Who Will Be Serene and Who Will Be Troubled?
A Rabbi and a Family Member Speaks about Mental Illness
Rabbi Dov Gartenberg
Adapted for Congregation Beth Shalom, Shabbat August 5, 2017
I would like to dedicate this derasha to two family members. First I dedicate my words in honor of my son, Mori Gartenberg who turned 30 this week. His name means God is my teacher and he has taught me much about the meaning and purpose of life. Second, I share these words in memory of my brother, Philip who left this world thirty years ago this month. Zichrono Livracha.
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 litany of existential disjunctions is a record of the anxieties of our ancestors. It provides us with a glimpse into their lives, their yearnings, and their fears. Three out of twelve of the dyads attract my attention today.
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 somberly contemplated fates all revolve around an ancient fear -- the fear of what we today call mental illness.
There was no word for mental illness in antiquity. Like the fear of death, the fear of succumbing 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 lasting cure.
Mental illness is part of my reality. Five living members of my family cope with bipolar disorder. I lost my brother, Philip to suicide thirty years ago from undiagnosed bipolar disorder this month.
Caring for a loved one living with mental illness is very taxing. The illness is unpredictable and disrupting. Witnessing a family member experience a psychotic episode is so disorienting that you don’t even recognize the loved one you thought you knew so well. More chronic conditions include disabling depressions or dangerous manias that lead to grandiosity. Then there are the frequent hospitalizations and the struggle to get information from medical personnel about your loved one’s condition. You live with the fear of the telephone call which brings news of a new crisis.
Mental illness is a family condition. Anyone here who has cared for a loved one living with mental illness or who lives with a mental illness knows that. During an episode of serious mental illness, a person loses her capacity to engage in basic activities of daily living. A psychotic episode can force even an adult into a condition of unwanted dependency on family members.
Mental illnesses are chronic illnesses. Consider a few startling facts about mental illness in America gathered by the NAMI, the National Alliance on Mental Illness.
- One in five adults − approximately 43.8 million Americans − experiences mental illness in a given year. One in twenty-five − about 13.6 million − lives with a serious mental illness such as schizophrenia, major depression, or bipolar disorder.
- Approximately twenty percent of youth ages thirteen to eighteen experience severe mental disorders in a given year.
- One half of all chronic mental illness begins by the age of fourteen; three quarters by age twenty-four. 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 people between the ages of fifteen and twenty-four. More than ninety percent of those who die by suicide had one or more mental disorders.
- Although military members comprise less than one percent of the U.S. population, veterans represent twenty percent of suicides nationally. Each day, about twenty-two veterans die from suicide.[i]
- Another huge problem in this country is addiction. Approximately 10.2 million people suffer from co-occuring mental illness and drug/alcohol addiction..
Five years ago, while living in Alaska, I became the director of the Juneau affiliate of 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 opened my eyes to the pervasiveness and devastating impacts of mental illness. It has also helped me become a better rabbi and human being.
Jewish religious tradition and culture have 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. Shoteh could describe someone suffering from profound mental illness or a person who is intellectually disabled. In rabbinic literature, it can also refer to a fool, an idolater, or a child savant with prophetic gifts.
The Shoteh in rabbinic law was legally stigmatized. In rabbinic literature, the Shoteh is often grouped together with deaf-mutes and minors. A Shoteh, like members of the latter two categories, was exempted from the observance of the commandments. The Shoteh was not permitted to represent 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, or discernment, a complex rabbinic term for the capacity for basic reasoning and decision making. [ii]
But a Shoteh, a mentally troubled person, could regain a normative legal status if he recovered his senses. It seems that the ancients also recognized, as we do today, that mental illness can be episodic.
Rabbinic tradition has also bequeathed to us blessings to recite when we encounter someone with a physical or mental disability. If you encounter a person who was born with a disability such as Down Syndrome, the proper blessing would be, “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.”
The late Judith Abrams, a scholar on the topic of disability in Judaism, commented that the choice of two blessings reflects the view that, on the one hand, a disability could be any of several common conditions that one could be born with. But, on the other hand, if the condition were to emerge later, it would be seen as a punishment by God. Since many serious mental illnesses appear in young adulthood, the blessing “baruch dayan emet” according to the sources is the proper blessing. To me, the ancient practice of reciting this blessing is, morally and theologically, deeply troubling. [iii]
Older halachah also stigmatized suicide, which we know today is most often an outcome of serious mental illness. The suicide victim historically was to be buried outside the community cemetery.
While some of the ancient sources about mental illness and disability are distressing, there is another strain in our culture and tradition that has courageously faced this issue. It is interesting that many of the pioneers in the fields of mental health and brain science in the past couple of centuries have been Jews, such as the Nobel Prize-winning brain scientist, Eric Kandel. 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 resisted and vanquished.
Reform, Conservative, and Modern Orthodox Judaism have made major halachic reforms in removing stigma about mental illness, including ending the practice of stigmatizing the victim of suicide, mandating the need for treatment, and portraying God as compassionate and as 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 individuals who suffer than we know about – many, indeed, within our congregations. A friend and religious colleague of mine, who suffers from bipolar disorder, aptly called mental illness the “no casserole illness.” When a person gets cancer or suffers a major injury, the Mitzvah Corps mobilizes to bring food to the sick person and his or her family. But, for several reasons, those who live with mental illness and their families tend to suffer in isolation, sometimes of their own choosing, sometimes due to the insensitivity of the community.
I speak about this openly with the hope of reducing stigma and increasing hope for those among us who live with mental illness, and for those family members and friends present who are helping them.
This week’s portion is also called Nahamu, based on the first verse of the Haftarah, “Be comforted, be comforted, my people.” My work with NAMI taught me that people living with mental illness and those courageous family members who care for them need hope and comfort.
Every one of us knows someone living with a mental illness. Tell your friend or your loved one about NAMI. NAMI offers incredible resources for a person struggling with mental illness that supplement therapy. If you are a close friend or family member of a loved one living with mental illness, consider the resources that NAMI provides for family members. I am a trained volunteer peer teacher of NAMI’s award-winning Family-to-Family course. Over 300,000 family members have taken this free course offered by NAMI affiliates across the country.
Please let people know that JFS is offering a Family to Family course in the fall in concert with NAMI of Greater Seattle. I am one of the teachers of this free course. The course gives vital information about diagnosis, medication, current science, treatment options, and lots of time for family members to talk about their situations. I will address specific issues that arise for Jewish families when a loved one suffers from disabling mental illness. I have taught this class now six times and have seen individuals and families transformed by the experience. Please share this information with friends who you think would benefit.
There are other things each of us can do to be more knowledgeable about this pervasive condition. Consider taking mental health first-aid training to learn more about how to recognize mental illness and suicidal signs, and to help a person who is suffering a mental breakdown or is showing subtle signs of depression.
Make sure that Beth Shalom is not only responsive to those who suffer physical illness, but also responsive to those who are struggling with mental illness, and to the families who are trying to care for them. Fight stigma against mental illness in any way you can. Make sure your care and your casseroles are available for all.
I remember when, many years ago, a loved one in my family was hospitalized due to a severe depressive episode. He was so sick and in such pain that I hardly recognized him. At the most distressing moment, one of the aides saw the distress on my face and took me aside. He told me, “It will not always be like this. Your loved one 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. What we do makes a difference.
[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