The Spirituality of Madness

June 3, 2010

“The Spirituality of Madness” is reprinted from Zeek’s Spring 2010 issue, The Spirituality of Healing, available for purchase here. Zeek thanks the Bay Area Healing Center for guest-editing this timely and significant issue on spiritual care.

Remove your sandals from your feet, for the place on which you stand is holy ground.– Exodus 3:5

The first time I walked into a psychiatric unit as a chaplain, I was terrified of being mistaken for a patient. The click of the locked door behind me made me worry that maybe “craziness” is contagious. And yet I soon learned that I feel liberated in psychiatric units. I am a second-generation Holocaust survivor, and extreme mental states are as common as rain in my family. As a child, I always suspected my family was the only one that experienced emotional suffering.

The medical model of mental disease tends to isolate us from each other. I believe that we learn more about ourselves and human nature when we understand our commonalities, and conceptualize mental distress and emotional suffering as occurring on a broad spectrum. I do not dispute that changes in brain chemistry cause terrible suffering to those we term “mentally ill.” I believe in the use of psychiatric medications, as well as therapy and spiritual care. However culture, personality, history, and spirituality impact our mental state equally strongly. For example, women in the 19th century who were afflicted by hysteria were suffering from a form of mental illness that was deeply embedded in both their own individual distress and in society’s suffering. This disease indicated a spiritual and cultural, as well as a physical, malady.

While few of us will experience what is considered severe mental illness or spend time in the under-funded psychiatric units that many of my clients cycle through, all of us have experienced an extreme mental state. Think back to the most painful and the most potent moments in your life: There is a shattering of identity that goes along with the death of a loved one, a sense of surrealism associated with being bedridden by the flu, a manic energy that possesses us when we are starting a new project or a new relationship. Many of the behaviors that our society understands as being pathological symptoms are in fact reasonable responses to life’s unfair and often tragic circumstances.

Being deemed crazy in our culture is a terrible fate – it leads to stigma and isolation, as well as economic, social, and spiritual losses. However, I have come to realize that the fear I feel when entering a psychiatric unit or being in the presence of severe emotional distress is also linked to holiness. In Hebrew, “yirah” means both “awe” and “fear.” Both holiness and madness inspire yirah deep in our souls. The struggle with mental illness is terrifying and extremely painful. No one chooses to suffer from emotional distress, yet it can also lead to profound shifts in awareness. The places where we wrestle with mental health are truly awesome in the fullest sense of the word. They are holy ground.

Madness and Meaning

Mental health crises often lead to a loss of meaning and a profound sense of confusion. Most of the mental health-care system aims to clear away confusion: psychiatrists try to find the right medications to eradicate delusions or dispel disorienting moods; therapists help patients tell a meaningful narrative of their lives; social workers assist in rebuilding shattered networks of support. All of this work is precious and necessary. After all, the disintegration that goes along with mental distress is frightening and interferes with day–to-day life and our obligations to our family, friends, and vocations.

Confusion, however, need not be understood as purely negative. Religious traditions teach that while confusion is destabilizing and painful, it can also be holy. Unlike medicine, which is focused on returning patients to a well-ordered world, spiritual traditions support people both in making meaning and in occasionally smashing through it. In Zen Buddhism, the use of koans, or unsolvable riddles, is a spiritual practice that explicitly aims to deconstruct our sense of meaning. In one famous koan, a Zen teacher named Wakuan complains when he sees a picture of a bearded sage, “Why hasn’t that fellow a beard?” In another, we learn that when you meet the Buddha, you should kill him. In yet another, a sage named Chao-chou falls down in the snow and calls out, “Help me up! Help me up!” A monk comes and lies down beside him. Chao-chou gets up and goes away. All these teachings open our minds to confusion and hence the spirituality of infinite possibilities.

Judaism also has texts and traditions that honor the holiness of confusion, as well as moments of meaning-making. The Book of Lamentations, which describes the destruction of ancient Jerusalem, portrays a world of chaos where suffering has no meaning and mothers cannibalize their young. This text is woven into the Jewish liturgical year through the observance of Tisha B’Av, the Jewish day of communal mourning, when this text is read aloud and traditionally accompanied by wailing.

We need both clarity and confusion. In Jewish tradition, Passover tells a clear and purposeful story of suffering and redemption – we were once slaves but now we are free. The yearly observance of Passover reminds us that we can be edified by the story of the Exodus and use it to bring a sense of purpose to our own moments of enslavement. However, Tisha B’Av honors the meaninglessness of suffering, the raw howl that so often accompanies emotional distress. Both Tisha B’Av and Passover are sacred moments in the Jewish year. Likewise, Jewish spiritual caregivers are called upon to bear witness to the holiness within mental states of confusion, raw grief, and disintegration, as well as moments of redemption.

A Jewish Voice

Judaism provides us with a number of resources for offering spiritual care and healing to those of us who are suffering, without asking us to make too much sense out of suffering. The Bible recognizes that extreme mental states are a part of human life. We learn in the Book of Samuel, for example, that King Saul would periodically and unpredictably be overcome by a ruach ra’ah, literally a “bad spirit.” The rapid mood swings that Saul experienced would likely be understood as bipolar illness in today’s psychiatric system.

Again, in the Haftarah (prophetic reading) for Rosh HaShana, Hannah calls out her pain in the Temple, unburdening herself of all the suffering that is “on her heart” after years of infertility. The priestly authority figures of the Temple react to her as if she is drunk or deranged because she is speaking to a presence that no one can see and because of the intensity of her emotional expression – not unlike the ravings we now call psychosis. In another example, Naomi is so grief-stricken after the deaths of her husband and sons in the Book of Ruth that she can’t even recognize herself or identify with her own name due to the depth of her depression.

Unlike today’s world, where mental illness is often surrounded by silence and invisibility, the social world of the Bible has room for all of these figures. There is recognition in the Bible that while mental distress is painful, it is also part of human experience. It is not just that all of these characters survive painful and disorienting mental states; it is that these states are part of what makes them inspired leaders of our people.

These examples don’t imply that mental illness is good. We must not forget that the journey through mental health challenges is incredibly painful – and that while some are deepened by the experience, others are irretrievably broken and become isolated and forgotten by their families, friends and communities. Living with mental illness means living with loss: Individuals and families may experience losses of physical or mental functions, relationships, employment, financial support, social status, and spiritual beliefs. Most of these losses are never marked and are surrounded by secrecy and shame.

What the biblical stories do teach us is that mental distress is a natural part of human life and a part of every society. Surviving our own moments of emotional suffering and finding the strength to walk with others through incredible pain are ancient and sacred obligations. Ruth clings to Naomi despite the depth of her depression and continues to see her as a worthwhile and dignified person, even when Naomi cannot recognize herself. We can only begin to follow in Ruth’s footsteps and accompany people through mental crises when we dispel the stigma that surrounds mental illness and begin to break down the walls of isolation that surround so many people’s suffering.

Although research shows us that nearly one in four families is impacted by mental illness, it is still frequently discussed in whispers at the edges of our communities. Jewish tradition speaks in a different voice about the need to name suffering out loud. Chapters 13 and 14 of the Book of Leviticus are entirely devoted to recounting the details of contagious diseases. While these diseases are certainly stigmatized in the Bible, Jewish tradition teaches us to chant these passages aloud in synagogue. Jewish law prohibits skipping passages that may seem grotesque or disturbing to some. Even the most terrifying symptoms must be chanted in a clear loud voice in our holiest places.

The Jewish cycle of mourning also addresses the need to dispel stigma around suffering. In Jewish tradition, official mourning begins with the funeral — not at the time of death — because losses first need to be named out loud and witnessed before people can grieve, heal, and move forward. Likewise, we need to make time to publicly name and mourn over the losses connected to mental illness before we can heal as individuals or as a community.

In most synagogues, there is at least one “crazy person.” Such individuals show up at the social hall in clothes that smell a little or are ill fitting. They make inappropriate comments in voices that are too loud or too quiet. Eventually, many of these people simply disappear from the community and no one asks where they went. One critical role of spiritual caregivers is to simply keep showing up for someone who might otherwise be forgotten. In the Mishnah, we learn that when we save a single human life it is as if we saved an entire world. When we cling to someone who has been pushed to the margins of society and rendered hopeless, we are helping to nourish an entire world.

Companionship

Companionship can often be the most important aid we can offer to those in pain; it is central to the work of spiritual care. A “companion” literally means “someone to share bread with,” while to “treat” is derived from the word root for “carrying.” A companion is someone who shares his or her lunch with you in the most painful moments in your life, not someone who tries to fix you. I once served a client who was an avowed atheist and alienated from Jewish religious community, but he craved a sense of belonging. I helped to connect him to a sense of community through sharing Jewish jokes and raunchy Catskills humor.

A friend of mine who has trouble with balance due to a brain injury once told me that when she falls down, everyone rushes to help her get up, but in those first moments she needs to gather her thoughts and dignity and she does not want to be pulled to her feet. “I think people rush to help me up,” she says, “because they are so uncomfortable with seeing someone lying on the floor. But what I really need is for someone to get down on the ground with me.” This simple teaching is 90 percent of spiritual care: Get down on the floor yourself before you drag someone to her feet!

In the Talmud (Berachot), the story is told of a time when Rabbi Yohanan falls ill and is suffering from deep emotional pain. Rabbi Eliezer comes to visit him and, like so many well-meaning would-be comforters, he tries to make sense of Yohanan’s suffering for him. “Are your sufferings welcome to you?” he asks. This question echoes the words of so many of us who are uncomfortable sitting with the depth of loss that accompanies mental illness. We try to find meaning within it too soon or blame the person who is suffering. Rabbi Yohanan answers simply: “No, neither my sufferings nor their reward.” When Rabbi Eliezer hears these words, he realizes that he cannot fix or make sense out of Rabbi Yohanan’s pain and he says simply: “Give me your hand.” Yohanan gives him his hand and Rabbi Eliezer raises him up. In this story, mental distress has no simple explanation or reward. However, we can “raise” each other up through offering our company and physical presence.

We do not need to be trained as spiritual caregivers to offer companionship to those who suffer. We affirm the value and worth of members of our communities living with mental illness through greeting people warmly, staying in touch, and showing up at home or hospital when needed, and, perhaps most critically, noticing when someone has disappeared from community and reaching out.

None of us chooses to suffer, but most of us will experience some mental health challenges in our life or be touched by someone impacted by severe mental illness. This suffering is a part of human life. If we ignore mental anguish, we are denying one of the most basic things that make us human beings and spiritual beings. This is what is meant by the Chasidic saying: “There is nothing as whole as a broken heart.” Spiritual wisdom includes an embrace of both brokenness and wholeness.

May the One who blessed our ancestors bless all who live with mental illness, our caregivers, families, and friends; May we walk in the footsteps of Jacob, King Saul, Miriam, Hannah, and Naomi, who struggled with dark moods, hopelessness, isolation, and terrors, but survived and led our people. Just as our father, Jacob, spent the night wrestling with an angel and prevailed, may all who live with mental illness be granted the endurance to wrestle with pain and prevail night upon night. Grace us with the faith to know that though, like Jacob, we may be wounded, shaped, and renamed by this struggle, still we will live on to continue an ever-unfolding, unpredictable path toward healing. May we not be alone on this path, but accompanied by our families, friends, caregivers, ancestors and the divine presence. Surround us with lovingkindness, grace, and companionship and spread over us a sukkat shalom, a shelter of peace and wholeness. And let us say: Amen.

The Spirituality of Madness

Elliot Kukla

Faith and Practice