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Pinhas 5782 - 988 Suicide and Crisis Lifeline

Saturday, July 23, 2022 - 23 Tamuz, 5782

Beginning this past Sunday, July 17, the quick-dial phone number 988 has been designated by the Substance Abuse and Mental Health Services Administration as our national Suicide and Crisis Lifeline. While the National Suicide Prevention Lifeline has existed since 2005, the new number of 988 allows for easier recall than the previous number, and expanded funding from Congress allows for updated technology and wider access for all residents of the United States and its territories. Now, 200 local, independently operated Lifeline centers exist to field calls, with our local center at the Louisiana Association on Compulsive Gambling in Bossier. As members of a religious tradition that emphasizes saving a life over all else, we each have the responsibility to repeat the number 988 to all of our acquaintances, to suggest calling that number to those who need it, and to use that number if we should ever need it ourselves. In a time and nation in which it is estimated that one death by suicide occurs every 11 minutes (SAMHSA), we must revisit our Jewish conviction that mental health be treated as just as integral to life as physical health.

Some of our prime examples of Jewish teachings on the topic of mental health exist in the works of Maimonides. Maimonides (Moshe ben Maimon or Rambam in Hebrew) lived from 1148 to 1204 CE, in Spain, Morocco, and for most of his adult life, in Egypt. He served as a court physician, the rabbi of his Egyptian Jewish community, and an extensive writer in philosophy, Jewish law, and medicine. In Jewish circles, he is best known for his Commentary on the Mishnah, the law code Mishneh Torah, and the philosophical treatise Guide for the Perplexed. In addition, he wrote eight different books that were crucial to physicians’ libraries in medieval times, books that covered treatment in general, treatment of specific diseases, an overview of his contemporary pharmaceuticals, and overviews of Greek medical writings. In the breadth of Maimonides’ work, as well as in his particular words, Maimonides emphasizes his value on rational thought in pursuit of a productive lifestyle.

For Maimonides, health is crucial for the purpose of keeping useful, and a doctor is responsible for providing whatever options are available for each patient’s health. In Maimonides’ Mishneh Torah, his central halakhic text, in his chapter Hilkhot De’ot, or “Human Dispositions,” Maimonides writes about health as a Jewish necessity: “Since the maintenance of a healthy and complete body is from God, for it would be impossible to understand or know anything about the Creator when he is ill, accordingly, a person needs to distance herself from things that are destructive to the body.” Throughout the chapter, Maimonides gives recommendations for proper eating, exercising, sleep, and other lifestyle choices. Later in the same chapter, Maimonides prohibits a sage from living in a city without a physician, a surgeon, a bathhouse, public restrooms, and running water, all necessities for living a healthful lifestyle. In his voluminous law code, Maimonides recognizes that without a physical and mental ability to focus on the law, one cannot follow that law. 

Elsewhere, he writes, “The purpose of his body’s health is that the soul find its instruments healthy and sound in order that it can be directed toward the sciences and toward acquiring the moral and rational virtues, so that he might arrive at that goal.” Health, for Maimonides, is not for the sake of the body alone, but rather, for the productivity of the rational and ethical mind. One cannot gain knowledge or achieve goals within the distractions of illness and malaise. Rather, one should always follow a middle path between asceticism and desire, between uncontrolled happiness and raging anger. Overall, Maimonides directs his medical ethic towards the development of a mental and physical stability worthy of allowing a person to be as efficient and able as possible. 

In Maimonides’ writings, he makes clear that mental health is just as valid and important as the physical:

On this account, the physicians have directed that concern and care should always be given to the movements of the psyche; these should be kept in balance in the state of health as well as in disease, and no other regimen should be given precedence in any wise. The physician should make every effort that all the sick, and all the healthy, should be most cheerful of soul at all times, and that they should be relieved of the passions of the psyche that cause anxiety. Thereby the health of the healthy will persist. This is also foremost in curing the sick, and especially those whose disease is psychic, like those who harbor hypochondria and morbid melancholy, because solicitude for the emotions of these is obligatory. It is the same for someone who is overcome by grief and obsessions, or by terror of whatever is unnatural to fear, or by the diminution of satisfaction in what is natural for him to enjoy. In all of these, the skillful physician should place nothing ahead of rectifying the state of the psyche by removing these passions. 

For Maimonides, “no other regimen should be given precedence” over mental health, as poor mental health can afflict both the physically healthy and the physically ill. He recognizes not only the reality of mental illness, but in addition, the utmost importance of its treatment. 

Maimonides’ positions are bolstered by the Jewish texts of his predecessors. While in Talmud Bavli Berakhot 5a-b, the Rabbis expound upon issurim shel ahavah, suffering as a blessed sign of God’s love, the Rabbis do not rest on simple support of the idea of suffering as a positive ideal. Towards the end of the sugya, a story appears in which Rabbi Yohanan and others help each other up from their suffering in illness and repeat to one another that that suffering, and even the reward of that suffering, is not worthwhile.

When speaking about mental illness, specifically, the Talmud is clearly aware of mental illness as a life-threatening reality. A pregnant woman whose mental state becomes unsettled may violate Yom Kippur and eat food, even forbidden food, for the sake of pikuah nefesh, saving a life. Rabbis in the Talmud die of a striking resemblance to our modern conception of depression, and such occurs in a tradition that prioritizes pikuah nefesh over every commandment except for prohibitions against idol worship, murder, and certain sexual practices. Pikuah nefesh can be sourced from Biblical verses such as Deuteronomy 30:19 - the call to “choose life - and Leviticus 18:5 - the command to do God’s mitzvot and to “live by them.” Maimonides is not the first in the Jewish tradition to bring attention to the importance of treatment for mental illness; such a priority comes from the Jewish demand for life-restoring treatment.

Today, in a society that prioritizes productivity over so much else, we are often moved to bottle our emotions or work through the pain on our own. “No pain, no gain,” or “You’ll sleep when you’re dead,” are comments I have heard from teachers and mentors of all fields. Mental illness is often equated with “craziness,” and therefore, seeking treatment can be seen to some as taboo or as an indication of inferiority. And yet, if we look at productivity in society from Rambam’s perspective, we see that productivity and life alike cannot continue without treatment of and attention to mental and emotional distress. When we encourage our friends, relatives, and even ourselves to seek help when we need it, we model the reality that getting support for mental health is just as life-saving as going to the doctor for physical support. We can even bolster that encouragement by being a presence in the room while another person sets an appointment with a professional or calls a lifeline. When we notice another person in crisis, we can take the first step of offering a shoulder to cry on and a hand to hold, when other actions may seem scary.

Each day, twice a day, in the first paragraph of the Sh’ma we remind ourselves to love God by speaking of God’s words b’shivtekha b’veitekha uv’lekh’t’kha va-derekh, while you sit in your house and while you walk on your way, and by posting God’s words al mezuzot beitekha u-vishareikha, on the doorposts of your house and upon your gates. In the third paragraph of the Sh’ma, we remind ourselves of the visual power of wearing tzitzit, allowing our eyes and our companion’s eyes to see our Jewish identities outright. Now that we have that easy-to-remember, better-funded lifeline number of 988, we can save lives by repeating the number in conversation and by highlighting the importance of our neighbor’s lives in the gratitude we express to them. We can carry around 988 wallet cards or display 988 Suicide and Crisis Lifeline posters in our workplaces. And of course, we can let our peers know about the other lifesaving resources we have at our fingertips, like our 211 number for local healthcare and livelihood resources. Mental health and self care are not just miscellaneous, modern catchphrases, but are values that we as a Jewish people have held for thousands of years. As we do with so many of our other values, let us show what we believe through the words we consciously say and display. Shabbat Shalom.

Sun, July 14 2024 8 Tammuz 5784