November 2012 A Publication of
MIND, BODY & SOUL
In Collaboration With:
A Mental Health Magazine
Putting the Pieces Together
& MIND, BODY SOUL
MIND, BODY SOUL ?
By Elisheva Stein
Ohel’s Kadimah Clubhouse Helping Those With Mental Illness Move Forwared
good day is a day when I wake up in the morning and I feel like I have a place to go.” These words were uttered by one of the members of the Kadimah Clubhouse. Individuals who are recovering with mental illness, are often searching for a place in the community to feel safe and welcome. Some feel that they are judged by their disability, their seemingly lack of productive work, and at times, for a perceived inability to overcome their disability. Mental Health Professionals have long known that stress and a “sense of failure” are contributing factors in the severity of mental illness. So
how can people with mental illness move forward towards recovery? Introducing the OHEL Kadimah Clubhouse. Kadimah provides; a safe and welcoming environment that individuals who are recovering from mental illness - can call their own. Members are able to nurture their talents and abilities and are provided the opportunity to take control of activities in their day. The members themselves decide what activities or training will take place at Kadimah. Based on member requests, the following types of programs have already been implemented: Job Training, Computer Training, GED preparation, Cooking, Administra-
tive Training, Cultural Awareness and the Dramatic Arts. This positive social environment provides additional support in the form of job placement and job coaching. The employment team provides vocational assessments, job training, job development and on-the-job support. While the programs at the Kadimah Clubhouse compliment traditional treatment options, the purpose of Kadimah is for the members to develop the skills necessary to help themselves, to have a job and be independent. Through members teaching other members coping skills and other strategies (with professional support) - that they themselves have
Holocaust Survivors Grapple with Religion, Identity and History at Major Conference
ecently, Cleveland, Ohio hosted the 24th Annual World Federation Conference of Jewish Child Survivors of the Holocaust and Their Descendants. Participants came from around the world and across the life span. First, second and third generations of those devastating wartime years were present, each contributing a unique perspective. The conference included many seminars and discussion sessions. Perhaps one of the most moving workshops was one facilitated by psychologist Michael Milgraum, who is a child of a survivor. The title of the workshop was “Spirituality After the Holocaust—Where was God and Where is He Now?” Milgraum, an Orthodox Jew, says, “The purpose of this workshop was not to preach God or Orthodoxy or really to preach at all. I believe we are enriched when we grapple with the infinite and spirituality, when we continue to ask questions, even if satisfac-
tory answers about human suffering are so hard to find.” Milgraum discussed the role of spirituality in his own life. The remainder of the session consisted of a lively audience discussion, with topics ranging from God’s involvement in the world, Jewish continuity, survival of Judaism as defiance against Hitler, tensions between religious and nonreligious Jews, faith and sources of hope. Milgraum stressed that the purpose of the workshop was not to prove who was right and who was wrong, but to create a forum where different perspectives could be heard and acknowledged. Milgraum is the author of Never Forget My Soul, a book discussing the multigenerational effects of the Holocaust and psychological/spiritual healing.
put into practice, the individuals gain in greater self-confidence, selfproductivity and independence. In the words of a member, “Kadimah means putting one foot before another and moving forward in life”. Individuals suffering with mental illness often feel loneliness and despair, but the stigma can melt away when they are working together with others who are surviving and flourishing, learning and growing. . Kadimah is located at 3611 14th Avenue, Suite 209, Brooklyn, NY 11218. For more information about the OHEL KADIMAH CLUBHOUSE and the services it provides, please contact OHEL at 1800.603. OHEL
New Psychotherapy Novel for the Frum Reader
n her new book “What Your Therapist is Really Thinking,” psychotherapist Mirel Goldstein gives people an inside look to some of the techniques that she uses as a therapist. The author explains that “there are lots of people who aren’t trained as therapists but can still do a lot of the things that therapists do to help people- whether it’s a teacher helping out a student, a parent helping out a child, or even spouses helping each other.” Goldstein has spent years studying a particular approach to psychotherapy called “Mentalization-Based Therapy,” which is about
how people learn how to pay attention to and make sense out of the things that happen in relationships- what people say to us, how we feel, and how other people understand what we mean when we say or do certain things. Goldstein “also wanted there to a be a book out there, for the frum reader, that gives a glimpse into some of the dynamics that happen in an intensive therapy, as opposed to one of the very short-term therapies that are so popular today.” The book is great for professionals as well as people who are interested in learning about relationship dynamics and emotions.
& MIND, BODY SOUL
CONTENTS November 2012
ind, Body & Soul: The title itself conveys the significance of our offerings within this special supplement. As human beings we face challenges every day. Some are daunting beyond measure while others allow success within easy reach. The spectrum is boundless. Yet, we are blessed with guidelines for living which Chazal has provided for us; how to eat, daven, raise children, shake a Lulav, and achieve personal Shlaimus. The multitude of guideposts instruct us how to shape our lives, our community, and our relationship with H”K”B”H. Yet within this multi-dimensional paradigm there is latitude for each of us to inscribe a unique signature upon our own lives. How do we determine our path? Which life events enhance us and which marginalize us? Every life is rich with defining moments which can heighten our awareness or diminish it. And they are building blocks with a cumulative effect on how we function. We may have dreams and aspirations, but don’t necessarily have a compass to help us achieve our goals. Over the past years, the frum community has enlisted psychotherapists more and more to help them navigate the issues in their lives. In the past, it was thought that people seeking treatment were too weak or disturbed to master their plight. I would posit the very opposite; seeking treatment is an act of strength November 2012
and courage. Just as a person seeks medical treatment for an infection, so, too, person seeks mental health treatment for an emotional or psychological challenge which seems insurmountable. The frum world has made significant strides in this area and we should applaud our progress and our evolving understanding of its benefits. The articles herein reflect a broad spectrum of challenges which are an integral part of the human condition. The authors are members of Nefesh, an International Organization of Orthodox Mental Health Professionals. Not only does Nefesh have a directory of therapists worldwide, but it also sponsors events and educational seminars with the purpose of broadening our understanding of the challenges we face and how we might approach them in a more productive manner. The subjects addressed are taken from the fabric of everyday life. We may have both lofty and mundane goals, and life is replete with a combination thereof. The articles are meant to whet your palette. I hope they do, and I hope they provide you with much food for thought. Shalom Umevorach,
Phyllis Mayer, LCSW Phyllis Mayer, LCSW executive board member of Nefesh, executive board member of the Task Force on Children & Families At Risk in the Frum Community, Private Practice in Brooklyn & Staten Island. She can be reached at email@example.com
Mind, Body & Soul Happenings
The Magic of “No”
Shidduch Crisis or Identity Crisis?
Bipolar – Not A Life Sentence
By Dr. Miriam Adahan
By Nancy Silberman Zwiebach, MS, PD By Rabbi Raffi Bilek
By Yitzi Horowitz, LCSW, CSAT-C
Anxiety in Children and Teens
A Ticking Time Bomb
How to Use “Mentalization” Skills to Enhance Your Relationships
By Benjie Stern, PhD
By Joy Naomi Jacobs-Muller, M.S. MHC
By Mirel Goldstein MS, MA
A Matter of Relationship
The Writing on the Wall
Dr. Jekyll and Mr. Hyde
This Year’s Book of Life Isn’t Sealed Yet…
By Mindy Hajdu, MS, LMSW
By Binyamin Tepfer PhD, CSAT-S, CMAT
By Tali Moskowitz, LCSW
By Dr. Judith Guedalia
By Batya Jacobs
& MIND, BODY SOUL Is a publication of the Jewish Press Published since 1960 and in collaboration with Nefesh International
SUPPLEMENT COORDINATOR Alice Tusk, LMSW ARTICLE COORDINATOR Chaim Sender, LCSW SENIOR EDITOR Karen Greenberg ASSOCIATE EDITOR Ita Yankovich EDITORIAL BOARD Phyllis Mayer, LCSW • Chaim Sender, LCSW Rabbi Simcha Feuerman, LCSW-R Nathan A. Solomon, Ph.D. • Lisa Twerski, LCSW AD COORDINATOR Shaindy Urman DESIGNER Alana White • firstname.lastname@example.org
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? Life Sentence Bipolar – Not A Elisheva Stein By Dr. Miriam Adahan
? haim* was admired in yeshiva ? his incredible diligence. His for days were consumed with learning ??? he could be found in the Beis and Midrash almost 24/7. For him, sleep was a waste of time. Great things were forecast for his future until neighbors found him lying in the middle of the street in Geula, hallucinating that he was Moshiach. Medications stopped his racing mind but made him feel like a zombie. He became depressed and a shell of his former self. His parents thought they were acting responsibly when they had him hospitalized and then put in a hostel. Rivki*, a lively high school senior, was flattered when she was chosen to lead fifty girls on a twoweek, end of the year outing. It was exciting, but between planning the next day’s activities and studying for her final exams, Rivki barely had time to sleep or eat. In fact, she discovered that she needed no sleep at all. By the end of the two weeks, she began to hallucinate and ended up in the emergency room. Despite a six-month stay in a psychiatric facility, where she received shock treatments and a variety of drugs, Rivki’s condition deteriorated over the next three years. Her mother heard about me and was willing to try a different approach. When I first met Rivki, she was overweight, lifeless and depressed. Eventually, during the three months it took to wean her off the meds, she adopted a healthy diet, went to aerobics classes and took the natural mood-stabilizers I recommended. She soon lost weight, regained the spark in her eyes and enrolled in college. She told me recently, “I feel like I’m alive again, having emerged from a three-year nightmare during which I completely lost my sense of self.” While I do not hesitate to recommend drugs for the severely disturbed or for a short-term crisis, I believe the vast majority of people can improve by learning to overcome negative thoughts and self-harming habits, and especially by getting adequate sleep and propernutrition. Telling people
they must be on meds forever is like saying that we must take antibiotics forever due to one infection. This is especially true during the turbulent teen years or during a single crisis, when it is normal to suffer from intense emotions, fears and identity issues. I know this because I went through one such experience myself forty years ago, at the age of thirty. Like many emotional and sensitive types, I loved the excitement which came with creative endeavors. So, as I was writing my doctoral dissertation in psychology, I gave full expression to the impulse. With ideas flooding my mind, I easily skipped breakfast and then lunch; I was on a high which filled me like no food possibly could. I felt no need for food or sleep. I wrote day and night, only stopping to take care of my daughter until she went to gan or returned. This continued for three weeks during which time I did not lose weight; I was sustained by a delicious divine energy. I thought I had reached such a high level of spirituality that I no longer had physical needs! But then, at the end of three weeks, I began to hallucinate, thinking that I had G-dly powers and secret information to reveal to the world. A relative took me to Dr. L., chief psychiatrist of a prestigious hospital who, after reviewing my history, looked grimly at my family member and said, “She will need to be medicated for the rest of her life and will probably need frequent hospitalizations.” He handed me a list of prescriptions and ushered me briskly out. Thankfully, this relative took me to a n alternative healer who had helped her in the past. He gave me a shot of vitamins, as well as various supplements to help me calm down. He told me about the importance of sleep and good nutrition, which no one had ever mentioned before. Since then, I have never relapsed, although I still take natural supplements, avoid junk foods and gluten, and make sure to get adequate sleep. I share this in a public forum because Big Pharma and its advertisers have teamed up to convince people that they cannot be sane without psychiatric meds.
They minimize the fact that, in addition to the “minor” side-effects, such as dry mouth, stomach upset and loss of libido, these drugs accelerate Alzheimer’s, diabetes, Parkinson’s, internal bleeding and osteoporosis. True, some people want to be put out of their misery quickly with drugs, but they must be informed of the consequences. If this article gives people hope to heal without drugs, then it is worth facing the ridicule and censure which is bound to come from people who are threatened by the concept of self-healing techniques. There are three main reasons why a perfectly functional and responsible person might have a breakdown.
LACK OF SLEEP
Few people are informed about the importance of sleep; in fact, we are constantly surrounded by the opposite message. We praise gedolim who sleep only 2-3 hours. We praise community activists who say, “You can call me 24/7.” Many people see sleep as a waste of time. Young men in yeshiva are proud of their ability to outdo even the gedolim by not sleeping at all! Some creative artists enjoy the flow of energy which accompanies and inspires their work. Writers often welcome the nighttime “high,” when ordinary mortals are asleep and they can use the peace and quiet to create. A new mother may find it impossible to sleep because the baby keeps waking up. She may think, “It’s not worth going to sleep, since I’ll only be woken up anyway.” New mothers may also suffer postpartum depression due to lack of sleep; if and when their babies do 4
sleep, they use the time to work. Teachers often tell me that they sleep only three-four hours a night. Young people are not told that almost any person who goes without sleep for three or more nights will start to hallucinate. While 1% of the population needs between 4-5 hours of sleep, ordinary people need between 6-8 hours. Less than that causes the body to produce cortisol and other stress hormones which can cause high blood pressure, diabetes and cardio-vascular disease. During sleep, the body performs numerous rejuvenating activities which it cannot do when we are awake, such as consolidating learned information and cleansing the cells of toxins. LACK OF NUTRITION Few people, especially in the frum world, want to hear about proper nutrition. People associate sugar with love and comfort. A good hostess makes people happy and “proves” her love by making rich desserts, regardless of future illness. Most people imbibe junk foods mindlessly, accepting obesity, diabetes and other illnesses as normal and unavoidable. Those who warn others about the dangers of junk foods are often ridiculed. Here are the facts: Every nerve cell in the body is protected by a myelin sheath, which is composed mainly of vitamin B. Without adequate B, people become agitated,
depressed and fatigued. B is lowered each time we use drugs or eat white flour and sugar, which also cause iron levels to fall. Ironically, a major sign of low B is a craving for sugar, which sets up a deadly
& MIND, BODY SOUL
cycle. Diet substitutes (except stevia) are even worse! Few schools teach good nutrition -- yeshiva and seminary food is notoriously lacking in B vitamins, because nutritious foods are costly. Many young people detest the taste of whole wheat bread and never eat fruits or vegetables. Such a diet is almost guaranteed to induce mental disorders due to the lack of essential minerals and vitamins. Yet most traditional doctors claim that nutrition has no connection to mental or physical health! ABSENCE OF LOVING
FAMILY OR FULFILLING ACTIVITIES
In this busy world, there is very little time to express love. Parents race off to work and return exhausted. Dysfunction, abuse and addictions abound. Without love, depression and fear flourish. People also get depressed when they are pressured to please others rather than engage in the activities which provide personal fulfillment. If you have intense mood swings or have had a psychotic episode, many will urge you to take psychiatric medication. It is very tempting to do so, but psychiatric meds will not provide love for the lonely or meaning for the unfulfilled. Nor will meds teach you how to be selfdisciplined, loving or full of faith. To avoid meds, we must learn not to be a victim of our moods. To gain “mood mastery,” you need: ❶ Regular sleep. Don’t count on your moods to tell you what to eat or when to sleep. Keep to a schedule despite the temptation to stay on the computer or engage in exciting activities! Make sure you get to sleep by 12 a.m. Sleep at least seven hours during a high mood, but not more than nine during a low. L-theanine (100-200 mg.) induces deeper and better quality sleep. Occasional melatonin can help, especially from the age of 50. You can also try hops, passiflora, uzrad and valerian to calm you occasionally. Turn your cell off at night, and do not tell anyone that you are available 24/7. ❷ Regular meals. Have healthy meals at around the same time each day, whether you are in the
action before things spin out of control. During “down” times, imagine yourself lost in a snow storm. If you stop moving, which is very tempting, you will freeze to death. Stick to your healthy schedule and do not let yourself lay
mood or not. When you are out, keep cheese, walnuts, almonds, and whole wheat or rice crackers with you so that you do not get hungry or suffer from hypoglycemia. The main ingredient in most psychiatric medication is sero-
“He became depressed and a shell of his former self. His parents thought they were acting responsibly when they had him hospitalized and then put in a hostel.” in bed all day. Volunteer, or find meaningful work. During “up” times, force yourself to shut out the internal excitement and relax with calming activities. I realize that many people will be outraged by these suggestions, especially those whose livelihood
tonin, 95% of which is produced in the digestive system. Your gut cannot function properly if it is filled with junk foods and medication, which is why so many people need an artificial source of serotonin. ❸ Hormonal stabilizers. Women who suffer from monthly ups and downs need gamma linoleic acid (GLA) in the form of borage or evening primrose oil (500 mg. every day and 1000 mg. ten days before the period). GLA is reduced after ovulation, which is why so many women have distressing pre-menstrual symptoms. Chasteberry is also a natural hormonal stabilizer. ❹ See a naturopath, who will prescribe a vitamin B supplement for stability. For manic thoughts, add 1000 mg. no-flush niacin and 1000 mg.niacinamide (B3). You might also need extra B5 or B6 and natural mood stabilizers, such as choline-inositol (500-1000 mg. twice daily). L-tryptophan creates serotonin and is calming. L-tyrosine and L-phenylalanine are natural anti-depressants. [These can be adjusted daily according to mood.] ❺ Check your thyroid functioning. Lack of sleep and lack of iodine can cause thyroid problems and mood disorders. ❻ Learn E.F.T., C.B.T. or other methods which teach you to downplay your moods and reprogram your mind with healthy thoughts. ❼ Exercise. Join a club with regular classes and go whether you are in the mood or not. ❽ Spot the symptoms and take
is threatened by self-healing methods. I have gotten hostile calls from conventional doctors who accuse me of being irresponsible and ignorant, and putting lives at risk by providing alternatives to psych meds. They repeat the refrain, “There are no side effects to psychiatric meds! Medication is the only way to deal with emotional problems.” However, I have fifty years of experience which has shown me that people who were functional before a psychotic episode can heal by adopting a disciplined lifestyle, learning to think securely and eat correctly. Teens, in particular, need to learn these skills so that they do not feel like passive victims of their moods, but develop the confidence to help them to ride out the emotional storms with positive thoughts and actions. Dr. Miriam Adahan is a psycholo-
gist, therapist, prolific author. She can be reached at email@example.com. In Israel, call 02.5868201. In the USA call 718.705.8404.
Helping Everyday Individuals with Everyday Challenges
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? of “No” The Magic Stein By Elisheva Nancy Silberman Zwiebach, MS, PD ? ? nyone who has attended one of my parenting workshops ??? be surprised to hear me tout will ing the word “no.” My usual mantra, after all, is “never say ‘no’ when you can say “yes.” I still maintain this “golden rule” because I find that many parents say “no” automatically because that’s the answer they would have gotten from their parents. Thus, it often comes without really considering for the request. Unfortunately, the opposite is also often true: parents won’t say “no” and don’t think about why the no was important in the first place. Believe it or not, studies show that over-permissiveness is more detrimental to a child’s emotional health than being too restrictive. We can look at the word “no” in two different ways. In one way, it’s a means of control, kind of a weapon in a classic power struggle -- and that’s when it needs to be guarded against. The other way of perceiving this word is as a way of setting up boundaries and defining the safe from the unsafe. It is from the latter meaning, that the magic arises. For children, the whole world is new and enticing. The toddler is just as bewitched by the electrical outlet as he is by the daisy. Both whet the appetite for exploration and discovery. That’s where the parent comes in. It is the parental experience that provokes a firm and resounding “NO” when that chubby little finger reaches out toward the outlet. It is that same “NO” that lets that child know that there is someone watching out for their welfare, looking to protect and guide them as they venture forth. At some point in the last “X” number of years, the word “no” has, for many parents, become a “four letter word” which they are reluctant to use because they feel it is wrong. The most extreme form in which this was demonstrated was shared with me a number of years ago. A teacher of two-yearolds, whom it had once been my delight to supervise, called me to ask for some advice. She currently had in her class the daughter of a psychiatrist. This dad had
instructed the teaching staff that they were never to use the word “no” with his daughter. Somehow, he and his wife had determined that hearing the word “no” would cause irreparable damage to the child, and so it would be omitted from her experience. In the class-
toy, which the mother retrieved for her. Once the little girl had it, she threw it down on the floor and signaled for another one. Once she had that, she repeated the process. She then got off the chair she was on, turned to her father, pointed at him and started screaming. He
room the child was out of control. She had no sense of boundaries, no understanding of others’ rights, and inappropriate behavior. From a teacher’s perspective, this child was a disaster, in her classroom. From a psychologist’s perspective, this child was screaming for help, flooded by impulses over which she had not learned any self-control and fears of not being protected from the dangers of the world. A not so extreme example occurred when a family came to my office in order to possibly enroll their child in our two-year-old program. Having only two chairs in this very small space, the parents sat down and put the little girl, standing, on the floor. As soon as we began to speak, the child pointed at her mother and started screaming. The mom got up from the chair and let the child sit in it. Then the little girl noticed a shelf above my desk with toys and books, put there to help children stay amused during such a situation. The child pointed, using verbalizations, at a particular
promptly got off his chair and let her sit down, with the mother then resuming her seat in the first chair. The process with the toys/books resumed until the girl, once again, “threw” her mother off her chair. At this point, the dad looked at me and with an embarrassed laugh, asked, “What are you supposed to do?” I responded, “You start with the word “no”. “No’s” and limitations are the verbal equivalent of swaddling. When we wrap a newborn in a soft blanket, we provide not constriction, but security. As the baby acclimates to the openness of the world outside the womb, we ease up on the wrapping and allow increasing freedom of movement. So it is as the child grows, when, with maturity and self-guidance, previous “no’s” turn into yeses and additional freedoms. Another story comes to mind, this about a 12 year old boy. The young man had gone to the movies with 3 classmates, 2 boys and a girl. The boy’s father had driven them and the girl’s dad was supposed to
drive them home. When the movie was over, the boy called his parents to announce the boys were waiting for the girl’s dad to pick her up, but that the boys would then walk home. The movie theater was on a major highway. The 3 boys each lived in a different town. It was late and completely dark with many roads having no overhead lighting. The boy’s parents said “absolutely not. You just stay where you are; daddy’s coming to get you. We’ll call Lisa’s parents and tell her we’re doing the driving.” When the young man walked into the house with his father, he was complaining bitterly, declaring “you never let me grow up; you treat me like a baby, etc.” What happened here? This boy did not want to walk home with his friends. If he did, he wouldn’t have called his parents in advance; he just would have shown up. He called his parents because he knew, he trusted, they would say “no.” Thus, he saved face in front of his friends, and he relied on what he knew about his parents -- they would not allow him to put himself in harm’s way. The “no’s” in a child’s life help him/her acquire the understanding of right from wrong, of appropriate from inappropriate, and of the permitted from the forbidden. It also helps children believe that they are loved, cared about, and protected, from the unknown and the dangerous. When used sparingly and in a positive way, they become the shelter under which a child is allowed to blossom into a confident adult. The Torah tells us we have an obligation to let another person know when he or she is doing something wrong. There is also a Yiddish saying, “G-d couldn’t be everywhere, so he created mothers” (and fathers!). G-d, in dealing with His children, allowed for questions, tantrums, rebellion, pleas and negotiations. He sometimes said “no” and sometimes capitulated, but He was always in charge - the Voice of Authority and The Final Word. I can’t think of a better role model. Nancy Silberman Zwiebach, MS, PD
Paramus, NJ • 201.843.1373 Individual, Couple, Family and Group Psychotherapy Psychometric Evaluations
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Parenting Expectations By Rabbi Raffi Bilek
abbi Noach Orlowek, shlit”a, defines anger as “the distance between expectation and reality.” I think this definition neatly explains much of the parental anger that we moms and dads struggle with as we try to raise superstar children. So much of our anger is the result of our having expectations of our children that are not met. This does not mean that we shouldn’t have expectations of them – only that we should be careful to temper those expectations with a clear picture of reality. Generally speaking, parents do not get angry at infants for dirtying their diapers. That’s easy, because we are expecting them to do exactly that. If an infant is not producing dirty diapers, we are even concerned that something might be wrong. We have an expectation that is easily and regularly being met. Yet when an older child who has already been potty trained has an accident, it is not uncommon for parents to get angry. They expected that their child could keep themselves clean and he did not. But is this really fair? It is unlikely that the child is deliberately flouting his parents’ rules in order to antagonize them. He probably didn’t notice he had to go, or miscalculated his ability to hold it, or any number of scenarios that would be quite understandable for a young child. Haven’t you ever forgotten to eat until you realized you were famished? Or miscalculated the time it would take you to get to your destination? We are human, and we sometimes make those kinds of mistakes. Adults usually don’t err in ways that end up in their going to the bathroom in their pants; but for children in their early years, it’s for the most part neither unusual nor purposeful. Parents who recognize that are more likely to react with compassion rather than anger. Similarly, tantrums are inevitable from time to time, but they’re perfectly normal. It therefore behooves parents to be on alert when kids are under the stress of hunger, fatigue, etc., which make tantrums more likely to happen. The anticipation of the event makes it much
less overwhelming when it arrives. However, if you believe that tantrums are deviations from your child’s normally acceptable behavior, you are probably going to have a much harder time accepting them with equanimity – which, is the best response. As Rabbi Leib Kelemen says, “You give in to a tantrum – you buy yourself thirty more.” (There is much more to say on this topic, which I will leave for another article.) Tantrums should be seen as normal for a human being who is only beginning to gain awareness of his emotions, wants, and needs. When one of my children throws a tantrum, I remind myself that this is the best she can do given her limited emotional development. Heck, I know many adults who have trouble controlling their emotions and staying level-headed in the face of stress and frustration. (Remember the last time you saw an angry customer yelling, illogically, at the cashier or receptionist about something which was obviously out of the latter’s control?) Can we really expect children to maintain perfect control over their burgeoning emotional faculties? Once we come to realize that our children simply lack the tools to respond in a more productive way, it becomes easier to tolerate “bad” behavior and to help them find the right way to deal with the problem. Remember that they will discover that path by watching us – if we react to difficult times calmly, they will learn to do so as well. If we lose our tempers when the going gets tough, how can we expect our kids to do any better? Interestingly, I think this same phenomenon is at work with teenagers. Teenagers are known for making excruciatingly bad deci-
sions and doing things that most grownups would consider stupid. Yet these are also relative assessments. We don’t call it a “bad decision” when an infant tries to stick his finger in the electric socket. We
don’t consider it “stupid” when a toddler pours her cup of juice on herself and then cries because she’s wet. They just don’t know any better, and don’t have the tools for assessing the consequences of their actions. Teenagers, being much more capable, sometimes fool us into forgetting that they are in fact not quite yet adults. Their decision-making abilities are not fully developed, nor is their capacity to evaluate consequences. This is demonstrated by both our tradition and by modern science. The Torah tells us that a person can be prosecuted in a Jewish court of law once they turn 12 or 13. However, a person is not held accountable in the Heavenly court until they are 20. In between those two markers are precisely the teenage years: during this time there is a measure of accountability, but not full accountability. The necessarily faculties for achieving full responsibility are cultivated in the intervening period. Modern neuroscience tells us the same thing: the wiring in the brain that is responsible for complex functions such as planning, prioritizing, and controlling impulses undergoes tremendous development during the teenage years– meaning that teenagers’ decision-making abilities are still a work in progress. If parents kept this in mind when confronted by the results of their
teen’s latest poor choice, they might find it much easier to feel compassion over anger. There’s an old joke in which a man asks his rav, “Where does good judgment come from?” “Experience,” replies the sage. “And where does experience come from?” continues the talmid. The rav responds, “Bad judgment.” Teenagers often have bad judgment. It leads them to unpleasant consequences, which we wish they wouldn’t have to suffer. At such times, the best response is to remind ourselves that they made the best decision they could at the time and to empathize with them. It is tempting to ascribe to them full culpability for their actions; but, just as with an infant at a socket, they are simply not equipped to make better choices. The fact that sometimes they do make good decisions, even hard ones, is no contradiction. How many times did your toddler fall before learning to walk right? How many mistakes did your gradeschooler make before learning his multiplication table? Consistency comes only after considerable practice and many errors. The teen years are be the practice period for decision-making. We should take a lesson from G-d himself in responding to our children. The Gemara in Sotah (14a) says that the Torah begins and ends with chesed: in Bereishit, G-d makes clothes for Adam and Eve; in Devarim, He Himself buries Moses. The two narratives have something more in common. Adam made a mistake that changed the course of his life; Moses likewise made a tragic error that prevented him from achieving his lifelong goal of entering Eretz Yisrael. Both of them failed to live up to what G-d had expected and hoped for from them; and yet G-d did not refrain even then from bestowing His goodness upon them. Shouldn’t we try to walk in His ways and offer our children the same unconditional love? Rabbi Raffi Bilek, LSW maintains a
private counseling practice online at www. frumcounselor.com and sees clients across the globe. He is also a speaker on issues related to domestic violence and sexual abuse in the Jewish community.
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? Identity Crisis? Shidduch Crisis or Elisheva Stein LCSW, CSAT-C By Yitzi Horowitz,
?y initial intention in writing ?this article was to explore various aspects of the “shidduch ??? but as I wrote I found my crisis” thoughts turning to a larger problem that needs to be addressed. A problem that contributes to the “shidduch crisis” and causes so many other problems in our community. The “shidduch crisis” is a nisoyon and we need to be careful about the propositions we make about it. The only proposition that is absolute about the “shidduch crisis”, like all nisyonos, is that it comes from Hashem and its fundamental purpose is to challenge us to become better people and closer to Hashem. I do not address my remarks to people who are not married. The profound loneliness and pain felt by so many is very real and it would be wrong for me to make a blanket statement about anyone’s suffering. Instead, I would like to address young adults and parents of children who are at the beginning stages of the shidduch process. My hope is to shed light on what I see as a serious problem in our community today. As the title of my article suggests, I am talking about people’s lack of self-knowledge. I am not talking about a cheshbon hanefesh regarding mitzvohs and aveiros; I am talking about being aware of who you are and how you operate as a person. Self-awareness is the key to living a healthy, welladjusted life. It is imperative in good decision making, and in the prevention of ga’aveh (haughtiness or being egotistical) as well as anxiety and depression. Self-awareness is certainly not easy, yet it gives us meaning in life. If you are not tapped into what your strengths and weaknesses are and how to use that knowledge to face challenges, you will not mature. We live in a product-driven society with many responsibilities and we are pulled in different directions. But there is a big difference between merely fulfilling your responsibilities and actually owning your life. If accomplishing your responsibilities is all you do in life then in effect you assume the role
of a human robot. To be human is to be the owner of your life; to lead a life full of meaning. Leading a life full of meaning is to live with these questions in the back of your mind: What do I want to make of my life? What characteristics do I have that can be used as assets and what are potential pitfalls? What makes me happy, sad and anxious? When do I challenge myself to make changes and when do I accept my lot in life? What are messages from Hashem and what are not? What are my morals and am I living up to them
how to engage their yetzer horah in the right way; they don’t know what their yetzer horah is. In his sefer, Da Es Atsmecha, Rav Itamar Schwartz (author of the series of seforim called Bilvavi Mishkan Evneh) posits that the first step to knowing Hashem is to know who you are. It is only through knowing who you are and how you work personally that you can know Hashem and follow his Torah in the way Hashem intended. It seems as though society has replaced self-knowledge with
and why or why not? What are my dreams, capabilities, hobbies, fears and sentiments? These questions are a tiny sample of what helps us navigate through life as ba’al habus of our lives. Ask an average person how they are feeling and too often the response is either “good” or “not good”. Better yet, many people answer “Boruch Hashem.” “Good” and “not good” are not feelings and we say “Boruch Hashem” when things are going well and not so well. We need to become accustomed to being aware of how we feel and think about things instead of living impulsively and robotically. Sadly, and more importantly, some people’s relationship with Torah and Hashem is just two-dimensional; they learn Torah academically and follow its Mitzvohs behaviorally but it has little impact on them personally. This causes a tremendous disconnect between people and the infinite richness of Torah. Even worse, while many people may know that the Torah says this is mutar and that is assur, they understand very little of
something that many people call mesorah but is really more aptly defined as “just doing what’s done.” Boruch Hashem we live in a time where Torah observance is flourishing. Modern technology (with all it’s nisyonos) enables a phenomenal amount of Torah learning. The kosher food industry has exploded and keeps us struggling with obesity instead of abject hunger. Affluence fuels our kollelim, kiruv organizations are bringing a plethora of people into the fold and the accepting progressive Western culture helps make all this possible. It is quite easy for people to observe yiddishkeit and feel happy. But there is an undercurrent of monotony and emptiness that has swept across our community. Our comfort has caused us to lead overly scripted lives. Too many people live on cruise control and allow the flow of “what’s done” to drive them through without actively involving themselves in the process. Too many people have “checked-out” of life. Who needs to think when you can ask your neighbor or hear
about the latest trend of “what’s done?” We have replaced our selfknowledge and subsequent selfgrowth with a corrupt vision of what mesorah is. I think it is fair to say that too much of what goes on in shidduchim is rooted in the “what’s done” in place of deciding based on “knowing yourself ”. A 20-year-old young man shared the following vignette. While he was contemplating leaving yeshiva to pursue his career, his rebbi said, “If you leave yeshivah you will be considered a ‘working boy’ and that will change the type of girls who will be willing to go out with you. You don’t want to marry girls who are looking for a ‘working boy’ because they are different than you (i.e. less frum). Even though I understand why you want to pursue your career, you really should stay in Yeshiva so people will think you are a ‘learning boy’ type and you can get married to a good (i.e. more frum) girl.” I don’t blame the student for being thoroughly confused. He is a serious and committed guy who happens to have a valid reason to leave yeshiva (including his level and seriousness about learning), and now has to sacrifice what his needs are in order to comply with our society’s notion of “what’s done.” I have the deepest respect for Torah learning and for the talmidei chachomim who fill our yeshivahs and kollelim. I am encouraging of beis medrash bochurim and yungeleit to be sitting in learning, but only if it is the right thing for them. Are our ways of approaching shidduchim enough of a reason that a person should push off his schooling? What happened to the partnership between hishtadlus and bitachon? And of course a couple needs to be compatible vis-a-vie frumkeit; but when we are making life decisions based on an expectation of “what’s done” there is something fundamentally wrong. Too many boys and girls are floating around Eretz Yisroel “learning” because they are following this scripted way of life. They have never been allowed to ask themselves if they want to be learning in yeshiva or know how to undertake
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the commitment of learning for a full year or two. Shidduchim plays a significant role in their decision to be there. The sheer volume of shidduch protocols falls under the rubric of what I am talking about. I believe there needs to be structure in shidduchim, but when two young adults are thrown into a date and they have to deal with all the “halachos” of what to say, when to say it, where to go, how to act and then also figure out the right thing to say to the shadchan, it leaves little chance for the couple to actually develop a relationship; and yes, developing a relationship is the goal of shidduch dating. Too many young adults don’t know what they want in Shidduchim, know less about what a relationship is but know a tremendous amount about “what’s done”. This narrow mentality continues to seep its way into marriage. Therapists continuously confront the issue of a young man or woman who is willing to get divorced without having an inkling
to be working towards that in our lives. John Gottman, one of the most well respected marital therapists, says that the best indicator of how a marriage will end up is how deep a couple is connected to each other. Let’s stop focusing on teaching people how to act nicely and instead focus on how to build meaningful and loving relationships. V’ahavta l’reyacha k’mocha -- if you can’t love yourself you can’t love someone else. So, if you want to prepare your children for shidduchim, encourage them over the course of their lives to learn about themselves. Do it yourself for your life. Learn and teach your children to develop and express themselves emotionally and creatively. Learn to develop and continue to build a relationship with yourself and create a home that is open to discussions about likes and dislikes, dreams, ideals and reality. Be open to discussing your struggles with life and Torah with your friends and your children.
of what they want or need in their relationship. Their expectations often leave them ill prepared to do the work necessary for a healthy marriage. We have scripted something that cannot be scripted- relationships. As a result, the shidduch system is failing too many. My article has covered two different topics that I have shown to be inextricably connected. It is not within the scope of this article, nor is it my intention, to solve the entire “shidduch crisis” or to alleviate the lack of self-knowledge. I only want to raise these issue together because of how they are connected. As a society, we need to shift away from the scripted nature of our world and focus more on our own lives as opposed to the externalities. While teaching our children that sinas chinam destroyed the Beis Hamikdash and being nice to one another is important, we need to be teaching our children about developing meaningful relationships, just as we need
Learn the chalakim of Torah that deal with personal development like sifrei mussar, chassidus and machshava. And daven to Hashem for guidance because this is how we realistically build a relationship with Torah and Hashem. May Hashem guide all of us to the relationships we need in life; whether it’s a spouse, a child, a parent or a friend. More importantly, may Hashem reveal to us the path towards developing relationships with ourselves. Most importantly, may Hashem bring us back to Him and fix our relationship with Him for good with the coming of the true Geulah b’miheira b’yameinu. Yitzi Horowitz, LCSW, CSAT-C is a
therapist who works with people ages 10100 and across the spectrum of frumkeit. He specializes in marital counseling, intimacy issues, addictions, issues surrounding homosexuality and depression. He can be reached by calling 347.809.0991 or emailing email@example.com. You can view his profile at http://frumtherapist.com/YitziHorowitz.
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? Anxiety in Children and Teens Elisheva SteinPhD By Benjie Stern,
? of anxiety among young ates ? people in America have steadily increased over the past ??? to seventy years. Today, five fifty to eight times as many high school and college students meet the criteria for diagnosis of major depression and/or an anxiety disorder. As many as 20 percent of children between the ages of 5 and 16 experience some type of anxiety, compared to the 5 percent of kids worldwide with attention deficit/hyperactivity disorder (ADHD).
These children are usually excessively self-conscious and perceived as shy. ✪ Generalized anxiety disorder—exaggerated worry and tension about everyday problems. Children with this disorder live with a sense of dread and frequently seek reassurance.
The good news is that childhood anxiety is treatable and even revers-
dure them. Parents can help first by not accommodating the fears or avoidance.“Pay attention to the anxiety,” says child and adolescent psychiatrist John Walkup, M.D. “But don’t play into the avoidance yourself and don’t use that and overprotectiveness as strategies.”As Walkup explains, “It’s counterproductive and undermines a child’s capacity to cope, tolerate and learn about the world—generating even more anxiety. Instead, children,
Anxiety in children can often be ignored with the assumption that the child will grow out of it. “In a way, it’s really a silent epidemic,” Mark Riddle, M.D., director of the Johns Hopkins Division of Child and Adolescent Psychiatry, says. “Most of the time adults aren’t bothered by it in their children until it’s severe and disruptive enough for professional help—if even then.” Childhood anxiety is a good predictor of depression and anxiety later in life. So, while it may seem minor in kids, anxiety can stunt a child’s growth and lead to bigger problems if left untreated. Social anxiety, for example, is the No. 1 nonacademic reason for dropping out of high school. Repeated and long-term panic attacks—a severe form of anxiety—may morph into phobias such as fear of leaving the home or going into crowded places.
ANXIETY DISORDERS DEFINED
The most common anxiety disorders in children are: ✪ Separation anxiety—marked stress when separated or anticipating separation from a parent or loved one. Physical complaints such as stomachaches commonly accompany this disorder. ✪ Social phobia—intense, persistent fear of being watched, judged and laughed at by others, and of doing things that would embarrass or humiliate oneself.
ible with cognitive behavior therapy/ exposure and response prevention (ERP) as well as parenting interventions. The trick is to identify the early signs and symptoms and take steps to address them. For parents, the first step might be to look into their own histories. Research shows a strong connection between parent and child anxiety. If a parent tends toward anxiety or has been treated for it, the children are more likely to have the same tendencies.So how do you know if your child is suffering and what can you do about it? Watch your kids for those behaviors that you may be already familiar with. Understand that for some children with anxiety disorders, reassurance won’t help. Other things to look for include unreasonable fears that don’t go away; physical symptoms that include heart palpitations, sweating, chills, stomachaches and headaches; and children who consistently avoid certain situations or become upset at having to en-
like adults, must face their fears. “We can’t underexpose our kids,” Walkup says. “Without forcing it, we need to let them feel the challenge of new or difficult situations” and feel more in control of their lives.Furthermore, parents need to be fearless themselves. “We live in a safer world than ever, but parents are more afraid for their children than they’ve ever been,” Walkup says. Anxious parents transmit that fear to their kids, whether they realize it or not.
RISE OF ANXIETY IN THE 21ST CENTURY
A study which analyzed children and college students from 1960 to 2002 reveals a dramatic shift in their sense of personal control. In the 1960’s, 80% of young people felt that they personally had ownership of their lives; in 2002, less than 20% felt this sense of autonomy. During the same 42 year time span, a similar trend is revealed in the rise of depression and anxiety in this age group. According to the
author Peter Gray, PhD, Professor of Psychology at Boston College, “when people believe that they have little or no control over their fate they become anxious.” Perhaps our today’s children have been schooled towards helplessness.
CHILDHOOD ANXIETY: WHEN TO GET HELP
It may be difficult for parents to decide when to seek professional help for childhood anxiety. Here are some questions to ask: ✪ Is my child’s behavior disproportionate to a specific situation? Have the physical symptoms of anxiety (stomachaches and headaches, restlessness, fatigue, etc.) persisted for longer than six months? ✪ Does anxiety impair my child’s life (i.e., stops him or her from going places and/or doing things)? ✪ Avoidance in particular is a red flag. Parents shouldn’t try to accommodate the behavior, but need to help their children manage and face their anxiety. Staying attuned to our children’s psychological needs can be as important to their development as recognizing the symptoms of colic or the common cold. As children go through life, they are deeply affected by its lessons: learning about loss or death, academic and physical challenges, defeat, and pain caused by the shortcomings of their parents or adult influences. The more we recognize what hurts them, the better able we are to respond to them with sensitivity and understanding. By helping our children make sense of their early life experiences, we are enabling them to cope in their adult lives. Dr. Stern, specializes in the treatment of
anxiety, depression, and OCD in children and adolescents. Offices located in Brooklyn and in Lawrence. He is the school psychologist in Magen David Yeshivah and as an adjunct college professor, has developed school prosocial anti-bullying programs, and has written, lectured and conducted workshops on a wide variety of child psychology topics. For more information or to schedule a consultation, please visit: www. DrBenjie.com or call 917.864.6274.
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A Ticking Time Bomb By Joy Naomi Jacobs-Muller, M.S. MHC
hmuel is an 8-year-old boy who cannot tolerate changes in his routine. If things do not go the way he expects, he erupts into a tantrum that terrifies his mother and siblings. For example, one night, Shmuel wanted to read a book that his brother was reading and promptly took it out of his brother’s hands. Shmuel’s mother tried to explain that this behavior was inappropriate, but Shmuel just didn’t understand. He wanted to read the book, so he took it. When his mother removed the book from his hands, Shmuel immediately fell to the floor crying and screaming. He then began to destroy the few books that were near him. Miriam’s mother asks Miriam, age 10, to stop playing a game and set the table for supper. When Miriam says “not now,” her mother insists that she do it, causing Miriam to scream that she’s in the middle of a game. Her mother tells her if she doesn’t set the table that instant she will be punished. Immediately after that, Miriam explodes in a rage, turning red in the face, screaming while throwing the game around the room. Does this behavior sound familiar to you? If so, you have probably explored every possibility to change the situation. You probably wonder why your other children behave just fine and what you might have done wrong. You might even blame your child, thinking that if they would just want to behave, they would. My hope is that this article will enlighten and help you in your situation. Children like Shmuel and Miriam are explosive children. It really doesn’t matter if their official diagnosis is Oppositional Defiant Disorder (ODD) or Attention Deficit Hyperactivity Disorder (ADHD); these children have a disability in several important areas or “skills.” As Dr. Ross W. Greene mentions in his book, The Explosive Child, “children do well if they can.” Many parents think their child is purposely being disobedient or willful. The parents think that if they only wanted to behave appro-
priately they would. This is where our Torah philosophy can come in handy, as it is very crucial to judge these children favorably and view them as mentioned above: If they CAN do well, they would; and if we honestly look at them from this perspective, it is much easier to offer them much needed assistance in developing the skills they lack. Collaborative Problem Solving or CPS is the term used when these explosive children and their
As Dr. Greene mentions in his book, CPS has three important components that must be used in the order they are listed here: “1) Empathy, 2) Define the Problem and 3) Invitation.” Empathy is the first step. You basically restate what your child stated as his needs. For example, in the case of Miriam above, the conversation would go something like this: Mother: Miriam stop playing and go set the table for supper.
ing you have the solution to the problem. Be open to your child’s initiative and you might be pleasantly surprised at how creative they can be. The other caveat is that the solution must be satisfactory to both parent and child. Keep working together to find a solution that will work for both of you. Mother: So Miriam, how can we both get what we want right now? You want to keep playing and I need you to set the table.
parents learn to work through their concerns together. This type of parenting is the only option for these types of children, as it will help them to develop skills and will hopefully avoid future explosions. Before I describe what CPS is, I would like to describe two other types of ineffective parenting skills that most parents utilize. The first is the “my way or the highway” method. This method requires that the child comply with the parental demands, and if the child does not comply, there are serious consequences. This type of parenting works for many typical children who have all the skills they need to comply with their parents’ demands. In fact, it might have worked with all your other children, just not with your explosive child. The other type of parenting is to completely drop all parental expectations and give in to the child’s demands. For the most part, this is an ineffective parenting choice unless it is used in an emergency situation in order to prevent your child from exploding. The negative is that you have dropped your own parental concerns which should then be addressed with your child at a later date.
Miriam: Not now Mother: I see you don’t want to set the table, what’s up? Miriam: I am right at the most exciting part of my game and I don’t want to lose. Mother: You are playing and the game is exciting and you don’t want to lose. We don’t stop at empathy. But it is the first step and you see that Miriam has yet to explode. With step two, defining the problem, you take your concerns and state them to your child. It is very important to make sure you have empathized first or your child will still feel as if you are doing the “my way or the highway” type of parenting. The continuation of the dialogue with Miriam would be: Mother: I understand that you want to win but the problem is that we need to have the table set for supper so that we can eat on time and it’s your turn to do that. As you can see, the parent has stated the problem clearly only after empathizing with the child. Now that the parent has stated her problem, it is time for invitation. This is where you invite the child to help solve the problem. One caveat: do not initiate this step think-
Miriam: How about I play for fifteen more minutes and then set the table? Mother: You would like to play for fifteen more minutes. However, that would make supper late and not be a solution since our supper has to be on time. Miriam: How about five more minutes? I am pretty sure I can finish and win by then. Mother: Okay, five minutes would work for me as well. Thanks for working this out with me. It might appear simplistic but this method really works. Of course, it might take you much longer to come to a mutual, satisfactory answer to the problem, but I guarantee it will be much shorter than any explosion would be! With CPS and lots of practice, you can have the peaceful and joyful home you’ve always dreamed of. For more information on CPS, I highly recommend reading Dr. Ross Green’s book The Explosive Child.
Joy N. Jacobs-Muller is a mental health counselor practicing at the offices of Dr. Kimberly Johnson, along with Rabbi Reuven Boshnack. Her website is www.mhcounselors.com.
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By Elisheva Stein
How to Use “Mentalization” ? Skills to Enhance Your Relationships
By Mirel Goldstein MS, MA ? ? hat’s the difference between private mental experiences ??? (things that happens inside of us), and concrete external behaviors (things that happen outside of us)? One of the main differences is that we can experience things that happen outside of us by using our senses. For example, when people smile, we can see their lips turned up in the familiar expression (an outside behavior). When someone looks away in embarrassment, it’s easy to see the eyes looking off to the side. When someone yells in anger, we can hear the loudness of their voice or see the red in their face. But looks can be deceiving! Have you been at a social event and put a big smile on your face, even though you were feeling terrible inside? Have you ever sounded angry, when you were actually feeling scared inside (such as when your child falls down and you yell “Be more careful!”) Have you ever looked really composed while speaking in public, when inside you were shaking? Have you ever told someone that you were really happy to see them, when inside you didn’t want to be around anyone at all? Most likely you can relate to at least one of the above scenarios. Many times our insides don’t match our outsides. Yet, most of how we read others is based on what we observe: their body language, expressions, tone of voice, and the words they say; and this is what can make relationships so confusing! We think we are reading other people accurately, and many times we are; but how many other times are we making guesses about what people feel, when we don’t know what’s going on inside their minds at all? This gets even more complicated when people tell us stories about their experiences. Suppose your son comes home from school and says, “My class is so mean. No one likes me. We were at recess and one boy started a ballgame. All the boys got to join in, but they wouldn’t let me play. I had to just watch all recess long! Everyone gets included
Wrong Interpertation Hurt
in everything except for me!” What would your automatic response be? Some parents might be dismissive, and tell the child to “get over it”. Others might be sympathetic and say, “I’m so sorry, that must have felt so bad.” Some might run interference, perhaps by calling the child’s teacher. Yet another parent might give advice, such as “Maybe you can befriend the boy who usually starts the game and ask him to include you next time.” There are so many possible responses! The tricky part is that this story (like every story) has two different types of information in it. Some of the information is about outside things; things that your son heard, observed, did, or had others do to him. But there are also subjective parts to this story, such as your son’s interpretations of what people felt or meant- and those are always guesses, because we can never see other people’s intentions. We can only assume. Can you tell which parts of your child’s story were about mental states, and which were about behaviors? If you can, then you possess a powerful tool for helping your child develop a sense of security and good social development. However, even if you can tell the difference between mental states and actions, it’s still hard to pay attention to those differences when we’re emotionally activated. That’s why it’s good to practice with lowkey scenarios. Let’s break down this example. “My class is so mean,” and “everyone hates me” both refer to mental states. “Mean” and “hating some-
one” are not things we can see. We can observe behaviors, but whether they are intended to be mean, or to be hateful, is something that goes on inside a person. How often do we think someone is being “mean”, only to find out later that we’ve misunderstood the situation? So, your son’s classmates may have been “mean”. Or, they may not have been “mean”. Even if someone’s behavior seems unkind, there are so many thoughts that go on in other peoples’ minds that affect their behaviors too. Knowing some of those private experiences might change the situation. For example, if a child recently lost a parent and started acting “mean” at school, we might feel sorry for him, rather than angry. What goes on inside of people makes a big difference. Perhaps your son came late to the game, and the teams were already picked. Maybe the boy said your son could play, but your son couldn’t hear because the game was so loud. It’s possible that your son was a “sore loser” in the last game, and the class was frustrated. Perhaps the boy in charge of the game was jealous of your son because your son does better than him in school. Maybe the boy’s father had bullied him that morning, and your son caught the brunt of it. Any information about the context is going to change how your son feels about the situation - even if the scenario was the same. Unless we ask questions, we’ll never have the chance to uncover any of these things. Now, back to the outside details in the story: Watching his friend play ball, asking to join and being told the word “no”, etc. are not men-
Wrong Interpertation Hurt
tal states, but behaviors that your son experienced directly. He then interpreted their “meanings” in a specific way. Many times, our interpretations are correct. But what happens when they’re not? This can lead to misunderstandings and emotional upset. When a person thinks that being left out of a game means that other people hate him, he is going to feel a lot worse than just disappointed about not getting to play. So our explanations of things we experience directly have a lot to do with our emotional reactions to them, and we often react based on false assumptions! So how can we slow this down? First of all, before reacting and doing something such as giving advice, sympathizing etc.., explore the context. Ask questions. Go over the story from start to finish, and find out as much as you can about what actually happened, and how he interpreted the situation. For example, you might say to your son: “Please tell me the whole story. Start from the beginning of recess. Tell me what you said, what you thought, what you did to try to join the game, and what they said to you or did.” Then, talk with your child about how he interpreted the situation, and ask him what clues he used. Perhaps you can offer some other possible interpretations, or ask your son if he can come up with any others on his own. Or, after hearing more details, it might seem that his interpretation was accurate based on the whole context, in which case you can offer advice, sympathy, or encourage resilience. But at least you will understand the situation before reacting to it! Here are some other scenarios to help you practice this skill. Read the scenario and then divide it between the “behaviors” and the “private mental states”. ✪ Scenario: Your daughter comes home from a date. She really liked the boy and feels really excited. The shadchan then calls and says that the boy had a nice time, but wants some time to think about whether he wants to go on another date or not. Your daughter feels Goldstein Continues on Next Page ➙
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A Matter of Relationship By Mindy Hajdu, MS, LMSW
oshe and Sarah have been married for 5 years. Moshe describes Sarah as controlling and critical. Sarah describes Moshe as withdrawn and aloof. The conflict between Moshe and Sarah has increased with time, causing each to feel disillusioned with the other. Just as in mainstream society, our community too has its share of couples living in a state of mutual disconnection and contention. The reason? “He needs to change!” she wags her finger. “She needs to wake up and smell the coffee!” he rebuffs. Each holds onto his or her position tenuously. Until then, husband and wife pass by like ships in the night, living two very lonely lives.
UNDERSTANDING THE RELATIONSHIP DYNAMIC
Humans are social, emotional beings, who crave connection with others. Our family and social network are the highlight of our existence—which might explain why we spend so much time talking about them, getting together with them and even blaming and criticizing them! We are the sum total of not just ourselves, but the people with whom we form attachments. These attachments – namely relationships—develop through a back and forth, or give and take between two parties. The “give” can’t happen without the “take” and the “take” can’t happen without the “give.” The classic example – A person cannot give a present to someone if there is no one to receive it, just as a person cannot receive a present if there is no one to give it. This might explain why locating a problem in “the other party” will not solve the issue. Aside from putting the “guilty” party on the defensive, this approach considers only one part of the equation. It Goldstein Continued from Previous Page ➙
angry and says “I really opened up to him this time and I thought he actually liked me and could accept me for who I am. I guess you can’t really be yourself, because people end up getting turned off. Next time I’ll just have to be less trusting and open about myself.”
locates the problem within the individual, without considering the impact of one person’s behavior on the other.
GOING DEEPER UNDERSTANDING THE CYCLE
But if we just say, “My son, Yaakov, wasn’t listening to me so I yelled at him,” and end there, thinking next time he will listen because I yelled, we are mistaken. The behaviors that take place between two people in a relationship are not linear, but cyclical. Meaning, one action doesn’t just cause another and then it ends there. It goes on and on, back and forth with increasing intensity. This might explain why Moshe and Sarah have experienced more conflict with the passing of time. Chances are that Moshe and Sarah, are caught in a negative cycle. The more Sarah tries to control Moshe, the more he withdraws: the more he withdraws the more she tries to control, and so on. There are no real guilty parties here, just one person fueling the other’s behavior. While hearing about negative cycles of interaction might sound depressing, –it is actually great news! Because like any cycle, (think washing machine, dishwasher) when one of the steps goes awry (your washing machine skips over the spin cycle!) the cycle can’t complete itself. And while we are definitely not promoting tamper-
ing with our household appliances, we are most certainly advocating for disruptions in our negative cycles of interaction. DISRUPTING NEGATIVE
CYCLES OF INTERACTION, PLANTING THE SEEDS FOR POSITIVE ONES
Because any disruption in a cycle will stop it in its tracks, here are ways to do it. ✪ Examine your behaviors along with the behaviors of your loved one. What behavioral patterns are emerging? Does the conflict seem to be increasing with time? ✪ Identify your role in the cycle. Simply becoming aware of your part in the equation will allow you to see how you might break the cycle and build a different kind of connection with your loved one. ✪ When your loved one throws you one of his or her typical behaviors (spouse is controlling, child tantrums, friend yells), say to yourself, “okay, my son/child/friend is doing his thing now, how could I respond differently than I normally would? Considering doing something different on your part is probably the most important step in turning the cycle around. ✪ Try to be consistent with your new behavior. It might not work on the first try, but after several attempts of doing things differently, your spouse/child/friend, won’t be able to keep up the cycle without
“Humans are social, emotional beings, who crave connection with others.”
✪ Scenario: You come home from work and your wife yells, “You didn’t call me all day. I was left all alone with the kids for hours, and you didn’t even care enough about me to check in and see how I was doing!” Do you want to develop even more sophisticated mentalization skills? Try practicing with hot-
button issues that frequently come up in your own home. Remember, play detective… ask a lot of questions, consider other perspectives, and try to understand as much as you can about the context. Mirel Goldstein MS, MA is a gradu-
ate of Columbia University; New Jersey Licensed Professional Counselor; Author
your fuel – which will mean he or she will begin to respond differently to you too! ✪ Work to plant seeds of positive, healthy connection. Keep in mind that one action will fuel another – so make yours a positive one. Stretch yourself to go the extra mile for the other person –“just because” – and not so that they will “owe you.” Fake it if you need to. The payoff for creating a positive behavioral cycle becomes exponentially greater as love and respect in the relationship deepen. We live in a world full of interactions and relationships with those around us. Taking responsibility for the roles we play in our relationships will help us to get rid of destructive patterns and allow us to create the meaningful, loving relationships we are looking for. Because as we all know, it takes two to tango. The content of this article generalizes the impact of one person’s behavior on another and is not meant diagnose or treat. In cases of severe addictions, abusive behaviors, or severe untreated mental illness, one party might have to significantly change his behavior in order for the two parties to be in a relationship. If this describes your relationship, please consult with a mental health professional before adopting any of the above practices. Mindy Hajdu, MS, LMSW, received her
MA in Secondary Education from Azrieli Graduate School, her MSW from Wurzweiler School of Social Work and has completed a year of training in family therapy at the Ackerman Institute for the Family. She is a supervisor at OHEL’s Preventive Care Program, where she provides training and supervision in areas of family therapy and crisis management. Mindy is available for consultation and supervision. She can be reached at mindyhajdu@ gmail.com.
of a recently published (frum) book about the psychotherapy process; Administrator for the International Society for the Study of Trauma and Dissociation (ISST-D)’s online training courses; and Former forensic specialist for Passaic County Justice Involved Services Program. Mirel sees patients privately in Passaic, NJ and can be reached at 303.204.7039 or firstname.lastname@example.org. Her website is www. goldsteintherapy.com
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By Elisheva Stein
The Writing?on the Wall: Noticing the Signs of Sexual Addiction
? By Binyamin Tepfer PhD, CSAT-S, ? CMAT
??? ddiction necessitates secrecy, double lives, and self-denial in order to allow self-destructive behaviors to persist over time. An addiction can survive so long as addicts can sustain their dual Jekyll and Hyde existence. Once the behaviors are discovered by loved ones, the addict can no longer easily maintain this lifestyle, and is often forced to confront the unpleasant truth about the reality he/she is living. Over time, addicts need to develop sophisticated methods of covering up behaviors, excusing irresponsibility, and lying about unacceptable parts of their lives. Their double life allows this self- denial to continue, keeping others unaware and unable to confront the addict. It is therefore imperative for people to know some of the common of addiction. This will ensure that such behaviors do not perpetuate and proceed unchallenged. Only after discovering the truth about her husband’s three-year long sexual addiction did Aliza finally begin to put together the patterns in her husband’s behaviors that had never quite felt right to her. Her husband’s repeated stories about why he took so long to come home from shul never seemed genuine; neither did the way he was so private about his cell phone, claiming his clients needed confidentiality. Only after discovering all the inappropriate contacts that her husband made and websites he frequented did things begin to make sense to her. Among the various addictions, sexual addiction in particular ranks high in the challenge of proving addiction. Sex addiction is comprised of behaviors all related to obtaining some sort of “high” from a sexually stimulating activity without ever ingesting any actual substance. There are no clear side effects that follow the behavior, as with other addictions such as chemical and alcohol dependency. In addition, technology offers many convenient options for sex addicts to easily maintain secrecy, compared with other addictive behaviors. Despite these fac-
tors, there are still discernible patterns that can serve as yellow flags to help friends and family raise concerns worth looking into. Some of the behaviors commonly associated with sexual addiction are: ✪ EXCESSIVE PRIVACY: Is there a pattern of excessive time spent alone? Do phone calls often need to be taken privately? Does the person often hang around the computer after everyone else goes to bed? Are they very protective of their phones and/or email accounts? Do they repeatedly change the webpage or shut down the computer when others come into the room? Do they often bring their wifi devices into private settings such as the bathroom for long periods of time? ✪ POOR EXCUSES: Has there been a pattern of inappropriate material found on the computer history with repeated excuses given, such as, “it must be from the babysitter.” Does the person respond to any possible allegation made against them with anger and rage? Is there a general pattern of lying? Reaction-Formation: Is the person overly focused on issues of sexual morality, more so than on other areas of spiritual wellbeing? (Those who stringently and excessively speak out against immorality sometimes struggle with these issues themselves.) ✪ MISSING MONEY: Is there ambiguity regarding expenditures? Are there questionable credit card charges? Is there much more effort and/or money spent on looking more attractive lately? ✪ SPOUSE RELATIONSHIP: Have they recently made new kinds of sexual requests? Do
the requests make their spouse feel uncomfortable and awkward? Has there been a strong change in levels of interest in sex (in either direction) within the marriage? Is there a lack of emotional connection during times of intimacy? Has the level of religiosity in general changed? Is
his wife was having several ongoing emotional relationships with other men. He confronted her with these facts, and was able to eventually get her to begin the counseling she so desperately needed to help her deal with her problematic relationships. Although none of the behaviors
there a lack of trustworthiness and dependability others have in them? Do they get very angry if their sexual needs are not met on demand by their spouse? Do they make justifications for being sexual with their spouse even at times when it is prohibited by halacha? Do they insist on exposing others such as their spouse to sexual stimuli they may not be comfortable with? Joel knew that things were off when he began noticing his wife’s excessive amount of time spent on social media sites, along with the intense privacy that she demanded in managing her different online accounts. Before long, Joel took these concerns seriously and confronted his wife directly, sharing with her how uncomfortable her current use of social media made him feel. The boundary that they both agreed upon was that she would not hide the identity of anyone that she “friended” on these sites. After looking into the identities of various contacts she had made, Joel realized that that
above can be taken in isolation as evidence of sexual, the list can still be useful in identifying patterns of behavior which, together with several other factors, can create a strong reason for concern and further inquiry. Despite the fact that the common response of family and friends is to downplay the matter, minimizing such signposts may be enabling such patterns of behavior to continue unchallenged. The first step we must take in helping our loved ones is to deal with our own denial that something questionable can be going on. Only then can we begin to take a more honest and responsible look at the writing on the wall, and confront what may be lurking just behind the facade.
Binyamin Tepfer PhD, CSAT-S, CMAT,
is a clinical psychologist in private practice in the Five Towns and Brooklyn. He specializes in marriage therapy, treating infidelity, and counseling for sexual and multiple addictions. He can be reached at 516.426.5415, email@example.com, and www.binyamintepfer.com.
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Dr. Jekyll and Mr. Hyde: Two Parts of a Whole By Tali Moskowitz, LCSW
he Mysterious Case of Dr. Jekyll and Mr. Hyde is a novella by Robert Louis Stevenson about a prominent doctor who believes that there are two parts to every person: good and evil. As an experiment, the doctor creates a potion that divides the two sides of his character, allowing him to transform between the good person and the evil person inside of himself. Sometimes he is Dr. Jekyll, the kind and educated doctor; and sometimes he is Mr. Hyde, dark, mysterious and violent. I cannot count how many times a client of mine has described a loved one as behaving like Dr. Jekyll-Mr. Hyde, or as having a “split personality”. These clients are often distressed and feel a need to understand how their loved one can “flip” from one extreme to another. It is distressing that only they know this “bad side” of their
yet his teachers describe him differently. The parent may ask the teacher, “Are you sure you’re talking about my kid?” If you see this split in yourself, don’t worry. This is entirely human. In fact, we have many parts to our personality, a multiplicity of the mind. Everyone has experienced arguments with themselves. One side of you is thinking one way and another side thinking the exact opposite! A woman struggling with weight loss may battle with different parts: One side wants to follow the diet while the other side of her just wants to eat sweets. Another person may view himself as generally very kind and gentle, yet when confronted with particular people, a different side of his personality emerges. Internal Family Systems Therapy (IFS), a type of treatment developed by Dr. Richard Schwartz, explains the mystery of Dr. JekyllMr. Hyde. In “Introduction to the Internal Family System’s Model,”
different “parts” of their personality. Some parts develop protective roles that may cause a person to behave in extreme ways. You may notice a grown person throwing
“It is distressing that only they know this “bad side” of their husband or wife, while others only see the “good side.” a tantrum or behaving in a selfdestructive way. During the course of life we experience events or go
in self-protective ways to prevent us from feeling emotional pain. In other words, when a person is reminded of past hurt, a part of him will try to push the pain away through protective behavior that appears like an overreaction. To an outsider, it can seem as abrupt as if he just drank a potion and turned into Mr. Hyde. Through getting to know our inner voices, our behavior can change. When we learn to create peaceful relationships with the inner parts of ourselves, our relationships with others naturally improve. Imagine that that there is a part of yourself that irritates you. Maybe you hate that you sometimes snap at your kids. If someone you know has a similar part to them, it may remind you of this part in yourself; and if you dislike this part of yourself, you may find that you also dislike this part of other people. On the other hand, if you get to know that part of yourself and have it work for you instead of against you, you will find yourself more forgiving toward others when they behave the same way. When a spouse or child behaves in a way that upsets us, we understand that it is only a part of them acting this way, and probably for a good reason. Although it may not be effective, we can understand that they are simply trying to protect hurt feelings. When we are able to identify and separate the different aspects of ourselves, we can each connect to our true self. We can lead our selves from a more grounded place instead of letting the protective parts of us lead. We no longer have the need to fight with ourselves and consequently become more forgiving of others. So the next time you see your sister, brother, son, daughter, husband, wife or good friend “flipping” on you, remember . . . there’s someone else in there. Tali Moskowitz is a Licensed Clinical So-
husband or wife, while others only see the “good side”. Any parent can attest to experiencing different sides of their children. A child can be intensely challenging at home,
Dr. Schwartz explains: “we have ongoing, complex relationships with many inner voices… that are similar to relationships we have with other people.” All people have
through challenging times that cause emotional pain. The IFS model of understanding human behavior explains that different sides of our personality behave
cial Worker and is trained in Internal Family Systems Therapy. She has been providing psychotherapy to children, adolescence and families for over 16 years. She has a private practice in Hewlett, NY and can be reached at firstname.lastname@example.org.
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This?Year’s Book of Life Isn’t Sealed Yet… G’Mar Tov
JOIN US FOR OUR FEBRUARY ISSUE By Elisheva Stein
H MIND, BODY S O& U L ? ?
February 2013 A Publication of
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A Mental Health Magazin e
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By Dr. Judith Guedalia
ccording to Webster’s Dictionary, a metaphor is a literary figure of speech that describes a subject “by asserting that it is, on some point of comparison, the same as another otherwise unrelated object”. I have nouns, verbs, and adverbs bouncing around my head and, as a Neuropsychologist, I am trying to understand what my ‘firing’ neurons are telling me. My personal definition of myself is a neuropsychologist melded with the combined (in chronological order) ‘selves’ as child, sibling, wife, mother, mother-inlaw, grandmother, greatgrandmother and of late, cancer patient. During my long nights, my iPad and I think a lot, which is a less than optimal activity given my state of being with many ideas and words popping into my head. Complicating matters further, we first moved to Israel in the late ‘60s and left in June of 1973 for a ‘sabbatical’ -- seven years of working and studying in various States of The Union-- to return in 1980. We have lived, studied and worked here in Israel ever since. I feel that the ‘bouncing ideas’ are somewhat like the Luigi Pirandello play Six Characters in Search of an Author. The words and ideas are in search of a metaphor to meld them: ✪ Non-Compete /Non-Proliferation Clause ✪ Aren’t you angry at G-d? ✪ Arab Spring/Arab Fall ✪ Martyrs—Those who Shout Allah Akbar vs. Shema Yisrael ✪ Excellence/Perfection and Akedat Yitzchak Looking at them in the light of day, I begin to see their connections to me at this point. My cancer, Stage IVB Grade III at diagnosis July 2010 --‘Top Marks’ with almost no ‘wiggle room’ for any forward movement, is with me as a partner for keeps. It has refused to sign a Non-Compete contract, a form that most businesspeople sign on employment. It is actually a type of ‘pre-nuptial agreement,’ hoping that the ‘marriage’ won’t end, but if it will, certain protection will be in place. I somehow define my psychological interventions differently, given the diverse population of patients I see, who feel I can ‘fix it’. I fervently pray that I can help them see ‘yesterday and today’ as givens, and ‘tomorrow’ as a four dimensional ‘place’ where, given the realities, we have choices how to live by them and live with them beyond their manifest limitations.
Well-meaning folk have a repertoire of interacting with a ‘Terminal’ patient and, possibly using the seminal work of Kubler-Ross, ask: “Are you angry at God?” Not infrequently, I have been made to feel ‘inadequate’ in the healing process by not exhibiting this ‘obvious’ behavioral response -- as if the cancer would go away if only I would accept being angry at G-d. My response to them, and to myself, has been: “To whom will I pray if I am angry at God and, more so, if I undermine my belief system?” This is met with incredulity and protestations that I am in denial. I might add that they also see my lack of crying on demand and carrying on my life irrespective of medical interventions with suspended belief in my working through my condition. I staunchly believe prayers -- mine, my family’s and those of my Am Yisrael family, help me day by day. So, I have chosen not to return to those people for help. I have been fortunate to find other more enlightened, experienced, and medically aware mental health colleagues, who are able to quietly absorb the pain, and not respond in ‘plasticized/Teflon-like’ platitudinal formulae. I am saddened by the hordes of patients who are not aware of their options, and learn to blame themselves for not being healed, as opposed to being strengthened by a professional who will aid them in finding the strength to make and live with their choices. A wonderful internet site that offers the ill, family and friends a place to learn, vent and share is www.csn.org/forum, the Cancer Survivors Network. On the site is a list of various cancer diagnoses and one clicks on the appropriate ListServ. The multinational folks who I have ‘met’, are smart, wise, open to sharing their experiences, and most of all, supportive and life affirming. We all observed the Arab Spring from afar, hoping that maybe at long last they would finally ‘spring’ into a 21st Century democracy. Here we are in the Arab Fall, watching how they are imploding and ‘de-springing’ into the mire and quicksand of the very early undemocratic rule of earlier feudal centuries. As frenetic as life here is, where Bet Shemesh, the home of many of my grandchildren and great-grandchildren, has become an epicenter of News Bites for religious fanatics, you might be surprised to learn the events of this Sukkot. Hundreds of children from various (mostly English speaking) neighborhoods went ‘Trick-and-Treating’ yesterday as they Sukkah hopped. They walked around, car-
“By asserting that it is, on some point of comparison, the same as another otherwise unrelated object.”
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rying plastic bags, in pairs or in groups, not all at the same time so as not to totally deplete the goodies left out in the Sukkot for those coming behind them, nor frighten the hosts of the oncoming cavalcade. Ironic, isn’t it, that this same freedom of movement is certainly not the rule in ‘safe’ USA at any time, most poignantly as last summer’s kidnap, torture and murder of an Ultra-Orthodox child in his Brooklyn neighborhood taught us; but even in secular neighborhoods around the US in two weeks’ time on Halloween! ‘Safe and Wellness’ is what I feel very seldom in my condition, but seeing the cherubic faces of our Sukkah visitors and their sense of safety walking around with their ‘stash’ of goodies, brought warmth and a sense of wellbeing, to my heart and soul. Lastly, I bring the week’s big news item here, as I heard from my USA family and friends, that a small contingent of soldiers, whose job it was to give water to fleeing-from-suredeath African illegal emigrants, was ambushed by a heavily armed group of terrorists. The group of soldiers was comprised of a few 18-19 year old conscripts, both men and women. One kippa seruga male soldier, after being mortally wounded, managed to kill one of the Terrorist infiltrators and wound another. A combatready female soldier, not a regular sight on the front lines here, managed to kill another. Seeing no military backup and the uneven numbers of terrorists vs. soldiers in the vicinity, a third soldier, female, with the recent memory of kidnapped soldier Gilad Shalit’s six years of torture, hid in the bramble. Rightly so, the army lauded the bravery of the dead soldier and the woman who shot and killed the terrorists. The one who hid was reprimanded, whereupon many newspaper articles and op-ed columns derided the army’s heavy handedness and derision in her case, and applauded to her bravery to hide so as to fight another day, and not be the epicenter of a future horribly uneven prisoner exchange. Moving along with my seemingly disjunctive associations, living in Israel, our country is not the beneficiary of friendly neighbors. Plus, lest we forget this reality, the hourly news channels’ constant bombardment of the air waves, with the fear of imminent death and nuclear disaster, at best ‘interesting’. It is almost a relief to think just of my ‘nuclear’ world, myself and my family, and my own internal combustibility as the ‘bad-buggers’, as I call them, proliferate in various spots in my anatomical map. Thank G-d, my various oncologists and I have been somewhat successful as the proverbial ‘Little Dutch Boy’, placing fingers in the holes in the dyke (i.e. using miraculous Radiation delivery systems, deft surgery, and
chemotherapy) waylaying and delaying a sadly bitter end. And so these random thoughts relate to my own case where, try as I might to ‘shoot’ the ‘bad buggers’ who have stolen into my body, I am happily lying low in whatever ‘briar patch’ Hashem and the field of medicine has to offer, giving me more time to fight another day. Continuing my bombarding thoughts, after reading on Yom Kippur of the binding of Isaac (Akedat Yitzchak), I recall a question I had as a child learning this in Yeshiva elementary school, that it seemed to me that the price of excellence and perfection before God was so high as to require the death of one’s child. Clearly, in my explicit memory, I recall my teacher’s saying that Hashem never expected to have Isaac be a human sacrifice, as this is profoundly against all of what Judaism and God stand for. But I also recall how I pushed on, saying Abraham didn’t know God’s plan and acted in ‘good faith’. There was a happy ending, if you don’t pay attention to some commentaries who say that Sarah may have died of a heart attack on hearing, about the ‘sacrifice of Isaac’ before the denouement. The good ending was that a Ram was found caught by its horns in the brambles, and hence we blow the shofar at the close of Yom Kippur to remind G-d the extent our forefather went when he proved, beyond a reasonable doubt, that he was a believer. These events and the heavily armed terrorists’ shout moments before their death, of Allah Akbar, God is Great, brought to mind a great difference between us and them. Before we die we acknowledge our sins and say “Shema Yisrael Hashem Elo/h/ainu Hashem Echad”- Here O Israel (Jacob) Your God is Our God, Your God is One. We don’t scream God Is Great, as we are about to murder in his name, but we leave this world reaffirming our connection with our heritage, with our forefather Jacob and the covenant He made to Abraham, Isaac and Jacob, that we, His Chosen People, will live on, beyond whichever madness is around us. That is my prayer to me, my nuclear family and my larger family, the Jewish People. Shanna Tova and G’Mar Tov (May this be a Happy, Healthy New Year and there should be a Good Ending) The author is the Director, Neuropsychology Unit; Chief
Psychologist; Shaare Zedek Medical Center; Licensed Supervisor and Specialist in Medical, Rehabilitation, and Developmental Psychology; EMDR Certified Practitioner: Supervisor; Certified ADOS Diagnostician; Co-Chair Nefesh Israel. Dr. Guedalia can be reached through her website: www.drjudithguedalia.com Also her new book: A Neuropsychologist’s Journal: Interventions and Judi-isms is available through Urim Press and www.amazon.com
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? Re-building Lives By Elisheva Stein
By Batya Jacobs
ne of my clients once told me about the first time that she was taken to a mental hospital. She was very confused. She didn’t feel comfortable in her body. She didn’t know how to be or what to do next. She kept on trying to run to the nurse’s station because she was terrified of the other patients. In the end she was strapped to her bed to keep her safe and out the way. She was diagnosed with schizophrenia. But did that diagnosis change who she was, or is she now just labeled a schizophrenic? There are many in the mental health profession who are very careful not to say “schizophrenic, ” instead they may say, “X is living with schizophrenia.” What difference does it make how you say it -- schizophrenia is schizophrenia. As one doctor acquaintance of mine put it “How can you say that a schizophrenic has hope? I think of schizophrenia as cancer of the mind, they get worse and worse until there is nothing left of them.” Boruch Hashem, that doctor was not working in the mental health field. The concept of “mental illness” is based on the assumption that mental issues fit into the same model as medical issues. Words like treatment, curable, incurable diagnosis become part of the vocabulary used to discuss mental “conditions.” Yet it is not at all clear that the mental and the physical are part of the same ball game. While researching an article on mental illness, I asked Dr. Gerald Caplan (z”l) former Professor at Harvard Medical School and former Head of the University Department of Child Psychiatry in Jerusalem “Are mental illnesses real?” He took me on a guided tour of the DSM (Diagnostic Statistic Manuel of Mental Illness). This definitive book presents all the accepted mental illnesses. For each condition it lists potential symptoms and states how many need to be found in order to conclude that the patient is suffering from that condition, (e.g. 5 out of the 8). There are recommendations for the type of treatment: medication and/or therapy. The DSM has recently been updated. Its contents are based on the observation of thousands of psychiatrists. The conditions listed have a statistic reality. They are not like a broken leg where you can see what is wrong. They are not even like influenza where you can see the virus under a microscope. Nowadays, brain imaging is revealing patterns of similarity between those who suffer from certain conditions and those who don’t.
Yet researchers can’t be certain which came first, the illness or the pattern. Many think, for instance, that schizophrenia describes a group of illnesses. Is an illness defined as a common group of symptoms or a common cause? Some categories have been dropped from the DSM because the “symptoms” have become socially acceptable. “Treatment,” Dr Caplan concluded, “follows the principle that if it works, use it, given that the aim is for minimal interference.” During a discussion about psychiatry today at a mental health clinic I was working in, the science of psychiatry was said to be in its early stages. It could generally describe but not yet predict. Much of the lay population of today is very knowledgeable about mental health. Many clients have told me exactly what damage their parents have done to them. Some rattle off their selfdiagnosed mental health condition, having come to such conclusions by using popular” diagnostic” scales. The client knows just how he should be affected by whatever he has and he obligingly produces all the right symptoms. It is ironic that the lay population seems to be much more confident in the reality of “mental illnesses” than the profession that created them. A diagnosis of schizophrenia, for instance, is based on observing two or three out of nine behavior categories and their subcategories that the patient has shown over a six-month period. The diagnosis is complex, but what does it really mean? It means that one can expect the patient to display some of the symptoms in the DSM list some of the time. Certain medications may help to reduce the effect of some of the symptoms. Schizophrenia is cyclical, so the patient can be doing well for some time and then be hit by a renewed attack. The diagnosis tells you what might happen next, not why it happened and not how to cure it, for it is incurable. Some time after being diagnosed with schizophrenia as a teenager, Dr. Patricia Deegan noticed that she was spending her days smoking cigarettes and waiting for the night to arrive. She realized that, if she didn’t do something, she would waste her entire life. She had to differentiate which actions and behaviors were due to her ”illness,” which to the side effects of medication, and which to her reaction to her diagnosis. She had to find out what she could and couldn’t do. Her goal was to re-claim her life, not to be “cured.” Dr. Deegan is a professor of psychology and
“The concept of “mental illness” is based on the assumption that mental issues fit into the same model as medical issues.”
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nia you live with. Schizophrenia affects you but it is not you. There is room to maneuver. There is room to observe how your ”illness” tricks you into restricting your life. There is even room to dream about the life you want to lead: “To me getting well means that I try to stay in the driver’s seat of my life.” That’s one persons dream. Dr. Patricia Deegan says that “it is possible to live a whole healthy life and still have a psychiatric disability.” It is not enough to have a diag-
her husband. Another client was hoping to hold onto her job while living her shana rishona and thinking about having children. When someone is labeled schizophrenic, the label comes with a list of symptoms, treatments and prognoses. The person ceases to be a unique individual, their motivations are understood in terms of their “ illness” and are often thought of as manipulative. This mass prediction often condemns the victims of such illnesses to a life of graded functionality: “She is a high functioning bipolar.” That’s it? That makes her sound hardly human. Perhaps she is also a mother who is doing her best despite her difficulties. Real people don’t “function” they “live’. If you are living with schizophrenia, whole chunks of your character, your values, your behaviors, might not be affected by those symptoms that comprise the particular form of schizophre-
nosis. Treatment of mental illness is not a matter of taking an antibiotic and you’ll get over it. The mental illness itself has its effects, the person’s reaction to being deemed mentally ill has its effects, the medication has its side effects and the label mental illness has its effects on all those around the patient. In most cases the acute symptoms can be stabilized and once that has been achieved the goal is to find the real person again. To see what they can still do; to go on living despite their limitations; to follow their hopes, dreams, values and commitments and re-build their lives.
Batya Jacobs is a Narrative Therapist working with indi-
viduals, couples and groups at the Jerusalem Narrative Therapy Institute in Yerushalayim, in Moshav Matityahu. She also works with phone and skype locally and internationally. She has degrees in psychology and social work. More writings by Batya can be found on http://www.jnti.net.
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helps those suffering with mental disorders to re-claim their lives, yet she still has to deal with the bad times when the “voices” deafen her despite the medications. Not that all people living with schizophrenia could necessarily become professors of psychology if they set their mind to it. But, as another of my clients who lived with schizophrenia said, “Nothing stands in the way of the will.” That client was working at building a relationship with
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