Muswell Hill Synagogue
Metzora + HaGadol 19/20 April 7.49pm 8.56pm

Teshuva, Psychotherapy and Mental Health

Rabbi David’s sermon Rosh Hashana Day 1 – 5778

When I was at University at the LSE, I undertook a process of becoming more religiously observant. I didn’t want to change in a radical way, more part of an organic process. I had been a good boy really as a child. I had been very actively Jewish. And then I went to yeshiva to study in 1993 where I saw many people whose shifts to religiosity were so quick and so sudden. I spent a number of years learning in yeshivot, and I remember the pressured atmosphere at this time of year. The word Ellul, the month leading up to Rosh Hashana, would already beckon in a period of worry and anxiety for many guys learning in yeshiva. What have I done wrong. What should I be confessing. What am I ashamed of. How can I atone. Come Rosh Hashana, there was a mixture of intent to pray, with fear and guilt all rolled in to one. And it could be hard for many guys whose lives had changed. They may have brought plenty of baggage into the learning hall; they may have had complicated relationships with parents and siblings. They may have had problems with the rapidly changing pace of modern life. This time of year, in the yeshiva, was not necessarily good for mental health.

Maybe we can also say the same about Rosh Hashana itself. It is a day of reflection on who we are. It is a day when we believe we are being judged by God. It is a day when we reflect on what will happen to our lives and the lives of those we love in the coming year. It is a much more difficult festival to access than say Pesach, or Succot – but it takes us deeper into our psychic world. It puts a mirror up to who and where we are – and this can be tough, threatening and filled with pain. When we consider who we are, we also do that in the context of a world that is moving and renewing at an unrelentingly fast pace, giving us very little time and space to consider who we are and how we can learn to be complete with that. And with that, comes a whole array of mental health conditions, from depression, to anxiety, to more serious conditions, that are increasingly being experienced by our population.

What has interested me this past year, is the relationship, or possibly separateness, between the Jewish concept of Teshuva or repentance, and the institution of psychotherapy. On the face of it they are extremely different concepts. Teshuva seems quite a mechanical concept, especially if we look at the writings of Moses Maimonides, Rambam. It connects to the religious corpus that is the Torah, combining its Written and Oral elements. It is an extremely behavioural concept, relating to how I act rather than how I think. Yes, some commandments of the Torah relate to belief or thought. But they too are understood as discrete actions, accumulating with other actions of a positive nature. Rambam’s classical understanding is of God totalling the good and the bad we have done to see what tallies as the largest. The tallying is something that we cannot do ourselves. Only God knows the value of each good and bad deed we do and so only God knows the final score so to speak.

In some ways, this classical approach is a very behaviouralist one. It suggests that the way forward for an individual is first to change behaviour to a way that God wishes. Through this change of behaviour, a person can then purify and cleanse their inner self. On Shabbat for instance, we pray in the silent prayer ‘Sanctify us with your commandments’ and only after do we say. ‘purify our hearts in order to serve you in truth’. The doing comes first, the inner cleansing comes second. And that was what I saw many of my friends go through. They wanted cleansing for the past. The way to do this was through religiosity, sometimes to the extent of a quite fundamentalist approach. This would lead to almost an eradication of a past that was causing shame and guilt.

But what if my religiosity is masking deeper personal issues. And what if these issues will come out at other times, such as in marriage, with children. This is where psychotherapy can help. It is of course religiously neutral. It is in a way a more existential approach. But there are religious approaches that also embrace existentialism too. For a person to serve God, for a person to fully understand a religious life; they also need to be insightful about themselves and how they have come to be themselves.

Here is a quote from Dr Michelle Friedman, Assistant Professor of Clinical Psychiatry at Mount Sinai Hospital, :

‘Teshuvah posits that appropriate behavior will pave the way for higher level understanding and transformation of feeling states. Cognitive-behavior therapy, which works to correct habitual negative self-perceptions and other cognitive distortions agrees with this point of view. Classical psychodynamic psychotherapy, however, posits the reverse–properly harnessed insight will motivate correct behavior’

In researching for this sermon, I came across a wonderful blog called ‘borei choshech’ – which means ‘Who created darkness’ from a blessing we say each morning. The author of the blog has depression, and writes about their religious experiences from the point of view of someone who is suffering from depression. The author also sees teshuva, repentance and psychotherapy going hand in hand. They write that:

‘Teshuva is therapy; therapy is teshuva. Teshuva literally means “return.” In my experience, therapy is also a return, although to the self, rather than to God. But they are interdependent paths: one cannot return to God without having first returned to oneself, and a return to the self is often accompanied by a return to God’

The author continues with these really insightful and helpful words:

‘Therapy, like teshuva, happens all year long. But Elul is a time for meta-teshuva, or meta-therapy. It is a time for stepping outside the therapist’s cozy office, out of the place of constant inner analysis, to ask the big questions: Is this process working for me? What am I putting into this process? What am I getting out of it? Am I in a better place, spiritually or psychologically, than I was a year ago? How is my relationship with my therapist? How is my relationship with God? And most importantly, how is my relationship with myself?’

So dogmatically pushing for one approach or the other may not work. Those who are working in the outreach world and trying to bring people closer to religious observance for instance, need to understand that they are dealing with people, who all will have complicated personal psycho-dynamic situations. And I suppose also those who receive regular therapy will need to reflect also on how the process itself is changing them. I think it is possible however, to say that psychotherapy, or a psychodynamic therapy, has immense value as part of a religious traditional life especially when such a life is taken on as a new challenge with all the changes that go with it.

Even outside of the world of religion itself, many of us are finding the speed of change and the pressure to achieve and stay afloat in this modern world quite crippling on our mental health. We have become a generation where material achievement is so important. The top job. The successful lawyer or business leader. We tend to glorify incredible, albeit rare stories of people who have ‘made it’ from very little – and yet ignore the thousands if not millions of ‘average’ people who contribute so much in their own way to our world. Hubris often seems to win. Humility can sometimes be hard to find. So yes, for some, religion is a reaction to the ever so quickly renewing and modernising world. Its slow pace of change feels right to many – and it offers a viewing point with which often to criticise and be proteted from the ever changing world. But that path is not open to many. And the pressure to succeed is great. And this is not just an economic question too. It is ethnic as well. Ethnic groups who are finding acceptance and integration difficult, may well suffer from higher rates of mental health issues. Our very own borough is a good example of this ethnicity element of mental health problems and already in 2012, Haringey Borough Mental Adult Mental Health stated that:

Patients from black or black British ethnic groups account for less than fifth (18.8%, Census 2011) of Haringey population but represent over a quarter (28%) of hospital admissions for mental health issues and further 44 per cent of admissions under the Mental Health Act

But the west of Haringey Borough is not at all free of mental health issues. Affluence and integration certainly cannot inoculate someone from mental health issues. Many of us here in this room may be affected. Even if one has not been diagnosed formally with a mental health condition, there is a good chance that you may have, are or will feel depressed or extremely anxious about something. It could be a change that has happened to yourself that has triggered it. It could be a change to your situation at home, to your spouse’s life situation. It could be a change of job. There are many triggers. And from the perspective of our Jewish identity, looking after one’s mental health is as important as one’s physical health. When we pray on Shabbat or Yom Tov for the welfare of those not well, we say the words ‘Refuat Hanefesh Urefuat Haguf’ – healing of the soul and healing of the body. So when the main body of Jewish law, the Shulchan Aruch, tells us that it is a mitzvah to go and see a Doctor – this surely means going to your GP both for your physical health and your mental health as well.

What is pressing today, is that we need to develop a way of talking about mental health issues, free of taboo. I don’t mean discussing the topic in an abstract way. I mean talking about our own struggles with mental health. How many of us quietly feel depression or anxiety, and yet we are not able to talk about it? And yet unlike physical ailments, talking would be so helpful to many who are depressed and anxious. Understanding that mental health issues can be coped with, given the right help and support.

I believe that the community has an extremely important role here. We all can learn about mental health. It may impact on us, or those who we are close to so to learn about the basics is so important. I undertook a 2 day Mental Health First Aid Course run by Mind Haringey. We will be offering this course in late October in our Synagogue so do sign up if you are able to undertake this. It will be on 2 consecutive Sundays. We have a developed a great Welfare service in this community for those who need. We have a great bunch of volunteers, administered so well and professionally by Louise Cooke. I really am so proud and appreciative of all that they do. I now wonder if we can think also around how such a system would work for mental health. This would not of course be offering serious psychotherapeutic and psychiatric interventions. But sometimes just having a chat with someone who knows your situation, can be of such help. Many of those who have depression, or an anxiety disorder, will be living with it on a regular basis. They may not express it all the time. But they will live with it, and worry about when it will creep up on them and show its face. So to feel a sense of community can be so helpful and full of solace for the one suffering.

But the most important catalyst for relieving the suffering that comes with mental health illness, is the individual themselves. And that is not always easy. But reaching out, reaching beyond the pain to someone close, a friend, a relative is so important. Recognising that you are important and that being helped begins with you is really critical. It reminds me of a linguistically simple but nevertheless vital idea. Rabbi Akiva tells us that a great rule of the Torah is ‘Love your neighbour as yourself’. We usually understand this as Hillel did – do not do to others what you would not want done to yourself. But think of the Hebrew ‘V’Ahavta L’Rayacha Camocha’ The letter K in the last word means ‘like’ and could be understood quantitively. In other words, you love your neighbour according to how much love you give yourself. Your self-esteem, your positive mental state, are vital in order to give love and affection to others and build relationships with them.

Listen to how the great Rabbi Joseph Soloveitchik words this

‘A human morality based on love and friendship, on sharing in the travail of others, cannot be practiced if the person’s own need-awareness is dull, and he does not know what suffering is. Hence Judaism rejected models of existence, which deny human need, such as the angelic or the monastic. For Judaism, need-awareness constitutes part of the definition of human existence. Need-awareness turns into a passional experience, into a suffering awareness’

We all suffer sometimes. Some more than others. We all have psychological needs. So let’s look after them. Let’s reach out when we need to. Let’s listen to others advice and support. And let’s pray this Rosh Hashana that we have the courage to help others suffering from mental distress, and the courage also to reach out past our pain when it is our time to need help.

Shana Tova.