IN-DEPTH FEATURES
Make a Lot of Laughter Among the Jewish People!-- A Chareidi Approach to Mental Health

The great gaon HaRav Arye Leib Shteinman once told me: "Mental sickness is a lot harder than physical sickness," relates Rav Mordechai Pindrus, head of the organization Misgav in Eretz Yisroel. Part of the difficulty lies in the lack of accessibility to the proper treatment—especially among the chareidi population. This sad state of affairs can cause neglect, lack of proper treatment, and deterioration. In an interview with Rabbi Pindrus we attempted to examine a number of perspectives in the area of mental health which relate to the Torah observant community.

In a small advertisement that was recently published on a regular basis in the chareidi newspapers, the following was offered: "A telephone reply service to coordinate a professional, experienced mental health counselor under the guidance of the gedolim." We telephoned the number, 02- 580-8008, and an amiable man by the name of Motty identified himself at the other end of the line. We asked if we could set up a meeting.

That amiable person, Motty, was none other than Rabbi Mordechai Pindrus from Beitar, who in recent years has made tremendous efforts in the field of chinuch. Pindrus has nurtured hundreds of young people in the chareidi community. Countless families owe him a debt of gratitude for all he has done for their sons under the auspices of various organizations. Today, he is investing all of his energies into the area of mental health.

Rabbi Pindrus arrived at the meeting with a simple Ovos Uvonim briefcase and went straight to the point of our meeting. External niceties are rather foreign to him, although when the need arises he evidently knows how to make use of their charms. He opens the briefcase, I cannot resist a peek inside—perhaps because the subject of mental health has been portrayed as something so mysterious . . .

And this is what I saw there: a blue book called Selected Chapters in Psychiatry, a light-colored booklet called Depression. A yellow book called, Mental Treatment, and others.

"Do those books have haskomos?" I query.

"Obviously not," he replies, "they are secular books. But I once heard from one of the gedolim in regard to psychology, that `You can believe the wisdom of the goyim,' which means that it is worth making use of the knowledge they have in the field to help people. However, we do have to consciously steer clear of improper things in the wisdom of the goyim.

"For example, when it comes to selecting the right doctor, HaRav Yitzchok Zilberstein instructed me as follows: `When you are able to choose between two doctors who are on the same level and one of them is Torah observant, it is preferable to choose that one. But if there is a significant difference in the level of both of them, it is better to choose the one who is more professional.'

"When halachic problems arise, I obviously have to apply to the poskim. In this capacity, I had the zchus to present my questions to HaRav Eliashiv and to be given clear responses."

Let's say someone calls up with a problem, how do you help him?

"First of all I have to find out what he has done about the matter so far, has he already been given treatment, and so forth."

Is he expected to identify himself?

No.

Do the people who call usually identify themselves?

"Ninety percent of those who call do not, and only 10 percent do. It is interesting that among the chareidi community in America the proportion is just the opposite. Ninety percent do identify themselves. Once a father called who was looking for a psychologist for his daughter. I asked him how old she was and he answered, `I phoned to ask you questions, not for you to ask me.' That is how frightened he was of exposure. He apparently thought that he was the only one in the world to have a daughter of that age."

Why does age actually make such a difference?

"Aside from the name of the person, any detail can be helpful and bring me closer to finding the proper solution. I am not embarrassed to add that even a person's origin is important. You see, my whole goal is to find the most suitable counselor for that patient. Unfortunately, in that particular case that I mentioned I was not able to help him because he was not willing to answer even the driest of questions. Without any basic information I was not able to set him up with a suitable counselor."

Rabbi Pindrus is far from happy about those so-called experts who give advice on solving mental problems based on their own ideas. It is permissible, it is necessary, it is even a must to encourage people in difficulty, but it is absolutely forbidden to advise them in sensitive areas where there is only limited understanding of the problem.

Rabbi Pindrus: "The law in this field is also very dissolute. If a person were to invent a method of treatment in the area of physical medicine and then receive patients in the capacity of a doctor, he would be sent to jail. But with regard to mental health, everything is allowed; he can just claim to be an `expert.'

"This problem exists all over the world, and especially among our people where there are so many well-meaning people who want to do good and are convinced that they understand the case. Everyone is sure that he is a psychologist at heart. He thinks since he has been able to solve his own problems why should he not be able to solve other people's?"

And besides, there are some psychiatrists who have given the profession a bad name!

Rabbi Pindrus smiles before responding: "I heard from a very senior psychologist that the reason for this is that the study of psychology is actually the psychological treatment - - but it is cheaper . . . It is true that there have been complaints, people often say to me, `I went to so many of them, and they were no help to me," or, `I have no faith in them.'

"I definitely understand. We have to realize that not everyone who decides to get involved in mental health is necessarily a good, or a wise, or a congenial person. So it is a mistake to make generalizations, and even if a person meets with people like that who, despite all their diplomas, understand nothing about psychology, he has to understand that the problem is with the person and not with the profession."

But what is a disillusioned person supposed to do in the circumstances?

We assemble all this information. That is precisely the reason it is so important for us to hear from the callers about the efforts they have made up till they contact us. There is a certain psychologist about whom we have collected a number of complaints, in terms of his not treating his patients properly. We hold on to this information for future purposes.

So you do actually serve as an information center?

"No, because if that were the case, I would leave the following answer on the machine: For depression, press number 1. For anxiety 2. For obsessive/compulsiveness . . . and so on . . . Really, we offer a personal acquaintanceship with the counselors. I am like a shadchan.

"Tell me, would anyone ever tell a shadchan that he had already checked out a number of suggestions, discovered they were not suitable, and had therefore decided not to get married? Our job is just to find the right counselor. Sometimes the applicant needs an expert who specializes in his particular problem and we direct him accordingly.

"Most of the counselors I send people to are those whom I myself have sat in the chair facing them, because I wanted to check them out and get a feel of what they transmit to their patients. Before I send someone out, I have to know where I am sending him and whom he is going to meet."

When you met the counselors did you find out that any had horns?

"A psychologist is a person just like any other person and does not have horns. One psychologist once told me that people think that he is a prophet; they think he knows everything they did the day before. You have to understand that a psychologist cannot tell the future. He is just a person who has studied various techniques on how to handle difficulties. He has access to these techniques, which differentiates him from someone who just really wants to help out — but does not know how to.

"I would like to point out that psychology today has undergone a most significant turnabout. Today, psychology has moved towards a method known as behavioral therapy, as opposed to the method used in the past known as dynamic therapy. At the core of behavioral therapy is the notion known in educational textbooks as "the heart follows the actions of the body." Psychologists are showing an increasing tendency to adopt this model, in which the patient is given exercises to carry out which facilitate the self-healing that is done under the guidance of the counselor but on his own merits!

"With regard to medication, I would like to explain a few things: the body sometimes needs a certain constituent that it lacks. Quite often a very oppressive problem can be solved with one drug. I once had a talk with a Torah observant, yiras Shomayim counselor who told me: "I do not heal the mind, I tell my patients that only HaKodosh Boruch Hu can heal that. All I can do is have an impact on the healing of the brain, since the greatest researchers show that there are countless feelings and behaviors which originate in the matter that exists—or is lacking—in the mind."

If the subject of medication is so simple, why is people's attitude to it so complex and loaded?

"I heard from a psychiatrist that when he gives out a drug, he is like a person standing next to a prison trying to release a prisoner. He holds a huge bunch of keys in his hands, one of which is the right one — but he does not know which it is. He keeps on trying until he finds the right key to release the person who is locked up.

"Similarly, the counselor tries to find the right constituent that will release the person from his anguish."

But is it not dangerous to try out different drugs?

"HaRav Shmuel Auerbach told me that even though the Chazon Ish was not enthusiastic about people taking medication, today the drugs are different and when a person needs them it is recommended that he take them. We have to consider that the drug companies constantly invest billions of dollars on the development of new medicines and they constantly try to make them so that they will have minimal side effects and, obviously, not be addicting."

In our circles, do people tend to conceal the problems of mental health more than other circles?

"The subject is very murky in all sectors. At a superficial glance, anyone who needs treatment is — excuse the expression — `crazy.' But that is not true."

Why is it not true?

"Everyone has moods like these, and various other ones too. HaKodosh Boruch Hu has implanted in us various defense mechanisms to be able to fight them. In an exactly similar way, we have bacteria that constantly surround us, but the body is immunized against them. At times, the antibodies do not manage to overcome them and then the person falls sick, and has to take medicines to help him get well.

"In the mental realm too, the defense mechanisms sometimes need outside help. So you see, not everyone who needs mental treatment is `crazy.'

"It is also important to distinguish between a mentally ill person and a person who is in need of psychological treatment. A mentally ill person is someone who suffers from an illness that affects his judgment, in contrast to a person who needs psychological treatment but whose judgment is intact. The latter is just disturbed by anxiety, depression, and the like.

"Sometimes, depression is symptomatic of a more serious illness and then it is really crucial to treat the depression to prevent the other illness from developing.

"But I must stress that not every depression is indicative of a mental illness. Sometimes a person can have a genetic tendency towards mental illness, but if he lives a tranquil life the illness might never surface and not affect him or her at all."

Let us go back to our first question. At any rate, it does seem that our community is more embarrassed by the subject, does it not?

"You are correct to a certain degree. In our circles, everyone tends to know everyone else, and so it is easy to become stigmatized."

Are people avoiding taking the treatment even when they need it?

"It is easier for a person who lives with emunah in HaKodosh Boruch Hu to avoid taking the treatment that he needs. He tells himself, `Am I sad? Hashem will help me to be happy!'

"That is certainly true, but the question is, why is it when his ear hurts he does not say, `Hashem will help my ear to stop hurting?'

"For a physical illness he goes straight to a doctor because he knows that a doctor has been given license to heal. So why is it that he does not go for mental disorders? There is another small factor worth mentioning here, that mental disorders often bring with them guilt feelings, which is not the case with physical problems, and this causes people to evade the problem."

Are there support groups in our circles?

"As far as I know, there are none in Israel, but there are many of them overseas. They can be very useful for two reasons. First, the patient and his family come to a realization that they are not the only ones in the world suffering from this problem. When a person suffers alone, it is much harder.

"HaRav Aharon Leib Shteinman told me, `Mental illness is much worse than physical illness.' When I talked about our operation with HaRav Moshe Halberstam zt"l, I said to him, `Ess is doh in tzibbur oychet kranker' (There are sick people in the community, too). The gaon corrected me, saying: `Ess is doh in tzibbur oychet gezunt . . .' (There are healthy people in the community as well). He meant to stress the fact that there are many people lo oleinu who are suffering but each one thinks he is the only one.

"We do have applicants who come from important and successful families, where no one would have dreamed they would ever have to grapple with serious problems in the area of mental health.

"The second reason why support groups are important is that when a person sees another person struggling and being helped, he becomes much more motivated to overcome his own difficulty."

Does a person who has a fear of being in public, and, for example, never takes the amud in davening, need treatment?

"If that is his only problem — and he is willing to forgo that pleasure — there is no reason for him to go for treatment."

And a person who suffers from a slight stammer?

"Does a person who has crooked teeth have to go to a dentist? If his teeth are extremely crooked, then yes. But if they are only slightly crooked then no . . . If the slight stutter does not affect his life very much, there is no need to go for treatment. But if does affect him considerably, then yes, he does need to go.

"In any event, he has to first check if it is not a physical disorder involving the muscles of the mouth, or something like that. That can be checked by a clinical communication specialist. If the specialist rules out this problem, it is worth checking out the psychological angle."

What about someone who suffers from what we call "nerven," (nerves) for example, he does netillas yodayim 71 times and still does not feel "clean"?

"Whenever the situation deviates considerably from normal behavior, it points to a problem. It could be that the problem is still small and then it is much easier to solve.

"There are people who suffer from compulsive thinking. For example, a certain thought sticks in his brain that keeps on recurring over and over again.

"Somebody once called me whose compulsive thought was, `Why did Rashi say thus and thus?' If the thought will not leave him alone, it is worth checking the matter out with someone who specializes in troubled thoughts.

"There are people who suffer from sleep disturbances, from social anxiety, i.e., they are incapable of being among people, they will choose a shul that is far away from their house, etc. There are people who suffer from compulsiveness with regard to cleanliness of the body.

"In connection with all these problems I once heard Professor Avi Weitzmann, a senior psychiatrist, put it like this: Every person has a little of all these disturbances. But they only need treatment when those disturbances disrupt his life.

"At any rate, we should bear in mind that even big problems can be solved by one small medicine. There are highly respected people, who hold high positions and duties, who take the medication and no one knows about it but them. The drugs literally save their lives."

When you recommend that a boy who is in shidduchim take medication, are you taking into account all the connotations of this?

"I see that your question is asked with some irony . . . It is perfectly obvious, of course, that it is easier for a healthy person who takes medication to get married—and run a house properly—than it is for a sick person who does not take medication."

But perhaps there are other solutions, that would not involve the stigma?

"The `perhaps' that you put before the question—is really the answer. It is indeed a `perhaps,' but no one wants his life to depend on a `perhaps.' The principle that applies here is, `if someone wants to change something, the burden of proof is on him.' Conventional treatment has proven itself as effective all over the world. If anyone has a new method to offer, he has to bring proof of it."

Rabbi Pindrus expresses his present goals in words said to him by HaRav Tzvi Meir Zilverberg: "`You should merit to bring more laughter to the Jewish people!' But the final goal is to close the organization — when Moshiach comes and there will be no more clients!"

A Few Words about Misgav Six years ago, Rabbi Alexander Orenstein, together with Rabbi Shia Ostreicher, established the counselling organization known as "Relief" in New York. They wished to open a branch in Israel as well. The organization applied to Mrs. Bistritzky, widower of the well known philanthropist, R' Shaul Alexander Bistritzky, to ask her to sponsor the Israeli branch. And indeed, in the summer of 5764 (2004), a branch of Relief was opened in Israel under the name "Misgav," which is run under the guidance of the gedolim. Unfortunately, access to the appropriate treatment in the area of mental health is sadly lacking, especially in the chareidi community. This sad situation can cause neglect, lack of appropriate treatment and deterioration. As a consequence, Misgav was set up with the aim of directing and accompanying the patient through the process of diagnosis and treatment, giving him backing and support, and making sure he receives the best treatment until his complete recovery. The helping process includes escorting, referring, and aiding both the patient and his family, and helping them to understand and examine the variety of possible methods of treatment. Misgav distributes newsletters about different illnesses, and can supply extra specific products when necessary. Since the establishment of Misgav a year-and-a-half ago, 800 clients have been treated. Its uniqueness lies in the fact that it is an organization that deals only with mental health, and has an extensive and large reservoir of suitable counselors. The organization works on a voluntary basis.

"With Rabbi Shmuel Munk of Bayit Cham People Do Not Know . . . Rabbi Shmuel Munk is known in Bnei Brak as the director of Bayit Cham, which deals with rehabilitation in the area of mental health. (It was profiled in Yated in the Pesach issue, 5764.) With regard to the chareidi perspective in this area, he speaks with uncompromising clarity: The problem of our community is a lack of awareness of the necessity for getting help. Young people who need help are locked up in their homes because their parents fear the stigma. Can parents be blamed for behaving in this manner? HaKodosh Boruch Hu should protect everyone from being tested. But I am trying to influence parents not to deny the situation but to go to Bituach Leumi and get support for rehabilitation. This morning a social worker asked me to find a shidduch for a bochur. I asked her, "And what is going to happen in another two months?" The boy has to be rehabilitated first. What is so bad about staying home with one's parents? When you are closeted in a house you cannot develop and you just stay dependent on your parents or on the government. I get a phone calls every week begging me to help mentally ill people leave the house, but it is not so simple. Why not? When a person goes into institutions, all kinds of halachic problems come up. There are almost no hospitals in existence which have a chareidi department. Then maybe the time has come to set one up? Actually, Dr. Rothschild is working very hard on that matter. He has already opened a chareidi clinic which, in a matter of a few days, will already be hard to get into. There is no awareness, no openness to the subject. I sometimes meet avreichim who, for their own mental health, really have to be doing some work with their hands. But who is Shmuel Munk to speak? He is a `Yekke.' What right has he to speak on the subject of Torah learning? And when I tell this to an avreich he is also afraid of the social repercussions, he will be called an am ho'oretz. And how can he dirty his hands by working? What causes this close-mindedness? In our circles, they are afraid of any connection with people who suffer from mental problems. This comes up especially in shidduchim, but they also have a hard time finding chavrusas. Parents will prevent their children from having any connection with anyone who is considered as having a mental problem. In fact, it is hard for them to find work, too. They simply do not have any work. Today, the community is more aware of the option of employing them, due to the Bayit Cham advertisements. People are already becoming more open to the possibility of taking in workers with mental health problems. But up until recently, employers would say to me: "What are you talking about? I have enough problems of my own! Do I have to support someone else as well?" But the truth is that if things are done in an organized fashion there is no problem employing them. The whole process is supervised and everything goes properly and smoothly. Rabbi Munk ends the conversation on a painful note: "People have no idea what dreadful problems are going on under the surface!"

An Historical Revolution! One person who really sees the positive side is Rabbi Avraham Ravitz who, in his former capacity as Deputy Minister of Welfare, aided Bayit Cham. He told Yated: I can see a veritable revolution in our community in terms of the approach to the subject of mental health. In the past, whenever anyone in our circles suffered from a mental disability — even a small one — first of all, they would keep it hidden. Obviously, the person would not get the treatment he desperately needed, and most certainly he would not get the treatment that would make him function like everyone else. The chiddush here is that not only are people with a mental disability — or a mental weakness — being helped to progress mentally, they are also being made to be as productive as other people, each according to his potential. They are getting satisfaction from the workplaces where they have been placed, as well as from the income they earn independently. All these things together make them feel like they belong in human society.

The tour was arranged under the auspices of Bituach Leumi, which is affiliated to the Welfare Department. Bituach Leumi is not responsible for healing the sick but aids in the rehabilitation funding so that even those who have mental disorders can build independent lives.

The Mental Health Department of Maayenei Hayeshua Hospital Since the opening of the mental health clinic at the Maayenei Hayeshua Hospital in Bnei Brak, two thousand patients have been treated there. Dr. Moshe Rothschild told the Yated: "One thousand of them could have even been helped ten years ago, had there been a clinic in existence that was suitable for the Torah observant community! If it were not for this place, many people would have been too embarrassed and would have preferred to relate to their illness as a punishment and as a kaporoh. They needed a place of Torah, where they would be treated with proper modesty." What is special about the treatment in the area of mental health among the Torah observant community? "In places which are not Torah observant, the psychology is full of apikorsus. It is absolutely dreadful!" Are the counselors that you have Torah observant? "Yes. We have only Torah observant people, but it is definitely a hardship since there are not too many of them around."

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