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I look just like you.

But I am living in a different world than you. I live in the world of OCD.

You sit next to me at the nail salon. You close your eyes and relax as you enjoy getting your nails done. I squeeze my eyes shut and try to control my breathing. I can’t handle the place where the polish doesn’t quite cover my nail. The pinkie that is not smooth enough. My cuticle that isn’t cut exactly like the others. They make my heart squeeze itself. They make me feel like I’m choking. My chest hurts and I need to throw up. I shake and want to run out of there. But I try to breathe and pretend to be normal. You look over and smile. I look just like you.

You sit in class taking notes on the lesson. I also take notes. But I need to go back over each word and rewrite it. Because it makes me nauseous when the letter isn’t complete. When one letter is bigger than the next. I don’t like how that “k” came out. I redo it. And redo it again. And rewrite each letter. I try to keep up with the lesson, but I’m busy battling my OCD. It’s hard to listen to the teacher and fight myself at the same time. My hands shake and my heart flips and flops and I need to throw up. I want to die right now. You look over to copy a line of notes that you missed- mine look just like yours.

You appreciate organization, don’t like messes. You like to clean up our dorm room. But you don’t know how I kill myself over our room. Since I can’t clean up for six girls, the obsessions and compulsions I’m suppressing overtake me in my own things. To you, I look like any other neat girl. But only I know how much more than that it is.

I line up my jewelry, all in the right order, one ring not a centimeter out of place, my watch at the perfect angle, my necklace perfectly centered directly in the middle of my bracelet. It takes me a full five minutes each night to get it just write. Five minutes and a whole lot of agony, nausea, hands shaking, and horrible thoughts that I can’t seem to control. You sit on my bed and marvel over my organizational skills. I cringe. You don’t know the torture and anxiety that just went into taking off my jewelry for the night. The suicidal thoughts that plague my mind as I look around the room. But you don’t know that. To you, I look like any other neat girl – just like you.

And then you go and rattle off “OCD” like it’s some kind of slang term. “I’m so OCD”. “Yeah, I’m OCD about my makeup”. “She’s so OCD”. If only you would realize that OCD isn’t some sort of slangy expression. Nor is it an adjective. I am not OCD. I have OCD. If only you would respect that. It is a disease that plagues my mind, messes with the way I function, makes me want to kill myself. I did nothing to get it. I am working to fight it, working to overcome. Please watch how you throw those three letters around. They mean more to some people than you think.

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Fast forward to age 20. I moved to a Jewish neighborhood on the East Coast. My first day there I went out for lunch and my jaw just dropped. Was I at a pizza shop or a sheva brachos (post-wedding ceremony)? What I wear for Shabbos, they wore casually during the week. I couldn’t tell who was married and who was single, because the long curly wigs the married women had on looked just like that of the single girl who has to look tip-top for shidduchim (potential marriage matches).

The Image is What Counts

In this new community, I entered an extremely toxic work environment consisting of members of the Jewish community. The girl whose cubicle was opposite mine was half my size; yet, she would only drink coffee and complain about her weight. I couldn’t help thinking that if she were fat, I must be massive. My coworkers incessantly commented on how good the skinny girls in the office looked as well as on my food and my looks. I felt as though I couldn’t repeat an outfit without warranting their attention.

I will never forget the girl who showed everyone a picture of 80 dollar shoes that she ordered for her three-year-old daughter. I couldn’t fathom spending 80 dollars on shoes for a child who would soon outgrow them, let alone for myself. I thought, “Even if you can afford them – which I personally do not quite understand – enjoy your shoes, but there is no need to flaunt it to the whole office.”

When they weren’t judging people’s looks, the conversation centered around what they were about to eat, what they had already eaten, and what they should eat next. This culture of judging others’ self-worth based on the superficial only served to fuel my worst self-image challenges and anorexia.

Dating Culture

The community’s dating approach was a mortifying display of superficial values and was anything but spiritually-based. A shadchan (matchmaker) once called me and said, “There’s a guy on your street and he’s perfect for you; don’t you dare ever leave your house looking anything less than perfect.”

Once, I drove three hours to see a shadchan with which I had booked an appointment a few months in advance – her appointments usually booked many months prior. I poured my heart out to her. I cried because I was so real with her about what I wanted in life. After the two-hour session, she said to me, “You need to wear more makeup.” I personally think I look really good with the natural look. I don’t like to wear a cake on my face! Her response was simple: “I am sorry, but I know what’s out there. I know what the guys are looking for, and I know which girls you are competing with. You don’t stand a chance unless you get your hair done and get more makeup.” She told me to follow up with her in a few days. I called her back and the first thing she said when I told her who was calling was, “Oh, hi, did you buy more makeup yet?” I hung up the phone and cried.

I called a different shadchan who asked for just my size and no other information. When I told her my size, she said “Okay, great, I have an idea for you! I’ll speak to him and call you back.” I couldn’t believe it. She wanted to match me with someone who I am supposed to live with for the rest of my life – solely based on my size?

I believe Judaism is supposed to be focused on the internal. What happened to sheker hachen v’hevel hayofi (charm is a lie and beauty is meaningless)? I am not currently looking to marry a religiously intense guy, but when I was, it seemed that the shtark (religiously intense) guy who learns all day and was supposed to have yiras shamayim (fear of G-d) cared most about adhering to appearances.

The Religion of Judging

It is shocking and hurtful to me to see what Judaism has become. At its core, it is a religion that is supposed to be about one’s relationship with G-d. However, my sister recently told me something that has rung true throughout my experiences in this Jewish community: “We are supposed to fit our lives into Judaism, but many people are fitting Judaism into their lives.” The obsession with physicality is not who the Jewish people are or were born to be; we were born to be with each other, not against each other.

We are one. We are Am Yisrael (the Jewish nation), and we must support each other for who we are internally, not what we look like externally.  While it’s hard not to become victim to the societal values that have consumed our nation, we must resist them together. Let us support each other. Let us be strong. Let us be who we were born to be.

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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.

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When Anorexia Strikes

It’s 2 AM. My heart is beating, and my head is spinning. I hardly ate anything the day before, but I am too scared to eat now. My parents think I don’t love them (because I refuse to eat), yet the only reason I even swallowed the little bit that I did was so that they won’t have to be at my funeral. If it were up to me, I would throw this all away so that the fight would finally be over. But, I can’t. Other people are relying on me to get better. If I kill myself, they will probably kill themselves, too. If I choose to hurt myself, that’s my issue, but I can’t do it to anyone else. They don’t deserve to suffer. I think about it all the time… If I killed myself right now, who would care? My parents and siblings would, but everyone else would probably get over it.

I go back and forth in my head for hours. I’m exhausted, and I just want to go to sleep. My stomach hurts, and I have heartburn. I am nauseous, and I want to throw up. I’m scared that if I were to get up, I would immediately collapse. Maybe I can just drink some water, and I’ll be fine. I drink another bottle of water, but I still can’t fall back asleep. If I get out of bed to get something to eat, my parents will wake up and get worried, plus it makes it so much harder to eat if other people see me eating, or even if they know I’m eating.

OCD Enters

If I decide to eat, I’ll also have to take out my retainer. What’s so complicated about that, you might ask? With OCD, everything is complicated. It requires taking out my retainer, eating, brushing my teeth, flossing, rinsing with mouthwash, brushing my retainer, and finally putting it back into my mouth.

It’s probably about 5 AM at this point. In the last three hours, I’ve texted four friends, trying to get encouragement. I go back and forth in my head, trying to weigh out (pun not intended) if I’d rather risk my heart rate dropping and potentially dying versus gaining an ounce. I get out of bed, prepare something to eat because I know it is the right thing to do, and cry while eating it. I probably also watch a show or listen to music to try to distract myself from what is happening. Finally, I must take care of my whole oral hygiene ceremony. At this point, my stomach still hurts but not because I didn’t eat; it hurts because I did eat. I am so angry that I have to eat, but at least now I can finally get a couple hours of sleep, because my body has the energy it needs to be able to sleep. I know, right? How interesting… I never realized I needed ENERGY to be able to go to SLEEP!

Mental Illness Doesn’t Get A Reset

It’s 8 AM, and it’s a brand new day, but unfortunately, Anorexia doesn’t believe in “new days.” My first thought is “I don’t want to eat, but I have to… But I don’t want to. I just ate a couple of hours ago. I’ll be fine.” I look in the mirror and hate what I see. Why did I have to wake just to deal with this? I get upset at Hashem. I don’t even want to say Modeh Ani (a morning prayer). I ignore phone calls from my friends, and I hide under the covers so that no one sees my body.

My mental illness affects me physically, emotionally, mentally, socially, and spiritually. It’s intense, it’s exhausting, and it’s frustrating. Not just for me, but for everyone else in my life, too (family, friends, community, and treatment team). People think they understand completely, but they don’t. They pressure me to get better, and say if I wanted to get better, I could do it in an instant. They say that I am not trying hard enough. They don’t hear all the voices in my head. They don’t see all the battles that I do win. They only know about the ones that I lose.

The Evolution of An Illness

People always ask me when this started or what caused it. Obviously, certain things made it worse, but I honestly think in a way, I was born into it. Ever since I can remember, my father has been dieting, and my parents have been extremely weight-conscious. I remember, at age five, my father telling me not to take dessert because I will get fat. Other parents were begging their children to come eat dessert. I was confused. My parents were telling me to stop eating the main meal, so why were other parents trying to get their kids to eat dessert? It made no sense to me.

Every single day, I would come home from school, and my father would analyze me and either tell me if I gained weight or lost weight. I know he meant well. He struggled as a kid with body image, and he wanted things to be better for me. In second grade, I asked a friend in the middle of a dodgeball game at recess if I was fat, and she responded, “It wouldn’t hurt you to lose weight.” I used to run if I needed something at another end of my house, so that I could use it as an opportunity to burn calories. I never felt comfortable eating in front of people. At Bar Mitzvahs or Weddings, I would nibble on something and then eat a real meal when I got home. Everything I think, say, do, wear, eat (or don’t eat)…it’s a whole conversation in my head. Caring so much what other people think is consuming.

It starts off with taking less dessert, or even a compliment from a neighbor, but before you know it, I am scared of a carrot. It can happen to anyone. It’s difficult for a person herself to recognize an issue when it’s been her norm for so long. I have found that most people are ignorant of the symptoms, even medical professionals. I used to be 100% sure I wasn’t anorexic. Luckily, my friend (who worked in the field) picked up on some subtle hints. If it weren’t for her, who knows if I would be writing this right now. Please, learn more. Read more. Ask more. Talk more. Hopefully, that will let us live more.

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The Connor Project: A fictitious movement based on a fictitious story conceived by the minds behind the fictitious Broadway play Dear Evan Hansen. For many, however, this project enabled the most real feelings they have experienced in a long time. Children, teens, and adults alike – who have felt overlooked for much of their lives – felt like they mattered.

How could a Broadway show elicit such powerful feelings? Dear Evan Hansen follows the story of its title character – Evan Hansen. Evan is a high school kid believed to have been the best and only friend of classmate Connor Murphy, who loses his life to suicide early in the play. Desperately wanting answers, Connor’s parents turn to Evan to learn about the life of the son they hardly knew. The challenge: Evan must contend with this role thrust upon him while battling his depression and crushing social anxiety, an illness so powerful that Evan would sooner lie in bed starving through the night than have to interact with the pizza delivery man. Also of issue: Evan in reality knew next to nothing about Connor.

Evan battles through his illness and lack of knowledge about Connor to try to bring some comfort to the Murphy family by coming up with answers to their questions. As if that isn’t hard enough, at the urging of a classmate who wants to keep the memory of Evan’s “best friend” alive, Evan starts The Connor Project. The mission of the movement is to make certain nobody has to feel alone and forgotten, presumably how Connor felt before losing his life. This is as well arguably the theme of the play – nobody deserves to be forgotten.

Forgetting Alana

Enter Alana Beck. She is the before-mentioned classmate as well as the co-President of the Connor Project. There is nothing about the play that epitomizes the state of mental health more than Alana. She is the forgotten character of Dear Evan Hansen.

While Evan and Connor get most of the attention during the production itself and post-play analysis, Alana is swept away. However, she just about defines the life of high-functioning anxiety. Don’t take my word that she is struggling; take her words. Lost in the shuffle towards the end of the play is what should be a stinging cry for help from Alana. While defending her interest in the Connor Project as more than just an item for the extracurricular checklist, she bursts out, “I know what it’s like to feel invisible. Just like Connor. Invisible and alone and like nobody would even notice if I vanished into thin air.”

Alana’s High-Functioning Anxiety

In addition to this blunt plea for support, she exhibits many of the signs Psychology Today identifies with high-functioning anxiety:

-She is a perfectionist and overachiever to an unhealthy extent – as she reports early in the play that she filled her summer with three internships and ninety hours of community service. High-functioning anxiety is fueled by an incessant fear of failure.
-She constantly feels the need to be doing something, jumping to self-appoint herself as co-President of the Connor Project and frequently starting new initiatives for the project. Those with high-functioning anxiety get anxious and feel they are not doing enough to succeed if they are not constantly active.
-She has trouble making friends or feeling she has friends; rather, she throughout the plays refers to her many “close acquaintances.” It is tough for many with mental illness to accept or make friends.
-She is pent up with energy she doesn’t know what do with, leading her to interrupt fellow characters throughout. This is also a sign of high-functioning anxiety,

Despite her compelling and important story, Alana gets swallowed up by splashier storylines. How ironic that a play about forgetting nobody could allow its own character in need to be overlooked by the critics and general audience. High-functioning mental illness needs our support as all mental illness does.

The Deafening Irony

This barely scratches the irony, however. Alana Beck, in fact, epitomizes what is wrong with how mental illness is viewed. Mental illness equality cannot hold weight when competing for attention with other important issues like LGBTQ rights or women’s rights or racial equality or similar hot button issues. Nor can mental illness equality gain a following of supporters when competing with other health causes like cancer awareness or helping those with disabilities.

This runs directly contrary to what the statistics say should get our attention most. More teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease, COMBINED. Overall, suicide is the second leading cause of death for those age 10-24. (2016 CDC WISQARS)

There are too many people going through their childhood, their lives, suffering and in indescribable pain, with not nearly enough people fighting for them. So much crushing loneliness. It doesn’t have to be this way. If only mental illness was not forgotten like Alana Beck is forgotten.

Diving Into The Disparity

Why is there such disparity between garnering support for most causes and support for mental illness equality? One factor is that it is easy to feel good about oneself for contributing to Yachad or NCSY or Sharsheret or Bnei Akiva or Chai Lifeline or you name the organization. This is predominantly because of two reasons:

Firstly, with those causes, one can tangibly see the pain or problem which they are helping with. There are clear signs of a person with autism or cancer, leaving no doubt they deserve all the support possible. Mental illness, though, remains stuck in secrecy and unclarity. One cannot simply look at their friend’s debilitating social anxiety.

Secondly, involvement with all of the above organizations is universally encouraged and applauded. One can smile ear to ear while proudly writing “Yachad Coordinator” on their Shidduch (dating) resume. Boasting being a volunteer for Refuat Hanefesh or Active Minds, however, could very well be greeted with confusion.

Be Part of The Solution

Watch the Dear Evan Hansen play. Or better yet, read the book. (Word is there’s a movie coming out too.) Take in the book’s lifelike descriptions of what it’s like to live with social anxiety. Enjoy the flashy gimmicks and cry along with the fellow theatergoers at the show. But don’t forget about Alana Beck. Please, don’t watch the play only to forget that it is incumbent upon each of us to fight for mental illness equality. Do not allow yourself to be part of the irony.

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I have been embarrassed for a long time because of the stigma surrounding mental health, and I still am even though I am writing about it. I am writing to break the stigma and show myself –and hopefully others– that there really is nothing to be ashamed of.

I was embarrassed about my anxiety and depression –especially when I first got diagnosed– although I am more OK with it now because I feel like enough people have these issues and that the awareness for them is strong and only getting stronger. Don’t get me wrong; I am still embarrassed about them, but I just understand them more. I understand that this happens to many people and that it’s not my fault. I am, however, way more embarrassed about something else: my OCD.

The OCD Cycle

I have OCD. I get stuck in the “OCD cycle,” and it’s taking over my life. My head is a scary place to be right now, and I have to live there every second of every day.

People have said to me, “There’s nothing wrong with you! Everyone’s like that! You’re not special!” I am not saying that I am “special;” I am saying that I am feeling a certain way and that I know something is wrong. Due to people saying this to me, I too often feel like my constant struggles aren’t enough to “qualify” me for having a legitimate case of OCD. Be careful what you say, because after hearing these things, I just feel worse about myself and like I’m an attention seeker.

Think Before You Speak

So, please, I beg you: don’t belittle someone’s mental illness. You are not in their head, so, therefore, you cannot know what they are feeling. When someone is telling you that there is something wrong, DON’T tell them there isn’t! It just makes things worse and creates more stigma and embarrassment for the person.

If you don’t understand what’s going on, ask!

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I was recently talking with a friend of mine who has Obsessive Compulsive Disorder and suffers from intrusive, guilty thoughts. He told me that he hates this time of year in the Jewish calendar because he has no need to create any more guilt for himself. His brain does a fine job on its own; thank you very much!

Indeed, the process of repenting for past mistakes can be unhealthy and psychologically difficult. As we move through the week of Asseres Yemei Teshuvah and our focus changes to rest exclusively on the concept of repentance, it is important to examine our approach from a religious as well as psychological standpoint.

Gult surrounding addiction

I work as an addiction psychiatrist and a common pitfall for those in recovery from drug or alcohol addiction is the negative psychological spiral when falling short of their goals. A failure to resist the urge to use or engage in an addictive behavior leads to self-beratement, starting a cycle of lower self-esteem and less strength to resist future temptation.

There is a danger in the process of repentance that the same pattern might emerge. It is assumed repentance required feelings of remorse and guilt, often equated with the Hebrew term “Charatah” or regret. Charatah is listed by Rabbenu Yonah as a required element of the Teshuvah process and the first step in this process.

The True Meaning of regret

But what is the true meaning of Charatah? There can be two possible considerations in this area. The first is an element of the relationship between people in general, the natural inclination is that one who wrongs another must suffer some punishment to even the score. Self-flagellation can take the place of this punishment. This approach could certainly lead to unhealthy psychological processes and assumes a logical falsity, that an individual’s guilt will somehow lessen the impact of a wrong.

This also is not consistent with Maimonides characterization of the repentance process. He defines atonement or “Kapparah” as separate from the repentance process and explains various things that may provide atonement, including suffering. He does not include feelings of guilt or self-flagellation.

What role does remorse play in repentance?

If the purpose of Charatah is not to provide some kind of tit for tat or punishment, what role does it play in repentance? Of course, in all behavioral change, there is a basic requirement that is self-evident that there is required some recognition that previous behavior was undesirable or the process would not begin. I would posit that it is this experience alone which drives the need for feeling Charatah or the desire for change. Regret in whatever magnitude is only required insofar as it leads to stronger commitment to change in the future, but has no value independently.

Maimonide’s position

This distinction becomes apparent in the words of the Rambam on Teshuvah:

1: Who has reached complete Teshuvah? A person who confronts the same situation in which he sinned when he has the potential to commit [the sin again], and, nevertheless, abstains and does not commit it because of his Teshuvah alone and not because of fear or a lack of strength. For example, a person engaged in illicit sexual relations with a woman. Afterwards, they met in privacy, in the same country, while his love for her and physical power still persisted, and nevertheless, he abstained and did not transgress. This is a complete Baal-Teshuvah. This was implied by King Solomon in his statement [Ecclesiastes 12:1] “Remember your Creator in the days of your youth, [before the bad days come and the years draw near when you will say: `I have no desire for them.'”…

2: What constitutes Teshuvah? That a sinner should abandon his sins and remove them from his thoughts, resolving in his heart, never to commit them again as [Isaiah 55:7] states “May the wicked abandon his ways….” Similarly, he must regret the past as [Jeremiah 31:18] states: “After I returned, I regretted.” [He must reach the level where] He who knows the hidden will testify concerning him that he will never return to this sin again as [Hoshea 14:4] states: “We will no longer say to the work of our hands: `You are our gods.'” He must verbally confess and state these matters which he resolved in his heart.

Maimonide’s explained

At first glance, the Rambam seems simple. First, he explains that full Teshuvah means a person presented with the same situation does not act in a sinful way. Then, he goes on to explain how he defines Teshuva. On closer reflection, however, a major question appears: why would the Rambam first describe what constitutes “full Teshuvah” and then in the next halacha as the question “What is Teshuva?” Would it not make sense to first describe what we are talking about and only then explain what the perfect version means?

I believe the explanation is Rambam is emphasizing that the definition of Teshuvah is not in its mechanics, i.e. that which he describes in the second halacha, but in its outcome, in changing the person to the extent that his future behavior would reflect this. For this reason, he begins the section with the example of perfect Teshuvah and only later describes the elements involved. In light of this, the requirement for Charatah, or regret, is necessary only as a tool to prevent future lapses, but not as an atonement for past forbidden pleasures or lapses.

This explanation also appears consistent with the Rambam’s ordering of the process of Teshuvah. Rabbenu Yonah in his Shaarei Teshuva writes the first step in repentance is Charatah and the second is leaving the sin. This order seems intuitive; when a person feels bad for what he has done, only then can he repent. Rambam, however, lists the leaving of the sin and determining in his heart not to return to it before listing the requirement of Charatah.

 The bottom line is that when it comes to changing behavior, guilt isn’t just unhelpful; it’s harmful.

The pitfalls of guilt

With this understanding of Charatah, we can decidedly say that guilt must remain separate from the Yom Kippur experience. Although a person feeling very guilty over what may appear to be a positive religious experience, we have learned in treatment that creating guilt actually has the opposite effect on behavior.

Historically, addiction treatment programs focused on a “tough love” approach and attempted to change behavior through confrontation and guilt. Over the past 30 years, the field has recognized that such an approach lowers the chances of success. One particularly striking example of this finding was in a study on the “victim impact panels” used by courts as an intervention to decrease drinking under the influence in individuals who were convicted of that offense. The intervention includes presentations on how drunk driving impacted the lives of family members of individuals who were killed by drunk drivers. Needless to say, participants reported feeling increased guilt and remorse about drinking and driving after such an intervention. Surprisingly, however, no difference was found between those who received this intervention and those who did not. In fact, in some groups, having heard this presentation actually increased the chances that the participants would drive drunk! On the level of talk therapy, treatment studies show that therapists who berate or guilt patients into changing behaviors actually increase the chances their clients will drink or use drugs.

The Bottom Line

The bottom line is that when it comes to changing behavior, guilt isn’t just unhelpful; it’s harmful. In the Rambam’s formulation of Teshuva, it would be the opposite of “complete Teshuva”. If this is the case, what is the benefit of the Rambam’s formulation of Charatah? Continuing the parallel with addiction treatment, the benefit is only in considering the negative impact of an action and connecting this impact with the behavior. For example, a person who smokes cannabis daily might consider the missed job interviews or school tests and the things they have missed out on. This is a reflection on a wrong not with guilt but with the ability to learn from missed opportunities.

I believe that this formulation allows us to rethink the time around Yom Kippur in a healthier and more productive way. The goal is not self-flagellation or guilt but rather a survey of past mistakes with a focus on self-improvement.

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1. Do the TV shows accurately depict people with mental illnesses?
2. Do the TV shows help defeat the stigma or instigate it?

Emma Pillsbury, Glee, OCD

One of the most beloved shows by the teens of yesteryear, Glee was not afraid to test limits. The main characters of this show are considered the “losers like me” of the high school social scene, but are also the underdogs. By dealing with pertinent issues through songs, Glee’s voice was heard loud and clear on its main theme of acceptance.

This show would be incomplete without sending a message about mental health. Enter Emma Pillsbury, the school social worker with a severe case of OCD. This is portrayed in her obsession with cleanliness, aversion to germs, and general personality. Her disorder is over-exaggerated and made out to be freakish.

Despite the inaccurate portrayal of OCD, Glee did great work in showing how Pillsbury dealt with her OCD. In the episode “Born This Way”, the students were challenged to embrace their insecurities. This frame of mind sparked Pillsbury to accept her diagnosis of OCD and seek treatment through psychotherapy and medication.

Although the show may have gone to extremes to describe Emma’s OCD, it ultimately sent a strong message. By showing that medication and therapy work and aren’t just for “loony bins”, as the stigma makes many believe it is, Glee does right.

Carrie Mathison, Homeland, Bipolar Disorder

Courtney Reyers, Director of Publishing for The National Alliance on Mental Illness, believes that Homeland accomplishes “one of the best jobs of portraying mental illness in modern television today with compassion, clarity and responsibility.” Many similarly report that the show’s protagonist, CIA operative Carrie Mathison, has her bipolar disorder portrayed accurately. Psychology Today chimes in, “What makes Homeland work so well in terms of its psychiatric realism, is that Carrie’s illness is an aspect of her character and a realistic part of the story, rather than her illness being the story and inaccurately portrayed. People who suffer from mental illnesses, such as bipolar disorder, can and do lead lives that are normal and productive, rather than sensationalized and distorted.”

This show picks the stigma up by the ears and shakes it to its core. We live in a world where people are afraid to hire those with mental disorders. Case in point, in the first episode Mathison is seen hiding her mental illness from the CIA. However, the character defies the mental illness stigma by kicking butt in her prestigious job.

Rebecca Bunch, Crazy Ex Girlfriend, Depression

Main character Rebecca Bunch was working hard at her New York job and making dough, but it made her blue. This “dramedy”, which features characters randomly breaking out in peppy songs, describing their feelings of love, angst, and the blues, depicts Bunch as an annoying, impulsive, moody, and way too perky character. She just can’t seem to get her life together. Bunch is that girl that you love to hate and hate to love. So what kind of message does the show send about people who are “crazy”?

Through all of the over-dramatized situations, songs and feelings, an impactful lesson emerges. Depression isn’t easy and neither is the process of overcoming it. Bunch is constantly in denial that she needs to get help, hates her therapist, and takes medication only when she decides she needs to. Even though some scenes are over-dramatic and inaccurately portray symptoms of someone with a mental illness, they emphasize how strongly these feelings can overcome someone. How those battling mental illness try to pretend everything is rainbows and daisies when it obviously isn’t. How they lie to themselves, make poor decisions, and can’t see things clearly. Bunch’s depression is what makes her real.

I initially viewed Crazy Ex-Girlfriend as a weird show, doing a childish job of portraying mental illness. It upset me that the main character seemed like a living, breathing definition of the stigma. However, after doing more research on the intent of the creators and learning how the show is meant to be a satire of the stigma, I gained a deep appreciation of this hidden masterpiece. Rebecca Bunch is tagged as the “Crazy Ex Girlfriend” and acts just like that label. This show actually lashes out at the stigma for creating the concept of “just a girl in love” who “can’t be held responsible for her actions” through the dramatization of Bunch.

Shining Lights in an Industry of Stigma

The stigma isn’t a person, place, or thing. It’s not a physical entity and it’s non-tangible. But it has seeped its way into all of our minds. Unfortunately, many TV shows and other media outlets tend to succumb to the rules of this monster. Fortunately, there are exceptions like Glee, Homeland, and Crazy Ex-Girlfriend. With shows like these that are brave enough to run straight into the belly of the beast, change is coming faster than ever. These productions show that it is possible to depict characters with mental illnesses accurately without the rules of the stigma latching on to it. I’m excited to see more Emma Pillsburries, Carrie Mathisons, and Rebecca Bunches. Are you?

Do you agree with the author’s portrayal of the three tv show characters? Do the shows in question weaken or strengthen the stigma? Please share your comments, thoughts, and questions for the author below.

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With Pesach quickly approaching, everyone is getting ready in their own way. Some cook the food, some make creative representations of the plagues and some prepare Divrei Torah. Pesach can be a time that coincides with many challenges and developing “Me Time” may be necessary. Pesach can also be particularly challenging for those with Obsessive Compulsive Disorder (OCD). Sometimes, practices that appear pious, may in fact, be a result of obsessive thoughts or compulsive behaviors. It is important to be aware of our challenges and to be mindful of what others may be going through.

What is OCD?

The Diagnostic and Statistical Manual (DSM-5) includes OCD in the section of Obsessive-Compulsive and Related Disorders along with hoarding, hair-pulling, and similar disorders. In OCD, one has a repetitive thought that becomes continuously intrusive until an act is carried out to suppress that thought. For example, one may be obsessed with the idea that they are contaminated and this thought will not resolve until they meticulously wash their hands. These obsessions and compulsions occur repetitively throughout the day.

What Does Pesach Have To Do With This?

Well, Pesach (along with most other Jewish events) comes with many religious requirements. It can be a particularly challenging time for people with OCD and sometimes the religious practices can become scrupulosity, a form of religious OCD. Some examples that come to mind are: 

• Eating: How much Mazta should you eat? What about Marror? Did she eat the amount of a Kezayit (olive)? Did I drink a Reviyit (half the cup)?
• Timing: Did you eat the Marror within the required time-frame? Did he eat the Afikomin before midnight?
• Cleaning: Did you clean the house well? Is it perfectly clean? Is Chametz in the corner behind the couch? Maybe you should check.

When is it Dayeinu (Enough)?

One key thing about OCD is that the obsessions and compulsions must significantly impact your daily life. What’s considered significant? According to the DSM-5, the compulsive, repetitive or ritualistic behavior must take up at least one hour of your day. Cultural context must be taken into consideration. If you spend more than an hour a day cleaning before Pesach, that is likely not an indication of OCD. However, if you are spending excessively more time cleaning than the norm for your community or are making multiple attempts at fulfilling the obligations of the seder, you likely have a problem. You should speak with your Rabbi and a mental health professional to preemptively get help before your symptoms worsen.

Wishing you all a Pesach of religious fulfillment, spiritual rejuvenation, and well-being. Let us be mindful of the challenges we and others may face and continue to bring awareness to our communities.

Some references and further reading:

• A Scrupulosity fact sheet
• Sefer Eiztot V’hadrachot (Advice and guidance based on letters with the “Kehillat Yaacov”) by J.M. Grinwald, 1991.
• Understanding Religious OCD

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1. Elyn Saks

In a Ted Talk, Saks shares her inspiring story.

“As a young woman, I was in a psychiatric hospital on three different occasions for lengthy periods. My doctors diagnosed me with chronic schizophrenia, and gave me a prognosis of “grave.” That is, at best, I was expected to live in a board and care, and work at menial jobs. Fortunately, I did not actually enact that grave prognosis. Instead, I’m a chaired Professor of Law, Psychology and Psychiatry at the USC Gould School of Law, I have many close friends and I have a beloved husband, Will, who’s here with us today.”

Subsequently, Saks researches the disorder that she struggles with. In addition, she showcases not only her success and accomplishments, but also how to destigmatize mental illness. 

2. John Green

Despite his battles with OCD and Anxiety, Green is a best-selling author who uses social media as an outlet for fighting the stigma.

“In the end, I feel that romanticizing mental illness is dangerous and destructive just as stigmatizing it is. So I want to say that, yes, I am mentally ill. I’m not embarrassed about it. And I have written my best work not when flirting with the brink, but when treating my chronic health problem with consistency and care. Thanks.”  

Furthermore, on Twitter he also destigmatizes medication:

“Like millions of others, I take medication to help treat my mental illness. Treating chronic medical conditions must not be stigmatized.” 

Lovato is both a wildly successful singer as well as a big mental health activist. In addition to speaking out, she also started Be Vocal, a mental health activism organization. There she shares personal stories and accomplishments regarding her bipolar disorder through that medium.

 “Living well with bipolar disorder is possible, but it takes patience, it takes work and it is an ongoing process. The reality is that you’re not a car that goes into a shop and gets fixed right away. Everyone’s process and treatment plan may be different. “ 

4. Howie Mandel 

Mandel is a professional comedian and game show host who struggles with OCD and ADHD. Although he won’t shake hands with contestants and co-workers, he still manages to climb to the top of the success ladder in his field.

“After I impulsively revealed that I have OCD on a talk show, I was devastated. I often do things without thinking. That’s my ADHD talking. Out in public, after I did the show, people came to me and said, “Me, too.” They were the most comforting words I’ve ever heard. Whatever you’re dealing with in life, know that you’re not alone.”

5. Brooke Shields

Shields, an actress and model, wrote about her experiences with postpartum depression publicly. 

“I was not really aware that I had it [postpartum depression]. It was devastating to my whole family. I had gone through numerous attempts to have a baby and when I did finally have this perfect, beautiful, healthy baby and it all but destroyed me. I couldn’t hold the baby, I couldn’t do anything for the baby, I couldn’t look at the baby. Every time I got near her, even the smell of the diapers of the baby. I would… My knees would get weak. I would… I just cried all day long and I thought I’d made the worst mistake of my life.”

Later on she details how early intervention and treatment helped her and allowed her to continue her life and career successfully. 

6. Michael Phelps

Phelps, a swimmer and an Olympic Gold Medalist, battled ADHD and (later in life) substance abuse. In interviews, he spoke publicly about both. Eventually, with the help of mindfulness and medication and SWIMMING, he became one of the most successful athletes in the world. 

“Your mind is the strongest medicine you can have…You can overcome anything if you think you can and you want to.”
“Obviously there were a lot of things that I needed to fix. It’s pretty crazy how big of a change I see from not having a drink… I see a complete change in how I am day to day. Completely clear-headed. I’m actually happy every day. I’m actually able to be productive every day. I think that’s something that I am very proud of and, you know, I think when I do retire I’ll be able to look back and say that was somethingthat really helped.”

7. Carrie Fisher

Even though Fisher passed away in the process of me writing this article, I included her. Throughout her life she served as both an accomplished actress as well as a big mental health advocate.

On numerous occasions, she spoke openly about living successfully with manic depression and bipolar disorder. “There is treatment and a variety of medications that can alleviate your symptoms if you are manic depressive or depressive. You can lead a normal life, whatever that is… have gotten to the point where I can live a normal life, where my daughter can rely on me for predictable behavior, and that’s very important to me.”

“I am mentally ill [and] can say that. I am not ashamed of that… I’m still surviving it, but bring it on. Better me than you.” 

8. Macklemore

Macklemore is a famous rapper/singer, who raps and speaks about his past problems with addiction. He started Half Of Us to bring awareness and fight the stigma.

“I wanted to get clean. I knew that my highest potential, the place that I was most spiritual, the place that I was the most rich in terms of my life, and my livelihood, and my art and my creativity, was when I was sober.”

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Over the years, this suffocating mask has taken on many forms. As a young kid in elementary school, this mask was one of my being a bully – a kid who was tough, strong, and unstoppable. As I matured throughout elementary school, my mask became less extreme and molded into forms that reflected truer, deeper aspects of myself, but nonetheless, it was still unmistakably a mask. In high school, this mask got me on student council, recognized as the one who was friends with almost everyone. My current mask, the one I wear in college, is the most reflective one of my true self thus far. It appears in many Jewish organizations, volunteers in various hospital/medical settings, and reads too many books to better relationships.

This mask always smiles, laughs, cracks jokes, and will do nearly anything to cover up my inner discomfort and vulnerability.

So What’s Under The Mask?

Major depressive disorder, obsessive-compulsive disorder, generalized anxiety disorder, social anxiety, intense loneliness, and frequent suicidal ideation. BUT, there’s also innocence, a deep craving to give love and be loved, a yearning for connection and a need to be understood.

I could describe the broken home I come from, the family protective services interventions, the irrecoverable traumas endured and bla bla…

But everyone has their own personal saga, their stories to tell, their suffering to share. The truth is you don’t need to have a story like mine to feel lonely. I’m just an average girl from the tri-state, in college, with brown hair, just like nearly every other Jewish girl.

The Medication Under The Mask

I began medication before senior year of high school and probably have tried every single pill on the market and maxed out (surpassed the highest possible dosage of a medication) many times. After a year and a half of failed experimentation, I finally found a combination and dose that works. Despite popular belief, medication is not pixie dust; you don’t just give a little sprinkle tinkle and voila. It’s much more complicated, and not all that magical. Medication does not make you happy, but it helps you take that first step by scraping off the edge. You decide to be happy.

Even while on medication, I can still fall into severe bouts of depression and even regress to certain behavioral and thought patterns of the past. However, just as a heart monitor goes up and down, this simply shows I’m alive.

Living with My Mask, Medication, and Mental Illnesses

My communication skills, or lack thereof, stink. It’s painfully difficult to communicate my desires, feelings, and vulnerabilities, almost as if my tongue were made of led. This happens a lot, where I become incapable of participating in conversation and interacting with someone that I want to connect to. My hands get all twisty, my eyes get all puffy, and my neck gets all jerky. Times like these are really frustrating and make me wish it would be socially acceptable to wear signs on our foreheads that read “In dire need of TLC (tender loving care)” or “Struggling to be open, but please don’t give up on me.”

My hope is that when you see someone struggling to open up or communicate, tell them, “It’s okay. Communication can be overwhelming. I know that this isn’t you, so when you’re ready, I really want to hear what you have to say.”

Why I Continue to Wear My Mask

I’ve chosen to remain anonymous because, unfortunately, the stigma that people with mental illness are “lower class” people who are needy and are burdens is all too common. But while I am hiding behind the screen, still wearing my mask, I need you to trust me as I say:

“To all of you who are suffering and feel worthless, I promise you that you are valued. While mental illness can create a painfully lonely existence, I promise there are people who love you, even if you don’t feel it or receive it in ways that you should or need.”

My Inner Struggle

Last year was a painfully lonely year, because not only did I already feel like I had no relationships, but anyone who I had even the tiniest bit of connection to was halfway across the world studying in Israel. I can’t even begin to count the number of times that I have stood on the subway platform and thought, “As the next train is approaching, I’m just going to jump.” As I hear the anticipated oncoming train, a voice in my head screams, “Don’t do it. One day, you’ll be glad you didn’t.” It’s usually the next time I receive love from someone, even just a simple hug, that I hear the same voice saying, “See?”

Why I Choose Life

Someone told me that once you’ve hit rock bottom, you can only go up, and suicide doesn’t fix anything; it only removes the possibility of things getting better. It’s true. I have my bouts of loneliness, but I know that one day, I will make an awesome wife, mother, and inspiring example for people to follow.

Just like ending your life is a choice, building it up to create something great is a choice too. The choice is yours. I choose the latter, and I hope you will too. Please take the time to give someone a hug and tell that person how much they mean to you. It is enough to save a life.

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