Yom Kippur Eve 5775, Kahal Kadosh Beth Elohim
H e a l i n g O u r M i n d s a n d S o u l s
Yom Kippur is a time for cheshbon hanefesh – an accounting of our souls. Cheshbon is a technical term. This isn’t meant to be a short reflective session – a conversation with a friend over coffee, a few resolutions formed during a head-clearing walk, a thoughtful journal entry or two – though all of these may factor in. A cheshbon is a bill, an audit – a hard look at reality that points to necessary next steps for the future. At an annual physical exam (and I hope we all have annual physical exams), our doctor asks questions, collects samples, takes measurements and then tells us: Here’s where you’re at, here’s where you should be, and here’s what you need to change to get there. Cheshbon nefesh means we do the same thorough examination, but we take a good hard look at the state of our minds and souls.
And when we do so, here’s what we find: Many of us in this country, and many of us in this congregation, struggle with challenges related to mental health. According to the American Psychological Association, one in four Americans 18 or older suffers from a mental disorder – diagnosable, though not necessarily diagnosed – which interferes with employment, school attendance, or daily life. “More hospital beds in the United States are occupied by people who have mental illnesses than those who have cancer, heart trouble and lung disease combined.” 6.7% of the U.S. adult population (nearly 15 million Americans) is affected by depression. 40,000 suicides are reported annually in the United States – almost twice as high as the reported number of homicides – and suicide is one of the few causes of death that is rising. More than 90% of those who commit suicide have a diagnosable mental illness – most commonly depression or a substance abuse disorder – yet only 15% were in treatment at the time of their death. Suicide is the third-leading cause of death among youth ages 15-24 and the second-leading cause of death among college students.
And, of course, these aren’t just statistics. Each of these numbers represents a person, and what impacts each person also impacts their families and friends and loved ones.
When Robin Williams took his life in August, people finally began to discuss some of these statistics and realities in earnest. We had laughed at his comedy and enjoyed his movies, so it felt like it hit home. But I had begun work on this sermon well in advance of that tragic event. Because it has hit much closer to home, far too often. Suicide and other self-destructive behaviors – eating disorders, cutting, risky sexual behavior – are “far more common than anyone previously thought,” and occur “as frequently within the Jewish community as anywhere else.” I assure you, our synagogue is no exception. It takes more than two hands to count the number of individuals who have attempted suicide in our congregation in just the past four years, and that’s only the instances I know of. The fact that most of us are not aware of this, can choose not to be aware of this, is a significant part of the problem.
At a World Suicide Awareness Day hosted at the United Nations, presenters taught that “suicide prevention and [mental health] awareness are most effective within one’s own community.” Yet in the Jewish community we don’t talk about it. We perpetuate myths that mental illness should be a private matter; knowledge of a suicide attempt will ostracize you from the community; if it’s known that one has, God forbid, committed suicide, s/he cannot be buried in a Jewish cemetery. A recent article about the taboo of discussing mental health in the Orthodox community expressed concerns about how doing so “might affect marital matches for [an individual] and his [or her] relatives.” I hear similar concerns voiced in our community about college searches, job opportunities – even that seeking professional help (a positive act) could be used to negatively impact divorce proceedings.
According to the Centers for Disease Control and Prevention, only 25% of adults who experience mental health issues feel that people are sympathetic toward their struggles. “We need so much more openness, transparency and understanding that it’s OK to talk about depression [and other mental disorders] as an illness. It’s not a weakness. It’s not a moral shortcoming. It’s not something people [bring] on themselves. … Understanding that is a pretty powerful beginning to helping a loved one [move toward healing].”
And here’s the thing – we, in the Jewish community, should be able to be open and transparent about it. For the failure to end the stigma associated with mental illness and the pursuit of mental health, chatanu – we have sinned. And it’s time now – it’s past time – to end it.
First, we need to take a look at what Jewish texts and tradition actually have to say about our mental wellbeing, and not simply perpetuate the myths. While Judaism acknowledges a distinction between mental and physical health, our tradition puts them on the same plane. The Mi Shebeirach prayer we recite for health asks for a r’ruah sh’leimah – a complete recovery, including r’fuat hanefesh u-r’fuat haguf – healing of the soul and healing of the body. The Rabbis affirmed that Birkat HaGomeil, the prayer we shared on Rosh Hashanah, should not only be said when one has survived or been spared danger to the body, but also for “recovery from mental illness or even upon significant alleviation of [emotional] symptoms where there is no definitive cure.” Maimonides taught that, before addressing a person’s physical needs, physicians must attend to a patient’s emotional and mental needs first.
And while Jewish law did develop such that one who committed suicide would be buried outside of a Jewish cemetery, “most rabbis now will agree that these laws were set to discourage suicide and not to punish those” who did. One need only look to the example of King Saul in midrash to see that one who committed suicide could, and should, be buried with honor. The Hebrew Bible records that Saul, given to despair and fits of turmoil throughout his days, took his own life by falling on his sword.
The midrash begins, “And there was famine in the days of David. … And The Lord said: ‘It is because of Saul’ (2 Samuel 21:1), because he was not mourned in the manner required by law.” God continues to list all of the good that occurred during Saul’s life and at once David gathers all the elders and notables of Israel together to go gather Saul’s bones from across the Jordan, outside of the community. “They took the bones, put them in a coffin, and then David commanded that Saul’s coffin be borne through the territory of each and every tribe. Upon the coffin’s arrival in a tribe’s territory, the entire tribe – the men, their sons, and daughters, as well as their wives – came out and paid affectionate tribute to Saul and his sons, thus performing the mitzvah of showing loving-kindness to the dead. When the Holy One saw this, He immediately filled with compassion and sent down rain.” In days of famine, a true blessing.
And there are other characters in biblical text who struggle with depression, as well. Hannah’s despondency at the inability to bear a child is so extreme that it prompts her husband to ask her: “Why do you weep? Why don’t you eat? Why are you so unhappy?” Yet, far from minimizing her story, we read it on Rosh Hashanah morning when the whole congregation can empathize with her pain. The prophets Elijah and Jonah both prayed that God might take their lives rather than face the daunting tasks that lie ahead. Still Elijah will be the one to herald the coming of the Messiah. And we will once again hear Jonah’s story tomorrow afternoon and, with the help of a panel of congregants, this year will reflect specifically on issues of mental health.
But this is just a beginning; we need to keep the conversation going. Our Adult Ed Task Force identified Jewish Living – including issues of both physical and mental wellness – as one of the areas we are committed to making sure gets addressed each year. And we are pleased that if you look at our temple calendar (online, in print and in our Shabbat announcement sheets), you will see that a Food Addicts in Recovery Anonymous Meeting takes place at our synagogue every Wednesday. Beyond the support all of these offerings give to those who attend them, they also make a statement that KKBE is a place where we are concerned about mental health – an important step in helping to reduce stigma.
The second step we can take is something each of us can do individually. It requires a cheshbon, an accounting, of our language. ADD, OCD, Bipolar… lately we’ve come to throw these terms around nonchalantly, and when we do it’s often to make light of a behavior. When someone is scattered, we say “he’s ADD” – by which we mean he’s all over the map. “I couldn’t keep up with his train of thought,” we might say, “if he even had one.” When someone is neat, has everything in order, we say “she’s OCD” – by which we mean she’s obsessed with details, has a place and a file for everything. “I wanted to help,” we might say, “but I was afraid to touch anything or get in the way.” When people are emotionally inconsistent, we declare “they’re bipolar” – by which we mean one day they’re happy-go-lucky, the next they’re angry or despondent. “When he’s even-keeled, he’s great,” we might say, “but you never know what you’re going to get.”
Increasingly, we use these terms – ADD, OCD, Bipolar and others – like they’re fleeting feelings that might be explained by waking up on the wrong side of the bed. Doing so not only grossly misrepresents the facts of these disorders, but belittles the challenges those who live with them face, often heroically. Consider the following that circulated a while back entitled, “If Your Friends Ever Say They Have ADHD, Just Show Them This”:
ADHD is about having broken filters on your perception.
[Other] people have a sort of mental secretary that takes 99% of irrelevant crap that crosses their mind, and simply deletes it before they become consciously aware of it. As such, their mental workspace is like a huge clean whiteboard, ready to hold and organize useful information.
[Those of us with ADHD]… have no such luxury. Every single thing that comes in the front door gets written directly on the whiteboard in bold, underlined in red letters, no matter what it is, and no matter what has to be erased in order for it to fit. … It’s like living in a soft rain of post-it notes.
This happens every single waking moment, and we have to manually examine each thought, check for relevance, and try desperately to remember what the thing was we were thinking before it came along. Most often we forget, and … cast wildly about for context, trying to guess what the hell we were up to from the clues available.
And what this author shared is only part of what it means to have ADD or ADHD. There’s hyper-attentiveness, as well, and the multiple challenges that can come with a variety of medications. Watching our misappropriation of diagnostic terms in everyday speech isn’t just a matter of being politically-correct. When we use terms in this flippant way, it’s meant to end the conversation. What we’re saying about someone or their behavior is, “Don’t try to do anything about it – that’s just the way they are.” When in fact what we should do is begin a conversation – learn more about the challenges someone may actually face and learn what we might be able to do to work more productively, positively and supportively with them.
Which brings us to the third thing each of us can do to make an impact on mental health; to help all of us – individuals, organizations, society – move past the stigmas associated with mental illness. We have to commit to improving our knowledge and understanding. Because, as it turns out, when we actually understand how an illness is caused or experienced, while we may not be able to cure it, there are often things we can do to make one’s living with it significantly better.
The term Dementia refers to a “group of diseases [that cause] loss of intellectual abilities, especially memory, emotional shallowness, and personality changes. Alzheimer’s Disease, which affects 15% of people over age 65, is included in this classification.” We know that the experience of dementia often leads to isolation – both for those who have it, and those caring for loved ones affected by it. It’s a devastating illness and there are no cures. But at one particular retirement facility in Phoenix, AZ, their motto in supporting those with dementia is, “We can’t change the way you think, but we can change the way you feel.”
At the Beatitudes Campus, dining room tables “are covered with white tablecloths, and food is served on bright-colored Fiestaware. This is an aesthetic choice but also a practical one. … The contrast between the vivid dish and the white cloth is helpful to visually impaired residents.” “Research has shown that endorphins released during a pleasant experience have a salutary effect on a person with dementia even after the experience is forgotten. [So] Beatitudes tries to provide residents with pleasurable moments throughout the day,” including spa-like touches in their bathrooms instead of the standard industrial feel. “Aides encourage anyone who looks weary to lie down [in their beds, as] falling asleep in an armchair or a wheelchair often causes stiffness and pain.” “Residents are sometimes given a body pillow to simulate the sleeping form of a spouse.” And Hershey’s Kisses and lollipops are “a mainstay” at Beatitudes, “on the principle that it is hard to feel very bad when there is something tasty in your mouth. And adults with dementia will sometimes soothe themselves by sucking, just as they did when they were babies.” All of these compassionate accommodations come from better understanding and, “despite the touches of gracious living at Beatitudes, the average cost of care is roughly the same as the cost at a typical nursing home.”
Imagine the difference we could make if we sought to understand all types of mental illness this way, and showed the same commitment to developing techniques for better health of mind and soul that we do with physical therapies for the body. Imagine what would be possible if we could just get past the stigma that keeps us from discussing mental health and illness openly, constructively and supportively.
I want to leave you with the inspiring story of the sister of one of my colleagues. Deena Nyer Mendlowitz, a comedian who lives in Cleveland, has battled crippling depression for much of her life. Three days before she graduated from college, she attempted to kill herself by driving her car over an embankment. She survived, but the depression continued, as did suicidal thoughts. Medication brought a slew of side effects, but provided little relief. So when her doctors suggested electroconvulsive therapy – or shock therapy, as it’s more commonly called – she said to herself, “I’m either gonna try this or I’m gonna end my life,” and so she gave it a shot.
Deena has now undergone 32 treatments in the past year. IVs and memory tests have become her norm. Memory loss is one of the most common side effects of shock treatment – a distinct challenge for a writer and comedian, but one which she knows she has to face. The bigger challenge is the stigma associated with her course of therapy – and this, too, Deena is facing head on. Wanting to help eliminate one of the obstacles that might keep others from seeking treatment, that keeps people isolated in their times of greatest need, Deena invited a local news crew to film one of her treatments this past summer. “[People] think of it as this barbaric treatment,” she said. “The only experience [they] know of shock therapy is ‘One Flew Over the Cuckoo’s Nest,’ … a horrible portrayal of it, and today, it’s a totally different experience.” And so she let people see that. When told that what she was doing was “so brave,” her response was spot on: “I want that to not be a thing,” she said. “I want it to be so okay to talk about, that people don’t think it’s brave to talk about depression.”
She’s right. That’s absolutely the way it should be, and so may we each do our part this coming year to make it so – not only for depression but for all mental illness. This year, may we strive to create a community where everyone can feel cherished and free to be open about the challenges they face. This year, may we strive to create a community where everyone can feel connected to love and hope and healing. This year, and always, may we strive to create a community of strength whose members might strengthen one another. Chazak, chazak v’nitchazek – may we all be strengthened by this holy community. Amen.
 Caring for the Soul: A Mental Health Resource and Study Guide, ed. Rabbi Richard F. Address.
 “The Sense of an Ending,” The New Yorker.
 “Inside ECT Treatment: Woman Tries to End Shock Therapy Stigma,” Fox 8 News, Richmond Heights, OH, July 21, 2014.