By Dr. Sharon Galper Grossman

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] More recently, 90% of US adults reported emotional distress related to the pandemic. The United Kingdom has described a similar increase in depression since the onset of COVID.[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 believed that their mental health has declined since the outbreak of the virus.[4] In July, in the midst of a second wave of COVID, mental health in Israel deteriorated even further with over 2.4 million Israelis (42%) reporting stress and anxiety. 

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. 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]

Jewish law classifies illness into two primary categories:  holeh she-yeish bo sakanah, life-endangering illness for which one may violate virtually all prohibitions and hole she’ayn bo sakanah, 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.  How does Jewish law approach severe mental illness?  Several Talmudic and earlier sources suggest that halakhah classifies severe mental illness as holeh she-yeish bo sakanah and that caring for that person creates a situation of pikuah nefesh. More recently, Rav Moshe Feinstein sees helping someone with mental illness as doing pikuah nefesh, which overrides nearly all prohibitions. For example, 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.  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 in consultation with rabbinic authorities. These poskim classify 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.  Rav Soloveitchick, in the name of his grandfather Rav Chaim Soloveitchick applies this classification to severe mental illness even when there is no risk of self-harm or harm to others.  Halakhah approaches milder forms of mental illness as a holeh she-ein bo sakanah.  Furthermore, some promote interventions that maintain psychological well-being even in those who do not have mental illness or psychiatric symptoms. For example, in Iggerot Moshe Even ha-Ezer  I:67 and Iggerot Moshe, Hoshen Mishpat 2:6, Rabbi Feinstein emphasizes the importance of preventing tza’ar, mental anguish, in the healthy. 

Many women 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 suggested 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, codified by the Rama in Yoreh Deah 201:75. 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, a woman may perform all preparations at home, come to the mikvah completely ready, bypass the changing room, and walk right into the mikvah, to ensure distance from the attendant and others at the mikveh. 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 teshuvot regarding the aveilut of sefirat ha-Omer and the three weeks during COVID-19. Rabbi Schachter writes that the level of aveilut during these periods 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 help alleviate the psychological distress of COVID-19.  

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. The individual who is not concerned does not have the right to tell others that there is no sakanah for them. You might consider the supermarket dangerous, while your neighbor does not. Similarly, you 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. 

Halakhah values the mental health and psychological well-being of all. Ve-Nishmartum Mo’ed Le-Nafshotechem obligates us to perform frequent self-assessments to determine if we suffer psychological distress and if so to try to reduce it with self-care, eating properly, exercising regularly, listening to music, speaking to supportive family members and friends, practicing yoga or meditation and adequate sleep.  However, sometimes these efforts are not enough and one requires the help of a mental health professional, which can be arranged thru Kuppat cholim or a family doctor. 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.  U’ktov L’Chaim Tovim Kol Bnei Britecha.  May Hashem grant us good health in the coming year, good physical health and good mental health.

Foot notes:

  1. https://www.pandemicimpactreport.com/report/PalssonBallouGray_2020_PandemicImpactReport.pd
  2. https://www.cbs.gov.il/he/mediarelease/DocLib/2020/225/19_20_225b.pdf
  3.   “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
  4. “An Open Letter from Dr. Daniel Berman and Rabbi Dr. Aaron Glatt,” March 15, 2020, Rav Hershel Schacter, Piskei Corona #43: Mourning Customs of the Three Weeks. https://www.yutorah.org/lectures/lecture.cfm/962617/rabbi-hershel-schachter/piskei-corona-43-mourning-customs-of-the-three-weeks/ 

 

[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.

[6] 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.

[23] Rav Asher Weiss, Minhat Asher, 21-22.

[24] “Mikveh and Health Advocacy,” Webinar The Eden Center and OU Israel, https://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,https://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, https://theedencenter.com/mikveh-and-health-advocacy/.

[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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