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Yom Shlishi, 27 Iyyar 5777

An Apology:  Moving Beyond the Stigma of Mental and Emotional Challenges


Rabbi Lee Bycel, Congregation Beth Shalom of Napa Valley

 

(This is a topic that I have been thinking about for years and feel it is critical to address now.  Although it is complex, nuanced and difficult, we can no longer avoid this subject.)


Some recent emails from students at USF, where I teach:


“Professor, I cannot attend class today.  I am in the midst of great emotional turmoil and the only appointment I could get with the psychologist was for this afternoon.”


“Professor, I will not be in school today, I am having an anxiety attack.”


 “I regret missing last week, a dear friend of mine committed suicide, and I could not come to class.”


I wish I could tell you that these emails were unique, but in talking with colleagues they are not.  We have all read the descriptions of the stress that our youth feel and the anxiety that so many of us experience. As Carl Jung once described, “About a third of my cases are suffering from no clinically definable neurosis, but from the senselessness and emptiness of their lives. This can be defined as the general neurosis of our times.”  Yet, as we all know, there are many others who suffer from mental illnesses that are far more devastating than the general neurosis of our time.  Today we are talking about both the depressive and anxious episodes we all experience in the journey though life, as well as the mental illnesses that are chronic and debilitating.


Regrettably, none of this is really new.  I want you to consider these three emails as we again take a look at the haunting tale of Abraham taking Isaac to Mt. Moriah with the mandate to offer him as a sacrifice.  It is a story about faith, about loyalty. It is a story that teaches us that God does not want human sacrifice.  It is a story about testing and questioning.  However, let us stick with the narrative.  Isaac goes along with his father – like any son – trusting, accepting and profoundly scared about this journey into the unknown.  I am sure Isaac could feel his father Abraham’s terror and doubts.  Am I really going to have to sacrifice my son?  Is this the God I believe in?  And the journey goes on for three days.  Finally, at Mt. Moriah, at that dramatic moment when Abraham lifts the knife and is ready to commit this horrific act, God calls out not to do it and instead there is a ram who is sacrificed.  


There are many questions that arise from this story:  What was Abraham’s state of mind after being asked to do such an incomprehensible act – horror, anxiety, this is unbelievable – what more can this God want from me?  Like the students who sent the notes to me, he probably wished he could send a note to God:  Won’t be able to be here today, not feeling well.   And Isaac asked the question of his father on the journey:  Here is the wood and knife, but where is the sheep?  We are told that Isaac was 37 or perhaps he was 13. What were his feelings:  Dad, have you lost your mind?  Do you really think I don’t get what is happening?  I love and respect my father, but I better get out of here!  And Sarah, where is she? Sarah is nowhere to be found in the story.


After the horror is over and a ram is offered, we are told that Abraham returned to his servants, and they went to Beer Sheva.  Where had Isaac gone?  One sage (Menachem Mendel of Kotzk) suggests that Abraham had to now live with the reality that Isaac would remember for the rest of his life those horrific three days and what his father almost did to him.  It is in Beer Sheva that Abraham would live out his life with his only mission really to find a wonderful wife for his son – Rebecca.


We learn about Sarah in the very next section.  Sarah’s lifetime was 127 years and she died in Hebron.    Did she die of a broken heart, having heard about the horror on Mt. Moriah?  Did she die from depression – of not believing that human beings, even her own husband, was actually capable of considering committing murder?  We are told that Abraham mourned for her.  But there is a textual challenge – he is in Beer Sheva and has to go to Hebron to mourn for her.  Had they separated?  Could their marriage not withstand this test?  Rabbi Shlomo Riskin offers this insight on what she might have said:  “Abe, if you are going to take my son Yitzhak, and you are going to take him on some journey to Moriah, no matter what God commands you or what you think God might be commanding, I will never live with you in the same house again.”


We know nothing of Isaac until he reappears several chapters later:  “Isaac had just come back from the vicinity of Beer- lehai –roi, for he was settled in the Negev.” (Gn. 24:24:62)  Where had he been after Moriah?  Was he in a mental hospital recovering from the trauma?   Was he just wandering around, lost and confused and unable to make sense of the world?  Would he spend the rest of his life in disbelief that his father ever took him on this journey?


The great 20th century writer William Styron offered many valuable insights into depression that can be applied to this text and what each of the three main characters may have been going through:  “Depression is a disorder of mood, so mysteriously painful and elusive in the way it becomes known to the self--to the mediating intellect--as to verge close to being beyond description. It thus remains nearly incomprehensible to those who have not experienced it in its extreme mode, although the gloom, ‘the blues’ which people go through occasionally and associate with the general hassle of everyday existence are of such prevalence that they do give many individuals a hint of the illness in its catastrophic form.”  (Darkness Visible, A Memoir of Madness)


 Or perhaps JK Rowling captures what each was feeling in talking about her own experience: “Depression is the most unpleasant thing I have ever experienced. . . . It is that absence of being able to envisage that you will ever be cheerful again. It is  the absence of hope. That very deadened feeling, which is so very different from feeling sad. Sad hurts but it's a healthy feeling. It is a necessary thing to feel. Depression is very different.”


This morning, I am asking us to consider this ancient text in a very different way.  This story is completely relevant to our contemporary situation – it shows that in Jewish tradition, from the very beginning as we struggled with what it is to be human, people suffered from what we now call mood disorders. These include:  depression, anxiety, bi-polar disorder, seasonal affective disorder, post-traumatic stress as well as many other mood disorders.   We see these disorders in some of our great sages and teachers, and we know that people throughout the ages have suffered from these disorders, prior to our even having names for them.  We are mindful of several sobering facts here in America, which paint a picture of  what one might call an epidemic of mental challenges and illnesses, especially during September which is National Suicide Prevention Month:

 

  • One in four adults−approximately 61.5 million Americans - experiences mental illness in a given year.
  • One in 17−about 13.6 million−live 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.
  • The number one cause of disability claims in America (more than cancer or heart disease)
  • Approximately 60 percent of adults, and almost one-half of youth ages 8 to 15 with a mental illness received no mental health services in the previous year.
  •  Serious mental illness costs America $193.2 billion in lost earnings per year (All sources cited above are from the National Alliance on Mental Health)
  • About a quarter of us have taken medications for depression or anxiety or other mood disorders in the course of our lives. (various sources)
  • Many people never seek treatment or lack the resources to receive help. (All of the above unless otherwise noted are from the National Institute of Mental Health). 

 

Mental illness is an equal opportunity and no-fault brain disorder.  I recall, as I am sure many of you do, the story of Senator Thomas Eagleton who was originally the VP selection of George McGovern in 1972.  He lasted 18 days until he was forced to leave the ticket by public pressure because of his having been treated for depression.  Eagleton said the following: "On three occasions in my life, I have voluntarily gone into hospitals as a result of nervous exhaustion and fatigue… As a younger man, I must say that I drove myself too far, and I pushed myself terribly, terribly hard, long hours, day and night."  In my 36 years as a rabbi, I have heard from many people their stories of nervous exhaustion and fatigue.  And yes, I have also felt that.  Are there really many people here who have not?  As I reflect on the Eagleton story, I wonder how much has changed since 1972. Are we ready to vote for a President or Vice President in 2016 who might actually admit having suffered from a mood disorder of some kind?


Early in my tenure here at CBS a woman came to talk with me about her depression.  Since then many people have shared their stories with me.  Let me paraphrase what I have heard:  “I have depression or anxiety or PTSD and often cannot function fully.  I feel that I cannot share this openly with my community as people would not understand.  I don’t want to be judged permanently for what may be a temporary condition.  We don’t judge people with cancer or heart disease. Why is there such a stigma about mental disorders?”


We tend to marginalize people with mood disorders, and we especially have little real tolerance for those with serious psychiatric disorders.  Why in the 21st century, when we know so much about mental health issues and the various causes of it - brain chemistry, genetics, neurological development, brain trauma, and mental conditions brought on by addictions – substances, computer games, gambling, are we still stigmatizing emotional challenges and mental illness?  Why when we are so keenly aware that we are living in a world that is so turbulent and chaotic and where books like Prozac Nation describe us so well, why do we still stigmatize mental health issues?  Why do so many people  feel ashamed – or is it our society that shames them?  In hearing about a depressive episode, we often trivialize their issues with a response: “but you look just fine.”  At times, we all have our own theories of how people should just snap out of it. None of us would dare say that about a cancer victim.


I believe that mild to serious mental health challenges and their often co-occurring substance abuse problems are the elephant in the room.  I find it ironic that we can be so open and supportive of so many other ailments while, at the same time, our society still finds these mental health issues so problematic.  Are we scared to talk about it?  Do people who are in a depressive episode scare us?  Do they say what we feel?  Do we not know what to say?  Are we challenged by our own discomfort?  One of the great Hasidic masters, Reb Nachman of Bratzlav, suffered from chronic depression. One disciple said this about him:


“No act in the service of God came easily to him; everything came only as a result of great and oft-repeated struggle.  He rose and fell thousands and thousands of times, really beyond all counting…He would enter into worship for a certain number of days; then again he would experience a fall…It was his way to start anew each time…At times he had several new starts within one day, for even within a single day he could fall several times and have to begin all over again.”


We all know that struggle, we all know of falling and stumbling – we all know the angst of living in this world, we all know how hard it is to pick oneself up, we all know that all we can do is to keep trying.  


Bratzlaver Hasidim are known for their ecstatic dancing and singing – and many have interpreted their actions as their remedy for depression.


Last night in our discussion of the Unetenah Tokef prayer we looked at natural disasters such as earthquakes. Today we look at a different part of the prayer:


Who will be tranquil and who will be troubled?
Who will be soothed and who will be scourged?

 

This morning these last two lines pierce our hearts and our souls.  Are tranquility and being troubled within our control?  We have no idea what the year will bring us and the challenges we face.  I don’t think this part of the prayer is about who will suffer from mood disorders and who will not, but rather, it is a response to how those who do experience these challenges or how we as family members or a community, might best help.  What we are all yearning for is some kind of tranquility, and it might just come from understanding that mental illness is a faultless disease just like physical ailments.  There is nothing to be blamed for or to feel bad about if one is suffering from depression.  It is as real as any other ailment and is a lot more painful because it is invisible.

 

The prayer continues:  “Who will be soothed and who will be scourged…” is a key to perhaps how we as a local and a national community need to better address the epidemic of mental issues.  The question for me is not just who will be soothed or treated, but will we be capable  as individuals and as a community to soothe and support?  Will we listen to the journeys of those with mood disorders with the same respect and compassion that we listen to the stories of others?  Will we create more ways that people who suffer from invisible diseases can feel welcome in our communities?  Will we work to rebuild a society where good mental health care is available to all regardless of economic status?  Will we resolve not to stigmatize those who have the courage to share their stories?  

 

More and more are telling their stories in memoirs and articles.  Just recently Jordana Steinberg, daughter of our California Senate President Pro Tem, Daryl Steinberg, revealed her journey to the public. (Sacramento Bee).  Her severe mood disorder emerged during her childhood.  Her mother Julie said around the time  of Jordana’s Bat Mitzvah:  “My fear was she was going to end up in prison, or be dead.  There was no one to give us any tools. No one.”  Thanks to a wonderful and very expensive residential program, Jordana is now in college. Her problems persist, but she has learned coping mechanisms and receives lots of support. Her father Darrell in his last letter to the legislature before stepping down from his post wrote: “The only reason my family and I are sharing such a personal and painful story is to let others in similar circumstances know that they have real hope.  We did not have much hope when we were dealing with this and yet, because of Jordana's persistence and a lot of help, she is living a complete and full life… It is an issue which knows no partisan lines.  Its impacts and suffering escape no race, class, gender, age, or sexual orientation.   It affects every other agenda we address in the Legislature, from education to criminal justice and much more.”

 

There are many people like Jordana who get better.  But too many people and their families suffer endlessly in part because we collectively push the uncomfortable issues away.  Senator Steinberg goes on to implore his colleagues to introduce bills that will improve the condition of mental health services in the way that Proposition 63 did in 2004.


As we all know there are all too many others like Jordana whose stories do not have such good endings.   There are many others, like our own Adam Lieberstein, whose schizophrenia could not be treated and consumed him.  His loving parents Gary and Patti tried everything in the world to help him, but regrettably there was no cure.  As Gary shared with me:  “Our son Adam was loved by Rachel, Patti and I and we tried everything we could to get him the right help.  And while a nation didn't mourn his passing, many people who know us are aware of what happened, although perhaps not understanding why, something we will likely never know  because we can't make logical sense out of acts that make no sense.  I have chosen to make our story public, and Patti has stood by my side in doing so, in the hope that we can make a difference for other people who are afraid to speak up or reach out on behalf of their family member, friend or themselves.  The primary message I am trying to get out is that you are not alone -- far from it.  And to encourage people to seek that help.”

 

We often read these stories with great interest because we know that there are many people out there with these issues and we don’t know how to talk about the epidemic of psychological problems.   Reading about them or having the tragic story of Robin Williams dominate the news allows us a freedom that we don’t seem to normally give ourselves – and that is to share our concerns.   The same day that Robin took his life, 55 other people took theirs, like they do every day.  Yet I wonder today, how many here in our synagogue are suffering with invisible diseases?  How many Jordanas or Adams or Robins are here in our midst?  I know that they are here and I want to share something with them and everyone.


We apologize for how we have stigmatized you. We apologize for how we have stigmatized you and how we have stigmatized and marginalized ourselves.  We regret the neglect of not paying attention to the signs and symptoms, the tears, words, gestures and body language. We regret that we are often scared by your stories and don’t know how to react or how to help.  We know that you did not cause your depression or anxiety and we wish that there were better treatments for you.  We want you to know that your Jewish tradition is well aware of these problems and can nurture and support us in our journeys.  We want you to know that we find the lack of good mental health services in our country, in our State, and in our county appalling.  Please know that we will work with our legislators in bring funding to mental health institutions.  Please understand that at times your honesty or your rage makes us uncomfortable and scared, but that we will not run away. We ask that we forgive ourselves. We ask for you to accept our apology.  


We are grateful for all those who care for people with mental illness and those who show tremendous devotion and courage in their ongoing caretaking.  We empathize with those who are no longer able to provide that help and agonize about the lack of assistance available. We acknowledge that we have much to learn.  For that purpose I assembled a Mental Health Resource Guide as well as gathered materials from NAMI and other sources.  These are available to you here.  I am also asking today for mental health professionals from our community to volunteer hours. Thus, we can have a resource bank available.


Today, as we wrestle again with this ancient story of Abraham, Isaac and Sarah, let us find comfort in knowing that having anguish in our souls about this story, about the real life implications of this profound narrative, makes good sense and can motivate us to action.   I think we can leave today uplifted if we allow ourselves to see in everyone - those with physical infirmities, those with cancer, those with mood disorders, and those with any physical or mental ailment - the image of God.  Perhaps on this day we can even be a bit more compassionate and forgiving of ourselves.  Mental health is a Jewish issue.  Mental health is a human issue.  I believe that we will show the best of our humanity in how we deal with this silent epidemic.  

Debbie Perlman, a contemporary psalmist, wrote the following Psalm on the Akedah:


“Give us strength, Almighty One,
To work free the mind-made knots,
Worrying them with our worries
Until a rush of wings clears the air.
Give us courage, Almighty One,
To cope with snarls and tangles;
Binds loosen and return,
Abide with us.”


And I would add:  Let us have the patience and resolve to know that when we include everyone, we gain as individuals and as a community.  Grant us the courage in this New Year to do our best to destigmatize mental illness and to work for a society that better helps all those who are suffering.


Rabbi Lee Bycel is the rabbi of Congregation Beth Shalom of Napa Valley and is an Adjunct Professor of Religious Studies and Social Justice at the University of San Francisco.  He is a member of the United States Holocaust Memorial Council and of the Committee on Conscience.