D’VAR TORAH ON BAMIDBAR FOR MENTAL HEALTH AWARENESS MONTH
by Chaya Weinstein, West End Synagogue
5/23/20
Shabbat Shalom!
This is a two-part talk: a D’var Torah, and a talk about Mental Health Awareness Month. I will first share a summary of Bamidbar, and briefly discuss mental illness in Judaism. I will then discuss current mental health issues, particularly relevant in this extraordinary time of COVID-19. I will finish with some suggestions and ideas about how you can take action in a meaningful way.
Much of the parasha is straightforward, describing the census conducted by the Israelites while wandering in the Sinai Desert. God gave specific instructions to the Levites about how to conduct their census and their roles in the Tent of Meeting. The Levites replaced the firstborn, who were disqualified when they participated in the worship of the Golden Calf. The three Levite clans dismantled the Sanctuary, transported and reassembled it at the next encampment. <https://www.chabad.org/parshah/article_cdo/aid/2121/jewish/Bamidbar-in-a-Nutshell.htm>
“It was just one short year after the Exodus…(On) the first official day of service in the Tabernacle, Aaron and his sons followed a very special ritual designed by G‑d. Everything seemed to be going beautifully. But then the unimaginable occurred: “As it is written, Aaron's sons, Nadav and Avihu (their Hebrew spellings), each took his pan, put fire in them, and placed incense upon it, and they brought before the Lord foreign fire, which He had not commanded them. And fire went forth from before the Lord and consumed them, and they died before the Lord.” < https://www.chabad.org/parshah/article_cdo/aid/4321414/jewish/The-Mysterious-Life-and-Death-of-Nadab-and-Abihu-Sons-of-Aaron.htm>
Their crime, it was said, was that “in a drunken state of spiritual ecstasy, they entered the Kodesh Hakadoshim with incense and offered a sacrifice to God. They, who were not the High Priest, on a day that was not Yom Kippur, entered the restricted space called the “Holy of Holies”. This is a place on earth that no human being is supposed to enter” <https://nefesheast.com/YitziHorowitz/achrei-kedoshim.html >
But the commentaries and Midrashim paint a very different picture of Nadav and Avihu up until this point. Their piety was reputed to be on par with Moses and Aaron! Up until that time, they were “clean from sin”. They were clearly treasured because their death was mentioned many times in the Torah. God even instructed all Jews to mourn their deaths. <https://www.chabad.org/parshah/article_cdo/aid/4321414/jewish/The-Mysterious-Life-and-Death-of-Nadab-and-Abihu-Sons-of-Aaron.htm >
So what went wrong? Some say that Nadav and Avihu, who were held to the highest of standards, were being punished for other infractions, disrespecting their elders and coveting their high positions. That they behaved casually before the Divine. That they didn’t think any women were good enough for them. There was intimation that in the past, they had given thanks for the Golden Calf. <https://www.chabad.org/parshah/article_cdo/aid/4321414/jewish/The-Mysterious-Life-and-Death-of-Nadab-and-Abihu-Sons-of-Aaron.htm>
Modern commentators regard their behavior as impulsive. As one author wrote,
“They rushed impetuously to worship God without due consideration and discussion with each other or with their father and uncle. Their behavior was in an act of misguided and overenthusiastic zealotry…” https://booksnthoughts.com/bamidbar-what-did-nadav-and-abihu-do-wrong/ >
There seems to be a troubling contradiction. Wouldn’t the children of Aaron understand religious ritual and protocol? Wouldn’t they know to check with their father and Moses before taking such action in the Holiest of Holies? In fact, given the gravity of the situation, and their sterling reputation, wouldn’t they bend over backwards to perform their duties with care, respect and impeccable judgment?
This made me wonder if perhaps Nadav and Avihu were experiencing symptoms of a mental health disorder. Perhaps the pressure of their vital role as the sons of Aaron, and the increasing responsibility being thrust upon them as priests, caused them to become overwhelmed and decompensate. Perhaps only being allowed to walk only halfway up to Mt. Sinai with Moses and Aaron was a narcissistic wound. They exhibited arrogance and grandiosity in thinking about their power to connect with God. This is reminiscent of a manic or psychotic state, where religious delusions are common.
Shortly after the brothers’ death, the Lord spoke to Aaron, saying: “Drink no wine or other intoxicant, you or your sons, when you enter the Tent of Meeting, that you may not die. This is a law for all time throughout the ages, for you must distinguish between the sacred and the profane…” (Lev. 10:8-11)<https://jbqnew.jewishbible.org/assets/Uploads/414/JBQ_414_2_wolakalcohol.pdf>
Thus, one may consider the possibility that Nadav and Abihu were living with the disease of alcoholism, also recognized now as a mental health disorder. “Since 1956, the American Medical Association (AMA) has identified alcoholism as a disease characterized by compulsive decision-making, impulsive behavior and relapse.” <https://www.hazeldenbettyford.org/articles/why-is-alcoholism-classified-as-a-mental-illness>
Some commentators say that Nadav and Avihu’s only sin was that their spiritual desire was so intense, that their bodies could no longer contain their souls, and they died. < https://booksnthoughts.com/bamidbar-what-did-nadav-and-abihu-do-wrong/> Why were their inner souls, and not their bodies, burned? Is the description by several sages of them being “polluted”, a metaphor for mental illness?
We might consider other characters in the Torah who had symptoms of depression, like King David. <https://pubmed.ncbi.nlm.nih.gov/15628039/ > He benefitted from music therapy, soothed by a harp. Every Rosh Hashanah, we read about Hannah, who was so depressed and emotionally distraught that she appeared to be drunk – all because she longed for a child. < https://reformjudaism.org/blog/2017/09/20/hannahs-prayer-seeking-wholeness-face-mental-illness> According to the midrash, Elijah the prophet became suicidal, but was brought back by a compassionate angel. https://ibpf.org/the-prophet-elijah-was-depressed/
Perhaps there was more understanding for these people with depression, because they all recovered. The Talmud describes a shoteh, or someone who is ”mentally defective”, as someone who sleeps in a cemetery, runs around naked or throws rocks. Dr. Rael Strous, the Israeli psychiatrist, describes this behavior as psychotic. < https://www.myjewishlearning.com/article/judaism-and-mental-illness/ >
Jewish law has considered the shoteh to be incompetent in legal and religious matters, unable to perform mitzvot, bear witness or get married. There were even occasions when the shoteh considered so untrustworthy that he was grouped with criminals, drunks, slaves and non-Jews. Dr. Strous points out that the Talmudic assumption is ‘shoteh lo samei be-yadan’ (essentially, ‘once insane, always insane’, since we have no cure). It is tragic that once a person was labeled as a shoteh, they were usually stigmatized for life. Dr. Strous believes that the spirit of Halakha has been one of increased sensitivity, especially in light of changes over the last 100 years. < https://www.bjpa.org/content/upload/bjpa/ment/Mental%20Illness%20-%20A%20Jewish%20Concern_.pdf >
Today, we know that there are a variety of symptoms of varying severity. Many are triggered by stress or trauma. People can also be asymptomatic for large stretches, or sometimes fully recover. And of course, there are medications that did not exist even 50 years ago. We now see that many individuals living with a mental illness now marry, raise families, and live observant Jewish lives.
Jews have been instrumental in the development of psychology and psychiatry. The father of psychoanalysis, Sigmund Freud, was Jewish. Other Jewish psychological greats include Erich Fromm, Frieda Fromm-Reichmann, Alfred Adler, Bruno Bettelheim and Abraham Maslow. <https://www.myjewishlearning.com/article/judaism-and-mental-illness/ >
The idea that Jews are more anxious and neurotic than others is a stereotype promulgated by the likes of Woody Allen and other entertainers. In 1992, the National Institutes of Mental Health debunked this myth, stating that the overall lifetime rate of psychiatric disorders did not differ among Jews. Their study did find that Jews suffer from major depression, schizophrenia and simple phobias at higher rates. There is also evidence of proportionally more Ashkenazi Jews with bipolar disorder. But Jews had lower rates of other mental health conditions, including alcoholism.< https://www.myjewishlearning.com/article/judaism-and-mental-illness/ >
How do we translate the ambiguous and mixed messages of the Torah, the development of psychology by Jews a century ago, and the stereotypes that persist into our modern day?
One means of raising awareness and fighting stigma has been to designate each May as Mental Health Awareness Month. This tradition began in 1949 by an organization called Mental Health America, in order to educate and promote dialogue. < https://www.mhanational.org/mental-health-month >
The World Health Organization, or WHO, declared mental illness as a leading cause of disability worldwide. WHO defines mental health as a state of well-being in which a person realizes their abilities, can cope with the normal stresses of life, work productively, and can make a contribution to the community. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471980/ >
Conversely, people with mental health issues often have a hard time coping with life stressors and have trouble functioning well in work, interpersonal relationships or in the community. This may be episodic or chronic. It may reach the point where people become a danger to themselves or others, which may necessitate inpatient psychiatric treatment. < https://www.medicalnewstoday.com/articles/154543 >
The causes of mental illness are varied, and include a combination of internal and external factors. The more commonly known are chemical imbalances in the brain, and genetics. Mental conditions can also be triggered by early stress and abuse, the trauma of crime, poverty and war; unresolved grief and loss, chronic pain, or an illness such as cancer or dementia. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1940091/>
Examples of common signs and symptoms to look for include:
· Feeling deeply depressed or anxious
· Confused thinking
· Poor coping skills
· Inability to concentrate
· Excessive fears, worries, or guilt
· Extreme mood changes
· Withdrawal from family, friends and activities
· Significant tiredness and low energy
· Detachment from reality (delusions), paranoia or hallucinations
· Problems with alcohol or drugs
· Major changes in eating, sleeping, and personal habits
· Sex drive changes
· Excessive anger
· Suicidal thinking
· Behavior significantly different than one’s typical way of acting
< https://www.mayoclinic.org/diseases-conditions/mental-illness/symptoms-causes/syc-20374968 >
According to the National Alliance on Mental Illness, or NAMI, only 60% of people experiencing a mental illness actually receive mental health services. In a mental health crisis, people are more likely to encounter the police than to get medical help. As a result, 2 million people with mental health conditions—most of whom are not violent-- are booked into jails each year. Without access to treatment, their mental health conditions worsen. After being released, many no longer have access to jobs or housing, and become homeless. <https://nami.org/Advocacy/Policy-Priorities/Divert-from-Justice-Involvement/Jailing-People-with-Mental-Illness>
One persistent myth is that people with mental illness are violent and dangerous. “Whenever mass tragedies take place, the media is quick to label suspects as ’mentally ill’… Yet, only 5% of violent crimes in the U.S. are committed by people with serious mental illness…individuals with mental illness are more likely to be victims of violence than perpetrators. There is no reason to fear a person with a mental illness just because of their diagnosis. <https://www.nami.org/Blogs/NAMI-Blog/October-2019/Six-Myths-and-Facts-about-Mental-Illness>
Many people with a mental health issue are afraid to self-disclose, fearing they will be judged, lose support and love, and even lose their jobs or relationships. Research has shown that American employers avoid hiring people with psychiatric histories. A majority of people hold negative attitudes toward people with mental illness. For many families, mental illness is a source of shame and embarrassment. The stigma of mental illness leads people to hide their condition and to avoid seeking treatment. < https://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/mental-health/art-20046477 >
Our reluctance to discuss mental illness is based, in part, on its associations with behaviors that are abnormal, uncontrolled, disobedient, threatening or unsafe. Such behavior by Nadav and Avihu was grounds for lethal punishment. But often, it is not retribution from God that we fear, but rather, looking into a mirror about the worst fears about ourselves and our own vulnerability.
In the United States, about 46 million adults live with a mental health condition. This represents 1 in 5 adults in the United States each year. This is a staggering number. < https://www.nami.org/mhstats >
If I asked you to name someone in your family who has had cancer, would you do so? Now, if I asked you to name someone in your family who has experienced symptoms of mental illness, would you do so?
My brother Adam had a normal childhood, did well in school, and had many friends. He graduated from college, was teaching high school and seemed to be doing well. Yet, he had psychotic episode at the age of 25 and wound up in the Emergency Room at Bellevue Hospital. He was diagnosed with bipolar disorder and obsessive compulsive disorder.
For over 15 years, Adam was in and out of treatment. He had difficult periods where he became manic or brooding. He had periods where he progressed to living in a supported apartment and doing volunteer work. He seemed to be improving over time, only to backslide. He was obsessed with morality and righteous causes. Yet, his obsession with not measuring up to a family of high achievers was what really caused him to suffer most. He was admitted to the hospital when he was 43 years old, and upon discharge, returned back to his day program. Sadly, he was not being properly medicated, and his condition was tenuous. He died by suicide.
The individual with an illness suffers, and the family suffers as well. Sometimes mental illness runs in families, making the ability to support family members all the harder.
Coronavirus is now the latest mental health stressor.
According to a Kaiser poll, nearly half of Americans reported that the coronavirus crisis is harming their mental health.< https://www.voanews.com/covid-19-pandemic/mental-health-problems-increase-amid-covid-19-pandemic > A federal emergency hotline for people in emotional distress registered more than a 1000 % increase in April compared with the same time last year. <https://www.washingtonpost.com/health/2020/05/04/mental-health-coronavirus/ >
A recent meta-analysis, published in The Lancet Psychiatry, of patients from Asia, Europe and the United States, noted that individuals with COVID-19 often presented in the hospital with symptoms of depression, anxiety and confusion. Although those cleared up in the short term, clinicians were advised to be aware of the possibility of depression, anxiety, fatigue, and post-traumatic disorder in the longer term. These can be exacerbated by widespread anxiety, social isolation, stigma, stress in being an essential worker, unemployment and poverty. <https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30203-0/fulltext >
You may have read in the news about an emergency room doctor in my hospital, Dr. Lorna Breen. She spent weeks ministering to the needs of coronavirus patients, and struggled with many patient deaths. She herself contracted the virus, and was just reaching her own recovery, when she died by suicide. As she had no pre-existing mental health issues, there is a theory that her brain was affected by the virus. < https://www.nytimes.com/2020/04/27/nyregion/new-york-city-doctor-suicide-coronavirus.html >
Yet for every Adam, and every Dr. Breen, there are countless others who improve with treatment. In fact, a majority DO improve. Recovery is possible, and the ability to improve from some conditions actually increases with age. <https://power2u.org/people-can-recover-from-mental-illness/ >
<https://www.webmd.com/mental-health/qa/can-people-recover-from-mental-illness>
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4577336/>
<https://health.clevelandclinic.org/not-normal-mental-health-problems-age/ >
The hospital where I work emphasizes medication management to correct chemical imbalances. In addition, social workers work to fortify outpatient treatment and community supports. The psychosocial rehabilitation staff, of which I am a part, runs educational groups, creative arts, exercise, stress management, meditation, prayer, and other group therapies. We also use a peer recovery model where people who have been in mental health recovery visit the hospital to share their experience, strength and hope.< https://jewishweek.timesofisrael.com/learning-together-in-a-mental-health-beit-midrash/ >
You may ask, “What can I do for myself or others?”
Here are some ideas:
MENTAL HEALTH ACTION LIST
West End Synagogue, New York, NY
Mental Health Awareness Month, May 2020
1) Monitor your own mental health. Use your coping skills, do self-care activities, and turn to loved ones for support. If you are struggling, consult a mental health professional. Help is available, whether short-term or long- term.
2) If you need emergency help for yourself or others, call 1-888-NYC-WELL, a 24/7 crisis intervention service. They also have a 24/7 text number: 65173.
3) Receive support: The National Alliance on Mental Illness (NAMI) Helpline is 212-684-3264. It is open Monday-Friday 11 AM – 6 PM. They offer a wide variety of resources, if you need a place to start.
The NAMI website offers free online classes and support groups, as well as opportunities for social and political advocacy: < https://www.naminycmetro.org >
< https://www.nami.org/Advocacy/Advocate-for-Change >
<www.ForLikeMinds.com > is a confidential social media support site for people living with mental illness, substance use, or a stressful life event, and their supporters.
4) Support causes that fight stigma. NAMI and Mental Health America are two of many organizations that do great work providing education and advocacy. Join us for the annual NAMI Walk, now virtual, after services on Saturday, May 30 to raise awareness and fight stigma. Donations are accepted year-round.
Visit <www.namiwalksnyc.org > . See also < https://mhanys.org>
5) Try to humanize language and action.
According the medieval Jewish Rabbi Radak, “Wounds may be cured, but not the hurt of words.” It is important that people are seen first as people and not seen as their mental health condition. Thus, we try to humanize language and actions, both to show respect and fight stigma.
Hurtful words are saying labels like “crazy” or “psycho”, or even “the mentally ill”. Instead, we can say people living with mental health conditions, i.e. “he is a person living with schizophrenia”, or “the woman died by (not committed) suicide”.
< https://www.mhfa.ca/sites/default/files/safer_language_reference_guide.pdf >
6) Include people with mental health issues. Add their names to the Mi Shebeirach (healing prayer) list. Visit them, bake them challah, or bake challah with them. Ask how they are; it is their choice about how much they want to self-disclose.
<https://jewishjournal.com/shabbat-sermon/235395/judaism-mental-illness/ >
7) Create greeting cards. This is a wonderful activity do online yourself or with your children or grandchildren. I am affiliated with a psychiatric ward greeting card project created by https://www.forlikeminds.com/psych_ward>.
You can send one or more cards with your own secular, inspirational and hopeful messages such as “Get well soon”, “Have hope”, “You can recover”. You can also send store-bought cards. Cards can be mailed or delivered to my doorman at Chaya Weinstein, 200 West 70 Street, 16L3, New York, NY 10023.
8) If you need emotional support, you may reach out to our West End Synagogue clergy. Our clergy members are trained in pastoral counseling, and are the first in line to help refer you to other sources through our synagogue network.
9) Our synagogue needs mental health professionals who could help augment the clergy in referring people with mental health concerns. Please contact me directly if you are interested.
Thank you very much, and Shabbat Shalom!
Chaya Weinstein
Chaya Weinstein, Ph.D., OTR/L is a psychiatric occupational therapist who works at New York-Presbyterian hospital, and in private practice.