Mental health challenges in the frum community

Dr. Michael Bunzel, chairman of the Department of Psychiatry at Mayanei Hayeshua Medical Center in Bnei Brak and medical director of the hospital’s newly-opened Mental Health Center, spoke about his center’s approach to dealing with mental health issues while maintaining a commitment to the halacha and the sanctity of human life. Medical ethics issues at Mayanei Hayeshua are overseen by a halachic committee of Gedolei Yisroel. This interview was prepared for American Friends MHMC.

What is special about the Mayanei Hayeshua Mental Health Center? 

Our Mental Health Center will become the largest psychiatric center of its kind in the Middle East. We believe that halacha and Torah hashkafa can actually assist in psychiatric issues. Social and communal interventions that are typical of Orthodox communities, such as social support, family support, rehabilitation programme, are already an integral part of the religious lifestyle. Our almost exclusively Torah observant staff have an exceptional level of expertise in their professional disciplines. 

How important is it for mental health practitioners to appreciate the culture of the patients they treat?

It can be very hard to diagnose someone unless you clearly understand his cultural framework and understand what normalcy is in that culture. For example, a secular doctor might misinterpret ritual behaviour, religious observance and even reliance on a higher power as being abnormal psychiatric symptoms. This can leave to misdiagnosis and mistreatment. 

Why has there been resistance in Orthodox circles to mental health issues?

There is a history of Orthodox suspicion of professional care of mental health problems. Halachic authorities such as Rav Moshe Feinstein used to be wary of psychological treatment because it was largely based on philosophies seen as antithetical to a Torah outlook. The split between the world of psychiatry and the world of the religious led to mutual distrust. Happily, the last 30 years have seen the emergence of new psychological treatments that are no longer regarded as threatening. Psychologists and psychiatrists now have greater awareness that religion is not only not a barrier to psychological rehabilitation, but can often facilitate this. The decline in resistance to mental health treatment among the religiously observant community has been helped by an increase in the number of religiously observant mental health practitioners, and by the bi-directional consultation that often takes place between rabbis and mental health professionals. I would go far as to say that we have a witnessed a revolution. Instead of rabbis and their communities resisting the treatment of mental health, they are now partners in the treatment.

Has the stigma of mental health led to mental illness in the Torah-observant community going untreated? 

Our data shows that 65 percent of the adults and 70 percent of the children who come in for mental health help would not have sought treatment elsewhere because other clinics are less sensitive to their unique Torah outlook. If mental health issues are stigmatized, the people who are suffering live in a world of secrecy and their problems only are exacerbated. There were times when anyone in Bnei Brak with a mental health issue would have to travel far away for treatment, so as not to be seen. Opening Mayanei Hayeshua’s mental health clinic right in the middle of Bnei Brak went straight in the face of the stigma. Mayanei Hayeshua has the support of the top rabbinical leaders; rabbis now work openly and constructively with our psychiatrists. The orthodox public is beginning to recognise that shidduchim are not doomed if a great-grandson is on an antidepressant. There is greater awareness that it is possible to use psychotherapy in a way that is guided by Torah values. 

What types of mental illnesses do you come across in Torah-observant communities? 

The Torah lifestyle protects against many ailments that are more common in nonreligious societies … every psychiatric illness in Western society can be found in the Orthodox community. 

Is the Torah-observant community immune to suicide? 

I wish I could say yes, but unfortunately I cannot. … Despite the focus on emunah in particular and religion in general as protective factors against suicide, the Torah-observant community is not immune to this tragic phenomenon.

Are there any myths about suicide in the Torah observant community? 

Yes, and these myths need to be addressed and corrected. For example, it is not true that “People who talk about suicide usually don’t commit suicide.” People who talk about suicide are a high risk group, and their veiled threats should not be ignored. It is also not true that “Suicide usually takes place with little or no warning.” About 80 percent of suicide attempts are preceded by warnings, whether vague statements or clear threats. It is not true that “People who attempt suicide are fully intent on dying.” Only 3.5 percent of people who attempt suicide really want to die, while the other 96.5 percent are sending clear warning signals to those around them, warning signals that we must not ignore. It is also not true that “People who attempt suicide remain suicidal forever.” Effective intervention can lead to erasing suicidal thoughts forever. 

Since asking someone about their suicidal thoughts could increase the risk of suicide, is it not better just not talk to about it?

We used to think that asking about suicidal thoughts increased the risk of people considering suicide. We now know that the opposite is true, and that silencing the talk only increases rates of suicide. … Effective interventions include restricting access to lethal means such as weapons and drugs in the home, and preventing access to tall buildings and bridges. Other interventions include pharmacological interventions in all ages, psychiatric diagnosis and treatment of psychiatric illness and depression, psychotherapies such as Cognitive Behavioral Therapy and Dialectical Behavior Therapy. School-based mental health and suicide awareness programs are helpful, and “Gatekeeper” training can help school staff, general practitioners and crisis hotlines to listen and refer more effectively. Electroconvulsive therapy also provides rapid relief from suicidal thoughts. Mayanei Hayeshua has just received a generous donation from an observant U.S. foundation to buy advanced equipment for reducing the possibility of harmful side effects. 

What can one say to someone contemplating ending their life? 

Many people contemplating suicide think that because of their mental or physical illness, or other trouble they are experiencing, they are a burden on their family, their close friends, their community or their society. They get the idea into their head that their suicide might be beneficial to those around them by relieving them of the burden. That’s why it is so important for people contemplating suicide to understand and to hear that such an act inflicts much worse suffering on their loved ones. It is extremely difficult for family and friends to cope when they have lost a loved one to suicide.

How would you summarize your message concerning suicide in the religious community? 

Like with all mental health issues, shame, stigma and silence only make matters worse. Suicidal thoughts are a part of mental illness, and therefore can often be treated and prevented if we are vigilant enough to recognize the symptoms. Halachic authorities now acknowledge the importance of psychiatric intervention, and have ruled that mental illness is often a question of pikuach nefesh, just like other medical emergencies. In the general society, suicide awareness and prevention initiatives are proving effective. There is no reason why the Torah observant community cannot do the same. The more open we are in addressing suicide in our community, the more we can help families who are affected by it.