The problem, however, is that while most Yeshiva and Seminary students in this period of emerging adulthood presume that their very presence in Yeshiva or Seminary will stir them into becoming someone who is more learned, more observant, and more spiritually streamlined– the year in Israel can – for some young people – be a risky emotional cocktail. 

What Students Mentally Bring with Them to Israel and its Potential Impact

Like most beverages, life contains a mix of different ingredients, such that the life journey of an 18-year-old young man or woman has already had its fair rollercoaster of influences and emotions. What this means is that by the time a young man or woman arrives in Israel for Yeshiva or Seminary, they already carry within them a blend of different elements that they have adopted or absorbed from home, school, camp, community, society, and the media.

In some cases, this blend is balanced and harmonious, and when a student leaves their home and comes to Israel, the new ideas and experiences that they encounter do not conflict with who they are. On the contrary, they serve to enrich the physical and spiritual mix that is now their new selves.

However, there are occasions when the mix of the new — on top of the base ingredients which make up this young person — can lead to the concoction of a highly dangerous cocktail.

Of course, this is rarely if ever done deliberately. Still, the results of mixing together ingredients without considerable reflection on the chemical makeup of the cocktail, and without sufficient pause for thought about the spiritual metabolism of the consumer, leads to the same outcome: disaster.

The problem is that none of us carry a clear list of the ‘live’ emotional and spiritual ingredients that are what makes us who we are. So, while it is commonplace to avoid giving food to someone with allergies which may contain a product that is dangerous for them, the absence of such a list means that one’s year in Israel may be a gateway to young men and women consuming emotional and spiritual ingredients that are triggering. Simply put, within a short period of time, and even while attending a relatively ‘tame’, ‘solid’ or ‘safe’ learning environment, a seemingly mellow individual can undergo a metamorphosis and become a dangerous mix of ideas and emotions which they don’t know and haven’t been trained how to handle.

The Gift of Technology 

Admittedly, the situation today is better than it was in previous decades. This is because in the pre-cell phone era, Yeshivas and Seminaries were truly “total institutions,” while today, the cell phone enables young men and women studying in Yeshiva and Seminary to maintain regular contact with their family back home. What this means is that if they are blessed with a stable home, they are then able to remain more emotionally and spiritually anchored even while in Israel. From the perspective of spiritual growth, this is often an impediment, but in terms of mental health, this can be highly beneficial.

Still, not every institution permits smartphones, nor does their usage provide anything more than a beneficial tool to help families maintain regular contact with their sons or daughters. Moreover, in cases where there is instability in a family, the mixing of toxic messages from home with alternative messages from the Yeshiva or Seminary can be very confusing. Simply put, whatever technology a young man or woman possesses, and whichever Yeshiva or Seminary they attend, there is always a risk that they can be shaken or stirred by ideas which they learn, or by experiences they have, which can result in a significant mental health crisis.

And this brings me back to my first point, because most students don’t come to Yeshiva and Seminary in Israel to study. Instead, they come to find themselves, or to change themselves – which means that there is an expected level of “flipping out” (taking on more religious observances in a short amount of time) that parents expect of their son or daughter. The problem is that the line between healthy growth and unhealthy flipping out is very thin. So how do we know when it has been crossed?

Warning Signs for Unhealthy Growth

The short answer is that given people are different, a comprehensive set of signs is impossible to produce. However, here are some things to bear in mind:

1. If a Yeshiva or Seminary student was previously able to emotionally self-regulate but is struggling to do so, this is a warning sign.

2. If they were in regular contact with family and have suddenly ceased to be in contact with them for a prolonged period of time, this is a warning sign.

3. If they begin doing things or saying things that they cannot explain to others, this is a warning sign.

4. If they become very aggressive or very defensive about some of their choices, this is a warning sign.

5. If there is clear evidence that they are not looking after their physical well-being, this is a major warning sign.

6. If they speak as if they are under the sway of one of their male or female teachers, this is a major warning sign.

Why to Look Out

It should be clear that while I was asked to write about “taking care of one’s mental well-being while studying in Israel,” I have referred to Yeshiva & Seminary students and not spoken to them directly. And the reason for this is both incredibly simple, and incredibly scary: Someone who is experiencing mental health challenges doesn’t always know that they are experiencing mental health challenges – in much the same measure that someone who has consumed a dangerous cocktail isn’t always aware that they have done so.

Unfortunately, the age of self-help has led many to think that mental health challenges can be self-diagnosed and self-treated. But this is simply false. As the Gemara (Brachot 5b) teaches us: “a prisoner cannot release themselves from prison,” meaning that just as we need others to release us from a physical place of restriction, we also need others to help us when we are experiencing mental health challenges.

And this is why every family who sends their son and daughter to Israel needs a “what if” plan – not because such crises are likely, but because if they do occur, thinking about how to address them once they’ve occurred is often unfortunately too late.

Please click here to read other professional posts

MAKE YOUR DIFFERENCE: CLICK HERE TO SUBMIT A PIECE TO OUR BLOG

The post Taking Care of One’s Mental Well-Being While Studying in Israel appeared first on Refuat Hanefesh.

Conscientiousness Gets the Spotlight

Religious people tend to be conscientious. It isn’t hard to see why being efficient, organized, disciplined, planned, and orderly could help with the religious routine. Take Pesach for example, where conscientiousness takes center stage. The Seder literally means “Order”; we follow a distinctly regimented fifteen-part process, with the Haggadah as our guide. Strict rules regulate behavior with specific measurements of how much matzah and wine are consumed. Not to mention the cleanliness and orderliness necessary to rid the house of Chametz. Pesach is a celebration of conscientiousness.

Everything in Moderation

Yet, there can be a dark side to conscientiousness. Too much conscientiousness is linked to obsessive-compulsiveness. Orderly can turn into rigid, disciplined into perfectionism, and hard-working into workaholism. One interesting manifestation of this downside was reported in a study concluding that conscientious people were more prone to negative mental health outcomes following unemployment. The lack of goals and routine, difficulty being flexible, along with the loss of a system that was so core to their identity, posed significant challenges. And as much as we can laud Pesach as a positive expression of conscientiousness, I am sure everyone has a personal experience where orderliness was taken just too far.

In truth, like with most traits, balance, moderation, and wise application is key. As much as the Seder is regimented, embedded in the order is a break from routine. We purposely do things that are out of order to spark the curiosity of the children. While the core text of the Haggadah is essential, we are also encouraged to personalize and dramatize the experience. Imagination and creativity, two facets of a different Big Five category (“openness to experience”) that are often seen as being negatively associated with conscientiousness, are also integral. An immersive Seder with singing, acting, and vivid mental imagery allows us to really envision ourselves as leaving Egypt. The Hallel prayer that we sing is not supposed to be a trite repetition of an ancient text, but a spontaneous outburst of songs of praise to God for saving us from the depths of despair.

For this Year’s Seder, Embrace Balance

The Seder experience is supposed to be a fine blend of predictability and spontaneity, rigidity and flexibility, orderliness and chaos. Too much in either extreme and we miss the point. From this perspective, the Seder stands as a paradigm for our lives in general. Finding a balance between extreme traits and providing opportunities for utilizing different aspects of our personalities in various settings is a fine recipe for psychological and religious growth. May we merit having a healthily conscientious Seder fused with an added dose of creativity and imagination.

Please click here to read other professional posts

MAKE YOUR DIFFERENCE: CLICK HERE TO SUBMIT A PIECE TO OUR BLOG

The post Is being Conscientious about Pesach a Positive or Negative? appeared first on Refuat Hanefesh.

I want you to stop and notice your reaction to the word “suicide.” If the word or subject makes you uncomfortable, you’re not alone. Suicide is an uncomfortable and challenging topic. Similar to other mental health issues, suicide is shrouded in shame and stigma–both of which are dangerous. According to the CDC, suicide is the second leading cause of death for youth ages 10 to 34. Death by suicide is the pandemic that was silently sweeping the world for years.

And it is getting worse.

One of the most alarming outcomes of the COVID-19 pandemic has been the rise in suicide-related deaths and mental health crises. Mental health concerns were a growing epidemic in their own right prior to the pandemic, and that certainly continues to hold true today. We were an anxious, overworked, and isolated society long before we were forced to shelter in place last March. The uncertainty and stress caused by the outcomes of the pandemic have further exacerbated peoples’ feelings of isolation and anxiety. These heightened emotions have been greatly affected by the measures set up to mitigate the spread of COVID-19–primarily quarantining and social distancing. While these steps are crucial, their ramifications on mental health and suicidality cannot be ignored.

Still, with all of these truths, I have hope that we can create a world that is safer from suicide. For the past six years, I have had an in-depth look into the prevalence of suicide among teens and young adults. I am a suicide prevention educator, author, and mental health advocate. I have personally helped dozens of teens struggling with thoughts of suicide, as well as instructed their families and caregivers in techniques to help facilitate a safe environment. I’ve seen heartbreak and devastation, and I’ve also seen resilience and hope.

I believe that we can all be empowered to help someone; and with the right tools, we can do so with confidence. Don’t get me wrong: Talking about suicide is hard. Addressing suicide with someone in your life is hard. I say: better to have a hard, awkward conversation than none at all. At its heart, suicide prevention requires empathy, awareness, and curiosity. Below are some steps to help make this necessary and challenging conversation a little easier:

1. Recognize the signs:

Often, people who are struggling with thoughts of suicide will not ask for help directly. Think about how difficult it can be to ask for help with our normal, everyday things. Imagine how much more so with something as serious as suicide. While they may not ask outright, people who are suicidal often show and tell us that they are struggling with their actions, language, and emotions.

Examples of such signs can be aggressive behavior, dramatic mood swings, withdrawing from friends or family, giving away their stuff, and impulsive or dangerous behavior. It is important to note, though, that you won’t know if these are indicators of suicidal behavior or thought unless you ask them directly if suicide is related. 

2. Bring it up:

Be clear and direct in a kind and patient way. Don’t be afraid to ask, “Are you thinking about suicide?” Being direct is not dangerous. It is the safest way that you can convey your concerns to someone in crisis. Use your actions and language to convey a sense of safety and support. Refrain from blaming, debating, or trying to solve the issue.

3. Listen:

Active listening is one of the kindest forms of attention we can offer anyone, and this is especially true if people are in crisis. Our gut response to people’s pain is to fix it, make it go away, or ignore it. What we do when we listen is give them space to speak and be heard without fear of judgement.

4. Increase their network of safety:

Help the person struggling with thoughts of suicide connect to ongoing support, such as a crisis line or mental health professional. Increasing their network of safety is a crucial part of their long term safety and health.

5. Stay in their circle:

Follow up or check in on the person struggling with thoughts of suicide. I can’t stress enough how important this is. People who are suicidal don’t want to be thought of only by their struggles. They want us to remember that they are still people too.

Please click here to read other professional posts

MAKE YOUR DIFFERENCE: CLICK HERE TO SUBMIT A PIECE TO OUR BLOG

The post Let’s Talk About Suicide appeared first on Refuat Hanefesh.

How This is Affecting Couples

One way that I’ve seen the pandemic affecting couples is how much time they spend together but how little time they have to enjoy each other’s company. While they are often with each other all day, it is within a highly stressful and tense environment, so their relationship is strained all day every day. If they have children, then the challenges become magnified as they have to navigate their own stresses, their dissatisfaction with their partners, and the needs of their children. Parents find themselves yelling at their kids more and then blame themselves for being bad parents. “I should be able to stop myself from screaming at them,” parents lament. “I’m better than this,” they will sigh. 

What I’ve seen happening with couples under this level of stress is that they are drowning so much in their own troubles that they have difficulty accessing compassion for their partners. Barely able to keep their heads above water, they can’t see past their most immediate challenge, and anyone who asks anything from them is just adding to the problem. 

What ensues are individuals who feel like they are unable to handle their own experience and then are met with more pressure from their loved ones. They perceive their partners as getting in their way at best, and intentionally attacking them or trying to ruin their lives at worst. How does this happen?

When we are too preoccupied with our own suffering, we cannot access compassion for others. Think about when you are so tired that you can barely keep your eyes open. When someone wants to talk to you about their day, how much can you care? I remember a time like this in my own life when my son was born. I was so exhausted and was having a hard time despite all the good in my life. It was hard to be happy about having a baby because I was so tired. When I was trying to feed my son a bottle, I was sure that when the top of the bottle fell off, it was intentionally trying to sabotage me. 

During times where we are completely overwhelmed, we tend to perceive everything as an attack, no matter who (or my case what) is involved. We can end up blaming our loved ones for problems that they may not have intended to create or may not really even exist. So how do we manage this?

Managing Covid Relationships 

I think that there are a few things we need to do in order to manage this level of stress. The first is to be a little more forgiving of ourselves. We need to get rid of as many “should” statements as possible. There is no “should” for how to ideally respond to a pandemic. It’s not a helpful way of thinking and it just adds guilt to the burdens we can barely lift. Good enough needs to be good enough because we can’t give more than what we have, and right now, most people are just tapped out. 

The second thing we need to do is be more forgiving of others. This can be incredibly challenging especially when we have a hard time doing so for ourselves (for some people the opposite is true). When we feel like someone we love is making our lives even more difficult, we need to be forgiving of them. But how can I possibly do that if I feel like they are ruining my life? 

I think the answer to that lies in curiosity. When someone we love is doing something that we perceive as an attack, we need to do our best to be as curious as possible – and this is not an easy task. We can ask ourselves, or them, why they would do something that has negative effects on us. We may find that they had no idea or that they were actually trying to make our lives easier but their methods weren’t what we needed. 

If we perceive that they are really trying to hurt us, we need to ask ourselves why someone who loves me would want to hurt me. Was there something that I did that contributed to this situation? Did I hurt them somehow? When someone who is generally our supporter seems to have turned on us, far more often than not, we are misreading the situation. Most often they are trying to help us or are completely unaware that they did something that made our lives harder. Also, if we are totally overwhelmed, there is a very good chance that our perception is off as well, and we need to stay mindful of that. 

Changing our scripts 

One final recommendation for how to access our compassion with our partners is to change the script. When couples fight, they have a tendency to already know how the fight is going to go because they’ve had this fight hundreds of times. They know what the other is going to say before they say it. When we’re in those fights, we don’t hear what our partner is saying, we’re thinking of our comeback. Before they can finish their sentences, we’ve got the next chess move worked out to prove that they are wrong. 

One way that we can catch ourselves while doing that is to try different speaker-listener techniques or to pause before responding and clarify if we understood what our partner was actually saying. We might find that we’re saying the same thing, but passionately disagreeing with each other because we didn’t really listen when our partner spoke. When we change the way that we respond, or even our timing when we respond, it helps us break from our regular script where we are deadlocked in arguments. If we want a chance at really communicating with our partners, we need to slow down and really listen. We may find that we are agreeing, or that we may not have considered all of the facts. Whatever the case may be, if we stick to our rehearsed lines, we’ll never listen, and we’ll never resolve our issues. If we can find a way to be present, listen, and clarify what our partners are saying, we have a shot at really working together. 

For more about how to listen without getting defensive, try reading this article from The Gottman Institute. 

Please click here to read Dani Bauer’s other pieces

Please click here to read other professional posts

MAKE YOUR DIFFERENCE: CLICK HERE TO SUBMIT A PIECE TO OUR BLOG

The post Communicating During Covid: a Look at How Covid Affects Our Relationships appeared first on Refuat Hanefesh.

In this week’s Torah portion (Vayishlach), as Yaakov is leaving Lavan’s home and heading back to his birthplace, he gets into an epic scuffle with an angel. This fight inflicts Yaakov with a case of sciatica, and as a result, all future generations are required to remove the sciatic nerve from meat prior to consumption. The Chizkuni, a 16th-century commentator, gives two explanations for this practice. Firstly, it is an eternal reminder that Yaakov got injured only after his family left him alone in a potentially dangerous situation. Whenever we remove the sciatic nerve we are to recall this mistake and internalize the necessity of escorting our guests and family to protect them from harm. Alternatively, it is to commemorate the miracle of Yaakov fighting with an angel and escaping with only the minor injury of an inflamed nerve.

The combination of the Chizkuni’s two approaches after a troubling experience has been found to not only reduce the risk of long-term trauma or negative feelings but to actually increase the chances of growing from it and coming away with positive life changes.

Growing from the Experience

The first approach is to take lessons from a negative event and change future actions based on that experience. In Yaakov’s case, that was to create a mental reminder to escort our family and guests and not allow them to be left alone in a perilous situation. Pausing to examine the internal and external forces contributing to a difficult period in our lives increases our chances of avoiding similar pitfalls or catastrophes in the future. The airline industry is a prime example of how this strategy could lead to major changes over time. After each accident or near-miss, they conduct a critical analysis and examine all the factors that played a role. Over time, this approach has allowed aviation to evolve from one of the most dangerous forms of travel to the safest. Each error and failure is viewed as an opportunity for improvement. 

Focusing on the Positive

The second and equally valuable approach we learn from Yaakov’s fight with the angel is to appreciate how the situation turned out better than it could have. One fascinating result of having a positive interpretation is increased chances for future fortuitous situations. Dr. Richard Wiseman, renowned author and Professor of the Public Understanding of Psychology at the University of Hertfordshire, has devoted his career to studying factors that lead to improved fortune. One crucial element he has found is that people who can find the positive in any situation are more apt to encounter and notice “lucky” situations. In an interesting study, he presented a scenario of a person being shot in the arm during a bank robbery. The study participants were asked if the person was lucky or unlucky. Those who insisted the individual was lucky focused on the fact that he wasn’t shot in the head. This group was more likely to objectively get lucky breaks with career and life opportunities. After tragic events, these individuals found a greater connection with faith, family, and friends along with a renewed sense of purpose in life.

Focusing on what didn’t go wrong and framing events in a positive way is a skill that can be practiced and developed. One way to hone this skill is built into the practice of Judaism. When a near-death event occurs, we traditionally proclaim thanks in front of the synagogue or host a meal of thanksgiving. There is no restriction on expressing thanks for any number of events in our life which could have very easily had a worse outcome. This is often difficult in the midst of a difficult situation, but it is worth looking back on our lives and contemplating events that at the time were extremely painful, but may have led to beneficial outcomes. The more we engage in noticing all we have to be thankful for, the more good fortune will come our way, and the better we will bounce back from trying circumstances. 

Let’s avoid the temptation to just ride out painful experiences. Instead, recall the prohibition of eating the sciatic nerve and use that example to examine our own tribulations for improvement opportunities while at the same time working to focus on the positive aspects. Engaging in these practices will lead to richer and more satisfying lives.

Please click here to read other professional posts

MAKE YOUR DIFFERENCE: CLICK HERE TO SUBMIT A PIECE TO OUR BLOG

The post Mental Health in The Parsha: The Blessing of an Inflamed Nerve appeared first on Refuat Hanefesh.

In this week’s Torah portion (Vayeitzei), as Yaakov runs away from his brother Esav towards his uncle Lavan, he pauses to offer a prayer. He beseeches Hashem and promises that if God guards him against danger and provides him with bread to eat and clothes to wear, then he will keep the faith and Hashem will be his God. The Kli Yakar, a 17th-century commentator, explains that Yaakov was not requesting physical protection and conditioning his faith on Hashem providing for him. Rather, he was spelling out the prerequisites for avoiding sin and increasing the likelihood of him returning spiritually whole. He specifically asked for only the bare necessities of bread and clothes. This would allow him to focus on spirituality without becoming distracted by the hedonic treadmill and ultimately neglecting his relationship with Hashem. 

Wealth vs. Happiness

The pursuit of money, career promotions, and fame often blinds us from the connections and experiences that bring true happiness and fulfillment in our lives. Without realizing it, we often trade our religion, family, and serenity for external expectations far beyond our original goals. As is famously brought down in Kohelet Rabbah 1:13, “He who has one hundred will want two hundred, and he who has two hundred will want four hundred.” The more we make, the bigger our desires grow and the harder we work to attain them at the expense of other areas in our life. It is often those who seemingly have the best lives and the most to be happy for that find themselves and their children with the greatest mental health deficiencies and the need to seek out therapy for lack of fulfillment and meaning in their lives. In 2018, Purdue University analyzed data from the Gallup World Poll and found that an income of $95,000 for a family of four leads to the highest life satisfaction, and people making around $65,000 have the greatest emotional well being. Once household income exceeds $105,000, happiness levels decrease. Granted, in many Jewish communities, the cost of living is significantly higher and the correlated salaries will increase, but it is important to note that there is a limit. Having a larger house, grander vacations, and more opulent vehicles does not necessarily lead to greater happiness. If we want to protect our own and our family’s spirituality and mental health, remember that sometimes less is more. Improving work-life balance may lower the cash in our bank accounts, but it is also likely to significantly improve our emotional well being and ability to lead an honest, purposeful life.

Please click here to read other professional posts

MAKE YOUR DIFFERENCE: CLICK HERE TO SUBMIT A PIECE TO OUR BLOG

The post Mental Health in The Parsha: When Less is More appeared first on Refuat Hanefesh.

Question: I suffer from both anxiety and depression, and sometimes have suicidal thoughts as well. I find that writing in a journal quiets those thoughts, and helps me deal with my depression and anxiety, but on Shabbat I have a problem, as it is prohibited to write. Is there anything I can do?

Answer: The question you ask is definitely complicated, and has a lot of different parts to it. Therefore, let’s try and break it down, one issue at a time.

Let us begin with the Halachic side of things. Writing on Shabbat is a Torah prohibition. As such, it would only be allowed in the most extreme of circumstances, in cases of Pikuach Nefesh, where someone’s life is on the line. However, it is worth noting that there are ways of mitigating the force of the prohibition. For example, if one writes with the left hand instead of the right (for those who are right-handed), or use a pen with ink which will eventually disappear (what is known here in Israel as a Shabbos pen, or a Zomet pen – the institute which creates them) – the writing would then be a rabbinic prohibition, not a Torah one.

There is a significant Halachic discussion regarding writing on a computer on Shabbat. The discussion is two-pronged: Is the usage of electricity on Shabbat a Torah prohibition? Is writing on an electronic screen considered writing on a Torah or even rabbinic level? Both these issues are hotly debated amongst Halachists. Nevertheless, there are quite a few notable Rabbis who believe the answer to both questions is no, and would therefore put writing on a computer in the same category as writing with one’s left hand, etc.

In order apply this information to the case at hand, we must be in a place where we adequately understand the therapeutic reality – but this is a very complex requirement, and it should be emphasized at this point that no case is like the other, and it would be impossible to rule clearly for all cases in one fell swoop. The complexity derives from the fact that in order to apply the above to a specific case, the case needs to be classified as a Choleh She-Ein bo Sakanah (חולה שאין בו סכנה), or a Choleh She-Yesh bo Sakana (חולה שיש בו סכנה). In other words: Does the halacha recognize the situation of the specific individual as one which is life-threatening, or not? And if not – how does one tell the difference between an individual who is mildly suffering, and one who is suffering more significantly, to the extent that the Halacha would consider him “unwell”? These questions have never been properly answered in the field of mental health, and still lack clear definitions in our Halachic literature.

To further exacerbate the issue, even a therapist cannot, at times, offer a clear diagnosis. While the end result of biological hazards and diseases can be fairly well-predicted, there is a large grey area when it comes to mental health. Indeed, many of those to whom I have given one leniency or another over the years, have felt guilty after the fact: “did I really need the leniency? In the end I was fine! Maybe I never really needed it?”. It is always impossible to know “what if”, and this compounds the issues already mentioned.

Luckily, the Halacha teaches us that “Safek Pikuach Nefesh” is as Pikuach Nefesh itself. In other words: we do not need to know that the individual in question is definitely in a life-threatening situation, only that he may be, that his reality is statistically relevant as far as we are concerned. While therapists are reluctant to give any guarantees about their patients, they are certainly able to discuss probable developments in an individual patient’s wellbeing, based on their history and personality. This opens up the possibility for rabbis to give a “Halachic diagnosis”, following the professional one.

This medium does not allow for a detailed explanation of how I reached the following conclusion, but after much deliberation (on both Halachic and professional levels) I would say thay the following individuals are considered high-risk, enough that they may violate Shabbat even when a Torah prohibition is involved, if it helps to alleviate what they are going through:

1. Anyone who feels a strong tendency to commit a suicidal act then and there, and knows that if he does not engage in other things there is a chance he will indeed do so.
2. Anyone who has a past of suicidal attempts, and now feels that an active suicidal thought (meaning: involving a specific plan of how to go about it), is beginning to plague his thoughts again.
3. People with disorders whose suicide rates are higher than 5 percent, and active suicidal thoughts begin to plague their thoughts.
4. A person who has a past of psychotic illness, or a past of psychiatric hospitalization due to a psychotic illness, and is now experiencing symptoms that from past experience indicate deterioration in this direction again.
5. A person who has a history of self-harm, and is now experiencing symptoms that from past experience indicate a deterioration in that direction again.
6. Additional situations which are harder to quantify, such as harder cases of depression.

In such cases, it should be clearly and unequivocally stated, that journaling is absolutely allowed, no questions asked. Those who are engaging in it, should not feel guilty for violating Shabbat – it is as much a necessity for them as it is to save someone from drowning on Shabbat. They must focus on their wellbeing, and know that they are doing the only thing they can do.

For those who don’t fall into these categories, but suffer significant functional impairment as a result of their mental situation (for example: not being able to function around the house, go to work, etc.) – they may be allowed to do things that are a rabbinic prohibition on Shabbat, but not a Torah prohibition (examples of which were previously discussed).

To me the most important takeaway from this, is that those who are struggling with these issues be encouraged to turn to their Orthodox rabbi, and ask the question. The answer to their specific situation is out there – we just need to make sure it reaches its destination.

Please click here to read other professional posts

MAKE YOUR DIFFERENCE: CLICK HERE TO SUBMIT A PIECE TO OUR BLOG

The post Preview of Rav Rosensweig’s Upcoming Book on Mental Health and Jewish Law: Journaling on Shabbat appeared first on Refuat Hanefesh.

Frum (Orthodox) Jewish communities worldwide are vibrant, bustling, and alive with social interaction, purpose of life, contributions to society, and dedication to the continuation of the traditional way of life. Centuries-old charitable organizations abound alongside new organizations that aid people with the current wave of problems: physical disabilities, bullying, cancer, abuse, addictions, children off the derech (strayed from religion), and more. Such organizations were created specifically to operate with sensitivity towards Jewish values and culture. I’ve raised a large family, sent my children to the Jewish Orthodox educational system and summer camps, and have seen these valuable organizations in action.

Silencing Mental Illness

In the last few decades, cases of mental illness have been steadily climbing in the population at large as well as in the Jewish communities, yet many do not seek professional help. The news has been quick to highlight the most extreme cases, instilling fear and distrust in the general public, while ignoring the wide spectrum of mental illness in which many have been helped to lead functional, full lives. In the close-knit Jewish communities, there has been silence on the subject in public forums, and the label of mental illness has been regarded as one to avoid at all costs. Families choose to hush up anything related to mental illness, hoping not to affect opportunities for their families in regard to marriage, jobs, and social status. Mental illness was not given its proper place among the chesed (service) organizations. There were unique reasons underlying the stigma in the Jewish community that stymied the progress of those programs, and many of those reasons still remain, although there has been progress recently.

In the educational system, teachers taught large classes and were preoccupied with keeping the struggling students up to class level. Many were not trained to recognize depression, anxiety, or social withdrawal. They may have reported to parents about troubling behaviors such as hyperactivity, poor peer interaction, or academic woes. But no one connected these behaviors to emotional or mental wellbeing. Even academic tutoring was frowned upon so as not to cast aspersions on the family’s reputation, and parents were opposed to putting their child in a class for underachievers.

Securing Proper Marriage Prospects

Good marriages for the children is what drives many cultural mores. Lineage, commonly known as yichus, plus current family status affects the family in regard to marriage prospects. In the Orthodox and Chassidic communities, marriage prospects are suggested and thoroughly researched by both families. This research includes lineage; educational, economical, and community standing; medical conditions; religious standards; and the status of siblings, among other factors. In the past when symptoms of mental illnesses were considered the result of poor behavioral choices, trauma, or bad parenting, it wasn’t quite as taboo; however, now that science has shown that there are biological genes that can be inherited and passed on, increasing the likelihood of mental illness in offspring, any mental illness connection has been hushed up even more. Bearing and raising children are among the most revered tenets of Judaism and for this reason in the Orthodox community it is widely encouraged, almost mandated, that young couples test for compatibility through the Tay Sachs testing system even before the first date to avoid perpetuating serious illnesses.

Getting Treatment within the Communities

In Orthodox circles the first person they might turn to is their rav/rabbi for advice. In the past, the rav would be reluctant to advise sending someone to a therapist for the sake of the family. Also, a rav would advise against seeing a non-orthodox therapist because of the secular leanings in psychology which could undermine religious dogma. Fortunately, two things have changed for the better: first the proliferation of Orthodox therapists, and more recently the trend to retrain older rabbis to be aware of and to be responsive to the needs of the community concerning abuse and mental illness. The trend is now more in favor of advising people to seek professional help, although not all do. Organizations in the last ten years have sprung up that offer confidential referrals to appropriate frum professionals.

However, getting treatment is not easy in a close-knit neighborhood where one must slip out to appointments unseen and hide taking medications. Also, no one wants to see a religious therapist whom they might encounter in their neighborhood at one of the many social functions. Therefore, appointments must be made outside of their immediate area.

Secrecy and stigma prevent any sharing with or receiving support from friends, coworkers, and even family members. In the last few years, there have emerged the beginnings of secret support groups for frum women, a welcome change.

Changing the Conversation with my Book

Awareness of mental illness in the community is still dangerously dismal, and so I decided to jump-start my newfound writing career with my book, Lemons in the Fog, a book born of necessity, from hearing the silent cries of the members of the Jewish Orthodox community struggling to maintain secrecy while desperately trying to preserve their dignity and health. Fiction is a powerful tool and a well-written novel allows the reader to put aside their own opinions and notions and live the life of the character. I created a 19-year-old yeshiva student to highlight the real-life challenges these anonymous young women and men living among us face daily, fighting an uphill battle. I wanted to open the door to empathy and compassion for those whose souls Hashem has entrusted with this mission.

Through the first person account of my protagonist, I wanted to impart to my readers an understanding of the ways mental illness manifests itself in youth; how one experiences the progress of the disease through the stages of denial, escape, shame, and loneliness; and the path one must take to return to a stable way of living by seeking treatment and support, which can lead to a bright future. I wanted to create awareness of the societal imposed stigma and isolation, and to demonstrate how this impedes recovery and stability. I hope that someone reading my book could recognize mental illness in themselves or in others and could call one of the phone numbers of confidential Jewish Orthodox resources listed in the back of the book.

Another lofty goal I had was to make those with mental illness not feel alone, to reveal that others had traveled this path and that they shared common experiences. I wanted to validate their journeys, to reassure them that someone in the community understands them and cares enough about them to accurately represent their struggles for others to see. 

I wanted to stoke the conversation about the unaddressed stigma in the community, and since the publication of my book eight months ago, I’ve received positive feedback and have been asked to speak and write about the motivations behind the publication of this book. It’s a good sign that people are listening.

Outlook for the Future

I have faith that the Jewish community will step up to support the mentally ill within the framework of camaraderie in the community, following in the footsteps of those unsung heroes who have created kosher therapeutic services and resources. Together we can ensure that all the members of our communities can live side by side with dignity so our society can continue to thrive.

Please click here to read other professional posts

MAKE YOUR DIFFERENCE: CLICK HERE TO SUBMIT A PIECE TO OUR BLOG

The post Mental Illness in the Orthodox and Chassidic Communities appeared first on Refuat Hanefesh.

Exercise and Mental Well-Being

Studies show that exercise can assist in addressing mild to moderate depression. As one example, a recent study done by the Harvard T.H. Chan School of Public Health found that running for 15 minutes a day or walking for an hour reduces the risk of major depression by 26%. Exercise is a powerful depression fighter for several reasons. Firstly, it promotes various changes in the brain, including neural growth, reduced inflammation, as well as new activity patterns that promote feelings of calm and well-being. Physical exertion also releases endorphins, powerful chemicals in your brain that both energize your spirits and make you feel good. Finally, exercise also can serve as a distraction, allowing you to find some quiet time to break out of the cycle of negative thoughts that feed depression.

Physical activity also helps quell anxiety. Exercise relaxes our muscles and relieves tension in our bodies. Since the body and mind are so closely linked, when your body feels calmer so, too, your mind will. Our sleep quality is also directly improved by physical activity, and a restful night of sleep can help us stay calm and grounded.

Sustaining a consistent workout routine can also improve our self-esteem. Regular activity is an investment in our mind, body, and soul. When it becomes a habit, it can foster our sense of self-worth and make us feel strong and powerful. We feel better about our appearance and, by meeting even small exercise goals, feel a sense of achievement in our habit building.

Starting To Exercise

How do we start? What if we’ve never tried a full workout routine? Does this mean I need to start going to the gym every day for an hour to mentally benefit from exercise?

No. As James Clear talks about in his book Atomic Habits (2018), the way to accomplish our goals is not to merely focus on radical change:

“We often dismiss small changes because they don’t seem to matter in the moment. If you go to the gym three days in a row, you’re still out of shape…Making a choice that is one percent better or one percent worse seems insignificant in the moment, but in the span of moments that make up a lifetime these choices determine the difference between who you are and who you could be.” (p.17)

When we focus only on the long-term goal, the perfect workout routine, we can get disheartened every time we fall down. There will be times when we make unproductive choices. There will be times when we don’t feel like getting off the couch and jogging around the block.

Taking Those Small Steps

What’s most important is that we focus on a small step or two that we can take, towards achieving the healthiest version of ourselves.

1. Take a 10 minute walk each day. Just getting out of the house and breathing in some fresh air will get your blood flowing and heart pumping. If you go grocery shopping and there’s a large parking lot, park towards the outer edge to get more walking done. Also, putting our carts back, not only helps the parking lot attendants, but gives us extra steps.
2. Stretch for 2 minutes daily. Stretching relieves some tension in our muscles and will feel freeing. Flexibility in our body will make our daily tasks easier, reducing some triggers of stress in our lives.
3. Meditate for 5 minutes. Meditation is something I’ve started recently, just closing my eyes and breathing slowly for a few minutes. Whether it’s guided meditation with a YouTube clip, or just focusing on our breath for a few minutes, clearing our heads helps us detox and maintain our emotional equilibrium.
4. Do a few push-ups. If you find the thought of even doing one push-up too challenging, try a few push-ups against the wall while standing. Slowly we can build up, week after week, and build upon our previous milestones.

Short-Term and Long-Term

Whenever making a goal, it is crucial to focus on both the short-term and long-term milestones. Having a vision of the short-term will allow us to feel like we are accomplishing on a daily and weekly basis. Long-term goals enlighten us on what is possible if we stay focused and consistent. The combination of these tools can provide us with the keys to success.

Choose Health!

Choi KW, Chen C, Stein MB, et al. Assessment of Bidirectional Relationships Between Physical Activity and Depression Among Adults: A 2-Sample Mendelian Randomization Study. JAMA Psychiatry. 2019;76(4):399–408. doi:10.1001/jamapsychiatry.2018.4175

Clear, J. (2018). Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones. Avery

Please click here to read other pieces pertaining to mental health

MAKE YOUR DIFFERENCE: CLICK HERE TO SUBMIT A PIECE TO OUR BLOG

The post Exercise For Your Mental Well-Being appeared first on Refuat Hanefesh.

First, for context, occupational therapy became prevalent in psychiatric hospitals in the early 1900s, as soldiers returning from World War I with depression and post-traumatic stress disorder were provided purposeful and meaningful activity via crafts and manual tasks. Though most OTs have moved away from this setting and toward more physical disabilities, a small population of OTs still work in psychiatric settings.

OTs evaluate patients in the following main performance areas: activities of daily living, cognition, upper-extremity strength and range of motion, and psychosocial factors, which include stress, coping skills, frustration tolerance, assertiveness and impulse control. Some problem areas OTs can address include depression, anxiety, and cognitive impairments. They run daily group therapy to include topics such as anxiety and depression management, coping skills, assertiveness, anger management, how to speak about mental illness, and positive thinking.

The Deafening Silence in the Religious Community

During the five years I worked in an acute psychiatric unit, I saw three religious Jews, and I still think about them.

I evaluated a 20-year-old religious male for occupational therapy. He was diagnosed with major depression. When I asked him who his support system was, he answered, “No one.” I then inquired further about his family or friends, but the reply was in the negative. After asking him if he could speak with his rabbi, as many rabbis are trained in psychology, he said, “I can’t speak to anyone because if I do, then I will never get a shidduch (suggested person to date).”

The second encounter I had in the acute psychiatric unit with a religious Jew was also with a young male in his twenties. At that time, the estimated length of stay in an acute psychiatric unit was one to three days. This male was admitted at some point over the weekend. I never treated him. However, when I walked into the unit on Monday and he recognized me as a religious Jew, he came over to me and sternly said, “If you ever see me in the community, pretend you never saw me.”

The last religious Jewish patient I treated in the psychiatric unit was a young mother with many children, including a baby. She was diagnosed with postpartum depression, which consisted of symptoms such as extreme melancholy, anhedonia (the loss of pleasure in once enjoyable activities) and feelings of guilt over not being able to care for her children.

Cover-Up Culture

All too frequently, I learn of Jewish men and women in both my community of Baltimore as well as other Jewish communities who have ended their lives by suicide. Some leave messages on their Facebook pages, including cries for help and near-misses. Some of their deaths are associated with addiction. Some are due to undertreated mental illness such as depression, bipolar disorder, or even anxiety (thoughts of death and suicide are also common symptoms of anxiety). And some are covered up to protect the family from the scrutiny and stigma the community would show them. After suicides, there is no public word about the underlying mental illness. And history repeats itself.

Silence cannot change the facts – mental illness can affect anyone of any race, culture, ethnicity, or age – including the Jewish community.

Speak Up Now

For a long time, my community had only addressed the concepts of grief and loss, as well as addiction. But this was a Band-Aid, a temporary fix or comfort. The real issues of “why” had not been talked about at all until recently (in part, due to initiatives I spearheaded). Fortunately, my community has begun to have that conversation about mental health topics in a general way. However, we still have room for critical growth in our understanding – such as discussing the underlying triggers of depression or suicide.

Changing our approach to mental health can only come once every community recognizes and speaks openly about mental health issues, supports one another, and encourages others to seek help. The truth needs to be known that once a mental illness is managed, people can live productive lives in their life roles. When mental illness is not treated or when people—especially young people like those I previously described encountering—are stigmatized and made to feel shame, their lives become bleak and unstable.

Mental Illness Fact Check

For someone who has never suffered from a mental illness, it is hard to relate to someone who has. One may even fear it is contagious or believe that all people with mental illness are violent or, at the very least, unstable. According to NAMI, the National Alliance of Mental Illness, one in every five people will experience mental illness at some time in their lives, whether it be mild or severe.

Just like with a physical illness that needs to be managed, such as diabetes or high cholesterol, people with mental illness can live the same productive lives as people without mental illness. Treatments can take the form of regular visits to a therapist, psychiatrist or psychiatric nurse practitioner, medications, and through the implementation of coping skills – such as exercise, prayer, having a support system, and keeping occupied via meaningful activity.

It is about time we get this message out to our community. End the secrecy. Start the healing. Speak up before it’s too late.

Please click here to read other pieces pertaining to stigma

MAKE YOUR DIFFERENCE: CLICK HERE TO SUBMIT A PIECE TO OUR BLOG

The post Our Community Leaders Must Speak Up Before It’s Too Late appeared first on Refuat Hanefesh.

Nostalgia is so important to society that the movie industry has made it into a multi-billion dollar venture – where they make remakes of movies but make them worse; yet, people are more than happy to go because of nostalgia. They don’t even mind so much that the movies are worse because they feel so good about remembering how they felt when it originally came out! What are we up to – Spiderman Fifty? I’m sure people don’t keep going to see them because the writing is so good.
Similarly, in the music industry, there are still plenty of “classic rock” stations going strong. What’s wrong with contemporary pop? Well, actually, everything. But also, people love to relive the good times they had in their childhood, and listening to their childhood music brings back all of those warm fuzzies.

The Day of Remembrance

Indeed, we talk a lot about our memories, making it fitting that memory plays a prominent role on Rosh Hashana. Our sages, in fact, refer to the day as Yom HaZikaron – which translates to the day of remembrance. In the Shemoneh Esreh prayer of Mussaf, we find an entire section dedicated to Zichronot (remembrances). We also, however, find something quite bizarre in this section.

The section begins by talking about how Hashem remembers everything that has happened:

“You remember the deeds of yore and account for the primal creations. Before you, all the wonders are revealed and many hidden things from since creation, for there is no forgetfulness before the seat of Your glory, and nothing is hidden from before You. You remember all that is done, and nothing in creation is concealed from You….”

In brief, this is an ominous warning that we can sneak nothing past the all-knowing God, with the implication that we are all at high risk for punishment since we have sinned and God knows it.

However, this section of Zichronot continues in a very different direction. It begins to address the times when Hashem remembered individuals not for bad but for good.

“For the remembrance of all deeds comes before You, and You investigate the deeds of all; Noah, too, You remembered in love and You recalled him with regard to salvation and mercy…”

And from here onwards this theme of remembering the good of our forefathers becomes increasingly stronger.

Praying to Remember The Bad or The Good?

Granted, there is quite the curious contrast between the beginning of the blessing – in which the one praying talks about how Hashem remembers all of their mistakes and shortcomings that they need to apologize for – and the second half where the one praying seems to “remind” Hashem of how they have some really great relatives such as Noach. But even more perplexing is the following basic question: What does it mean that God remembers? Is there a thought that He might forget the amazing actions of our forefathers? Does He too rewatch the same old movies?

Rabbi Aharon Lichtenstein approached this question with great insight, explaining that memory has two basic modalities.

The first is that our memory acts as what Rabbi Lichtenstein calls a “reservoir of the past.” We remember things that happened in the past, recalling the good times and the bad. We reminisce.

However, there is a second aspect to our memory, and that is how our prior experiences shape our current actions. The events that occurred to us previously help dictate the choices we make and inform our decisions. They condition us.

For example, my son Yair has started opening the garbage and throwing things in it. Now, when I see him walking around the house with one shoe, I have to double-check the garbage to make sure he didn’t throw it out. I have subsequently learned to start locking the cover of the garbage. My experiences with him have shaped my actions. My memory dictates my behavior

To sum up the two modalities: one element of our memory is like a photo album where we can reflect on the past, but the other is how our memories affect our future.

Understanding The Prayer

Rabbi Lichtenstein used this insight to explain the strange transition in the Zichronot prayer from an ominous warning of sneaking nothing past Hashem to recalling the greatness of our ancestors.

We begin by highlighting the fact that Hashem has complete awareness of all that has happened, so we should be careful not to sin. Then, we appeal to His mercy by asking him to allow the good things we have done in the past to influence His decisions about our future. Obviously, God doesn’t need reminders of what happened; we are simply asking Him to act kindly in light of the positive actions we have done in the past, and promise to act similarly in the future.

Our Approach to Rosh Hashana Memories

This duality in the function of memory is not only relevant to how Hashem approaches the day, but it is as well incredibly important for the way that we as humans approach Rosh Hashana. Sure, we can look back at the past year and recall all the good and difficult times sprinkled throughout, but we must also take a closer look at our past and think about how it plays a role in our decision making for the future.

We can also take a look at our current actions and try to understand how they have been influenced by our past experiences. When we do this, we become more aware of why we do what we do, which gives us the power to change.

A Powerful Example From an Encounter with a Client

This client’s parents were upset that he was constantly watching Netflix or YouTube. I asked the child to think about why he watches so much TV. He couldn’t explain his actions, so I asked if he did so for entertainment or as an escape. At first, he was puzzled by the question, but then, slowly, he answered that he uses media as an escape from all the tension in his house. It distracts him from the intense fighting his parents have nightly. However, he couldn’t understand why I thought it matters that he does it for an escape as opposed to any other reason.

We spoke about how if the issue is that he is watching TV for entertainment, he might curtail it by just being more mindful of how long he spends on watching shows or by thinking about how much work he needs to get done each night for school. However, if the issue is that he is trying to escape his feelings, then a completely different strategy needs to be used. The real work would be to help him deal with whatever he is escaping from. He would need to completely rethink how he processes his feelings and why he needs to avoid them. Ideally, we would have a conversation with his parents about how their feuds affect him and what they can do to have a healthier family.

I tried to show him how having awareness of our motivations and what factors are pushing or pulling us can give us choices of how we react and, ultimately, that allows us to be back in control.

Take Control of Your Reality

The key to Rosh Hashana is to become more aware of how we are influenced by our past experiences and how they inform our actions today. Once we can do that, we are given the choice of how to respond. It is this choice that empowers us to grow.

Let’s make the effort this year to think about our actions and why we do them. Let’s not just have good memories by happenstance, but instead make great memories by allowing our actions to be inspired by our positive memories. In every sense of the word, let’s make this a year truly worth remembering.

Shana Tova

Please click here to read Dani Bauer’s other pieces

Please click here to read other pieces pertaining to Torah and mental health

MAKE YOUR DIFFERENCE: CLICK HERE TO SUBMIT A PIECE TO OUR BLOG

The post Yom HaZikaron (Rosh Hashana) – The Day of Remembrance: How Our Past Affects Our Future appeared first on Refuat Hanefesh.

When OCD Meets Religion

“Religious OCD” or “scrupulosity” is a form of OCD where the obsessions and compulsions affecting you are centered around religious beliefs and rituals. (2) This can express itself as obsessive thoughts that you are not morally good enough or that when something bad happens, it’s your fault. You may experience compulsions such as repeating a ritual until you get it “right”, repeatedly saying a blessing until you feel you were focused enough, or going outside the norm to make sure you don’t commit a sin.

Religion itself doesn’t lead to OCD; however, those who grow up with religion – and especially those who grow in religious societies and already have OCD – might experience OCD symptoms that are affected by their religion. (4)(5) Those with OCD who grow up with religion have been found to have a 5% to 33% chance of having scrupulosity, which is characterized by pathological guilt about moral or religious issues. For those with OCD who grow up in religious societies, such as Egypt or Saudi Arabia, the chances of scrupulosity being their form of OCD expression rises to 50-60%.

Managing OCD

There are an array of tools and techniques that can help manage religious OCD.

One approach is called Exposure and Response Prevention therapy (ERP). ERP with a trained therapist will help you to gradually learn to ignore the anxiety associated with obsessions and compulsions and stop giving in to them. (6)

Another approach, as a complement to therapy by a qualified professional, is to combine therapy with the guidance of a religious leader who is knowledgeable about OCD. (3) The rabbi or other religious authority can help you learn to balance the need to maintain your mental health with the obligations of your religious practice. This approach with ERP therapy can help make OCD much more manageable. (1)

While there isn’t any known, long-term cure for OCD, it doesn’t have to control your life or your religious practice. By understanding when your concerns are disproportionate to your situation and learning how to manage your symptoms in a healthy way, you can lead a healthier, happier life.

Sources:

(1) Huppert, J. D., Siev, J., & Kushner, E. S. (2007). When religion and obsessive-compulsive disorder collide: Treating scrupulosity in ultra‐orthodox Jews. Journal of Clinical Psychology, 63(10), 925-941.
(2) Greenberg, D., & Huppert, J. D. (2010). Scrupulosity: A unique subtype of obsessive-compulsive disorder. Current Psychiatry Reports, 12(4), 282-289.
(3) Greenberg, D. (2008). Ultra-orthodox rabbinic responses to religious obsessive-compulsive disorder. The Israel journal of psychiatry and related sciences, 45(3), 183.
(4) Wu, M. S., Rozenman, M., Peris, T. S., O’Neill, J., Bergman, R. L., Chang, S., & Piacentini, J. (2018). Comparing OCD-affected youth with and without religious symptoms: Clinical profiles and treatment response. Comprehensive psychiatry, 86, 47-53.
(5) Buchholz, J. L., Abramowitz, J. S., Riemann, B. C., Reuman, L., Blakey, S. M., Leonard, R. C., & Thompson, K. A. (2019). Scrupulosity, Religious Affiliation and Symptom Presentation in Obsessive-Compulsive Disorder. Behavioural and cognitive psychotherapy, 1-15.
(6) Rector, N. A., Richter, M. A., Katz, D., & Leybman, M. (2019). Does the addition of cognitive therapy to exposure and response prevention for obsessive compulsive disorder enhance clinical efficacy? A randomized controlled trial in a community setting. British Journal of Clinical Psychology, 58(1), 1-18.

Please click here to read other pieces pertaining to OCD

MAKE YOUR DIFFERENCE: CLICK HERE TO SUBMIT A PIECE TO OUR BLOG

The post Religious Rituals and OCD Interference appeared first on Refuat Hanefesh.

Be Careful What You Drink

In June of 1999, a health scare gripped the world. Several children in a Belgium elementary school began developing severe headaches, nausea, chills, lightheadedness, and shortness of breath. They worsened to the point of requiring emergency transport to hospitals. Within a week the sickness had spread to affect six schools and hundreds of individuals throughout Belgium, France, and neighboring countries. A favorite soft drink, Coca-Cola, was identified as the culprit with small amounts of hydrogen sulfide in some bottles the proposed mechanism of illness. Countries throughout Europe initiated mass recalls and began pulling all products made by Coca-Cola from shelves. The recall was the greatest in the history of Coca-Cola, with 30 million cans disposed of at a cost of greater than one hundred million dollars and countless more losses from negative PR.

Things Are Not Always As They Appear

As toxicologists and scientists began studying this further, they realized something alarming. There was actually no evidence of any high enough levels of contaminants to be consistent with the reported symptoms. So what was their explanation for what had caused all these people to fall ill? It was a simple case of mass psychogenic illness or mass hysteria.

There have been many similar cases of mass hysteria over the last several centuries. These illnesses are often misidentified until after a pandemic ensues with no biological evidence of an inciting precipitant.

How Does This Happen?

Mass hysteria typically involves vague abdominal and neurological complaints without physical exam findings and occurs in workplaces or schools where people have close contact with each other. All it takes is one person getting sick. Individuals see their colleague falling ill and then worry about getting sick themselves. This is a normal reaction that happens all the time and aside from a little uneasiness, passes by without causing any further harm. However, anxiety can cause our brain to misinterpret regular physiological sensations – such as a rumbling stomach – and to attribute them instead to illness. In the right conditions, this can lead to hyperventilation and induction of further symptoms. Once a few people in a close environment start reporting symptoms, it can spread like wildfire. The worse it gets the more likely people are to convince themselves that they too have “caught the bug”.  Women and those with current physical or mental stress are more likely to develop symptoms, but anyone can be susceptible especially in an environment of fear.

The good news is that just as it spreads quickly, it also quickly resolves. People typically recover over the course of weeks without residual effects. Treatment involves separating exposed individuals from each other, putting an end to fear-eliciting communications, and if possible, explaining to them the psychological nature of their illness.

The Perfect Storm

In the coca cola incident, misinterpretation of symptoms was likely exacerbated by the media coverage and the massive recall response. The initial students who fell ill were at a higher risk secondary to the stress of final exams which they had just completed. This coupled with the actual odd odor coming from some of the coke bottles and the close contact with each other set up the perfect scenario for the development of a psychogenic illness.

We Can Control Our Minds

Aside from an interesting historical account, what can we take from this story? Our minds are extremely powerful. So powerful, in fact, that they can convince us we are deathly ill. However, the capacity of the mind does not stop with it’s potential for harm. The mind is equally capable of reversing severe physical or emotional pain. With proper training and practice, we have the ability to eliminate or reduce the consequences of biological disorders.

How Can You Control Your Mind?

One way to take back control of your mind is through the practice of mindfulness. This is the act of bringing attention to the present moment and can be easily learned through psychotherapy or several available mobile apps. Recent studies have shown that 7-10 minutes a day of mindfulness is equally effective as medications in controlling chronic migraines. Further, it can reduce symptoms of ulcers and irritable bowel syndrome and decreases risks of anxiety, depression and dementia. A frequent opportunity to practice mindfulness is on Shabbos when waiting for the head of the household to make the blessing on bread. Instead of impatiently waiting in silence, try being mindful of your surroundings and the experience you are having. If practiced regularly on just a weekly basis, the results can be profound.

Another easily achieved mechanism that can rewire our brains to reduce physical and emotional distress is the act of keeping a daily gratitude journal. People who write down a couple things they are grateful for each day have reduced pain perception, asthma attacks, and improved overall emotional well being. This does not need to take up a lot of your time. It can be accomplished in just a few minutes each morning by concentrating while praying and giving thanks to Hashem for all the unbelievable miracles He has performed for you and your family. The more specific examples you think of, the better your results.

We each have the ability to hone these tools and harness the capacity of our minds to improve our physical and mental health regardless of our circumstances. Let’s take back control of our bodies and not let our minds control us.

Please click here to read other pieces pertaining to anxiety

MAKE YOUR DIFFERENCE: CLICK HERE TO SUBMIT A PIECE TO OUR BLOG

The post Mind Games appeared first on Refuat Hanefesh.

The Fear

Let me illustrate with an example. Shimon was 15 when his parents received a call from his Rosh Yeshiva (school head). Shimon had always been an excellent student and an enthusiastic learner. Some older students at the yeshiva had introduced him to using marijuana. This helped him relax and feel as though he was enjoying himself.

At first, it did not affect his learning. As time went by and he progressed to daily use, his memory and concentration deteriorated. His performance in class was markedly degraded. A school counselor confronted him, and he admitted that he had not only been smoking marijuana every day but had begun to experiment with ecstasy as well. He promised to stop using drugs and scheduled regular visits with the counselor. Although he told this trusted advisor that he was no longer using, he quickly relapsed and returned to previous levels of use. The Rosh Yeshiva told the parents that Shimon would not be able to continue at the school unless he first sought treatment for his substance use problem.

This story highlights a very typical progression from experimentation to regular use, and from regular use to impaired functioning. It is not surprising that parents would have no knowledge in advance of this problem. Keep this narrative in mind as we discuss the nature of substance use disorders and the effects thereof.

Grasping The Current State

Between 3-6% of adolescents nationally suffer from a substance use disorder. Those of us working in mental health are all too sadly aware of the most recent scourge of opioids and their attendant fatalities. We know too well the horrors created by excessive alcohol, cocaine, and other substance use. These disorders are truly terrible for adults to confront; the growing child or teen is far less equipped to face these frightening challenges.

The current diagnostic terminology found in the Diagnostic and Statistical Manual 5th edition of the American Psychiatric Association is the standard in the field. It describes “Substance Use Disorders” for the various substances (e.g. “Opioid Use Disorder”). It has done away with terms like addiction, dependence, and abuse.

The key concepts in understanding these disorders include loss of control of use, continued use despite mounting consequences, impairment, and tolerance and withdrawal.

Loss of Control

The first of these, loss of control of use, is when a point is reached in the relationship of the person with a particular substance at which they can no longer make a choice to use or not. While efforts are almost always made to reduce use as consequences accrue, the person must eventually admit that they are powerless to stop using and require an intervention. The person struggling with such a disorder often finds this very confusing and extremely humiliating. These psychological effects often fuel denial and rationalization. Continued use despite mounting consequences is a clear result of the loss of control of use.

The Consequences

Consequences of loss of control occur in multiple domains. For the child and adolescent population, these will often be seen in particular areas such as a decline in academic function. Other consequences can include impaired memory, concentration, and motivation.

One particularly sad consequence can be disturbed family relationships. Trust and honesty are damaged, as secrecy and lying are invariable partners in substance use disorders. The struggle to redefine one’s relationships with parents, normal in adolescence, becomes far more pronounced and pathological. Parental values are often openly rejected in favor of those of a deviant peer group. Parents can become desperate to try to bring order to the chaos created by the child’s drug use. Efforts to impose control can then lead to a spiral of rebellion and reaction. Parents, terrified by the dangers posed to their child’s wellbeing and even survival, may find that the greatest danger to their child is the child himself.

As teens abandon previously cherished values, goals, and relationships, we often see instability in relationships with peers and new affiliations. The adolescent surrounds himself with like-minded friends who support his ideas about drug use. The alliance against parents and the larger society reinforces and crystallizes the self-destructive rebellion. The adolescent finds himself in something of an echo chamber, wherein his own misperceptions and errors are parroted back to him.

It goes without saying that the above examples do not exhaust the potential consequences of substance use disorders. Legal consequences become more prominent as adolescents approach adulthood. Involvement in criminal activity to finance substance use is common. In certain cases, young people will steal from their own families to pay for drugs. The ultimate consequences lie in the realms of injury, incarceration, overdose, and even death.

Tolerance and Withdrawal

Tolerance and withdrawal refer to physical phenomena frequently seen in substance use disorders. These are seen most prominently with alcohol, benzodiazepines, other sedative-hypnotic agents, cocaine, and opioids. Tolerance refers to the brain’s adaptation to regular exposure to a drug. Withdrawal refers to physical and emotional symptoms that emerge from sudden cessation of using a drug to which one has become tolerant. These syndromes range from the mild to the intensely uncomfortable to the life-threatening, depending on the level and duration of use and the properties of the drug itself.

The Signs

What should parents look for if they begin to suspect their son or daughter may be suffering from a substance use disorder? The answer to this question flows from what we have said above about the effects of substance use disorders. The following signs may point to such a condition: academic decline, withdrawal from the previous peer group, withdrawal from previously valued activities (such as sports or volunteer work), development of a new, possibly delinquent peer group, and significant changes in family relationships. The teen may become secretive, defiant, and argumentative. If these constitute significant changes from what they were previously like, it behooves those caring for them to explore the possibility of substance use. More severe signs should prompt a higher index of suspicion: staying out beyond approved curfew, money or belongings missing from the parents, defiance towards authority figures outside the home, aggression, obvious signs of intoxication, heightened impulsivity, and mood instability.

Children vs Adults

The contrasts between the effects of substance use disorder in adults and in children and adolescents are functions of developmental differences. Adults do not typically have parents overseeing their activities, and thus tend to have less overt conflict about their substance use until it reaches higher levels. Although we are close to our spouses, parents are particularly attuned to changes in their children and are more ready to sound the alarm when they become concerned. The adolescent does not have the same presumption of autonomy as the adult, and so treatment can be started with somewhat less resistance than with adults.

The adolescent is at a critical developmental juncture both biologically and socially. Problems at this time may have long-lasting effects on education, career, and marriage. The adolescent brain is still developing and changing rapidly, and substance use may have more profound negative results. On the other hand, adults may have more insight and capacity for self-monitoring and thus may be more willing to pursue evaluation and treatment.

Closing Thought

With this knowledge in hand, parents can be alert for the behavioral changes in their children which may signal the presence of a substance use disorder. The most reliable indicator that something is wrong is ultimately the intuition of the parent. Parents know their children better than anyone else. Once the inner alarm is raised, parents can use the information presented in this article to explore the possibility that the problems they are seeing are due to substance use disorder.

Please click here to read other pieces pertaining to addiction

MAKE YOUR DIFFERENCE: CLICK HERE TO SUBMIT A PIECE TO OUR BLOG

The post Substance Use Disorder in Children and Adolescents appeared first on Refuat Hanefesh.

The sizable breakaway group leaves the sanctuary and quickly makes its way to the synagogue’s basement, where an assortment of herring, crackers, and hard liquor covers a long table. One of the older men recites kiddush, and everyone reaches for the collection of bottles at the end of the table – helping themselves to white rum, whiskey, and scotch. The “kiddush club” begins.

After a few short announcements – and more than a few drinks – the group returns to the synagogue for the end of the prayer service.

Sounds like harmless fun, right?

Participants of kiddush clubs point out that these gatherings build camaraderie and even help raise donations for the synagogue. Kiddush clubs usually form as a way to let off some steam in the middle of a long davening and have a good time. People get antsy sitting for three hours in shul and sometimes just need a break. As for the alcohol, proponents argue that the group usually consists of mature, responsible adults who come down for a quick shot and then go back up to rejoin the service.

Social activities within a synagogue can be beneficial for fostering community, and sure, these clubs are fun, but at what cost? Many kiddush clubs cross the line to irresponsible and sometimes dangerous.

Aside from the issue of disrespecting the Torah service, kiddush clubs glorify the consumption of alcohol and set a negative example for children who are smart enough to notice the smell of booze on their father’s breath. Moreover, many kiddush clubs do not prevent teenagers from joining the l’chaims (a common phrase said before drinking in Judaism, sometimes in celebration) and do not stop them from drinking in excess.

At kiddush clubs, excessive drinking is the norm. Some kiddush clubs have the “policy” of not dismissing the group until the bottle is finished. While chanting “finish the bottle” may be harmless when shared among a group of 50, a smaller kiddush club of 12 may be at risk of alcohol poisoning.

Some Rabbis have tried to put a stop to Kiddush clubs, but many are reluctant to speak out because they fear it would be politically detrimental to their career.

A Gateway to Addiction

Alcohol abuse is a pervasive problem in the Jewish community and the youth are certainly not excluded. A 2017 study done by the Israel National Council for the Child revealed that in 2014, 27% of boys (and 14% of girls) in 10th grade reported that at least once in the previous month, they had drunk 5 or more alcohol servings in a short span. Additionally, 12% of boys (and 5% of girls) in 10th grade reported having used marijuana at least once. Regularly engaging in excessive drinking can become a gateway to experimenting with drugs, driving under the influence, and other life-threatening decisions.

As an addictions counselor at Retorno, the largest Jewish organization in the world for the prevention and treatment of addictions, I have seen numerous young adults struggling with alcohol addiction. Alcohol dependence leads to serious problems with family relationships, loss of employment, and trouble with the law. Often, participants in our rehab programs tell us that their drinking problem did not begin as an addiction, but rather, as a way to have fun socially or to relieve stress. In many cases, lack of resilience and low self-esteem also play a role in developing addiction. (Our expert staff works to address the underlying issues of addiction in order to achieve long-term recovery.)

As the Torah ark closes at Ohel Yitzchak, congregants take their seats and the kiddush club attendees file back into the sanctuary. A few tipsy men continue their jovial banter, and it takes a few moments for everyone to settle down. A group of teenagers opts to remain in the shul basement to continue the drinking games instead of returning to the service. Should we be concerned? By condoning or even encouraging kiddush clubs, are we enabling youth drinking? And at what point does this “harmless fun” turn into a dangerous activity that could later open the door to addiction?

Please click here to read other pieces pertaining to addiction

MAKE YOUR DIFFERENCE: CLICK HERE TO SUBMIT A PIECE TO OUR BLOG

The post Are Kiddush Clubs Just Harmless Fun? appeared first on Refuat Hanefesh.

Gratitude and Humility

A key component to expressing thanks is the admittance of humility. The experience of humility, or being in a humble state, should not be in the colloquial sense of humility, implying submission, deference or insignificant. Rather, the experience of humility, as expressed in many Jewish texts (e.g. R’ Saadia Gaon and throughout Mussar and Chassidus), suggests a flavor of assertiveness in the submission; i.e. a significant insignificance. Meaning, it is a sign of strength and self-esteem in being humble and pushing aside one’s immediate needs.

For example, the root of the word “Modeh” from the morning prayer Modeh Ani means thanks. “I thank You for returning my soul this morning.” However, another meaning of the word Modeh is to confess or admit. In this sense, as R. Shimshon Pincus explains, you are expressing that you needed Someone else to return your soul. When you state this first thing in the morning, you are admitting that there is Something greater than you, that there is a larger purpose. This admittance, a characteristic of humility, is the gratitude and, for many, requires internal strength. To be grateful to someone for an act they’ve done for you is to admit to them that they have helped you in some way. Thus, the first step toward gratitude is to recognize how you have been aided, i.e. humility. Next, you express that gratitude to that person honestly and sincerely.

How To Express Gratitude When It’s Easy

Sometimes you need to just say it. To demonstrate, I’d like to begin with expressing my gratitude to the Refuat Hanefesh Administrative Team for this invitation to explore the topic of gratitude. There – that was easy. What am I thankful for? The ability to learn something and share it with others. Those are two values I hold dear. In full transparency, I am also thankful for some public exposure and the opportunity to connect.

Expressing gratitude, in fact, helps the giver as much as the receiver. Maybe more. Psychologists Watkins, Uhder, and Pichinevskiy (2015) found that a treatment group focused on expressing gratitude was associated with increased well-being and also contributed to increased accessibility to positive memories. A quick Google Scholar search shows numerous articles identifying similar mental health benefits – published in the past few years alone. Expressing Gratitude might actually help the giver more than the receiver. So if it is easy, say thank you.

How To Express Gratitude When It’s Not Easy

If you’re having a tough day (or week, or month, or…) that’s a great time to start making a list of things you are grateful for. It sounds counterintuitive, but it can jump-start your day, reconfigure your brain, and lead to other positive experiences. It is no wonder that in Judaism we begin our day by expressing thanks, saying the Modeh Ani prayer to what many believe is the Ultimate Giver. Start your day off that way and it can improve from there. (On that note: Modeh Ani can be an automatic experience that many robotically mutter. Next time you say it, think about one thing you’re grateful for. Or make a list the night before and have it ready in the morning. Try that for a few days and let me know how that goes. Make Modeh Ani Mindful Again.)

Note that the reverse of gratitude, ingratitude, can be a painful and anger-filled experience. Interestingly, internalized humility – according to Maimonides – is an antidote to anger (see the Laws of Personal Development, Chapters 1-2). Perhaps it is not a stretch that expressing gratitude and, in turn, experiencing humility, can contribute to decreased interpersonal anger (and perhaps increased mental health benefits).

So, how do you express gratitude to someone that you still harbor feelings of anger towards (as some may feel around the upcoming Thanksgiving dinner table)? Similarly, how do you grant forgiveness to someone you are still hurt by?

Tips For Showing Gratitude When It Isn’t Easy

Creating a plan to say thank you in this scenario is obviously very tough. To explore how someone has aided you when they’ve hurt you requires a deep and introspective experience. Here are some tactics to help with gratitude, when you don’t really feel it.

1. You can implement a well-known trick for actors who despise one another but are contractually forced to work on a project together. Find something, no matter how small it may be, that you can appreciate in the other and focus on that. The key here is recognizing that you have gained something, no matter how small it is.

2. Fake it ‘til you make it. Say thanks even when you might not mean it or don’t believe it needs to be stated. Try it and see how you feel. Start with something easy, like thanking the Starbucks barista when they get your drink right, and try it for a few days. This is helpful for getting in the gratitude spirit and routine of expressing thanks.

3. It might be helpful to find some me time over Thanksgiving to ensure that it is a smooth process. Activities of self-care can help you take some time to appreciate what you can be thankful for.
You might also choose to go on gratitude escapades: short wilderness trips through nature. Those, ski trip, or getting lost in the city can remind you what is important in life and cultivate a deep experience of gratitude (and humility).

4. Make a journal of your gratitude every day leading up to Thanksgiving. Begin (or continue) journaling every evening. You can use a fancy journal or a piece of paper. One sentence per day is enough and can be a lot. On Thanksgiving, you might write: “I am grateful for the delicious turkey that we have on Thanksgiving.” Personally, I don’t like turkey. However, I am certainly grateful for my partner’s efforts in preparing it. So I’d probably write: “I am grateful for my partner’s efforts to make Thanksgiving a delicious and enjoyable experience.”

Here are some prompts to help you get started:

Today, I feel gratitude for… (insert anything, seemingly menial and grandiose).

Today, I am grateful for… (insert an action that someone did) because it helped me… (insert any beneficial outcome, seemingly menial or grandiose).

Push yourself to use positive language. For example, reframe “I am grateful for the loud person finally leaving the room” or “I am grateful for that person because they shut off that annoying phone” into “I am grateful for the additional silence today because it allowed me the space to focus and remain calm.”

Grab Gratitude

Sometimes you just have to grab gratitude. If you can’t sincerely express gratitude, then do it haphazardly. Fake it ‘til you make it. Remember, gratitude, though not always easy, has the potential to benefit all parties involved. Some might wish to implement an inter – and intra – personal exploration program through consistent gratitude journaling and, for some, a simple  “Thank You” will be enough. Regardless, this Thanksgiving, let’s make some conscious efforts to implement gratitude in our lives again and reap its benefits.

Please click here to read other pieces pertaining to relationships

MAKE YOUR DIFFERENCE: CLICK HERE TO SUBMIT A PIECE TO OUR BLOG

The post Thanksgiving: How To Say Thank You (When You Just Don’t Feel You Have Anything to Say Thank You For)? appeared first on Refuat Hanefesh.

A respected 1952 study found that “only twenty-three percent of the children of the Orthodox intend to remain Orthodox. Earlier, in 1818, the Attorney General of the United States, William Wirt, predicted that Jews would be indistinguishable within 150 years. President John Adams anticipated that Jews might, in time, “become liberal Unitarian Christians.”

And yet, our communities are not only here but are thriving. History has proven our ability to achieve the “impossible” over and over again.

But We Have Failed as Much as Anybody with Substance Abuse

There are some areas where Orthodox communities have not achieved success. Given our ability to resist many negative social trends that have overwhelmed the rest of society, we might have hoped that the opioid epidemic and widespread substance abuse would pass us by, but this has not happened. There’s no need any longer to cite statistics; the secret is out.

It Starts with Community

I believe that the reasons for our failure become clear when we look at the key reason for our success in so many other fields: community. Judaism is a model for how to grow tight-knit communities. These communities are not just one of our plus points, but the secret of our success. It is the feeling of togetherness and mutual support that give the individual the strength to apply the hard work required to lead a Jewish life in the face of all the obstacles the modern world presents.

Our Communities Have Failed to Confront Substance Abuse

When it comes to drug use, our community structures have proven powerless to help. Drugs are a powerful acid, dissolving the bonds of community that exist to support members of the community experiencing difficulties.

One reason for this is the powerful sense of stigma and shame that still surround drug use. Families who have a member struggling are too likely to try and cover the issue up, dealing with the issue “in-house” instead of turning to the community for help.

However, as awareness of the spread of drugs within our community increases and stigma subsides, a more fundamental problem remains.

Addiction Offers an Alternative Community

Addiction and the lifestyle that accompanies it inevitably draws its victims out of the community and raises boundaries that keep them isolated. Much as some may want to help, an addict is drawn into a different world, and a different community – that of fellow drug users and alcoholics. This alternative community provides the same feelings of support and togetherness, but it draws its members not toward greater levels of achievement, but further into dependency and despair.

The deep sense of loneliness that exists in the heart of every addict creates a need for a community that is especially strong. To help people trapped in drug abuse, we need to harness that need for community and channel it in a positive direction.

Working Towards a Solution: The Therapeutic Community

The need for community can be met in a rehabilitative community, where people seeking to escape addiction provide mutual support. The bonds of friendship and understanding that people who can empathize with each other’s experience give each member the support needed to rise out of addiction. Studies show that the shame and frustration often encountered in addiction can be overcome through the experience of seeing the same struggles in others.

Within a community, seeing the imperfections and struggles of others fills us with a greater sense of compassion towards others and, moreover, towards ourselves. Without community, we may feel alone or judge others harshly. However, living within close proximity to others helps us appreciate the limits of our own collective humanity. Surrounding ourselves with a network of supportive individuals enhances our psychological well-being. Simply knowing that others are available to help us can give us the strength to confront life’s challenges.

Finding That Community

While our communities continue to work towards achieving that environment conducive to treatment, treatment centers are a great option The problem is finding a community-based treatment facility that is appropriate for an observant Orthodox Jew. Apart from the obvious problems of Kosher food or keeping Shabbos, for which solutions can perhaps be found, there is the more fundamental problem of the non-Jewish nature of the community of recovering addicts.

One option for finding this community is Retorno, the world’s premiere Jewish organization for the treatment and prevention of addiction. Individuals seek recovery alongside a community of people on the same journey toward sobriety. Substance abuse corrodes community and dissolves the most basic bonds of mutual responsibility that bind us. Retorno helps our young adults regain their footing and find their way back to sobriety, family, and community.

Ultimately, our communities from America to Europe to Israel must do a better job of supporting rehabilitation from drug addiction.

The post Community Life and The Addiction Crisis in The Orthodox Community appeared first on Refuat Hanefesh.

Probably the most popular book on talking to children is How to Talk so Kids Will Listen & Listen so Kids will Talk (Faber & Mazlish, 1999). It addresses common communication problems in order to build foundations for lasting relationships between adults and children.

ADHD and Us

Perhaps the most difficult communication is that between a parent and a child with ADHD (Attention-Deficit/Hyperactivity Disorder). Yet, I am certain that anyone reading this article either knows someone who has been diagnosed with ADHD or has a child with ADHD. Dr. Russel Barkley, a world-renowned ADHD researcher, describes it as a “specific developmental disorder…comprised of deficits in behavioral inhibition, sustained attention and resistance to distraction, and the regulation of one’s activity level to the demands of a situation (hyperactivity or restlessness).” Barkley emphasizes that ADHD is not primarily a disorder of paying attention, “but one of self-regulation.” This may impact those with ADHD’s sense of time or the ability to complete tasks in a timely manner.

Communicating with a child with ADHD is different than talking to one without the disorder. Special care should be taken when reacting to a child, student, or friend with ADHD.

They Act… and We React

Although it may seem that children with ADHD are acting stubbornly or impulsively, these children very often do not have total control over their behaviors. Of course, we all have some control over what we do. However, those with ADHD have a particularly difficult time managing similar behaviors.

For example, you and your family are about to have a nice Friday night dinner. The beautiful singing to open sets the stage for an uplifting meal. During the singing, your 11-year-old (with ADHD) is seen poking her younger sibling, despite being told many times to stop, or given that look (you know that look). Yet, this child cannot stop the impulse and continues to poke. How do we react to this child in such a situation? For many, the natural reaction would be one of criticism and disappointment.

While it is crucial to set limits and foster expectations for our children, our reaction to a child with ADHD should be chosen with care and skill. Those with ADHD do not choose to have it, just as parents do not give their child ADHD. Still, being present, it must be dealt with properly. I’d like to offer just a few suggestions.

Reacting Compassionately

It may be helpful to respond to a behavior privately, rather than in front of the family, and especially guests. A child should also never be made to feel that they are bad for doing something which they may not have complete control. Often this child will carry around a lot of guilt, depending on how others react to them. This child, particularly, needs to feel accepted and understood.

Dr. Barkley stresses that parents should not personalize the child’s problem, expecting them to be able to control impulses in the way the parent, a sibling or friend might be able to. Doing so is unhelpful. It is most probable that the child with ADHD will not be able to live up to that comparison. Parents should stay calm and try to find a way to keep in mind their child’s neurobiological challenges. At times, this may require a parent to walk away before responding. Simply telling a child with ADHD to “focus more” or “try harder” is ineffective and may have a long-term, negative impact on their self-esteem. However, validating the child’s struggle allows the child to feel accepted as who he or she is and builds their confidence.

Accentuate the Positive

Acknowledge the child’s positive behaviors and accomplishments. This should apply even to behaviors that are expected (i.e., homework, cleaning up, bathing). Rather than tell a child to stop doing something, try telling the child what to do. I have heard that by the time a child turns 12-years-old, they will have received approximately 20,000 negative comments! That’s a scary figure.

To conclude, parenting is a challenging job and tends to be more challenging when raising a child with ADHD or other behavioral issues. It is important for a parent not to feel like a bad parent if a situation does not go as smoothly as one would have liked. There are going to be tough situations, and there is not necessarily an easy answer for each one. The most valuable thing you can offer your child is your understanding, as well as your flexibility in learning to better accommodate them.

The post Communicating with Children with ADHD appeared first on Refuat Hanefesh.

Plan Strategically

Choosing when to go
The time of year of the vacation is extremely important. Sure, you may want to hit the beach when it’s warm and sunny, but planning your trip around weather alone isn’t a good idea. The biggest consideration you should make is your regular, everyday schedule. If you know work has more demands during the month of June, for example, that shouldn’t be the time for the beach trip. Instead, maybe visit in August once things have slowed down. Doing this will help reduce stress in that it mitigates worries about work.

In the event of an emergency
While it’s important to stay positive and not dwell on the fact that something can go wrong during vacation, you should have a plan in place, or at least an idea for how you will handle a bad situation. Traveler’s Insurance is a great bet to protect yourself, especially if you are traveling outside of the country. Should you forgo the insurance, at least take time to learn about your credit card coverage. Knowing this and preparing in advance will no doubt put you in a better position in case something happens.

Stay Active

It’s no surprise that exercise, in general, makes you feel good. Every time you exercise, endorphins are released. These are chemicals in the brain that fight pain and also improve the ability to sleep and ultimately reduce stress. Now combine that with vacation. Exercising when you’re on vacation will only enhance your ability to reap all the mental benefits of your time off. Participating in aerobic exercise, especially, helps to stabilize your mood overall; it only takes five minutes to produce anti-anxiety effects.

Your body can also produce endorphins with meditation, acupuncture, and massage therapy. Researchers at the University of California-San Francisco found that while everyone benefits from vacation, both physically and psychologically, learning how to meditate is key. Starting or continuing a meditation practice can help regulate stress and fight off diseases, lower blood pressure, and increase your brain’s chances to respond more patiently and compassionately. More importantly, its stress-reducing effects can last for almost a year, well beyond your vacation.

Keep Your Home Safe

While you’re traveling, the last thing you want to do is deal with a burglary back home. Here are some useful tips to protect your home and allow you to enjoy your time away peacefully:

● Stay quiet on social media. Don’t post about vacation plans before or during your trip.
● Stop your mail, or have a neighbor or friend pick it up while you’re away. If someone is willing to do this for you, provide a spare key; don’t hide a key nearby.
● Hire someone to mow, if needed.
● Leave your car in your driveway, and set house lights both inside and outside on timers. Setting TVs and radios on timers works well, too.
● Hide jewelry and other valuables and lock up any legal documents.
● Place a sign in your yard that shows you have an alarm system in place.

Final Thoughts

If we don’t take a break from work, our health deteriorates, according to a study from the University of Pittsburgh’s Mind-Body Center. Simply put, going on a vacation and engaging in other leisure activities is good for our health. When on vacation, it certainly pays to enjoy it to the max. Use these tips for good measure.

The post How to Reduce Vacation Stress And Maximize the Benefits of Time Off appeared first on Refuat Hanefesh.

According to the National Institute of Mental Health, any of the above scenarios display behaviors that should concern you.

Other actions to watch for include:

● Talking about having no reason to live
● Feelings of hopelessness
● Talking about shame, guilt, or unbearable physical or emotional pain
● Feelings of being or becoming a burden to loved ones
● Talking about death/wanting to die
● Increased use of drugs or alcohol
● Constantly acting agitated or anxious
● Complete social withdrawal
● Poor sleeping/eating habits
● Being conflicted about feelings of rage/talking about seeking revenge
● Extreme mood swings
● Writing stories or poetry about death
● Saying an emotional goodbye to friends and family for no reason
● Making a will or giving away personal possessions

Risk Factors

The Suicide Prevention Resource Center points out that suicide doesn’t discriminate. Although risk factors vary by culture, sexual orientation and age, there are a few that are applicable to nearly all suicidal people. These include:

● Previously attempted suicide
● Mental health disorders
● Access to guns, drugs or other lethal means
● Family history of suicide
● Loneliness and unintentional social isolation
● Chronic/terminal disease or disability
● Inability to access behavioral/mental health care
● Drug use and abuse

Substance Abuse and Suicide

The Substance Abuse and Mental Health Services Administration cites drug and alcohol abuse among the top three risk factors for suicide. Additionally, those with a proclivity toward drug abuse often suffer with a dual diagnosis, meaning that they have a separate mental health condition co-occurring with a substance abuse disorder. This greatly increases a person’s risk of suicide or attempted suicide.

The National Addiction Institute explains, “When a person with a substance use disorder is also suffering from a mental health disorder, it is critical that they carefully manage both disorders to ensure that a relapse from one to the other does not occur. Once both disorders are fully active, the person’s condition can turn life-threatening.” Unfortunately, this demographic is often overlooked by society that continues to view substance abuse as an action instead of a disease. But pushing past these social stigmas and receiving help for both disorders is paramount to an addict’s recovery and ability to overcome suicidal thoughts.

How to Help

If you or someone you love has displayed any of the above behaviors and is actively contemplating suicide, seek help immediately. Call 911 or visit an emergency room. If you don’t believe there is immediate danger, you can still help. Don’t be afraid to reach out to a friend or family member you believe may be struggling with feelings of taking their own life. More than anything, do not berate the individual and tell them you believe they are simply trying to seek attention.

Attention may be exactly what they need. A person who is feeling suicidal may believe they are invisible to the outside world. They may have been told repeatedly that their opinions, thoughts, and feelings don’t matter. Sometimes, all it takes is a friendly face and a listening ear to get past the lowest point. Once the crisis has passed, you can help your friend by encouraging them to seek help for their depression. Remind them that their intense sorrow is a temporary situation and that there is a light at the end of the proverbial tunnel.

Resources that may help circumvent suicide include:

Suicide Prevention Services of America (630) 482.9696
The Rape, Abuse & Incest National Network (RAINN) (800) 656-HOPE
The Trevor Project (LGBTQ) (866) 488.7386

Visit LiveScience.com for more resources including information on prevention and suicide statistics.

You are not helpless. If you fear a loved one is at risk of self-harm, stop pretending their pain will go away on its own. Reach out and offer a helping hand. You may save a life.

Please click here to read Caleb Anderson’s other pieces.

The post Suicide Prevention: Warning Signs and When to Seek Help appeared first on Refuat Hanefesh.

Bari Mitzmann has a bachelor’s in psychology and a masters in special education. She is currently the Associate director of Las Vegas NCSY. Bari began sharing her experiences with anxiety and depression on Instagram. The tremendous amount of feedback motivated her to create Barianna.com, which features several articles about fashion, inspiration and living with mental illness.

Bari will candidly share her story of peripartum depression along with the fears and insecurity that went along with it. She will imbue us with lessons she learned and what she wished she had known when she was going through it. Most importantly, she will answer viewers questions to help them alleviate their own fears, acquire tools to overcome their challenges, and understand how to help their friends and loved ones who may have perinatal depression, anxiety or psychosis.

The conversation will take place live on the Refuat Hanefesh Facebook page at 8:30pm est on Sunday, April 22nd.

https://www.facebook.com/refuathanefesh/

The post Perinatal Depression: You Are Not Alone appeared first on Refuat Hanefesh.

Some feel like they are suffering having to sit through long Seders with family, who always manage to find the right words to get the entire family in a fight. Some even dread Pesach’s arrival because they are anxious about spending so much time with family, anticipating what someone will inevitably say to get under their skin. How do we avoid getting dragged into the same arguments every year at the Seder? How do we not take offense to the same annoying joke made at our expense each year?

An Answer Found in Matzah

If we look to our sages, we can often find deep answers to difficult questions. In his commentary on the Haggadah, the Maharal commentator offers a great insight on matzah. He asks why it would be referred to in Rabbinic literature as “Lechem O’ni”, which is traditionally translated as “bread of affliction” or “bread of a pauper”. This seems entirely contradictory since freedom generally implies the ability to do whatever we want, while poverty is generally associated with being prevented from doing what we want.

In explaining this apparent difficulty, the Maharal notes that matzah is not bread that is eaten by the poor. There can be fancier versions of matzah (and the prices nowadays seem to be in consonance with this notion). However, the essence of matzah itself is poor in that it is devoid of all additives. An additional approach is that in some ways, a pauper is freer than the wealthy person. Our sages teach us in Pirkei Avot 2:7 that the more possessions we have, the more worry that comes. When we are heavy with assets, we can also be heavy with concerns for maintaining our status. The Maharal suggests that someone with no possessions is in a way more free than someone with great wealth because he will not be restrained by his ties to worldly things.

Achieving Freedom from Family Conflicts

How do we take the message of the Maharal and find our own freedom? By stripping away all of the layers that we have and taking an honest look at our real basic elements. Doing this allows us to identify what our flour and water are, and we shed all of the additives that distort our true selves.

To show this approach in action, I once worked with a client who dreaded Thanksgiving because he always ended up feeling upset by the end of the holiday. His siblings would push buttons he didn’t even know he had, and his grandparents would fight with his parents. The whole event was miserable. When we processed what was going on, he realized that everyone was just fighting for attention because their own needs weren’t being met in healthy ways. So, they would find substitutes to get the approval and attention they craved.

Realizing this was the key to navigating lengthy family meals. He was able to go to the next family function and not play into all of the power struggles and fights for attention since he didn’t feel the need to fight anymore. Because he removed all of his layers, he was able to be in touch with his insecurities and vulnerabilities. He didn’t feel as hurt when someone pointed them out. The more confident he was in whom he was, the less others were able to bother him. Getting down to his basic elements was the most liberating experience he’d ever had. It freed him from the scrutiny of others and allowed him to feel happy with himself.

Let’s Do It

This Pesach, let’s internalize the words of the Maharal. Let’s strip away all of our additives and focus on the message of the matzah, not the marror. Instead of highlighting the bitterness of servitude, let us express the beauty of true freedom.

Please click here to read Dani Bauer’s other pieces

Please click here to read other pieces pertaining to relationships

MAKE YOUR DIFFERENCE: CLICK HERE TO SUBMIT A PIECE TO OUR BLOG

The post Freedom and Owning Our Insecurities appeared first on Refuat Hanefesh.

We thank Jonny Ritz and Company, specializing in custom made Jewelry and excelling in customer service for sponsoring this live conversation. You can learn more by visiting jonnyritz.com.

Delirium: The Secret Killer

Refuat Hanefesh: As we were advertising this live conversation, it became clear that many people don’t know what delirium is. Why should we be concerned about this topic?

Dr. Rasimas: Our bodies do a lot to defend our brains and keep them functioning well. So when a physical illness affects thinking and behavior, it means that illness needs to be taken very seriously. In fact, the illnesses that cause delirium are almost always potentially life-threatening, and delirium itself increases the risk that people will not recover because it gets in the way of the necessary treatment.

RH: With that said, can you please briefly describe what delirium is?

DR: Delirium is a syndrome that looks like mental illness, but shows up in people who are physically sick. A useful way to think about it is the idea of “Acute Brain Failure”. You may know people who have had heart failure or kidney failure, meaning that what we expect of those organs is no longer working properly. Well, a person with delirium doesn’t think or act or understand what is going on around them the way we normally expect them to. And the cause of that set of problems is an underlying diagnosis, not of a mental illness, but a serious medical condition.

RH: So you’re telling me this is not a mental illness. Who is responsible for treating it?

DR: Delirium is in the Diagnostic and Statistical Manual of Mental Disorders, largely because the symptoms that it produces are the sort that psychiatrists are experts in recognizing. But it is important that all kinds of doctors, especially those who work in hospitals and emergency rooms, can recognize it too. That’s because definitive treatment is going to require expertise from outside of psychiatry.

RH: How can you tell if someone is delirious? Do all people with delirium look the same?

DR: There are some things that are common to all delirious people. But sometimes when people suffer this kind of attack on their brain, they react with anxiety or agitation out of confusion. Other times, the sickness itself saps them of so much energy that they are mostly lethargic and don’t interact much at all.

RH: What are the visible signs?

DR: Delirium makes it hard for people to stay awake and pay attention, even when important things are going on. They often have problems getting good sleep at night and then can’t help but sleep intermittently during the day — their normal day/night patterns get messed up. Also, they have memory problems, particularly with remembering things that are new since the time they got sick. One of the scariest things is seeing, hearing, and feeling things that aren’t real and then not knowing how to make sense of it all, sometimes having irrational fears. They often don’t understand things told to them, so they can be hard to reassure. And they also don’t communicate in reasonable ways. It’s hard for them to follow what is going on around them. Sometimes even choosing what to eat or whether to have a shirt on or off is impossible for them to decide.

RH: What causes delirium?

DR: A long list of different kinds of medical problems can cause delirium. Everything from lung problems that decrease the amount of oxygen that gets into the blood and to the brain to major infections that travel around the body and cause problems for a number of different organs, including the brain. Other causes include out of control diabetes, a new cancer, and exposure to environmental toxins like lead, carbon monoxide or other gases.

RH: Tell us more about the medical risks and what medications increase risk.

DR: Medications that interfere with clear thinking are the ones that increase risk. These include some anti-anxiety drugs, some recreational drugs, and a number of medications we use for other conditions but affect brain function. Having an episode of delirium makes recovery harder and usually keeps people in the hospital longer.

RH: How commonly does it occur?

DR: It’s hard to quote a useful number for each possible cause. But in general, about a quarter of people who end up sick enough to be admitted to the hospital experience delirium at some point in the course. Some studies suggest that as we approach the end of life, depending on the specific incurable illness that is leading to death, the rates of delirium are 75 to even 90 percent.

RH: Who is at greatest risk for delirium?

DR: The “Acute Brain Failure” analogy helps to answer this question. With heart failure, the people most likely to have an acute episode are people who already have heart disease. Similarly, with delirium, people who already have a disease or established problem with brain functioning are more likely to suffer delirium when they get sick. Those conditions include dementia, epilepsy, a previous head injury or stroke, significantly low IQ, and age. Older people are more likely to have delirium than younger people; though, it does occur even in the youngest of children. Having a surgery that involves getting anesthesia is also a risk, even if it’s an elective procedure and the person wasn’t really sick at all beforehand.

RH: Is it preventable? Can we do anything in our day-to-day life to help ourselves avoid it?

DR: Well, obviously there are some diseases we get that we just can’t control. And of course, we can’t stop the aging process. But there are some things that keep brains healthier to protect against delirium if we are to have a serious medical problem. That includes regular exercise, which is the best prevention strategy known for Dementia. Protecting our heads when we get that exercise in the form of bicycle helmet use and protective equipment in contact sports is a good idea. So is taking good care of our blood pressure and blood vessels with a healthy diet and medications, if needed. Also, avoid abusable drugs and excessive consumption of alcohol, since they can cause lasting damage to the brain.

RH: Can delirium be predicted?

DR: Unfortunately, it really can’t in most cases. People who have had delirium before and are getting sick from the same kind of problem that produced delirium in the past does make it more likely they will experience it again. I can predict that if you use a large amount of cocaine or synthetic marijuana or other drug, it will happen reliably. But otherwise, we have screening measures in place in all hospitals to try to make sure we catch delirium as early as possible, so we can do something about it.

RH: When someone gets sick, can we do anything to reduce the risk of delirium?

DR: It is helpful to give doctors a good accounting of all the medications and chemicals someone has in their lives so we know what to watch out for and avoid bad interactions that can affect the brain. Having familiar faces visit the hospital can help. Frequently reminding someone in simple terms where they are, what has happened to them, and what to expect next is reassuring and helps their brains process the situation better. We also emphasize keeping lights on during the day with some level of stimulation and as much physical activity as can be managed. Making things quiet and restful to promote sleep at night is crucial. It can be hard to keep the chaos of being in the hospital from contributing to the risk, but this should be our goal.

RH: What are the medical treatments?

DR: The most important treatment for someone with delirium is to fix the medical problem that set it off. Without that, the risk for bad outcomes stays high, and delirium usually doesn’t go away. When the delirium itself causes major problems, we sometimes will use medications to make sure people don’t hurt themselves or someone else out of confusion. We also use antipsychotic medications to treat the distress caused by misperceiving what is going on. Other medications can keep people calm during these difficult times but can perpetuate the cycle of confusion, so we try to use caution. If we can, we rely on reassurance and patient, sensitive human care to carry through.

RH: Are there long-term consequences that result from delirium?

DR: Even after recovery, although we think of delirium as reversible, some people can have problems with their thinking being less efficient than it was before they got sick. The recovery back to routines of daily life can be slow, even if the physical recovery seems complete. And, to focus on mental health for a minute, having delirium increases the risk that during the months, even up to years after the time in the hospital, people can have serious problems with depression, anxiety, and even PTSD from the experience of delirium.

RH: Can we do anything after delirium to reduce these risks?

DR: There aren’t any results of research or clinical experience that tell us there are medication treatments that prevent the long-term problems. But in the hospital, putting together a kind of “diary” of the experience has actually been shown to really help a lot. It may seem like a time that you or the sick person may not want to remember at all, but losing our memory for stressful times is actually worse for our sense of well-being. Keeping track of what has happened day by day and reviewing it with patients when they are awake helps them make sense of the experience and probably makes depression and PTSD after recovery less likely.

RH: Based on those risks, does it make sense to preemptively treat illnesses such as anxiety, depression or PTSD, or should individuals who developed delirium be followed more closely after discharge from the hospital?

DR: Both of those suggestions make sense. We’re not certain about the size of the effect, but having treatment in place – especially social support – for people who already have a mental illness does make it more likely that delirium will be less problematic. And we certainly think it is important to screen for problems with mood, anxiety, cognition, and overall social and occupational functioning in the weeks and months following a hospitalization where delirium was an issue.

Other live conversation videos can be found here.

The post Delirium: The Secret Killer – A Live Conversation Transcription appeared first on Refuat Hanefesh.

Why Users Use

For many drug abusers, their journey into addiction begins with what they perceive to be a harmless experimentation. However, after their first high, many users believe their substance of choice is doing them more good than harm. Over time, a chemical dependency develops which can fundamentally alter a person’s brain function. They fixate on those initial good feelings. Compounding the problem is that it may take more and more of the drug to get there. As a user’s tolerance increases, his or her connection with reality begins to dwindle. This is where other issues and destructive behaviors begin.

Drugs and Domestic Violence

Addicts and alcoholics often become physically and mentally abusive to those they love. They may be angry that their spouse cannot supply them with enough money to support their habit or annoyed that children have woken them from a drug-induced sleep. The American Society of Addiction Medicine reports that between 40% and 60% of domestic violence cases are steeped in substance abuse. Even men and women who show no penchant for violence may become abusive as they fall deeper and deeper into addiction.

Addiction Affairs

Drug addiction and alcohol use can lead to extramarital affairs. The reasons are varied but often center around social acceptance and seeking someone who condones these bad behaviors. An affair triggered by addiction has nothing to do with the addict’s love for their partner, which is one of the hardest things to accept once recovery begins. Drugs, alcohol, and infidelity are equal opportunity issues that don’t discriminate based on race, social status, or income. This is evidenced by the high-profile breakup of Khloe Kardashian and Lamar Odom.

The Road to Relationship Recovery

Recovery from addiction is a long and hard road. When marred by other complications, it is a road that may seem impossible to travel. Couples wishing to re-establish a bond must understand the first step is looking at the situation as honestly and openly as possible. Unnegotiable is that the drug use must end so that the addict can comprehend his or her actions. Drug rehabilitation therapy is a good place to start. This is offered in both inpatient or outpatient treatment centers that will offer the addict an opportunity to detox and cope with the physical symptoms of withdrawal. If both partners are willing to communicate with one another, there is hope that the relationship may continue.

Atonement

The chemically-altered brain is not wired to ask for forgiveness. It doesn’t see how the addict’s behavior affects his or her loved ones. However, once the addict clears their head, they must make amends for their actions. Asking for forgiveness – and being honest about everything – is a good place to start. It will take time, but otherwise strong relationships may be able to reestablish trust if the addict is willing to be active and intentional in their recovery.

When the Relationship Dies

While small infractions in either of the three A’s (addiction, abuse, affairs) may be forgivable, sometimes, a combination of the three will damage the relationship beyond repair. When the addict won’t completely admit their issues, is unwilling to change, or when the victim of the situation simply can’t look at their partner in the face anymore, separation may be the best course of action. This outcome, while unfortunate, does not necessarily have to viewed as a strict negative. Ending a relationship can be a new starting point for both parties and may serve as a milestone and reminder to each that change is an inevitable part of the healing process.

Please click here to read Caleb Anderson’s other pieces

Please click here to read other pieces pertaining to addiction

The post The Addiction Relationship Effect appeared first on Refuat Hanefesh.

What is the best way to navigate these challenges? What approach should I take at yet another Chanukah party where Aunt Sylvia constantly criticizes me for not choosing a particular career path? Is it even possible not to blow up in her face?

How do we survive – or even enjoy – the holiday season?

The Cycle is To Blame

The foremost thing to remember is that the enemy is the cycle, not the people. Meaning, we tend to find ourselves in the same endless arguments with the same family members. Feelings get hurt, and then we do the same thing at the next get-together. We identify the person with whom we get into the most arguments and then assume that they are the problem. That way, we conveniently have someone to blame, and it’s not ourselves.

A healthier approach might be to think of the cycle itself as the problem, and we the guilty participants. The problem is not that Aunt Sylvia is bad, and it’s not that I am impossible. The problem is that our interactions together need fixing. We stumble into the same pattern over and over, and it is the interactions between the two of us that need to change.

Emotionally Focused Therapy

There are a lot of different ways to change, but I think a good starting point is considering primary emotions and secondary emotions. One of the tenets of Emotionally Focused Therapy (EFT) is that there is a vast array of emotions, and the more we understand them, the more control we gain over them. Learning to understand our emotions can help us learn how to use them and focus them properly.

EFT theorizes that some emotions are what we are really feeling, and other emotions may appear on the surface but aren’t really at the heart of the issue. If I trip and someone laughs at me, for example, I may express anger towards them even though my true feeling is embarrassment.

It’s Time for Change

One of the first steps to gaining control over our emotions is to identify and name what we are really feeling. Once we do that, we can express what we are feeling to others, and the conversation can then shift. Rather than yelling at everyone to get out of the kitchen, or lashing out at Aunt Sylvia for her constant criticism, I can react differently. I can explain that I feel rejected when Aunt Sylvia only focuses on my brother’s accomplishments and ignores mine. I can express hurt, or say that it feels like someone has no confidence in me, or that I feel marginalized.

As a disclaimer, I would add that this approach works only when both parties are interested in change. If I am not interested in improving the situation, then you can be as in touch with your emotions as you want, but I may not reciprocate the same kind of sensitivity or awareness.

Finally, if I recognize how I am really feeling instead of leaving it as simply “angry” or “frustrated”, I gain more power over how I choose to react in a given situation. Recognizing that what I am really feeling is rejected will likely keep me from displaying anger and pushing others away. Ultimately, this EFT-based approach can lend me power in taking charge of my life and my choices.

Being The Light

This Chanukah, like others before it, will have its parties and family get-togethers. Some of them we wish we could go to, and others we would find any excuse to avoid. Wherever we find ourselves, let’s do our best to be a light to others. By recognizing and expressing our primary emotions, we can set the tone for communicating in a helpful, intentional manner.

Please click here to read Dani Bauer’s other pieces. 

Please click here to read other pieces pertaining to relationships

MAKE YOUR  DIFFERENCE: CLICK HERE TO SUBMIT A PIECE TO OUR BLOG

The post Chanukah Guilt… I mean Gelt: Navigating Chanukah Parties using Emotionally Focused Therapy appeared first on Refuat Hanefesh.