The changing world of Jewish law and mental health

There has been a demand for this type of halachic work for some time. Why has it taken rabbis so long to address the subject?

 Busting the stigma of mental health (Illustrative). (photo credit: Wikimedia Commons)
Busting the stigma of mental health (Illustrative).
(photo credit: Wikimedia Commons)

“How many Orthodox rabbis does it take to change a light bulb?” goes the old joke. The answer, of course, is “What – Change??” The point of the punchline is that Orthodox rabbis are resistant to change and have difficulty adapting Jewish tradition to the realities of modern life.

A discussion with Rabbi Yoni Rosensweig and Dr. Shmuel Harris, co-authors of Nafshi Bish’elati: The Halachot of Mental Health, which was recently issued by Koren Publishers, belies the riddle’s punchline and illustrates how rabbis can utilize empathy and understanding, together with an expert analysis of Jewish law (Halacha) and medicine to make positive changes in today’s society.

On a sunny summer afternoon in Beit Shemesh, this writer met with Rosensweig and Harris to understand the reasons for the great interest in their book and the additional ways in which Rosensweig and Harris are attempting to make rabbis more sensitive and aware of issues in mental health.

In recent years, mental health has been acknowledged as a significant factor in overall health and wellness. According to the World Health Organization, depression is one of the leading causes of disability, and suicide is the fourth leading cause of death among 15- to 29-year-olds. People with several mental health conditions die prematurely – as much as two decades early – due to preventable physical conditions such as cardiovascular disease and type 2 diabetes. In addition, the pandemic has exacerbated many of the symptoms of mental illness. During the pandemic, nearly half of US adults reported symptoms of anxiety and depression.

The Jewish community is no less susceptible to mental health challenges. While physical ailments are usually not accompanied by stigma, people are frequently reluctant to disclose their struggles with mental health, and many do not know how to react when they learn of their neighbor’s struggles in this area.

 DR. SHMUEL HARRIS (L) and Rosensweig, authors of ‘Nafshi Bish’elati: The Halachot of Mental Health.’ (credit: Maaglei Nefesh) DR. SHMUEL HARRIS (L) and Rosensweig, authors of ‘Nafshi Bish’elati: The Halachot of Mental Health.’ (credit: Maaglei Nefesh)

“Before I started dealing with these questions, I was not exposed to questions of mental health. Many people didn’t come up to me and tell me what was going on with them. I didn’t even know how rife it was within my own community. I had absolutely no idea.”

Rabbi Yoni Rosensweig

The youthful Rosensweig, 41, who has been the rabbi of Beit Knesset Netzach Menashe in Beit Shemesh since 2010 and is known as an accessible and approachable rabbinic figure, says he did not grasp the significance of mental health and Jewish law early in his rabbinic career. “Before I started dealing with these questions, I was not exposed to questions of mental health. Many people didn’t come up to me and tell me what was going on with them. I didn’t even know how rife it was within my own community. I had absolutely no idea,” he says.

Today he fields more questions per week on the subject than he received in the totality of his previous 13 years in the rabbinate. And while the increase may be due, in part, to his expertise in the area, it does indicate that questions regarding mental health and Judaism are a subject of growing concern in the community.

Over the years, Rosensweig developed an understanding of mental health issues and how Jewish law can address questions in this area. He studied weekly with Dr. Shmuel Harris, a psychiatrist and former head of psychiatric services at Hadassah-University Medical Center on Jerusalem’s Mount Scopus and current director of Machon Dvir, a behavioral health clinic in Jerusalem, to broaden his understanding of mental health. The pair first met during Rosensweig’s tenure as rosh kollel of the Torah MiTzion Kollel in Melbourne, Australia, from 2006-2009. Harris was a medical student at the time in Melbourne, and they have studied together for many years since their first meeting.

Both Rosensweig and Harris each learned important lessons from their joint study. “My main takeaway that I learned from my years of studying with Dr. Harris,” says Rosensweig, “was the nuance that is needed in addressing each and every case and understanding it properly. If you don’t properly understand the case, you can’t give a ruling. And the level with which nuance was needed is something I learned throughout our time together.”

For his part, the soft-spoken Harris says with his distinctive Australian accent, “It helped me understand the significance and the power of having a rabbi that understands mental health, and in effect is part of the treatment team and what can come out of collaboration. This is something that even has clinical results, and it’s essential for many of the patients that we’re looking after where Halacha is their worldview – it is how they live their lives. By not incorporating that in an active way, I think we’re doing a tremendous disservice to those patients and clients.”

Putting the laws of Judaism and mental health in writing

Nafshi Bish’elati: The Halachot of Mental Health, the result of the years of Rosensweig and Harris’s joint study, was one of Koren’s top sellers at Hebrew Book Week, selling out its initial print run, and attracting a great deal of attention throughout the Jewish world. At first glance, the book is an unlikely candidate for bestseller status. It weighs in at a hefty 512 pages, and its pages are filled with rulings of Jewish law, commentary and notes. It has no pictures, nor does it include any English translation.

The book includes 15 chapters on such subjects as laws of Shabbat, holidays, kashrut, mourning and laws of family purity, within the confines of mental health. A sampling of questions includes: May someone suffering from anorexia fast on Yom Kippur? What approach to answering questions on kashrut should a rabbi provide to someone with obsessive-compulsive disorder (OCD)? Is one obligated to honor one’s parents if they were abusive? In writing the book, Rosensweig consulted extensively not only with mental health professionals but with leading rabbinic figures around the world due to the novelty and unusual nature of the subject matter, which had never before been treated in such a comprehensive manner.

The list of rabbinic authorities comprises halachic authorities across the spectrum of the Orthodox world, including rabbis Eliyahu Abergel, Yaakov Ariel, Baruch Gigi, Re’em Ha’Cohen, Yehuda Herzl Henkin (zt”l), Mordechai Willig, Asher Weiss, Yitzchok Zilberstein, Dov Lior, Eliezer Melamed, Nahum Rabinovitch (z”tl), Yitzchak Sheilat, Hershel Schachter and Yuval Cherlow. Rosensweig says people will be helped by the book only if they trust it, so having well-known names in the book is important. He adds that having diverse opinions is essential for a topic where diversity is inherent in the experience of mental health.

Judging by the public’s response to the book, there has been a demand for this type of halachic work for some time. Why has it taken rabbis so long to address the subject?

Rosensweig suggests two reasons for the rabbinic delay in treatment of the two subjects. First, he says, “It’s taken mental health some time to get to the place that it’s at. If you compare DSM I (the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association that classifies mental disorders) to volumes III and on, you will find that at the beginning, psychiatric diagnoses were very much based on psychodynamic theories and interpretations, which made it more difficult for mainstream medicine to take those things seriously. But from DSM III onward, it became much closer to the methodology of Western medicine.”

As a result, he explains, it not only became more palatable for modern medicine, but it became easier for halachic authorities to take it into account. “The fact that you’re not dealing with explanations, which are difficult to quantify, but you’re dealing more with the symptoms, and you’re saying, ‘Here are five out of nine symptoms,’ is also helpful on the halachic level, because also halachically, we like to quantify.”

The second reason why Halacha and mental health has not been widely examined, he says, is because most rabbis are largely unfamiliar with conditions of mental health, such as depression, post-traumatic stress disorder or OCD. Rosensweig adds that rabbis are less conversant with these issues because congregants are reluctant to disclose their conditions due to the societal stigma associated with them and, correspondingly, are less informed.

Harris agrees. “I think that the stigma has really held people back from asking these questions and the feeling that maybe there aren’t answers,” he notes. “The shame that’s involved makes it impossible to ask the questions and the feeling that maybe the rabbis aren’t going to understand and won’t be able to issue a ruling.”

Harris says that in recent years, greater awareness about mental health has penetrated the Orthodox communities. “There was no real discourse going on, and no public discourse, and I think that that has changed tremendously. Even if you take a look in more right-wing haredi communities, there’s a lot more discussion now about mental health issues, even just on a public level. It’s spoken about in an anonymous way that protects confidentiality, but it’s becoming more common and more acceptable to speak about.”

As a result of this increased awareness, says Harris, members of the community, rabbis and mental health clinicians recognize the importance of incorporating the halachic and religious framework as a part of both diagnosing and treating mental health issues.

The halachic approach to answering questions about mental health

While Rosensweig says that each case and query he receives must be judged on its specific issues, there is one basic approach that he uses. “As a ‘halachist,’” he says, “I’ve learned over time that it’s really difficult for me to say in one or two sentences, ‘what’s the approach?’ However, with that said, the approach has to be one that balances the mental health needs with the religious needs. I say ‘balances’ because it can’t be one at the expense of the other. I’m not saying, ‘The person has mental health needs, so let’s just flush his religion down the toilet.’ That’s not it. A lot of times, people do the opposite. They flush their mental health down the toilet, because of religion. But the answer is not to go the other way. The answer is to find the balance between the two, so the person can conserve both, because they will be in as much distress if they have to give up their religious life as they will be if they have to give up their mental health. It will be distressful, but it will just be from the other side, so we don’t want them to be in any distress. And hopefully, we can find that happy middle.”

Rosensweig cites a query he has been asked numerous times, highlighting the issues inherent in the topic: May a person suffering from depression, anxiety or an eating disorder listen to music on Shabbat because it helps them? “When a rabbi receives that question,” he says, “the first question that he asks himself if he does not have a good background in this issue is, ‘what does it mean ‘it helps them?’”

A rabbi who is unfamiliar with the issue, says Rosensweig, will find the question baffling because he does not understand the effect that the music has on the patient. He may think that for the patient, listening to music is like taking medicine that will cure him. Rosensweig explains that the comparison is faulty – for a person with depression, listening to music is not like taking a pill or an antibiotic.

To issue a ruling on this subject, says Rosensweig, one needs to truly understand what is going on in the mind of the person. “People who are suffering from depression are drowning in their own minds and their own thoughts. They’re suffering greatly. We can’t even imagine what that’s like.” If a person suffering from depression is left alone with their thoughts for too long, the depression can lead to other, more dangerous forms of self-harm. While in some cases, he says, reading a book or taking a walk can calm and settle the mind of one suffering from mental illness, that may not always be the case.

Harris adds that the fact that a person suffering from mental illness can summon the bravery and courage to ask this type of question illustrates the religious commitment of the questioner, which requires that the rabbi reciprocates with sensitivity and understanding. “On some level, irrespective of the ruling, there needs to be a demonstration of that sensitivity and understanding of the fact that they’re asking the question. The spiritual sensitivity, I think, is what is spoken about.”

Harris points out that spiritual sensitivity, an understanding of the mental health issues, and a connection with mental health professionals with whom the rabbi can interact, can lead to better outcomes and make the task of both the rabbi and the mental health professional easier.

Rosensweig says the question of allowing a person with mental health issues to listen to music on Shabbat is an example of the type of situation where a rabbi who does not understand the nature of the illness may not realize the purpose of the music and may render an incorrect ruling. “There’s a lot of suffering going on inside the person that they’re trying to get away from, and they’re asking for help or asking for some sort of assistance. If we don’t give it to them, that’s not good because they’ll often use other coping mechanisms, which aren’t necessarily as healthy. They can start cutting themselves, and they can start doing other things.”

The manner of the halachic ruling, he explains, is crucial in maintaining both the person’s religious faith and his mental health. “The ruling has to be very tailored to the person in a way that is sensitive once again not only to the mental health needs but also to the religious needs,” he explains.

Returning once again to the person who needs to listen to music on Shabbat, Rosensweig says that while there are more lenient interpretations regarding the use of electricity on Shabbat, he will try to issue a ruling that will preserve the questioner’s feeling of retaining their connection to Judaism. Rosensweig advises the person to plug the phone into electricity before Shabbat, create a playlist on their phones, set it to play in a never-ending loop, and connect the headphones so that the music won’t disturb others. Additionally, this solution will not require them to press any buttons.

In this way, he says, “A person feels like they are keeping Shabbat. The person feels like I haven’t pushed them out of Klal Yisrael [the Jewish people]. We always talk about the stigma and how people with mental health [issues] feel like they’re not seen or heard. I would be doing the very same thing if I gave them a ruling that made them feel like they’re not part of the congregation or that God hates them. I have to issue a pesak [ruling] that respects their religious boundaries to the greatest extent that I can while dealing with the mental health challenges that they’re facing.”

Rosensweig cites another query that he received that he found especially meaningful. “Before Yom Kippur, I received a call from a woman with a child with autism. Some children with autism are nonverbal at the beginning, and when they’re nonverbal, they use assistive technology, such as a tablet to communicate. The woman wanted to know if the child could use it to communicate on Yom Kippur with his parents.”

Rosensweig replied that he could answer the question but noted that the same halachic issue with using a tablet on Yom Kippur is present every Shabbat. What does she do each week, he asked?

The woman replied, “We don’t keep Shabbat.” Says Rosensweig, “You may think this is only for the religious person, but the truth is most secular people observe Yom Kippur. It was a very eye-opening situation for me because she wanted to keep Yom Kippur completely, and suddenly she was faced with a situation where she couldn’t use the tablet, and she was wondering what to do for her son who has autism. We live in a very traditional society – even if one doesn’t keep everything, people keep the laws of hametz on Passover, and people observe the laws of Yom Kippur. I think there’s a lot of potential reach beyond the religious community.”

Teaching rabbis to understand mental health issues

While Rosensweig and Harris, through their book, have helped make the subject more accessible to others, they have created an organization called Maaglei Nefesh – The Center for Mental Health, Community & Halacha, which is training rabbis and community religious leaders in mental health and Jewish law. Rosensweig says that until now, most seminars for rabbis on mental health included a psychiatrist, psychologist or social worker who would speak on the subjects of eating disorders, OCD and depression and anxiety because the assumption is that while rabbis are deficient in the real-world skills of mental health, they have the necessary halachic expertise.

“I completely disagree with that,” says Rosensweig. “The basis for our program is the assumption that rabbis, with all due respect, do not know how to rule on questions of mental health. It is a specific field that needs further training. If you received semikhah [ordination] or studied in yeshiva, that in no way prepares you for the complexities of a halachic question on mental health. You need training in rabbinics.”

The seven-session seminar that Maaglei Nefesh offers also provides information and training on issues regarding mental health and how to approach it from a communal perspective. “We also teach how to deal with things inside the community from the perspective of referring onward, and occasionally someone inquires about how to carry on a conversation with someone who comes with a mental health question, because it’s not just always about the Halacha. There are things beyond that.”

Finally, Maaglei Nefesh invites people who have experienced mental health issues to the classes to relate their experiences and suffering. “I always say if you haven’t gone through it, you don’t know what it is,” says Rosensweig. I’ve never gone through it, and I definitely don’t know what it is from the inside, but I’ve spoken to many people, and the only way to get into the field without going through it is to hear and to hear again and again, and then you can start soaking it in.” 

The rabbinic training institute has taught two cohorts and is in the midst of its third group. Classes are also provided to women kallah instructors, women rabbinic leaders (rabbaniot), and yoatzot Halacha (women halachic advisers). Rosensweig provides the halachic training, psychiatrists give professional training and social workers offer the communal aspect of the program.

Rabbi Avichai Epstein is a therapist and coach living in Asael, a settlement near Otniel in the South Hebron Hills. He participated in the Maaglei Nefesh course in December 2021 and says he took the course to gain a greater halachic perspective for his work. Epstein adds that the combination of the clinical knowledge provided by Harris and the halachic guidance from Rosensweig was helpful. He notes that the sessions with people undergoing these mental health challenges were particularly enriching. “It is changing theory into practice in front of your eyes,” he says. “Having learned for so many hours what the psychiatrist says, and hearing Rav Yoni present the halachot – when you see a mother talking about her child, it is so powerful. And I began to think that I could be of help to that mother, or to other people in such situations. It really ignited a deep desire to delve deeper into understanding mental health issues with a halachic and rabbinic perspective. It was very powerful.”

Since completing the course, Epstein has joined the virtual support center created by Maaglei Nefesh, which provides assistance by Zoom, email and phone to people with questions about Halacha and mental health (https://mnefesh.org). He adds that as a rabbi, one of the most important components of the course is the empathy and compassion that the course inculcates in its participants. “It has an immense effect. It is tremendous how it resonates with people,” he says.

Rosensweig continues his efforts to help the lives of people suffering from mental health issues, crisscrossing the globe to speak and raise awareness on Halacha and mental health. An English translation of Nafshi Bish’elati is in development and will be released in 2023. Citing the ancient mi sheberach prayer recited in the synagogue on behalf of the sick, Rosensweig says, “we pray not only for a ‘refuat haguf’ – physical health – but also for ‘refuat hanefesh’ – spiritual and mental wellbeing.” That being the case, perhaps it can be said that Orthodox rabbis have learned how to change the light bulb. ■