This shiur was given as part of a mental health awareness event. Below each source, I have included the approximate comments I made and the ideas I discussed in the shiur.
Understanding of and Sensitivity to Internal Experience
תנו רבנן איזהו שוטה היוצא יחידי בלילה והלן בבית הקברות והמקרע את כסותו איתמר רב הונא אמר עד שיהו כולן בבת אחת רבי יוחנן אמר אפילו באחת 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 והלן בבית הקברות אימור כדי שתשרה עליו רוח טומאה הוא דקא עביד והיוצא יחידי בלילה אימור גנדריפס אחדיה והמקרע את כסותו אימור בעל מחשבות הוא כיון דעבדינהו לכולהו הוה להו כמי שנגח שור חמור וגמל ונעשה מועד לכל.
§ The Sages taught: Who is considered an imbecile? One who goes out alone at night, and one who sleeps in a cemetery, and one who rends his garment. It was stated that Rav Huna said: One does not have the halakhic status of an imbecile until there are all of these signs present in him at the same time. Rabbi Yoḥanan said: He is considered an imbecile even due to the appearance of one of these signs. The Gemara asks: What are the circumstances of the case under discussion? If he performs them in a deranged manner, then even the appearance of one sign should be enough to classify him as an imbecile. If he does not perform these actions in a deranged manner, but has a reason to act this way, then even if he performs all of them he should not be deemed an imbecile. The Gemara answers: Actually, the baraita is referring to one who performs these actions in a deranged manner, but each action on its own could be explained rationally. With regard to one who sleeps in the cemetery, one could say that he is doing so in order that an impure spirit should settle upon him. Although it is inappropriate to do this, as there is a reason for this behavior it is not a sign of madness. And with regard to one who goes out alone at night, one could say that perhaps a fever took hold of him and he is trying to cool himself down. And as for one who tears his garments, one could say that he is a man engaged in thought, and out of anxiety he tears his clothing unintentionally. Despite these possible explanations, since one performed all of these together they are considered like the actions of a forewarned ox that gored an ox, a donkey, and a camel.Since this ox gored three different animals on three separate occasions, it is considered predisposed to gore and becomes forewarned for every type of animal. Likewise, if someone performs three different deranged actions, it is assumed that there is no logical reason for his behavior and he is classified as an imbecile.
This Gemara, just like the process of diagnosis, is based on the notion that a certain set of symptoms create a reliable supposition of mental illness. This reflects the clinical methods of diagnosis even today, where for example 5 out of the 9 symptoms listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) for depression can warrant a diagnosis. These symptoms include depressed mood, diminished interest and pleasure in most activities, and changes in sleep habits.
This Gemara also lends an appreciation for the internal experience of an individual. Much of life is not just about the actions performed but how they are done and why. Someone might do something for precise and rational reasons that to another person appears outside the ordinary. This is why it is important to be careful and analyze each circumstance on a case-by-case basis to determine what is best for the individual at hand. This debate continues in the field of clinical psychology today as well, as clinicians become aware of patients’ unique backgrounds and seek to respect them while looking out for symptoms that suggest that something is wrong.
We also see from here how halachic literature seeks to assess the circumtances (metzius) carefully before making judgments or rulings based on the situation. A component of psak halacha (ruling of law) is the circumstantial reality as is relevant to the question at hand as well as the ruling itself.
תלמוד בבלי מסכת ראש השנה דף כח עמוד א
שלחו ליה לאבוה דשמואל: כפאו ואכל מצה – יצא. כפאו מאן?
אילימא כפאו שד, והתניא:
עתים חלים עתים שוטה – כשהוא חלים - הרי הוא כפקח לכל דבריו; כשהוא שוטה - הרי הוא כשוטה לכל דבריו. !?
אמר רב אשי: שכפאוהו פרסיים אמר רבא: זאת אומרת: התוקע לשיר - יצא.
פשיטא, היינו הך?! מהו דתימא? התם - אכול מצה אמר רחמנא והא אכל; אבל הכא - זכרון תרועה כתיב, והאי מתעסק
בעלמא הוא. קא משמע לן.
רש"י מסכת ראש השנה דף כח עמוד א
התוקע לשיר - לשורר ולזמר. כך שמעתי מפי מורי הזקן. וביסודו של מורי רבי יצחק בן יהודה ראיתי: התוקע לשד - להבריח רוח רעה מעליו.
שו"ת הרב"ז חלק ב (אבן העזר) סימן נ
זאת אומרת התוקע לשיר יצא, ופירש"י שם בד"ה התוקע: בשם יסודו של מורו ריב"י [שהי' לו גי'] התוקע לשד להבריח רוח רעה מעליו ע"ש. אף שבעת שכפאו שד והרוח רעה הוא חולה, אפילו הכי, כיון שבעת שהוא תוקע להבריחו מעליו, ודאי הוא חלים - לפיכך יצא.
Talmud Bavli Masechet Rosh Hashana 28a
§ It is related that the following ruling was sent from Eretz Yisrael to Shmuel’s father: If one was forcibly compelled to eat matza on Passover, he has fulfilled his obligation. The Gemara clarifies the matter: Who compelled himto eat the matza? If we say that a demon forced him, i.e., that he ate it in a moment of insanity, this is difficult. Isn’t it taught in a baraita: With regard to someone who is at times sane and at times insane, at the times when he is sane, he is considered halakhically competent for all purposes and is obligated in all the mitzvot. And when he is insane, he is considered insane for all purposes, and is therefore exempt from the mitzvot. If so, someone who was compelled by a demon to eat matza is not considered obligated to perform the mitzvot at all.
Rav Ashi said: We are dealing with a case where the Persians compelled him to eat. Rava said: That is to say that one who sounds a shofar for the music,having no intent to fulfill the mitzva, fulfills his obligation, since the critical issue is hearing the blast and not the intent of the blower.
Rashi; Rosh Hashana 28a
One who blows (shofar on RH) lashir – to make music and song.
So I heard from my elder teacher.
But in the Yesod of my teacher Rabbi Yitzchak ben Yehudah I saw:
One who blows (shofar on RH) lashed = to chase away a ruach ra’ah from upon him.
Responsa of R. Betzalel Zev Spirn
This implies: One who blows (shofar on RH) lashir – fulfilled his obligation
Rashi explained there in the name of the Yesod of my teacher Rabbi Yitzchak ben Yehudah (who had an alternate text):
One who blows (shofar on RH) lashed = to chase away a ruach ra’ah from upon him.
Even though at the time that he was compelled by the demon or the ruach ra’ah he is sick, nonetheless since at the time that he blows to chase it away from upon him, he is certainly chalim – therefore he fulfilled his obligation.
Doing mitzvot has an internal component in addition to the external actions (ma’aseh mitzvah vs. kiyum hamitzvah is one formulation of this idea). One who is not in touch with reality is unable to do mitzvot properly. However, many mental illnesses have periods in which one is symptomatic and periods of remission. An example of this is schizophrenia, in which [as they are clinically termed] positive symptoms (hallucinations and delusions) can crop up during periods of stress and can also be absent for a long while. During these times, clinically-termed negative symptoms can be especially observed, such as apathy and lack of pleasure and emotion. Halacha recognizes this. The moment that one is able to do a mitzvah, he has fulfilled his obligation. Therefore, one is not always categorized permanently in halacha as a person who is mentally ill but he/she can be categorized circumstantially based on what he/she can or can’t do. This acknowledges the nuances of the experience of a person with a mental illness. The experience of mental illness is different for every person, even those with the same illness.
שו"ת ציץ אליעזר, יב:יח:ח
(ח) ומדי עסקי בנושא זה של ברכת הגומל ראיתי לרב חשוב אחד מרבני ארץ ישראל שכתב לפסוק בנוגע לחולי נפש שנתרפא בזהו לשונו: "ומסתברא לי שגם מי שחלה בחולי נפש אף שאין המחלה יכולה לגרום לסכנת חיים מ"מ הנרפא חייב לברך, וגם זה בגדר חולה ונתרפא... בדין שהנרפא חייב לברך ברכת הגומל, ברם יתכן לפטור אותו מטעם שאין רפואתו ברורה שעלולה לחזור אליו מחלתו הקודמת ונמצא דעדיין לא נתרפא, אבל כל שברור לנו שהמחלה לא תחזור מן הדין שיברך." עד כאן לשונו.
עברית
Responsa of the Titz Eliezer (R' Eliezer Waldenberg) 12:18:8
And also in dealing with the topic of saying Berkat HaGomel – I saw an important Rabbi from Israel who wrote to pasken in respect to the mentally ill and these are his words:
“It seems to me that also mentally ill, even though it doesn’t [obviously] lead to life-threatening situations they are nonetheless required to bless because it is also in the category of the sick person who is healed... and the law is that anyone who is healed need to bless berkat hagomel, yet perhaps we should exempt him from blessing Gomel because his healing isn’t clear considering that he might have a relapse and it shows he wasn’t actually healed! But anyone who clearly healed should bless.”
There is a recognition that mental illness is similar to physical illness, which modern clinical science has largely embraced with support from research. Just as one becomes afflicted with mental illness, he or she can heal from episodes of it. This allows one to recognize healing from mental illness as part of his experience and to thank G-d for it. As much as mental illness is separate from a person's normal psychological functioning, it can sometimes become a part of a person’s identity or life story by choice. Acknowledging that mental illness is part of one’s journey and deriving meaning from it is important for healing for many people. Like any life struggle, mental health issues can create meaning in myriads of ways. How have you been able to derive meaning from your struggles with mental health or have seen others do it?
Including Hashem in one’s journey, as one is able, is worthwhile.
As we now segway into the second part of this shiur, how have you included G-d in your journey? How have others?
Relationship to G-d
An individual who is unable to understand the basics of mitzvot is exempt from doing them [while he is not lucid]. We do not obligate someone who is not of able mind to perform mitzvot that he/she is unable to perform. This builds on the theme that halacha is meant to be kept by humans who are capable of observing it properly (a similar idea: lo nitna Torah l’malachei hasharet, the Torah was not given to the ministering angels [but rather to humans]). Sometimes it is impossible to keep all or some halacha and halacha recognizes that.
מתני׳ מי שהוציאוהו נכרים או רוח רעה אין לו אלא ד' אמות החזירוהו כאילו לא יצא הוליכוהו לעיר אחרת נתנוהו בדיר או בסהר ר"ג ור' אלעזר בן עזריה אומרים מהלך את כולה רבי יהושע ור"ע אומרים אין לו אלא ד' אמות: מעשה שבאו מפלנדרסין והפליגה ספינתם בים ר"ג ורבי אלעזר בן עזריה הלכו את כולה ר' יהושע ור"ע לא זזו מד"א שרצו להחמיר על עצמן פעם אחת לא נכנסו לנמל עד שחשיכה אמרו לו לרבן גמליאל מה אנו לירד אמר להם מותרים אתם שכבר הייתי מסתכל והיינו בתוך התחום עד שלא חשיכה: גמ׳ ת"ר ג' דברים מעבירין את האדם על דעתו ועל דעת קונו אלו הן עובדי כוכבים ורוח רעה ודקדוקי עניות למאי נפקא מינה למיבעי רחמי עלייהו
MISHNA: With regard to one whom gentiles forcibly took him out beyond the Shabbat limit, or if an evil spirit took him out, i.e., he was temporarily insane, and found himself outside the Shabbat limit, he has only four cubits that he may walk from where he is standing. If the gentiles returned him, or if he came back while still under the influence of the evil spirit, it is as though he had never left his Shabbat limit, and he may move about within his original limit as before. If the gentiles brought him to a different city that was surrounded by walls, or if they put him into a pen or a stable, i.e., animal enclosures, the Sages disagree. Rabban Gamliel and Rabbi Elazar ben Azarya say: He may walk about the entire city, as the whole city is considered like four cubits. Rabbi Yehoshua and Rabbi Akiva say: He has only four cubits from where he was placed. The mishna relates: There was an incident where all of these Sages were coming from Pelandarsin, an overseas location, and their boat set sail on the sea on Shabbat, taking them beyond their Shabbat limit. Rabban Gamliel and Rabbi Elazar ben Azarya walked about the entire boat, as they hold that the entire boat is considered like four cubits, while Rabbi Yehoshua and Rabbi Akiva did not move beyond four cubits, as they sought to be stringent with themselves. The mishna further relates that on one occasion, they did not enter the port [namel] until after nightfall on Shabbat eve. The others said to Rabban Gamliel: What is the halakha with regard to alighting from the boat at this time? In other words, were we already within the city’s limit before Shabbat commenced? He said to them: You are permitted to alight, as I was watching, and I observed that we were already within the city’s limit before nightfall. We acquired our resting place in the city during the twilight period. Therefore, it is permitted to walk throughout the city even after nightfall. GEMARA: Since the Gemara discussed one who stepped beyond the Shabbat limit due to an evil spirit, the Gemara cites a related baraita, in which the Sages taught: Three matters cause a person to act against his own will and the will of his Maker, and they are: Gentiles, and an evil spirit, and the depths of extreme poverty. The Gemara asks: What is the practical halakhic difference that emerges from this statement? The Gemara answers: It is significant as it teaches one to request mercy for people who suffer from those problems.
One who was forced to break halacha by his mental illness is excused from the violation. We recognize that if someone is compelled in such a way, it is not really him but his illness that is doing the action. This distinction is important for recognizing the humanity of someone as well as for enabling healing. What are ways to acknowledge the humanity of others when they suffer from mental illness and to let them know that we respect them?
We also learn that mental illness is separate from whom a person truly is in the Talmudic statement that a mental illness takes a person away from an understanding of both himself and G-d. It hints at the importance of recognizing the good and true things about a person and about his relationship with G-d and how these things can exist separate from and in spite of his illness. At the same time, this statement illustrates how important it is to pursue healing from mental illness and to support the healing of others, because mental illness can take a person away from some of the most important things in life.
We learn that halacha is applicable to all areas of life, and one way to see this in practice is by looking at halachic responsa (she'elot uteshuvot), in which unique cases are assessed halachically. The next source we will look at is one such example.
הרב אשר וייס, שו׳׳ת מנחת אשר קלא, קכח
HaRav Asher Weiss, Responsa Minchat Asher 134 (Certain excerpts)
A student who is devout and G-d fearing suffers from Obsessive-Compulsive Disorder (OCD) and for the most part is unable to say a bracha or shema according to halacha, and sometimes spends a lot of time trying to say G-d's name properly to no avail, and experiences a lot of anguish. According to the doctors who are experts in this [condition] the treatment is to never go back in prayer, and if he does not feel he said the prayer properly, he should not make another try [Exposure and Response Prevention Therapy (ExRP), a form of Cognitive Behavioral Therapy (CBT)]. In this way, the doctors hope to save him from his distress.
It is the halacha that the first obligation a person has is to do whatever is required to find healing from this illness and for this it is even permitted for him to bypass and not do mitzvot in the Torah...
And this I learned from the Chatam Sofer who wrote of a child deemed to be insane and answered whether it was permitted to send him to an institution where they will take care of him and there is a chance of healing him and taking him out of the category of "insane" and making him obligated in mitzvot. However, this institution has non-kosher food...
And this is similar to that which Chazal say in BT Yoma 85b, that "one may violate one Shabbat so that he [later] can keep many Shabbatot." So if we do not allow him to skip mitzvot even a little, he will never heal and will continue skipping mitzvot. It is preferable because of his distress that this is the way to go.
HaRav Asher Weiss, Responsa Minchat Asher 128 (Certain excerpts)
And the source for these things we find in the Midrash of Tehillim 45, "My heart whispers good things" is to say that if one cannot confess with his mouth, his heart can whisper in teshuva, and G-d will accept his confessions; and David says to Shlomo, my son know G-d your father, and serve him with a full heart and free soul."
Mental illness can directly affect one’s religious observance. Patients who suffer from Obsessive-Compulsive Disorder (OCD) may sometimes experience religiously-themed symptoms (this cluster of symptoms is clinically known as scrupulosity). They may include repeating religious actions until one feels he has done them correctly, intrusive thoughts and images with counter-religious themes that cause sufferers anxiety and distress, and excessive fears of G-d and punishment— all counter to what is traditionally accepted and/or practiced according to Jewish sources. The halachic approach to this reflects the beauty and intricacy of the halachic system, where we see the unique halachic dispensation to forgo mitzvot currently in order to do more in the future, the worthwhileness of putting oneself back into the position of being obligated in mitzvot, reliance on science by following doctors’ advice in order to reach a healthy and normal religious life, and appreciation of psychological health and comfort by halacha.
This teshuva (responsum) also sheds light on normative religious practice. We may sometimes have a tendency to under-appreciate normative halacha, which often seems rote and mechanistic. Looking at the above, however, can highlight there is a standard way in which the intricacies of halacha are fulfilled and in which it is proper to approach religious life. When one’s observance of halacha or approach to Judaism goes awry due to illness, for example in the way described above, it is never because of Judaism and halacha itself. This is often visibly obvious, because the religious actions or thoughts that appear as symptoms of OCD are carried out with the mindset that underlies other symptoms of OCD. Genuine religious attitudes and behavior (including the healthy attitudes and behavior of OCD patients that fall outside their symptoms) come from internal religious sentiment.
This distinction will hopefully make it easier to appreciate halacha as a whole as well as support and understand individuals who are having trouble with it due to illness. How can we better appreciate halacha in our community? How can we use Torah to bring us joy?
Further, we see in this teshuva a suggestion of how one can go about fulfilling one’s religious duties in an extenuating circumstance. It is a case study for how halacha can function as an eternal system, in that it can bend to extenuating circumstances of human life (sha’at hadchak). How have you seen halacha function in unusual circumstances? What can we appreciate about halacha and the applicability of Torah in general as a result of this? How does this inform the centrality of Torah in our lives?
How to Support Others
(משלי יב, כה) דאגה בלב איש ישחנה רבי אמי ורבי אסי חד אמר ישחנה מדעתו וחד אמר ישיחנה לאחרים
§ The Gemara explains another verse in Proverbs: “If there is care in a man’s heart, let him quash it [yashḥena]” (Proverbs 12:25). Rabbi Ami and Rabbi Asi dispute the verse’s meaning. One said: He should forcefully push it [yasḥena] out of his mind. One who worries should banish his concerns from his thoughts. And one said: It means he should tell [yesiḥena] others his concerns, which will lower his anxiety.
Having social support is very important for mental health. Having someone else to speak to, especially in times of trouble, can be emotionally beneficial for a person. What are some examples you have seen of this in your life? How can we be more present for the people we care about?
The Gemara continues to address the issue of suffering and affliction: Rabbi Yoḥanan’s student, Rabbi Ḥiyya bar Abba, fell ill. Rabbi Yoḥanan entered to visit him, and said to him: Is your suffering dear to you? Do you desire to be ill and afflicted? Rabbi Ḥiyya said to him: I welcome neither this suffering nor its reward, as one who welcomes this suffering with love is rewarded. Rabbi Yoḥanan said to him: Give me your hand. Rabbi Ḥiyya bar Abba gave him his hand, and Rabbi Yoḥanan stood him up and restored him to health. Similarly, Rabbi Yoḥanan fell ill. Rabbi Ḥanina entered to visit him, and said to him: Is your suffering dear to you? Rabbi Yoḥanan said to him: I welcome neither this suffering nor its reward. Rabbi Ḥanina said to him: Give me your hand. He gave him his hand, and Rabbi Ḥanina stood him up and restored him to health. The Gemara asks: Why did Rabbi Yoḥanan wait for Rabbi Ḥanina to restore him to health? If he was able to heal his student, let Rabbi Yoḥanan stand himself up. The Gemara answers, they say: A prisoner cannot generally free himself from prison, but depends on others to release him from his shackles.
Sometimes circumstances are such that one cannot help himself, and one must rely on the support of others to help him up. There is nothing wrong with that. What are ways we can decrease the stigma of asking for help?
(יא) ומי שחטא עליו חברו, ולא רצה להוכיחו ולא לדבר לו כלום, מפני שהיה החוטא הדיוט ביותר או שהיתה דעתו משובשת, ומחל לו בלבו ולא שטמו ולא הוכיחו – הרי זה מידת חסידות. לא הקפידה תורה אלא על המשטמה. כן כתב הרמב"ם שם.
And he who has been slighted by his friend and does not want to make it known to his friend, because his friend is very much a "foolish sinner" or his mind is confused, and forgives him in his heart and does not hate him and does not rebuke him- this is pious. And the Torah is not strict [on the "foolish" friend] except for in the case of hatred [of the first friend]. This is what the Rambam wrote.
It is important to be sensitive to those around us who have mental illness. Sometimes our friends and acquaintances may be going through a particularly rough time and may not be acting like themselves. We should try to give them the benefit of the doubt and be there for them. Being patient with our friends will only lead them to appreciate our support more.
(ד) הַשּׁוֹטֶה אֵין מִקָּחוֹ מִקָּח וְאֵין מִמְכָּרוֹ מִמְכָּר וְאֵין מַתְּנוֹתָיו קַיָּמוֹת. וּבֵית דִּין מַעֲמִידִים אַפּוֹטְרוֹפּוֹס לְשׁוֹטִים כְּדֶרֶךְ שֶׁמַּעֲמִידִין לִקְטַנִּים:
Neither a sale nor a purchase involving a mentally incapable or emotionally unstable individual is binding, nor are the presents he gives effective. Instead, the court must appoint a guardian for such a person, just as it appoints guardians for minors.
This refers to not holding an individual in the throes of mental illness accountable for things they are not doing with sound decision-making capabilities. An example of where this comes up is in bipolar disorder. Bipolar disorder consists of alternating periods of depression and mania. Symptoms of mania include euphoria, racing thoughts, increased energy, impulsivity and risk-taking behavior. Spending sprees which are visibly out of character can occur as well, and it is important to protect an individual from when it is necessary.
We also can understand from here the importance of the community and its institutions in supporting people with mental illness. How can we do better as a community to give those with mental illness the support they need?