MATTERS OF THE MIND: WHAT EVERYONE NEEDS TO KNOW ABOUT MENTAL ILLNESS

• Common Myths Regarding Mental Illness• Types Of Mental Disorders• Physiological Causes• Stigmatization • What To Say/Not To Say• Suicide Intervention

ברכות•תפילה•תפילין•שבת•כשרות •טבילת כלים•טהרת המשפחה•רפואה•אבילות•נישואין•חינוך•חושן משפט••Mental illness??

Deborah, 16, suffers from a mood disorder and an anxietydisorder for which she has been seeking treatment for severalyears. She finds great relief in being able to distract herselffrom episodes of anxiety by using her smartphone as adistraction. As a result, she finds Shabbos to be a particularlychallenging time to be able to successfully manage heremotions. May Deborah use her smartphone on Shabbos as adistraction from her anxieties?

Elizabeth, 38, has struggled for many years with aneating disorder. After years of treatment, she hassuccessfully refrained from restricted eating for closeto one year. Her therapists warn that fasting, even forone day, could potentially trigger a relapse. Whatshould she do on Yom Kippur?

Paul, 52, likely suffers from bipolar disorder, although he hasnever been formally diagnosed, as he refuses to seek counselingor treatment. As a result, the members of his family tirelesslystruggle to maintain peace and stability within their home. Paul’soldest daughter, Jennifer, recently got married and her newhusband has been encouraging her to distance herself from herfather. He insists that her father’s controlling personality isstifling her and prevents her from achieving personal happinessand stability in her other relationships. She has come to acceptthat ending all communication with her father would be in herbest interest and inquires if this is indeed permissible.

Esther, 15, suffers from anorexia and iscurrently undergoing inpatienttreatment. In an effort to optimizetreatment, all meals are prepared onsite by the trained staff and no outsidefood may be brought into the facility.May Esther eat non-kosher food as partof her treatment? If she refuses to eatnon-kosher food, may her family lie toher and tell her that the food is kosher?(May other members of her family eatthe food?)

Adam, 16, suffers from bipolar disorder andhas been placed in a treatment facility inUtah. Direct contact with family is limitedto highly supervised, specially structuredvisiting days which take place approximatelyevery 6 weeks. Visiting day has beenscheduled for Friday and Saturday. MayAdam and his parents join the rest of thegroup and participate in the activities whichwould certainly interfere with their ability toproperly observe Shabbos?

Josh, 13, has recently become a bar mitzvah and has begunwearing tefillin for the first time. He suffers from severe OCDand an acute anxiety disorder, due to which he finds itexceedingly distressing to come in direct contact withleather. The experience of wearing tefillin triggers anavalanche of emotions that bring him to the verge of tears,and sometimes beyond. Should he be required/encouragedto wear tefillin?

Steven, 45, is a recovering alcoholic and has not had analcoholic drink for over one year. May/should themembers of his family refrain from drinking wine atthe Pesach seder, in an effort to protect Steven frompotentially harmful exposure to alcohol?

Tammy, 38, has three children and has had two serious boutsof postpartum depression. With extensive therapy andmedication, she has successfully brought her depressionunder control, but has been advised to use contraception toavert future pregnancies. Despite the proper use of birthcontrol, she discovers that she is pregnant and is suddenlyoverwhelmed with a wave of shock, fear and extreme panic.Fearing that another pregnancy may trigger another majorbout of depression, she seeks a heter to proceed with anabortion.

Susan, 43, suffers from depression and although she hasnever attempted suicide, she occasionally experiencessuicidal ideation. The most effective calming technique thatshe has developed with the guidance of her therapist,involves writing down her thoughts as they are occurring. Ifshe has thoughts of suicide ideation on Shabbos, may shewrite down her thoughts?

DISCLAIMER

Nothing stated or implied this evening should beapplied as a .פסק Given the obviouscomplexities and nuances within ,הלכה as wellas the particular and individualized needs whenmanaging mental illness, anyone seekinghalachic guidance should seek personalcounsel.

HALACHIC CATEGORIES THAT MAY APPLY TOONE SUFFERING FROM A MENTAL DISORDER

שוטהאונסחולה שיש בו סכנהחולה שאין בו סכנהמיחוש בעלמאאיסטניס

יפולשלאכדיעשהמצותלבטלהאדםרשאי"•עלרבהוןמלבזבזהואפטורדאם.ויחלהלמשכבממונויהאולא,לחלותחייבשאינוה"ההמצוות

".מגופועליןחביב

יבטלהמיצרמןויחלץיתפראלאאםשהרי"•שיחללמוטבאמרינןג"כהוכללנצחאלהמצוות"הרבהשבתותיחללולאאחתשבת

במידמצינוממהזוסבראהוכיחס"והחת"•שבתיוםבאיזהיודעואינובמדברשמהלךאבלחייוכדיאלאמלאכהלעשותלושאסור

מתחוםיותרללכתשלאאותוהגבילולאמןלצאתשבידוכללעשותעליודהלא,שבת

לקייםכדייישובלמקוםולהגיעהמדבר"וכדיןכדתהשבתמצות

נזיר("לשמהגדולהעבירה"ל"חזאמרו"ונראה...מסוייםגדרבזהנתבררולא...):כג

אשתדיעל,אפשרדאיבמקוםזהדכללאתלהושיעעבירהמסרההקיניחבר

דאטו,אחרבעניןא"דאופשוט,ישראללמדווממנה.לגוועישראללכלתתן

הישרהוהסבראהברורהשהדעתדבמקוםואלבשבלנהוגא"דאנותנתוהפשוטהעבירהגדולה...פעולהנדרשתכ"ועתעשה"לשמה

OCD – OBSESSIVE COMPULSIVE DISORDER

Obsessions:• Recurrent, persistent thoughts, impulses or images that are experienced as

intrusive and inappropriate, causing marked anxiety or distress. They areexcessive and unreasonable, not grounded in reality, and a product ofone's own mind rather than someone else's conditioning.

Compulsions:• Repetitive behaviors that a person feels driven to perform in response to

the obsession, to resolve and quiet the worries by preventing somedreaded event or situation, but that are an unrealistic or excessiveresponse to the situation.

AND - the obsessions or compulsions cause significant distress or interfere withthe person’s normal routine, occupational (or academic) functioning, orusual social activities or relationships.

DEVOTION OR DISORDERWHAT IS THE DIFFERENCE BETWEEN OCD AND RELIGIOUS SCRUPULOSITY?

Yaakov was admired from a distance. Many boys in the yeshiva were amazed at his ability todaven such a long Shemoneh Esrei. He would spend close to an hour every Shacharis, seeminglyintensely engaged in tefilla. However, his closest friends and his Rebbe knew the truth: Instead ofdavening with kavanna, most of Yaakov’s time in Shemoneh Esrei was spent agonizing over thepossibility that he missed or mispronounced a word, compelling him to carefully repeat wordsand phrases over and over. Yaakov was not engaged in a deep mystical exercise. Rather, hewas engaged in a torturous battle with himself. He sought the advice of his Rebbe, who wouldconstantly assure him that he was worrying about nothing, but it did not make a dent in calmingYaakov’s fears. One time, after an extremely frustrating give and take over Yaakov’s endlessworries about tefilla, his Rebbe became exasperated and told him, "Yaakov, I promise that youwill not be held accountable for missing a word of prayer. I personally guarantee that I will takeyou out of Gehinnom with my own two hands. Now, stop worrying!" After that, Yaakov stillworried, but he was afraid to bring it up anymore with his Rebbe, so he suffered in silence.

“Totally Engrossed: Extreme Piousness or Obsessive Compulsive Disorder?” - Ohel

DEVOTION OR DISORDERWHAT IS THE DIFFERENCE BETWEEN OCD AND RELIGIOUS SCRUPULOSITY?

Rivka is a happily married young mother. She was always careful about halacha; her friendsused to call her "the rebbetzin." Lately, though, she has become overly concerned with kashrus.She keeps coming up with interesting but strange she’eilos that don’t seem to bother mostpeople. For example, she wonders why it is OK to use the same water pitcher for milchig andfleishig. She watches how everyone in the family touches the handles with greasy hands andthen goes on with eating and touching the food. When she brought it up to her husband, heshrugged off her concerns saying, "They don’t have separate pitchers at my Rosh Yeshiva’shouse, so why should we!" But Rivka remained uneasy. Because of this, Rivka feels obligated toclean and scrub every kitchen counter and every shelf in the refrigerator. After watching all this,her husband says, "Rivka, it’s not Pesach. You can take it easy on the cleaning." Instead ofbringing her comfort, her husband’s mention of Pesach only causes Rivka more distress giving hersomething new to worry about.

“Totally Engrossed: Extreme Piousness or Obsessive Compulsive Disorder?” - Ohel

Joseph W. Ciarrocchi, The Doubting Disease: Help for Scrupulosity andReligious Compulsions, pg. 8

A superficial view may lead an observer to conclude, as do somemental health professionals, that religion is the source of scrupulosity.After all, a scrupulous man obsesses about sinning if he feels attractedto a pretty woman only because he believes this constitutes"committing adultery in his heart." The superficial view fails todistinguish between religion causing the disorder from religion as itsbackground. Religion does not cause scrupulosity any more thanteaching someone French history causes him to believe he isNapoleon. All human beings exist in some cultural context… Culturalbackgrounds provide the scenery around which emotional problemscreate the drama…

OCD – OBSESSIVE COMPULSIVE DISORDER

Obsessions:• Recurrent, persistent thoughts, impulses or images that are experienced as intrusive and inappropriate,

causing marked anxiety or distress. They are excessive and unreasonable, not grounded in reality, and aproduct of one's own mind rather than someone else's conditioning.

Compulsions:• Repetitive behaviors that a person feels driven to perform in response to the obsession, to resolve and quiet

the worries by preventing some dreaded event or situation, but that are an unrealistic or excessive responseto the situation.

AND - the obsessions or compulsions cause significantdistress or interfere with the person’s normal routine,occupational (or academic) functioning, or usual socialactivities or relationships.

DEVOTION OR DISORDERWHAT IS THE DIFFERENCE BETWEEN OCD AND RELIGIOUS SCRUPULOSITY?

The DSM IV (Diagnostic and StatisticManual for Mental Disorders) also requiresthat the person suffering from the disorderacknowledges or recognizes at somepoint that the obsessions or compulsionsare excessive or unreasonable. In otherwords, if the person is irrationallyobsessing over some matter, but he orshe never feels any distress about it andconsiders it normal, it is not a diagnosablecase of OCD.

DEVOTION OR DISORDERWHAT IS THE DIFFERENCE BETWEEN OCD AND RELIGIOUS SCRUPULOSITY?

David Greenberg and Eliezer Witztum, Current Treatments of OCD Chapter 10, pg. 176

OCD symptoms of a religious nature are not found in all areas of ritual, nornecessarily in the areas of ritual most hallowed by the religion. In ourexperience with religious Jewish patients, for example, Sabbathobservance is a very important feature of religious life associated withmany detailed laws but does not appear frequently among the religiousobsessions of OCD in our clinic. However, cleaning the perianal regionbefore prayer gets one line in the footnote of a latterday code of Jewishlaw, but this ritual presents often in patients with OCD in our practice. Thepresentation of OCD in a religious context is less typically religious than it isclassically obsessive-compulsive…

DEVOTION OR DISORDERWHAT IS THE DIFFERENCE BETWEEN OCD AND RELIGIOUS SCRUPULOSITY?

David Greenberg and Eliezer Witztum, Current Treatments of OCD Chapter 10, pg. 180

Dr. David Greenberg’s Test:• Compulsions transcend requirements of religious law• Compulsions have a narrow focus on one area of religious experience• Compulsions focus on something that is trivial to religious practice, but

normal for OCD• Compulsions cause the patient to ignore, or to be unable to fulfill, other

areas of religious law• The patient repeats actions because of doubt, where law would not

require it.

DEVOTION OR DISORDERWHAT IS THE DIFFERENCE BETWEEN OCD AND RELIGIOUS SCRUPULOSITY?

קלד' ב ס"ת מנחת אשר ח"שו

קלד' ב ס"ת מנחת אשר ח"שו

ס' ל עמ"ר יעקב ישראל קניבסקי זצ"עצות והדרכות מכתבי הג

Rabbi Dr. Abraham Twerski,Foreword to Religious Compulsionsand Fears pg. 16

“[A]n OCD sufferer may notnecessarily be reassured by theopinion of the poskim. One womanwith OCD threw out three sets ofdishes because she could notaccept the Rav's ruling that thedishes were perfectly kosher,saying, "The Rav did not understandmy she'eilah."

קלד' ב ס"ת מנחת אשר ח"שו

רכיה -יז :משלי ג לוםיה וכל נתיבות נעם דרכי ד ש

יראה וגילו ' העבדו את -יא :תהילים ב רעדהב ב

מחה באו ל ' העבדו את -ב :תהלים ק ש רננהב פניו ב