Inspiration

Let’s Talk About Depression and Mental Health

August 12, 2014

This article originally appeared on finkorswim.com.

It’s time we had a conversation about mental health. Two weeks ago, I lost a dear friend to a toxic combination of severe mental illness and crushing addiction, two very dangerous conditions that compound their severity exponentially. Yesterday the world lost a genius who battled severe depression and addiction until he ended it all with an apparent suicide. Losing Robin Williams was tragic and a bitter pill to swallow. But seeing some of the reaction in the Orthodox Jewish community to his death coupled with the reaction to the death of Yissy, many of my fears that we are lagging behind in our communal approach to mental health were confirmed.

I am not a mental health expert. But I know that I am not a mental health expert. That’s why I consult with experts and do my own research to try to understand things beyond my expertise. I spend a lot of rabbinic counseling time working with people who are struggling or even succeeding in their personal battles. Many of these battles are related to mental health. Many others struggle with addiction. (That will be the topic of an upcoming article.) I’ve learned a lot and I am going to learn a lot more. Most importantly, I’ve learned that the stereotypes and assumptions in our community need to be addressed.

First, the stigma. We dance around mental health because of the stigma we attach to anyone suffering from mental illness. Our communal currency is reputation and our currency pays for marriage prospects, prestige, and influence. Mental health affects one’s reputation and severely devalues the person who is suffering as well as their family. The price is steep and the incentive to hide or ignore warning signs is great. It’s a sad irony because dealing with mental health issues as they crop up is much more effective than trying to treat a condition that went undiagnosed for an extended period of time. Further, mental illness does not go away by itself. So we are actually setting ourselves up for greater failure by not dealing with mental illness in its early stages.

More importantly, mental illness can appear out of nowhere at any time. Debilitating diseases or cancer can afflict perfectly healthy people even after decades of perfect health. We don’t know what life can bring. Someone struggling with their mental health and succeeding is a worthy, if not admirable, potential life partner. Every individual case is different. Stigma makes them all the same. The stigma needs to go away.

Most remarkably, sometimes the absence of stigma can make it easier for those with mental illness to manage their struggles. The stigma makes it harder and the lack of stigma makes it easier.
Second, just because a mental health issue is identified and treated does not mean it will be cured. In fact, mental illness is never cured. It’s just managed. But we need to be aware that just because we do all the right things and make all the right decisions, mental illness may persevere over our efforts. Not everything can be fixed. Sometimes we do everything right and it’s not enough.

This does not mean that the stigma attached to mental health issues is warranted. Again, every issue is different and every person is different. Stigma makes everyone bad. Not every mental health issue can’t be managed and the ones that are managed are undeserving of any stigma. Even the the ones that are managed less effectively don’t deserve stigma. They deserve our attention and sympathy. Stigma makes it easy to relegate them to the trash heap of society.

Third. When we say that mental health issues can be managed, we really mean that the struggle is constant but with proper care the struggles can be overcome. That being said, it takes a lot of will power to overcome those struggles and they do not get easier. Sometimes mental illness can fade in and fade out as well. But the struggle is eternal. Even while dormant, there is a constant threat that the symptoms will return.

It takes tremendous strength to wage war with yourself. Fighting mental illness can feel like destroying your own self. The condition is so much a part of the person that the struggle can seem like a civil war with no winners, only losers.

In particular, depression is very difficult for some people to understand. It can seem like run of the mill melancholy to outsiders. Or wrought by specific circumstances to others. But depression is an illness. It does not allow its victims to simply choose happiness or to just snap out of it. Depression is real. It may or may not be the result of any number of external factors, but no matter the cause, it is a severe malady. Against the victim’s will, life comes to a screeching halt. It’s not because the person is sad. The sadness is the symptom of the illness. You can’t tell a person suffering from clinical depression to “cheer up” any more than you can tell a cancer patient to “heal thyself.” That’s not how it works.

We are more comfortable saying that schizophrenia is a real illness. “That’s a real mental disorder” we say. “Depression was invented by gentile doctors. Torah can make a person happy! Depression is just indicative of a lack of proper simcha shel mitzvah.” Or something like that. This is dangerously primitive thinking.

Depressed people will contemplate suicide. Often. There are experts who can help. If you know someone who even jokes about suicide, try to get them help. Don’t do it on your own. Unless you’re a psychiatrist, it’s above your pay grade. Suicide is not an option for people who do not struggle with mental illness. It is an option for people suffering from depression. It’s shocking and scary to learn a loved one is struggling with suicidal thoughts. But it happens. It’s serious.

The brain is a body part. Happiness is experienced by a healthy, functioning brain. Happiness is not actually in your heart or your soul. It’s in your brain. If a brain is not functioning properly, it’s broken, like any other body part. We can see when an arm is broken. We can’t see germs so until recently we didn’t acknowledge their existence. But if you look under a microscope you can see germs. Case closed. Depression seems to be unobservable. But depression actually is observable. Brain scans of people suffering from depression are noticeably different in the areas associated with happiness and joy. It’s there. It’s real.

Depression can look like a regular case of being sad to an outsider. The outsider might even think that depression and feeling sad are the same thing. This can lead to terrible mistakes in dealing with depression. You can be cheered up if you are sad. Most people who are feeling sad would welcome it. But for someone suffering from depression, the brain does not respond the same way as it does for someone without depression. The outsider might think that the depressed person simply lacks the initiative, or will power, or interest in feeling better. They may think that happiness is a choice. For most people, happiness is a choice. For people with depression, happiness is not a choice. It’s beyond their reach. It’s like asking a 7 year old child to dunk a basketball on a 10 foot rim with no help. Not going to happen. Not the child’s fault. We wouldn’t ask a child with severe autism to give a public speech. Don’t ask people with depression to just grin and bear it. That’s causing more harm than good.

So let’s try to look at depression and other mental health issues through the lens of modern medicine. For people actually struggling with their mental health, let’s get them the help they need. But always mindful, that we cannot stigmatize those who seek help. Let’s remember that people who struggle with mental illness, will likely always struggle with mental illness. It’s a daily battle. No one beats mental illness and just forgets about it. Mental health requires constant vigilance for many people. It’s a journey that spans a lifetime. Be helpful. Be sensitive. Be aware that your brain probably doesn’t work the same way their brain works. Ask how you can help.

In this light, it makes little sense to draw lessons from Robin Williams’ suicide unless it’s a lesson about mental illness. And even then, for those of us fortunate enough not to struggle with mental health, there’s not much we can learn either. We can appreciate just how great a struggle it can be for many people, regardless of the circumstances of their lives, just to survive the internal war in their own minds. We can learn that talent and humor and genius and money are not real factors when it comes to clinical depression. Indeed, this is an important lesson, but it is limited to our understanding of others. It’s likely only barely relevant to most of us. But we are far from this level of understanding.

I did a Google search for Jewish articles on depression. One at Ohr.edu spent two paragraphs on clinical depression and twelve paragraphs on normal people who are sad. Aish.com features an article extolling the virtues of self healing one’s depression by choosing to be happy. I am grateful that it worked for the author, but this is hardy a sane option. Then there is an article by Rabbi Dr. Abraham Twersky from 2010 that covers some of the same points outlined in this article. It’s a great article. But it’s very short, and over 4 years old. Other than that article, I think Google betrays our lack of sophistication in this area.

We can’t fix depression and other mental illness. But we can educate our communities on these issues. Next time there’s a talk on the subject, attend, take notes, ask questions. Bring what you learned back home. Talk about it at your Shabbos table. Let’s start the conversation.