Book review – Nafshi BiShe’elati: The Halakhot of Mental Health

Ben Rothke

 

T.J. Hooper was a precedent-setting tort case[1] in 1932. Two tugboats, one of which was The T.J. Hooper, were towing barges. During a storm, the barges sank, and their cargoes lost. The owners of the cargo sued the barge owners, who in turn sued the tugboat owners. The barge owners claimed that the tug operators were negligent because they failed to equip their tugs with radios that would have warned them of the bad weather.

The tugboat companies defended under the prevailing practice theory. They claimed that because no other tugboat operators in the area were using radios, this constituted the industry standard of care.

Judge Learned Hand found the tugboat companies liable because they did not use readily available technology, radio receivers, to listen for broadcast weather reports, even though radio use was not yet standard industry practice 

Judge Hand observed, “Indeed, in most cases, reasonable prudence is, in fact, common prudence, but strictly it is never its measure. A whole calling may have unduly lagged in the adoption of new and available devices. Courts must in the end say what is required. There are precautions so imperative that even their universal disregard will not excuse their omission”.

I thought of the T.J. Hooper case when reading a most remarkable new book Nafshi BiShe’elati: The Halakhot of Mental Health[2] by Rabbi Yonatan Rosensweig and Dr. Shmuel Harris. Mental health is virgin ground in halacha and requires the subtle judgment of the most seasoned poskim. When Rav Asher Weiss used the term OCD in his teshuva in 1994 (Minchat Asher 2:134), it was, as I understand it, the first usage by a posek of the term OCD.

The authors quote Rav Shlomo Zalman Auerbach (1910-1995) who was asked if one may turn on an electronic device on Shabbat to play music for a choleh sheyesh bo sakana who likes it. Rav Auerbach responded, “My son may permit this, but I have difficulty.”

He explained, “When I was growing up, a sick person needed warmth, food, and drink. While I can understand these new psychological needs, like music, are in fact needed—of course you are right—it is very difficult for me to permit them.”

A century ago, giving the sick person, be it one who was physically ill or with a mental malady, warmth, food, and drink was all one could do. This was an era where ear infections were fatal, and those with mental illnesses were considered incapable of being productive members of society or even counted as part of a minyan.

Today, with far-reaching advances in mental health care and pharmacology, a rabbi today who provides a congregant with warmth, food, and drinks instead of a referral for psychological care may have blood on his hands. The authors write that rabbis should avoid trying to provide psychological treatment in place of a licensed professional.

This is required even though the rabbi’s role throughout history as a spiritual guide in whom his disciples and community can confide is still as crucial as ever. He should differentiate between someone in need of sage counsel or an attentive ear and someone with a mental illness who needs professional care. Consequently, it is imperative that rabbis receive mental health training so that they can adequately distinguish between mental states and identify signs that warrant referral for professional treatment.

The authors are a remarkable pair with Rosensweig, the accomplished rabbinic scholar, and Harris, the physician. Rosensweig serves as the Rabbi of the Netzach Menashe synagogue in Beit Shemesh, Israel. He also teaches in various post-high school institutions and is the author of a number of books. In 2021, he founded Maagalei Nefesh[3], on an organization that deals with issues about mental health and halakha.

Harris is a psychiatrist who has served as the former head of psychiatric services at Hadassah Mt. Scopus. He is also the founder of Machon Dvir[4], a mental health organization servicing the English-speaking community in Israel.

The late Chicago-based posek Rav Gedalia Dov Schwartz said when dealing with transgender issues, “They didn’t really prepare me for this in yeshiva.” Schwartz echoed the sentiment that what was studied in the pristine study halls was often theoretical and abstract and didn’t match what was occurring in the real world.

When it comes to mental health, many communal rabbis are finding that yeshiva didn’t prepare them to deal with congregants who have mental health issues. Many of which can be exacerbated by halacha. These rabbis must be educated in various areas and understand the many mental health issues to properly and effectively minister to their congregants.

Eating, for example, plays a large part in Jewish life. Between the weekly Sabbath meals, the Passover seder, and various holiday meals, nearly 20% of the Jewish calendar revolves around meals or a fast.

So when a rabbi has a congregant with anorexia nervosa or other types of eating disorders, how they respond can have life or death repercussions as eating disorders have one of the highest mortality rates in comparison to other psychiatric illnesses, as 20% of anorexia nervosa deaths, are due to suicide. In addition, those with eating disorders are much more likely to engage in self-harm and experience suicidal ideation.

Anorexia nervosa is germane not just to eating but to fasting also. The authors detail situations where a person suffering from anorexia nervosa would be obligated to eat on a fast day, including Yom Kippur.

Most rabbis will wear out their copies of Hamadrich, The RCA Lifecycle Guide[5], as it is the go-to guide for various lifecycle events. Yet when it comes to mental health and halacha, there is no Hamadrich. And that is precisely the gap that Nafshi BiShe’elati brilliantly fills.

The book deals with every area where mental health and halacha intersect: Shabbat and holidays, marriage, divorce, relationships, prayer, kashrut, and much more.

As the authors live in Israel, they quote heavily on Israeli poskim. Readers will be introduced to poskim such as Rabbis Eliyahu Abergel, Reem Hacohen (Rosh Yeshiva of Yeshivat Otniel), Yuval Cherlow (Rosh Yeshiva of Yeshivat Hesder Amit Orot Shaul), and more.

In many areas, halacha addresses the status of the shoteh, someone not in total control of their mental facilities. The concept of shoteh is a difficult one to define and has been applied in relation to many different cases. The most common uses of the term have been reserved for and most closely describe the clinical phenomenon of psychosis, the state in which the individual lacks the ability to distinguish reality from fantasy.

With that, the book open with an analysis of shoteh, and the different levels it entails, including shoteh gamur, general shtut, shoteh ledavar ehad, and more. Defining what and who a shoteh is not an academic exercise. It can, in fact, have life-and-death consequences.

One is allowed to violate the sabbath for someone as the presumption is that it will enable them to observe many sabbaths in the future. One could argue, although the halacha is not like this, that Shabbat may not be violated to save a shoteh, as it will not bring them to observe more Shabbatot.

While a shoteh is exempt from the performance of mitzvot, the Maharil writes that if a man has a son who is a shoteh, he has fulfilled the mitzva of procreation, as writes that the shoteh has a soul, is a bar mitzva, and those of sound mind are cautioned about him.

The authors quote heavily from the late Rav Nahum Rabinovitch (former Rosh Yeshiva of the hesder yeshiva Birkat Moshe in Ma’ale Adumim). Rav Rabinovitch’s genius was matched by his sensitivity to the human condition.

Rav Rabinovitch believed that the very act of performing a mitzva can preserve a sense of being in good health for the shoteh, so it is important for them to perform mitzvot with or without assistance.

In Rupture and Reconstruction: The Transformation of Contemporary Orthodoxy[6] Professor Haym Soloveitchik writes of the swing to the right, where a significant increase in chumras has had significant consequences for Jewish society and the nature of Jewish spirituality.

When dealing with the halachic needs of those with mental health issues, the authors quote valid halahic sources which show how far right and strict things have become as normative halacha. This includes countless things from running and jumping on Shabbat, having non-Jews play instruments on Shabbat for newly married couples (which was the custom in Ashkenaz during the Middle Ages), certain aspects of mikvah usage for women, and more.

As to mikvah use, women with anorexia suffer intensely whenever they must attend to their body or appearance. Cleaning the body and preparing it for mikvah immersion is not a simple affair for them, as it brings negative feelings about their body, sometimes including disgust, to the surface.

The authors write that it is very important for rabbis answering questions from women with eating disorders to be sensitive to their tremendous difficulties and instruct them to go easy on the mikvah preparations and do only the absolute minimum required by Halacha.

Similarly, the mikveh attendants must be aware when someone has an eating disorder and should respect their privacy and do their best to create a pleasant and relaxed environment for them.

The concept of yeridat hadorot is the belief in the intellectual inferiority of subsequent and contemporary Torah scholarship and spirituality compared to that of the past. Yet when it comes to dealing with those who are deaf, mute, or both; and those with mental health issues, one can certainly say it is aliya hadorot. Our ability today to deal with and integrate Jews with those maladies pales in comparison to how they were handled and treated in generations past.

This is a book of unique erudition on a crucial topic, and Nafshi BiShe’elati: The Halakhot of Mental Health is a remarkable guide that is required reading not just for every rabbi but for everyone. Most of us know someone who has a mental health issue or is just one degree of separation from those who do.

It wasn’t that long ago that those with Down Syndrome were never let out of the house, and those with severe mental issues were lobotomized. Society in general, and Jewish society specifically, has come a long way in terms of mental health and how to deal with it. The book shows how Halacha is more than able to deal with these mental health situations. It’s incumbent on every rabbi and member of the Jewish community to understand how to deal with our brothers and sisters suffering from mental health issues.

This extraordinary book should be read by those looking for a serious and scholarly guide about halacha and mental health, a reference completely dedicated to halacha’s fealty.

[1] http://itlaw.wikia.com/wiki/T.J._Hooper
[2] https://korenpub.com/products/nafshi-bisheelati-halakhot-of-mental-health
[3] https://mnefesh.org
[4] https://machondvir.org/
[5] https://korenpub.com/products/hamadrikh-the-rca-lifecycle-guide
[6] https://traditiononline.org/rupture-and-reconstruction-the-transformation-of-contemporary-orthodoxy/