Yes, of course sunlight is the best disinfectant.
But it’s not as if all you have to do is tug a bunch of problems out into the backyard at noon and let the sun bleach them clean.
It’s a process. Even metaphorically, it’s a process. In order to heal mental health issues, you have to be able to acknowledge their existence and then face them straightforwardly if you are to stand a chance. The more the stigma is allowed to block them from sight, the more they fester. The more they are freed from stigma, the more they can be assessed, diagnosed, discussed, and dealt with.
Lianne and Etiel Forman know about this process firsthand. Their daughter Elana, one of their five children, had abused drugs and alcohol since she was in high school; a gifted student, she managed to keep her problem hidden for years. She’s now in recovery, and her parents, both lawyers and prominent members of Teaneck’s Orthodox community, have dedicated themselves to helping make other parents’ paths easier, or at least better marked, than theirs had been.
Last April, they called a community meeting that drew a huge crowd — estimated at somewhere between 600 and 700 people, far more people than chairs or even standing room — at the Torah Academy of Bergen County. Since then, they’ve created their own group, Communities Confronting Substance Abuse, and have held other meetings. The community’s interest has remained strong.
Now, Communities Confronting Substance Abuse is partnering with Refa’enu, a Teaneck-based group started by local writer and activist Dena Croog to combat the stigma and increase the understanding of mood disorders and mental illness, to offer a symposium on mental health and addiction on May 5. (See box.)
Some of the feedback she and her husband got after their earlier panels and discussions “said that it was great, but narrowly focused,” Lianne Forman said. “It was a lot about addiction, and it focused on schools and teenagers. One person said to me, ‘We don’t have a teenager, so it’s not relevant to me.’ And you can’t cover everything.”
But she knows that drug addiction is a symptom rather than a cause, an indicator of an underlying problem, although certainly a problem in itself; so “although our organization is still focused and will continue to be focused on substance abuse and addiction awareness education and prevention, we partnered with Refa’enu. The purpose of the partnership is to say that addiction is a mental health disease, and there are other, broader mental health issues that we want to tackle together.
“Addiction is a disease,” she said. “Substance abuse is a symptom, like depression. You can be addicted to anything — to gambling, to shopping, to sex, to overeating, to anything that produces a feeling of completeness. It is self-medicating, and you cannot break away from it.”
Many people can gamble, shop, overeat, or do many other things without developing an addiction to them, she added. It’s a risk “to people who are psychologically prone to it. If you are not, so okay, so you engage in that behavior. So what? But if you are, then that behavior becomes everything to you, to the exclusion of everything else.” And that turns into a very big problem.
She and Ms. Croog started talking “about how we wanted to do a communal event; when we first started talking, it was about getting on the map, making people aware of our existence. And I sensed that she had a kindred spirit. We both want to help other people, based on our own experience.
“We are not into politics or posturing. We just have two organizations that are aimed at helping other people.”
Although both she and Ms. Croog are Orthodox, both of their organizations and the May 5 symposium are “open to everyone,” she said. “Ours has never been aimed only at Orthodox Jews. It’s aimed at Jewish schools. These are issues that touch everyone.”
The symposium will open “with a keynote conversation” between two people, Dr. Norman Blumenthal and Lisa Twerski, she said. (Dr. Blumenthal is a clinical psychologist who, among many other impressive credits, works with children, specializes in trauma, and heads a program at RIETS at Yeshiva University; Ms. Twerski is a highly credentialed social worker who specializes in domestic violence and substance abuse.) It won’t be a lecture; the organizers are aiming for a less formal, less frontal, more engaging affect. The conversation will focus on stigma. “How does it manifest itself, specifically in the Jewish community? Is it different in faith-based communities? How do we eliminate it?
The focus on stigma is “because it’s a barrier for a lot of things,” Ms. Forman said. “It’s a barrier to understanding what the other person is going through. If you don’t understand, if you have misconceptions, that would lead you to stigmatize someone. The stigma is a barrier that stops us from being supportive, from both an individual and a communal viewpoint.
“There are two problems. One is that what people think they already know is based on misunderstanding and misconception. The second is that people believe that it doesn’t affect them, since they don’t have a family member or friend they’re aware of who has that problem. They believe that it will never affect them, so what’s the point of learning about it?
“But it can affect you. And even if it doesn’t affect you immediately, if it affects someone in your community, then it affects you too.
“There are no guarantees. That is why we are so insistent on awareness and education. Even if it’s not relevant to you now, who knows what the future will bring?
“And then, for the sufferers themselves, stigma is a barrier in getting help. If they feel that they are out of the norm, that they are not accepted by the community, then they either will try to hide their issues or they will break away from the communities.”
There’s a tension in being part of a tightly woven faith-based community, she said. “I think that faith-based communities — not just the Jewish communities, but faith-based as opposed to secular — are more insular and more concerned with helping each other. If you are living in a system and community that emphasizes your relationship with God and with your fellow man, then you have a wonderful opportunity to be supportive. You have the chance to band together and become a better fellow man.”
Dena Croog agrees that combating stigma is important, and feels strongly that it makes sense to include the symptom that is substance abuse in the understanding of the underlying issue that is mental illness. She’s glad for the chance to partner with the Formans, and she also feels strongly that recognizing the problems and working toward solutions should not be confined to the Orthodox community. “Refa’enu is nondenominational,” she said; she’s worked not only with many local Orthodox shuls but also with the Union for Reform Judaism, as well as with the non-movement based Ruderman Family Foundation, which concentrates on disabilities and inclusion.
But beyond that, she said, “Lianne and I are coming from different directions in that the Formans are coming as parents of someone who has substance abuse issues. They are coming from the family’s perspective, the parents’ perspective, which is really important.
“But I am coming from a first-person perspective.”
Ms. Croog wrote an op-ed in this paper in 2014. The headline was “I have bipolar disorder,” and the first line was “Well, that’s out of the way.” She’s been very open about her disorder — which, she said, is shared by about 9.5 percent of Americans, including a proportionate number of Jews — and has worked to destigmatize it. She’s a moving writer, whose columns deal with living with bipolar disorder — and also living with children, living in a family, living in the Jewish community, and just plain living. Her work shows that a mood disorder is another part of life. She destigmatizes by example.
“It’s important that both the family perspective and the first-person perspective are recognized as valid and important,” she said. “Now there are more people who talk about it from a family perspective, and about how to help people who have a disorder.
“I think that it is important not to otherize people who have a disorder. It’s unintended, but sometimes it comes out a little bit. Sometimes it comes out as ‘they are suffering, and we need to help them.’ As someone who has a mental illness, it is more empowering to think of it from my perspective.
“I think it’s important to have more events like this, with different organizations coming together,” she said, precisely because they can provide a spectrum of vantage points. “It is important for the community to see it from different viewpoints. To see many plotlines coming together.”
It’s vitally important that people understand more about mental illness, Lisa Twerski said; the conversation that will open the symposium “is to help them understand what mental health stigma is and how it gets in our way, how it affects all of us, even people who are not struggling with mental illness and do not think they have family members with mental illness.
“Stigma deepens and widens problems in the community, because we act out of fear and ignorance. Then, we are more likely to buy into the stereotypes of mental illness, about what a drug addict looks like, or what a mentally ill person looks like.”
Paying attention to what you see can matter.
“There is a lot of nuance and subtlety, especially in the beginning stages of mental illness,” she said. “That is the time to catch things and attend to them. If we don’t pay attention — if we don’t have the education, if we are afraid to learn about it because we’re afraid it can be frightening — then that is a missed opportunity.”
It’s far better, easier, and more productive to intervene at the beginning stages of any mental health problem, she said. If you wait, “it can become more serious, and require even greater effort or intervention.
“When there is a low-level case of anxiety or depression, or a new budding case of addiction, being able to treat it sooner rather than later increases the possibility of the intervention being successful,” she said. “Not necessarily a quicker resolution, but a quicker road to healing than when somebody has been addicted for longer, or depressed for longer, or anxious for longer. You are just fighting so much more then to get to them, to help them, to get the disease under control.”
It’s not only friends or family who can be slow to admit that there’s a problem, she continued. Sometimes it’s the person. Admitting that you have a problem can be inherently scary; if that problem is fogged in shame or misinformation, it can seem even scarier. “If if you have a niggling idea that you really do have a problem, who can I talk to? And maybe they’ll rush me right away to rehab, or on medication. That can be a scary thing.”
Think of it this way, she said. If you need knee surgery, you ask your friends. Who cares if everyone soon knows that your knee isn’t so good? But if you’re asking for help with substance abuse, well, maybe you don’t want anyone to know. So maybe you don’t ask. And anyway, who would you ask? No one you know has asked. In public, at any rate. And so it continues.
The community also has to know what its resources are, Ms. Twerski said; in fact, the workshops that will follow the opening conversation include information about where people can turn for help.
She tells a story. “There was a young woman who had a serious depressive episode after a breakup in high school,” she said, careful to blur the details. “The mom didn’t want to think of it as anything more than typical teenage angst, even though the daughter was saying, ‘I need help. I need someone to talk to.’ But the mom just tried to get her out of it. It wasn’t full-on depression, but it was more than teenage angst.
“It was low-level enough so that the mom was able to pull her daughter back into the mainstream high school experience, but the daughter later said that ever since then, she’d struggled with random thoughts and with mood changes.
“She got engaged young, and then, on the eve of her wedding, she had a full-blown psychotic break of some sort. Obviously that was devastating. You wonder what might have been different if her mood had been stabilized and the problem had been attended to and dealt with, from the time she started showing some problems.
“She was fairly well stabilized after that; medication was really helpful, and therapy was really helpful, but it put a bomb in her relationship and in her plans, and it seemed to come out of nowhere.
“I understand the concerns that a parent would feel, putting a teenager on medication and into the network of therapy. It’s a hard choice. You have to make hard choices.”
Is there anything particularly Jewish about any of this? Not really, Ms. Twerski said, although each group thinks that the stigma its members face is unique, or at least far worse than anyone else’s. “I do a lot of work with domestic violence, and once, years and years ago, I was asked to be on a multicultural panel on domestic violence,” she said. “I was the last speaker. And everyone said the same thing. Everyone went into it thinking I will say what is different about our culture, but it was all the same.” In the end, she didn’t say much about the Jewish community; instead, she told them that she’d sound just like everyone else.
“I think we have similar struggles,” she said.
“We are very family oriented,” she added. “That is our strength. We take care of our children.” But the need to show that your children always are spectacularly wonderful can get in the way of acknowledging them as real people, with problems. And that is not at all unique to the Jewish community.
Efrem Epstein, the founder of Elijah’s Journey, will run one of the workshops. Elijah’s Journey advocates for suicide awareness and prevention. Its name comes from the story of Elijah; the group’s tack is unusual in that it works with Jewish texts to show how some Jewish foundational figures, who are shown to be flawed but overcome those flaws, face — and face down — thoughts of suicide. Elijah, the great prophet who we evoke at times of transition and liminality, who we call to at Havdalah as day turns to night and Shabbat to the week, was so overcome that he wanted to end his life. In Mr. Epstein’s translation of the Book of Kings, “I have had enough — let me die!” Elijah said. “I have dreams, goals, and values that I will never achieve. What reason is there for me to live?” And God, speaking softly, told him to “go on a journey and reassess.” And he did.
“In the context of Jewish texts, it is more organic” to discuss the idea of suicide and its prevention,” Mr. Epstein said. “It is easier to assimilate it as a Jewish issue.
“That’s the hiddush,” the innovation, the new insight — “that we offer,” he said.
Elijah’s Journey also stresses the importance of “listening to the best practices from experts in mental health organizations,” he said. “Many synagogues say that they want to do programs, ‘and there is somebody in the synagogue who is a social worker, so let him run it.’ The research is very cutting edge. To be a mental health professional, you have to be trained in suicidal ideation. Synagogues do not.
“So there are two separate things, texts and best practices.” Both matter.
“The stories about mental health are so very much part of our heritage, just like stories about tzedakah, or about caring for the elderly. In the Book of Ruth, we learn about the kindness Boaz shows to Naomi and Ruth. In many other stories as well, we learn about acts of chesed, about how to support somebody who is struggling.”
That’s exactly the support the community, at its best, can give people suffering from mental illness, he said.
Who: Communities Confronting Substance Abuse and Refa’enu, along with support from many other local organizations
What: Present the Mental Health and Addiction Symposium
When: On Sunday, May 5, from 9 to 11:30 a.m.
Where: At Yeshivat He’Atid, 1500 Queen Anne Road, Teaneck
How much: It’s free
Who will speak? Speakers include Dr. Norman Blumenthal, Lisa Twerski, representatives of the Bergen County Narcotics Task Force, Dr. Jeff Berman, Dr. Kenneth Carpenter, Dena Croog, Ruth Roth, Efrem Epstein, Lesley Gabel, Rabbi Zvi Gluck, Dr. Rebecca Harcsztark, Dr. Lee Hindin, Dr. Matis Shulman, and Ashley Sudol.
Workshop topics include what’s going on locally, misdiagnosis, family communication, peer support, text study, marijuana, sexual abuse, eating disorders, brain chemistry, opioids, and vaping.
For more information: Email firstname.lastname@example.org or go to www.time2talkaddiction.org