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Hashem Helps Those Who Help Themselves

By: Abe Goodson and N. Bakst  

THE ROCKY ROAD TO REALIZATION 
I sit at the table in the Yeshiva dining room oblivious to the easy chatter that fills the air. It seems surreal, part of another world where I do not belong and­ cannot enter. My little island is lonely, but the Spartan regimen I have imposed on myself leaves no room for social life. I must be totally aware of what I am eating; otherwise, I may starve to death. It is some time since I have become convinced that if I eat too much at one meal, I will not be hungry at the next. So, I pick at my mashed potatoes and worry that the tiny portion I am consuming is too much. The other bachurim, who have long since concluded that I am "different," talk and joke amongst themselves, unaware of my plight. Finally, the torturous meal comes to an end. But, rather than leaving my worries behind in the dining room, I merely transfer them to another location. 

The laundry room suddenly looms nightmarish in my imagination. Logically, I know that if I want clean clothes, sooner or later, I will have to do laundry. But what if there won't be enough detergent in the vending machine? I agonize. Or perhaps I won't have the right amount of change. These are senseless, groundless fears ­figments of an overactive imagination, but to me, they are larger than life. The Hanhalah (faculty) is at a loss. Perhaps my diligence and excellence in learning has lulled them into the false belief that my troubles are just insignificant quirks, part of a passing phase, something I will eventually outgrow. 

At any event, the tragic saga of my teenage continues unabated into adulthood. I am hospitalized twice, once for as long as twelve weeks. The humiliation of being forcibly fed haunts me. Only the warm intervention of the Novominsker Rebbe gives me some comfort. Another time, I intentionally try to damage my arm, in a desperate ploy for attention. Yet, I continue to "sweep my problems under the rug," with the hope that I will soon "grow up" and be rid of them. The final travesty is my ill-advised marriage, into which I plunge headlong, without logic and with no plans for counseling. After ten years of vainly attempting to settle our difficulties on our own, my wife finally convinces me to get help. Two more years are lost in ineffective treatment, until I eventually find a clinician who correctly diagnoses me. Only after I receive proper treatment, which includes medication and cognitive-behavior therapy, am I able to begin recovery and restore serenity to our family. 

Not everyone diagnosed with mental disorders is as fortunate. There is a vast multitude of people like me, across the United States, most of them hiding in the figurative closet for fear of being stigmatized and ostracized. We rightly worry about losing friends, jobs, Shidduchim, and spouses. According to a recent report on mental health by the United States Surgeon General, mental illness ­which includes major depression, manic-depressive illness, schizophrenia and anxiety disorder ­ is the second leading cause of disability and premature mortality in the United States. Yet, more than 50 percent of all people with diagnosable mental disorders fail to seek treatment. The stigma attached to mental illness is responsible for a great deal of resistance among the population to seeking help. According to the Surgeon General, "Every day language encourages a misperception that mental health or mental illness is unrelated to physical health or physical sickness. In fact the two are inseparable." Recent ground-breaking discoveries have successfully tracked many emotional problems to real, measurable physical changes in the human brain, presenting clinicians with a wide arsenal of tools for treating these problems. Exciting, new medications restore a neurochemical balance in the brain, and, when used together with psychotherapy, have been shown to be extremely effective in combating many disorders. Still, old stigmas die hard, and medication for mental health is as yet widely shunned. Thus, while mental illness is no less legitimate than other physical illnesses given by the Ribbono Shel Olam, and the suffering of the mentally ill is no less acute than that of the physically ill, it is compounded and its treatment frustrated by the stigma which dogs it. 

THE ORTHODOX RESISTANCE 
Misconceptions and general lack of familiarity with mental health in the Orthodox Jewish community further complicate the course for Frum people who need help. For example, to tell or not to tell of mental illness when dealing with Shidduchim has become the subject of debates, forums, Halachic rulings, and so forth. Sadly, emotional difficulties that seem minute prior to marriage may come to dominate an entire relationship after the Chassuna. When one withholds information of such problems, as one is naturally inclined to do in order to "get a Shidduch," the results may be disastrous. Once I decided that I was "ready" to find my Shidduch, I was advised that I should inform my wife-to-be that I had suffered from anorexia nervosa as a young teenager, but since I had overcome the eating disorder, there were no additional concerns about entering into marriage. I deluded myself into believing that the intermittent adjustment problems that I had experienced in the past would have no bearing on married life. After all, I was assured, once I was married to the right person, things would "fall into place." In fact, things did "fall" after we were married, but not into place. It was only after ten years of causing my wife great suffering that I finally consented to obtain professional help. Like physical illnesses, real mental disorders rarely resolve themselves without competent professional intervention. Not the passage of time, nor going to Yeshiva, seminary or college, nor entering into marriage nor any other life changes are cures for resolving such disorders. Having avoided a concerted course of therapy during my teenage years when I was relatively free of major responsibilities, I only succeeded in guaranteeing that the same disorder would exhibit itself during a stage in life when my wife and children yearned vainly for emotional stability. 

THE PITFALLS OF POSTPONEMENT 
According to Rabbi Abraham J. Twerski in "Successful Relationships: At Home, at Work and With Friends", when issues that can be resolved during childhood or teenage years are neglected, they may lead to additional adjustment problems. "When matters reach a crisis point and the problem is acknowledged, some of the damage cannot be undone. Young people whose personality problems were supposed to be solved by marriage may end up in unhappy marriages, which may not survive. In these cases, the children of these marriages may come into this world with two strikes against them." 

It is then critical that any past or present emotional difficulties be shared fully with a prospective spouse. Honest disclosure before marriage can pave the way for an especially close partnership, precisely because the Middah of Emes (truthfulness) and trustworthiness were displayed at a critical time when so much was at stake. Fear of sabotaging a Shidduch through disclosure may be countered by steadfastly trusting that Hashem Yisbarach, Who has selected each person's Shidduch, will not allow harm to befall the intended Zivug when one is Yashar (completely honest) with the other person. Despite the obligation to be honest, though, simply disclosing potential problems to a prospective spouse without presenting a strategy for success is foolhardy. Premarital counseling by G-d-fearing professionals is available today and provides opportunities for honest disclosure in a safe environment. 

THE RELIGIOUS DIMENSION 
Mental disorders within our community often masquerade as religious practices and prevent the patient or his family from seeking treatment. A typical example of this is exhibited as a form of obsessive-compulsive disorder known as "scrupulosity," in which the person alternates between an obsession that he has not fulfilled a religious obligation and the compulsion to repeat the performance. This disorder is often misread as religious devotion. In fact, rather than strengthening a person's ability to serve Hashem properly, mental ill-health robs him of that function. Rabbi Shimon Schwab ZT”L once likened a person with a physical illness to an "airplane that cannot get off the ground." Mental illness is equally debilitating. For nearly thirty years, I was unable to Daven with Kavanah (devoted concentration) until I began taking medication for obsessive-compulsive disorder. I lacked the ability to judge others favorably (Dan L’Kaf Zechus) because, prior to receiving appropriate medical treatment, I often had a distorted negative opinion of people around me. What's more, once I began to overcome these challenges, the process led me to a wonderful closeness to Hashem Yisbarach. Rabbi Akiva's famous assertion "Chavivin Yesurin" ­ (suffering is dear) ­applies as much to suffering from mental illness as from physical pain. 

Financial constraints are another major deterrent in the quest for adequate treatment of the mentally ill. Many insurance plans provide minimal or no mental health benefits. The reality of financial hardship posed by mental health problems cries out to members of the Orthodox Jewish community, Rachmanim Bnei Rachmanim (merciful ones the sons of merciful ones). We have seen how well our community has responded to the needs of special children and those with learning disabilities. The next frontier is that of mental disorders. We need to establish community funds (Gemachim) to help families meet the financial obligations with or engendered by extended therapy. 

In certain Orthodox Jewish communities in the United States, an alliance has been successfully formed between rabbis, Jewish educators, parents and mental health professionals. These alliances work interchangeably, as mental health professionals help leadership figures understand the problems of the mentally ill, and in turn, practitioners are educated about the special needs of their Orthodox patients. Through educational forums, mental health professionals provide guidance to community leaders, educators and parents on how to recognize mental health problems at early stages and what modes of therapy are available. Training sessions also focus on the subject of preventive mental health intervention. It is hoped that as a result of such training exercises, parents and educators will become sufficiently educated to discern when professional intervention is needed and to select the appropriate therapist, should the need arise. 

FINDING THE APPROPRIATE PROFESSIONAL 
Concerns about finding the appropriate professional for the Orthodox patient may understandably dissuade some people from seeking mental help therapy. The fear of being treated by a therapist who lacks the proper reverence and respect for the patient's religious value system is well-founded. On the other hand, not all Orthodox therapists have suitable expertise in the type of disorder experienced, and are in the required place at the right time. Once my wife and I finally began therapy, it took us two years to realize that we were wasting our time with our respective practitioners. In fact, my therapist succeeded in creating more distrust between my wife and me, rather than helping us. Alternative strategies for finding appropriate therapists should be explored. Alliances between community leaders and mental health professionals may be helpful in dealing with these issues, as well. Educators need to conduct training sessions for mental health professionals, in order to gain an expanded pool of expert, trustworthy therapists to call upon when a referral is necessary. Ideally, such therapists will subscribe to the patient's belief system, or at least view it as an asset. An added word of caution to those who suffer from mental disorders: As with all other illnesses, it pays to be your own advocate. Relying on the final word of a practitioner is imprudent. The patient should read mental health literature which explains the characteristics of and available treatment for the mental illness that is diagnosed or suspected. And, finally, place your trust in the Ribbono shel Olam, the Healer of all illnesses, Who surely paved the way to recovery before giving the illness. 

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  • United We Stand: The Impact of Disabilities on Marriage...
  • Unique Needs of Children in Foster Care...
  • The Success Story that Finally Happened...
  • It’s a painful process to watch. We joke about it all the ...

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