Obsessive-compulsive Disorder

Your doctor has surely informed you that numerous individuals find themselves in the same situation that you describe (imagining that they did something imperfectly; that their hands are not clean, [i.e., ritualized hand washing,] for which reason they must wash their hands again, etc.).

When one makes a concentrated effort to be inattentive to these thoughts (not fighting these thoughts but being unmindful of them to the greatest possible degree), then [such thoughts] will dissipate with the passage of time, eventually disappearing entirely.

For example, when you desire to [re]wash your hands, do not make an issue of it. Rather, either say to yourself that this thought is insignificant and meaningless, [and pay the thought no heed,] or do wash your hands and then immediately occupy yourself with something that has absolutely no connection to your prior act [of washing your hands].

One’s frail general health also serves as one of the causes for this disorder. Strengthening your general health will thus be of additional assistance in easing your condition.

Also, in order to hasten your healing, you should consult with a doctor who is also a friend and follow the doctor’s directives.

Inspect the mezuzos [in your home to insure that they are all kosher according to Jewish Law].

Please convey your name and your mother’s name to me so that I may mention you in prayer at the holy resting place of my father-in-law, the Rebbe, of blessed memory, [for a full and speedy recovery].

(From a handwritten response of the Rebbe, circa 1973)

Advice on Conquering Alcoholism

In reply to your letter of Teves 24 in which you write about your good resolution [to stop drinking] after you received my previous letter, and that, after a period of time you were unable to withstand the test, etc.

The words of our Sages are known regarding such situations, that a person should not be crestfallen if he could not withstand a test and fell through. Surely this should not lead to hopelessness, Heaven forfend, in your battle with your evil inclination. To the contrary, hopelessness and dejection are the weapons used by the evil inclination. It says to man — to Israel, (the people who are close to Him;) “you are called man”, each of them being a descendent of the Patriarchs, Avrohom, Yitzchak and Yaakov — to cease battling him, [for you see that you have previously failed, hence surely] “you will not be successful” etc. [in the future as well].

To the contrary. If you fell through and realize how abhorrent and bitter it was to fall through; not only was this opposite the will of the Creator, the Giver of the Torah and the Commander of the mitzvos, but it also led to destruction and devastation of one’s physical life in this world, this should empower you to a greater and fiercer degree to stand fast in your abovementioned battle [with the evil inclination]. Ultimately, the promise that “If a man sanctifies himself somewhat below he will be sanctified a great deal from Above” will come to fruition.

A) In order to strengthen yourself in the above battle and hasten your victory, it would be most appropriate that you only carry around enough money to purchase minor items and the like.

B) To the greatest extent possible, see that you find yourself only in the company of people who observe Torah and mitzvos. Particularly so, since every Jew is so commanded, in line with our Sages’ teaching, “Much [sinful] behavior is a result of [bad] friends,” while “It is good for the righteous; it is good for his neighbor,” with the opposite being the case as well.

C) Since many physicians are aware of medications that help a person overcome and conquer one’s desire for such strong drink and with the passage of time to totally end such desire, you should ask them about this and follow their directives. It is also must crucial that you know by heart several chapters of Mishnayos and Tehillim and review them from time to time. Particularly so, when you are under the impression that you have such a desire….

(Igros Kodesh, Vol. 22, p. 110ff.)

Irregular Attraction

People are born with diverse natures, and education is always necessary to set the person properly on his/her feet. This applies to the training of good traits as well as the modification of bad traits.

Good tendencies in children must also be nurtured, directed and cultivated through proper education and training, for if not, the uneducated intellect can run amok and go against its own good nature. His actual conduct will not match his good tendencies.

When a child has character traits that are abnormal and undesirable, it is certainly the responsibility of the parents and teacher — those who love and really care for the child — to train the child and modify his/her attributes.

It is also self-evident that the behavior modification must be followed through, despite the objections and arguments of the child that this trait is: (a) part of his “nature,” or (b) that he is willing to suffer the consequences, or, (c) that there will be no negative results of his actions. The necessary forcefulness must obviously be applied to be successful.

All this holds true in the normal course of growing up — evaluating and distinguishing the good and bad traits, and guiding the growth and maturity of the child.

There are times, however, when a child is born with a genetic deviation or deficiency, for example some emotional or mental disorders which have symptoms such as “tearing out their own hair,” “[excessive] nail biting,” “knocking their heads against a wall,” or some other self-destructive traits.

It goes without saying that one who loves and cares for this child will do all he/she can to correct this aberrant behavior and seek a training plan, a learning module, or an educational framework to cure this deviation.

When the child grows up and is cured, he will surely feel a sense of gratitude to the ones who had “not spared the rod” of education and had pulled out all the stops to correct his deficiencies.

These universal principles of education as applied to children may also be adapted when we speak of rehabilitating adults. They, too, can be educated to modify their harmful traits and they, too, will be eternally grateful for such vitally important help.

Every person has the ability to choose “life.” For some it is easier and for others it is harder, but without a doubt, if one so wills, he can overcome those traits which are offensive or self-destructive.

Educators, therapists and counselors should keep in mind that the possibility exists to eventually correct the problems, even though the troubled client might vehemently claim (which might actually be quite true) that his deviations are inborn and part of his nature.

They can be helped; and experience has shown that in the end they will express their eternal gratitude for the firm direction and support they received from family, counselors and friends.

Maimonides teaches:

Free will is bestowed on every human being. If one desires to turn towards the good way and be righteous, he has the power to do so. If one wishes to turn towards the evil way and be wicked, he is at liberty to do so (Laws of Repentance 5:1).

Consequently this true free will, described by Maimonides, is decisively all-powerful. Yet, in the laws relating to “Moral Disposition and Ethical Conduct,” Maimonides admits that:

Every human being is characterized by numerous and exceedingly divergent moral dispositions ... One man is choleric, always hot tempered; another sedate, never angry ... one is a sensualist whose lusts are never gratified; another is so pure that he does not even long for the few things that our physical nature needs ... [Then there are those who are by nature] stingy, generous, cruel, merciful, and so forth. (Laws of Ethical Conduct 1:1)

Maimonides adds:

Of all the various dispositions, some belong to a person from the beginning of his existence and correspond to his physical constitution. (Ibid. 2)

In other words, some people are born with the nature of stinginess, etc., and others are born with different natures! Does everyone really have free will to freely choose right from wrong even if it seems to be against his/her nature?!

The commentaries on Maimonides explain that he means to say that although one may truly have an inclination and leaning by his very nature, and although he may show a propensity for certain conduct, none of these factors can “force’’ him to act in a particular way. He still has an absolutely free will!

The ideal way to control and overcome the offensive predispositions is to be trained, while still a child, by the strong and firm controlling hand of the loving parent and educator. But it is never too late for this educational process to begin; a human being can always learn, improve and progress.

At this point let us turn our attention to a phenomenon affecting some of our society, the problem of individuals who express an inclination towards a particular form of physical relationship in which the libidinal gratification is sought with members of one’s own gender.

Empirical truth has shown us that this form of abnormal relationships has been totally negative.

1) In a normal relationship, the results which follow bring forth children and create a new generation, which goes on to bring future generations, to the end of time. The abnormal trait brings no positive results and no offspring.

2) This trait is self-debilitating. It causes a dissipation of the strength of the individuals involved, is purely selfish, and no one else receives anything from it.

3) Another very important reality: the individuals who practice this form of relationship are filled with the self-abnegating feeling of being strange and queer; they feel that they are doing an abnormal act.

Both in the case of men who have these relations, and in the case of women, they know that this tendency is not normal. They look at the world around them and they know that their practice is abnormal.

Except for a very few “orders” where this deviation is practiced, the whole world conducts itself in a normal way. Besides, both parties involved in this said relationship know that it was only the normal form of family relationship that brought them into the world!

4) Also important: Those who feel that this form of conduct is permissible and they continue to practice this deviation, will in the end see that it brings to excessive, abnormal weakness and the most horrible diseases and maladies, as we are presently beginning to discover.

When one knows the truth, that this trait is destructive, and is honest enough to acknowledge this fact, one will realize that it is no different from a child who is born with the tendency to tear out his hair, or bang his head against the wall.

But there is a very tragic difference in that when this trait is practiced, it is very much more devastating because it destroys the body and the soul.

There are those who argue that an act which brings pleasure and gratification is, or even must be, good. This rationalization is analogous to taking a deathly poison and coating it with sugar. Along comes someone and says, “I see sugar, there is no poison in this sugar pill.” To prove his words, he tastes it and swears it is sweet!

Someone else may come along and say, “I don’t care if there is poison in the sugar. So long as I can enjoy the momentary pleasure of the sweetness, albeit in an abnormal fashion, I don’t care what the consequences will be!”

Certainly, they themselves will eventually complain very strongly against those who misled them, and also against those who saw what was going on and did not do all that was possible for them to do to prevent it from happening.

It makes no real difference what causes an individual to presently choose this form of relationship.

Even one who was born with this inclination and was not educated in his youth to correct it (no matter who is to blame) and is now an adult, must also be motivated to educate him/herself now, for it is still just as destructive; it is still just as abnormal, etc.

An important point to stress is that there is no insult intended and no derogatory attitude suggested; it is a case of healing a malady. When a person is ill and someone volunteers to help him get well, there is no disrespect involved, not at all!

At the same time, we must keep in mind that the vehement and vociferous arguments presented by a patient — that he is really well and that his condition is a healthy instinct, or at least not destructive — do not change the severity of the “ailment.”

In fact, this attitude on the part of this individual indicates how serious his malady really is, how deeply it has penetrated into his body and psyche, and how perilous it really is for him.

And so, special action must be undertaken to heal the person and save his life. And again, there is no insult at all and no disrespect involved; only a true desire to really help.

If he claims that he was born with this nature, this is indeed all the more reason to reassure him that no disparagement was meant, for it is no different from the case of one who was born with the tendency to bang his head against the wall. Do we shame that unfortunate one?! Nevertheless, everything must be done to remedy the situation.

And dubbing the deviation with some Greek term, or calling it an “alternative lifestyle” will not in the least influence the seriousness of the problem.

The question must be answered: Does this type of relationship contribute to human civilization? Does it, at least, benefit the individual? Is it truly satisfying after the act? Or, does it only provide momentary gratification?

And furthermore — this point should be carefully pursued — are all his/her protests about the “great pleasure” and “satisfaction” derived from this relationship really true? Or, has he/she just been saying this for so long that now he/she is not willing, or is ashamed, to admit that he/she is wrong!

In G‑d’s world of goodness and justice, when one comes to purify and be purified, he is assisted from Above. Despite the misguided way of the past, everyone has the capacity to change. People who open their eyes and realize their error, will at the end voluntarily accept the truth.

All civilized society accepts the said tendency as a perversion, and although in the past there were pagan tribes and “orders” which included these practices in their idolatrous rituals, history has shown that their memory is lost and their customs have vanished!

A special responsibility lies on the parents, educators and counselors to educate those afflicted with this problem. Their duty is not to [educationally] “spare the rod,” but at the same time to take a loving and caring attitude by extending a helping hand.

(From a Sichah of Purim, 5746)

Confusion of Gender Identity

This is to acknowledge receipt of your letter of the 7th of Av.

There is surely no need to point out to you at length that one of the basics of our Torah, Toras Chayim [the Torah of life], is that Hashem is the Creator and Master of the Universe, whose benevolent Providence extends to each and everyone individually, and that He is the Essence of Goodness, and it is in the nature of the Good to do good, particularly in regard to our Jewish people, to whom he has given His Torah, Toras Chayim, of which it is stated that it is “our life and the length of our days,” together with its Mitzvos whereby Jews live.

As you know, and indicate also in your letter, there are Mitzvos which apply to Jewish males, and those that apply to Jewish females, and the distinction in regard to the fulfillment of the Mitzvos, is a far-reaching one.

In light of the above, it is not clear why you should want to interfere with Hashem’s blessings and contemplate a change of sex; especially as it would immediately bring in complications regarding Torah and Mitzvos, even assuming that there would be no problems in other areas. And since it would be quite plain and understandable, there is no need to elaborate on it.

As for your writing that you have sometimes had the desire to have been born a female, etc. — it is not surprising that a human being cannot understand the ways of Hashem, Who surely knows what is best for every individual. However, if this desire is somewhat troublesome to you, it would be advisable that you should talk things over with a Torah-observant psychologist.

I suggest that you should have your Tefillin checked to make sure they are Kosher.

With blessing,

(From a letter of the Rebbe, dated 22nd of Av, 5745)

When Severe Mental Illness Threatens a Family

In reply to your late-arriving letter, in which you describe the situation in the family,1 particularly with regard to health matters, etc., and you ask my opinion in this matter:

Generally speaking, your writing that the doctor stated that there is no hope for a full recovery is strange indeed, when in many known similar situations there was clearly a complete recovery.

I personally witnessed similar situations in which the individuals became better, and moreover, they have been fine for more than ten years; additionally, they married (for [one] of the individuals whom I have known the entire time was previously single; he has since married and has had children) and are engaged in established jobs.

With regard to a particular situation, it is impossible to know clearly and with certainty [about the eventual outcome], but clearly, the statement of the doctor that the situation is hopeless is definitely out of place. At the very most, he can say — and indeed all that a human being is capable of saying — that he does not take responsibility for the future [if his advice is heeded], but [he can say] no more than that.

With regard to the circumstances as you describe them, particularly that there are children who are still in their formative years, one must surely try to find any and all reasons and justifications for the marriage to remain intact.

Moreover — and this is of great importance — you should be in constant contact with specialists in this field, to rouse them and question them from time to time whether the new methods of treatment and new medications that appear quite often would be beneficial in this situation.

May the A-lmighty, Who oversees each and every individual with individual Divine providence, He Who is also “Healer of all flesh and Performer of wonders,” direct you and all those mentioned in your letter in the path that is truly good for them, in a manner of overtly revealed goodness — goodness that is good both “to heaven and to man.”2

May G‑d will it that there be a rapid major improvement in the situation — particularly as we find ourselves now in the month of Adar, a month blessed with success for the Jewish people in all aspects....

(Igros Kodesh, Vol. XX, p. 183)

Hospitalization and Treatment of a Mentally Ill Patient

…Understandably, in such a situation, you are to follow the directive of the specialist about whom you write, [i.e., that your daughter be hospitalized,] for this will also benefit your daughter, tichye — surely she will be unable to receive all the benefits and care [at home] that she can receive in the surroundings suggested by the doctor.

However, before you [hospitalize her], you must find out more details about the particular institution; specifically, to establish a connection with the physician there, so that you will know what is transpiring with her, and most importantly — and this is easy to understand — that you be able to be certain that she is receiving the required attention and not treated in an indifferent manner.

May it be the will of G‑d, “Healer of all flesh and Performer of wonders,” that your actions on your daughter’s behalf act as the conduit through which to receive G‑d’s blessings, as the verse states:3 [“G‑d will bless you] in all that you do.”

It may be worthwhile — if you did not ascertain this until now — to acquaint the specialist with the state of her menses; if it is not in order, surely improvement in that area will assist in bringing about a general improvement in her overall status.

Inquire from him as well whether in these circumstances it would possibly make sense to medicate her with drugs from the class of aminocids and whether to treat her with shock therapy4 and the like.

(Igros Kodesh, Vol. XX, p. 240)

Tefillin as a Spiritual Aid in Healing Schizophrenia5

[See to it that there is] scrupulous observance of putting on tefillin by those in need of a blessing [for healing], as well as by their fathers, etc.

The connection between [the healing effect of tefillin and the illness of schizophrenia] is very simple indeed, ([it is] in keeping with a manner of conduct that is also very simple [to comprehend]) — that of “measure for measure”:6

Schizophrenia (whatever its cause) consists of a dissonance between actual facts (true reality) and how the ill individual “sees” them and comprehends them in his mind.

As a result, 1) his emotions are consonant with what he sees and perceives — panic and fear that others are seeking to harm him, etc.; 2) from time to time there are changes — from one extreme to the other: from unfounded fears to unfounded elation, etc., a total fragmentation of the psyche and perspective.

Tefillin [can be spiritually efficacious in combating the above, since] part7 of the mitzvah [of tefillin] and its spiritual effect [consists of] submission of the heart (the emotions) and the brain (intellect) to the “G‑d of truth,”8 concerning Whom the verse states,9 “I am G‑d; I have not changed.” The result: harmony between the mind, emotions and reality.…

(Likkutei Sichos, Vol. XXXVI, p. 297)

Assisting Someone Who Is a Total Recluse

In reply to your letter from the 15th of Tammuz — that I just now received — in which you write about [the problems that] ... sheyichye [is having, and about the fact that he is a total recluse]:

It would seem from your letter that this individual should first and foremost actively begin seeking the company of others; this will serve as a good beginning for his overdue recovery.

Although — consonant with the saying of our Sages, of blessed memory, that “All beginnings are difficult” — his initial efforts to begin mingling with others will surely be difficult for him, he must force himself to do so. No doubt his friends will assist him in this matter.

Since, however, one should only demand of a person that which he is capable of doing, it is self-understood that my intent in the above is not that he suddenly change from one extreme to the other, i.e., that he interact with others for many hours a day. Rather, he should do this step by step, beginning with those with whom it will be easiest for him to connect.

He should do so, however, with the intent and goal that his interaction with others will continually increase to the point that he will do so naturally, not finding it a struggle to speak and mingle with others.

It would also be advisable for him to give a class to some group, doing so in the manner mentioned above: a relatively minor and easy subject that will not cause him overly great strain and require strenuous effort. In conjunction with the above — and this is of paramount importance:

He should be firm in his knowledge ([knowledge that is] based on the actual truth) that his present situation can improve one hundred percent — it need only be in a manner of [making these improvements] incrementally.

Additionally, his efforts should be based on the fundamental principle that service of G‑d is to be with “joy and gladness of heart,” as explained in the Tur and Shulchan Aruch, Orach Chayim ch. 231. And as stated above, it is more than likely that he will see for himself how eminently achievable this goal is.

Since you were the one who brought his question to me, you surely will not slacken your efforts; eventually the young man will be grateful to you for all you have endeavored to do for him, even if initially he will seem resentful.

(Igros Kodesh, Vol. XIX, p. 371)

Dealing with Agoraphobia

A) Relate to your situation in an “easy” manner. In other words:

1) Be aware that truly many individuals suffer from the above, and yet live tranquil and serene lives, etc.

2) When you will need to enter a hall, a shul on Yom Kippur, and the like [do the following:] If it will be easy for you to do so, then do it. If not, do not engage in an internal struggle and battle; do not force yourself at all to do this. Pray at home (during the time of congregational prayer), and do not make an issue of this.

B) Enhance your religious observance. Your trust in G‑d will then be strengthened as a matter of course, and this will lessen your worries, including the above worries (for G‑d is watching over you).

(From a letter of the Rebbe, dated 3 Tishrei 5737)

Incremental Psychological Progress

I received your letter of Friday, the 7th of Iyar, in which you ask my advice on how to assist Mr. ... [with his psychological problems]:

Generally speaking, it would be advisable to discuss the matter with a doctor; perhaps it is possible to find a doctor who had occasion to examine him.

I have also written a letter to him, which he may have shown you. It would be well to find an opportunity — of course without his knowing that I suggested this to you — to emphasize to him once again that the customary progress is measured in incremental steps and he should not expect to radically change himself in one fell swoop. Even if his progress is slow, in his circumstance, this incremental improvement is indicative of the manner of his progress.

(From a letter of the Rebbe, dated 17 Iyar, 5719)

Kleptomania

…With regard to your son ... sheyichye, who seems to display a propensity for stealing, G‑d forbid:

You should turn to a professional, since this is a form of [psychological] weakness and doctors now have means of healing this ailment.

Understandably, this should not keep you from reciting an extra chapter of Tehillim daily as well as giving a few cents to tzedakah prior to Shacharis and Minchah specifically for your son’s merit.

Inspect as well the tzitzis of your child’s tallis kattan and make sure he does not go with his head uncovered. Check the mezuzos in your home as well.

If it is customary for the students to wear an additional head covering under the hat, he should be schooled in this as well. However, this should be done in an unostentatious manner, and [moreover,] it should emanate from the suggestion of his friends.

I hope that you will be able to convey glad tidings regarding the above.

(Igros Kodesh, Vol. V, p. 174)

Lobotomy

In reply to your letter of the 22nd of Sivan with the attached pidyonos in which you write about the idea of having surgery performed:

You do not, however, explain what form of surgery you are referring to — possibly you are referring to a lobotomy. If that is the case, then I do not — at least for the time being — agree with the idea of this operation, since until now this operation has very often proved unsuccessful.

It follows that all other forms of healing should be attempted before this step is taken, particularly since it is known that among the latest medications and therapies there are those whose positive results can only be discerned after a year or two.

It would be worthwhile for the doctor who is in charge of the patient’s care to write in detail about the situation regarding the treatment of ... tichye until now in the manner that one doctor writes another. This will be shown to a specialist here....

(Igros Kodesh, Vol. XVII, p. 207)

In a follow-up letter to the woman’s doctor, the Rebbe continues to explain his opposition to a lobotomy:

I acknowledge receipt of your letter from the 23rd of Tammuz, and I thank you for making the effort to describe the situation of the patient….

It is the opinion of the preeminent local specialists in this field, based on their experience in dealing with very many similar situations, that if the ailment has endured for many years and all other forms of treatment have been tried and have been unsuccessful, then they would be in favor of the surgery; [i.e., to perform a lobotomy].

Understandably, the final decision — as to whether the patient meets the above criteria — belongs to you, since the patient is under the care of the institution that you direct.

…With regard to the surgical procedure of lobotomy, a treatment that has been introduced in the last few years:

Like all scientific matters, particularly medical procedures, [and with lobotomies as well,] it is virtually impossible that there not be changes in doctors’ attitudes and the extent of implementing procedures from year to year; the more extensive the reliable data of past outcomes, the more these changes are — based on past experience — well-founded and more enduring. Surely you are aware of all this much more than I.

In light of the above, it is readily understandable that any procedure that cannot be undone once performed, such as surgery, is to be utilized only after all other attempts have been exhausted — as you yourself write in your letter. Consequently, such a procedure is to be performed only when absolutely necessary and can in no way be further delayed.

This is why we witness that lobotomies in the United States are kept to a bare minimum, and even when performed they are only done after many years of [unsuccessfully] treating the ill patient with other forms of treatment. Even then, the majority of lobotomies are performed because — (as a result of a lack of funds) — the patient cannot be adequately [or] properly supervised.

Finally — and surely you know this better than I — even when the surgery is successful, here [in the United States], the instances where the patients are able to return to a normal life are extremely rare, if in fact they occur at all — notwithstanding the fact that you write “that almost all of them returned [after surgery] to a normal life.”

As to the statement in your letter that you “do not desire to be a partner to murder”: A lobotomy is not only an operation that involves excising a physical part of the body, it also involves excising part of the person’s personality and psyche. As such, you can say that such a procedure also involves, as it were, a partial murder of the individual — it is merely that when there is no other option, one chooses this less extreme measure.

All the above explains my position regarding a lobotomy, an opinion that is based on the directive of our Torah, the “Torah of Life,” that one should exercise any and all means even for the short-term salvaging of life.

This is particularly so with regard to mental illness, about which many matters are still unclear, both with regard to the causes of the illness as well as the manner of healing this illness. How much more so during the last few years, when critically important methods of treatment and fundamental changes are constantly occurring in the field of mental illness. It is therefore worthwhile to apply maximum effort to delay the lobotomy for as long as possible — until there is absolutely no other choice....

(Igros Kodesh, Vol. XVII, p. 282)

The Psychiatrist as Healer

…You invite my comments on the problems you mention in connection with your profession as a clinical psychiatrist in relation to your patients, specifically on moral and religious issues.

There is no need, of course, to point out to you that there can be no hard and fast rule that could be applied to all patients alike, since every individual is a world in himself. However, there are some points that would be valid in all cases.

To begin with, what is reprehensible from the view point of the Torah, called Toras Chayim (because it is the true guide in life), cannot be condoned.

This should not be confused with the principle of pikuach nefesh (a danger to life) which takes precedence over Shabbos, which is itself a directive of the Torah, requiring that the laws of Shabbos observance be temporarily suspended in such a case; it is not a violation of Shabbos, but a Divine directive like that of Shabbos observance which, in case of pikuach nefesh, is subordinated; and it is certainly not something left to human discretion or judgment.

Clearly, the said principle cannot serve as a basis for condoning other violations of Torah laws in order to help a patient get rid of guilt feelings, or make him feel better.

At the same time, there is also the instruction “The irate person is not a good teacher” (Ethics of the Fathers 2:6).

This applies, of course, not merely to a teacher who teaches any subject or theory, but also to one who teaches and guides and advises in matters of daily life and conduct.

A further helpful point to bear in mind is that through increased learning of Torah and stricter adherence to the mitzvot — though these are a must for their own sake — a Jew widens the channels to receive G‑d’s blessings, including deeper insights and understanding to cope with problems and to make the right judgments and decisions.

P.S. Needless to say, there is no point at all for you to change to another specialty in medicine that would not disturb your peace of mind, etc.

On the contrary, inasmuch as in your present profession you can now be guided also in your therapeutic methods by the Torah, it will be both a greater merit for you and of greater benefit to your patients — which makes it even more imperative that you continue specifically in your present field.

One of the ways to lessen and eliminate the personal emotional agitation, etc., is to consider your patients in the way the Torah explains their condition, namely, that “a person commits a transgression only because of a ruach shtus (an impulse of folly) that beclouds his mind”; in other words, because of mental illness. And the more serious is his malady when he does not want to recognize and admit that he is ill.

What has been said here is not to imply that it is necessary to tell the patient bluntly that what he has done is prohibited by the Torah and therefore he must not behave that way.

The approach should rather be in keeping with the method suggested by Maimonides when teaching a child. He writes that when teaching a child Torah, the child should be encouraged and induced to learn eagerly by promising and giving him candy and similar rewards that appeal to his childish mind, until such time as he will understand that the learning itself is the greatest reward.

Similarly, in the case of these patients whose knowledge and standard are still on a child’s level, for the essential thing is the actual result.

(From a letter of the Rebbe, dated Rosh Chodesh Adar II, 5736)

Advice to a Mental Therapist

I acknowledge the receipt of your letter from the 27th of Teves, which I just received. You ask for a blessing and advice regarding [your efforts to psychologically heal]….

I will mention you in prayer and for a blessing at the holy resting place of my father-in-law, the Rebbe, that you succeed in your treatment of the above patient as well as all the other patients whom you assist.

With regard to your seeking advice: This is, after all, your profession, and “There are none so wise as those who have direct experience.”10

It is particularly difficult to offer counsel from afar, as the conditions of the country, the family and so on, have a direct bearing on the situation. Those who observe the situation up close are always better able and more expert at arriving at a form of therapy.

However, since you have already written to me, and everything is by Divine providence, I wish to stress something that I have witnessed numerous times in similar situations:

In most similar situations, a decisive and effective method — which, to my amazement is not used, at least not as much as it should be used — is that of hesach hadaas, getting the patient to entirely remove his mind from thinking such [negative] thoughts.

The more the patient succeeds in ceasing to think about and to dwell upon those issues that are the cause of his problems, the greater will be the ability of the person’s natural healing powers and his other positive and curative aspects to function with increased intensity and bring about healing.

Because of the special circumstances of those who are afflicted in this manner, one cannot always succeed when speaking to them openly and directly about the need to get rid of these thoughts.

However, the most important thing is that they actually stop thinking such thoughts; it really doesn’t matter how to bring this about. This, therefore, can also be accomplished by having them become occupied with something that is totally unrelated to their state of health.

In order to bring this about in actuality, it is necessary to have them perform actions that lead to personal psychic gratification, such as by doing someone else a favor — something that in any case is acceptable to all [and therefore should not be difficult to convince them to do].

This is particularly so during our times, when instability is so great and people’s needs are so numerous. It is relatively simple to find a way for these individuals to help other people — actions that are consonant with the [needs of the] locale and [of the] individual who requires healing.

An additional aspect to this manner of behavior is the fact that doing someone else a favor is not only good in itself, but carries with it its own reward — a truly great reward for a mitzvah.

[This reward is,] in the words of our Sages, of blessed memory:11 “More than the householder does for the poor person [by providing his needs], the poor person does for the householder [by providing him the opportunity to give tzedakah].”

There is more to say on this matter, but I am sure that for you, the above will suffice....

(Likkutei Sichos, Vol. XXXVI, p. 323)

Treating Battered Women and Children

I received your letter of June 14th, in which you write about your communal activities, especially your involvement with a shelter for Jewish battered women and their children, and the difficulties connected with it.

I am confident that your awareness of the importance of the cause, and also seeing the help that it brings to these tragically affected women and children, makes it easier to overcome whatever difficulties you may encounter.

At the same time, it is well to bear in mind that the work you are doing demands a special sensitivity, [i.e.,] a sensitivity also from the viewpoint of Yiddishkeit, which, under the tragic circumstances, often is a factor to be reckoned with especially.

In light of the above, I trust that you will accept my suggestion that you should consult with at least one competent Rabbi who is familiar with the detailed and intricate factors involved in this activity, particularly insofar as Yiddishkeit is concerned.

In this connection, one must especially bear in mind that the requirements of the Shulchan Aruch [Code of Jewish Law] are fully adhered to so that everyone can benefit from the services, even if one is not a very strict observer otherwise.

For example, when a glatt kosher meal is served, everyone can enjoy it, whereas if it is not glatt kosher, it would present a problem to those who observe glatt kosher. It should also be remembered that when we are speaking about Yiddishkeit, it is something that deeply affects both the spiritual and physical aspects of Jewish life.

(From a letter of the Rebbe, dated 5 Tammuz, 5744)

Hypnosis as a Technique in Psychotherapy

…I would like to make a further point, though entirely not in my domain, namely, in reference to hypnosis as one of the techniques used in psychotherapy, as mentioned in your letter.

I have always been wary of any method that deprives a person of the free exercise of his will and which puts him in the power of another person, even temporarily — except, of course, in a case of a pikuach nefesh [a life-threatening situation].

Certainly I would not favor the use of such a method on a wider scale....

(From a letter of the Rebbe, dated 21 Adar II, 5738)

The Power of Faith and Good Deeds In Treating Mental Illness

…I am making use of this opportunity to add another point, although this is [more] in your area, [i.e., psychiatry]:

The course of the illness and treatment of ... proves (if proof is even necessary) how mighty the power of faith is in serving as a basis and foundation for man’s inner peace and tranquility, and for minimizing — and at times even nullifying — inner personal conflicts as well as the “complaints” a person might have about those around him.

This is particularly so when this power of faith is related to, and finds expression in, actual deeds such as public service, performance of mitzvos, etc.

This is so, notwithstanding and in contrast to the school of thought that faith and religion demand of a person acceptance of a Divine yoke and suppression of one’s instincts and natural inclinations, for which reason, [they maintain], it is not desirable in general, and particularly in the case of an individual who is in need of psychiatric treatment....

With esteem and blessings that you succeed in your career, healing the ill and leading them to a healthy life — life that is worthy of the term “life.”

(From a letter of the Rebbe, dated 3 Tammuz, 5729)

Mental Health Depends on Spiritual Health

From time to time I have the opportunity to see your writings on mental health in the newspapers.

For someone like you — particularly in light of the conversation I remember having with you in the past — it is superfluous to emphasize that healing the psyche of a Jew is dependent on his connection to Torah, concerning which it is stated,12 “For they are our life and the length of our days” and the performance of its commandments, concerning which it is stated,13 “You shall live by them.”

If, with regard to all human beings, the health of the body is connected to the health of the soul, this is even more accentuated and apparent with regard to a Jew.

(Igros Kodesh, Vol. XXIV, p. 247)

Logotherapy

I find the articles of Dr. [Viktor] Frankel14 ([of] Vienna) of particular interest with regard to the above [concept that a person’s faith and its connection to good deeds and finding meaning in life enhance man’s inner peace and tranquility, and minimize — and at times even nullify — internal and external conflicts].

However, to my surprise, it seems that his school of thought has not been sufficiently publicized and accepted.

Although there are many reasons why this may be so — among them that this is also related to the behavior offered by the attending psychiatrist, [i.e., the lifestyle lived by the psychiatrist himself] — the question remains [as to why his theories have not been sufficiently accepted].

(From a letter of the Rebbe, dated Tammuz 3, 5729)

Positive and Negative Forms of Psychotherapy

…Surely I need not make you aware of the directive of our Sages, of blessed memory, which states:15 “A person should never give up hope,” particularly as it is expressed in [the teachings of] Chassidus. The immediate conclusion to be drawn from this statement is that you should not cease your efforts in trying to influence the said individual to follow the proper path.

I believe I have already written to you regarding this matter, that we verily observe in similar circumstances that an indirect influence can have better results than trying to influence the individual directly.

I would also like to note the following in connection to your writing that the said individual finds himself under the care of a mental healer. It is not entirely clear to what kind of doctor you are referring. However, there is a specific class of therapists who commence their therapy by deriding G‑d, spirituality, honoring one’s parents, and the like.

If that is the type of therapist he is seeing, then even if the therapist is distinguished in his field, much examination and clarification is required in order to ascertain whether the benefit he may receive from him outweighs the long-time harm that may result [from this form of therapy] with the passage of time.

Of course, many such therapists have been effective and have healed utilizing virtuous methods, particularly since the time that one professor found the courage to declare and announce that (in opposition to the well-known individual who founded this form of therapy) belief in G‑d and religious inclinations as a whole lead to a meaningful life, are of the most efficacious manners of healing, and so on and so forth.16

Nevertheless, for any number of reasons, this philosophy has not permeated many branches of therapy. It would therefore be worthwhile to find out more [about the therapist and his form of therapy].

(Igros Kodesh, Vol. XXII, p. 227)

See To It That Therapy Is Received

…Enclosed is a copy of my response to ... Since that individual is unaware that I have sent you a copy, you on your part should try to find out in a diplomatic manner whether a psychiatric specialist was visited, what was said, and whether his instructions are being followed....

Certainly there are eminent specialists in this field in your locale, and it is worth making an effort that the advice of one of them is sought, as the matter about which was written about, unfortunately, is not all that uncommon in someone whose mental health is unstable.

There are many methods of healing this problem, particularly since — as stated in the letter — this matter began in conjunction with specific events, and knowing this makes it simpler to treat.

I await glad tidings from you with regard to all the above....

(Likkutei Sichos, Vol. XXXVI, p. 326)

Old and Newer Methods of Treating Mental Problems

…You write that doctors are suggesting that you receive insulin treatments again. It is generally common to have this treatment repeated.

However, of late, many different methods have been discovered to treat such a type of illness, some of which say to continue with insulin and electroshock, etc. Lately, the method of treatment via medication and psychotherapy has become more prevalent.

May the “Healer of all flesh and Performer of wonders” speed your recovery through the method of treatment that is best for you.

…Understandably, regarding the course of action, you should follow the instructions of your doctor. However, you can make him aware (in a diplomatic manner) of the above.

(Igros Kodesh, Vol. XXI, p. 436)

…In reply to your question:

During the last few years, doctors here have vastly reduced the use of insulin and shock therapy and have replaced it with medications, and they are quite pleased with the results — although this form of healing takes longer to effect.

In any event, it is very important that — in a pleasant way — you see to it that he occupy himself with some form of labor or with some other matter that will not cause him to feel pressured.

(Igros Kodesh, Vol. XXII, p. 157)

Medication Rather Than Injections for Depression

You write about taking injections, etc.:

I am surprised by this, since lately pills are used; they are both more effective and have less side effects. Moreover, there is no need to be in a hospital when they are used.

Here use is made of the [anti-depressant] Tofronil. Surely this medication or something similar to it is known about in Eretz Yisrael.

It is almost certain that a change of location, such as visiting friends for several days, will have a salutary effect, in a manner of overtly revealed good.

(Likkutei Sichos, Vol. XXXVI, p. 332)

“Mind-Expanding” Drugs

I am in receipt of your letter of October 18th, which you write in the name of your friends and in your own behalf, and ask my opinion regarding the new drug called L.S.D., which is said to have the property of mental stimulation, etc.

Biochemistry is not my field, and I cannot express an opinion on the drug you mention, especially as it is still new.

However what I can say is that the claim that the said drug can stimulate mystical insight, etc., is not the proper way to attain mystical inspiration, even if it had such a property.

The Jewish way is to go from strength to strength, not by means of drugs and other artificial stimulants, which have a place only if they are necessary for the physical health, in accordance with the Mitzva to take care of one’s health.

I hope that everyone will agree that before any drugs are taken one should first utilize all one’s natural capacities, and when this is done truly and fully, I do not think there will be a need to look for artificial stimulants.

I trust that you and your group, in view of your Yeshiva background, have regular appointed times for the study of Torah, and the inner aspects of the Torah, namely the teachings of Chassidus....

(From a letter of the Rebbe, dated 20th of Marcheshvan, 5725)