Dear Dr. Yael,
I attended a speech by a rabbi in my town, who my husband is very fond of and admires. The shiur was on Pirkei Avos and somehow he got onto the topic of people “farginning” another. He started talking about the “D” word, which he would not utter in full and said it was an illness talked about in the gemara, I believe. He said people that suffer from this “machala shachor” should go live in a desert where there are wild animals, and left it to be assumed that they would meet their death there.
As soon as he said, “machala shachor” depression came to my mind. Then he went on to quote Rambam who recommended that one afflicted with this “machala shachor” should listen to music, take walks in the gardens, and go see beautiful buildings. The rabbi made a sarcastic comment about music that judging from the amount of music available in our days, it must be 99% of people are treating themselves for “machala shachor.”
I am the daughter of a woman who has been on Prozac for over twenty years. I know that this rabbi’s “cure” recommendation that depressed people just work on their character and learn how to “fargin” someone else’s joy is way off course. In my opinion, he is reckless and self righteous to think that this is how depression can be cured. Does he begin to understand that over 90% of suicides were with people who were suffering from depression?
I would like your advice on how to reach within the bowels of our rabbinic community and eradicate such misconceptions that can cost someone their life, leaving them living joylessly, or cost them their life to suicide, chas v’shalom. Can there be some training that can save people from being misguided to such “fixes” for depression rather than seeking out professionals that can help them?
For me this issue is further complicated by the fact that my husband admires this rabbi. I hate to think what would happen if he ever asked his advice regarding depression or any other emotional challenge in his life.
It is hard to imagine that a real illness, like depression, can be treated like it is something someone can just “get over.” Thus, I can definitely understand your horrified reaction. There are definitely things that can help people try to overcome depression, but as you mentioned, professional help is necessary and should be the first step to help the person begin to feel better.
Many people with depression require medication in conjunction with psychotherapy. Research has found that cognitive behavioral therapy (CBT) is often most helpful with depression. People suffering from depression will frequently have a negative way of thinking about themselves and the world around them. This negative perception is often how the person thinks about life in general and is not confined to their depression. Many or all of their experiences are distorted through a negative filter and their thinking patterns become so ingrained that they are not even aware of the errors in judgment they make that are based on irrational thoughts. CBT intends to show people how their thinking affects their mood and to teach them to think in a less negative way about life and themselves. CBT is based on the concept that thinking negatively is a habit, and, like any other bad habit, it can be broken. As mentioned above, sometimes people need to combine psychotherapy with medication, and if the depression is severe, they may need the medication to help them utilize the psychotherapy. Psychotherapy, especially CBT, can be used on its own to help someone with depression, but every case is unique and needs its own treatment plan.
Depression, as you emphatically stated, cannot be taken lightly. If someone was diagnosed with a medical illness that was life threatening, chas v’shalom, they would need to seek out the experts in that particular field and to follow whatever treatment plan that is given to them. It is unclear why people do not feel the same way when it comes to mental illness. Mental illness is very serious and requires the same course of treatment as medical illness. Experts in that specific field should be sought out and a treatment plan needs to be followed. Listening to music may indeed be a part of that treatment plan, but music by itself is surely not a cure for depression. This widely spread misconception unfortunately is not limited to the frum world. Many individuals feel that mental illness is not “real” and that it can be “cured easily.” Reality is that mental illness is very real and it requires treatment by a competent professional. Many organizations are trying to bring these very issues into the forefront and believe it or not, there has been a lot of growth in this area. We hope that the community continues to value the importance of focusing on understanding mental illness and that your letter helps others realize the seriousness of depression.
Perhaps you can speak with a Rav that you feel comfortable with about how you can address this specific issue with this Rav. It may be a good idea to explain to this Rav how his talk was perceived. It is important to be dan lecaf zechus (judge him favorably) and approach him with the utmost derech eretz. A letter may be the best way to go. Thank you very much for bringing this issue into the forefront. These kinds of letters help Klal Yisroel understand the seriousness of depression and other mental illness. Hatzlocha!