These notes are based on Rav Brudny’s remarks at the recent Agudah conference for Mental Health Professionals. Please consider any mistakes to be mine.
I was officially invited to this conference to teach, as a הבאה ללמד. But when speaking to such an audience it is הבאה ללמד ונמצא למד. This Chabura deals with the tremendous pain and dysfunction out there. It is always an opportunity for growth for me when interacting with those who deal regularly with the pain of Klal Yisrael and I try to glean whatever I could.
There are a few unique Yesodos and messages that are important for this audience to hear.
1) There is no question that there is advantage for people with frum hashkafa to treat those in our community. Those who need treatment are much better served by someone who understands the fundamentals of their השקפת החיים and truly understands the phenomena that they are discussing. We cannot fully relate to a Torah person's struggles unless we live it.
I am often consulted from those outside the community who have a hard time just getting it. For example, a wonderful person from an inpatient treatment center contacted me to learn about Shabbos and what role it plays in the life of an Orthodox Jew. She wanted to learn of the importance of it as well as the emotional struggles for those who grew up with Shabbos and then experienced it as a negative in their adolescence. Not experiencing Shabbos first hand, both the beauty and its possible challenges, is a blindness that intellectual explanations can't fully compensate for. This is one of many examples. Similarly, I was recently asked to speak for Orthodox high school students. Questions related to gender, marriage, and similar issues came up. Only someone who is infused with השקפת התורה and the importance of קיום המין, our mission to perpetuate mankind, as opposed to self-gratification can truly understand these concepts. Wonderful therapists who are not hedonistic still do not fully grasp our mindset. They view marriage and family life as a choice, a concept foreign to us.
Our task as therapists is not to intertwine השקפת החיים with our clinical work. We are not Mashgichim; we are caregivers; we are professionals. But we can't treat those from our circles unless we have a true understanding of the Jewish subconscious. If we are aware of the inner voice inside our clients, our work will be that much more wholesome. Not being aware of this is clinical blindness. This is why the combination of being a Torah Jew and mental health professional is integral.
2) You are fortunate to be a part of a giving profession. Is there a better way of making Parnassa than where the parnassa is a byproduct of giving? Your days are spent providing empathy, counsel, and healing. This necessitates serious energy to empathize and fully understand others. This requires putting up with difficult clients. This is giving of the self! What could be more beautiful than that? Yes, you take money for it but Rav Dessler writes in his קונטרס החסד that this is a mindset. One can engage in mundane and profitable work like Nechnuya the shoemaker but with proper intent you are a giver! Your work is so consistent with our values as Torah Jews.
3) Mental illness is something that has always been here and discussed in the Torah. This helps provide context for those suffering. The תוכחה is full of terms of what we see in our practices. Words like מהומה, קול עלה נדף, ונסתם ואין רודף, שגעון, תמהון לבב. From the Torah's perspective this is יככה השם--an affliction.
Learning Shmuel aleph one recognizes that שאול המלך the B’chir Hashem suffers from a חולה similar to melancholy. This was something given to him מן השמים. Furthermore, it is documented that two of our Gedolei Oilam of the last 200 years struggled. In the Sefer ראשןן לשלשלת בריסק (Karlinsky), the author discusses an episode where the Bais Haelvi underwent a depression after his Rebbi, Rav Yehoshua Leib, was forced to leave Russia due to false allegations. Similarly, in the כוכבי אור חלק ב, talmidim of Rav Yisroel Salanter mention in a letter that at that time Rav Yisroel wouldn't see or speak to people because he is not in a matzav of “Menuchas Hanefesh". Printing these kinds of things is a chidush and a possible בזיון. But perhaps min hashomayim it was allowed in order to give chizuk to many others who are struggling with mental health related issues. If giants of this magnitude have experienced this, it is normal. These struggles are similar to pneumonia or physical illness. It doesn't reflect anything negative on the person and needs to be treated.
Questions
1) How can mental health professionals work together with Daas Torah?
This could be done, should be done, and has been done. If both are seeking the אמת and the best for the client, it is a seamless process. I have never experienced any friction.
I know my role and don't diagnose or treat.
2) How should mental health professionals deal with input from Daas Torah which they don't view as helpful for the client?
This sounds to me as a situation where a Rov or Rosh Yeshiva sent a particular client to a clinician and is upset with what the clinician is doing. And the clinician may know something that the patient told him in confidence. It can often be touchy where MHPs need to preserve client confidentiality and the client may not be ready or willing to share sensitive information with a school or a Rov. This can cause the daas Torah to be upset but the clinician was unable to disclose the full picture. Several solutions were discussed for this dilemma.
3) How should a therapist navigate when asked Shidduch information of those who are struggling with challenges that can be detrimental to a marriage? )e.g., a clinician is asked Shidduch information regarding a client struggling with bipolar disorder).
The Chofetz Chaim writes that if someone is aware that a prospective person seeking a shidduch struggles with a Choli Pnimi then one needs to share this information. לא תעמוד אל דם רעך as well as לפני עור mandate informing the other party of potential difficulties in Shidduchim where it will likely affect the marriage (incidentally, the person is obligated to disclose this information about themselves). On the other hand, violating confidentiality has legal, financial, and professional ramifications. One needs to be aware of these obligations and handle them in a sensitive manner with Halachic guidance. At times, even without violating confidentiality, one can speak in a sensitive way that the questioner is not put at ease and at least gets the unspoken message to inquire further. This is an art that sensitive people can pick up with time. Even saying something like "My Rov told me to NEVER discuss what happens in therapy" will encourage the questioner to inquire further.
A central question which needs clarification is if the disorder meets the standard of machla pnimis where it will likely affect the marriage, which usually involves healthy and safety risks. Practically, when it meets this standard, it is usually publically known.
4) How can one protect themselves from overexposure to chet? When one is well meaning and doing the ratzon hashem and looks to maintain their Yiddishkeit, they will not be negatively affected.
5) How can one be non-judgmental when dealing with those violating halacha? I don’t even understand this question! Chazal say אל תדין את חברך עד שתגיע למקומו. There is always a history and a reason why the other person may be struggling. There is no room for us to judge those who are struggling because everyone has a story that led them to do the behaviors that they are doing. The Yetzer Hora is very powerful and can torment people. We should never judge, but rather seek to understand and beנושא בעול . This doesn’t mean to agree: Kares is kares and geneiva is geneiva. But it does require us to understand and empathize with the history that brought them to this point.
6) Can validation be misconstrued by the client as condoning? I once went to Rav Shach and asked a similar question regarding my concerns of validating someone's hashkafa questions that bordered on Kefira. Rav Shach told me that the person should be allowed to ask anything and you should answer well and calmly. Rav Shach said that this needs training for the person to balance saying something in a manner that is soothing and not condoning. We validate pain and suffering and struggles that lead people to do avairos. We don’t validate the actual avairos.
7) How does one go about treating someone who is only shomer torah umitzvos out of fear of society and parents? By helping him develop self-confidence and inner peace his shmiras hamitzvos will likely fall.
One needs first to assess the long-term prognosis of this individual. This assessment should be done in collaboration with clinicians who have much experience in this area. Often, this profile when left untreated can result in sudden drastic turns for the worse. When Yiddishkeit is not based on a solid foundation it can be easily lost. Therefore, at times it is advisable to take this risk and slowly build the person. At the same time, this is not always the situation. After assessing (together with input from experienced colleagues), consult with Daas Torah.
8) The Rosh Yeshiva painted a picture of collaboration between Rabbonim and Mental health professionals. However, in some circles MHPs put down Rabbonim and Rabbonim put down MHPs. How can one navigate these situations?
It is not a perfect world. But the very existence of this well-attended conference along with many other projects highlights the great strides that we have made in this area, something that would not have been possible a few years ago. We need to do keep working towards the good and focus less on areas of imperfection.
9) How can one navigate when the Daas Torah is giving seemingly harmful advice. For example, telling an unstable bochur to go to Eretz Yisroel and things will work out or telling someone just to go to the Mikvah and everything will be resolved?
Try not to talk against the Rosh Yeshiva. Try to collaborate. Offer to discuss with the Daas Torah, which the client will allow if they have an open-mind. If your assessment is that they are using the Daas Torah as a shield for their own foregone conclusions, then keep in mind כשם שמצוה לומר דבר הנשמע כך מצוה שלא לומר דבר שאינו נשמע. If it is a Sakanah, you can contradict the Daas Torah (keeping in mind not to say something that will not be listened to).