Torah and Depression


Rabbi Daniel Myers


It is with quite a bit of trepidation that I write this essay, and I think a word of caution is appropriate. One of the confessions that we enunciate in Vidui is “Yaatznu Ra”, where we ask Hashem for Mechila, forgiveness, for offering bad advice. Are we referring to the wicked person, who purposely offers others misleading guidance? Not necessarily; it is possible to say that this statement refers to a fine individual who wants nothing more then to help his fellow Jew; however, he offers advice in an area, which is not his expertise. Despite his good intentions, he should have been humble enough to admit that he is simply ill equipped to offer help in such an area. Rabbi Abraham J. Twerski writes: “A Rabbi who has not formally learned the requisite skills of counseling comes to depend upon his personal attributes alone (intuition, empathy, sensitivity, life experience, and native intelligence.) These are certainly important components of good counseling and need to be part of the Rabbi’s repertoire, but they alone are not sufficient. Basic counseling skills must be acquired.” (A Practical Guide to Rabbinic Counseling p.15 of preface) It is with this in mind that I share a few thoughts about so sensitive a topic, one that is not my expertise. I hope that I could offer a few limited insights from a Rabbinic perspective based on ideas culled from our Baalai Mesorah, life experience, and other sources as well.

A most crucial question that must be addressed when dealing with the topic of depression is the following: According to the Torah, is depression a physical phenomena, a psychological malady, a spiritual illness, or something else altogether? Let us take a look at various Rabbinic statements regarding this topic. Rav Akiva Tatz Shlita writes: “There is no negativity in the moment of new creation. While the energy of creativity is flowing, depression and despair are impossible. The spiritual root of depression is lack of growth in the personality. When time ticks away and nothing new is being built, when all is static, the soul feels the cold hand of death. The sadness of the end of life is that activity is no longer possible, no change can be generated, and all is frozen. That is the essential difference between life and its opposite, and a soul has a premonition of that final state when it is inactive in this world. This is a great secret in the understanding of depression, and this is the reason that the cure for depression is activity; at first, any purposeful activity, but leading as soon as possible to activity of the soul, the movement of growth.” According to Rav Tatz, one’s spiritual’s stagnancy is a major cause of depression.

Others approach depression from a different angle: Rav Aryeh Ackerman, director of 12 Steps to Self Esteem, writes: “Your emotions exist in order to motivate you to take an action. Guilt signals one to change, pain signals one to care for oneself, and boredom, depression or anxiety, signals oneself to bring about a change. Many people experiencing emotional or behavioral difficulties, who seek psychiatric treatment for depression, have been depressed for most of their life as result of their negative self-image. Anti-depressant medications will usually not help these people. Instead of the therapist trying to figure out what is wrong with the client, he may try to point w to the client what is right with him. The Torah gives intrinsic meaning to all life regardless of what he can or has achieved. Self-esteem and happiness are interdependent. Hope is to joy what despair is to depression. According to Rav Ackerman, there is a strong connection between one’s self esteem and his vulnerability to depression.

A third approach is apparent according to Rav Twerski. He writes: “It is of interest to note the historical perspective of depression. The common term in Torah literature, and that which the Rambam uses, is Morah Shechorah, which literally means “black bile.” This term derives from the ancient physiological concept that there are four “humors” or liquid substances flowing throughout the human body. There are the white bile, the yellow bile, the red bile and the black bile. According to ancient theory, a person is in good health when all four humors are in proper balance, each existing in the appropriate proportion. If this delicate balance is in any way upset, the result is illness. Depression occurs when there is a disproportionate excess of the black bile, hence the term Marah Shechora for depression. This ancient terminology carried over to modern English, which still retains the term “melancholia” (melan=black, chole=bile) for depression. In the mid-19th century there was a marked shift in thought about the origin of depression and this was accentuated by Sigmund Freud and his disciples.

Freud is most famous for his elaboration of theory of the theory of the unconscious mind, and the effects of unconscious thought on feeling and behavior. There is certainly a great deal of evidence to support the concept that there are ideas which reside in the unconscious portion of the mind, ideas of which a person is unaware, and that these can have a profound effect on one’s thoughts and actions. For example, it is commonly observed that when a person suffers a loss of any kind it is often followed by sadness or depression. Thus, the rather frequent occurrence of depression in the postmenopausal woman was explained as being due to the woman’s incontrovertible evidence that she had lost a characteristic of youth. Inasmuch as normal life is often punctuated by adversities of various sorts, it was not too difficult to assign the occurrence of any depression to some sort of unpleasant circumstance or loss that the person has experienced. While there is little doubt that some depressions may indeed be a reaction to a loss, the generalization that all depressions are due to a loss, perceived unconsciously if not consciously, seems to be stretching things a bit. This uniform theory of depression began to be challenged in the late 1950s.During that decade, the first truly effective medication for treatment of high blood pressure, a derivative of a plant, rauwolfia, was introduced in the United States. While the drug was highly effective in lowering blood pressure, it had a number of unpleasant side effects, one of which was that it could produce severe depression. The depression caused by rauwolfia was in every way similar to the depressive illnesses that psychiatrists had been seeing for ages. It thus became evident that chemical changes within the body can produce depression. The position of the Rambam and the ancients was essentially vindicated: depression can be, and very often is, due to a chemical imbalance within the body, and is not necessarily the result of a loss or other psychological cause. (Getting Up When You’re Down p.16-18) According to Rav Twerski, although depression can be caused by stress and loss, it is often brought on solely by chemical changes in the body.

We see that the Rabbis attribute depression to spiritual, emotional or chemical sources. The fact is, that the human psyche is quite complicated, and there are many factors that may lead to depression. Often, it is difficult to assess the cause of the malady because the sufferer is embarrassed by his affliction, considering emotions as something, which should be under his control, and an emotional issue such as depression is a sign of weakness. (Regarding the complexity of depression, see The Science Times 18/10/05 p.1 “Can Brain Scans Detect Depression? Not Yet.”)

In addition to the previous issues, something else should be taken into account as well. Fatigue, irritability, lack of concentration and loss of interest in enjoyable activities are common symptoms of depression. These symptoms are also symptoms of obstructive sleep apnea, which is a disorder that occurs when the tongue or throat muscles relax too much during sleep and block the airway. In one study, many individuals who showed signs of depression were treated for sleep apnea for four to six weeks. Many of them showed decreases in their depression scores, as well as a marked improvement in measures of daytime sleepiness. (Science Times 20/9/05 p.7) As a matter of fact, many therapists tell their clients who suffer from depression that whenever they begin to feel down, they should take the H.A.L.T. approach, which means that the clients should try to assess if the trigger for their blues is that they are Hungry, Angry, Lonely or Tired. Some compare depression to a flashlight in one’s mind, which only shines on the individual’s (perceived) depressing aspects of life. Therefore, encouraging the client to recognize possible catalysts before the flashlight becomes focused on the gloom may be helpful.

Once we realize the complexities of depression, it is crucial that we react to one suffering from bouts of depression in a truly Jewish manner. Chazal have given us guidelines for all areas of life, and for this as well. First of all, we must embrace the Mishna in Pirkai Azoth (2:5) “Al Tadin Et Chavaircha Ad Shetagia Limkomo,” one can not judge his friend until he has reached his place. Until an individual experiences- physically, spiritually, mentally, and physically – the pain, anger, rage, sadness, etc. that his friend is feeling – he simply cannot understand his friend’s challenges and the way that the latter deals with those challenges. Any assessment based purely on one’s mind without recourse to a similar emotional experience must, by definition, miss the mark; one’s mind simply cannot comprehend another’s emotions. Therefore, when a friend is depressed and does not want to get up, deal with life, go to Shiur, work, etc., one must be careful not to project his feelings onto the sufferer, callously assuming that he should simply “snap out of it” or “get with the program.” (We are not referring to one who is simply being lazy, and may be in need of some well-deserved Musar. A good parent, friend, teacher, Rebbe or relative must wisely differentiate – with professional help, if necessary – between depression, “the blues” and laziness.) One who takes such an approach may unintentionally cause feelings of abandonment and grief to his friend. As Iyov cried out in pain, regarding his friends: “My brothers have betrayed me like a seasonal watercourse, they shift like the flow of streams, tucking themselves under ice, hidden under concealing snow.” (Iyov 6:15,16)

The Halacha dictates how to act when one’s friend is in pain: The Baalai Mesorah actually delineated a few different states of one who is suffering: Regarding an Onain, the Mishna in Pirkai Avoth (4:18) states: “Do not console your fellow while he is an Onain, when his deceased relative is lying before him.” The Tiferet Yisrael (ibid.) writes that the Onain will be in Zaar, pain, if he sees that his friend is consoling him instead of grieving with him. (The Tosfoth Yom Tov (ibid.) adds that this restriction applies even to one consoling an Avail, not just an Onain, if the former is in a state of Anacha, intense crying.) Once a person is an Avail, there is no longer a restriction to console the individual; on the contrary, there is a Mitzvah of Nichum Availim. Nevertheless, the Halacha dictates that the Minachaim must follow the lead of the Avail. If the Avail does not want to talk, then the consolers should remain silent, if the Avail indicates that he wants to be alone, then the consolers must leave. (Shulchan Aruch Yoreh Daiah 376:1) The Halacha also states that the Minachaim should be together with the Avail in his Availut; therefore, he should sit on the floor with the Avail, and is not allowed to sit anywhere else. (Shulchan Aruch Yoreh Daiah 387:1. See Taz 387:1 regarding the Minhag today not to sit on the floor with the Avail.) Obviously, we are not dealing with Availut here; nevertheless, we are dealing with a fellow Jew who is suffering, and there is much to be derived from Hilchot Availut.

What do we learn from these Halachot” That when a friend is suffering, sometimes we must suffer silently with him, and at other times we must suffer vocally and actively with him. The comfort may come in various forms, depending on the state of the afflicted. A good friend will try his best to understand his friend’s mood and assess what form, if any, the consoling should take. Usually, affection (emotional and physical, when acceptable) is very helpful, telling the sufferer how much he is loved and needed, confirming his uniqueness and indispensability, which is so crucial at a time when he may feel otherwise. At times, our friend may simply want to feel “Emo Anochee V’Zarah,” (Tehillim 91) that we are with him in his distress, and would prefer silence over the spoken word. Or, he may find consolation in Pesukim of Tehillim, such as: “Favor me, Hashem, for I am feeble, heal me, Hashem, for my bones shudder with terror” (6:3), and “Why, Hashem, do You stand aloof, do You conceal Yourself in times of distress?” (10:1) where he can identify with David Hamelech, who also experienced much pain, calling out to Hashem, pleading respectfully but passionately, for help. Sometimes guarded optimism is appropriate, such as “you got through this last time, I am confident that this will pass too,” at other times, a more upbeat approach may be suitable, redirecting his mental flashlight from the gloom to the good, trying to help him focus on all the gifts that he has been blessed with. The bottom line is that a true friend will be genuine, understanding, sympathetic and empathetic; then, and only then, will he decide the appropriate next response.

May Hashem grant us all the strength to deal with life’s challenges, overcome them, and, ultimately, become better human beings from them.