Two parables and a line from a song illuminate a path away from conventional psychiatry. A parable came from a man named Chacku Mathai. The lyrics to the song were spoken by a neuroscientist, a Nestler colleague at Mount Sinai and director of research at the US Department of Veterans Affairs. The other parable served as a statement of principle for a psychiatrist who had turned away from a traditional and esteemed career:
Once upon a time there was a prince gone mad. He thought he was a turkey. He took off his clothes and slid under a table and refused to eat anything other than to peck at bones and pieces of bread, which were left for him on the floor. The king and queen were distraught. They called the royal doctors, but one after another failed to cure. The prince remained a turkey, naked and pecking.
Then a sage arrived to offer his services. He undressed and sat down under the table, munching.
“Who are you?” asked the prince. “What are you doing here?”
“And you?” asked the sage. ” What are you do here?” “I’m a turkey,” said the prince.
“I too am a turkey,” said the sage.
They thus spent time together, getting to know each other, until the day when the sage asked the king’s servants to bring him some shirts. “Is there a reason a turkey can’t wear a shirt?” the sage asked the prince. Everyone puts on a garment. The sage motioned for the servants to have pants on and asked, “Is there any reason why a turkey can’t wear pants?” The same happened with socks and shoes, and soon they were both completely dressed.
Then the sage asked for regular food and when it was brought asked the prince, “Is there any reason a turkey can’t eat good food?” I think we can eat whatever we want and still be a turkey.
They feasted together, and some time later the sage asked, “Is there any reason a turkey has to sit under the table?” Of course, a turkey can sit at the table, with its place well set up.
And in this way, the prince was completely healed.
Pesach Lichtenberg, who found professional wisdom in this rabbinic tale, had grown up and gone to medical school in Brooklyn and the Bronx, then moved to Israel and completed his training as a psychiatrist in the early 1990s. had been swept away by the psychopharmacology of the time, and once, while walking around a senior colleague, he had listened to a patient speak, he told me, “about God and demons and the messiah and and so on. I was fascinated. I’ve always had the problem of being intrigued. I lost myself in his descriptions. But as we walked away from that person, the senior psychiatrist said, “That’s not him.” It’s his dopamine talking. It struck me as such a wonderful idea. Lichtenberg laughs almost bitterly behind his little goatee. “Today, I am ashamed to be able to think like this.”
Lichtenberg was ironic and thin; it wasn’t hard to imagine him hunkering down under a table with a patient. But for the majority of his career, that’s not what he did at all. He chaired a psychiatric ward in a Jerusalem hospital. We visited his former workplace not long ago. The hospital first approved and then denied his request to show me around the ward, but we descended inside the building to a semi-subterranean level, where we walked down a series of long, completely undecorated corridors. that led to the locked doors. As he chatted with the current manager, I looked out a window at the bunker-like area where patients received their time out. Two men occupied a pair of concrete benches. One was sitting hunched and numb, the other lying on the concrete in a fetal position.
For more than twenty-five years, Lichtenberg kept men like these soaked in drugs. “Half the dose was for calming the patient,” he said, “and the rest was for alleviating staff anxiety.” But even so, the staff felt his dosage was insufficient. “I later found out that the legendary head nurse of the ward, an Auschwitz survivor, thought I was being too nice and would take matters into his own hands. He would complete. The head nurse of the entire hospital m finally made it clear: he’s giving you injections in your back, because you don’t know how to treat your own patients.
As Lichtenberg grew completely disillusioned, in the mid-2000s a new patient was brought into the ward in a state of acute psychosis. Avremi – Abraham in English – was in his twenties, an avid student of kabala, an ancient form of Jewish mysticism. Weeks earlier, Avremi had purchased the thirty-seven fruits that symbolize the four worlds of kabala, resulting in the seven most divine pure fruits. Building a meal around these, he celebrated a holy feast with Kabbalistic friends, and that night and over the next few days he began to feel, he recalled when I met him, ” that my legs were a little less on the ground. Everything was in God’s hands except belief. And maybe even belief. Only one rope held me to the ground. And then that rope was cut. Everything was God; it was as if I was entering a calm light.
His new wife, Yisca, the daughter of Yemeni immigrants to Israel, was not happy. She and her family were at least as devout as Avremi, but it was scary. “Things started going more and more,” he said. He had meetings with a Bible prophet and with Nebuchadnezzar, the Babylonian king who destroyed Solomon’s temple in the sixth century BCE. He consulted a revered living rabbi, asking him if, as he suspected, he had been chosen for a pre-messianic purpose. . “The rabbi closed his eyes; he was thinking. And then he told me that was not the case. I was very disappointed; I had felt that I was on top of the world; but I accepted what he said at that time. Avremi reflected, however, on what another rabbi had taught him, “if a person, a single person, wanna the messiah to come, he will come. So I thought, maybe I don’t want more than anyone else on the planet, but I want to want this way, and I will pray from this position – like from a heart sanctuary – the position to want to want.
He told his wife that he was going to the old city of Jerusalem, to the hotel, the two-thousand-year-old wall that touches the remains of the second Jewish temple, built by the descendants of Solomon. Because of this proximity, the wall is the most sacred place of prayer in all of Judaism. Avremi left, dressed in white. He also wore a flowing white tunic. It was up to the messiah to wear it when he appeared.
Avremi prayed in front of the rough limestone block wall. It was a clear, warm day, and the square in front of the hotel was filled with ultra-Orthodox worshipers of all kinds in their long black or embroidered coats, the socks that distinguish their sects, their fedoras and fur hats, alongside non-Orthodox visitors yet moved to press their lips to the stone and to write prayer words on slips of paper and slip the folded scraps into the cracks and crevices of the wall. Avremi prayed and prayed. He joined a group of Orthodox children and prayed with them, as the children’s prayers would help him in his mission. The messiah did not materialize. He thought of the determination of Joshua, the biblical warrior, as he led the Israelites in their attempt to conquer the promised land, and he lowered himself to the stone floor at the foot of the wall. He wouldn’t give up. With his white prayer shawl draped over his head, he swayed back and forth to the rhythm of his incantations, a white mound of extraordinary devotion even by the standards of the ardent believers around him. He sat over and over, prayed over and over, hour after hour after hour, and then – he vaguely knew what was happening – he was carried away in an ambulance.
He was placed in an isolation room, diagnosed as psychotic and possibly suffering from catatonia, a disorder marked by the stupor and immobility that can accompany schizophrenia. He was about to be treated with an antipsychotic and a benzodiazepine. By then it was morning and Lichtenberg had arrived at work. He brought Averemi to a meeting of staff and psychiatrists-in-training. “I felt like a mouse,” Avremi said. “Or a rabbit. Or a rat. To like, Let’s see this psychotic person, let’s see his illness. But at the same time, I felt that one of them had a beautiful voice, that he had empathy, that he honored me. I felt, because of this, that my eyes were starting to get a little watery. Before that I was in so much stress and euphoria, both, I felt nothing, I was numb, I thought I would give my life if necessary to bring the messiah. But the empathy in his voice made me start feeling my feelings.
Lichtenberg, a religious skeptic who had been raised in one of Brooklyn’s Orthodox communities, arranged for a rabbi from Avremi’s family to come into the room. The rabbi conducted a ritual releasing Avremi from his vow to bring the messiah, and Lichtenberg participated, a kind of dramatization of the parable of the prince turkey. He sent Averemi home without pills, without a prescription, without even recommending that he consider taking medication.
A decade later, Avremi reappeared in Lichtenberg’s life. He was studying to become a psychologist. In the same hospital and ward where they had first met, Avremi began working with patients under Licthenberg’s supervision, then helping Lichtenberg plan and eventually open a set of homes – known under the name Soteria Houses – with a transformative approach to treating those whom mainstream psychiatry calls psychotics, those living in alternate realities.
The Soteria Houses of Lichtenberg, which have won the support of the Israeli government and the country’s public insurance system, are magical places. The main philosophy of the treatment can be summed up in two words, “being with”, and is carried out, above all, by melavim, companions – full-time paid interns whose mission of betterment is simply to be engaged, empathetic, deeply curious and convinced, to leave residents, who stay for up to 12 weeks, feeling less alienated, less alone in their subjective world. Clinicians play a secondary role; Also secondary are medications, which are generally avoided unless residents are already arriving on medication.
In 2016, Avremi became the first director of one of the houses, a hiking house just outside Jerusalem’s Old City. Today, he is approaching a doctorate. in psychology, publishing articles and conducting the first study comparing the effectiveness of Soteria care to that of traditional treatments – mainly medical – in psychiatric hospital wards.
Since The Spirit and the Moon: My Brother’s Story, the Science of Our Brains, and the Search for Our Psyches, by Daniel Bergner. Copyright © 2022 by Daniel Bergner. Reprinted courtesy of Ecco, an imprint of HarperCollins Publishers.