Mental health has gone through unbelievable changes in the last 150 years. It would be beyond the scope of this article to enumerate those changes, but suffice it to say that the field has gone from being vague and mysterious to being fairly well-defined and quantitatively assessed. Where before there was no clarity on how to differentiate between one disorder and another, today we are witnessing a virtual explosion of categories and sub-categories to try to capture every minute difference in the presentation of mental health phenomena.
The result of this change for our communities cannot be overstated. Since the spectrum of mental health disorders has been continuously growing, it has led to the increased presence of those with mental health challenges in our communities. In other words: when the world of mental health disorders mostly included only severe and extreme presentations, such as psychosis or mania, such individuals usually lived in an institution (especially as the advent of anti-psychotics had not yet occurred). Today, however, when so many of those diagnosed with mental health conditions live routine lives—living at home, working in routine places of business, interacting with family and friends, etc.—it has created a totally new reality to contend with.
In the Orthodox community, the rabbi is affected significantly by this change. If I had to guess, I would dare say that an average community today has at least 30 percent of its members dealing with one mental health challenge or another. While in the past such individuals were “out of sight, out of mind,” today they are part and parcel of every community. This, of course, is a wonderful development, for it means that someone dealing with mental health issues may receive support on a far greater scale than before. However, for that to happen, we need to be firmly aware of what the individual needs, and what we can do to support them. The role of the rabbi has therefore morphed, and new challenges present themselves. This article will reflect specifically on what that role may entail.
The New Role of the Rabbi
This new role expresses itself in three different spheres: the personal, the family, and the communal. On a personal level, the rabbi has always functioned as a source of halakhic, spiritual, and philosophical guidance. With mental health this is no different, though the issues the rabbi might face will enjoy significant novelty, both in terms of subject matter and in terms of ways of thinking. When it comes to the halakhic aspects, the rabbi will need to have a basic familiarity with eating disorders, mood disorders, personality disorders, psychosis, neurodivergence, etc. and will need to relate to cases involving anorexia, depression, OCD, PTSD, bipolar disorder, borderline personality disorder, ADHD, and so much more.
When one person in the family struggles with mental health challenges, the entire family is affected.
The complexity of some of the questions a rabbi may get in these areas is what led me to create Maaglei Nefesh, the Center for Mental Health, Community, and Halacha and to offer rabbinic training for dealing with these issues in Israel and abroad. The confines of this article do not allow me to do justice to even one of the questions I get, with all its intricacy and complexity, but I trust the reader will take my word for it: questions abound, and their solution is extremely necessary for many.
It is not only halakhic questions that are asked, but also philosophical ones: Why am I suffering with no end in sight? What did I do to deserve this? What does Hashem want from me? Is there a reason I am afflicted with this disorder? How can I find meaning in a life that brings constant pain and distress? These questions are accompanied by a spiritual search as well: well: If I cannot perform all the mitzvot, then what does it mean for me to be a religious Jew? If I cannot fast on Yom Kippur due to my anorexia, how am I supposed to feel on Yom Kippur? Does anything change for me? And if I need my phone to self-regulate on Shabbat, then how do I still maintain the sanctity of the day? These are not just practical halakhic questions, but also (and perhaps primarily) spiritual ones.
Solutions Affect the Whole Family
This covers the first part of the role of the rabbi, and in some sense there is nothing new here: this has always been the role, and only the subject matter and its attendant consequences have changed. However, there are two additional roles where I believe that the change is more dramatic. In these roles the rabbi is genuinely asked to do things that rabbis have not done before. Let us begin with discussing the family. It is a fundamental truth that we all must realize and internalize: when one person in the family struggles with mental health challenges, the entire family is affected. The challenge does not—and cannot—remain circumscribed within the world of the individual. This means that innovative solutions to problems must be envisioned on a family level, and not just an individual one.
One father asked me: “I am suffering from depression. It is very difficult for me to get up in the morning and go to shul. Must I do so?” I answered: “No, if it’s too hard for you, just daven at home.” But then he asked: “But rabbi, if I don’t go to shul, what will my kids do?” Here we clearly see the problem. It is relatively simple for me to reply and care for the plight of the individual, but it becomes quite fraught when the “solution” actually creates a whole new set of problems. Everyone is affected. Solutions need to be found for the entire family structure, and not just for the individual.
Another parent asked me: “My daughter has autism. She has temper tantrums during which she breaks things in the house, and sometimes hurts herself or her siblings. The only thing that calms her down is playing games on her tablet. Can she do that on Shabbat?” I said: “Yes, she can do that on Shabbat, since it’s the only way to calm her down.” But then she asked me: “But what about my other kids? I don’t want them to be jealous of their sibling who is on the screen! I want them to experience Shabbat as it properly should be experienced!” Again we see the problem. It is relatively simple to respond to an individual’s distress, but becomes exponentially more complex when discussing an entire family. Indeed, this is a skill that rabbis will need to develop and cultivate over time if they are to give a holistic response to mental health challenges.
Solutions Affect the Community
The final consideration is the communal one. Here, too, I believe the role of the rabbi changes significantly, and this change may be the greatest of all—certainly in terms of its scope and reach. Many times the rabbi feels that they must simply attend to the needs of the community, rather than lead a movement within it, but when it comes to mental health the rabbi must understand that their actions may very well set the tone for how the community views this topic. When I speak in communities, I offer them the following equation: “When you halakhisize, you destigmatize.”
What this means is that when you speak about something not only in abstract philosophical or even heartfelt emotional language, but rather in concrete legal terms, it gains a dimension of reality that it did not have before. Rabbis can speak from the pulpit for hours about how important being sensitive to those with mental health needs is, but it will never be as impactful as a statement that someone suffering from post traumatic stress disorder is halakhically permitted to utilize certain leniencies in order to avoid dissociating or experiencing flashbacks. There is a power to the legal language that sends a message to the community at large: this is real, and so much so that we are willing to pay a halakhic price in order to care for the person.
This message is also given through relaxing some of the decorum that is so precious to most shuls. If we are to be truly inclusive of those with mental health challenges, we must realize that it will require some sacrifice on our part. If, for example, a community is in earnest about its desire to see those in wheelchairs attend services, it will most certainly build a ramp and make sure the shul is wheelchair accessible. No one would take seriously a rabbi who merely spoke about it, but didn’t require the community to put its money where its good intentions are.
Similarly, it might be easier to say that we are interested in being inclusive towards those with dementia, for example, than actually having them come to shul and introduce some level of instability. A community that enjoys a relatively silent and solemn davening experience may be bothered by an older member now plagued by dementia, who gets confused or shouts out several times during Shaḥarit or Torah reading. And people might find a boy with ADHD who feels the need to pace back and forth along the aisles during davening to be distracting and annoying. It is precisely here that the rabbi’s leadership will be pivotal.
If we are to be truly inclusive of those with mental health challenges, we must realize that it will require some sacrifice on our part.
In summary, the emerging role of the rabbi in the field of mental health requires a revamping and rethinking of sorts. It requires learning new concepts and understanding new realities, tailoring solutions to complex family frameworks and scenarios, and helping the entire community pivot towards a better understanding of mental health and of those facing mental health challenges.
May we merit to bring greater understanding and inclusiveness to our communities.
