Mental Illness in the Torah

Image: Painting of David and Saul, Franco-Flemish School, unknown Master, 19th century. Public Domain. Several characters in the Bible may have suffered from mental illness, but King Saul is one of the most dramatic depictions.

In many ways we seem to still be in the dark ages when it comes to mental illness. Treatments are far from perfect, access to treatment is often difficult, and most of all, the stigma attached to mental illness is cruel. A Washington Post article, Halloween Attractions Use Mental Illness to Scare Us, reflects a casual cruelty about mental illness that would be completely unacceptable relative to physical illnesses such as cancer or polio.

Mental illness is mentioned in the Torah. Like physical illness, it was understood to be either a misfortune or a punishment from God. It is listed among the curses in Deuteronomy 28:

Thus if you will not listen to the voice of the Eternal you God, to observe to do all God’s commandments and God’s statutes which I command you this day, all these curses shall come upon you, and overtake you… (Deut 28:15)

The Eternal will strike you with madness, and blindness and astonishment of heart and you will grope at noonday as the blind grope in darkness. You will not make your ways prosperously. You will be oppressed and robbed always, and there will be none to save you. (Deut 28:28-29)

While on the surface this might be an upsetting passage, let’s look below its surface meaning for two interesting things. The first is that Deuteronomy 28 refers to boils, scabs, tuberculosis, fevers and inflammation in precisely the same way it refers to shigayon, usually translated “madness.” There is a fundamental understanding of illness as illness, whether it is physical or mental.

The second is that verses 28 and 29 offer a striking description of the ravages of mental illness.  Lev in Biblical Hebrew is not just the “heart” – it is more accurately described as the seat of thought and emotion, what we moderns refer to as “mind.” I offer a paraphrase in modern English for verses 28-29:

The Eternal will strike you with mental illness, so that your mind will not work properly. You will be unsure of your perceptions, and your sleep cycles will be disrupted. You will find it hard to find employment. You will be vulnerable to criminals and exploitation, and it will be difficult to find help.

The author of Deuteronomy had a remarkable knowledge of the experience of mental illness. However you understand authorship of the book (divine dictation, divine inspiration or human authorship) it shows a striking familiarity with the phenomenon.

Today we no longer understand physical illness to be evidence of sin, and there is no reason to see mental illness in that way, either. The mentally ill are not at fault, and deserve the same compassion we give any other person afflicted with illness. Both physical and mental illness are curses upon humanity, but much of the misery they cause can be alleviated with human compassion.

What can we learn about mental illness from Torah? First, we can learn that it has always been with us. Thousands of years ago, it was not all that different than it is today. Secondly, we can learn that it is in fact the equivalent of physical illness: it threatens life and livelihood.

What has changed from Biblical times is that we are aware that we are the hands of God in this world. It is up to us to use our heads and our hearts to relieve the suffering of the afflicted, with the employment of science and the balm of compassion.

Mental Illness and Yom Kippur

Image: A well-dressed woman sitting bent-over on a bench. Photo by RyanMcGuire via pixabay.com.

Before I learned to read Hebrew, Yom Kippur could wreck me. The language of “sin” and “repentance” that I learned as a child sent me into a tailspin of despair.  Avinu Malkeinu [Our Father, Our King] was a fearsome image before which I cowered, a failure. A whole day of that, plus fasting, sent me into a black pool of depression.

The years that I was in otherwise good emotional shape, I’d be OK. But I remember a couple of years when Yom Kippur coincided with a round of depression, and I shudder. What should have been a holy day became a spiritual battle.

For me, and for others who suffer from a mental illness or affective disorder, holy days and holidays can carry an extra punch. There’s no shame in that; it’s also true for anyone who has had a recent trauma or whose close friend or relative has died.

Here are some things I have learned. I share them for the benefit of anyone who needs them this week:

PIKUACH NEFESH (pee-KOO-ach NEH-fesh) means “preservation of life.” It overrides nearly every other commandment. Do whatever you need to do to take care of your body/soul this week. If that means go to the beach for your Yom Kippur “service,” do it. If that means eat, take your meds, go to a meeting,  or call your therapist, DO IT.

FASTING – Fasting isn’t good for everyone. It’s bad for diabetics, pregnant women and people with a history of eating disorders. If there is some reason fasting isn’t good for you, DON’T FAST on Yom Kippur. (Again, pikuach nefesh!) All you have to say to anyone is “health reasons.” (Really, they should not be quizzing you anyway.) One strategy for dealing with feeling left out of the fast is to take one or more meals with someone else who doesn’t fast. Trust me, there are many Jews in that category. You are still welcome at the Break-the-Fast, don’t worry!

MEDICATION – If you are on medication, take your meds and take them properly. If you are supposed to have food or water with meds, eat or drink. Medications do not solve everything, but they can be a huge help. There is no shame to taking them, and they have saved lives. I take mine every day, and I say a blessing when I do it.

LANGUAGE – If you grew up in a Christian household, the language of prayer of the High Holy Days can be intense. “Sin” is an English translation for a range of Hebrew words, which mean everything from “mistake” to “malicious wrongdoing.” “Repentance” is the English translation for teshuvah, which covers a much larger concept than merely being sorry. It means turning, changing course, and sometimes, coming home.

If you find the language of the High Holy Days upsetting, I can suggest two things to do, one immediate and the other long-term. The first is to schedule some time with your rabbi (after the holy days!) to talk about “sin” and “repentance.” The long-term solution that worked for me was that I studied Hebrew and set myself free from clumsy translations.

DON’T BE SHY – Don’t be shy about taking whatever action you need to take about your self-care. Remember it is a mitzvah, a commandment, to take care of yourself and to stay alive! If services are too upsetting, don’t go. Go for a walk, go to the beach. Maybe this year your teshuvah, your turning, will be to give your rabbi a call after the holy days are over and get the name of a good therapist.

Whatever your situation, know that you are not alone! Many of us deal with some mental health issue over Yom Kippur. Help is available if you reach out for it.

This is an updated version of a post I wrote three years ago.

Bipolar Disorder and Judaism

Image: David Plays for King Saul (Ernst Josephson, 1878), public domain

What does Judaism have to offer on the subject of bipolar disorder?

I’ve already written about the general topic of Judaism and Mental Illness, as well as Judaism and Depression. Today I’m going to look at Judaism’s take on bipolar disorder, also sometimes known as manic-depressive disorder.

Just as there are examples in Jewish scripture of depression (e.g. Psalm 38), there is also an example of bipolar disorder. No less an authority than the British Journal of Psychiatry has suggested that perhaps that was what was troubling King Saul in the Book of Samuel. King Saul was sometimes terribly sad and withdrawn, and his servants regarded it as an “evil spirit” come upon him. (1 Samuel 16) Saul’s illness increased, so that he was plagued with both depression and with bursts of energy (1 Samuel 18).

Verses in 1 Samuel 10 describe something that sounds like a manic episode. King Saul comes upon some prophets, and is himself caught up in a prophetic frenzy. People who witnessed this episode commented that it was not typical of King Saul. Over time, Saul became paranoid, sure that David was going to seize his kingdom by treachery. King Saul was a man of great charisma and promise who ultimately committed suicide on Mount Gilboa. (1 Samuel 31)

The Book of Samuel accounts for Saul’s behavior by talking about the “spirit of God” descending upon or removing itself from Saul as punishment for his disobedience to God’s orders. Characters in the book wonder if he is possessed by an evil spirit at times. Modern day Jews do not believe in “evil spirits” and instead see behaviors like Saul’s to be manifestations of mental illness. We don’t believe that mental or physical illness is a “punishment from God” – rather, both are medical conditions with natural causes. 

It is a sacred duty, a mitzvah, to treat any person with mental illness with compassion. That duty extends not only to others but to ourselves.

Also, because it is a mitzvah to care for the body, if one suspects they have bipolar disorder, it is a mitzvah to seek medical care and to take the advice of one’s doctors seriously. This can be very challenging, since mental health care is by no means as easily available as it should be, and there is much room for improvement in treatment protocols.

Treatment for bipolar disorder can be a challenge. Therefore it is up to the rest of us, to friends and family and community, to support anyone who suffers with the illness to whatever extent we can.

 

What if I Can’t Get to Synagogue?

Isolated House by Hugh Venables
“Isolated House” by Hugh Venables

Location and/or illness make it difficult for some Jews to get to synagogue. How in that situation are we to access Jewish community?

First, the offline solution: If you live in a city that has synagogues, but you just can’t access them, call the synagogue. Express your interest in being a part of their community. Ask to talk to the rabbi, and explain your situation. I can’t promise you that every synagogue will have outreach to shut-ins, but I can promise you that rabbis care about the Jews in their neighborhood. Understand that options may be limited for non-members. However, it is always worth contacting them.

Years ago, before I became a rabbi, my rabbi called me and asked if I would be willing to visit a widow in the congregation who had agoraphobia. Her husband had been her major tie to the world, and now that he was gone, my rabbi was worried about her. I began visiting Anne (not her real name) once a week and doing her grocery shopping. We developed a friendship. Later, when my schedule changed and I could not be as reliable for shopping, I went back to the rabbi and told him. He found someone else to visit, but Anne and I stayed in touch. (Note that this required a large enough community and a willing pool of volunteers; not every synagogue will be able to deliver on something like this.)

Second, the Internet raises many more opportunities for Jewish connections. Here are some resources to check out if you don’t live near a synagogue, or if you are confined to home by illness or disability:

OurJewishCommunity.org provides the most comprehensive online access to progressive services, rabbis, and Jewish community. Rabbi Laura Baum and Rabbi Robert Barr serve both OurJewishCommunity.org and the brick-and-mortar Congregation Beth Adam in Loveland, OH, near Cincinnati.

ReformJudaism.org maintains a list of congregations that live-stream Shabbat services, with information about access. Services are currently available in four US time zones (Eastern, Central, Mountain, and Pacific) and at least one congregation archives services on YouTube.

JewishWebcasting.com offers a wide variety of Jewish experiences online, with links to news, podcasts, and opportunities for prayer.

Lehrhaus Judaica based in Berkeley, CA offers some of its classes online. Click this link to see the current list of courses on the Hebrew Language, Introduction to Judaism, Jewish texts, and other topics. (Full disclosure: I teach one of their online courses and am on the board of LJ.)

I hope that whatever your situation, and whether it is a short-term challenge or a long-term situation, you can find a way to connect Jewishly. Certainly I appreciate your readership and look forward to conversation in the comments on this blog!

Insight from Depression Comix

As a fellow blogger wrote, “If only it were so simple…”

Depending on the kind of mental illness and its severity, it might be like the cartoon below: feel the storm coming and hunker down. But there are other possibilities:

— Feeling the storm coming, and work frantically to batten down the hatches with the meds at hand before chaos…

— No warning, just the storm arrives, and there is nothing in the larder, no time to cancel, just SPLAT and then aftermath for a while…

— Or the storm arrives and passes…. and you wake up with your life in disarray, the house in need of Crime Scene Cleaners, your bank account empty and half your friends furious for mysterious reasons.

I know folks for whom each of those scenarios has happened. So if you have a friend with mental illness, be kind. If you are one of us, know that you aren’t alone, even if it feels like it. (And thanks, comic artist, for a great cartoon!)

Depression Comix

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My Friend is Depressed: Now What?

Van Gogh "Sorrowing Old Man" 1890
Van Gogh “Sorrowing Old Man” 1890

What can Jewish tradition teach us about helping people who are depressed?

REACH OUT – Make contact, either by phone or in person. There is a beautiful story in tractate Berakhot 5a-b of the Talmud about three rabbis. The first rabbi, Chiyya bar Abba, fell ill. Rabbi Yochanan went to see him, and asked him if he welcomed his suffering. Rabbi Chiyya said no. Then Rabbi Yochanan reached out his hand, took the sick rabbi’s hand, and raised him up.

Rabbi Yochanan fell sick. Rabbi Hanina, his teacher, went to see him. He asked the same question, and got the same answer. Then he took Rabbi Yochanan’s hand and raised him up. The text itself asks then, why couldn’t Rabbi Yochanan heal himself? It answers itself, saying, “The prisoner cannot free himself.”

Finally, Rabbi Eleazar fell ill. Rabbi Yochanan went to see him. He finds the rabbi lying in a dark room and crying. Rabbi Yochanan asks some questions about Rabbi Eleazar’s sadness. When Rabbi Eleazar says, “i am weeping because you are going to die someday.” Rabbi Yochanan says, “Yes, that’s very sad” and then they both cry for a while. Then Rabbi Yochanan says, “Do you welcome your suffering?” and Rabbi Eleazar says no, and Rabbi Yochanan takes his hand and helps Rabbi Eleazar up.

What can we learn from this? First of all, it is good to visit people who are sick, whether they are physically or mentally ill. We don’t know exactly what was wrong with Rabbi Chiyya bar Abba, but Rabbi Yochanan visited him, expressed his care, and helped him get better.

Second, we learn that people can’t heal themselves. Never tell a person with depression to “snap out of it.” Instead, ask how they are feeling, listen, and if you can “give them a hand,” literally or metaphorically, do so. Few of us can heal miraculously like Rabbis Yochanan and Hanina, but friendly contact can help.

The case of Rabbi Eleazar is particularly interesting. In his case, it’s clear that the illness is depression. So one thing we learn is that the ancient rabbis saw overwhelming sadness and “lying in a dark room” as a genuine illness. Secondly, Rabbi Yochanan treated Rabbi Eleazar’s sadness with respect. He didn’t say, “That’s silly, everyone dies sometime!” He agreed that it was sad, empathized with his student, and then helped him up.

OFFER COMFORT – In 1 Kings 19, the prophet Elijah hears that Queen Jezebel wants to kill him. Initially, he runs for his life, but after a day’s journey into the wilderness, he sinks down to the ground under a tree and says, “I just want to die.” Then he falls asleep. After he sleeps for a while, an angel comes to him and sets down food and water, saying only, “Get up and eat.” Elijah does so, then lies back down to sleep some more. The angel comes again, bringing more food and water, and says, “Get up and eat; the journey has been too much for you.” Elijah eats and drinks and feels stronger – he is able to travel ahead to Mt. Horeb, where he has an encounter with God.

The angel brings food and water to Elijah. He offers sympathy (“the journey has been too much for you”) but no advice or analysis. He doesn’t scold or tell Elijah to snap out of it. And he is not impatient when Elijah says nothing, just eats the food and goes back to sleep.

The angel is an example of one way to help a depressed friend. Don’t ask “what can I do?” because that requires thought and decision making. Simply bringing by a bit of comfort food, and delivering it without demanding much social interaction can be very helpful. A brief bit of human (or angel!) connection can be helpful. If you decide to bring food, bring it in a disposable dish. That isn’t very “green,” I know, but washing dishes takes energy. It also doesn’t have to be a whole meal. It can be a slice of cake or a bowl of soup to heat in the microwave.

The same is true for some small errand or chore. Don’t do housework (that may feel like criticism) but visit briefly and bring in the newspaper or the mail that has collected on the doorstep. All of these things say, “I care about you.”

The important thing is to keep it simple.

Finally, we have an example of the wrong thing to do for a depressed person:

DO NOT GIVE ADVICE – The Book of Job offers some powerful examples of “how not to help.” Job suffers one misfortune after another, and when his friends come to see him, they focus on their belief that he must have done something to bring his misfortune upon himself. He needs to repent his sins and get right with God! (Job 4-27)

When our friends are distressed, we are distressed. The desire to fix things can be almost unbearable, especially if we think we know a remedy. We want to point out the obvious and give advice. We ache to tell our friend to get some exercise, to eat right, to see a better therapist, to snap out of it!

Just as it was for Job’s “comforters,” this impulse is worse than useless. Many depressed individuals are already mired in a swamp of “shoulds” and “oughts,” and the depression has paralyzed them. Giving even the most well-meaning advice can make them feel worse. If they want help finding a therapist or getting some exercise, that’s different – but pushing unwanted “solutions” will be unproductive.

GET HELP: If someone in your community is depressed, tell your rabbi! He or she wants to know and will know how to contact the person.

Finally – this is very important! – If a person talks about suicide, take it seriously. Call a suicide hotline or their doctor. Never assume that talk about suicide is “kidding” or attention seeking. If there was anything at all to the talk, it’s important that they get help immediately. Even if later they say they didn’t mean it, you can’t take that chance. The principle of pikuach nefesh – the preservation of life – demands that we take such talk at face value and react.

Being a good friend to a person with depression is a mitzvah. It is tempting to stay away from people who are in pain – pain is unpleasant, after all. But reaching out, checking in, offering food or simple help – those things can make a huge difference. Be a mensch!

Depression and Judaism

I have two black dogs. One makes me laugh, and one makes me cry.

Jojo is Black Dog #1.
Jojo is Black Dog #1.

This is Jojo. Sometimes we refer to her as Jojo the Clown, because she makes my entire family laugh. She has a dance that she does when she sees new people or favorite people, aka “the Jojo dance,” which consists of her front paws doing a waltz and her back paws doing the Charleston. Someday I need to stop laughing long enough to make a video.

Jojo is a rescue dog. She languished at her foster home, waiting for new people. The old people had gotten sick and had to give her up. After months of being passed over (something that often happens to black dogs) she became depressed. For comfort, she stole food from the other dogs, and her normally 9 pound body ballooned to 15. When Linda and I met her, she was a sad little depressed dog. She lay there, looking sad until I picked her up. Then she peed all over me.

I immediately identified with Jojo; we both had “black dogs.” That was what Winston Churchill called depression: his black dog. I have that kind of black dog, too, and from time to time it sticks to my heels like glue. Lately, I have been visited by Black Dog #2. (Jojo is Black Dog #1 – of course she is #1 – she makes me laugh.)

When Jojo got a home, and the right meds, she returned to the self she was meant to be. And I find her encouraging during my spells with Black Dog #2. If Jojo could learn to dance again, so can I.

Part of recovery is following doctor’s orders and taking my meds. And part of it is immersing myself in the home of my heart: Judaism. Judaism teaches me in my morning prayers, “The soul … within me is pure.” I’m not bad, even if I feel bad. Moreover, I can do good: I can do mitzvot. I can study texts, I can pray, I can give tzedakah, I can teach my students, and I can relieve suffering (in small ways). Like Jojo, I can rejoice in having a home, even if “rejoicing” consists of eating good things and staying in touch with loved ones until I feel like more strenuous rejoicing.

Judaism teaches me that when God finished Creation, God saw that it was “tov me’od,” – it is very good. All of it. Including a certain depressed rabbi.

I am writing about this because I know that some of my readers, some whom I don’t even know, also suffer from depression. You aren’t alone, just as I am not alone. There are lots of us. And with the right help, and doing mitzvot (eating right, following doctor’s orders, getting outside ourselves to do mitzvot for others) it will be OK.

It is the tough weeks when I am most grateful for being a Jew. I have a storehouse of wisdom saved up for me by the Jews of the past: the Torah, the Tanakh (Bible), the Mishnah and the Gemara, and wise words written by centuries of wise Jews. Even when I can’t get it together to study them, I can see them there on my shelves: centuries of faith, seeking to do good.

We’re all going to be OK.