Physical and Mental Health during the High Holy Days

Image: A woman holds one hand to her head, another raised as if to say, “Stop!” Photo by RobinHiggins/Pixabay.

Before I learned to read Hebrew, the High Holy Days 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. Even the relatively lighter “hit” of Rosh Hashanah was hard.

I have several students who are diabetics. Each has a highly personal way of managing their blood sugar, and it is critical to their well-being. Allowing the blood sugar to get out of whack isn’t just uncomfortable, it can be life-threatening.

I know a woman who struggles with eating disorders. For her, the talk about fasting for Yom Kippur has a siren edge to it. The Rosh Hashana table, laden with sweet dishes seems to her like a giant honey trap.

For those with a physical or mental illness, the High Holy Days can be a difficult time. The basic and most important rule is that we must choose life: in other words, do what we need to do to survive. Without life, there is no holiness.

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

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. Don’t wait to collapse, or for permission – just do whatever it is you need to do for your health.

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.” (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!

The Yom Kippur fast is not a weight-loss opportunity. The point of Yom Kippur fasting is holiness; we can seek that holiness in the discipline and humility required to follow medical directions.

MEDICATION – If you are on medication, take your meds and take them as your doctor has directed. If you are supposed to have food or water with meds, take what you should take. Messing around with medications is sinful: take them the way the doctor says to take them. There is no shame to taking them, and they have saved lives. I take mine every day, including Yom Kippur, and I say a blessing when I take them.

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. One is to schedule some time with your rabbi  or another teacher to talk about Jewish approaches to “sin” and “repentance.” The long-term solution that worked for me was that I studied Hebrew and set myself free from clumsy translations. This doesn’t require full fluency in Hebrew, just enough to let you say and understand the prayers.

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 health issue over Yom Kippur. Help is available if you reach out for it.

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Depression and Jewish Tradition

Image: A somber landscape with rocks, trees, and ponds. (FrankWinkler/Pixabay)

Although there is a beneficial aspect to sadness it prevents people from becoming overly joyous over the pleasures of this world. Nevertheless one should not pursue the state of sadness, since it is a physical disease. When a person is despondent, he is not able to serve his Creator properly. – Yonah ben Avraham Girondi (1200-1263)

Jews have known for centuries that depression is an illness, not a moral flaw. In the 13th century, this great Jewish ethical teacher was unequivocal: “it is a physical disease.” He understood that it interferes with one’s most basic functioning. (I am talking about clinical depression, as I suspect the rabbi was, more than a mere “bad day.”)

One of the things that often happens when a person is depressed is that they fall behind on tasks. It is difficult to focus, and they miss deadlines. Then, having fallen behind, shame enters the picture: “Not only am I depressed, I am a rotten person.” Thus the pain of depression snowballs into an avalanche of the spirit.

It is miserable to grow depressed over one’s depression.

The first thing to know is that science has proven Rabbi Yonah right: Depression is a physical disease. When we are depressed, connections are not being made properly in our nervous system. This is no more a moral failure than any other illness.

When I have struggled with depression, I have not been able to “snap out of it” or pray my way out of it. What does help is understanding that my brain does this sometimes, and it is not the end of the world. What helps is taking my meds, talking to a therapist, and knowing that this, too, will pass.

If you are reading this because you are currently suffering, or because someone you love is currently suffering from depression, know that the situation is not hopeless. Know, too, that you are not alone. This is an illness that has plagued humanity since ancient times. Fortunately help is available! Reach out, or ask someone to reach out on your behalf. You are not bad, you are suffering, and you deserve care.

Stuck in Egypt: The Movie Seder

Image: Battle scene, Pharaoh skewering someone. Photo by chaos7/pixabay.

Note: I first posted a version of this piece two years ago. I offer it again in case someone needs it. Please note that I don’t recommend this approach to seder unless you really can’t stand to be with others – but in some circumstances, it can be a helpful way to observe the holiday.

Passover 2009 was a time when it seemed like we could not get a break. I don’t remember all the troubles – it’s a fog now – but I had been struggling with depression and after six years in rabbinical school, I had only part time work as a rabbi. One son had a job so scary that I couldn’t think about it. The other son was having a tough time with bipolar disorder. The previous year California voted in Prop 8, taking marriage rights away from gay men and lesbians like ourselves.

We didn’t have energy for a seder that year. Looking back, I think we were in the depths of Egypt and it was hard to even imagine a seder. I didn’t feel like going to someone else’s seder and smiling and making nice, and neither did Linda.

But we still had the commandment to observe the chag [festival.] We take these things seriously. It wasn’t OK to just ignore it, no matter how tattered we felt.

So we came up with what I remember as The Movie Seder. Purists will be horrified, but that year it was perfect for us. We had a box of matzah, we made a green salad, charoset and something basic for dinner, I think roast chicken.

At the kitchen table, we did the preliminaries: lit and blessed the candles, made kiddush, and washed without blessing. Then ate our salads and broke the matzah, moving to the living room couch. There we had more matzah, horseradish, greens, charoset and the roast chicken. We put on a recording of The Prince of Egypt and settled in to watch as we munched on the ritual food. When they got to the red sea, we broke into dessert (chocolate matzah!) We sipped wine all the way through; we had four cups, I’m sure.

And I have to tell you, while it wasn’t a proper seder, at the end we felt better. The music and the beautiful messages of the film had lifted us just a bit. Watching it together, eating together, talking about the movie reconnected us in ways I still don’t entirely understand. I just know that I rose from that seder “table” ready to trudge on through that year’s wilderness.

That seder was years ago. A lot has changed. We aren’t nearly so worried about either son. Prop 8 and DOMA are gone (good riddance) and we feel like citizens at last. I’m in a good place emotionally, and I have work I love. Linda survived cancer, again. Linda and I are finally legally married, baruch Hashem. But I think of that funny little seder with great affection: it got us through a very bad time.

When you are deep in Egypt, sometimes your seder has to be basic. If you are having a rough year of your own, don’t skip the seder. I encourage you to buy a box of matzah, a jar of horseradish, some salad greens, and a bottle of wine or grape juice. Sit with your beloved or a few good friends. Make the blessings. Put on a good Exodus film (I recommend The Prince of Egypt or The Ten Commandments) and hear one of the great stories of all time. Allow yourself to relax into the story, to inhabit it; that narrative tells us things we need to know in a difficult year.

The Haggadah teaches us that “in each generation, each person is obligated to see himself or herself [lirot et atzmo] as though he or she personally came forth from Egypt.” Part of the reason this works is that over the course of a lifetime, most of us will have an experience of our own personal Egypt. If you are in Egypt today, I wish you deliverance.

L’shanah haba’ah birushalayim!

Next year, in Jerusalem!

Enough With the Diagnoses!

Image: A braying donkey. Paid photo by Shutterstock. All rights reserved.

“Donald Trump is a sociopath / has narcissistic personality disorder / has ADHD / has Alzheimers / has XYZ.” I see it over and over on social media from people with medical credentials (who should know better) and people with no medical credentials (who need to learn better.)

It does not serve any useful purpose to diagnose another person from afar, and for professionals, it is a serious breach of ethics.

Don’t believe me? Here’s what the American Psychiatric Association has to say on the subject.

Now you may say, oh, that only applies to medical professionals!

Judaism also has something to say about this kind of talk, for all Jews. For this we have to use a couple of texts. First:

When a man has in the skin of his flesh a rising, or a scab, or a bright spot, and it becomes in the skin of his flesh the plague of tzara’at, then he shall be brought to Aaron the priest, or to one of his sons the priests. – Leviticus 13:2

The Torah is very cautious about illness. On the rare occasion it speaks of it, it demands that an expert make a diagnosis. We in the 21st century don’t regard kohanim (priests) to be experts on disease, but in Biblical Israel they were trained to recognize tzara’at (the skin disease often mistranslated as “leprosy”) and to recognize many internal problems in animals. In this case, people are actually forbidden to diagnose themselves or others; they are commanded to go to the expert.

You shall not go up and down as a talebearer among your people; neither shall you stand idly upon the blood of your neighbor: I am Adonai. – Leviticus 19:16

This is the famous prohibition against rechilut [gossip]: Even when our words are true, we are not permitted to talk idly about other people. How much the moreso when we talk about a judgment we are not qualified to make? How much the moreso when it is about a judgment that a qualified expert would not make because it would be unethical for them to do so?

Now you may be saying, “But rabbi! It’s obvious that Mr. Trump has XYZ! Here is the evidence in his tweet or his behavior!” That which is obvious is not necessarily true. An example: An elderly woman becomes forgetful. She gets lost on a walk. Her children are distressed and say, “Oh, it is obvious that Mom is getting Alzheimers!” But when mom falls at home and is taken to the hospital, the diagnosis she receives isn’t Alzheimer’s. It turns out that her medications have been the culprit all along. After her meds are adjusted, she returns to her old self. It may have obvious to her children that she had Alzheimer’s, but their amateur diagnosis was false.

A second problem: Most people who talk about Mr. Trump having “XYZ” disagree with his politics and/or his behavior. We have a habit in our society of using words like “crazy” or “insane” when people behave in ways we don’t like. Sometimes it is an attempt at a benign explanation or excuse (“The shooter must have been mentally disturbed!”) The trouble with these words is that they also reinforce the inverse: they suggest that someone who is mentally ill is likely to be a criminal. In fact, most people with mental illnesses are highly unlikely to be dangerous to others. The meme of the “dangerous psycho” perpetuates discrimination against these largely harmless people.

So when I call someone I don’t like, or whose behavior I don’t like, a “mental case,” I am not doing anything about that person’s behavior, I’m just perpetuating a damaging stereotype. That’s not OK.

In the case of a public figure whose words and actions are certainly our business, it’s better to focus on the words or actions themselves.  For instance, it’s perfectly fine – in fact, a civic good! – to point out a lie by citing evidence. It’s constructive to condemn a hurtful or criminal behavior.

Amateur diagnoses of any public official are a waste of time and a waste of valuable public energy. Only a qualified professional who has actually examined a person can make a real diagnosis. A bunch of people on Twitter can go on about how “crazy” someone is or how “he is obviously an example of RPD” but they are just running their keyboards and wasting our time. They are also slandering the vast number of people with illnesses and disorders who mind their own business and hurt no one.

If we are genuinely worried about the incoming administration, we will do better to stick to ethical behavior and actions that will produce results. Some former congressional staffers have put together a very impressive guide to effective action and they have made it available online. That way we can accomplish good and avoid the sin of rechilut.

הִגִּיד לְךָ אָדָם, מַה-טּוֹב; וּמָה-יְהוָה דּוֹרֵשׁ מִמְּךָ, כִּי אִם-עֲשׂוֹת מִשְׁפָּט וְאַהֲבַת חֶסֶד, וְהַצְנֵעַ לֶכֶת, עִם-אֱלֹהֶיךָ

It has been told to you, O human, what is good, and what Adonai requires of you: only to do justly, and to love mercy, and to walk humbly with your God. – Micah 6:8

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.