The blog of the Roaring Fork Valley (Reform) Jewish community
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Rabbi David Segal and Cantor Rollin Simmons

Friday, October 3, 2014

On Suicide and Mental Illness (Kol Nidrei Sermon 5775/2014)

Rabbi David Segal
Aspen Jewish Congregation
Kol Nidrei 5775 • 03 October 2014
“To be read at the opening of DPS (Dead Poets Society) Meetings: I went to the woods because I wanted to live deliberately… I wanted to live deep and suck out all the marrow of life! To put to rout all that was not life… And not, when I came to die, discover that I had not lived… H.D.T.” (Henry David Thoreau, Walden)
Robin Williams, in the role of English teacher John Keating in the (1989) film Dead Poets Society, weeps at his desk as he reads these words. They’ve been inscribed by hand in a copy of the poetry textbook for his English class. The book belongs to a star student, Neil, a theater and poetry enthusiast. Neil is also a member of the Dead Poets Society, a student group that meets secretly to discuss great poetry and the meaning of life. Neil struggles against an imperious father who wants him to attend Harvard and become a doctor, despite Neil’s love of literature and the arts. When this scene takes place, Neil has just taken his own life, and Mr. Keating mourns. 

Confronted with this tragic death, the private boys' school reacts defensively, almost cruelly. Spurred on by Neil’s angry, grieving father, they investigate the Dead Poets Society. They blame Mr. Keating (Robin Williams) for encouraging Neil’s impudence toward his father and even for causing Neil’s suicide. It is, of course, a profoundly misguided way to understand and respond to suicide. 

This is not an easy topic to discuss, but discuss it we must, with open eyes and an open heart. The fact is that suicide is very difficult to understand. It does not result from a neat, linear cause-and-effect chain. In more than 90 percent of cases, it is a result of a diagnosable (if not actually diagnosed) mental illness. One in four Americans — one out of every four of us in this room — will be affected by some form of mental illness during our lifetime. That can include depression, bipolar disorder, schizophrenia, eating disorders, and post-traumatic stress disorder. Substance abuse aggravates all of these conditions. Suicide is not a sign of weakness, a character flaw, or a cowardly act. It is the tragic result of a complicated mix of “factors such as hopelessness, impulsivity, and traumatic life circumstances” (Harpel).

Simplistic and reductive misunderstandings of suicide are all too common. When Robin Williams died by suicide this August, we heard some of the usual misconceptions:

“But he was so funny and full of life!”
“It’s such a selfish act.”
“How could anyone choose to do this?”
“How could he cause such pain to his family?”
“It was a coward’s way out.”

If we haven’t struggled with depression ourselves, it is hard to understand what it feels like. Martha Manning, in her book Undercurrentstries to describe her disease of the mind:
The emptiness of the depression turns to grief, then to numbness and back again. My world is filled with underwater voices, people, lists of things to do. They gurgle and dart in and out of my vision and reach. But they are so fast and slippery that I can never keep up. Every inch of me aches. I can’t believe that a person can hurt this bad and still breathe… It’s not that I want to die. It’s that I’m not sure I can live like this anymore. (Manning, 99)
Dr. Kay Redfield Jamison is a world-renowned expert on bipolar disorder and the author of numerous books on mental illness and suicide. She has suffered from bipolar disorder most of her life, and here is how she described the mental state behind her own suicide attempt:
No amount of love from other people — and there was a lot — could help. No advantage of a caring family and fabulous job could be enough to overcome the pain and hopelessness I felt… I knew my life to be a shambles and I believed — incontestably — that my family, friends, and patients would be better off without me. (Solomon, 265)
The first thing I want to say, probably the most important thing of all, to anyone who has had these thoughts, is that your family and friends — and we, your community — are not better off without youIf you hear echoes of yourself or someone you know in these descriptions, help is available. 

You can call 800-273-TALK for the National Suicide Prevention Lifeline wherever you are, 24 hours a day, seven days a week. You can also contact the Aspen Hope Center’s 24-hour Hopeline at 970-925-5858. There are trained crisis counselors on call at all times. (The Hope Center has also provided some printed resources for our community, so please take some with you as you leave tonight.) You can ask a friend, teacher, colleague, relative, rabbi for help. We will do what we can and will do our best to refer you to the professional who has the skill to help you most. As one mental illness expert said, “Empathy is important, but competence is essential” (Jamison, “To Know Suicide”).

The vast majority of the time, mental illness does not lead to suicide. We can’t predict with certainty when it will, although we can try to look for warning signs and risk factors. Nationwide, someone dies by suicide every 13.3 minutes. The rate among men is four times that of women, and higher among Whites than any other ethnicity. Rural areas with above average substance abuse and gun ownership show increased suicide rates. The Western states, including Colorado, have the highest rates in the country. 

Pitkin County averages four suicides a year, and our Jewish community has been touched by this tragedy. How many more untold stories are there of people who struggle in the shadows, invisible to those whose help they need? Tonight is an invitation to you to stop suffering alone, in silence. Tonight we invite you to reach out for help, to know that it can get better, to have faith that it will get better. We, your community, might not always say the right thing, we might not fully understand how you feel, we might even seem uncomfortable talking about it — but we still care. We can still help you find the help you need.

Tonight is also an invitation to all of us, whether we’ve dealt with mental illness personally or not, to be that hand to reach out to, that shoulder to lean on in someone’s time of need. 

There are four mitzvot, four Jewish calls to action, that can help guide our understanding of and response to mental illness: Bikur Cholim (visiting the sick), Pikuach Nefesh (saving a life), Nichum Aveilim (comforting mourners), and Halvayat HaMet (accompanying the dead). The first two speak to the kind of community we should strive to create to make it easier for those struggling with mental illness to find relief and healing. The second pair speaks to the way we should respond as a community when the tragedy of suicide occurs.

The first two mitzvot, again, are Bikur Cholim (visiting the sick) and Pikuach Nefesh (saving a life). Bikur Cholim encompasses visiting someone in the hospital, taking food to the homebound, offering help and presence when a crisis interrupts daily life. When it comes to illnesses of the body, we are pretty good at this. It’s easy to mobilize a Mealtrain schedule for someone undergoing chemotherapy or recovering from back surgery. Sadly, it’s not as natural when it comes to depression. We might whisper about it, but we rarely address it openly. We might express our disbelief that someone could be suffering so deeply when they seem so happy on the outside. At our worst, we suggest that someone with depression should just “perk up” or “snap out of it.” As a rabbi who struggled with depression wrote, “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” (Helfgot).

Pikuach Nefesh, the principle that saving a life trumps almost every Jewish law, demands that we cure our ignorance, break through our superficial understanding, so we can learn to be present for someone who is choleh — ill — with a disease of the mind or spirit. We should be proactive in creating a community where it is safe to ask for help. We should check our judgment at the door when we realize it could help save a life. 

Our culture values individualism, which is good up to a point. But too often we make a false idol out of the virtue of individualism. We act as if self-sufficiency is the goal in all things, as if reaching out for help is a sign of weakness and failure. I believe that the suicide rate is higher among men, in part, because our image of masculinity leaves little room for vulnerability. But regardless of gender, our culture tells us to look down our nose at people who need to lean on others rather than take care of themselves. 

If we take seriously the value of Bikur Cholim and Pikuach Nefesh, of being present for the ill and rescuing a soul, we can change the culture. We can create a community where we don’t avert our eyes or stare in judgment when someone suffers from mental illness. We can cultivate a thick network of real relationships, so that we notice when someone is withdrawn, struggling, lonely, lost. Signs to watch for include someone who talks of hurting himself, sleeps too much or too little, withdraws from activities, and other marked changes in behavior or mood. As the experts say, trust your gut. If you’re concerned, it’s always better to say something than to let it go. It is a myth that asking someone if they’re suicidal is dangerous; it’s not. It’s more dangerous to say nothing.

Even when we do this well, even when we notice warning signs and minimize risk factors, sometimes it is not in our power to fix it, to prevent the unthinkable. As Martha Manning wrote, “I realize that if love were the cure, I would have been healed a long time ago.”

The second pair of mitzvot teaches us how to be present for the survivors of a loved one who dies by suicide. Nichum Aveilim (comforting mourners) and Halvayat Ha-Met (accompanying the dead) demand, like the first mitzvah pair, that we check our judgment at the door, and that we show up. We accomplish Nichum Aveilim by bringing food to a shiva home and participating in a minyan, by checking in with a mourner days, weeks, months later. We fulfill it when we give mourners the space to reminisce, question, struggle, and cry with us. We perform Halvayat Ha-Met, accompanying the dead, by attending a funeral, hearing a eulogy, saying the Kaddish, throwing a handful of dirt into a grave. In my experience of this community over the past four years, we are ready, willing, and able to show up for each other in times of mourning.

There are certain classical Jewish texts that ban funerary practices for suicides — no shiva and no burial in a Jewish cemetery. Imagine the pain, the shame, felt by families already struggling with grief and shock, as well as the anger and betrayal often associated with surviving a suicide loss. Mercifully, that ban was not mainstream and is rarely if ever practiced today. Let’s make sure we haven’t created an emotional or social banishment for survivors of suicide loss because of our misconceptions about it. Let us practice empathy rather than avoidance; let us bring blessing and not lay blame.

*    *    *

As the students in Dead Poets Society learned, words matter. How we talk about mental health, whether we talk about mental health, affects how we treat it. We must be willing to talk about it; it must not be taboo. What we say in someone’s time of need may be life-changing. Please, God, let us be present to others in need. Please let our words at moments of vulnerability be words of life, words of inclusion and restoration, and not judgment. Please let those who suffer with a disease of the mind trust us to be their lifeline. Let them find the strength to reach out from their darkness — and let us be there to bring light.

At the end of Dead Poets Society, Robin Williams’ character Mr. John Keating prepares to leave his classroom for the last time. The powers-that-be at the school blamed him for the tragic suicide of his student and fired him. As he makes his way to the door, one by one the boys in his English class stand on their desks and declare, “O Captain! My Captain!” in tribute to their teacher. They speak out of their pain and guilt over the death of their classmate; they speak out of love and respect for their beloved teacher, wrongfully blamed and banished. They speak out because they’ve learned that silence can lead to darkness. Their words and their actions affirm life; they aspire to a life of meaning and impact. 

I want to close with part of that poem, “O Captain! My Captain!” which Walt Whitman wrote in 1900 in memory of President Abraham Lincoln. In Whitman’s words we hear grief for the loss of a life mingled with gratitude for that life’s legacy.

O Captain! my Captain! rise up and hear the bells;  
Rise up—for you the flag is flung—for you the bugle trills;
For you bouquets and ribbon’d wreaths—for you the shores a-crowding;  
For you they call, the swaying mass, their eager faces turning;  
    Here Captain! dear father!  
      This arm beneath your head;  
        It is some dream that on the deck,
          You’ve fallen cold and dead.  

My Captain does not answer, his lips are pale and still;  
My father does not feel my arm, he has no pulse nor will;  
The ship is anchor’d safe and sound, its voyage closed and done;  
From fearful trip, the victor ship, comes in with object won;
    Exult, O shores, and ring, O bells!  
      But I, with mournful tread,  
        Walk the deck my Captain lies,  
          Fallen cold and dead.

These mournful words, like all eulogies, articulate the legacy of the deceased, the impact of his life, that he lived, that he was and remains loved. He is missed because he mattered. Those of us who struggle with depression, whose spirits suffer in darkness — and, in truth, all of us — need to hear words like these while we still breathe and walk the earth. Like Thoreau, we need to know that we have “lived deep” and “sucked out all the marrow of life.” We need to be reminded that we matter. 

We can’t do this alone. At the end of the day, the purpose of a sacred community is to create a space where it’s safe to be ourselves, and where we matter to each other and to the world. 

The rest is commentary. Let us go and live it, for however long we have left. 


Sources and Recommended Reading

I’m thankful for sermons and advice from the following rabbinic colleagues: Elka Abrahamson, Ariana Silverman, Jen Gubitz, Ronne Friedman, Yaron Kapitulnik, and Jonathan Kligler. Thanks to Julie Wagner, Goldie & Werner Knurr, Or Mars, Jamie Bornstein, Rabbi Daniel Crane Kirzane, and Rabbi Anne Lewis for their helpful suggestions and recommended reading. And many thanks to Joanne Harpel for her wisdom, expertise, and editorial help.

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