New York – The student newspaper of Yeshiva University The Observer has an interesting interview with rabbi Rabbi Nathaniel Helfgot on his thoughts on how depression is perceived by the Jewish community. Rabbi Helfgot revealed in 2001 that he suffered from severe depression, and now talks about it of how he has recovered.
The Observer: Thank you so much for speaking with us, Rabbi Helfgot. Could you give us some background information about who you are, what you do, where you teach, etc?
Rabbi Nathaniel Helfgot: I currently serve as Chair of the Departments of Tanakh and Jewish Thought at Yeshivat Chovevei Torah Rabbinical School as well as coordinate YCT’s community events such as the popular Yemei Iyun on Tanakh since 2002 ( a program which I am delighted has been copied and adopted by the students and administration at YU the last two years). I am a proud graduate of Yeshiva College, Azrieli Graduate School, and musmach of RIETS, who also spent significant time studying Bible and Jewish philosophy intensively at Revel. For fifteen years, between 1987-2002, I taught Judaic studies full time in various yeshiva high schools in the New York area and worked part-time in the mid 1990’s as educational coordinator of the Torah U-Mada project which was then headed up by Rabbi Dr. Jacob J Schacter. I serve on the executive committee of the Orthodox Forum and other boards as well as serving as associate editor of the Meorot Journal and a contributing editor to Ten-Daat. I had the great privilege to publish a sefer in memory of my father z”l, Divrei Berakha U-Moed under the auspices of Yeshivat Har Eztion, and to edit the volume Community, Covenant and Commitment: Selected Letters and Communications of Rabbi Joseph B. Soloveitchik under the auspices of the Toras haRav foundation. I currently am working on a number of projects including editing two Hebrew volumes of writings of mori ve-rabi Rav Aharon Lichtenstein. I live in New York City with my wife and four young children on the Upper West Side.
The Observer: Your article, entitled “Dimensions: A Young Man’s Story of Torment: Surviving Depression,” published in Jewish Action in 2001, was one of the first to raise the issue of depression to the Orthodox Jewish community in a big way. How did you decide to write that article?
Rabbi Helfgot: I had been suffering from depression over the course of 3-4 years, having had three very serious bouts of depression in the late 1990’s. Thank God, I had been able to go back to work and in the interim get married, have a child and get back to my old self with the help of therapy and anti-depressant medication. During those years, I often would speak with family members and close friends, and people would inevitably say to me, “I had a cousin who had depression,” or that they knew someone who had had post-partum depression, or that they themselves had gone through clinical depression. Every third person I spoke to either had had an episode or knew someone who had experienced it.. Now, when you’re depressed, your mind is confused and disoriented. You often feel extremely lonely and believe that nobody else has ever had this horrible mental anguish. It turns out, however, that lots of people have experienced it, including many in the full range of the Orthodox community. The problem was that nobody would talk openly about it. I was in a place communally where you couldn’t be honest and address it forthrightly. For example, at the school where I taught, when I took a leave of absence, they told the kids Rabbi Helfgot was “ill” without any further explanation. On one hand this reflected a healthy respect for my privacy and feelings. Yet I also believe that if someone were going in for an operation for cancer or heart surgery, they would have told the students or parent body more details about what was going on. In regards to mental illness, however, there was this type of blanket silence , where nobody would talk about it honestly.
So having suffered from serious depression and having recovered and returned to full strength, I figured that I wanted to do something positive with this painful experience. The non-Jewish world was ahead of us on this, like in many areas of socially based stigmas. Tipper Gore, Al Gore’s wife, Mike Wallace and others had spoken publicly about their experience with depression. People in the general society of the late 1990’s then could talk more honestly, there was more empathy, and people could get up and not be stigmatized.
In addition, in the course of those years, one or two people whom I knew well had committed suicide. Thank God I personally had never had thoughts of suicide. Thus, I also thought that maybe if we talk about depression more openly and honestly, we’ll be able to help one or two people not to go down that path. Maybe we can make this whole closed world of mental illness less stigmatized, make people less afraid, and make it so that family members and friends won’t be so afraid to get help. We can sensitize people to the issue. So I figured, why not write something?
I wrote a long piece and sent it to Jewish Action. Nechama Carmel, the editor, helped me polish it. Barukh Hashem, it made an impact; I know that they gave it out at the Nefesh Conference that year in the winter of 2001 for hundreds of Orthodox mental health professionals to read. I know also that it became one of the assigned readings (and continues to be so) in the first year Pastoral Counseling class at YCT pioneered by Dr. Michelle Friedman close to a decade ago. People still call me from time to time for advice and to give a helping hand. The first two years after I wrote it, I would get calls all the time. I had to be careful, though, because I am not a clinician or therapist; I could only talk about my experience and suggest advice. In broad terms I had a “happy” story, as stories like these go. Good friends had directed me to different therapists; I clicked with my first therapist; I had uni-polar depression, not bipolar disorder, and my situation I had a happy ending.
Interestingly, I was teaching while coming out of depression, and I became more sensitive to certain students who I realized had depression. That was an interesting experience for me. There are certain ways that it manifests itself in high school kids. It may present itself a little differently in children or high school kids- maybe through drug use (not always), alcohol abuse, or in other ways such as listlessness in class or even hyperactivity. It’s a question of presentation. It’s not just an adult malady.
I don’t want to be grandiose about the article; but once I came out of my depression I began thinking to myself, what should I do with this life changing experience? This is real suffering; let’s do something constructive with it in the spirit of the Rav’s philosophy in relation to suffering and evil in the world as he outlines in Kol Dodi Dofek. I don’t want to say gam zu l’tovah [this too is for the good] but wanted to say something positive.
The Observer: How did you decide to publish your article in Jewish Action specifically, and not in another forum?
Rabbi Helfgot: I didn’t want to write a small piece, but rather, a long piece that took people through the whole experience, the process of the first depression, the aftermath, feeling better and slipping back a year later into another depressive episode- something very substantive. It was not an academic piece so it wasn’t for Tradition, and was too long for a newspaper like the Jewish Press. I had written for Jewish Action before, so I figured that was the most logical place. Back then we didn’t have blogs, where you could publish something instantaneously. Today I might have put it on a blog.
The Observer: Given the fact that depression was not talked about in the Orthodox community, how did you find your therapist? If someone else in the Orthodox community was looking for a therapist, how could they go about it?
Rabbi Helfgot: Depression is the most common mental illness; some psychologists refer to it as the “common cold of mental illness.”
I worked at Frisch before I joined the founding faculty at Maayanot. I had a good friend from Frisch, Dr. Johnny Krug; he is a Rabbi, actor, director and psychologist. When I was going through all my changes and feeling something weird, strange and painful, and experiencing physiological symptoms of no appetite and inability to sleep or concentrate, I called him and asked him if we could meet to talk. He picked me up and after a long and open chevrusa of sichat nefesh he said, “I think you’re going through depression” and recommended me to a therapist. I actually couldn’t use the first therapist, because I knew him, so that therapist recommended me to another one, and we just clicked.
The Observer: How was the experience of therapy and taking medication for you?
Rabbi Helfgot: Excellent. When you’re in depression and are going through a “major depressive episode,” you need therapy just to encourage you and to have someone to “hold your hand”, telling you that you will make it through, making sure that you don’t make any “stupid” decisions, or to ensure that you’re not suffering an harsh side effects from the medication. Medicine often helps treats the immediate crisis and after it kicks in (usually in 6-8 weeks) it helps to begin to lift up the veil of pain and mental suffocation that is depression. Until you’re on the medicine and it is working, you are not clear enough to really start benefiting from therapy.
The Observer: What kind of stupid decisions could you make?
Rabbi Helfgot: Well, for example, let’s say you walk into work one day and decide to quit your job because you’re so overwhelmed, instead of asking for a leave of absence. Stupid decisions like that.
In the midst of the intense period of depression most people have therapy 1-2 times a week depending- if symptoms are beginning to abate. Therapy is there to make sure that there’s no relapses. In addition it is critical to monitor whether you’re on the right dose of medication, should you pull back, if you are married how is it affecting your sex life and relationship with your spouse, and as symptoms start to abate, to help you try to figure out what caused the depression. Was it biological or a biochemical issue; is there something underlying the depression? In my mind it’s usually a combination of nature and nurture.
For me, I don’t think I discovered the magic bullet for why I went into depression. Was it because I had been to Israel the year before (1996) on a learning sabbatical and had witnessed a number of suicide bombings and their effects first -hand; was it a subconscious reaction to being lonely because I was not yet married? Or was it simply a purely chemically induced imbalance of serotonin in the brain triggered by the onset of fall and winter? I simply don’t know.
In therapy, after the intense depression and its symptoms begins to abate, you end up talking about many other things. I personally think that every person in the world, whether they have an illness or not, perfectly healthy people without a trace of depression would benefit from some period of therapy. In psych programs, you have to go to therapy yourself before you can give therapy to others. You explore feelings, emotions; it opens you up. If there was any “silver lining” to the depression it is that I ended up in therapy for an extended period of time. It was the useful, I don’t want to say “blessing” After the symptoms of depression abated, continued once a week, then once every two weeks, then once a month, and in the later therapy, we were talking about issues regarding relationships, emotional issues, opening up to another human being, feelings of spirituality, relationship to family, career goals and aspirations and so much more, far beyond the initial discussions about depression and it symptoms..
A little over two years after my first depressive episode, I was married in November, 1998. I often feel that I wouldn’t be married, or at least, wouldn’t be married to the wonderful woman that I did meet, if not for the fact that therapy helped me to open up emotionally as a human being and as a Jew.
The Observer: How would you describe depression?
Rabbi Helfgot: Depression, at least as I understand it, is on a spectrum. We’re not talking about being in a bad mood, upset after flunking your test for your driver’s license or something like that. We’re talking about sustained feelings (over weeks and months) of hopelessness, despair, coupled with physical manifestations such as significant weight loss or weight gain, los of appetite, inability to sleep, or inability to get out of bed, feelings of uselessness which can spiral into an inability to do anything, and in the most extreme cases, lead to thoughts of suicide.
Low-level depression is termed dysthymia. It is a persistent, long-lasting sense of unhappiness, emotional blankness, profound ongoing alienation, but you are able to function and have pretty normal sleep but you are unhappy. That can be treated of course with anti-depressants such as Paxil or Zoloft, or possibly even over the counter natural remedies and talk-therapy alone might work.
Major depression, however, is when you have a significant depressive episode when you are totally, very much, at least during the intense phase, often listless, have no appetite, can’t sleep and in deep mental anguish. In addition this fall into depression is often coupled with a cycle of anxiety, sometimes even panic because of the depression. Often, mental health professionals will first treat the anxiety to calm you down, giving you an anti-anxiety medication such as Ativan or Klonopin, for a few weeks. That’s a major depressive episode in a context that it is sustained for at least two weeks or more.
And at the end of the spectrum there are levels of extreme depression that involve the need to hospitalize someone because they are simply not able to function or care for themselves or have begun suicidal ideation.
The Observer: Do family members generally understand what their relative who is suffering from depression is going through?
Rabbi Helfgot: One of the purposes behind my writing my article was besides encouraging people to get help, was also to sensitize family members about what depression is and what one can do to assist someone suffering through it. Just as you wouldn’t say to someone suffering from diabetes, “pull yourself out of your insulin levels,” you can’t tell someone with depression to snap out of it. Depression is a mental illnesss. There are chemicals that your brain isn’t getting. Depression and bipolar are mood disorders, as opposed to other mental illnesses which are harder to treat.
It is important for people to become sensitive so family members can be helpful, understanding, and the same goes for co-workers and bosses. If you would give someone time off to go to chemotherapy, I hope that we would give them time off to go to a therapist. It is long past time to move away from an uninformed attitude that depression is something that’s “all in your head.”
Depression was once called a “nervous breakdown.” When I grew up, that was the term. The problem is that the word “depression” is also used for things which aren’t clinically defined as depression (e.g. “I am really depressed because I only got a b+ on my exam”). William Styron, the great writer, was one of the first major figures to write about his own personal struggle with depression in the early 1980’s. In his book Darkness Visible, he described it as a “mind-storm” or a “mind-volcano.”
The Observer: Did you anticipate the impact your article would have on the Jewish community?
Rabbi Helfgot: I did realize that there was a kind of undercurrent of people waiting to come forth and discuss this in the open. To my chagrin, I still feel that we as a community have not progressed far enough. There certainly is more openness than there was ten and twenty years ago. I compare it to HASC, Yachad, where 40 years ago these children were basically hidden away. The community moved to a place where of course, we celebrate these children, have shadows, Kulam and Kulanu, so mental health is going in that direction, also. It’s definitely much better than it was, but we still have an unacceptable level of stigma. We need more openness. That having been said, Stern had a program, I’ve spoken at shuls, and there’s been a lot more discussion about it.
Depression in a way is the easiest to speak about because it’s the most common. It’s easier to deal with than the more difficult mental illnesses such schizophrenia, bipolar, personality disorders- but work needs to be done to make everybody feel embraced and supported.
The Observer: What should a student do if s/he suspects his/her friend is suffering from depression?
Rabbi Helfgot: Talk to the friend and gently ask how they are feeling and what can they do to assist in any way. They may want to direct their friend to talk to a local therapist or alternately one should go to the Counseling Center at your college and get advice from a trained professional on what you should do or what kind of advice you should give your friend.. God forbid, you don’t want them to get to a place where they might hurt themselves. Just recently, a kid in Columbia committed suicide, and he was just 19 years old. It’s imperative to get help in the moment of pain.
The Observer: Were there any books about depression you found helpful while you were depressed? Secular or those geared toward the Orthodox community?
Rabbi Helfgot: In the midst of depression, it’s hard to concentrate. I didn’t find that many books. I appreciated Kay Jamison’s An Unquiet Mind, William Styron’s Darkness Visible, Andrew Solomon’s The Noonday Demon. Those are secular. There are some people who may find certain Jewish wisdom helpful to them. It’s not about reading or connecting to some idea. Medication helps you get to the point where you can work on things.
The Observer: Did God or religion play a role in your depression? Did you take comfort in God; were you angry at God?
Rabbi Helfgot: I want to be perfectly honest; for me personally it was hard to connect to God during my intense bouts of depression. There are people who I’m sure turn to God or religion for their depression. I couldn’t daven, couldn’t concentrate, not because I was angry at God, just because I wasn’t in that place spiritually, emotionally or mentally that allowed me to access those modes. At the same time I couldn’t watch TV as well,- even mindless entertainment was too intense. It was just this blank emotional slate with a lot of pain.
As I started to heal religious life and halakhic living was helpful as an orienting structure. It’s good to have structure in your life when you are coming out of depression and reclaiming your life patterns. But that could be any structure; for me as religious person it happened to be a halakhic structure.
On the other hand, during the intense period of depression, it’s can for example, be a very painful, excruciating thing if you’re sitting at a Shabbos table surrounded by people who are happy and you are very unhappy.
The Observer: You mentioned that we as a community haven’t gone far enough to remove the stigma from mental illness. What should we do?
Rabbi Helfgot: In the course of my travels, I would meet many people who’d tell me they also had depression. They were willing to tell me, but weren’t willing to talk about it publicly. If people just talked about it…
We today speak honestly and openly about cancer. People used to say yene machla [that illness]. We need to get to a place where just talking about this a lot is natural. Lots of people have high blood pressure, high cholesterol, depression- that’s part of the reality of life and the fragility of the human condition.
After I wrote this article, I ran a conference on this topic sponsored by Yeshivat Chovevei Torah and the OU in 2001. 300 people came to the West Side. It was the first conference that I know of for the community (not a professional conference.) The highlight of the program was that I got four other people to tell their story.
1. A woman from Teaneck
2. Yeshivish Rav from Passaic
3. President of a school from Teaneck
4. A high school kid
We need to create more programs and discussions such as these in our shuls and in our schools across the board.. There are Roshei Yeshiva who have had depression, presidents of shuls, men and women, rich people, poor people etc. We need to create a culture where everyone can speak about their experience and help get us to the point where there the stigmas are erased.
R’ Jonathan Sacks wrote a book about the grief he felt about the death of his father, which, if you read between the lines, is really about depression, but even he refrained from calling it that. We have to understand that depression is an equal-opportunity machla [illness].
I believe that Jewish men have it a drop more, statistically. About 15-20% of the population experiences depression, if I remember correctly- that’s a lot of people.
The Observer: What do you think of Rabbanim or other well-meaning people who tell those suffering from depression that depression is not a Jewish idea, and that it is a mitzvah to be happy always?
Rabbi Helfgot: This is not the place to examine whether that concept or philosophical approach has deep roots in Jewish sources or is a relatively new import. I would just note that I believe there are many gedolei yisrael who we look to as polestars, such as the Rav zt”l who would not endorse such a hashkafat olam as religiously meaningful. But even if one were to adopt such a position, I still think it is the height of malpractice- religious and psychological malpractice- to say that it is a mitzvah to be happy, so snap out of it. This has the potential to seriously touch on issues of onaat devarim and pikuach nefesh [danger of life] problems.
It is like telling someone who can’t get up out of their wheelchair they need to daven shemoneh esrei with their feet together- it’s stupid. There’s a concept in halakha called ones- if you’re anus, you’re not obligated. If you’re sick in bed, you can’t pick up a lulav in the sukka. So it’s the same thing; telling someone to go do the mitzvah gedola l’hiyos b’simcha [it’s a great deed to be happy always] is not productive.
The Observer: Are there any other thoughts or is there any other advice you can give us regarding depression?
Rabbi Helfgot: There are two other things.
1)There are some people in the community, both in the general community and in the Jewish community, who have a bias against medication. They have a shita not to put anything in their mouth which is not “natural”. They think the only therapy is talk-therapy.
For serious depression, talk-therapy alone often does not cut it. You require medical intervention to allow you go get to a place where the therapy is effective.
2)Then there are those who are against taking medication because they don’t believe depression is biological. That is also a very dangerous shita. Are all medications effective? No. There are many people who have to try many different medications before they find the one that works, but you have that for other illnesses also, like blood pressure or high cholesterol.
Finally, it’s also important to recognize there are some extremely untreatable depressions which don’t respond to any of the medications. I’m talking about people where the alternative is suicide. In those cases, ECT, Electric Convulsion Therapy, is extremely effective on very non-responsive depression and should be explored. It has a bad reputation because people don’t really know what actually goes on in 2009; their image of ECT is from the 1970’s film One Flew Over the Cuckoo’s Nest. In extreme cases, ECT has done very well. It is safe, and one of the most effective techniques for dealing with very difficult depressions. I know people who’ve gone through it where it was very successful. Now, it’s true that you have horror stories from the 1950s-60s, but there are other horror stories from then, too, like giving drugs to pregnant women that they should never have taken. We know more now. I was at a San Diego conference recently where I heard a world expert talk about the effectiveness rate, which is high. It’s not perfect, and that doesn’t mean there aren’t side effects, like short term memory loss, but when the alternative is suicide…
Some people who are not familiar with the medicine and science think that Prozac, Paxil and other drugs change your personality. This is untrue. If you’re fundamentally a serious person, it’s not going to make you happy-go-lucky. Depression doesn’t allow you to be yourself, but the right medication often allows you to return to yourself.