good thing to do because it can be clarifying. What we need here is a sense of, what is it that makes sense for me to do? What precautions should I take? What precautions shouldn't I take?

I have a 17-year-old son who lives with his mom in California. He and I were on the phone the other day. He's a basketball player and very serious about it. He said, "I don't want to put my life on hold." And my response was, "If you go outside too soon, your life may be on hold for a hell of a lot longer than if you stay inside, because if you get sick, it's serious. But you also need to start looking at the evidence and asking yourself the right questions, because I can't be there all the time and neither can your mom."

Everybody really needs to use these kinds of tools to help themselves. The tools we teach are extremely good at bringing us back into a state of psychological and physiological balance — slow, deep breathing being a very basic one. Because it's only in that state that we're going to be able to make the most intelligent decisions about what to do. It's only in that state that we're going to be able to really look our fear in the face and find out what we should be afraid of and what we shouldn't be afraid of.

It's a process that's very much integrated. We're talking now about how to deal with the emotions. But the first part of what we do in our groups and our online trainings and webinars is teach people to just take a few deep breaths. That's advice I'd also give to those who are watching this video: Just take a few deep breaths in through the nose, out through the mouth, with your belly soft and relaxed. You can keep breathing this way while talking. That's the antidote to the fight-or-flight response. We all learn about fight-or-flight in first-year physiology. We need to deal with it. We need to bring ourselves into balance. That's the way we're going to make the wisest decisions for ourselves and be best able to help our patients.

Wilner: As you mentioned, part of modern culture is that we now have access to all of this information worldwide. There's a continual stream of newsfeeds, people flipping on their phones, receiving constant updates, 24/7. That's a new phenomenon. Does that steal from us the time we had before for just breathing and synthesizing data as opposed to just acquiring it all the time?

Gordon: You're absolutely right. It does and it's a challenge. It can't steal from us unless we're letting our emotional, psychological, and physiological pockets be picked!

What we need to do is to make it our priority to come into balance. I don't watch news all day long — a little tiny bit in the morning and in the evening, just to get a sense of what's happening. That's enough. And I think everybody needs to take a step back, ask if this is really what they want to be doing, and to come into balance.

The other thing that's really important is physical activity, especially during this time. In addition to using slow, deep breathing to come into balance, physical exercise and movement of any kind is extremely good as an antidote to fight-or-flight and that shut-down, freeze-up response that we get into when we feel completely overwhelmed.

We've got to take it into our own hands. The media just want to sell us things. Let's face it: They're not here for our good. Our job as physicians and healthcare professionals is to really reinforce for people not only what we can do for them, but what they can do for themselves.

Wilner: I'm certainly interested in learning more about mind-body medicine. For those watching this video who feel the same, where do you recommend they go to learn more?

Gordon: We have a website, cmbm.org, which features a number of webinars. I do a free webinar there every week. We have mind-body skills groups that meet once a week for 8 weeks. There are six physicians in my group and all kinds of health professionals in other groups. We have a training program, which we're bringing online. We've trained well over 6000 people around the world and would love to train more. You can read about that on the website.

We're starting to do more and more consulting with healthcare organizations. We're working with the largest division of Veterans Affairs, which is in Florida, as well as in south Georgia and the Caribbean. We're working with a large health system in Indiana and others elsewhere. In addition, we're working with groups of physicians and mental health professionals, helping them to integrate what we have to offer into what they're already doing.

That's our job — to help you do your job.

Wilner: Dr Gordon, I feel more relaxed just speaking with you. Thank you for talking with me and sharing your experiences with Medscape. I look forward to learning more.

Gordon: Thank you. My pleasure.

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