As the sun goes down tomorrow, the Jewish holiday of Passover begins, and it begins with a story. The story of the exodus of the Israelites from the land Egypt. From slavery to freedom.
Essential to Passover is the retelling of the story of the exodus as if it we, too, were slaves in the land of Egypt. We are instructed to make this epic drama of a people long ago our own. As I reflect on this past week, I find the story of the exodus embedded in unexpected conversations throughout. I am reminded of the universal yearning for self-determination. I am also saddened by the cascade of costs, including the mental health costs, that are exacted when voice and agency are thwarted in the absence of freedom.
1. Zoom call on Monday. Because that is how we connect these days. I spoke to someone recently released from prison where he did time as a result of substance use. In the United States, more individuals with serious mental illness and substance use disorders are incarcerated in jails and prisons than hospitalized for care in psychiatric hospitals. Serious mental illness is intrinsically challenging. It makes having voice and agency challenging. It is a tragic societal blunder to attempt to address the problem by restricting freedom rather than providing effective care and treatment.
2. Taxi Ride on Tuesday. I had a conversation with the driver who shared with me his exodus from Albania when he was a young man. Having been granted political asylum in the United States decades ago, he has raised his family here. Just recently he saw a film about the war that he lived through. It has triggered nightmares and flashbacks that had been dormant for decades. He says it is a small price to pay for the freedom he knows today.
3. Trauma on Wednesday. A young entrepreneur is building an App to provide guidance and support to people who have developed mental illness as a result of traumatic events. She knows what this means, having lived through a political ambush in a place far from home. She thought she would never see loved ones again, but somehow when the shooting stopped she was still alive. Tormented and traumatized, she had survived but the mental health implications were debilitating, and she became a shadow of herself until she got help.
4. No Food or Water for Voters on Thursday. Georgia’s governor signed a bill that outlaws the provision of food or water to people waiting in line to vote. This is just one of over a hundred bills introduced in twenty-eight states designed to restrict voting access. As the U.S. reckons with its own history of slavery, these laws suppressing the right to vote have real meaning. The cost of slavery and racism is manifested in profound health and mental health inequalities to this day. It’s not just about food and water. It’s the canary in the coal mine.
5. Experts by Experience on Friday. I gave a lecture for our Priorities in Global Mental Health course today focused on the peer movement and recovery in mental health. The peer movement returns voice and agency to people who have historically been stripped of their rights. Slaves have no rights and no voice. People with mental ill health are frequently silenced by prejudice and discrimination as well. Some are silenced by the mental disorder itself. In some parts of the world, external limits are imposed on people’s freedoms, including making it illegal for people with mental illness to vote or marry.
The Passover Seder is the quintessential journey of becoming free human beings. We pursue freedom the way sunflowers follow the light of day. With that freedom comes agency, self-determination, health and mental health. But, let us not forget, as my late father-in-law recalled each year, freedom is more fragile than we like to think. Eternal vigilance is its guardian.