Dear Shadchante,
You had a lot of guts to discuss emotional stability. It
would greatly benefit the public if you would further open
the discussion to include mental health and
shidduchim. I know every situation is different and
great poskim must be consulted but... Is there any way
of writing a Layman's Guide to what may be related re mental
health problems?
I know these topics are VERY SENSITIVE, but the issues are
burning and the disinformation is ruining many lives; many
families are being broken up because of purposeful
disinformation/lack of honesty, etc. On the other hand, non-
professional and inaccurate stereotypes abound which make
shidduchim a mine field for people with mental health
problems and for their families....
Along with all your other blessed activities, I think this
would be the most important /albeit most difficult type of
topic to handle. If you ever write a book on Shidduchim, I
think that if this topic is dealt with in your wonderful,
thorough and interesting manner . . . then the book will be
a best seller...
I am pretty sure that many would agree.
Thanks
R. S.
Answer:
Dear R.S.,
The disease no one talks about — To develop further a
past Yated published article on emotional stability, I
feel that mental health cries for its own space. Few subjects
are so misunderstood and its sufferers so ostracized. The
fear to tackle the subject leads to all kinds of illogical
conclusions about mental health. The statistics are high;
nevertheless, the lack of information and prejudice is
rampant.
Doing research for this article, I came across the title,
"The disease no one talks about," referring to mental
illness. The stigmas and fears associated with psychiatric
disorders stem from lack of information and ignorance. By
nature, the fear is exacerbated by its subjectivity; for less
is known about the function of the brain than of other
organs.
Definitions The basic description of functional
impairment is measured by inability to perform certain
routine or basic daily tasks. Signs are what objective
observers can document; symptoms are subjective to warning
signs that there are deviation standards. Mental health is
much more than the absence of mental illness. It is about
physical and emotional well-being, about having the capacity
to live a full and creative life and also the flexibility to
deal with its problems. On those lines, due to the complexity
in the fields of thoughts, alterations in thinking, moods,
and behavior, diagnosis of a possible unsteadiness is based
on collective severity and occurrence of certain symptoms.
Therefore, with the understanding that mental disorders are
not the result of moral failings or limited will power, but
legitimate illnesses that are responsive to specific
treatments, much of the negative stereotyping would
dissipate.
Mental Illness in the Religious Community
The issue is not new to the observant. Chassidic sources for
example, address despair in a way that resonates strongly
with those who have experienced depression. But there seems
to be a lack of guidance to encourage the use of the latest
medical advancements in the field and seek professional
assistance.
The frum world cannot deny that we also suffer from
it, albeit in a different dimension. Making it taboo to
discuss the subject will only feed denial. Certain community
segments have been making a marked effort to give broader
public awareness. In fact, an Orthodox mental health
conference in New York, sponsored by several synagogues,
attracted roughly 450 people, including mental health
professionals, rabbis and lay people. The speakers at that
conference pointed out that there are specific difficulties
with the issue in the Orthodox community. "First is denial,
which leads to a sense of shame and secrecy among those
facing psychiatric disorders, leaving them in dangerous
isolation." "Don't tell anyone," Rabbi E. related at the
conference. "Pretend it wasn't mental illness. Make it sound
like a thyroid condition." The feeling of disgrace makes one
and his family renounce the help so desperately needed and
even forgo possible roads of recovery! There is a panic of
being different from the rest, of being labeled "crazy," a
social outcast. "And then who will want to play with my
children? Who will want to hire me?"
Stigma erodes confidence that those disorders are medical and
can be treatable. Blowing the situation out of proportion
makes the burden even heavier then it really is! It seems
that taking action and seeking treatment would mean assuming
an unacceptable label and making the condition public! Some
negate the condition by hiding behind an exaggerated
compulsion on religious externals. This overly intense
fervor, almost like fixation, promotes that over indulging in
rituals will solve all problems. It can lead to "masking"
obsessive-compulsive behavior (OCD), for example, which is
mistakenly regarded as acceptable because it takes the form
of observance, said a Rabbi of a well-known congregation.
"When I was in college, I put on tefillin five times a
day," he said. "I was obsessive. Sometimes you'll see a young
man standing in front of a mirror adjusting his
tefillin just so, for 15 or 20 minutes or more. Or
washing his hands over and over. That should tell us that
something is wrong."
Another unfortunate example is the masmid husband so
caught up in his learning who excuses himself from any family
time. Such a 24-hour-a-day involvement exempts him from
responsibilities of interacting at all with his wife and
children at the cost of their happiness and healthy bond.
Along the same lines, there are also those who are obsessed
with chesed. Being occupied in community issues in an
all-compassing, obsessive manner, should not be at the
expense of one's family. Such people might give over their
idealistic energies to society with an extremely taxing
schedule but forget even the most basic family needs. We all
know the expression that charity begins in the home.
Mitzvah observance requires balance and knowing what
to do when; rather than following an immature drive.
"Shidduch Factor"
The "shidduch factor" remains another serious obstacle
to the treatment of psychiatric illness. The lives of single
adults and their families' lives are scrutinized by the
families of potential suitors. A mental illness is thought to
stain the reputation of even an extended family. "Many
families are so obsessed by shame and concern for `what
people will say' that they neglect to give this individual
the treatment he requires and allow him to be literally
buried in his misery. Their concern for shidduchim of
their other children causes them to overlook the needs of
this wonderful member of the family, and they willingly
renounce their rights to government support which is sorely
needed for his rehabilitation (article about mental illness,
Yated, March, 2004)."
On those lines, an observant psychiatrist sadly recognized
that "Abject paranoia abounds in the community when
shidduchim are at stake. I`ve been asked to write
prescriptions for patients using false names and to lie to
insurance companies — all in an effort to conceal
information that families feel will condemn them to second or
third class shidduchim."
Rav Shach has been quoted in various contexts regarding the
importance of letting people know about the mental health of
a candidate. We do not want to harm someone who is ill, but
if the truth is covered up, in the end it explodes in the
face of all concerned, and there is a lot of friction in the
marriages made under false pretenses which often lead to
dissolution of the marriages. Many people suffer from the
repercussions — most of all the mentally unwell who are
usually dumped in a most public way. It not uncommon for
sufferers to hide their problems from their future spouses
before marriage. The problems then usually erupt after the
person is 'safely' married and the partner must pay the
penalty. The marriage may be jeopardized. Or at least there
will be a serious breach of trust and understandable
resentment for being misled. Obviously, when to reveal and
how to present the case calls for a halachic query from a
very knowledgeable experienced posek.
Risks
A research scientist who has published a number of studies
about various facets of mental illness wrote that in order to
protect themselves, many people end up downplaying their
illness, making believe that it's not so bad . . . The
individuals affected by such conditions describe them as
"light" and "well" or "successfully" managed.
There are real and legitimate issues to be grappled with when
someone is already known to have a serious condition, even if
it is currently "mild." Each case has to be handled on its
own merits, which our world doesn't seem to be particularly
proficient in doing these days.
I know a divorce which was mostly based on the fear the wife
had of a certain diagnosis. I am not sure if she even
consulted the husband's doctor, but was only alarmed by
general data gathered on the disease.
On the previous case, he was willing to give permission to
the psychiatrist to show her medical records and answer her
questions. It is a good sign when the patient is open to
reveal all the information. Otherwise, suspicions could paint
a picture worse than the actual reality.
Even when there is a diagnosis, each case has its own make-
up. Just as someone can suffer from mild headaches and find
immediate relief from a simple aspirin, other such pains can
be severe and incapacitating.
Some mental illnesses are caused by a chemical imbalance,
when the brain neurotransmitters have a faulty function. In
addition, genetic predispositions are also factors depending
on heredity risks such as a diagnosed relative with
symptoms.
One of the main components to inquire about is the severity
of the case. The medical history will indicate the age of
onset, degree of incapacitation during a crisis, mode of
recovery, response to medication and therapy. Depending on
the tendency for the illness, sometimes proper treatment can
minimize the dangers. All those factors are interrelated.
Psychological trauma or environmental stressors also trigger
certain behaviors. Therefore past and present records picture
the general outline. But there are also prognostics . . .
Although the future is unpredictable, many conditions will be
exacerbated by regular stresses of marriage, pregnancy, child
rearing, work, daily responsibilities etc. Even when certain
drugs keep the situation under control, hormonal pregnancy
imbalances and the delicate nurturing of a fetus will
complicate the treatment.
There are a considerable percentage of patients who, with
medical help and the right medication, can lead such a normal
life that we couldn't even discern anything different or
abnormal in their behavior. In fact, an Orthodox doctor told
me that even in our community there are a high percentage of
people taking tranquilizers to dull the edges of very tense
lives. Readiness for marriage requires stability. The patient
must be under competent supervision and have professional
backing that projects the feasibility of marriage. At the
same time, the indispensable rabbinical advice can offer much
needed guidance. For even in the most simple of cases,
halachic issues will certainly arise.
Rebbetzin Travis has many years of experience and success
in helping people through shidduchim. Any comments,
questions and stories can be sent to: dytravis@013.net or at
(02) 656-3111
