The Jewish Response to COVID-19

Much has already been said and disseminated about how the Jewish people should be responding to this global calamity. What is the message we are supposed to take from this? What rectification are we meant to enact? What does Hashem want from us?

Obviously, nobody can claim to know the answers to these questions for sure. Fortunately, any teshuva is good teshuva. If you see a message for you in this situation, you should absolutely run with it. Have you been lax in a certain area? (Answer: probably. We all could be doing better in something, right?) Can you work on improving it? If we end up better people as a result of adversity then we are on the right track.

This is of course somewhat less satisfying than having a clear sense of what the message is. This is one of the drawbacks of being without prophets. In our era, we are probably not going to be able to know with certainty what Ratzon Hashem is. I’ve seen and heard a number of attempts at explaining what we are supposed to learn from this situation.

Did we not take tefillah b’tzibur seriously enough, so now it’s been taken away?

Were we not careful enough with the kavod of others, so now we’ve been separated from them?

Was there too much sinas chinam, so now we’ve been isolated?

Did we neglect our family relationships, so now they’re the only ones we can interact with?

Did we fall prey to our taavahs, and therefore we’ve been forced to cease contact with other people?

These are all possible explanations. And the concomitant remedies are all well worth our time. Yes, we should work on our davening. Yes, we have to do better in our bein adam l’chaveiro. Yes, we should put more time and effort into our spouses and children. Yes, we should ramp up our levels of kedusha. Any teshuva is good teshuva. Don’t waste the opportunity!

I do think we have to be careful, however, about some of the peripheral interventions that have been suggested for these failings – segulos, extra tefilos, kabbalistic rituals. I am not by any means suggesting these are not authentic Jewish responses in a time like this. Bigger and wiser rabbis than me have made such suggestions, and I don't mean to disagree with them. However, it is important not to put the cart before the horse.

Saying ketores in the morning is valuable and has a solid basis in mesorah. Reciting extra Tehillim equally so. BUT: these should not be done at the expense of the fundamentals! Namely, if you are pressured for time (and who isn’t these days?), and spending an extra five minutes praying is going to add to your stress level, which will come out on the heads of your family members, it’s not worth it. I think any of the gedolim who have suggested taking on special tefilos or practices would agree with this - not at the expense of the basics of Jewish belief and behavior.

If you can add more tefilah to your day without it negatively impacting your family, go for it. But if you cannot – and that is totally reasonable in this reality – then you don’t need to try. Moreover, you cannot say ketores and tell yourself you're doing the right thing if you're at the same time being nasty at home or cutting ethical corners at work.

I am hesitant to sound like I am contradicting our spiritual leaders. But if I may humbly suggest, I think for many of us (and I include myself in this), focusing and reinforcing the basis is where the focus needs to be as we try to make it through this incredibly challenging time. (And if you have time and energy for extras, more power to you!)

• Remember to daven every day (meaning, for men three times a day and for women whatever you have been accustomed to doing). With schedules upended it’s all too easy to miss one.
• Stay away from inappropriate materials on the internet (including indecent websites and those that peddle in lashon hara).
• Shalom bayis keneged kulam. Put all your extra energy into keeping your cool, being nice to your spouse and children, and modeling for your children how you would like them to behave under stress.

This last point bears further elaboration, because I think it might actually be the most important. If you miss mincha because you are overloaded managing work and kids, there is tashlumin for that. There is no tashlumin for losing your temper because your 3-year-old spilled her yogurt.

Make sure to take some to yourself, even a few minutes a day, to let yourself cool down. If you’re walking around all day on the edge of losing your temper, you’re bound to explode at some point. Recognize that this is an exceptional time in many regards, and your life will not operate like clockwork right now. Accept the imperfectness of the situation.

If you are being nice to your family, davening regularly, and maybe even keeping some semblance of a regular learning seder, you are a hero. You don’t need to fast or say ketores to be doing Hashem’s will here. Those are fine things to take on if you can. But be realistic about what you can and what you can’t take on. Don’t say ketores then go yell at your kids for disturbing you during ketores. One moment of anger can erase all the spiritual benefits of a good psalm reading.

Focus on the cake, and add the icing only afterwards. If you can keep putting one foot in front of the other during these challenging times, if you can meet your basic halachic requirements and display good middos at the same time, then you are doing Ratzon Hashem.

Does Your Therapist Need to Be Frum?

How important is it for you as an observant Jewish person to seek counseling from an observant Jewish therapist? The truth is that while any competent therapist ought to be able to help you with the issues you are facing -  whether it is depression or marriage counseling or anything else - there are certainly benefits to working with someone who is on the inside of your cultural circle. Research in fact bears out that people tend to see the most success in their therapy when they are matched with therapists from their own cultural background. Here are some of the reasons you might be better off with a therapist from an Orthodox background.

You don’t have to explain as much.

Even the best and most understanding counselor, if not already quite familiar with Orthodox practices, will need explanation about the many ways in which what we do is different from what the rest of the world does. Think about trying to explain Shabbos to someone who has never heard of the concept before. “We don't work on Saturday. Every Saturday. Except I don't mean work like you think of work. I mean all kinds of things that are considered, uh, creative labor, like cooking or driving or turning on lights.  Which I know is not really labor, but that's the definition of it. Also, Saturday really starts on Friday, at sundown, and goes until sundown on Saturday. Except not really sundown, actually, when three stars come out. Medium-sized stars.” Hopefully, if you have a good therapist, they won't start looking at you funny just because you are describing a religious system different from theirs - but it still is a lot to explain before you can get to the point of what you even wanted to talk to them about it. With a frum therapist, all that is already understood and taken for granted. It's a lot of time and effort saved.

You aren’t judged on your religious beliefs or behaviors.

Theoretically a therapist is never supposed to being judging you, but one can imagine it might be difficult for someone totally ensconced in Western values to be fully accepting of some of the things we do.  You’re struggling with stress and anxiety and you’re thinking about having more kids? You’re having trouble with your non-frum parents and you still refuse to eat at their house? There are certain values we maintain in the Orthodox world that need to be taken as given; trying to negotiate on whether you really need to eat kosher is probably not a helpful route to take for you. (Note that I am not advocating shutting out one’s parents over kashrus; of course there are many ways to appropriately address the problem(s) described above - but ditching kashrus is probably not one of them for you.)

You don’t have to worry about getting advice that runs counter to halacha.

This also relates to the question of what kind of advice you might get from a non-Orthodox counselor.  This can arise in many different areas - such as a suggestion for an anxious person to be more lax on their halachic standards (which may or may not be appropriate - I am not saying that be lenient is automatically a bad idea), or a recommendation to watch a certain show or movie that may not be appropriate. One topic where this is especially relevant is around issues related to intimacy, where that which is common practice in secular society might be completely forbidden in the Orthodox world. (This is a very delicate topic and requires specific personal guidance, from a rav as well as the right counselor.)

Your therapist just gets it.

Culture is a broad concept that comprises many facets - religion, language, shared history, music, and values, to name just a few.  Nobody can fully understand another culture unless they live it.  And while that level of understanding may not be strictly necessary for a therapist to be able to help you, it sure makes it easier. It also usually makes it more comfortable for clients when they know their therapist has a solid understanding of the issues they are conversing about rather than trying to learn it on the fly.  It’s hard to explain the many shades of meaning and feelings generated by one’s child going off the derech, by a broken engagement, or by a frum person showing up in the news as a criminal. Sharing these experiences with a counselor who understands the nuances of these situations is an added relief and comfort.

There are certainly more advantages to working with a frum therapist; I’ve only mentioned a few. This is not to say that working with someone outside the frum world is necessarily a bad idea. Everything has pluses and minuses, and you have to make the decision that’s best for you.  If you think you’d like to work with a frum therapist - from the comfort of your own home, no less! - feel free to be in touch with me to see if I can be of help in your situation.

When Your Spouse Has a Mental Illness

I recently contributed to the growing Refuat HaNefesh blog, a site dedicated to destigmatizing mental illness in the Jewish world and educating people about it. I lent some insight about my expertise, marriage and relationships, to this particular topic.  Check it out here.

The Experience of Depression

I am working with a client who is struggling with severe depression. With her permission, I am
posting a poem she wrote this week that I think powerfully depicts the experience of a depressed person.

I'm sitting in a room that's full of people,

But to me there could be not a soul. 

I feel so lonely, don't know what to do,

No one understands, no one to talk to.

I have no energy to reach out, no reason to try,

Why is this happening to me, why oh why.

I'm not good at anything, have no skill to my name,

Nothing good will happen to me, ill never get fame.

I'm completely hopeless and also helpless,

Bottom line is i'm totally worthless.

No matter how many hours i sleep,

To function is no easy feat.

My concentration is extremely poor,

I have negative thoughts that don't exit the door.

I need to diet, i'm so very fat,

If i stop i don't know what my weight will be at.

I have no interest in any daily activity,

Or when anyone says "come with me".

There's nothing worth living for in life,

 But don't worry i'm not using a knife.

Everyday i always feel so ill,

It doesn't work to take any pill.

There's so much stress and anxiety too,

I cant work, don't know what to do.

I feel guilty about everything that happens,

If i get over it, always depends.

Of things that happen i always get a scare,

I cant be calm, there's always a fear.

I'm nauseous and also very dizzy,

Who knows what will be with me.

I hate to be with other people,

They are always so judgmental.

I lay in bed constantly thinking,

Trying to sleep, twisting and turning.

I guess i have to take initiative,

To call a therapist if i want to live.

This is a very stressful first step to take,

To think about it gives me a headache.

I finally got the courage to make the call,

And let me tell you it was not a ball.

But now that i started therapy,

Some changes im seeing very slowly.

I finally started my medicine,

Not to take it will be a sin.

One day maybe ill get to a support group,

To get there ill have to go through a big loop.

Eventually ill act and function normally,

Which will be great for you and for me.

Ill be able to go places alone,

Without constantly checking my phone.

Within myself ill feel comfortable,

I wont feel so alone and dull.

Ill be able to laugh and also to cry,

It will be natural, i wont have to try.

For all this to happen i really cant wait,

Because i'm definitely not in a good state.

All this will happen and some more,

I don't even know what there is in store.

Ill have friends and people will like me,

It will be good, just wait and see.

Ill be able to daven and be a better jew,

And be zoche to Mashiach bemiheirah biyameinu!

The last few stanzas in which she expresses her hope is a testament to progress she has made in therapy. These would not have been there a few weeks ago.

A Dog Named Depression

This short video offers a fantastic perspective on what it's like to be depressed.  If you think you might have depression, check this out, and recognize that you are not alone.  You can reach out for help, and things can get better.

If you are not suffering from depression, this video will give you a better idea of what it's like to go through it.  This can be especially helpful for friends and family of people with depression

Ten Tips for Raising Sexually Healthy Orthodox Daughters

And here's another article sent to me by a friend that address the women's side of sex ed in the Orthodox community.  Also well stated.

http://blogs.timesofisrael.com/10-tips-to-raising-sexually-healthy-orthodox-daughters/

Happiness 101

I thought this video had a number of very helpful ideas.  Tal Ben-Shachar is one of the leading figures in Positive Psychology today (and, interestingly enough, he's Israeli).

Back to the Grind

Okay, we are back from our extended break over Pesach and Chol HaMoed. I hope your holidays went reasonably well and that you are refreshed to get back to your regularly scheduled broadcast instead of drained.

The truth is that the holidays tend to be stressful times for many. Jewish social service agencies often report an uptick in calls from people seeking help around this time.  If you need to get some stuff off your chest, or want to do some couples or family work (in-laws, anyone?), be in touch and let me know how I can help you!

Mental Illness in the Jewish Community

This article came out recently in the New Jersey Jewish Standard, and I think it is absolutely right on the money.  It's called, unabashedly, "I Have Bipolar Disorder." Take a look.
http://jstandard.com/content/item/i_have_bipolar_disorder

A Beautiful Mind

And now, for the lighter side of psychotherapy... here's a thought I recently had: there seems to be an awful lot of mental illness in "Beauty and the Beast" (over and above, of course, the whole Maison des Lunes number):

• Belle: Stockholm syndrome
• Beast: Intermittent explosive disorder, possibly Asperger's disorder
• Belle's father: dementia
• Cogsworth: obsessive compulsive personality disorder
• Lumiere: possible sexual addiction
• Gaston: narcissistic personality disorder
• LeFou: dependent personality disorder

Did I miss any?

Mental Illness - Rules of the Game

I just read a brief review of The Book of Woe, a critique of the DSM-V (the latest edition of the Big Book of Mental Illnesses that mental health professionals use to categorize disorders and people). It contains the following apt description:

The basic message is this: everyone in the mental health profession knows full well that the DSM is a work of fiction—that the hundreds of “disorders” described therein are just labels for fuzzy, overlapping clusters of symptoms and that we have never found a definitive biological marker for even one of those disorders. Mental health professionals pretend that the disorders are real, but they're not, period.

I have long maintained openly that the categories laid out in the DSM are made up and not very useful for actually helping the people who suffer from the disorders therein.  The only part I disagree with above is that "mental health professionals pretend that the disorders are real" - because I am a mental health professional, and clearly, I don't. Nonetheless I am forced to play along with the labeling system because unless you have an "approved" disorder, your insurance probably won't pay for your therapy.  Stressed out because of your boss, your significant other, your children? Major depressive disorder (probably unspecified type).  Worried about your financial situation?  Marital trouble? Generalized anxiety disorder.  Does everyone who gets these diagnoses meet all the criteria? Unlikely - but if you want coverage, you have to play by the insurance companies' rules, which thus far still include the DSM's fiats. (I must confess to being ignorant of the rationale for the insurance companies' approach, but I imagine it has to do with practicality over precision - see below.)

I think it is important to note, however, that the DSM and its labels are not entirely useless.  Firstly, diagnoses help somewhat with being able to identify clusters of symptoms as representative of a certain disorder which thus requires a certain treatment.  You don't do cognitive-behavioral work with psychotic disorders; if someone appears to have borderline personality disorder, dialectical behavior therapy is the only treatment that has demonstrated any effectiveness. 

Likewise, categories are helpful for research purposes.  If we want to know what has been effective for people who are struggling with exaggerated worry, we need some definitions in order to study what sort of treatment yields the best results.  The problem is that the categories often become gospel. Many or even possibly most people with anxiety problems might respond to treatment X, but certainly not all of them will.  People, after all, are people - no two alike.

As an on-the-ground practitioner, I use the labels to satisfy the insurance companies; but I am in agreement with the author of this book that by and large, the whole approach is something of a farce.

Change

http://www.thedailybeast.com/newsweek/2012/12/16/oliver-burkeman-on-failed-new-year-s-resolutions.html

I liked this article. It highlights the fact that change does not result from a simple decision to change, but rather requires a more protracted schedule of working on it.

How Depression Sees It

Just ran across this article called "How Depression Sees It: The Woman Who Gave Birth in a Tree" which offers an authentic description of what it's like to have depression.  Those of us who do not suffer from this illness have a hard time understanding what it's like, which is why articles like this are useful to sensitize us to the anguish of those who do, to help us get it.

Another good resource for this is the acclaimed book Darkness Visible: A Memoir of Madness, by William Styron, in which he takes us through his own experience of severe clinical depression.  Both of these make for fascinating reading, and will broaden your mind to gain some insight into what the suffering is really like for people with depression.

Destigmatizing Therapy (continued)

A friend of mine in Houston, Texas contacted me in relation to the article I published on destigmatizing therapy.  She is working with a frum family whose daughter is suffering some kind of attention disorder.  In order to proceed with therapy, she had to contact the girl's high school, but the family was reluctant to allow her to do so, since they did not want the school to learn about their child’s disorder and treatment.  It is not clear whether they were doing so out of embarrassment and shame over their daughter's condition, or out of fear of potential consequences from the school administration, which itself may have prejudices and biases regarding mental illness.

 

This seems to echo the dilemma I brought up in the article, namely, on one hand a therapist is bound to protect client confidentiality; on the other hand, the therapist does not want to reinforce the idea that there is anything to be ashamed about.

 

Not an easy problem to solve.

 

Refa'enu

I just found out about another very useful online resource: a yahoogroup called Refa'enu, a support group for members of the Jewish community and their loved ones who face the challenge of living with a mood disorder. Check it out at http://health.groups.yahoo.com/group/refaenu.