Sharon Galper Grossman and Shamai A. Grossman
Meet four casualties of a parallel pandemic, the emotional fallout of COVID-19. Shmuel is an athlete and Torah schoolteacher who recently recovered from COVID-19, but now he is plagued by nightmares and flashbacks. He is anxious, cannot concentrate, and is unable to teach. Hava is a mother of four who has been exercising social distancing, isolating herself from her family at home. Initially, she wiped down all surfaces in the house once per day and washed her hands each time she touched something from the outside. As time progressed, she began to wash and clean more frequently so that she now spends most of her day disinfecting. She is scheduled to go to the mikvah tomorrow night but is gripped by fear of leaving the house, visiting a place that she has not cleaned, undressing, touching surfaces there, and immersing in the water.
Chaim is quarantined in his bedroom after exposure to his grandson, who contracted COVID-19. His wife checks on him frequently through their home’s internal security cameras. She often sees him crying. One morning, she notices that he is curled up in a ball in bed, having missed zeman tefillah. Despite her best efforts, she cannot cajole him to dress, shower, or daven. And Sarah is a veteran nurse who works in an overwhelmed emergency department where she witnessed many patients succumb to the virus due to shortages of medication, staff, and ventilators. She had looked forward to a five-day break from the stress of caring for patients without the necessary means to help them. When she fails to return for her shift, a colleague calls the police, who find her unconscious in her apartment after an apparent overdose. After a lengthy resuscitation in the hospital, she awakens and reports to the psychiatrist that she had become increasingly depressed over Shabbat because she was alone and lonely.
The challenges that these four individuals face illustrate the profound impact COVID-19 has on mental health, fostering stress, anxiety, and mental illness, and compromising one’s ability to perform mitzvot and engage in religious life.
They are not alone in this parallel pandemic. Kaiser Permanente has reported that nearly half of Americans believe that COVID-19 has harmed their mental health.[1] In the month of April 2020, more than one in four American adults suffered serious mental distress and illness, a 700% increase from April 2018.[2] The United Kingdom has reported a similar increase in depression since the onset of the virus.[3] In the third week of May, after the Israeli government exited lockdown and the country returned to routine, one-third of Israelis reported feeling stressed or anxious, and one-fifth felt depressed or isolated. Over one million Israelis believe that their mental health has declined since the outbreak of the virus.[4]
Several factors account for this dramatic decline in mental health, including fear of infection, uncertainty over a second wave or whether the first wave has ended, absence of an effective vaccine or treatment, financial difficulties, less communication with supportive friends and family, and grief from the loss of loved ones.
In addition, infection with the virus may precipitate mental illness. Delirium is common in the acute stage of SARS, MERS, and COVID-19.[5] In previous coronavirus epidemics, after the acute stage of illness passes, the risk of depression, anxiety, fatigue, and post-traumatic stress disorder rises. There is currently little data on the long-term psychological impact of COVID-19. However, given the large number of individuals who have already been or might become infected in the future, it could have a profound impact on mental health.[6]
Health care workers like Sarah, who serve on the front lines of the epidemic, face an exceptionally high risk of psychological distress, as they struggle with overwhelming work schedules, increased patient volume, shortages of protective equipment, absence of an effective treatment, and fear of infecting themselves and those around them. Over 70% of healthcare workers from Wuhan, the source of this epidemic, demonstrate psychological distress and more than half suffer depression.[7] The COVID-19 epidemic has the potential to cause long-term harm to the mental health of our health-care providers. In Italy, 50% of healthcare workers on the front-lines of this epidemic suffer PTSD.[8] A recent editorial in the New England Journal of Medicine declared, “We are now facing a surge of physical and emotional harm that amounts to a parallel pandemic,” and called for a national strategy to protect clinicians’ well-being.[9]
This article offers an overview of how Halakhah approaches mental illness and psychological well-being in light of the devastating psychological effects of COVID-19 and the potential for long-term psychological impairment from infection.[10]
Early Identification of Mental Illness in Judaic Sources
Biblical and Talmudic sources employ several terms to describe mental illness. I Samuel 16:14 offers the first biblical reference to depression, describing Saul’s bouts of ruah ra’ah, mental illness, after he loses the crown to King David. King David visits Saul and plays music for him, which cures him of the problem. Abarbanel describes ruah ra’ah as melancholia, an illness in which sorrow, severe anxiety over one’s fate, and depression (characterized by racing thoughts and dramatic fluctuations between deep sadness and elation) replace imagination and the ability to concentrate. Taanit 22b explains that an individual may fast on Shabbat if he is pursued by a ruah ra’ah. Why does ruah ra’ah justify fasting? Rashi (s.v. mipnei ruah ra’ah) explains that a person might drown or die, because an evil spirit enters his body and causes him to run with abandon endangering his life. Meiri s.v. (zehu beiur ha-Mishnah u-pesak shelah) defines the condition as hallucinations from which one flees madly. Bava Metzia 84a recounts Rabbi Yohanan’s pain over the death of his havrutah Reish Lakish. He wandered from place to place rending his clothing, weeping and crying, declaring “Where are you, son of Lakish?” He screamed until his mind was taken from him, an apparent reference to insanity. Rambam Peirush ha-Mishnah to Shabbat 2:5 defines ruah ra’ah as “melancholiat” where the individual prefers to be isolated in a dark room. In Shemonah Perakim Chapter 5, he calls mental illness marah shehorah, black bile treated with music and walks in the garden or around beautiful buildings. Rashi and Meiri describe psychosis while Bava Metzia and Rambam focus on different levels of depression. It appears that these early sources understood that there was a spectrum of mental illness characterized by a wide variety of symptoms.
How Does Halakhah Approach Mental Illness?
Characteristics of mild depression include irritability, negative thoughts, feeling unusually tired, hopeless or overwhelmingly sad, being frequently on the verge of tears, self-loathing, difficulty focusing, lack of motivation, a desire to be left alone (reminiscent of Rambam’s definition of ruah ra’ah in Peirush ha-Mishnah), unexplained minor aches and pains, or loss of empathy. Severe depression can include stronger forms of these symptoms and can be debilitating, precluding performance of one’s usual activities. In addition, severe depression can involve delusions, hallucinations, and thoughts about self-harm or suicide.
Jewish law classifies illness into two primary categories – holeh she-yeish bo sakanah, one who has an illness that involves danger to life, for whom one may violate nearly all prohibitions; and holeh she-ein bo sakanah, an illness that is not life- or limb-threatening, for example an “ordinary” bedridden patient for whom a Jew may not violate a biblical prohibition. He may violate a rabbinic prohibition with a shinui, a change. However, one may ask a non-Jew to violate a biblical or rabbinic prohibition on his behalf.
Several sources suggest that Halakhah defines someone who suffers from severe depression as a holeh she-yeish bo sakanah and that caring for that person creates a situation of pikuah nefesh. Shabbat 29b teaches that one is permitted to extinguish a flame on Shabbat for someone who is afraid of ruah ra’ah, which Rashi defines as an evil spirit, a psychosis. Shulhan Arukh (Orah Hayyim 571:3) suggests that one who suffers ruah ra’ah is exempt from rabbinically decreed fasts. Hatam Sofer (Orah Hayyim 83 s.v. nahazor le-inyanenu) permits institutionalizing a child in a facility that will feed him non-kosher food. He reasons that if the child does not enter the institution, he will remain a shoteh and thus will be exempt from all mitzvot. In other words, we violate one prohibition now to ensure fulfillment of many more mitzvot in the future. However perhaps, we cannot extrapolate from a shoteh to one who suffers severe depression, as a shoteh is already exempt from performing mitzvot, while one who suffers from severe depression is not.
More recently, Rav Moshe Feinstein sees helping someone with severe mental illness as doing pikuah nefesh, which overrides nearly all prohibitions. In Iggerot Moshe (Yoreh Deah II:59), he rules like Hatam Sofer that a young adult who suffers from mental illness may be placed in an institution that serves non-kosher food because should he not be institutionalized, he might harm himself or others. In Iggerot Moshe (Even ha-Ezer I:65), he permits use of a contraceptive diaphragm for a woman who suffered two serious bouts of postpartum depression. He writes that her mental illness poses a danger not just to her but also to her young children, since it is not possible to watch over her to ensure that she does not cause any harm.
Finally, in Iggerot Moshe I:67, an engaged middle-aged man who has not fulfilled the mitzvah of peru u-revu asks if he may marry his fiancé, as her kidney disease precludes pregnancy in the short-term. Rabbi Feinstein cites several reasons for forbidding the marriage but concludes that if annulling the engagement will cause psychological distress and pose a safek sakanah, uncertain danger, to either party, but specifically the woman, whose medical condition might worsen, they may marry and use contraception. This teshuvah suggests that Halakhah seeks to preserve the psychological well-being of the otherwise healthy as well as those who already suffer mental or physical illness. Indeed, one may violate a prohibition to improve the frame of mind of a holeh who suffers a physical ailment if deterioration of his psychological state will compromise his medical condition.
Nishmat Avraham in his introduction to Shulhan Arukh Orah Hayyim 328, which discusses desecration of Shabbat for pikuah nefesh, similarly writes that we treat someone with mental illness no differently from someone with physical illness, violating Shabbat according to the severity of his illness, risk of endangerment to himself and others, and recommendation of his physicians. Thus, Halakhah classifies serious mental illness as pikuah nefesh either because the individual might come to harm himself or others, or because he might become incapacitated and incapable of performing mitzvot in the future. If nurse Sarah had shown signs of psychosis or severe depression, Halakhah would potentially treat her like a holeh she-yeish bo sakanah, permitting the desecration of Shabbat to help her.
How Does Halakhah Approach Milder Forms of Mental Illness?
Exploring this question from several angles suggests that Halakhah approaches milder forms of mental illness as a holeh she-ein bo sakanah.
Mild depression seems to satisfy several relevant criteria. Shemirat Shabbat ke-Hilkhatah 33:1 defines holeh she-ein bo sakanah as someone who needs to lie down rather than move around freely, has fever or pain that weakens the body such as a migraine headache, or one who might become ill if he does not receive medical treatment. Shulhan Arukh Orah Hayyim 328:17 classifies as holeh she-ein bo sakanah as one needing to be confined to bed, which is often the case with mild depression. Tzitz Eliezer 12:18:8 permits someone who has recovered from non-life threatening mental illness to recite birkhat ha-gomel, because he classifies mental illness as a form of illness. Rav Asher Weiss has explicitly classified mild depression as holeh she-ein bo sakanah for which one may be permitted to take medicine on Shabbat or ask a non-Jew to violate a prohibition.[11]
The possibility that failure to treat mild depression could exacerbate an individual’s current condition might also justify its classification as holeh she-ein bo sakanah. In Assia 42-3 (11, 2-3), Nissan 5747, 32-36, Rav Yitzhak Zilberstein recounts the story of a holeh whose doctor permitted him to fast on Yom Kippur because he was no longer in any danger. Rav Velvel Soloveitchick (the Griz) ruled that the patient must eat, telling the doctor that pikuah nefesh is not just limited to present danger but also includes the possibility that fasting might harm him in the future, should he fall ill again. This story highlights the importance of addressing mental health proactively. Monitoring and implementing early interventions to protect the mental health of health care workers on the front line of COVID-19 pandemic, those who have faced quarantine and long-stretches of isolation, and those recovering from infection, could have helped prevent nurse Sarah’s severe depression, Grampa Chaim’s mild depression, and Reb Shmuel’s post-traumatic stress disorder. Thus Chaim, who cannot get out of bed to daven and whose medical condition might deteriorate if left untreated, would be considered holeh she-ein bo sakanah, and his wife could ask a non-Jew to violate rabbinic prohibitions, such as turning on the air conditioning on Shabbat, on his behalf.
The Rabbis prohibit practicing medicine on behalf of the healthy on Shabbat to prevent shehikat samanim, crushing of medicine, which would constitute a violation of the melakhah of tohen, grinding. The prohibition does not apply to a holeh. Even if one does not classify mild depression as holeh she-ein bo sakanah, someone with mild depression who takes antidepressants may do so on Shabbat. Tzitz Eliezer 8:15:15 permits sleeping pills on Shabbat, explaining that we should treat them no differently than other medicines; just as medicines to treat physical ailments calm specific parts of the body, sleeping medicine calms the nerves. He cites poskim who permitted pain medicine on Shabbat. In Tzitz Eliezer 14: 50, Rav Waldenberg permits anxiolytics on Shabbat because they calm nerves and relieve tension. He explains that the prohibition against taking medicine on Shabbat applies to medicines that treat the underlying disease, whereas sleeping pills and anxiolytics only relieve symptoms and so do not fall under the prohibition of shehikat simanim. Logic dictates that we can approach antidepressants, which do not treat depression but only its symptoms, similarly.
Obsessive-Compulsive Disorder (OCD)
Obsessive-compulsive disorder (OCD) is an anxiety disorder associated with recurring, unwanted thoughts, ideas, or sensations (obsessions) that drive one to do something repetitively (compulsions). The repetitive behaviors, such as hand washing, checking on things, or cleaning, can significantly interfere with a person’s daily activities and social interactions. In a teshuvah regarding OCD, Rav Asher Weiss rules that someone with this condition whose physicians specifically recommend that he refrain from repeating words, should not repeat words of tefillah even when he knows that he has not said the words correctly.[12] He writes that one may give up on a positive commandment to prevent becoming bedridden or sick or to recover from an illness. He points out that someone who is lost in the desert and does not know which day is Shabbat may only perform the melakhot that will enable him to survive. Yet he may walk beyond the tehum, even though any given day could be Shabbat, since he must do all that he can to leave the desert and return to civilization to perform mitzvot. From this example and that of Hatam Sofer (Orah Hayyim 83 s.v. nahazor le-inyanenu), he concludes that the individual with OCD may lapse in the recitation of berakhot and keriyat shema in the hope of ultimately performing these mitzvot scrupulously. This is the position of Rav Yitzhak Zilberstein in Kerayna de-Iggerita (373) in response to a similar question regarding the management of OCD. Rav Asher Weiss adds that an individual with OCD should not refrain from eating bread to avoid reciting birkhat ha-mazon, reasoning that if he did so, there would be no end to the efforts he may make to avoid mispronouncing prayers.
Mikvah preparation can be particularly challenging for a woman who suffers from OCD. She might spend hours preparing for immersion tormented by doubt as to whether she did so properly, avoid relations because she is convinced that minor inattention to a detail invalidated her immersion, or pose the same question to a halakhic authority each month. In his Laws of Niddah (9:25), Ramban addresses anxiety associated with mikvah preparation and advises against excessive stringency in the laws of hazizah, barriers to immersion: “If one searches for uncertainties to disqualify immersion over some trivial matter, there is no end… One should not give thought to grave uncertainties that are endless such as whether one closed her eyes too tightly, clenched her lips too tightly, and other questions, because who can distinguish between too tightly and not too tightly?” In general, but especially for someone who suffers from OCD, one must distinguish between halakhic requirements and anxiety-provoking stringencies to ensure that observance of mitzvot does not cause angst.[13] Such an approach would greatly reduce Hava’s anxiety regarding mikvah during COVID-19.
Post-Traumatic Stress Disorder (PTSD)
Witnessing or experiencing a terrifying event can lead to post-traumatic stress disorder (PTSD), which can involve flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the event, such as those that Reb Shmuel displayed. Acute illness, especially severe, life-threatening illness with admission to an intensive care unit and mechanical ventilation, are known triggers.[14] Cognitive behavioral therapy and cognitive processing therapy are effective treatments. However, music therapy, which relieves depression, can also reduce symptoms and improve functioning.[15] Although Halakhah generally prohibits music during times of mourning, some poskim permit its use to relieve psychological distress and depression. Thus, in his discussion regarding the prohibition against listening to music as a sign of sadness following destruction of the Temple, Shevet Ha-Levi 6:69 states that it is a mitzvah to listen to music to calm one’s nerves. Similarly, in Shevet Ha-Levi 8:127, Rav Wosner permits listening to music to relieve nerves during the three weeks. Music cured King Shaul of his ruah ra’ah and might have helped comfort our four casualties of the parallel pandemic, as we will discuss below.
Preventing Depression and Promoting Psychological Well-Being in Healthy Populations
Halakhah values the mental health of the healthy and promotes interventions that maintain psychological well-being even in those who do not have mental illness or psychiatric symptoms. A number of poskim permit the violation of prohibitions to prevent depression in individuals without a history of mental illness. Iggerot Moshe I:67 emphasizes the importance of preventing tza’ar, mental anguish, in the healthy. Similarly, in Iggerot Moshe, Hoshen Mishpat 2:66, Rabbi Feinstein permits a young, healthy woman to undergo plastic surgery to relieve tza’ar. He concludes that the surgery does not violate the prohibition of havalah, inflicting a wound, since it is for her benefit. In Iggerot Moshe Yoreh Deah 4:49 he permits a heresh (one who cannot hear or speak) to receive an aliyah for his bar mitzvah, aufruf, or other special occasions, thus relaxing a rabbinic prohibition in order to prevent humiliation or depression. Similarly, Rav Ezra Basri permits visiting the grave of a deceased relative on Rosh Hodesh, a festive day when such visits are generally prohibited, to prevent depression.[16] This ruling is particularly critical for mourners who are already at high risk for depression from the emotional burden of their personal loss. Finally, Rabbi Yitzhak Zilberstein permits someone with a speech impediment whose speech therapist instructed him to call businesses, specifically strangers whom he does not know, as a way to treat a severe stutter, although he has no intention of purchasing their products.[17] He does not consider these phone calls geneivat da’at, a deliberately misleading act, if there is a suspicion that his condition will lead to depression. He considers depression a hashash sakanah, a possible danger, citing the example of Rachel begging, “Give me children, or I shall die” (Genesis 30:1), to prove that depression can lead to self-harm. He concludes that if there is a medical need or safek pikuah nefesh, the phone calls are permitted. These rabbinic rulings suggest that Jewish law values interventions that promote mental health and minimize psychological harm, even if such interventions interfere with the performance of mitzvot or violate rabbinic prohibitions.
Halakhic Rulings Promoting Mental Health and Well-Being During Coronavirus
Several rabbinic authorities have issued statements during the COVID-19 pandemic that seek to promote mental health and well-being. Fourteen Sephardic rabbis issued a statement permitting the use of Zoom for the Passover Seder to lift the spirits of the elderly, who were separated from their families, to “give them motivation to keep fighting for their lives, and to prevent depression and mental weakness which could lead them to despair of life.”[18] They issued this statement under the condition that video conferencing was set up before the holiday and continued until after it, and limited its application to “emergency times only” and those who need it. Several rabbis harshly criticized this statement,[19] and a number of those who initially endorsed the statement subsequently retracted.[20] Nevertheless, the statement reflects the concern of rabbinic authorities over the mental health of the elderly and those in social isolation during COVID-19.[21]
To this end, Rabbi Hershel Schachter ruled that the family of someone quarantined over yom tov who suffers from depression or mental illness, and whose physicians worry that spending yom tov without speaking to family puts him at risk for suicide, may and even must telephone or leave the internet open for him.[22] He cites the aforementioned Taanit 22b, which classifies ruah ra’ah as sakanat nefashot. He also quotes Iggerot Moshe Even ha-Ezer I:65 and Rav Velvel Soloveitchik, who state that severe mental illness qualifies as pikuah nefesh. He extends this permissive ruling to any sick person whose physicians believe his condition may worsen over yom tov to a safek sakanah. Similarly, he rules that if a parent who is ill lives outside of Israel and has a non-Jewish aide, children in Israel may call the aide when it is no longer yom tov in Israel but is still yom tov in the diaspora, and ask the aide to show the parent his family on his phone. “Under great and pressing circumstances,” Rav Schachter permits leaving the phone on before yom tov but prohibits leaving a computer screen on. Nurse Sarah might have benefited greatly from these rulings, which could have relieved her depression and isolation over Shabbat and potentially prevented her from attempting suicide.
Many women, not just those with OCD, have expressed concern regarding the safety of the mikvah during COVID-19. To this end, poskim have issued rulings to make mikvaot safer during COVID-19 and ease women’s anxiety regarding immersion. Rav Asher Weiss and others have permitted immersion in the mikvah during the day, either on day eight[23] or even day seven under the condition that the couple does not see each other until after nightfall, to decrease the number of women there at any one time.[24] Some have permitted doing all preparation, including hafifah and iyun, at home, to minimize contact with surfaces, time at the mikvah, and exposure to others.[25] Poskim generally discourage showering after immersion, based on Ohr Zarua 1:755:3, to avoid washing off the mikvah water and invalidating the immersion. Indeed, in Yoreh Deah 201:75, Rama codifies this position. Yet, Rav Schachter rules that during COVID-19, the prohibition against showering is a stringency, and allows women to shower upon returning home immediately after immersion, in order to reduce the risk of infection.[26] He quotes Iggerot Moshe Yoreh Deah II:96, which permits a woman who is istanistit, pampered, and cannot tolerate refraining from bathing an entire day, to shower immediately. If an istanistit may shower after the mikvah, then certainly a woman immersing during COVID-19, who is not pampered but simply acting out of proper vigilance, may do so. Rav Asher Weiss echoes Rav Schachter’s position.[27] After immersion on Shabbat during COVID-19, Rav Schachter permits a woman to shower in cold water, a practice that is generally discouraged. On yom tov, he permits her to shower with a small amount of hot water, despite his general opposition to showering with hot water on yom tov. He allows health care workers returning from caring for patients on yom tov to shower in hot water and on Shabbat, with a shinui.[28] He distinguishes between the two situations, arguing that immersing on Friday night is not a requirement (the woman could have delayed immersion until Saturday night), whereas the healthcare worker was required to work and could not defer his shift until after Shabbat. Thus, Hava might be comforted by the knowledge that she may perform all preparations at home, come to the mikvah completely ready, bypass the changing room, and walk right into the mikvah, distancing herself from the attendant and others at all times. In addition, she may immerse during the day.[29] On weekdays, she may bathe immediately after immersion. If she is scheduled to immerse on Friday night, she may then shower in cold water.
Concerns over the mental health and psychological well-being of the public inspire Rabbi Schachter’s teshuvah regarding the aveilut of sefirat ha-Omer during COVID-19. Rabbi Schachter writes that the level of aveilut during this period is comparable to that of the twelve months of mourning, when listening to music is prohibited.[30] This restriction was originally limited to festive music, which might lead to dancing, and only later came to include all forms of music. He adds that Rav Joseph B. Soloveitchick did not prohibit listening to classical music, which is a form of art. For some, during the COVID-19 pandemic, refraining from listening to or playing music might cause emotional distress beyond the intent of this restriction. He permits listening to music if the purpose is to ease domestic tension or pressure, or to return to a “normal disposition.” He extends this ruling to rare instances during shivah, when listening to music might prevent “a depressed state of mind.” This teshuvah emphasizes the importance of preventing and treating depression and relieving anxiety, and might give great comfort to our teacher, mother, grandfather and nurse during the Omer, Three Weeks, and other periods of mourning.
Frame of mind and easing tension are central to Rav Asher Weiss’ teshuvah permitting a husband to drive his wife to the hospital on Shabbat when she is in labor during COVID-19,[31] although hospital and government regulations designed to minimize exposure of patients and those accompanying them require him to leave once she is admitted to the labor floor. He bases his teshuvah on Shabbat 128b, which allows one to light a candle for a blind woman in labor even though she cannot see, because the knowledge that the light has been lit will comfort her. Similarly, a husband is permitted to accompany his wife to the hospital on Shabbat to calm her mind, even though there is no medical need for him to be there. During COVID-19, anxiety over possible infection compounds a woman’s underlying fears of giving birth and might lead to excessive emotional distress. He permits the husband to accompany her to the hospital because his presence, even briefly, will improve her psychological well-being. This teshuvah reinforces the importance of prophylactic measures to promote emotional health and minimize COVID-19-related anxiety.
As countries ease the restrictions of lockdown, we are facing a myriad of potentially anxiety-provoking decisions regarding the level of risk we will accept. Should we send our children to camp and school, shop in the supermarket, participate in a minyan, whether outdoors or in a synagogue? Halakhah guides us in navigating these decisions, giving weight to the individual’s perception of risk.[32] Rav Schachter writes that the halakhic permissibility of low-risk behaviors depends on individual, subjective assessment of risk. Shomer petaim Hahem – the principle that God looks out for those who can’t protect themselves – applies if one at risk is not worried about the danger. However, if one is nervous about the danger, shomer petaim does not apply, and the situation becomes a safek sakanah. The individual who is not concerned does not have the right to tell others that there is no sakanah for them. Hava might consider the supermarket dangerous, while her neighbor does not. For Hava, then, the supermarket is a safek sakanah; her neighbor is permitted by shomer petaim Hashem. Similarly, she might consider the supermarket safe and the bakery unsafe, and might feel differently about these risks at different times, depending on the circumstances and the specific situation. Similarly, if going to school precipitates Reb Shmuel’s PTSD, he should be exempt from the obligation to teach Torah.
Conclusion
While personal protective equipment can protect us from infection, it cannot protect us from the emotional and mental devastation of this epidemic. Halakhah treats mental illness no differently from physical illness. Suicide, psychosis, and severe mental illness are pikuah nefesh and classified as holeh she-yeish bo sakanah, overriding the performance of nearly all mitzvot, whereas we can consider mild OCD, PTSD, and mild depression holeh she-ein bo sakanah. Halakhah allows for leniencies for those suffering from these mild conditions, permitting both those afflicted and those who care for them less stringent performance of mitzvot and violation of rabbinic prohibitions on Shabbat. Furthermore, Halakhah values the mental health and psychological well-being of all. Lo ta’amod al dam rei-ekha and ve-ahavta le-rei’akha kamokha obligate us to treat those who suffer from mental illness with sensitivity, reach out to others, inquire into their mental health, verify that they are not at risk, and offer support, especially during this challenging time.
[1] Joel Achenbach, “Coronavirus is Harming the Mental Health of Tens of Millions of People in the US, New Poll Finds,” Washington Post (April 2, 2020), https://www.washingtonpost.com/health/coronavirus-is-harming-the-mental-health-of-tens-of-millions-of-people-in-us-new-poll-finds/2020/04/02/565e6744-74ee-11ea-85cb-8670579b863d_story.html.
[2] Jean M. Twenge and Thomas E. Joiner, “Mental Distress Among U.S. Adults During the COVID-19 Pandemic,” PsyArXiv (May 7, 2020), doi:10.31234/osf.io/wc8ud.
[3] “Loneliness during Coronavirus,” Mental Health Foundation (May 26, 2020), https://www.mentalhealth.org.uk/coronavirus/coping-with-loneliness.
[4] https://www.cbs.gov.il/he/mediarelease/DocLib/2020/149/19_20_149b.pdf.
[5] Jonathan P. Rogers, et al, “Psychiatric and Neuropsychiatric Presentations Associated with Severe Coronavirus Infections: A Systematic Review and Meta-Analysis with Comparison to the COVID-19 Pandemic,” Lancet Psychiatry (May 18, 2020), https://doi.org/10.1016/S2215-0366(20)30203-0.
[7] Jianbo Lai, et al., “Factors Associated with Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019,” JAMA (March 23, 2020), https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2763229.
[8] Rodolfo Rossi, et al., “Mental Health Outcomes Among Frontline and Second-Line Health Care Workers During the Coronavirus Disease 2019 (COVID-19) Pandemic in Italy,” JAMA (May 28, 2020), https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766378.
[9] Victor J. Dzau, et al., “Preventing a Parallel Pandemic — A National Strategy to Protect Clinicians’ Well-Being,” New England Journal of Medicine (May 13, 2020), https://www.nejm.org/doi/full/10.1056/NEJMp2011027?query=TOC.
[10] For further discussion in these pages of Judaism and mental health, see https://thelehrhaus.com/scholarship/in-god-we-trust-or-do-we-the-fears-of-isaac-and-jacob/, and https://thelehrhaus.com/scholarship/a-jewish-theology-of-depression/.
[11] Rav Asher Weiss, “Halachik Challenges with Mental Illness,” Refuat HaNefesh, https://www.refuathanefesh.org/shiurim-and-lectures/.
[12] Minhat Asher 2:134.
[13] Dovid Lichtenstein, “Suspending Mitzva Observance to Treat OCD,”in Headlines 2. Halachic Debates of Current Events (Menucha Publisher, 2017), 311-325. Available at pages 23-37 of PDF located at https://s113.podbean.com/pb/ca2ea4fb7dd6532aedb7b0e455ff8491/5ee91576/data2/fs31/769564/uploads/show_28_OCD-in-Halacha.pdf?pbss=52f87909-f8e2-5a71-af6a-21efe2c19286.
[14] Helle Spindler and Susanne Pedersen, “Posttraumatic Stress Disorder in the Wake of Heart Disease: Prevalence, Risk Factors, and Future Research Directions,” Psychosom Med. 67 (Sept.-Oct. 2005):715–23, http://dx.doi.org/10.1097/01.psy.0000174995.96183.9b. See also John Griffiths, et al., “The Prevalence of Post Traumatic Stress Disorder in Survivors of ICU Treatment: A Systematic Review,” Intensive Care Med. 35 (June 9, 2007):1506–18, http://dx.doi.org/10.1007/s00134-007-0730-z.
[15] Nora Landis-Shack, et al., “Music Therapy for Posttraumatic Stress in Adults: A Theoretical Review,” Psychomusicology 27(4) (December, 2017):334‐342, doi:10.1037/pmu0000192.
[16] Ezra Batzri, Sha’arei Ezra 2 Yoreh Deah 87.
[17] Yitzhak Zilberstein, Hashukei Hemed – Gitin (Jerusalem: Yefe Nof- Y. Posen, 5770 [2009/2010]), 62a, 400- 401.
[18] March Oster, “Some Orthodox Rabbis in Israel Approve Use of Video Conference for Seder,” Jewish Telegraphic Agency (March 25, 2020), https://www.jta.org/quick-reads/some-orthodox-rabbis-in-israel-approve-use-of-video-conference-for-seder.
[19] Rav Asher Weiss, Minhat Asher, Leket Shiurim U-Shealot Iggerot U-Maamarim L-Noseh Ha-Karonah (Jerusalem, Israel: Minhat Asher, 2020), 75-76.
[20] https://www.kikar.co.il/352847.html.
[21] For further discussion of the Zoom Seder controversy, see https://thelehrhaus.com/timely-thoughts/making-seder-out-of-the-zoom-seder-controversy/.
[22] “An Open Letter from Dr. Daniel Berman and Rabbi Dr. Aaron Glatt,” March 15, 2020, Rav Hershel Schacter, Piskei Corona #2, Sick in Isolation, pages 4-6 of PDF located at https://www.torahweb.org/torah/docs/rsch/RavSchachter-Corona-All.pdf.
[23] Rav Asher Weiss, Minhat Asher, 21-22.
[24] “Mikveh and Health Advocacy,” Webinar The Eden Center and OU Israel, http://theedencenter.com/mikveh-and-health-advocacy/, Rav Shmuel Eliyahu, minute 34:00-35:00.
[25] “Mikveh and Health Advocacy,” Webinar The Eden Center and OU Israel,http://theedencenter.com/mikveh-and-health-advocacy/.
[26]“An Open Letter from Dr. Daniel Berman and Rabbi Dr. Aaron Glatt,” March 15, 2020, Rav Hershel Schacter, Piskei Corona #12: Showering After the Mikvah, https://www.yutorah.org/lectures/lecture.cfm/950654/rabbi-hershel-schachter/piskei-corona-12-showering-after-the-mikvah/..
[27] Rav Asher Weiss, Minhat Asher, 23.
[28] “An Open Letter from Dr. Daniel Berman and Rabbi Dr. Aaron Glatt,” March 15, 2020, Rav Hershel Schachter, Piskei Corona #26: Showering When Returning Home from the Hospital or the Mikvah on Shabbos or Yom Tov, pages 37-39 of PDF located at https://www.torahweb.org/torah/docs/rsch/RavSchachter-Corona-All.pdf.
[29] “Mikveh and Health Advocacy” Webinar The Eden Center and OU Israel, http://theedencenter.com/mikveh-and-health-advocacy/.
[30] An Open Letter from Dr. Daniel Berman and Rabbi Dr. Aaron Glatt,” March 15, 2020, Rav Hershel Schachter,
Piskei Corona #30: The Aveilut of Sefirah, pages 48-49 of PDF located at https://www.torahweb.org/torah/docs/rsch/RavSchachter-Corona-All.pdf.
[31] Rav Asher Weiss, Minhat Asher, 34-35.
[32] Rabbi Hershel Schachter, “The Correct Behavior When Dealing with Danger,” Torahweb.org (2020), https://www.torahweb.org/torah/special/2020/rsch_sakana.html.
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