"Mental Illness Occurs in the Best Families, and Today Even the Ultra-Orthodox Have Learned to Stop Being Ashamed"

Next to the well-known and established building of the 'Maayanei HaYeshua' Medical Center, the ultra-Orthodox hospital located in Bnei Brak, a magnificent seven-story tower now stands. This tower houses a new hospital wing, inaugurated just over a year ago: the Mental Health Wing. The name of the wing, given in consultation with Rabbi Chaim Kanievsky, is 'Marbeh Da'at'.

"Dr. Moshe Rothschild established 'Maayanei HaYeshua' about thirty years ago, and fifteen years ago he began to say that it was necessary to build something similar to address mental health," says Tzipi Bornstein, the head of the mental health center. "When he started talking about it, they told him that no one would come, that in the ultra-Orthodox community, there is a stigma around mental health issues. But he began, in a small way, with one doctor, one psychologist, and a few caravans. Today, however, we are sitting in a luxurious building with hotel-like conditions, all designed to serve those in need of mental health services at all levels: we have an emergency department, psychiatric clinics, day hospitalization, and inpatient wards." The only type of mental health service the place does not provide? Involuntary hospitalization. "We are an open department. Everything is done with consent," says Bornstein.

The number of people seeking help is high. In one month, 'Marbeh Da'at' has 1800 active cases. Between six to ten new consultations arrive at the clinics each day. Although the hospital offers its services to everyone, most of those seeking help are from the religious and ultra-Orthodox sectors. There is no other place in the country where religious people suffering from mental health issues can feel so comfortable. Besides complete separation in treatment and hospitalization between men and women, all therapists, including senior psychiatrists, are religious. Only some of the psychiatric nurses in the inpatient departments are not religious.

Who actually seeks treatment?

"Mental illnesses and issues exist in every population, including the religious and ultra-Orthodox sectors," says Professor Strauss, head of the psychiatric department at Maayanei HaYeshua. "There is no reason for stigma or shame because, as the cliché goes, it happens in the best families. There is no community and no place without those needing mental health treatment."

The illnesses themselves are no different, but their manifestations can sometimes vary. "For example, obsessive-compulsive disorder among the religious can manifest in ways related to observing Jewish law, and someone who is psychotic can experience delusions focused on religious themes," Professor Strauss explains. "On the other hand, among religious individuals with severe depression, there are fewer suicides. This is a statistically recognized fact, according to which religion is a protective factor against suicide. Unfortunately, there are many suicides among those who leave the religious community, who suffer from a lack of belonging both here and there."

How do you know when it is time to seek real mental assistance?

"Mental illness is something that disrupts functioning. Anyone whose functionality is impaired due to a mental problem should come to our emergency department. There, a psychiatrist will assess the situation and recommend the appropriate treatment: day hospitalization, inpatient ward, etc."

Bornstein describes the demographics of the patients, at least those in day hospitalization, as differing between men and women. "Among men, most of our patients are older bachelors. Among women, most are mothers with children."

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Is this due to the prevalence of postnatal depression and anxiety? Bornstein says that indeed many consultations are due to this background, but she explains that quite a few patients have hardcore mental illnesses, from schizophrenia to manic depression.

"We do see a lot of postnatal depression," adds Professor Strauss. "But not only depression. There is also postnatal anxiety, trauma after birth. One of our advantages, being part of a hospital, is that the women's health staff can often refer suffering women to us, sometimes even from the pregnancy stage – since depression during pregnancy is a very high predictor of depression and other problems post-birth."

Mental issues triggered by birth are generally not predictable in advance. But do the professionals at the center support the establishment of a family by those already diagnosed with significant mental illness?

"It varies from case to case," says Bornstein. "We have a guidance group for married couples with mental troubles, who receive a lot of support and guidance. Generally, we certainly do not recommend marrying when there is no stability in the illness, when medication has just changed, and so on. Marriage is not a cure, and all the problems will persist afterward. But when there are patients, both of whom we know well, our professionals are ready to provide an opinion on whether there is a possible basis for marriage between them, based on the type of illness, its severity, the nature of the individuals as we have come to know them, and so on."

Support for married couples with mental challenges is not the only family-oriented treatment that 'Marbeh Da'at' offers. "We opened a Parents and Children's Center within the hospital. True, there are a few such centers in every city, but none of them are willing to accept families where the parents or the child have a mental health background. What happened was that we noticed that when it came to children, for example, every year we'd get another child from the same family for treatment. The final persuasion for me, and what I told the National Insurance Institute to get their support, was when a pair of parents came to us and requested help from the children's clinic. We asked where their child was, and they explained they were parents of six children, none of whom was a problem – they were the problem. They didn't know how to manage. There wasn't any particular child they needed to bring. They just needed help raising their children properly...

"For such parents, we opened this center. It is set up like an apartment, and parents receive modeling for proper parental behavior. How to prepare lunch, how to sit with the children on homework. How to greet the child when he comes home from school. Seemingly simple things that are lifesaving. We had a mother who shared that until she went through our training, she would put her children to sleep with a rolling pin in her hand..."

These parents' parenting struggles, Bornstein explains, stem from a combination of factors. Yes, many of them have mental problems, but many also come from distressed families where they never saw how a healthy, normative home should function. "We treated a family where the children were always late for school. When we checked what was happening at home in the mornings, we found that the good-hearted father was preparing each child exactly what he wanted to eat, even if it was pasta with a specific sauce... it was no wonder they were always late for school."

The Parents and Children's Center at Maayanei HaYeshua is a good symbol of the approach they believe in here: treatment is good, but prevention is even better. Many of the emotional and mental issues that children develop, Bornstein explains, can be prevented by proper parental guidance. "It's not a definitive rule," she warns. "Certainly, we have patients who are the ninth child out of twelve, for example, and no other child in the family has any problem. We once had a child from a well-functioning family, sibling to well-functioning children, who tried to commit suicide three times before the age of ten. These things happen – but they are rare. Ninety-nine percent of the population does not have schizophrenia, and many problems can be prevented."

When Bornstein talks about preventing problems, she essentially refers to the trigger question, the most important factor in developing mental illnesses. Scientists now agree that mental illness is a product of an interaction between genes and the environment. Without a certain genetic predisposition, a person will not become ill – but certain environmental conditions are also needed for the illness to break out. These environmental conditions are the trigger. In the case of a child with a very strong genetic tendency toward psychosis, the parents probably will not be able to save the situation: the triggers can be so minor in the eyes of others that avoiding them would require raising the child in a bubble of armored glass. Fortunately, in most cases, the environment plays a larger role in the question of proper mental development.

"We recommend treating long before there is already a clear mental disorder," says Bornstein. "A common phenomenon, for example, is children with a low ability to cope mentally. If your daughter failed a test and is disappointed – that is normal. But if for several days she can't do anything but talk about the test and cry over the failure – that's where we say: 'This girl needs treatment.' She does not yet have a mental problem but needs to learn to cope. The mind is like a muscle that requires training. Especially in our generation, where there is abundance, and children usually do not need to face hardships, coping skills are low. Parents need correct guidance to allow their children to develop their mental strength and not cushion them too much. If your daughter is overweight, do you workout instead of her because you pity her? In the same way, you need to leave room for the child to cope, not arrange the whole world for him. And if he still continues to struggle – that's what therapists are for."

What message do you have for the community, the healthy people around those coping with mental illness?

Professor Strauss: "First, do not be afraid to refer, to check. Do not fear to ask. There is no reason to fear treatment and no reason to be ashamed of a mental problem. There is no difference between someone suffering from high blood pressure and someone suffering from clinical depression. Both require certain treatments to achieve balance and function properly. Additionally, the faster mental health issues are treated, generally, the quicker the recovery. If help arrives late, the treatment may take much longer."

Tzipi Bornstein: "We are always looking toward the community. We consider ourselves just a transit station: the patient comes from the community and returns to the community. Therefore, we have good connections with infant welfare nurses who refer women with postpartum depression to us, with school counselors who bring us girls with eating disorders. Everything is done in cooperation, in mutual trust. This, to me, indicates more than anything the huge change that has occurred in the view of mental health problems in the ultra-Orthodox community."