Who Will be Serene and Who Will be Troubled?
Rabbi Dov Gartenberg
Rosh Hashannah, Or Hatzafon, Fairbanks, Alaska
At the height of the most dramatic and intense prayer of these Days of Awe, Unetaneh Tokef, we chant a litany of fateful dyads-“who shall live and who shall die.” This list of existential junctures is a record of anxieties of our ancestors. It provides us a glimpse into their lives, their yearnings, and their dreads. Three of the dyads out of twelve attract my attention tonight.
Who will be at peace and who will be troubled? מי ינוח ומי ינוע
Who will be serene and who will be disturbed? מי ישקיט ומי יטרף
Who will be tranquil and who will be tormented? ומי ישלו ומי יתיסר
These dyads focus on an ancient fear-the fear of what we call today, mental illness. There was no word for mental illness in antiquity. Like the fear of death, the fear of falling sick to mental anguish and suffering is part of our reality, just as it was for them. While we know much more about mental illness than our ancestors, we have, like them, found no cure.
We lost the greatest living comic of our generation a few months ago due to suicide as a result of mental illness. Can you imagine how Robin Williams suffered? We ask ourselves how a person who had fame, fortune, admiration from his peers, a loving family, and access to the best of the best health care could take his own life? Mental illness remains one of the enduring mysteries of human existence.
Mental Illness is a part of my reality. I lost a brother to suicide. I have a brother who lives with bipolar. I am a parent of a child living with bipolar. Ever since his early adolescence, our son has suffered from serious mental illness. It started to manifest with severe mood swings. It progressed to obsessive thoughts. It worsened with the appearance of severe depression, self-injury, and a full blown eating disorder. By high school he was missing semesters due to hospitalizations and extended time in psych units and a stay at a residential program in Idaho.
Our son is very gifted. Despite these setbacks he completed high school with honors and gained acceptance to a top university. But his illness continued to disrupt his studies with intermittent hospital stays and medical leave. Now at 28 and a graduate student, he continues to improve how he handles his illness. He takes his meds. He has assembled a strong mental health support system. He has a loving wife and a loving family who are his allies. But there is no cure for bipolar illness. It can only be managed with medication and healthy life choices.
Mental Illness is a family condition. Anyone here who has cared for a loved one living with mental illness or lives with a mental illness knows that it completely changes family dynamics. During an episode of serious mental illness a person loses much of her capacity to handle basic daily life skills. Even for a teenager or an older adult, a psychotic episode pushes her back into a dependency on family members. Mental illnesses are chronic illnesses. Listen to a few startling facts about mental illness in America gathered by the National Alliance on Mental Illness.
- One in four adults−approximately 61.5million Americans−experiences mental illness in a given year. One in 17−about 13.6 million−lives with a serious mental illness such as schizophrenia, major depression or bipolar disorder.
- Approximately 20 percent of youth ages 13 to 18 experience severe mental disorders in a given year. For ages 8 to 15, the estimate is 13 percent.
- One-half of all chronic mental illness begins by the age of 14; three-quarters by age 24. Despite effective treatment, there are long delays−sometimes decades−between the first appearance of symptoms and when people get help.
- Suicide is the tenth leading cause of death in the U.S. (more common than homicide) and the third leading cause of death for ages 15 to 24 years. More than 90 percent of those who die by suicide had one or more mental disorders.
- Although military members comprise less than 1 percent of the U.S. population, veterans represent 20 percent of suicides nationally. Each day, about 22 veterans die from suicide.[i]
Two years ago after a 30 year career as a pulpit rabbi, I became the director for the Juneau affiliate of the National Alliance on Mental Illness-known as NAMI. NAMI is the largest grassroots organization supporting, educating and advocating on behalf of those living with mental illness and their families. Working for NAMI has opened my eyes about the pervasiveness and devastating impacts of mental illness. Working for NAMI has also helped me become a better rabbi and human being.
When my son started getting ill seventeen years ago I was a congregational rabbi in Seattle serving a congregation of 450 families. Looking back, I did not know how to face this issue with my congregation. I assume that those who were more involved knew that something was wrong, but we kept mum on how serious it was. My son was afraid of disclosing for fear of stigma and he isolated himself, a tendency common for people living with mental illness. We tried to keep our worry and concern hidden from almost everyone.
So we soldiered on. Years have passed and now I am a professional advocate for those living with mental illness including my son. It took me 17 years to give this sermon.
Our Jewish religious tradition and culture has a complex relationship to mental health. We know about biblical figures who suffered from mental illness such as King Saul or Samson. In rabbinic Jewish culture the word for someone with a mental disability is Shoteh. Words like Shoteh carry a cluster of meanings. The word Shoteh could describe someone suffering from profound mental illness or a person who is intellectually disabled. Shoteh in rabbinic literature can also mean fool, an idolater, or a child savant with prophetic gifts.
The Shoteh in rabbinic law was legally stigmatized. Shoteh is often listed in rabbinic literature with deaf-mutes and minors. A Shoteh, like these two other statuses, was exempted from the observance of the commandments and of representing the community in any form including serving as a prayer leader. According to the rabbis these categories of persons lacked the capacity for Da’at-discernment, a complex rabbinic term for the capacity of basic reasoning and decision making. [ii]
But a Shoteh I am talking about, a mentally troubled person, could regain a normative legal status if he recovered his senses. It seems that the ancients also recognized like we do today that mental illness can be episodic.
Rabbinic tradition also has bequeathed to us blessings for saying when we encounter someone with a physical or mental disability. If you encounter a person who was born with a mental disability such as Down syndrome you would say, “Blessed are you, Lord our God, Ruler of the Universe who creates such varied creatures.” However, when you encounter someone with a late onset disability such as an injury or an illness, you say the same blessing we say upon hearing of a death. “Blessed are you, Lord our God, Ruler of the Universe, the True judge.” Judith Abrams, a scholar on the topic of disability in Judaism comments that the choice of two blessings reflect the view that disability is either one of a number of normal conditions which people or born into or if the condition is later onset, it must be a punishment or an act of God. Since mental illness generally becomes apparent in late childhood, adolescence, and adulthood, the dayan emet blessing would be said according to this source. The implication of mental illness as a punitive act of God makes this morally and theologically troubling. [iii]
Furthermore rabbinic law stigmatized suicide which we know today is most often tied to serious mental illness. The victim of suicide was to be buried outside the community cemetery.
Most rabbis in our times recognize suicide as a result of despair and illness and not an intentional act against God. The practice of burying a suicide outside the Jewish cemetery has been long discontinued in most Jewish communities.
While some of the ancient sources about mental illness and disability are distressing, there is another aspect of our culture and tradition that has courageously faced this issue. It is interesting then that many of the pioneers of understanding mental health and brain science in the past couple of centuries are Jews such as Sigmund Freud, Alfred Adler, and the Nobel Prize winning brain scientist, Eric Candell. One of the key insights of these scientists and theorists of modernity is that mental illness is a brain disorder, that it is treatable, and that the terrible stigma found across cultures about mental conditions needs to be fought and vanquished.
Reform, Conservative, and Modern Orthodox Judaism have made major reforms in removing stigma about mental illness including ending of the practice of stigmatizing the victim of suicide, mandating the need for treatment, and portraying God as compassionate and seeking the welfare of those who suffer from mental illness. After all, the Torah also commands that we are not to curse the deaf or put a stumbling block before the blind. (Leviticus 19) The Rabbis did not interpret this verse narrowly, but extended it beyond “blindness” and “deafness” to any limiting condition that humans suffer from. We are not to take advantage of the vulnerabilities of those living with mental illness. Rather we are required by tradition and contemporary moral awareness to extend compassion, hope, and access to healing and recovery to those who suffer.
Because of the stigma of mental illness, there are many more who suffer than we know about. Within congregations, there are many who suffer silently these potentially devastating illnesses. Someone aptly called mental illness the no casserole illness. When people get cancer or suffer a major injury the congregation mobilizes to bring food to the sick person and his family. But for various reasons those who live with mental illness and their families suffer in isolation, sometimes of their own choosing as was the case with our family or due to stigma about mental illness within a congregation.
I speak about this openly with the hope of reducing stigma and increasing hope for those among us who live with mental illness and those family members and friends present who are helping them.
Here are some things that you can do.
Get involved in your local NAMI to advocate for better mental health services in the Fairbanks area and in the state of Alaska. NAMI Alaska is also is ready to train volunteers who are family members or persons living with a mental illness to become peer teachers for their excellent peer driven courses and support groups. If you are one of these people, volunteer. It’s a mitzvah.
Take mental health first aid training when it is offered here in Fairbanks to learn more about how to recognize mental illness and suicidal signs and to help a person who is suffering a mental breakdown.
Make sure that your synagogue is not only responsive to those who suffer physical illness, but also responsive to those who are struggling with mental illness and their families who are trying to care for them. Make sure your caring casseroles are available for all.
I remember many years ago when my son was hospitalized in one of the more severe depressive episodes. He was so sick and in such pain, that I hardly recognized him. At the absolutely worst moment, one of the aides saw my distress on my face and took me aside. He told me, “It will not always be like this. He will find a way out of this.” I will always remember those words of hope and encouragement.
That is what we should do, provide hope, support, and encouragement for those we know who face this enormous challenge. As it says at the end of ‘Unetaneh Tokef’. “Teshuvah, tefilah, and tzedaka maavirin et roa hagezera”. I translate it here to mean, “by turning toward, by advocating, and by generous righteous and caring acts we diminish the severity of the decree.” We have the power to make a difference and bring hope to those who suffer.
[i] From the NAMI Fact Sheet, “About Mental Illness”
[ii] From Judith Abrams, Judaism and Disability: Portrayals in Ancient Texts from the Tanach through the Bavli, Chapter 6.
[iii] Abrams, p. 118-119