Halachic Position Paper
Mental illness is a disease, and the suffering experienced by the mentally ill is real suffering.
Israeli society is just learning to recognize these facts, and they pose a challenge to the community and to halakha. Compassion is the key, both in guiding the halakha and in communal action.
The challenge to the community demands assisting the suffering individual and his family in overcoming shame and conquering the ignorance and stigma that occasionally exist in the community at large. Accomplishing this demands proper education and the willingness of community leaders to effect change. Ways to support the individual and his family must be found, in a practical sense and by raising awareness and overcoming stigma and unfounded beliefs.
In the halachic context, instructions for treatment of mental illness involving the suspension of prohibitions must be sharpened. The nature of the danger involved in these illnesses must be defined, the accepted methods of treatment must be understood, and subsequently, halachic conclusions of permitted and forbidden must be determined. This challenge demands decisions in a field which, in many of its aspects regarding the nature of each illness and the methods of treatment is subjective, whilst taking care not to impair the decisiveness of the psak, the possibility of recuperation, or the treatment methods.
This short article discusses the halachic status of the treatment of the mentally ill.
Pikuah Nefesh- Life Threatening Situations
‘Mental illness’ is a general category which includes many psychological ailments. Halachically, it is important to distinguish between situations in which a mental illness belongs to the more severe group of impairments- those suffering from an objectively severe affliction, or those with suicidal tendencies, and those in the ‘less’ severe category, who suffer from other symptoms.
For one who belongs to the first category, it is permissible to violate Torah prohibitions in order to save him from this state, or to prevent his entry into such a psychological state. Poskim mention three factors that must be considered, even if they demand the desecration of Shabbat, in order to prevent a person from suffering a severe psychological blow:
The first factor is the concern that the psychological damage could lead to a life threatening situation. The mentally ill may lose their capacity to look after their own safety, and at times can pose a danger to themselves or to others.
The second factor relates to the value of the observance of the commandments. This dictates that even if a mental health professional determines that the situation is not one which is life-threatening, there is an obligation to conserve a person’s spiritual strength. A person who loses his sanity is exempt from the commandments, and is considered to have lost their spiritual stature. There is a requirement to try to prevent this loss, or to return a person to a state of obligation, even if it involves the desecration of the Shabbat. One Shabbat may be desecrated so that he will be able to observe many Shabbatot.
The third factor posits that losing sanity in and of itself is equivalent to a life threatening situation, because when a person loses his mind, he loses his identity and personality, and even his desire to live.
The critical question regarding treatment of non life-threatening mental illness is the halachic status of the illness. Is it to be considered an ‘illness’ [ what halachic decisors call ‘holeh she’ein bo sakana’– non-life threatening illness] or ‘meihosh be’alma’, a mere feeling. If the first possibility is correct, a variety of actions which are normally forbidden can be taken in order to relieve the individual’s suffering. The most reasonable position emerging from an analysis of the halachic sources is that a mentally ill individual whose functioning is significantly impaired is considered halachically ‘ill’.
In light of this:
- One who suffers from a mood disorder and takes medicine on a regular basis during the week is allowed to continue on Shabbat because taking medicine is permissible for one defined as a ‘holeh’. Moreover, it is permissible even if there is a doubt as to whether one is sick. This is especially true in our day when there is no concern that a person will transgress a prohibition in order to prepare the medicine himself.
- A young man with an anxiety disorder has trouble sleeping, and his functioning is affected after this continues intermittently for more than 24 hours. During the week, he listens to relaxing music which allows him to fall asleep. His therapist is of the opinion that this is the only way for him to do so. There is room to consider allowing him to do this even on Shabbat.
According to most contemporary poskim, activating a music playing device is a rabbinic prohibition. For the sake of a holeh she’ein bo sakana, this can be permitted when done in a different manner (shinui). However, because this allowance is innovative, the following conditions should be met, if possible: that the condition was diagnosed by a professional, that listening to music is proven to be an effective treatment for the patient. The device should be prepared before Shabbat, so that it can be activated with one push of a button, which should be done with a shinui. Earphones should be used in order to minimize the extent to which noise is produced on Shabbat.
- A person who suffers from depression discovers that playing the flute relieves his feeling of depression. His therapist attests that this indeed improves his mood. Is he allowed to play on Shabbat when suffering an episode of depression?
Playing music as a psychological treatment is attested to from ancient days. Playing an instrument on Shabbat is a rabbinic prohibition. The question of this prohibition’s applicability in the post-Talmudic period was discussed by the poskim and most determined that the prohibition remains. Many poskim allowed playing music during the period of mourning prohibitions in order to heal the sick person’s soul. However, regarding prohibitions of Shabbat, no such allowance is recorded. There is room to consider allowing this in the above conditions, based on an allowance for the sake of healing a ‘holeh she’ein bo sakana’. However, since this is an innovative suggestion, there is room to allow the sick person himself to exercise his judgement, because ‘the heart knows the bitterness of its soul’.
- A woman suffering from post-partum depression needs significant psychological support according to the doctor, and a hug from the man she loves can help save her from psychological distress. Since she has not yet immersed in the mikveh, she is forbidden to her husband. Is it permissible for him to hug her in order to help her?
A hug between a man and women who are forbidden to one another is prohibited- some say on the level of Torah law, and some saw as a rabbinic prohibition. For some poskim, it seems that the severity of forbidden touch is only when it has sexual intent. Touch without sexual intent is certainly discouraged, and even forbidden, but in circumstances of special need there is room to consider permitting it. Therefore, because in the case of depression, a hug can prevent a woman from sinking into the depression, there is room to consider permitting a hug which is not in the context of sexual intent. However, this should only be done when a number of conditions are present which limit it to necessary situations, and prevent it from slipping into forbidden territory:
- A medical diagnosis, and the decision of a halachic figure that the condition is one of ‘holeh she’ein bo sakana’.
- Defining this solution as necessary, and lacking other solutions (for example, if another person could provide the necessary support.)
- The couple is responsible to maintain the boundary of only necessary hugging, without allowing slippage into forbidden actions.
- There may be more room to be lenient in public than when the couple is alone.
“And you will sate the afflicted soul, and your light will shine in the darkness, and your gloom will shine like the noon…
He will sate your soul during famine, and will strengthen your bones” (Isaiah 58:10-11)
 For further discussion and sources, please visit our website