One of the great privileges of my budding career in the rabbinate has been the opportunity to study with the Center for the Jewish Future (Yeshiva University), and to complete their Continuing Rabbinic Education (CRE) programs in areas including sexuality and relationships, mental health, and end of life care. One of the issues that came about in the course of my studies, an issue of critical importance to halachically-observant Jews, is that of Obsessive Compulsive Disorder (OCD).
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V), published by the American Psychiatric Association (APA), describes a diagnosis of OCD as follows:
- Presence of obsessions, compulsions, or both:
Obsessions are defined by (1) and (2):
- Recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
- The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).
Compulsions are defined by (1) and (2):
- Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
- The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
Note: Young children may not be able to articulate the aims of these behaviors or mental acts.
- The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
- The disturbance is not better explained by the symptoms of another mental disorder
The challenge for the Orthodox rabbi or mental health professional in treating or counseling those with OCD is manifold. The halachic system is intensely focused on details and minutiae. There are countless details that must be adhered to when fulfilling mitzvos properly.
The Sforno alludes to this in his comments on the pasuk, Devarim 16:1, “Shamor, et-chodesh ha’aviv, ve’asita pesach, laShem Elokeicha. Ki b’chodesh ha’aviv, hotzi’acha Hashem Elokeicha miMitzrayim—laylah.” This pasuk instructs us to make sure that Pesach will always take place in the springtime, and the Sforno writes, “Shemor behatmadat hashgachah sheyehi nisan chadash ha’aviv al y’dei avuri hachadashim vehashanim sheyechavenu bahem shenei hallevanah im shenei hachamah;” make sure that the month of Nissan always occurs in the spring, by manipulating the calendar, if necessary and inserting an extra month of Adar. By doing this the solar orbit (year) and the lunar orbits, (12 moons equaling a year) can be brought into line with each other.
Why does the Jewish calendar not simply follow a solar year? If, in any case, we must make sure that Pesach falls in the spring, what is the purpose of consistently following lunar years, if eventually one has to align these with the solar years? His answer is most telling: so as to complicate life. In order to make sure that the month of Nissan and the festival of Pesach will always fall in the spring, one has to make difficult astronomical calculations. The Torah deliberately complicated the Jewish year by modeling it on a lunar year, so that Nissan would not automatically fall in the spring, so that the Sages would have to make complicated calculations. These difficulties make us more aware of HaKadosh Baruch Hu and of our role in sanctifying life through the arduous, detailed work of observance. However, this concern for details and a desire to be machmir, to do things in the most l’chatchila way possible which is yotzei as many shitos as possible, with a sense of hiddur and being lifnim mishuras hadin, can often be easily lost when the individual nosedives into the depths of OCD within the context of observing Halacha and keeping mitzvos.
(Behavior that appears to be overly detail-oriented is not in and of itself symptomatic of OCD. In fact, the DSM V’s definition of OCD stipulates that the person must experience recurrent anxiety-provoking thoughts (obsessions), which then induce the person to behave in a manner to address these fears (compulsions), and the operative point is that these behaviors must be significantly debilitating, such as causing extreme distress or disabling social or occupational function. The DSM also requires that the person suffering from the disorder acknowledges or recognizes at some point that the obsessions or compulsions are excessive or unreasonable.)
The Steipler Gaon, in line with modern mental health advice, argues that the rabbi should not seek to reassure the OCD congregant, but should urge them to seek help after the point where they have already been issued a psak once. “Such thinking is a tactic of the yetzer hara in order to make observance of the mitzvos so burdensome that he will eventually, G-d forbid, shirk the yoke of the Torah. He should realize he will not endure this suffering forever because it will eventually pass over time. The main point is that he should follow the rulings of rabbinic authorities without analyzing their reasons and without second guessing them.” (Eitzos Vehadrachos Meyosad Al Michtavei Maran Baal Hekehillos Yaakov, p. 55.) There is the concept of “Ve’hevei medakdek b’mitzvah kalah kevachamurah” (“Be as scrupulous in observing a minor mitzvah as a major one”); all mitzvos should be performed in the best possible manner, which is the concept of hiddur mitzvah (beautifying a mitzvah). On the other hand, Chazal tell us about the concept of ein l’davar sof (there would be no end to the matter) if reasonable limits were not imposed. In addition, I believe it would be beneficial to tell over to congregants that their behaviors cannot be construed as reflecting ratzon Elokim because of “Lo nitnah Torah l’malachei hashares.”
The approach of the Minchas Asher, HaRav HaGaon Asher Weiss, is also most useful in articulating a pastorally and hashkafically sound approach to the matter of counseling those with OCD. He addresses the teshuva, chelek beis, siman 134, to a talmid chacham who suffers from OCD, who has been instructed by doctors to never repeat words during davening even if he thinks he mispronounced them. He asks whether he should listen to them and, assuming he should listen to them, should he take measures to minimize the problems that may result from possible improper recitation of brachos, such as never eating a k’dei svi’a of bread so that he never has a chiyuv midoraisa to bentch.
The answer of the Minchas Asher is most helpful for a rabbi to follow when counseling those with OCD- first, he is firm that the shoel should listen to the doctors even if it means neglecting mitzvos aseh. This has an origin in Rema’s discussion of spending money on mitzvos aseh (OC 656:1- “Mi she’ein lo etrog, o sha’ar mitzvah overet, eino tzarich levazbez aleiha hon rav, uchmo she’ameru. Hamvazbez al yevazbez yoter mechomesh, afillu mitzvah; vedavka mitzvat aseh, aval lo ta’aseh yiten kol mamono kodem sheya’avor.”) Rema paskens that one only needs to spend 1/5th of his money to keep a mitzvas aseh. If it will cost more, one is instructed to not fulfill the mitzva but rather let it go.
Furthermore, the Avnei Nezer (EH 1:8) paskens that if a man was married and after 10 years couldn’t conceive, he wouldn’t have to divorce his wife, even if it means not fulfilling the mitzvas aseh of priyah v’rivyah, because if a person doesn’t need to give up 1/5th of his money to fulfill any mitzvas aseh, then certainly one does not need to give up his beloved wife who is worth so much more to him than money.
(This is seemingly at odds with the gemara in Yevamos 64a, which states that a man must divorce after 10 years if the wife cannot produce a child, although the Avnei Nezer likely is holding like those shitos which say that one must only divorce in Eretz Yisroel and that the din is inapplicable in chutz la’aretz- Rashi, Yevamos 64b, DH Miketz Asar Shanim, says: “limodecha She’ein yeshivat chutzah le’aretz olah lo dilma mishum avon chotzah le’eretz hem akurim;” implies this, and the Hagahos Maimoniyos (Hilchos Ishus 15:4) rules that a man in Chutz la’Aretz cannot be forced to divorce his wife after ten years of childlessness, because it might be the lack of zechus of Chutz la’Aretz that prevents him from having children (and thus it will not help to marry another wife). He adds, citing the Avi’Asaf, that nowadays even in Eretz Yisrael Beis Din may not force a man to divorce his wife after ten years of childlessness. The Gemara in Bava Basra (60b) relates that the Chachamim considered enacting a prohibition against marriage when the nations began to persecute the Jewish people. They reasoned that it is better for the Jews to cause their own end by not having children than to be destroyed by their enemies. The Chachamim, however, decided against such an enactment on the grounds that it would have been too difficult for the people to observe. Nevertheless, the very proposition of such an enactment shows that nowadays Beis Din is not required to force a person to fulfill the Mitzvah of Piryah v’Rivyah.)
From this, the Minchas Asher also learns that a person undergoing treatment for OCD can certainly violate any positive mitzva because one’s mental health is worth more than 1/5th of his money and doesn’t have to be sacrificed for a mitzvas aseh. Therefore, the mitzvas aseh may be violated to save the victim’s mental health. He even suggests grounds to permit them to violate a lo sa’aseh.
The gemara, Shabbos 69b, discusses the case of one who is lost in the wilderness and doesn’t know what day is Shabbos. Rava says, b’chol yom v’yom oseh lo k’dei parnasato, that each day he should just do enough work to eat. Tosfos (DH Oseh K’dei Parnasato) says, “Aval lehallech yachol kol mah sheyirtzeh rak bayom shemeshamer de’i lav hachi lo yaggia la’olam layishuv;” we are mekil about the techum Shabbos for him. He may walk as far as he wants (Chachamim exempt him from concern for Techumim), except for the day he observes [to be Shabbos]. If not, he would never reach civilization! We are willing to let him do this so that he may come to keep Shabbos properly many times in civilization.
Rav Weiss applied a similar logic to OCD patients. Since their OCD was preventing them from fulfilling mitzvos, we would be willing to temporarily allow them to violate some mitzvos so they could fulfill all of them properly in the future. He’s saying like the Chasam Sofer, “Mutav sheyechallel torah zeman mah kedei sheyishmor mitzvot harbeh;” Rav Weiss himself concludes on this point: “Reshit chovato shel ish zeh la’asot et kol hanidrash al menat limtzo mazor umerapei lemachalato, ulesham kach muttar lo af la’avor al mitzvat hattorah.” This man’s primary obligation is to do everything that is necessary for him to cure his illness, and to this end he is allowed even to violate the Torah’s mitzvos.
He also cautions against trying to minimize such halachic problems, as the constant search to avoid halachic sfikos and dilemmas will merely feed his obsessiveness, when the whole point of the exercise is to help him learn to live with it. The Minchas Asher allows that if the shoel is concerned with occasions that he is being motzei others, he should let another do it instead, such as in asking guests or his wife to make Kiddush, and he shouldn’t be embarrassed to ask for help in this way, since he would not be ashamed to ask for assistance if he were missing a limb; this form of disability is no different. I believe this is a treasure for the rabbi who counsels the frum Jew with OCD in the proper derech regarding shmiras hamitzvos and the very important mitzvah of following professional advice in the course of OCD treatment. Rav Weiss is not offering reassurance, but rather is offering a harmonious psak which is both halachically sound and places the OCD treatment at the center of the individual’s wellbeing. This represents the best possible approach for the Orthodox rabbi counseling those with OCD.