On Halacha and Mental Health

A Conversation with Rabbi Yonatan Rosensweig

By: Ilan Preskovsky

Can a person suffering from severe depression listen to music on Shabbos? Must – or, indeed, can – someone who has been in recovery for years from an eating disorder fast on Yom Kippur? How is someone suffering with depression or a mood disorder supposed to approach the Yamim Nora’im or the three weeks leading up to Tisha b’Av?

With the exponential increase in awareness about mental health that has come about over the past few decades, these and other vital questions regarding the intersection between mental health and halacha have become increasingly prevalent and increasingly urgent. When Rabbi Yonatan Rosensweig – an established author of a number of books on Jewish law and the rabbi of the Netzach Menashe congregation in Beit Shemesh – was confronted with exactly these sorts of questions, however, he quickly discovered a severe lack in actual halachic literature that deals with such a problem, either in-print or online.

“About six years ago,” Rabbi Rosensweig explains, “some people came up to me from my congregation and asked me a few questions on mental health and halacha and I didn’t really find anything in writing. Not nothing, exactly, but close to nothing. There’s certainly plenty of things that are word of mouth but that’s obviously hard to find and corroborate.” To prove Rabbi Rosensweig’s point, if you do a quick Google search for “books on mental health and halacha”, there are indeed literally only one or two other books that come up on this vitally important subject.

Nonetheless, these questions needed answering and Rabbi Rosensweig understood that the only way he could possibly answer them, or to even properly understand them, was to consult with a mental health professional. Fortunately, he was already friends with a psychiatrist, Dr Shmuel Harris, and the two had been meeting up on a regular basis to learn together. When Rabbi Rosensweig suggested that they focus their learning specifically on questions of halacha and mental health, what quickly started as the means to answer a few specific questions became something very much more than that.

“At the beginning, the goal was just to answer a few shailas (questions) but with time I realised that this is a book that I really ought to write. So, together with Dr Harris, we worked on the book for two years or so and then took the first draft to different rabbinical figures and got their opinions on different issues on the book. I also sent it to a number of mental health professionals and got their opinions on the book. Slowly but surely, after a process of about four years or so, we finally published it.”

The book – which is currently only available in Hebrew as Nafshi Bishe’elati (https://korenpub.co.il/en/products/nafshi-beshelati) but with an English translation due out next year – is undeniably a serious game-changer. But there are some pretty obvious questions that come with it:

First, though Rabbi Rosensweig and Dr Harris have some impressive credentials behind them, by what authority do they have to pasken (make halachic rulings) on such issues – especially outside the Modern Orthodox/Dati Leumi community in Israel of which they are part?

Second, despite there being a guidebook that mental health professionals use to diagnose their clients – the Diagnostic and Statistical Manual of Mental Disorders (known as the DSM, now on its fifth and quite contentious edition) – any psychologist or psychiatrist worth their salt understands that each case they are presented with is entirely different and that the DSM offers only, at best, a jumping off point for being able to properly diagnose what’s actually going on and to treat it accordingly. How is it possible, then, to write a halachic codec on a subject that has to be dealt with on so much of a case-by-case basis? Halacha, in its implementation, is often dependant on the particular circumstances of the individual (hence the cute but accurate refrain, “ask your local Orthodox rabbi”), but when it comes to mental health, can we even speak of it in the broadest of principals?

Building a new method

Though it might seem the more delicate of the two questions, the first is actually much more easily answered. As Rabbi Rosensweig mentioned, he approached a number of different major rabbis to get their input in the book and he was very careful to make sure that he spoke to rabbinic personalities from across the Orthodox spectrum when putting together the book; from those who represent the more liberal sides of modern orthodoxy through to the most charedi.

More than that, he was very careful to ensure that the book was so well researched that it would be beyond reproach in and of itself, regardless of his or Dr Harris’ own personal authorities. “The book speaks for itself,” Rabbi Rosensweig insists, “Everything is very, very well sourced. I think it would be very hard to read the book and to think that the author is an am ha’aretz or doesn’t have yirat shamayim… We did our best to be very very careful to source everything and to dispel any sort of fear that a serious job wasn’t done in this field.”

That second question, though, was something that Rabbi Rosensweig took on right from the off. “It became apparent to me very early on when writing the book that this would be an issue. For example, I would come to Dr Harris and I would say, ‘someone with depression wants to listen to music on Shabbat – yes or no?’ and he would say that every case is different and I can’t answer that. Besides, [Dr Harris would say] what does ‘depression’ mean? What is the history? I need you to spell it out for me a bit more. What are the symptoms? Is there anhedonia [an inability to experience pleasure]? Trouble sleeping? Suicidal thoughts? In other words, the word ‘depression’ is as valueless halachically as it is professionally. It’s a catch all phrase for a certain group of symptoms, phenomena, and behaviour, but at the end of the day for the psychiatrist to treat the depression, they need more information. Also, halachically, that’s true. You can’t pasken on the basis of just the word ‘depression’ or the word ‘OCD’ or the word ‘bipolar’.”

With this realisation in mind, Rabbi Rosensweig and Dr Harris knew that they would have to “invent a sort of halachic language” that would be able to address this very particular field of thought. “It took me months or years to figure out how exactly to talk about these things in a way that makes sense… Instead of defining, we described. In other words, instead of giving a word that’s a definition, like ‘depression’, we described a case.” But, Rabbi Rosensweig stresses, the cases he represented had to be of a specific type. “We tried to hit a middle ground so as not to give a case that is so specific that it can’t be translated to other cases, but on the other hand, not to give a case that’s so generic that it doesn’t really mean anything – that you can’t really learn anything from it.” As a result, they made use of these sorts of “paradigmatic” (as in, of a certain paradigm or model) cases and in the footnotes would explain exactly the process of how they reached such a psak in the first place. By doing so, others would be able to apply similar principals to similar cases. Or not, as the case may be.

Putting it into practice

Even with a method in place and the book finally having been published, Rabbi Rosensweig is quick to emphasise that “paskening from a book” is never a great idea (and paskening from an article written by a lay person about that book all the more so!) and that, ideally, it should be used by, say, community rabbis as a way to give them greater context when confronted with such questions – but only community rabbis who are actually equipped to deal with the real-world intricacies of mental health.

It’s for this reason that Rabbi Rosensweig has started offering pastoral and halachic training to community rabbis so they would be better equipped to handle such questions. “I think rabbis should not be dealing with these issues unless they’ve learned about them,” he puts it very plainly. “This isn’t a critique or to say anything negative – everyone’s trying to help and be there for those who are suffering. And that’s very important. But you can easily say the wrong thing and do more harm than help if you don’t understand the issues involved underlying concerns of every disorder in the DSM-V. It takes a little bit of shimush, hands-on experience, seeing a few cases – just like any field. And that’s why I’m doing this. I don’t think that rabbis can pasken on such matters out of books. It’s not enough just to see one or two cases. You really need to listen to a number of different people, to hear them out, to understand from within.”

As, for example, the question that opened this article: can someone with depression (or anxiety, or obsessive compulsive disorder, or post-traumatic stress disorder) listen to music on Shabbos if it helps them to deal with their mental illness? Now, while Rabbi Rosensweig and Dr Harris do come up with halachic reasons for why someone suffering from depression may indeed be allowed to do so – including complicated principles like what kind of Shabbos laws can one break for different levels of illness or whether the use of electricity on Shabbos is directly derived from Torah law or is a rabbinic prohibition – each individual case needs to be weighed up accordingly.

A diagnosis, Rabbi Rosensweig admits, isn’t a necessity, but it certainly adds plenty of clarity about what he’s actually dealing with when it comes to making a halachic decision for the individual. “Halacha doesn’t need diagnoses per se, because halacha treats the individual, not the diagnosis. If a person comes and his leg is in terrible pain, as a halachist it doesn’t matter to me what caused the pain. What matters is that he is in pain right now and whether I can allow x or y or z [to alleviate it]. However, with that said, [in terms of mental health questions] I always prefer a diagnosis because it’s always good to know what’s happening with a person, because with mental health, it’s very difficult for someone to properly explain what’s going on with them and to put into words a qualitative experience. So, it’s good to have a diagnosis so that the posek can understand what he’s dealing with, can ask the right questions to ascertain the degree that the person is suffering, and also what it could lead to.”

But it’s not simply a matter of clinically working out a list of symptoms so that the correct halachic variables can be calculated according to those criteria. The reason why it’s so important for local Orthodox rabbis to be the ones making halachic decisions, in general, is because each decision really needs to be made holistically, according to the many, often times conflicting needs of each individual. If this is true in general halachic matters, all the more so with so complicated and nebulous an area as someone’s mental health. As such, when confronted with a question of whether or not it’s permitted to listen to music for therapeutic reasons on Shabbos, Rabbi Rosensweig would need to look at the past, present, and future repercussions of the individual’s particular mental health issue to answer that. There’s also the big question of why the person is asking him this question in the first place.

The more cynical among us may assume that allowing such leniencies just opens the floodgates for people without serious mental health issues to take advantage of them, but Rabbi Rosensweig rightly points out that the reason why a person would take the time to contact him with these incredibly personal questions is precisely because both their mental health and their spiritual dimension and religious observance are extremely important to them, and they’re looking to find a way to balance the two. “It’s not about giving leniencies. Sometimes you have to give leniencies, sure, but it’s really about finding the balance between those two fields.”

Which is why, for example, when Rabbi Rosensweig does allow a person to listen to music on Shabbos, he is careful to take on board their spiritual needs as well, and usually recommends that they make a day-long playlist on their phone before Shabbos comes in and to leave it playing; needing to do little more, therefore, than to slip on their headphones when they feel they need it. On a purely halachic level, this is better than actually operating the phone, but even more importantly, it allows the person to take care of their mental health needs without completely sacrificing their observance of Shabbos and being able to rest easy that they were able to do so while “breaking” Shabbos as little as possible.

Similarly, when someone with or recovering from anorexia nervosa approaches him with a question of whether or not to fast on Yom Kippur – and given the volatile and deadly nature of anorexia, the answer is usually not to, even years after having seemingly recovered from it – the question is very often not whether they’re allowed not to fast, but whether they’re allowed to do so!

The impact of halacha – and Judaism, in general – on mental health

Beyond just halachic dilemmas, there’s clearly a question that needs to be asked: what role does halacha and Judaism in general play in one’s mental health. Rabbi Rosensweig quotes a gemara in response to this. “’If a person is zocheh (merits) then the Torah will be an elixir of life, but only if it’s used properly. If it is used improperly then, like any potent medication, it wreaks havoc and causes much pain and distress.” Elucidating further, “Do I think that halacha is a force for good for a person’s mental health challenges? Generally, yes. Halacha can give stability. It can be a tremendous anchor for a person who is going through a mental health crisis… mental health challenges often come from a lack of stability in a person’s life, so they can latch onto halacha, and Judaism in general, for dear life because it’s the one thing that still keeps them connected, whether it’s the individual laws or Hakodosh Baruch Hu Himself. It can be a real life saver. If a person has depression, for example, Dr Harris talks about ‘behavioural activation’ – if a person has trouble getting out of bed, then what better tool to get him out of bed than to tell him to go to minyan. If he’s used to going to minyan then it helps to have that point in the day when he knows he has to be at this specific place.”

That said, there’s clearly a flip side to all this. All religion, including Judaism, can really exacerbate mental illness too. Whether it’s becoming obsessive-compulsive over the observance of the most unnecessary stringent forms of halacha or wallowing too much in the mournfulness of the “three weeks” when you’re already suffering from a depressive disorder. Or, simply, coming to loathe Shabbos because the tools you normally have available to you to cope with your depression, anxiety, or whatever, are not available to you – or, as we can see, appear that way, at least. “It all depends, you have to do it right,” says Rabbi Rosensweig in closing, “That’s the bottom line. I don’t think halacha is a hindrance or that we have to move it out of the way. I think what we need to do is strike a good balance between a person’s spiritual inclinations and their mental health needs.”

And, really, it’s precisely because halacha and mental health have such a massive impact on one another that Rabbi Rosensweig has dedicated so much of his time over the past few years not only to improving contemporary halachic literature’s understanding of mental health questions, but promoting the importance of mental health within the sphere of religious, observant Jewish life. It’s why he wrote a book on the subject, it’s why he has made himself easily available to contact on Facebook, and why he and Dr Harris have joined forces with Nadav Ellinson, a hi-tech executive, to create the not-for-profit organisation Maaglei Nefesh: “the centre for mental health, community and halacha” (https://mnefesh.org/) that, along with training communal rabbis to properly deal with mental health questions, provides an all-in-one resource for Jews who are struggling with striking that all-important balance between religious life on the one hand, and caring for their religious and spiritual needs on the other.

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