The Stigma Of Mental Illness In The Jewish Community- What Can We Do?

This morning I joined hundreds of members of the Bergen County Jewish community at the Mental Health And Addiction Symposium sponsored by Communities Confronting Substance Abuse, (an organization spearheaded by Lianne and Etiel Forman, of which I have spoken in the past),  and Refaenu. 

The morning of workshops began with tackling the topic of stigma and mental illness in the Jewish community, as presented by Dr. Norman Blumenthal and Mrs. Lisa Twerski.  Those of us who work in this field have confronted this stigma often.  ( Ironically speaking, while the Jewish community is still working at getting to the point where people willingly go for treatment, Jews were actually instrumental in establishing the field of psychology.  Whether Freud, Adler, Erikson, Maslow, Kohlberg, Seligman some of the major theorists and creators of fields of psychology were Jewish.  And, yet, the stigma still exists). 

Dr. Blumenthal aptly stated that we need to shift our thinking regarding mental illness.  People truly believe that those who experience mental illness have “brought it on themselves.”  Likewise, mental illness is often seen as a sign of weakness or defect of character.  In essence, we need to view mental illness as no different from any other physical illness. Every illness has three components: a genetic predisposition, physiological illness, and an environmental component.  For example, someone with a cardiac condition may have a genetic predisposition as he has a history of heart conditions in his family. He has some illness- a clogged artery etc.  and of course the environmental component- too much stress at work, not enough exercise, too much fatty foods etc.  The same should go for mental illness.

Dr. Blumenthal pointed out so poignantly that in the same way that we say a mishabeirach in shul for an ill relative, and a person goes up to the bima and says, “My friend has cancer, please pray for a refuah shelaima,”  a person should also be able to go up to the gabbai and say, “My father is diagnosed with depression or my cousin has OCD, please daven for a refuah.”  Wow!  Mrs. Twerski pointed out that when someone has any other illness, the community rallies around the family with meals, carpools, and any support needed. With mental illness, the family is alone.

The stigma is so harmful that added to the stress of having an illness is the additional stress and pressure of needing to keep secrets.  This pressure does not exist with other illness.

Both Mrs. Twerski and Dr. Blumenthal mentioned that this stigma exists in all communities, but when it comes to marriage (shidduchim) it often becomes exacerbated.  Dr. Blumenthal pointed out that in essence, a person who has experienced the challenges of mental illness, and has faced difficulties and came through with resiliency may actually be better suited for marriage than someone who has not.  Who knows what difficulties life may present in the future, and the one who has overcome difficulties in the past may be the one to marry.

In his article, “Dealing With Depression” Rabbi Efrem Goldberg admits that as a young rabbi  when meeting a person with depression he too thought, “Why can’t he just snap out of it?” or “If he were to just focus on his blessings and simply choose to be positive he wouldn’t be depressed at all.”  He too was “ignorant and insensitive to what depression is all about.”

Rabbi Goldberg points out that our use of the word “depressed” is a disserve as we may use it to describe what we feel our favorite team is out of the playoffs. By using terms like this we deny that true depression is a chemical illness that can be incapacitating. (A combination of genetic, biological and environmental factors).  

Rabbi Goldberg points out that Judaism itself admits that mental illness is a true illness.  He quotes rabbinic sources for the reality of depression.

Over 800 years ago, Rabbeinu Yonah wrote: ‘Although there is a beneficial aspect to sadness in that 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.’  The Talmud (Shabbos 30b) tells us about an evil spirit that is so dangerous it can be lethal and therefore, one can extinguish a candle on Shabbos to calm it. The Rambam (commentary on the Mishnah) explains, ‘The Evil Spirit is referring to melancholy. There is a type of melancholy that will cause the ill person to lose his mind when he sees light or when he is amongst other people. He finds peace only in darkness, in solitude, and in desolate places.’”  There has also been some suggestions for mental illness found in Tanach. (For example, King Shaul having a “ruach raah” -  is that depression, anxiety?).

Judaism has never denied the existence of mental illness. Yet, the stigma still exists.

In a groundbreaking article in a 2001 Jewish Action  Rabbi Nathaniel Helfgot spoke of his own struggles with depression “Dimensions of Torment: A Young Man’s Story of Surviving Depression.”  In this article, he described his ordeal in great detail, which in of itself was a service to those suffering who could then see, “It is not just me!”  He too reiterated the fact that mental illness is an illness. “It is no more possible for the depressive to emerge from his depression than for the cancer patient to will away his tumor or the diabetic to magically lift his own insulin level by wishing it upwards.”

Rabbi Helfgot wonders that the next time we read of someone in the Jewish community succumbing to the mental illness we should wonder,

...could these people have been helped before they reached the point of no return? Would they have felt less shame turning to someone if the community had created a culture where mental illness was not “someone’s fault” or reflective of a personal flaw, but a disease to be treated and discussed in the same way and with the same empathy that one speaks of kidney disease, diabetes, and high blood pressure?

...Too many of us still speak in whispers about mental illness. The stigma persists. This is troubling because mental illness is a condition that is experienced by many of our own flesh and blood. About 20 million Americans currently suffer from some form of clinical depression and close to one in eight Americans will experience some form of “major depressive episode” at least once in their lifetimes[v]. These statistics mean that either we, a member of our family or a friend or colleague will experience some form of serious depression sometime in our lives. It is a phenomenon that touches us all. Moreover, the stigma of mental illness is troubling because, God forbid, it perpetuates a climate where people who can be eased of their suffering are reticent to seek out the help and support they desperately need, lest they or their families be misunderstood, stigmatized, or treated as less than “normal” (read: the pernicious and debilitating concern, if not terror, that grips many in relation to shidduchim). In the worst cases, it may even lead to fatalities where untreated illnesses lead desperate people to take their own lives when all hope is lost and the pain can no longer be borne.

Why has the stigma persisted about mental illness while we have come so far with other illnesses? As Dr. Blumenthal asserted,  for some reason, perhaps stemming from Freudian psychology, there is a blaming component of mental illness-  particularly blaming the parents.  Today there is more evidence-based treatment and less blame.  And the person suffering from mental illness cannot be blamed for it. Just like someone who suffers from cancer cannot be blamed.

What can we do as a community to move ahead?  

Dr. Blumenthal stressed, first, as parents and educators, we can target the nature of education we give the children. We are often neglectful with familiarizing students with emotional vulnerability and the value of setbacks.  We are human.  The avot and biblical characters had emotions. We can have setbacks and emotional vulnerability.  It is okay to be sad and feel like you are on the brink.  We do need to teach our children about mental illness, just like we speak to them about other illnesses.  And, when someone we know is suffering from mental illness, explain to our children when it means to be depressed, anxious etc.

Rabbi Goldberg provided some areas where we need to be better educated. I am simply going to quote him because I could not have said it better myself:

May is Mental Health Awareness Month, a perfect time to educate ourselves. As we resolve to be more sensitive, please consider the following:

·    Don’t use the term “depressed” unless it is clinically appropriate. Find another way to say you are sad, bummed out, disappointed or feeling blue. Saying you are depressed over a relatively minor issue minimizes the suffering of someone struggling with true depression.

·    When someone you know is acting differently or unusual, don’t judge them or jump to assumptions about them. Ethics of the Fathers (2:4) quotes Hillel who said: “Do not judge another until you have stood in his place.” Since it is impossible to stand in another person’s place, to be them, to have their baggage or to live their struggles, we can never judge another. Instead, we should be kind, sensitive, supportive and understanding of everyone around us.

·    Never assume you know everything going on in someone’s life or what motivates his or her behavior. Ian Maclaren, the 19th-century Scottish author once said, “Be kind, for everyone you meet is fighting a battle you know nothing about.”  Cut others slack; give people the benefit of the doubt.

·    When you know a friend or family member has depression or other mental illness such as bi-polar, anxiety disorder, etc., be as supportive as you would be with someone suffering with a physical illness or disability. Offer help and assistance, check in, and let them know you are just thinking of them. Unlike acute illnesses, most of the time, depression is chronic. Once diagnosed, it can be controlled, lessened, or perhaps, even go into “remission.” But it is never cured. Support will be needed in some form always.

·    When reaching out to someone with depression, never judge, criticize or make comparisons. Don’t offer advice or minimize the person’s suffering. Simply listen, be present, and be a friend.

·    When someone has depression it places a tremendous burden on other members of the family who often need to take over chores, responsibilities and even produce greater income. Go out of your way to be inclusive of them, to check in on them and seek to unburden them.

Mental illness affects all of us.  Rabbi Larry Rothwachs, a prominent supporter for the needs of those facing mental illness,said in an article Mental Illness, Stigma, and the Jewish Community: Achieving Lasting Change” just this past week:

Do you or someone you know suffer from mental illness? If you answered yes, you are correct.  If you answered no, guess again. Tens of millions of Americans suffer from a mental disorder and, just as with cancer or diabetes, the Orthodox Jewish community carries no immunity.  Studies show that the incidence of mental illness within our community mirrors that of the general population. While the management and treatment of mental illness varies from person to person and depends upon the nature and intensity of the disorder, we are all directly connected to individuals with mental illness, whether we realize it or not.

And, as Rabbi Helfgot shared in 2001: (again, I couldn’t have said it better myself)

“It is long past time for us all to break the silence and speak openly about mental illness, not just at conferences of Orthodox mental health professionals, but in the public forums of our schools and yeshivot, our conventions and fora, and in the pages of our newspapers and publications. In much of our frum world, despite the fact that significant progress has been made, the vestiges of these stigmas linger on. It is time for this last stigma to fall and fall quickly in the spirit of menshlichkeit, rachmanut, and the recognition that we are all created b’tzelem Elokim.”

Advisory Update:

Sixth Grade: Students began a unit on social exclusion and peer harassment.  They learned the L.E.A.D.E.R.S. strategies for the bystander.

Seventh Grade: Students discussed the “bystander effect” and why people tend to do nothing when they witness injustice.

Eighth Grade: As our 8th graders are getting closer to their Holocaust production and commemorated Yom HaShoah, they viewed the movie “The Wave” and spoke about the lesson for our own lives.