Wednesday, October 24, 2012

Gerald Wiviott's Yom Kippur Speech

From Yom Kippur to Ecclesiastes: Models of Change in the Bible
 By Gerald Wiviott MD
A few years ago I was asked to lead a psychotherapy seminar for psychiatry residents in the diploma course at McGill. The seminar had previously been led by a psychoanalyst and the focus had been on aspects of analytic theory and technique. I felt that psychiatry was changing; no longer was the analytic model the major influence on our profession…we were entering the world of science where psychopharmacology was changing our treatment strategies, and brain chemistry was the paradigm that offered the most promise in explaining the causes of mental illness and the emergence of symptoms. The talking therapies were also evolving to make them more efficient, more effective, and more appropriate for a wider range of patients than costly and time consuming psychoanalysis. So the focus of my seminar became “What is the mutability factor in various forms of psychotherapy?” Experts in various therapies were invited to present to the residents and to try to spell out what they thought were the ingredients in their brand of therapy that led to change.
The analysts said “insight”.  The existentialists listed “authenticity”, Self-psychologists talked about empathy, and systems therapists spoke about “strategies.” Of course in one way or another, they all added that the relationship with the therapist is important. No one mentioned “inspiration” and I found that surprising. I think that we were all afraid of giving ourselves too much importance, as if enthusiasm or modeling were dirty words.

I was thinking about these ideas when I was asked to give this Yom Kippur afternoon talk on the subject of “change.”  First of all, let’s limit the discussion to changes that people make in their lives. I don’t want to talk about contingencies (changes like an earthquake or politic upheaval or cycling accidents) that require adaptation and resilience. That is another kind of change. I want to address intentional changes, the kind that lead to attitude modification, behaviour shifts, life altering decisions, and relationship transformations. This is the message of Yom Kippur: we have a final day to influence God’s decision about our destiny during the coming year. Since Rosh Ha Shanna, we have been aware that our fates are being inscribed and the books will be sealed on this day. And the service has been designed as if it were a kind of therapy to motivate us to make the necessary changes so that the coming year will not see us punished by a judgemental God.
For the next 30 minutes or so, I want to talk about the elements that contribute to change, or rather, how people come to realize that they want or need to change, and what allows them to successfully make and maintain the necessary steps. We’re talking about “therapy” but in the broadest terms. Like Jerome Frank in his seminal work, “Persuasion and Healing” first published in 1967, I also want to look for common elements that lead to change. Frank wrote specifically about conventions that are found in every culture and in every historical period designed to help the “demoralized” regain their zest for life. Whether it is the shamans of Africa or the Priests in the Temples of Asclepius in ancient Greece, or analysts’ offices in Manhattan, there are similar elements in each setting: 1) there is a designated healer, 2) there is a specific venue where healing occurs, 3) there is a prescribed ritual or method of accomplishing the healing, and 4) both the healer and the sufferer accept the validity of the method.
I would like to be little more specific in this talk.  I’m going to suggest a number of ways in which we could categorize the catalysts, or the mutability factors, for change: 1) Inspiration: (Having an example, or wanting to be a participant) 2) Motivation: (fear of consequences, health, happiness, 3) Provocation: (being challenged or dared) 4) Support: (the necessary accompaniment to lasting change.
So what is the mutative ingredient of Yom Kippur? In a word, it’s Freudian. It’s no coincidence that Freud died on Yom Kippur, 1939. His work is a testament to guilt, shame, and conflict. According to him all our problems, the stuff that motivates us to seek help, can be attributed to our dark side. It’s as if he took “original sin” to a new level, took it out of the hands of priests and put it front and center into the hands of psychotherapists. During the golden period of Freudian theory, almost every leader in the field of psychiatry was an analyst and most residents in psychiatry were obligated or encouraged to undergo their own personal analysis. If they were unable or unwilling to acknowledge the illicit behaviors, the unacceptable thoughts, the selfishness, the jealousies, and the lingering feelings of shame from previous events, the analyst was only too quick to point out the defensive maneuvers that kept such ideas unconscious. Yes, everyone had something that lurked in the psyche, something that bubbled up to the surface to cause anxiety or depression or fear of success, and it was the job of the analyst to uncover those hidden sources of anguish. It wasn’t so much confession; confession is easy because it relies on conscious awareness. No, Freud went one better. He would get people to become conscious of dark secrets that they weren’t even aware of; it was a kind of suggested confession and it was called “insight”. But the mutative agent was not much different from what we are experiencing today in our service. Together we have read, and will read, whole lists of behaviours and thoughts about which we should feel guilty. I imagine the Viddui and Ashamnu are still reverberating in your minds as you listen to me.  Unless we take responsibility for having engaged in those deeds or harboring such thoughts, and vow to repent, we will feel the punishing hand of God writing our names in the ledger that could condemn us during the next year. If the less-than-noble parts of ourselves didn’t cause symptoms before today, recognizing the consequences of harboring such parts without confessing and repenting is enough to evoke terror. The stakes are high…”Who shall live and who shall die.”
Freud never pretended to have control over life and death, but one of his analysands, Joseph Wortis, a New York psychiatrist who was analyzed by Freud, wrote about his experience on that famous Oriental rug covered couch: “There was the unpleasant prospect of developing what Freud called resistance, against him, my present lord and master; who sat in quiet judgement while I talked, like a stern Old Testament Jehovah, and who seemed to take no special pains to act with hospitality or reassurance…” Freud strongly believed that his theories of the mind were absolutely valid and that therefore his treatment offered the only cure for psychological maladies because only by uncovering the underlying (often unconscious) forces of unacceptable wishes, ideas, and feelings, could people be cured of their misery. And many were. The threat contingent upon not doing something, either repenting on Yom Kippur or developing insight in analysis is a powerful motivator for change and if the motive is strong enough, change is possible. Today, to be “in the good book” we need to stop coveting, refrain from gossiping, renounce lying, and attempt to fulfill God’s expectations for us. In a remarkably parallel way, under Freud’s guidance, we will finally be rid of our anxieties and personality quirks that contribute to life’s miseries if we become aware of previously unknown forbidden sexual desires, hidden hostile thoughts, and unacknowledged guilt connected to unsavory deeds.
Jay Haley, a well-known psychotherapist once remarked that if people want to change, they are not in therapy. Sounds strange until you think about it…the assumption is that anyone can change if they want to; ergo if someone seeks therapy (implying they can’t change on their own) it’s because obstacles to change are getting in the way, or, they are actually fooling themselves when they think they want to change. In fact, the rewards of not changing may be too great (the successful conman) or the fear of what change might bring inhibits the motivation to make the desired changes. Here’s where analysis and Yom Kippur differ: analysis tries to remove the stumbling blocks by interpreting the so-called resistances that impede change, while the stakes are so high during the High Holiday season that resistances sufficiently shaken can be overcome.
Times, they are a changin’.  No longer is psychoanalysis the holy grail of therapies…most of this congregation knows that (half of the congregation are either therapists or in therapy or have been in therapy or think they should be), and also most of this congregation is not likely to take literally the threat that if we don’t repent on Yom Kippur our fate is sealed. All the repetition of sins, all the chest beating as we utter or shortcomings, and all the tales of Jewish martyrs will not be enough to motivate us to make fundamental changes in the way we live our lives. Even most analysts no longer take literally the existence of unconscious dark forces that manipulate and coerce us into misery and dysfunction. The days of reifying Freud’s template are over.
But other therapies have made use of the fear factor to promote change. Irving Yalom, the well-known writer and therapist speaks of “existential shock therapy” to shake up his patients in order to catalyze change. He tells his/her patient to draw a line on a piece of paper with one end representing the moment of his/her birth and the other the moment of death. Then he tells the patient to place a mark on the line to indicate where he/she feels they are at that moment. It is a sudden confrontation with mortality, a realization often avoided by people. Of course, as we think about the Yom Kippur service we see that death images abound and we are constantly reminded of our mortality. Like Freud, Yalom too was influenced by the High Holiday rituals though he is in avowed atheist, but that is the subject of another talk.
I’m going to suggest other parallels to examine the religion/therapy models of change. The first is the role of inspiration, specifically the power of an inspiring person. Mordecai Kaplan has inspired many of us to return to our Jewish roots and to feel comfortable with our traditions and religious practices even as he was labeled “heretic” by the orthodox community. And Rabbis, not resorting to charisma, can by their example of compassion, dedication, creative leadership, and “menchlikeit” inspire congregants to transform their lives. 
For better or worse, there is also the attraction of charisma. The Chabad movement, as an example, has its spiritual leader, The Rebbi, Menachem Schneerson, who even after his death continues to inspire his supporters and disciples who are making Chabad the fastest growing denomination in Western Judaism. Here in Montreal, Chabad now has houses in every part of the city. In addition to free membership, the Lubavitch movement attracts people by its mystical and idealistic message, but Schneerson’s charismatic leadership is responsible for recruiting followers who have changed their beliefs, attitudes, and behaviors in accordance with the Rebbi’s message.
 A novel  experience can also be inspirational. Last year, my son, Matt, went to Burning Man, a weeklong event where 50,000 people come together and create a temporary village on a plot of Nevada desert. People create huge art projects, and wooden effigies are burned at the end of the week, a celebration of temporality or the ephemeral nature of life. An article that Matt sent to me touches on the power of an event to lead to fundamental personal changes: “Properly executed, a Burning Man experience can shift the paradigm of what is important, even what makes a meaningful life. It will bring into sharp focus just how myopic we can be with our judgement of others, and it can profoundly alter one’s perspective of humanity’s potential.” If we want to change, the challenge then becomes to indulge our curiosity and generate the courage to engage in new experiences.
Likewise in therapy, we have seen the explosion of self-help books, where the appeal rests mostly on the inspiring story of the author rather than the instruction or suggestions contained in the book. Another growth industry is the Life Coach. Again it’s the power to inspire change rather than specific techniques or a novel approach that makes a successful coach. I admire inspiring coaches. I wish I were one. I can look back and appreciate my good fortune in having had excellent coaches at various times in my life. Yes, they were knowledgeable; yes, they had experience; and yes, they taught technique. But what set them apart was their capacity to inspire confidence that change was possible. They did that by conveying a sense of caring, a sense of understanding who I was, and an enthusiastic optimism that I could make the necessary changes to achieve my goals…not their goals. That was the kind of inspiration that motivates change. I’m going to come back to that point later.

So far, I’ve looked at two examples of change producing events. The first was the scare/confession model and the second is the “inspiration” paradigm. The first is exemplified both by Yom Kippur’s explicit message of sin and punishment, and by psychoanalysis’s more subtle suggestion that it’s our underground reservoirs of guilt and shame that keep us miserably trapped in repetitious patterns of frustration and failure. And the second example is inspiration possibly by the energy, optimism, and image of a successful coach. For sure there are dangers. We must guard against the possibility of being seduced and manipulated by the appeal of charisma.  Furthermore, when the conditions for change are entirely dependent on the continued cheer-leading of the coach, then no genuine and enduring change is possible. But coaching does work and charismatic leaders have created flocks of devoted followers who are grateful to be part of the group.

A few weeks ago, I had a lovely conversation with Ron while enjoying a cappuccino as we sat on a Monkland Ave. terrace. Of course the topic turned to books and Ron mentioned “Subversive Sequals” by Judy Kinstler. The book suggests that two stories from the bible may deal with similar themes, but that one will contradict or subvert the apparent meaning of the first. Without going into detail I’ll point out as examples: comparing the Jonah story which we will read this afternoon with the Noah story. While Noah meekly, passively did as a punitive God instructed him, Jonah (also underwater) displayed some degree of autonomy, but, more importantly, in the Jonah story, God displayed the capacity for compassion toward humanity. And the citizens of Nineveh, after being given sufficient warning were able to change their ways. I’m not doing the subtlety of her thesis justice, and I’m certainly not properly recognizing her scholarship, but I want to convey that I found her ideas sufficiently interesting that I was motivated to see if in the Bible I could find something subversive about Yom Kippur. After all, not everyone in our Congregation takes Scripture literally; we may not respond to the threat of a sealed fate with the same rush to repent that might have been the norm generations ago. Does that mean we’re not spiritual or religious or capable of teshuvah? Of course not. As much as we might revere Abraham as the father of monotheism, I don’t think most of us would follow his unquestioning obedience to a God who instructs him to sacrifice his son. Perhaps it’s more accurate to say that we are too rational than to say that we are cynical. Maybe we are a bit too stubborn to suspend disbelief, but the awesome “quaking in our boots” that might have previously accompanied today’s recital of guilt and punishment doesn’t seem to arouse such terror or to provoke a passionate desire to repent.
For better or worse modernity has broken free of the linear, the rational, and the logical. While we still appreciate Mozart and Beethoven, it was Stravinsky who shook up the musical and esthetic world with Le Sacre Du Printemp. It was Picasso who taught us a new way of seeing things with his distorted figures, and Einstein and Heisenberg showed us that reality is not what our everyday experience leads us to believe. All this to say that change also may come about in novel, unexpected, and counterintuitive ways. And one of those ways is paradox.
An example: I saw a young man who was hospitalized following a motorcycle accident. He suffered a broken femur and a broken wrist. I was asked to see him because he was refusing to engage in physiotherapy claiming that he was too weak and the pain was too great. The staff felt that there were psychological reasons for his refusal to “follow the recommendations of the professionals.” He told me that the worst part of his injuries was the right wrist fracture because it meant that he would not be able to draw a gun out of his holster and since he had always dreamed of becoming a policeman, he now must give up the dream. After listening intently, I told him that I was going to ask the nurse to bring him a wheelchair so that he could start practicing using it. I added that I understood that the pain must be too great plus the disappointment about giving up his dream and that I could understand perfectly why he would never put in the effort to walk again. And as I started to leave, he shouted after me not to bring in the wheelchair. I told him that I knew he was proud, but that it was clear to me that he shouldn’t try too hard. And I asked for a chair to be brought in.
Two days later, when I went on the ward, his nurse and the physiotherapist both said that right after my previous visit, he was eager to go down to the rehab room and get on the parallel bars. Of course I was pleased and went back to see the patient who again was lying in his bed. When he saw me, a sly smile crossed his face and he said, “Doc, I know what you were trying to do. You wanted to make me angry so I would do the treatment, but I saw through it.”  And I replied, “I guess it didn’t work.” We both laughed, shook hands and I wished him well.
Those of you familiar with the work of Victor Fraenkel will see the similarity between the paradoxical approach I used in the above case and his brand which he called “logotherapy”. Basically he pointed out that sometimes the more we try to do something, the more we focus on getting it right, the more often we screw it up. He used the example of a man who came to him because his job demanded that he give public speeches, but every time he had to give a speech, he sweated so profusely that he became terrified of getting up in front of a crowd. “How many handkerchiefs do you typically use to dry yourself?” asked Fraenkel.  “I just take one” said the gentleman. “Next time,” said Fraenkel, “take three and saturate all three.” Of course at the next therapy meeting which took place after a couple of speeches, the man announced that it didn’t work…he could not saturate even one handkerchief!
At this point I want to take a bit of a break and get personal in order to highlight an example of change. I have had the good fortune to participate in fund raising bicycle ride called the 401 bike challenge. Monies raised go to support the Sara Cook Ward of the Montreal Children’s Hospital, a unit that treats kids who are battling cancer. The 401 bike challenge is a two and a half day ride from Toronto to Montreal. It is challenging. Last fall, one of the fellows with whom I occasionally rode on weekends, Mark, told me that he was going to do the 401 ride this year. When he told me that, he weighed about 280 pounds, and he would get tired after a slow 50 kilometers ride. The second day of the 401 covers 260k from Belleville to Cornwall. I heard from another friend that Mark told him that if I could do the ride, he could do it. For better or worse, I guess he felt inspired.
A video company decided to make a video about Mark’s training and determination, a kind of inspirational video. I was interviewed for the video and they asked what I thought about Mark’s chances of completing the ride.  I have to admit that I had serious doubts about his fitness and even his judgement, and I expressed them on camera. But over the course of the winter I would get reports about Mark’s progress…he was seeing a nutritionist, he lost over 50 lbs, and he was training three and four times a week. By the time the ride started, he had lost over75 lbs and had completed several difficult bike trips in preparation for the Challenge. He successfully completed the Challenge which was especially remarkable this year because the rain and headwinds which confronted us on that second day made it even more arduous. When we reached the end of the ride at the Children’s Hospital, a very tired Mark managed to say to me with a sneer, “I wanted you to eat your words”
There is something common in all three examples, the boy who had the accident, the man who sweated too much, and the story about Mark. In each case there was a dare, a challenge to go beyond what someone else thought possible for them. Motivation was aroused as a response, not to encouragement, but to scepticism. It gave rise to an “I’ll show you” attitude. It doesn’t always work, but when used appropriately, it can be a very effective change agent. Part of its power rests on respecting the individual’s pride and, yes, stubbornness. Many of us, despite our overt request, do not want to be told what to do. Heavy handed messages of “you should do this” either appear like common sense or the person has been given the same advice countless times already and it hasn’t worked. 
And that takes us to the subversive sequel to the Yom Kippur service. I’m talking about Ecclesiastes. Probably written somewhere between the 4th and 2nd Century BCE, it was hailed by Thomas Wolfe as the “greatest single piece of writing that I have ever known, and the wisdom expressed in it the most lasting and profound.” Known for phrases like “Vanity of vanities, all is vanity” and “The sun also rises, and the sun goes down…there is nothing new under the sun” and finally the Pete Seeger song “Turn, Turn, Turn” “For everything there is a season, and a time for every purpose under heaven.” Its existential weariness has a contemporary ring to it. It makes me think of Samual Beckett’s novel “Malone” or his play “Krapp’s Last Tape” or Camus’s “Myth of Sisyphus” which proclaims that the only important philosophical question worth asking is whether to kill oneself. If everything is as meaningless, empty, futile, fleeting, or absurd (depending on the translation of the word “hebel”) then what difference does it make to struggle through a life without meaning? Over and over again Koholeth, the preacher, acknowledges that we all die, rich and poor, the wise and the fool, honest and unscrupulous, human and animal, and, on top of that, knowledge is not going to make us happy; “He who increaseth knowledge, increaseth sorrow.”
The second theme, almost like an antidote to meaninglessness, is the injunction to enjoy life. “There is nothing better for a man than that he should eat and drink, and make his soul enjoy the good in his labor.” “Then I commanded mirth, because a man has no better thing under the sun, than to eat, and to drink, and to be joyful…” “Go your way – eat your bread with joy, and drink your wine with a merry heart..Live joyfully with your wife whom you love all the days of your life of vanity…”
Imagine a therapist working with a client who seeks help because of depression, the all-to-common depression that accompanies a sense of meaninglessness, ennui, or emptiness. One approach, quite literal, would be to refute the idea that life is meaningless and to suggest that depression predisposes one to see it that way, but, really, life has a purpose, and in therapy we will find the purpose. A second therapist might suggest ways that the patient could find meaning, perhaps volunteering or learning a new skill. A third therapist, paradoxically disposed, will agree wholeheartedly that life is meaningless; so one might as well enjoy it. Why might that be more effective? Because it avoids the inevitable fight about world views, it prevents the therapy from becoming a fight about life itself, and it fosters a relationship with the therapist.
Let me offer an example of therapy based on this principle: I saw a family in which the 25 year old son was talking about being suicidal.  Mother and father were beside themselves with worry, mother even crying while her son, in my office, casually said that life held no interest for him and suicide was an option. When I heard that, I went to my bookshelf, pulled out “The Myth of Sisyphus” and read the first page where Camus speaks of the importance of facing the possibility of suicide. I complimented the young man on his courage to face such a difficult decision. Of course, Mom and Dad were appalled that I didn’t take another tack and dissuade their son from even thinking such thoughts, but their son brightened up, and, for the first time in a long time, told his parents not to worry. The next time I saw him, he was sitting in the audience as I gave a lecture to medical students.
But Ecclesiastes goes further than merely postulating that everything dies in the end so you might as well seek pleasure. In keeping with my attempt to posit a message subversive to the Yom Kippur Service, and to show the paradoxical therapeutic intent of the writing, I have to bring God into focus. At the beginning of this talk, I spoke of the heavy handed message of the Yom Kippur God, the God who reminds us repetitively of our guilt, His power to determine our fate, and the urgency of repentance. Ecclesiastes brings the same message, but oh so different. After hitting us over the head with the ultimate futility of striving, of competing, of gaining wisdom, of confronting evil, of attempting to control our destiny, we come to the last paragraph: “This is the end of the matter. All has been heard. Fear God, and keep his commandments; for this is the whole duty of man. For God will bring every work into judgement, with every hidden thing, whether it is good, or whether it is evil.”
Like a hypnotic suggestion after being lulled into a state of comfort with pleasure seeking as an antidote to ultimate vanity or futility, we are gently told to “Fear God and keep his commandments.” There is no reflexive opposition, no need to dredge up sources of guilt, no life or death consequences to overwhelm us. Just a statement of what’s important in a world of unimportance. The message from Koholeth lets God’s words resonate, for some people, more profoundly than the words spoken by God Himself. God’s message updated, ironically, by the “carpe diem” of Nietzsche.
I want to go back to my riding companion Mark for the final word on the question of change. At the end of the 401 bike challenge, while we were at the finishing line in the park next to the Children’s Hospital, the video crew that filmed Mark’s training and participation on the ride asked him for a few words now that he had reached his goal. He said, “If you believe in yourself, you can do it.”
Whether the catalyst for the changes you want to make comes from inspiration, or from motivation to achieve a goal, or the result of feeling challenged to go beyond yourself, I hope, today, Dorshei Emet has provided a place for you to start the process.
And here I’m going to quote from an email I received from a friend, Beth Stutman (another 401 rider): “What I need to say about change is that”, referring to Mark’s end-of-ride comments, “if you don’t believe enough in yourself (faith) then find someone who does to help you!...A coach, a therapist, a friend, a teacher, a support group…whatever it takes –find someone, some place, to help support that desire to change.”
Whether the catalyst for the changes you want to make comes from inspiration, or from motivation to achieve a goal, or the result of feeling challenged to go beyond yourself, I hope, today, Dorshei Emet has provided a place for you to start the process.

I believe that is why we are here today, to find in this community, sufficiently likeminded folk gathered together, people who share our view (a la Jerome Frank) of which rituals facilitate change, and who by their participation give us the support we need to make the changes that will enrich our lives. For sure, if those aims are realized, we have heard the call of the shofar and we have entered the holy space of Yom Kippur.

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