In this interview with Dr. Michael Bunzel, Chairman of the Department of Psychiatry at
Mayanei HaYeshua Hospital in Bnei Brak, Dr. Bunzel speaks about mental health in the frum community. He was instrumental in the founding of the hospital’s recently opened, state-of-the-art mental health hospital. Housed in a seven-floor, ultra-modern building, with every possible amenity and comfort, the Mental Health Center is designed to reduce the potentially unpleasant aspects of clients seeking mental health treatment. Mayanei HaYeshua Hospital is legendary for upholding the principles of Jewish law and the sanctity of human life in all its departments, and a halachic committee of gedolei Yisrael oversees all medical ethics issues. With this groundbreaking achievement, the hospital, doctors, and rabbanim hope to apply these invaluable principles to the crucial field of mental illness.
What is so special about the Mayanei HaYeshua Mental Health Center?
Dr. Michael Bunzel: Our Mental Health Center will become the largest psychiatric center of its kind in the Middle East. We believe that halacha and Torah hashkafa (religious outlook) can actually assist in psychiatric issues. Social and communal interventions that are typical of Orthodox communities, such as social support, family support, and rehabilitation programs are already an integral part of the religious lifestyle. The staff, almost exclusively Torah observant, have exceptional level of expertise in their disciplines.
How important is it for mental health practitioners to appreciate the culture of the patients they treat?
MB: Cultural differences should be respected and understood if we want a way into someone’s soul. Indeed, there is a universal trend today toward more culturally sensitive medicine. Psychiatric services should be rendered by practitioners who are aware of the idiosyncrasies of the patient’s subculture if they want a higher chance of succeeding. It can be very hard to diagnose someone unless you clearly understand his cultural framework and understand what normalcy is in that culture. For example, a secular doctor might misinterpret ritual behaviour, religious observance, and even reliance on a higher power as being abnormal psychiatric symptoms. This can lead to misdiagnosis and mistreatment.
Traditionally, there has been resistance in Orthodox circles to mental health issues. Why?
The Orthodox community used to be suspicious of professional care of mental health problems. Halachic authorities such as Rav Moshe Feinstein were wary of psychological treatment because it was largely based on philosophies antithetical to a Torah outlook. The split between the world of psychiatry and the world of the religious led to mutual distrust. Happily, the last 30 years have seen new psychological treatments that are no longer regarded as threatening, and likewise, psychologists and psychiatrists are more understanding that religion is not only not a barrier to psychological rehabilitation but is often even a facilitator of it. Resistance to mental health treatment has steadily declined due in part to the increasing number of religiously observant mental health practitioners as well as the bi-directional consultation that often takes place between rabbanim and mental health professionals. There has been something of a revolution. Instead of rabbis and their communities resisting the treatment of mental health, they are now partners in the treatment.
How much mental illness in the Orthodox community goes untreated?
We can never know the precise answer. If mental health issues are stigmatized, the people who are suffering live in a world of secrecy, and their problems are only exacerbated. The greater the stigma, the fewer people get treated. We do know that, according to our data, 65 percent of the adults and 70 percent of the children who come in for mental health help at Mayanei HaYeshua would not have sought treatment elsewhere, because other clinics are less sensitive to their unique Torah outlook.
Is there less stigma than before?
MB: There were times when anyone in Bnei Brak with a mental health issue would travel as far away as possible for treatment, so as not to be seen. Opening a clinic right in the middle of Bnei Brak at the community's general hospital was to go up straight in the face of the stigma. People predicted that no one would show up when we opened our clinic in the heart of Bnei Brak. But show up they did, and quite rapidly our clinic was bursting at the seams.
Mayanei HaYeshua has the support of the top rabbinical leaders, and this certainly helps reduce the stigma. Rabbis now work openly and constructively with psychiatrists. The Orthodox public is beginning to recognise that shidduchim are not doomed if a great-grandson is on an antidepressant. They realise that it is possible to use psychotherapy in a way that is guided by Torah values.
What types of mental illnesses do you come across in the religious community?
MB: While the Torah lifestyle protects against many ailments that are more common in nonreligious societies, such as personality disorders, and while research has proven that a religiously rich life is protective against some psychiatric problems, such as depression and anxiety, Torah-observant Jews are unfortunately not immune to psychiatric illnesses. Every psychiatric illness that you find in Western society can be found in the Orthodox community as well.
What about suicide?
MB: Suicide has become a major issue in the general population in the U.S.A. and Israel. Some significant statistics in the general population include:
- Suicide is the leading cause of death amongst 15 to 24-year-olds in some countries, in other countries it is the second leading cause of death.
- Suicide is the fourth leading of cause of death among children ages 10 to 14.
- Suicide is the tenth leading cause of death among all individuals worldwide.
- There are 20 to 30 times the number of suicide attempts as there are those who die by suicide
Is the Orthodox community immune to suicide?
MB: While much research has focused on emuna (faith) in particular and in general as protective factors against suicide, unfortunately, the Torah observant community is not immune to this tragic phenomenon. I saw one religious media source recently which reported that 77 suicides have occurred in the Torah observant community worldwide since Rosh Hashanah 5776, r”l. Whether this is an exact statistic or not is less important. Even one suicide a year is a tragedy that we should attempt to prevent.
Why is it so hard to talk about preventing suicide?
MB: There are many myths that have to be corrected when talking about suicide. Some of those myths are the following:
- “People who talk about suicide usually don’t commit suicide.” The truth is that people who talk about suicide are a high-risk group, and their veiled threats should not be ignored.
- “Suicide usually takes place with little or no warning.” Actually 80% of suicide attempts are preceded by clear warning, anywhere from vague statements to clear threats.
- “People who attempt suicide are fully intent on dying.” Actually only 3.5% of people who attempt suicide really want to die. The rest are sending clear warning signs to those around them, and they should not be ignored.
- “People who attempt suicide remain suicidal forever.” The truth is that intervening in a crisis effectively can lead to erasing these thoughts forever.
- “People who threaten suicide are only making empty threats and should be ignored.” Actually 75% of completed suicides have made suicide attempts in the past.
- “Only depressed people commit suicide.” The truth is that risk factors for suicide are not only mental illness, although it is an extremely high risk factor. But poor physical health, family history of suicide, serious medical illness, substance abuse, unemployment, and general loneliness are also important risk factors.
Does asking about suicidal thoughts increase the risk of suicide? Isn’t it better to just not talk about it?
MB: This is what we used to think – that asking about suicidal thoughts increased the risk of people considering it. To the contrary: Silencing the talk only increases rates of suicide, while actively talking about it may prevent suicide. We now have scientific evidence for this. Recently, a paper was released that summarized 225 research papers from the last 10 years on the subject of preventing suicide, which has proven that idea wrong. Namely, intervening early when the possibility of suicidal thoughts exists has proven to reduce the risk of suicide. Other interventions that have proven to be effective include 1) ascertaining and restricting access to lethal means (such as preventing access to weapons and drugs at home, preventing access to high buildings and bridges), 2) pharmacological interventions, which entails psychiatric diagnosis and treatment of psychiatric illnesses, such as depression, 3) psychotherapies such as CBT and DBT, and 4) school-based mental health and suicide awareness programs. All these proved significantly helpful in preventing suicide. Also showing some evidence of effectiveness is “gatekeeper” training, where people such as school staff, general medical doctors, and crisis hotline workers are taught to listen to at-risk individuals and refer them to proper therapy. It should be noted that electroconvulsive therapy provides a rapid relief of suicidal thoughts, and our hospital has just received a generous donation from an Orthodox foundation in the U.S. for the most up-to-date equipment so as to reduce the possibility of side effects.
What can one say to someone contemplating ending their life?
MB: Many people think that they are a burden on their close friends, family, or society in general because of their mental or physical illness, or any other trouble that they may be having. Therefore, they often contemplate suicide, at least in part as being beneficent to those around them by relieving that burden. These people must understand that their potential suicidal death inflicts much worse suffering on their loved ones, as it is very difficult for families to cope after losing a loved one to suicide.
How can families cope after a suicide?
MB: The best way found until now to help families who lose a member to suicide is group and family therapy. Evidence has show that suicides that were not worked through in therapy led many times to additional family members contemplating suicide because of the accumulating stress and misery of keeping the family secret as taboo.
In summary, is there anything you want to emphasize concerning suicide in the religious community?
MB: Like all other aspects of mental health, being ashamed, stigmatized, and silent about problems only makes matters worse rather than better. Suicidality is a part of mental illness, and therefore can often be treated and prevented if we are vigilant enough in recognizing it. Halachic authorities today recognize the importance of psychiatric intervention and rule that, in many cases, mental illness is a matter of pikuach nefesh, just like any other medical emergency.
Suicide awareness and prevention initiatives are helping many communities, and there is no reason why the Orthodox Jewish community can’t do the same. If the community is not open about the issue, it will be only more difficult to help families who are affected by it.
Suicide prevention strategies revisited: 10-year systematic Review, Zalsman et al, The Lancet Psychiatry, Volume 3, No. 7, p 646–659, July 2016