Wednesday, February 16, 2011

2011-02-11 Catch Me I'm Falling: Judaism and Mental Illness

This sermon is dedicated in memory of Scott Peck who passed away last year and struggled his adult life with serious mental illness. May he be remembered for a blessing.

This is an excerpt from a song from the Pulitzer Prize winning musical, Next to Normal called Catch Me, I'm Falling.

Maybe I'll let myself fall

Watch me I'm falling


Maybe the falling

Isn't so bad after all

Isn't so bad after all

Watch me I'm falling

Watch me I'm flying

Somehow surviving

DR. MADDEN (spoken, overlapping)

We may need to look at

A new drug regimen

You have to continue taking medicine


If you leave it untreated, it may be catastrophic.

Diana (spoken)

I've had this lovely and fascinating relationship with you doctors

and your treatments for 16 years but now I think

I'm done.

DR. MADDEN (spoken)

Diana, medicine isn't perfect, but it's what we have.

DIANA (spoken)

Goodbye Dr. Madden.

Diana is a mother who refuses to let go of the illusion that her dead son is still alive after 16 years. She suffers from delusions and depression. They are a very vivid example of our popular culture confronting the impact of mental illness on families.

Our tradition acknowledges the pain and impact of mental illness. As Rabbi Jeffrey Rosen writes,

"All the gates are locked except for the gates of ona'ah [a person crying out in pain]

Baba Metziah 59B

This statement from Baba Metziah poignantly highlights the anguish which is so often felt by

both families and individuals who experience mental illness. Because of the stigma and fears

associated with mental illness, both the person with the disease and their family feel isolated and

shamed. Those who suffer from mental illness often speak of the feeling of being a pariah, of feeling excluded. Of all the parts of the body, the mind is the one least well known – almost as if a line has been drawn across the neck and everything below is researched and the mind is left alone. Only at the end of the twentieth century has any significant money has been applied to brain research." (For a sterling example of education on this matter, see Charlie Rose's The Brain Series)

According to Rabbi Jeffrey Rosen who is also a mental health researcher, mental illness is an equal-opportunity disease knowing no distinction according to wealth, social class or education. One in four families knows the pain when someone in their family experiences serious and prolonged mental illness. One in ten people experiences some form of mental illness in their lives, the most pronounced form being clinical depression, which is a biological disease like diabetes.

If it is true that one in four families are affected by prolonged mental illness, it must be the case that of our 165 households at least 40 would be affected by mental illness. Yet very few people disclose this unique challenge to their rabbis. Many of my colleagues corroborate my experience in synagogues. We generally know when someone has cancer or heart disease or one of many physical ailments, but we hardly hear of congregants suffering from depression, bipolar disorder, schizophrenia or the variety of serious mental ailments that can afflict us.

The first onset of mental illness is on average at the age of 18 to 19. In contrast to when a family has a child affected by autism or down syndrome, the condition is identified early in the child's life. Families make painful adjustments in the expectations they have for that child. It is vastly different for the family who experiences mental illness. The child has often travelled through the normal stages of

development with perhaps some minor hiccups. The parents develop dreams – and what good

Jewish parent does not have dreams for their child?

Then suddenly or over time a disabling condition emerges. Their child struggles for years which often includes failure in school, difficulties with peers, or maladaptive behavior. These require seeking the right medical help, trying to find the right medications, treatment, or even special programs that deal with the illness. Families spend years living on the treatment roller coaster as a family member goes in and out of hospitals and treatment facilities. This also places enormous financial strain on families which discover that mental illness is not covered in the way that physical illness is.

Meanwhile the mentally ill person struggles to live a normal life, or even pursue ambitious goals, but is often waylaid by a depression or psychosis. In unfortunately many cases the mental illness are so debilitating that a person's dreams are shattered and he is unable to live a normal life.

Next to Normal gives testimony to the long struggle that a family faces as the mother goes up and down while the father and the daughter struggle to maintain.

What is mental illness?

Mental illness is a term used to describe a group of disorders causing severe disturbances in

thinking, feeling and/or relating. Often the result is a substantially diminished capacity for

coping with the ordinary demands of life. The causes of mental illness are not fully understood.

The evidence shows that the brain's neurotransmitters do not function properly due to a

chemical imbalance in the brain. This is comparable to other imbalances that cause illnesses in

other parts of the body. Other factors which may contribute in vulnerable people include

heredity and stress, and the use of 'recreational drugs', alcohol, or tramua of various kinds.

There are different types of mental illness. They differ in their symptoms, their degree of

severity, and their effects on each person's life. The effect is not only on the person but those

around them, the family as well as the work environment. Schizophrenia is not multiple

personality disorder but rather a situation where the person has delusions and hallucinations

and is often coupled with paranoia. One person in a hundred experiences schizophrenia. The

mood disorders include mania, manic depression and clinical depression (which is different from

episodal depression). One in ten people experiences clinical depression in their lifetime. Among

all psychiatric disorders, people suffering depression are most prone to suicide, Anxiety

disorders cover a wide range of mental illnesses and include phobias, general anxiety disorder,

panic disorders, obsessive–compulsive disorder, and post-traumatic stress. Approximately one

in twelve people are affected by one of the anxiety disorders.

Adding together these proportions, we discern that approximately one in every five people

experiences one form of mental illness or another. The cost to society due to lost wages,

demands on health care systems, social service needs, etc. are enormous, and in the United States

have been estimated to be in the hundreds of billions of dollars.

Since the causes of mental illness are not fully known, there is little effective prevention.

As with diabetes and many other physical diseases, many symptoms of mental illness can be

controlled with medication, and there is an ever-widening array of medications available for

mental illness. While drugs are not cures, they markedly reduce symptoms for most people.

Research to determine the causes and to plan strategies for prevention and rehabilitation are

progressing. Proper treatment may substantially improve the functioning of persons with these

illnesses, and in some cases the patient may completely recover.

A Jewish Understanding of Mental Illness

Rabbi Rosen helps us to understand the challenge of mental illness in his retelling of the famous Talmudic story of the four rabbis who enter 'pardes'. Just as Ben Azzai, Ben Zomma, Elisha ben Abuya and Rabbi Akiba experienced different outcomes in paradise; there are different possible outcomes for the person experiencing mental illness. Rabbi Akiba represents those who recover completely (about one-third of people who experience schizophrenia only have one episode); Ben Zoma may symbolize those who can be part of society with the help of medication while suffering periodic breakdowns and disruptions to their lives. Rabbi Elisha Ben Abuye symbolizes those who live, but suffer chronically and whose outlook on life has changed permanently from their illness. Ben Azzai who died upon reaching paradise represents those who and some never return from their own

world to be part of ours.

Theologically we all struggle when these diseases occur. It is obviously not a struggle between

the Yetzer Hara [evil inclination] and the Yetzer Tov [good inclination]. The biological process

which leads to mental illness is something over which the person has no control. We think of the

world as something created by God, but left in human hands. Chemical imbalances and genetic

predisposition to mental illness are unfortunate realities of this imperfect world. Maimonides understood this reality of the world as" kminhago ha'olam nohag. - The world continues according to its way." While God created the Universe and watches over it, God lets things progress, including genetic change.

How then should we be sensitive to mental illness in our congregation and in communal Jewish life? Our tradition challenges us to bring all Jews into the community of Israel. The Jewish community has made improvements in supporting people with mental retardation and developmental disabilities. But we have not been so effective with persons with mental illness. It is only when we confront the stigmas of our society that we will enable the days of the messiah to approach, for our congregations will be a 'house of prayer for all peoples'7 without discrimination and open to Klal Yisrael.

As someone who has experienced severe mental illness in my family, I have as a rabbi tried to model a specific rabbinic response to mental illness. These insights I share with Rabbi Rosen.

• be an information and referral source;

• let the family know they are not alone;

• avoid being judgmental;

• refrain from offering simplistic solutions to complex problems;

• be supportive of the entire family, including those members who infrequently come to

services, as these are the people who may feel the most isolated;

• encourage the family to continue to be a part of congregational life.

On a congregational level, we need to be compassionate. That is why it is important that we have a Hevrat Hesed in the congregation to help families facing both physical and mental illness. One example in mental illness cases is providing meals for a family in which a family member is hospitalized for a mental illness. Oftentimes these stays are longer than hospital stays for other types of illnesses, thus the strain on families is greater.

Congregants should encourage fellow congregants who suffer from mental illness or their families to come to speak to the Rabbi and to come to worship and other gatherings at the synagogue. Be a companion, offer an ear, discourage isolation and negativity.

In the Book of Genesis, we read the story of the three angels visiting Abraham and Sarah. The

story is poignant and we think more about the message that the messengers brought to this

couple. Perhaps more important is what was going on with Sarah and Abraham. According to

the Rabbis, Abraham is recovering from his recent circumcision. Abraham is sitting at the tent

door in the heat of the day when he looks up and sees three strangers. He welcomes the

travellers without preconditions and does not ask their yichus [a Yiddish expression implying a

mixture of social status, wealth and genealogy]. We are challenged to open the doors of our

synagogues to all and offer a place ''at the table' just as Abraham did.

Also in Genesis we read: 'Shall not the Judge of all the world, judge justly?' The story revolves

around how the people of Sodom and Gomorrah treated strangers or visitors. The Rabbis

suggest that the punishment of destructions was meted out because there was no hospitality

shown by those who lived there. Hospitality takes many forms. The most obvious is that given to

the wayfarer. So many of those who experience mental illness are also 'strangers within your

gates', for even if we once knew them they are strangers to us now. Some of that change is due to

their experiences with mental illness; some is just the normal growing process each of us

experiences. Our challenge is not to be like the people of Sodom and Gomorrah but to offer

hospitality and openness to each person who enters our doors.

Mental Illness is not just a lack of willpower but rather something which demands justice as well

as a just response.

I end with the poignant cry of the mother, Diana, in Next to Normal. Her cry is the cry of the mentally ill. We need to heighten our awareness of their suffering and work together to reduce this unique type of pain.

Catch me I'm falling

Catch me I'm falling

Flying head first into fate

Catch me I'm falling

Please hear me calling

Catch me before it's too late

Catch me before it's too late

Catch me before it's too late

No comments: