Saturday, February 9, 2019

Mental Health and Mitzvot: A Source Sheet

Yes, I know I haven't posted here in forever. It's not for lack of things to say...

In any case: I'm scheduled to give a shiur this Monday evening on "Mental Health and Mitzvot". Specifically, I expect to look at four ways in which halachah addresses mental illness as a reason for exemption from the Torah's obligations. Because I'm including some material which people may not be familiar with, I thought I would post the source sheet here, for those who still frequent these cobwebbed webpages. I expect to post a recording of the shiur on YUTorah.org.


Cases
(1)   Susan, age 14, is undergoing nutritional rehabilitative therapy for life-threatening anorexia; her treatment team helps her develop healthy eating habits through regular meals, while she works on her underlying emotional issues. Yom Kippur is coming; must Susan fast?
(2)   David, age 55, has been in counseling for 30 years for anxiety attributed to lifelong emotional abuse by his father. The abuse was largely verbal, through criticism and insults, from early childhood through the present. David’s father passes away; is David obligated to sit shivah?
(3)   Samantha, age 25, is hospitalized with schizophrenia; her doctors believe that her delusions place her at risk of self-harm. Is Samantha’s family obligated to arrange kosher food for Samantha?
(4)   Avraham, age 18, experiences severe OCD, with a particular manifestation in the area of prayer. He cannot complete key lines, like the Shema, without hesitation and repetition which drag on for more than an hour at a time. During the treatment process, Avraham’s psychologist would like to try ERP, instructing Avraham to recite prayers just one time, even if the pronunciation or level of concentration are halachically inappropriate, and keep going. Is this acceptable?

Argument 1 for Overriding Halachic Imperatives: Halachah Endangers Health
1.   Talmud, Taanit 22b; Rashi’s commentary
יחיד שנרדף מפני נכרים או מפני לסטין ומפני רוח רעה על כולן יחיד רשאי לסגף את עצמו בתענית
מפני רוח רעה - שנכנס בו רוח שידה, ורץ והולך, ושמא יטבע בנהר או יפול וימות.
If someone is pursued by non-Jews, bandits or ruach raah, for any of these someone [else] may cause himself suffering by fasting [on Shabbat].
Rashi: The spirit of a sheid enters him, and he runs about; [one prays] lest he drown in a river or fall to his death.

2.   Rabbi Moshe Feinstein (20th century USA), Igrot Moshe Yoreh Deah 2:59
אולי יש לדון מצד מחלתו אם יאמרו הרופאים שיש בזה ענין פקוח נפש, כגון דעלול מזה להרוג את עצמו באם יהיה לו איזה צער, או דיעבור על דברים שאסורים גם בדיני המדינה ולא ישמע להפאליס ויריב עמם עד שיבא מזה שיהרגוהו, או שיאמרו דעצם המחלה היא סכנה שבאה לו מקלקול שבמוחו וא"א לרפאותו אלא במקום ההוא
Perhaps there is room to debate regarding his illness: If doctors were to identify a life-saving issue, such as that he might respond to pain with suicide, or that he might violate civil law, not listen to the police, and resist such that they might kill him, or that the illness itself is dangerous such that his brain is damaged, and he can only be healed there…

3.   Rabbi Moshe Feinstein (20th century USA), Igrot Moshe Even haEzer 1:65
באשה שנשתטית אחר הלידה בשני הילדים שהולידה והרופאים אסרו לה להתעבר אם יש להתירה לשמש במוך י"א תמוז תשכ"א.
הנה ודאי צדק כתר"ה ששטות הוא ענין סכנה לא רק לעצמה אלא גם להילדים הקטנים שאף מי ששטותו אינו לעשות רע, אפשר להתהפך שתרצה לעשות רעה לעצמה ולהילדים ח"ו ואי אפשר להעמיד שומרים על זה. ולכן יש להתיר לה לשמש במוך...
Regarding a woman who became insane after the birth of her two children, such that the doctors forbid further pregnancy. May she use contraception?
Certainly, his honour is correct; insanity is dangerous not only for herself, but also for her small children. Even one whose insanity does not currently incline toward harm could still change, wanting to harm herself or her children, Gd forbid, and one cannot stand guard for this. Therefore, one should permit her…

4.   Rabbi Isser Yehudah Unterman (20th century England, Israel), HaTorah v’HaMedinah 4 pp. 26-27
ובהעמק שאלה מפרש כי פלוגתתם תלויה בפלוגתת בן פטורא ורע"ק... ונפלאים בעיני הדברים מאד, כי אי אפשר לומר דכאן מיירי בסכנת נפש ממש שהאחרים ימותו בצמאון, דהאיך יתכן הדבר שר' יוסי יאמר כי כביסתן קודמת לחיי אחרים? ואעפ"י דערבוביתא דמאני מביאה לידי שעמום, מ"מ אין זה כלל וכלל בגדר סכנה קרובה ולא נחשבה אפילו לספק סכנה אלא לדבר שיכול להסתעף ולבוא לסכנה...
And in Haameik She’eilah he explains that their debate depends upon the debate of Ben Petura and Rabbi Akiva [regarding choosing between saving one’s self and saving others]… This is very shocking for me, for one could not say that this case involves actual danger to life, that the others would die of thirst! How could Rabbi Yosi say that their laundry precedes the survival of others? And even though dirty clothes can trigger depression, still, this is not at all “imminent danger” and it is not even considered potential danger, but something which could evolve into danger…

5.   Rabbi Moshe Sofer (18th century Pressburg), Chatam Sofer Orach Chaim 83
מ"מ בהא סלקינן דלרוב הפוסקים משמע בפשיטות דבמה שמעמידו אצל נכרים אינו כמאכילו בידים... א"כ הכי שרי ובתנאי שכשיגיע לבן י"ג שנים ויום א' יוציאוהו משם עכ"פ.
Still, we conclude that from most authorities it seems clear that keeping him with non-Jews is not the same as personally feeding him [non-kosher food]… If so, one may do this, so long as they remove him when he reaches 13 and one day.

6.   Rabbi Yechiel Michel Epstein (19th-20th century Lithuania), Aruch haShulchan Orach Chaim 320:26
ודורס האדם שלג ברגליו ואינו חושש ואף על פי שלא ימלט דדרך דריכתו נימס מעט שלג מ"מ כיון דזהו דרך הלוכו לא שייך לאסור בזה וא"כ נהיה סגורים בבתינו כל ימי החורף ולא גזרו בזה...
One may trample snow without concern, even though some snow must melt when he walks. Still, since this is the way of walking, prohibiting this is not relevant; we would be locked inside all winter, and they did not make such decrees…

7.   Rabbi Ovadia Yosef (20th century Israel), Yabia Omer 3:Yoreh Deah 23
ראיתי להגרא"י אונטרמן שליט"א בשבט מיהודה (עמ' שיד) שאחר שחילק בין סומא לנכפה כאמור כתב בזה"ל, שוב התבוננתי כי אין לחלק בין זל"ז ויש סכנה ממשית גם לסומא, ולכן מקרי פקוח נפש לרפאתו מעיורון, משום שלא יתכן שהסומא ישב תמיד בבית, וכשעובר ברחוב אורבות לו סכנות שונות, וגם צריך לעלות ולרדת במדרגות ואין הסכנה נמנעת...
I saw that Rabbi Isser Yehudah Unterman wrote the following, after distinguishing between [the levels of danger involved for] a blind person and an epileptic: I then thought that one should not distinguish between them, and there is substantive danger for the blind person as well, such that healing him of blindness would be called 'saving a life'. It would be impossible for the blind person to stay at home eternally, and various dangers would lie in wait for him on the street. Further, he must ascend and descend stairs, and danger is not absent…

8.   Rabbi Yitzchak Weiss (20th century England, Israel), Minchat Yitzchak 4:8:2
אמנם נתעוררתי מת"ח גדול אחד, דאם מניעת התפילין יוכל לגרום צער להחולה, שנפשו עגומה עליו, לאיש ירא וחרד, על האי אפשרות לקיים מצוות תפילין, וחושש שלא להיות בכלל קרקפתא דלא מנח תפילין ח"ו, וחלישת הדעת הזו, תוכל לפעול ג"כ חלישת בהבריאות של החולה, אז יש להקל להביא עמו התפילין, - והראה לי שכה"ג כתב לו הגה"צ מליובאוויטש שליט"א, בנדון חולה אחד, שהי' שאלה בדבר אם מותר לו להתפלל וללמוד...
In truth, a great scholar pointed out to me that if withholding tefillin could pain the patient, as he is depressed about [missing] the chance to don tefillin, and he is intensely Gd-fearing, and he is concerned about being in the category of “the head that does not don tefillin”, Gd forbid, and this depression could catalyze weakness of the patient’s health, then one may be lenient to bring tefillin with him. And he showed me that the Lubavitcher Rebbe wrote thus to him regarding a patient where there was a question of permitting him to learn and study…

Argument 2 for Overriding Halachic Imperatives: Halachah Imposes a Great Burden
9.   Talmud, Berachot 19b-20a
אמר רב יהודה אמר רב המוצא כלאים בבגדו פושטן, אפילו בשוק. מאי טעמא? אין חכמה ואין תבונה ואין עצה לנגד ד' - כל מקום שיש חלול ד' אין חולקין כבוד לרב.
מתיבי "קברו את המת וחזרו, ולפניהם שתי דרכים אחת טהורה ואחת טמאה, בא [האבל] בטהורה באין עמו בטהורה, בא בטמאה באין עמו בטמאה, משום כבודו," אמאי? לימא אין חכמה ואין תבונה לנגד ד'! תרגמה רבי אבא בבית הפרס דרבנן...
Rav Yehudah said, citing Rav: One who finds shaatnez in his own garment should remove it, even in the market. "There is neither wisdom nor understanding nor counsel opposite Gd (Proverbs 21:30)" – where there is desecration of Gd, we do not give honour to the great.
But we have learned, “After burying the body, when returning, if they have two paths, one tahor and one tamei, if [the mourner] takes the tahor path then they escort him on the tahor path, if he takes the tamei path then they escort him on the tamei path, for his honour.” Why? Cite Proverbs 21:30! Rabbi Abba explained: This is a beit hapras, which is only impure rabbinically.

10. Rabbi Yisrael Meir Kagan (Chafetz Chaim, 19th-20th century Poland), Shaar haTziyun 322:12
עיין בפרי מגדים שמצדד דהוא הדין דמותר לקטום הקיסם ביד כדי לחצות בו שיניו אם אי אפשר לו לחצות בו בלא זה, וכפי מה שכתבנו מקודם דקטימת הקיסם ביד הוא רק משום שבות
See the Pri Megadim, who contends that the law permits cutting the splinter by hand to pick one's teeth where he has no other way to pick his teeth. It is as we have written, that cutting the splinter by hand is only rabbinically prohibited.
11. Rabbi Moses Nachmanides (Ramban, 13th century Spain), Laws of Niddah 9:25
ומדיני החציצה לא טוב היות האדם מחמיר יותר מדאי ומחפש אחר הספיקות לפסול טבילתה בדבר הקל, כי אם כן אין לדבר סוף... לא יכניס אדם ראשו בספיקות החמורות אשר אין להן קץ וסוף.
With the laws of chatzitzah, one should not be overly strict, seeking doubts with which to disqualify immersion for minor matters. There would be no end to this… One should not insert his head into serious doubts, which are interminable.

12. Talmud, Moed Katan 27b
ואמר רבי יוחנן הכל חייבין לעמוד מפני נשיא חוץ מאבל וחולה.
Rabbi Yochanan said: All must rise for the nasi, other than a mourner or one who is ill.

Argument 3 for Overriding Halachic Imperatives: The Patient is Exempt
13. Talmud, Chagigah 3b
תנו רבנן: "איזהו שוטה? היוצא יחידי בלילה והלן בבית הקברות והמקרע את כסותו." איתמר רב הונא אמר עד שיהו כולן בבת אחת. ר' יוחנן אמר אפי' בא' מהן. היכי דמי? אי דעביד להו דרך שטות אפילו בחדא נמי! אי דלא עביד להו דרך שטות אפילו כולהו נמי! לא, לעולם דקא עביד להו דרך שטות... כיון דעבדינהו לכולהו הוה להו כמי שנגח שור חמור וגמל ונעשה מועד לכל. אמר רב פפא אי שמיע ליה לרב הונא הא דתניא "אי זהו שוטה זה המאבד כל מה שנותנים לו" הוה הדר ביה. איבעיא להו כי הוה הדר ביה ממקרע כסותו הוא דהוה הדר ביה דדמיא להא, או דלמא מכולהו הוה הדר? תיקו.
“Who is a shoteh? One who travels alone at night, and who sleeps in a cemetery, and who tears his clothing.” Rav Huna said: One who displays all of these at once. Rabbi Yochanan said: Even one of these behaviours.
But what is the case? If he acts apparently irrationally, even one [act] should suffice! If he does not act irrationally, even all of them would not suffice! No; this is where he acts apparently irrationally, but one could explain [each symptom in a rational way]… Once he performs all of them, it is like an animal that gores an ox, a donkey and a camel; it is now identified as dangerous for all.
Rav Pappa said: Had Rav Huna heard the lesson, "Who is a shoteh? One who destroys that which people give him," he would have recanted.
Does Rav Pappa mean he would have recanted from listing the trait of tearing his clothing because it is similar, or that he would have recanted from all of them? This remains unclarified.

14. Rabbi Yosef Karo (16th century Israel), Beit Yosef Even haEzer 121
ולכאורה היה נראה דחד מהני ארבע דתניא בגמרא בעינן ליחשב שוטה, אבל אי עביד שאר דברים אחרים דרך שטות אכתי בחזקת שפוי הוא... אלא דמדברי הרמב"ם שלא הזכיר דברים הללו אלא סתם וכתב "שנטרפה דעתו וכו' בדבר מן הדברים" משמע דהני ד' דברים השנויים בברייתא לאו דוקא אלא לדוגמא נקטינהו והוא הדין לשאר דברים. ונראה שהכריחו לפרש כן מדחזינן דבברייתא קמייתא קתני תלת ולא קתני "מאבד מה שנותנין לו" ובאידך ברייתא קתני "מאבד מה שנותנין לו" ולא קתני אינך תלתא...
It would appear that one of the four behaviours mentioned in the Talmud would render a person a shoteh, but performing other irrational acts would leave a person in his presumed status of sanity… but from the Rambam, who did not mention these acts and only said, "one whose mind is torn… in some matter," it sounds as though the four items taught here are not specific, and are only examples, and other behaviours could also do it. It appears that he was driven to state thus from the fact that the former source listed three behaviours and did not list "destroys that which people give him," and the latter source listed "destroys that which people give him" and did not mention the other three…

15. Rabbi Moshe Feinstein (20th century USA), Igrot Moshe Yoreh Deah 4:29
הנה ודאי איכא חילוק בין שוטה ובין פתי ביותר (עי' בזה מש"כ באגרות אה"ע ח"א סימן קס"ד לעניין חליצת פתי ביותר) - ששוטה לא תלוי בכשרונות הבנת דברים ועניינים. דאף בעלי כשרון להבין הדברים, אפשר שדעתם תהא משובשת ומטורפת, והיינו שיודע ומכיר שאיכא חילוק בין הדברים שרואה, אבל הוא טועה בדמיונו ומתחלף אצלו הדמיונות בזמנים קצרים מאוד...
Certainly, there is a difference between a shoteh and one who is exceptionally unintelligent – for being a shoteh is not about powers of understanding his affairs. Even one who is able to understand matters may have a confused, torn mind, meaning that he knows and understands that there are differences between the things he sees, but he errs in his delusions, and his delusions change in very brief periods of time…

16. Rabbi Yosef Karo (16th century Israel), Shulchan Aruch Choshen Mishpat 35:8
שוטה, פסול. ולא שוטה שהוא הולך ערום ומשבר כלים וזורק אבנים בלבד, (אלא) כל מי שנטרפה דעתו ונמצאת דעתו משובשת תמיד בדבר מהדברים, אף על פי שהוא מדבר ושואל כענין בשאר דברים, הרי זה פסול, ובכלל שוטים יחשב.
A shoteh is disqualified [from testifying]. This is not only a shoteh who wanders without clothing and breaks implements and throws stones, but anyone whose mind is torn, so that his mind is confused perpetually on some matter, even though he speaks and inquires on point in other areas. He is disqualified, and considered a shoteh.

17. Rabbi Moshe Sofer (18th century Hungary), Chatam Sofer Even haEzer 2:2
הנה לדון בדיני השוטים א"א כ"א בראיית עיני הדיין המבין מה טיבו ומהותו וא"א לברר בכתב מה ענינו וטבעו ומהותו וכמ"ש הרמב"ם פ"ט מה' עדות ואין לדיין אלא מה שעיניו רואות
Judging in the matter of shotim is impossible other than through the eyes of a judge who understands his nature. One cannot clarify his nature in writing. As the Rambam wrote), "The judge only has what his eyes see."

18. Rabbi Baruch Frankel-Teomim (18th-19th centuries Galicia, Moravia), Ateret Chachamim, Even haEzer 18
ומה שרצה כבוד מעלתו להמציא שאם השטות מצד חולה מרה השחורה שאנו קורין מלאנקאלי אינו בכלל שוטה, לא מחוור, דתחת שם מלאנקאלי הוא גם משוגעים גמורים, כאשר ידוע לאשר יש לו ידיעה קצת בספרים המחוברים בזה... וממילא אם הגיע האדם בעל מלאנקאלי להתמיד שטות בדבר שמורה על טירוף דעת, בוודאי הוא מכלל השוטים לשיטת הרמב"ם... יהיה סיבתו מה שיהיה.
His honour’s wish to innovate that if irrationality derives from illness of black bile, which we call ‘melancholy’, then he is not a shoteh, is not clear to me. The class of ‘melancholy’ includes people who are entirely irrational, as is known to anyone who has some knowledge of the texts composed about this… As a result, if someone with ‘melancholy’ displays perpetual behaviour in a matter which demonstrates a torn mind, he certainly is within Rambam’s category of shoteh… regardless of the cause.

19. Rambam (12th century Egypt), Mishneh Torah, Laws of Testimony 9:10
הפתאים ביותר שאין מכירין דברים שסותרין זה את זה ולא יבינו עניני הדבר כדרך שמבינין שאר עם הארץ, וכן המבוהלים והנחפזים בדעתם והמשתגעים ביותר הרי אלו בכלל השוטים, ודבר זה לפי (מה) שיראה הדיין שאי אפשר לכוין הדעת בכתב.
Those who are especially foolish [peti], who do not recognize contradictory statements and do not understand matters as other normal people do. Also, those who are confused and hasty in their minds, and those who are especially foolish, are in the category of shotim. It is as the judge sees it; one cannot specify a mindset in writing.

20. Rabbi Yehoshua Falk (16th century Poland), Sefer Meirat Einayim, Choshen Mishpat 35:22
המבוהלים והנחפזים בדעתם והמשתגעים ביותר - נראה שכל הני פירושם הוא שאינם מתונים בעניניהם, אלא כל מעשיהן עושין במהירות ולא מבינים לסוף הענין ולתכלית המעשה, מ"ה זה ג"כ בשם שגעון ושטות יחשב:
"Those who are confused and hasty in their minds, and who are especially foolish" – It appears that the meaning of all of these is that they are not patient in their affairs. They perform all of their deeds hastily, not understanding the end of the matter and goal of the act. Therefore, this is also considered foolishness and irrationality.

21. Rabbi Shemuel de Medina (16th century Turkey), Even haEzer 239
ולכאורה נר' שאין לנו מבוהל ונחפז גדול ממי שהוא מנוגף בקדחת עזה והרי הוא בכלל שוטה שפסול מן התורה
It appears that none are more confused and hasty than a person who is struck with powerful fever; he is a shoteh, biblically disqualified.

22. Rabbi Yechiel Michel Epstein (19th-20th century Lithuania), Aruch haShulchan Even haEzer 121:13
בעלי המרה השחורה שאין עושין כלום דברים של שגעון רק יושבין בעצבות ורחוקים מחבורת אנשים ואין מבקשין לאכול וכשנותנים להם לאכול אוכלין, ואין מתחילין לדבר וכששואלין אותן עונין מעט דברים, ואין מדברים דברים של שגעון, יש להתיישב אם דינם כשוטה אם לאו ולפי הסברא אין בזה סימני שטות אלא מחלת העצבות בלבד ותלוי בראיית עיני הב"ד להבין דרכו ועלילותיו.
People of black bile who do not perform any irrational acts, but only sit in sadness, far from human company, and do not seek to eat but do eat when given food, and do not initiate conversation but respond a little when addressed, and do not speak irrationally, one should analyze whether they have the status of shoteh, or not. Logically, there is no sign of irrationality here, only a disease of sadness. It depends on the court’s view, to understand his ways and their causes.

Argument 4 for Overriding Halachic Imperatives: Enabling Future Observance
23. Rabbi Natan Zvi Friedman (20th century Israel), Netzer Mata’ai I 8:1
ואם הלימוד הוא "'וחי בהם' ולא שימות בהם", נכלל בזה גם רפואת חולי-רוח, שהרי מקרא מלא דיבר הכתוב (דברים ל) "לאהבה את ד' אלקיך, לשמוע בקולו ולדבקה בו כי הוא חייך ואורך ימיך." וכל זמן שהוא שוטה הוא פטור מכל המצוות שבתורה...
וכן מוכח דבר זה לפי הדרש האחר המובא שם ביומא בשמו של רבי שמעון בן מנסיא, שלומד דין פקוח נפש שדוחה שבת מדכתיב (שמות לא) ושמרו בני ישראל את השבת — חלל עליו שבת אחת כדי שישמור שבתות הרבה. מפורש להדיא שהיתר של פקוח נפש הוא כדי לאפשר לו קיום מצוות להבא, שאם לא נפקח עליו את הגל לא יוכל לקיים מצוות להבא. אם כן במקרה שהוא בריא בגופו אבל חולה ברוחו, והיום הוא לא יכול לקיים מצות כי שוטה פטור מכל המצוות, מצוה לחלל עליו שבת כדי שישמור שבתות הרבה. וזה פשוט וברור לפי דרשא זו.
If the deduction [teaching that we violate Shabbat to save lives] is from “’And he shall live by them’ – and not die by them,” this includes healing the emotionally ill, for Devarim 30 speaks explicitly, “to love Hashem your Gd, to listen to His voice and adhere to Him, for He is your life and the length of your days.” As long as he is a shoteh, he is exempt from all of the Torah’s mitzvot…
And so is clear within the other exegesis brought in Yoma, from Rabbi Shimon ben Menasya, who learns the law of overriding Shabbat to save lives from Shemot 31, “And the Children of Israel shall observe Shabbat” – Desecrate one Shabbat for him, so that he will observe many Shabbatot. It is explicit that the license to save lives is to enable future fulfillment of mitzvot, for if we would not overturn the debris for him, he could not fulfill mitzvot in the future. If so, in a case where he is physically healthy but emotionally ill, and today he cannot fulfill mitzvot because a shoteh is exempt from all of the mitzvot, it is a mitzvah to desecrate Shabbat for him, so that he will observe many Shabbatot. This is simple and clear, according to this exegesis.

Application to our cases
24. Rabbi Asher Weiss (21st century Israel), Halachik Challenges in Dealing With Mental Illness, 11/24/16
Many times in the past I paskened that girls suffering from anorexia could eat normally on Yom Kippur. Not l’shiurim [minimal amounts, below the standard of ‘eating’]. Because even though there is no direct sakkanah [danger], it’s a terrible ailment, and people, and girls, die from anorexia, to my dismay. I personally know a few families that lost children to this terrible malady. And the way to treat them is difficult, and it’s a long haul, and it takes a long time to design a plan of eating. And any interference, any interruption with that pattern could set the patient back months, or years, and ultimately could endanger the patient’s life. So it does seem to be a chiddush [novelty] to many, and some rabbonim didn’t really agree with my psak, but my psak was that girls suffering from anorexia, Yom Kippur, should eat in the normal pattern that was worked out in the personal, tailored plan for them, and they should not try to eat l’shiurim.

25. Rambam (12th century Egypt), Mishneh Torah, Laws of the Mourner 1:1
ואין אבילות מן התורה אלא ביום ראשון בלבד שהוא יום המיתה ויום הקבורה, אבל שאר השבעה ימים אינו דין תורה...
There is no biblical law of mourning other than on the first day, if it is the day of death and burial. The rest of the seven days are not biblical law…

26. Rabbi Moshe Isserles (16th century Poland), Shulchan Aruch Yoreh Deah 340:5
רגיל לעשות עבירה, אין מתאבלין עליו (מרדכי סוף מ"ק).
For one who sins regularly, we do not mourn.

27. Rabbi Shlomo Luria (16th century Poland), Yam shel Shlomo to Gittin 2:4
ועוד, איך יעלה על דעת האדם להאבילו מה שאין לבו אבל, ואין יום מר לפניו, ונהי דבאבל ממש לא חלקו רבותינו בין אוהב לשונא, הכא יש ויש לחלק.
Further: How could one think to make him mourn when his heart does not grieve and it is not a bitter day for him? Granted that for actual mourners our sages did not distinguish between friends and enemies, here there is room to distinguish.

28. Rabbi Mark Dratch (21st century USA), Honoring Abusive Parents, Hakirah 12 (2011), pp. 111-112, 118
R. David Cohen suggests yet another reason for exempting an abused child from the obligation of honor. Asserting that there are limits to how much a person is allowed to spend in order to fulfill a positive commandment—no more than one-fifth of one’s monetary assets—he argues that emotional distress and psychological consequences are excessive personal costs that free one from an obligation. He maintains that Halakhah does not re-victimize abused children by forcing them to honor their abusers; that would be a price much too high to pay.
Furthermore, the Talmud concludes that while a child must expend time and effort in order to honor a parent, the child does not have to spend any personal resources; the obligation is fulfilled mishel av, with parental assets. While many acts of honor make demands on a child’s time, emotions, and energies, the emotional and psychological burdens imposed on an abused child in order to honor an abusive parent far surpass any appropriate mi-shel ben filial (responsibility)…
Another factor that supports exemption from mourning is that most, if not all, mourning rituals are rabbinic obligations and, in general, rabbinic rulings are sensitive to their impact—financial and personal—on those who are to observe them, providing exemptions when those obligations exact significantly adverse consequences. The Sages often did not apply their rulings be-makom tza’ar, when they caused great pain or distress; in situations of hefsed merubah, significant financial loss; and when kevod ha-beriyot, the basic dignity due to all humans, is violated. And specifically with regard to mourning, the principle is that the law follows the lenient opinion. These factors need to be considered when confronting the imposition of mourning on abused children.

29. Rabbi Asher Weiss (21st century Israel), Minchat Asher 2:134
לדעת הרופאים המומחים בתחום זה דרך הטיפול היא שלעולם לא יחזור פעמיים על דיבור או תפילה... כאשר ברור לו כשמש שלא הגה את השם כדין ולא יצא יד"ח בברכתו האם מותר לו לאכול?...
אף אם נאמר דאסור לעבור על איסור כדי להתרפאות, שאני נידון דידן שהרי אם לא יתרפא ויחלץ מן המיצר יבטל מצוות אלה לנצח, וכל כה"ג אמרינן מוטב שיחלל שבת אחת ולא יחלל שבתות הרבה... נראה גם בני"ד דמותר לאיש יקר זה לבטל ברכות וק"ש כדי להתרפא ויכול לקיים מצוות אלה כהלכתן ודקדוקיהן.
Doctors who are expert in this field believe that the way to treat it is that he never repeat any statement or prayer… When it is clear as the Sun to him that he has not said the Name properly and he has not fulfilled his duty in his berachah, may he eat?...
Even if we would say that one may not violate a prohibition for medical purposes, our case is different, for if he would not be healed and freed from his crisis, he would violate these mitzvot forever. In any such case we say, “Better to desecrate one Shabbat, and not desecrate many Shabbatot”… It appears in our case, too, that this precious person may cancel blessings and Shema to be healed, so that he will be able to fulfill these mitzvot properly.

30. Rabbi Shlomo Wolbe (20th century Israel), פסיכיאטריה ודת, Bishvilei haRefuah 5 (1982) pp. 79-80
www.daat.ac.il/daat/chinuch/tehnologya/volbe-psych.pdf
אמרנו, כי גם חוסר ידיעה גורם עיכוב בהבאת חולים לטיפול פסיכיאטרי. קרובים, חברים, מחנכים שמים לב כי אדם סובל, או שהוא מתנהג בצורה מוזרה, אבל אינו עולה על דעתם כי לפניהם מקרה של מחלת נפש. לא פעם מיעצים לצעיר מדוכא שיתתתן בהקדם. לפעמים באמת עצה זו נכונה היא, אך לא במקרה של דכאון מאני וכדומה. רק פסיכיאטר יכול להכריע בזה. דוגמה אחרת: קרה לי פעמיים, שבאו אלי תלמידים במצב של פניקה, ותוך בכי חזק התלוננו כי ״אבדה אמונתם״: זה הי' התקף שיצופרני והם היו זקוקים לטיפול דחוף... אני מניח כי מה שקרה לי פעמיים, קורה גם לרבנים ולמחנכים אחרים, שאינם יודעים פרק בפסיכיאטרי', ונתאר לעצמנו, אם במקרה כזה היו מנסים להרגיע את החולה ולחזקו באמונה — ובדאי ייווכחו לדעת מאוחר יותר שלא הצליחו בזה, אבל בינתיים עבר זמן יקר והחולה בא לטיפול באיחור שיכול להיות גורלי...
בעיות אלו משותפות לציבור הדתי ולפסיכיאטרים. יש צורך דחוף בארגון קורסים לרבנים בפועל ולמחנכים, במטרה להפיץ ידע בסיסי על הסימפטומים של נוירוזה ופסיכוזה ודרכי הטיפול שלהן בקווים כלליים, כדי שידעו להפנות חולים בהקדם אל הרופא. ידיעה בסיסית היתה מסלקת הרבה משפטים קדומים!
We have said that ignorance causes a delay in connecting the ill with psychiatric treatment. Relatives, friends, educators notice that someone is suffering, or behaving oddly, but it doesn’t enter their mind that they are seeing a case of emotional illness. More than occasionally, they advise a depressed youth to marry early; sometimes this is good advice, but not in a case of manic depression and the like. Only a psychiatrist can determine this. Or another case: It happened to me twice that students came to me in a panic, and while crying powerfully complained that “they have lost their faith”: This was a schizophrenic episode, and they needed urgent care… I assume that what happened to me twice also happens to other rabbis and educators, who do not know anything about psychiatry. We can imagine that in such a case they would try to calm the ill person and strengthen his faith – and certainly, they would come to know later that they did not succeed, but in the interim precious time would be lost, and the ill person could come to treatment with a fateful delay…
These problems are shared by the observant community and the psychiatrists. There is an urgent need to organize courses for active rabbis and educators, with the goal of spreading basic knowledge of the symptoms of neurosis and psychosis and their modes of treatment with general guidelines, so that they will know to direct ill people to doctors early on. Basic knowledge would remove many prejudices!


Monday, September 17, 2018

Davening, Fast and Slow (Derashah for Yom Kippur 5779)

Here is my current draft; feedback (especially before Yom Kippur!) wanted...



I’d like to dedicate my derashah this morning in memory of Ari Fuld, HY”D. I was in school with Ari, and his older brother Donny. As most of you know, Ari was murdered this week by a terrorist in the Gush. That’s how he died; at the end of the derashah, I’ll have more to say about how he lived.

Thinking, Fast and Slow
In a 2011 study, researchers reviewed parole decisions by Israeli judges.[1] They found that judges who had just returned from a food break approved about 65% of parole requests. That percentage dropped in the ensuing hours, to the point that rulings just before the next food break rejected almost all parole requests. Then, after the food break, they went right back to 65%.
Another study, this one out of MIT in 2006.[2] They asked students and executives to participate in an auction. For each item, they asked the participants to first record the last two digits of their social security numbers as though that was their bid. Then they asked them to enter an actual bid. Believe it or not – people with higher social security digits bid up to 346% more than those with lower numbers. For example: On a cordless keyboard, the people with digits between 00 and 19 bid an average of $16; those with digits between 80 and 99 bid an average of $56.
Educated, experienced judges; students and executives at MIT! How could they be so easily influenced by appetite, and irrelevant numbers?
Starting about twenty years ago, Professors Amos Tversky and Daniel Kahnemann[3] sought to explain these and other cognitive slips by pointing to research[4] which shows that our brains consume more energy than most other parts of the body. As Kahnemann wrote, “When you are actively involved in difficult cognitive reasoning or engaged in a task that requires self-control, your blood glucose level drops.” (I don’t know how many calories you burn by listening to this derashah, but I know I burned a lot of them composing it.)
In 2002, Kahnemann won the Nobel Prize for his work, which enshrined in scientific history something we all intuited in high school: Concentration uses energy; therefore, our brains avoid doing it. To the extent possible, we get by with what Kahnemann calls shallow “System 1” thinking, using approximations of the world around us and loose methods of problem-solving, to conserve energy. Only when forced to concentrate, such as due to a sense of danger, do we go to the more thorough, intense and precise “System 2” thinking.
This is why the parole decisions become more negative as the judges’ blood sugar drops; it’s easier to be machmir. And this is why the MIT bidders were influenced by entering random digits before bidding – they didn’t focus carefully, and so they were subliminally influenced by the social security digits they entered.

Davening, Fast and Slow
Kahnemann’s insight regarding thinking is important beyond behavioural economics; here in this room, and all around the BAYT, we can observe a related phenomenon – System 1 Davening and System 2 Davening.
From the vantage point of Torah and halachah, System 2 davening is the goal – an intense religious experience. But more often, we are like the Israeli judges and MIT bidders. Witness the passage from the Talmud Yerushalmi[5] in which one sage admitted, “When I stand in Shemoneh Esreih, I count birds.” Another acknowledged, “I count the bricks in the wall!" And a third confessed, "I'm grateful for my head, because when I arrive at Modim it bows on its own", even if I'm not thinking about the words! As Tosafot[6] said, even our greatest sages have had trouble concentrating for davening.
But what can we do about this? Today is a landmark opportunity to ask Hashem for a clean slate, how can we avoid falling into the automated System 1?

Medical answers
There are some great solutions for the problem of System 1 thinking; Professor Pat Croskerry from Dalhousie has done remarkable work in teaching doctors how to avoid System 1 pitfalls when seeing patients.[7] But these methods are hard to apply in the middle of the day on Yom Kippur. One step, for example, is to be well-fed to avoid the low blood-sugar phenomenon… good luck with that today. So what can we do now, right here?[8]

The Importance of Emotion
One answer may be to turn to an aspect of our personalities which is more powerful than our thoughts: Our emotions.

Psychologists and philosophers have long debated the role of emotions; already in 1890, American philosopher William James wrote that he was tired of the efforts in the field, and would prefer to listen to “verbal descriptions of the shapes of the rocks on a New Hampshire farm” rather than read papers on the role of emotions.[9] But I think a key element suggested by evolutionary biologists is useful here: our emotions are activated when issues of survival are raised.[10] Our intellect solves problems; our emotions help us survive.

Because our intellects aren’t always alert to the stakes and threats at hand, we fall into System 1 thinking, or System 1 davening. But when circumstances trigger fear or love or anger or sympathy, that overpowers the intellect, energizing us, stimulating our nervous system, our endocrine system, our circulatory system, and forcing us to focus.

Further – the more vital an emotion, the more intense the sense that survival is at stake, the greater the power to command our attention. Rabbi Yosef Dov haLevi Soloveitchik[11] made this point; he described a man in pursuit of an aveirah so sweet, so desirable, that he steamrolls his intellect in pursuit of the opportunity. But on the way to his rendezvous, as he races across a frozen lake, his foot slips – and suddenly, the thunderclap of fear for his life overwhelms all that he had been feeling a moment earlier and grabs the reins ; the more vital the emotion, the tighter its grip.

Applying this to our tefillah and teshuvah
This is how we can break out of System 1 davening – by summoning vital emotions which compel our concentration.

  •     Music can summon those emotions; 900 years ago, Rabbi Yehudah haChasid[12] wrote that when we daven we should find tunes which will draw our minds into rhythm with the words we are saying, whether they are psalms of thanksgiving or anguished pleas. I find certain tunes do this for me; I say almost none of the piyutim in the repetition of the amidah, but I try to sing וכל מאמינים and כי אנו עמך, because the memories they evoke for me summon tears of hope and joy which, for me, are life itself.
  •     A memory of an emotional experience can do it. Over a century ago, the Piaseczner Rebbe, Rav Kalonymus Kalman Schapira, was approached by young men who wished to refine their personal spirituality. In response, he wrote a book called בני מחשבה טובה, and in that book[13] he counseled that whenever we become excited, whenever we feel extreme joy or love or sorrow or fear, we commit those feelings to memory, and then we call forth those feelings when we are ready to perform mitzvot, and to daven. For me, I can call forth the image of my mother giving me a berachah before Yom Kippur.
  •     Recalling a loved one can do it. Moments ago, people recited Yizkor and remembered relatives who have passed on – the emotions those relatives summon in our hearts are valuable, too. And for those of us with the good fortune to be able to step out for Yizkor – we can still think of people like Ari Fuld הי"ד. Ari’s widow, entering Yom Kippur without him. Ari’s four children. Ari’s parents.

If low blood sugar and exhaustion undermine our concentration, then let us jumpstart our emotions – with a tune, with a memory, with a loved one, with something which will alert us to the intensity of the moment, the magnitude of the opportunity of כי ביום הזה יכפר עליכם לטהר אתכם [14] to start again with a clean slate. Then we will be able to daven a System 2 davening, with a full heart and a dedicated mind.

Closer
An article about Ari Fuld appeared on Aish.com in 2007;[15] it described his deployment in Lebanon as a paratrooper during the Second Lebanon War. Every day, before heading into battle, his unit would say Viduy, as we will at musaf, minchah and neilah. And one day, 28 kilometers deep in Lebanon, they came under direct attack by Hizballah. Two groups of soldiers fell to rocket fire, and Ari was tasked with leading a group of soldiers to retrieve as many bodies as he could. As he described it, “We left most of our protection behind, and all of our gear. All I had on me were my Tefillin, a book of Psalms, and some other holy writings. Oh -- and bullets. A whole lot of bullets.”
They took just ten steps out of the orchard where they had been hiding, and then they heard a whistle – and seconds later, three missiles landed right where they had been, in the orchard. Ari felt blood coming from him; he had been hit by a piece of a mortar. The medic found that the shrapnel had gone through his protective vest, but had miraculously stopped there – he was safe, for the moment.
When they made it back to Israel, Ari was inspired to take a year off from his career, to devote himself to study Torah. And after the year was over, he turned down financial opportunity, choosing instead to join the staff of Yeshivat Netiv Aryeh. He displayed that mortar shrapnel in his home, beside his kiddush cup and menorah, as a sign of the miracle of his survival.
I tell this story for three reasons:
First: Because I think it’s important that we remember Ari not as yet another casualty, but as a remarkable human being and Jew.
Second: Because by following his inspiration to take time off to learn Torah, Ari demonstrated what we have been talking about – using emotion to override life’s automatic gear and focus our energies.
And third: Because when we say viduy today, we can call the viduy of Ari’s unit to mind, and they can inspire us to abandon System 1 davening, and invest in System 2.

Ari said of the shrapnel he kept, “That warped piece of iron that you're looking at... it looks like a piece of garbage - but that's my miracle.” May his story inspire us to our own miracle, to a day of davening which is not about counting birds, or bricks, or the moments left in the fast, but instead about confronting our deepest truths, connecting with Hashem, admitting and apologizing for our wrongdoing and truly committing ourselves to growth, and so earning a clean slate and a גמר חתימה טובה.




[1] Extraneous Factors in Judicial Decisions, Proceedings of the National Academy of Sciences of the USA,  https://www.ncbi.nlm.nih.gov/pubmed/21482790
[3] See, for example, Thinking, Fast and Slow pg 42
[5] Yerushalmi Berachos 2:4. There are variant explanations of אפרחייא
[6] Tosafot Rosh haShanah 16b and Bava Batra 164b [But see Pnei Moshe (they were distracted by Torah), Pri Tzaddik to Vayyeshev, http://www.temanim.org/shtaygen/dvr_tora/70/2-8.pdf]
[7] See Diagnostic Failure: A Cognitive and Affective Approach and https://www.youtube.com/watch?v=GFE6D5460oE
[8] For my shiur for doctors, see https://www.yutorah.org/lectures/lecture.cfm/902006 Also, my shiur on cognitive bias and teshuvah is at https://www.yutorah.org/lectures/lecture.cfm/906339
[10] For example: Evolutionary Explanations of Emotions, Human Nature 1:3 (1990); The Nature of Emotions, American Scientist 89:4 (2001) https://www.jstor.org/stable/27857503
[11] Beit haLevi to Parshat Yitro
[12] Sefer Chasidim 158
[13] אות ח-יא
[14] Vayikra 17: For on this day Gd will accept your atonement, to purify you