Mental Illness: The Moral Imperative

Sermon given October 25, 2002, by Rabbi Barry H. Block

During my last year of Rabbinical School, I enjoyed the opportunity to study Jewish business ethics, in a joint seminar of Hebrew Union College and New York University’s School of Business. One of the terms I learned was nogea baddavar. If a person is nogea baddavar, an interested party, he or she may not participate in a legal proceeding. While a sermon is not a trial, I would be remiss if I did not begin a sermon about mental illness by acknowledging that I am nogea baddavar. My wife is a psychiatrist. Better insurance coverage for mental health could have a positive impact on Toni’s practice. Fortunately, though, I would not benefit in my own endeavors as a Board certified pop psychiatrist.

Our topic, though, is a matter that has been gaining serious attention in the Jewish community. In the last year, both our Union of American Hebrew Congregations and the Central Conference of American Rabbis have called upon us all, to educate ourselves better about mental illness and to advocate for enhanced resources to care for the psychiatrically ill.

Perhaps mental illness even plays a role in this week’s Torah portion. Tonight, I read about the birth of Isaac. Immediately after that section, we read that Ishmael, Isaac’s half-brother, is making sport. Sarah becomes so incensed, that she insists that Ishmael and his mother, Hagar, be expelled from Abraham’s camp. As you know, Ishmael is the father of the Arab people. This incident marks the beginning of Arab-Jewish rivalry, which continues to this day.

The Rabbis offer a variety of explanations for Sarah’s behavior. Most of the midrashim suggest that she is protecting her son from harm. And yet, in the Torah itself, the danger is unclear. The text merely tells us that Ishmael is “making sport.” What if Ishmael is just playing, and the danger to Isaac is all in Sarah’s mind? One way to understand Sarah’s action may be that she is suffering from post partum depression, even from psychosis. Perhaps she imagines, or at least exaggerates, the danger to her young child. With appropriate psychiatric diagnosis and treatment, the age-old conflict might have been avoided.

Now you see what I mean when I say that I’m a pop psychiatrist.

Seriously, though, our Jewish tradition has been aware of mental illness for centuries. Maimonides was both Rabbi and physician, in Egypt, some 800 years ago. He wrote that, when a doctor observes a mental problem, treatment of the psychiatric malady must take priority. Our own Healing Prayer mentions mental and spiritual, as well as physical, healing, based on the ancient Mi Shebeirach, imploring God for refuat hanefesh ur’fuat haguf, healing of soul and healing of body.

In modern America, the treatment of mental illness may be responsible for some of the positive stereotypes about Jewish men. Perhaps you have heard that Jewish men don’t drink. Hopefully, we are mature enough to acknowledge that we do have alcoholics among us, and yet studies actually show that the incidence of alcoholism among Jewish men is considerably lower than it is for men in the general population, even when those studies are adjusted to reflect socio-economic factors. An epidemiological survey, which I read in one of Toni’s journals, offers a possible explanation: A much higher percentage of Jewish men are treated for depression, when compared to men in the general population. The suggestion is that a large number of alcoholics really suffer from depression, which they are treating with alcohol. If so, the American Jewish experience demonstrates that psychiatric treatment is successful.

In America today, mental illness takes a terrible toll. During any one year, up to 50 million Americans suffer from a clearly diagnosable mental disorder. Depression affects nearly one in every ten Americans. Almost one-quarter of the elderly who are labeled as senile actually suffer from some form of treatable mental illness.

The economic impact of mental illness is significant, as otherwise capable men and women are taken from the work force, while employed people suffering from mental illness frequently miss work as a result of their ailments. A tremendous percentage of the homeless people we see on the streets are in fact suffering from severe and persistent mental illness. Hundreds of thousands of mentally ill persons currently reside in our nation’s prisons. While reasonable people disagree about acquittals on the basis of mental illness, nobody disputes that psychiatric pathology is a significant cause of crime.

Sadly, we are all too aware that we must also address mental illness as a matter of pikuah nefesh, saving lives, the highest mitzvah in Judaism. Each year, some 5000 young people, aged 15 to 24, commit suicide in America, with thousands more adults taking their lives. Suicide usually ranks first or second among causes of death of teens and young adults.

I am aware of men, women and children in our own congregation, who struggle with a variety of mental illnesses. I know, too, that many among us face brain disease alone. Too often, people are ashamed of their ailments. Even more frequently, psychiatric patients correctly perceive that, if people know about their diagnoses, their mental illness will overshadow every interaction and define the way they are viewed in the community.

I pray that our congregation will always be a safe and comfortable place for people with brain disorders. May our hearts be open, reaching out to our neighbors in the hour of deepest depression. May our minds be open, seeking to understand the person whose behavior has become difficult to comprehend. May our doors be open, even to the folks whose mental illnesses have made them most difficult to accept. Let us welcome them all in our congregation and community, with love and caring, with dignity and respect.

May we also join in the crusade of our Reform Movement. Let us insist that medical science seek a cure for schizophrenia, as well as cancer. Let us raise funds for research on depression and diabetes. Let us demand that health insurance cover bi-polar disorder as well as it protects us when we need heart surgery. Let us insist that our society’s safety net catch the poorest among us when they suffer from psychosis and when they are in an automobile accident.

Some progress has been made in recent years, particularly on the health insurance front. And yet, full parity has not been reached, meaning that limits are still lower for mental health coverage. Some business leaders oppose parity, on the grounds that health insurance prices will be driven too high. And yet, the economic costs of not treating the mentally ill have been demonstrated to be even higher. Reimbursement rates, lifetime maximums, and hospitalization limits should be the same for medical, surgical and psychiatric treatments. It’s a matter of life and death.

Across the nation, our society needs to do a better job of providing community-based mental health treatment. We should be ashamed, in the greatest nation in the world, when a person with schizophrenia is housed in a homeless shelter, or lives on the street, instead of being offered easy access to excellent mental health care. In our home of the free, we should be mortified, when a person with bi-polar disorder is incarcerated for a crime that she would not have committed if she had received proper psychiatric care. In this land of opportunity, we may not stand idly by, while young people so despair of the future that they take their own lives.

Here in Texas, the facts are downright shameful. Nation-wide, average annual state spending for mental health is $64 per person. Even that amount has been judged far from sufficient, but Texas provides barely one-quarter that amount, just $17, with the level expected to drop to $10 per capita in 2003. Texas currently ranks 42nd out of the fifty states in this area. The situation is even worse here in Bexar County, where our Center for Health Care Services receives just $13 per capita for mental health care each year.

During the current campaign season, with all those ads, all those debates, all those events, with millions of millions of sound bytes expended to garner votes, no candidate has attracted my attention with commitment to mental health care. Sadly, I can understand. Even the politicians who care about the mentally ill know that the issue, critical as it is, continues to reside beneath most people’s proverbial radar screens. Sex and scandal are more comfortable subjects than psychiatry.

Let us, then, leave this place tonight with the fervor of the prophets. Let it be known: We embrace the mentally ill in our midst, they have been with us from the days of Abraham and Sarah, and even before them. Let us be clear: Mental illness is real illness. We expect our health insurance, and our government, to care for the mentally ill, as well as the physically infirm. Let our voices rise in prayer: We pray for healing of body, and we pray for healing of mind.