New York – The Rambam talks about depression, referring to it as ‘marah shechorah’, which literally means “black bile.” In his time, it was thought that there are four types of body fluids, and when these are not in proper balance, disease results. Depression, Rambam says, is due to an excess of the black bile.
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This of great interest, because the Rambam was centuries ahead of his time. In fact, in 1961, when I began my psychiatric training, it was believed that depressions are due to psychological causes, and treatment was directed at understanding and remedying these causes. The reasoning went something
like this. When a person suffers a loss, one become depressed. Therefore, when a person is depressed, one must look for what kind of loss one sustained.
In the 1950’s, it was found that derivatives of the rauwolfia plant could lower blood pressure, and these drugs were welcomed by medicine. Although the drugs did indeed lower blood pressure, they had a side-effect of causing depression, sometimes even resulting in suicide. This indicated that depression can also be caused by a chemical change in the body, in this case brought about by a medication. It was subsequently found that chemical changes in the body can also result from viral infections, the stress of surgery, exhaustion and hormonal changes, such as occur in premenstrual and postpartum women. Sometimes these changes are of genetic origin.
The important point to realize is that a person may be depressed even in absence of a psychological cause, but due to chemical changes in the body. These types of depression can be effectively relieved by appropriate medication. This was Rambam’s understanding of depression 800 years ago.
The most common symptoms of depression are sad mood, loss of interest in things, difficulty concentrating, either loss of sleep (especially early morning awakening) or excessive sleep, loss of appetite, decreased libido, crying without a reason, and hopelessness. As these symptoms progress, a person may develop a death wish and may attempt suicide.
The incidence of depression in the Jewish population is significant, and this maybe because of a genetic vulnerability.
However, it must be remembered that “depression” describes a feeling, and that a person may indeed feel depressed even though there was no chemical change in the body. A person who grieves the loss of a loved one may feel depressed. A person who lost his job or is experiencing an adversity of any kind may feel depressed. Inasmuch as such depression is not due to a chemical change in the body, antidepressant medications are of little help. But it is possible that the grief and worry may actually produce a chemical change, so that a chemical depression is superimposed on the reaction to adversity.
There are also some people who have a “depressive personality.” They are chronically unhappy and just do not feel that the world is a nice place to live. This attitude may begin in childhood, so that there are children who “mope” for no apparent reason, and are chronically dissatisfied. Many cases of depressive personality are due to low self-esteem, which I described in my books Life’s Too Short and Angels Don’t Leave Footprints. This kind of depression generally does not respond to antidepressant medication.
Depression due to a body imbalance is generally referred to as “clinical depression.” It may last from several weeks to many months. It is not unusual for clinical depressions to recur. If medication has provided relief, it is a serious mistake to stop the medication when one feels better. Medication may be discontinued only by doctor’s instruction. Unfortunately, there is no laboratory test to determine whether there is a chemical imbalance, and it requires the diagnostic skills of a doctor.
A person suffering clinical depression needs competent treatment. It is wrong to tell him “Just pull yourself together,” just as it would be cruel to tell a drowning person “Just pull yourself together.” This is adding insult to injury.
Because depression are quite common in the Jewish population, it is important to gather information on the condition, so that proper help can be provided at the earliest time. Untreated clinical depressions can progress to very serious consequences. Refusal to seek help because one does not wish to be “stigmatized” as a psychiatric case is the height of folly and may be very dangerous.
Of course, one should pray to Hashem for help. Halacha requires that a person take antibiotics for pneumonia and the proper medication for diabetes. Refusal to take such medications is being a chasid shoteh (pious fool). Depression is no different. One must seek proper treatment and pray to Hashem for a refuah.
Rabbi Dr. Abraham J. Twerski D is an ordained rabbi, graduated from Marquette University Medical School and is the the author of more than 60 books.
I had no idea that depression was specially common among Jews. Quite sad.
I think that one of the causes of depression among us might be because we have great expectations as a people.
If I came home from school with a 90 on my test, my father instead of showing appreciation would say: Why not a hundred?
I am mentioning this because many might recognize themselves here. Parents: if your child comes home with a 90, even an 80, then praise him/her and lock in your gains. Others aren’t as lucky as you are.
Why is it common among the Jewish population?
Depression usually sarts in the teenage years. While in most societies teenagers have a range of activities to help distract of aliviate their depression such as sports, music etc. Chasidic teenagers just have the Gemara again and again. I believe that even whilie shunnig sports, Chasidic Yeshivas could help their Buchirim by having a Gym room with treadmills etc. Cardiovascular excercises such as running,biking,etc. have been scientifically proven to prevent and ward of depression.
I am the son of a survivor, and have suffered from depression my whole life ever since I can remember. Thank G-d in my thirties I finally recognized what it was and sought medical help. I have been on anti depressants since then…and probably will be for the rest of my life. Folks, Ha Rav is correct, you cannot just pull yourself together, you cannot “suck it up” it is a chemical issue, and you can try to control it without drugs my exercise, sun exposure, drink etc, but ti will not go away and will just get worse as you get older. I still struggle with it every morning, but I am able to function quite well. I can hoenstly say, though, that if I did not take the meds., I would be divroced, out of work, drug or alcohol abuser adn perhaps dead by my own hand. Boruch Hashem, beli ayin hora, I have shalom bayis, a good job, great family…beli ayin hora again. The depression does tend to get worse as I get older, but I visit my doctor when I feel it getting worse nad get an adjustment in my meds. Do I feel crazy? No. Do I wish I did not have this chemical imbalance, of course. But I thank Hashem every day for all the He has given me. And I thank HaRav Twerski for the article.
This is all BS. Even the drug companies are now required to print on label- Drugs are THOUGHT to work by correcting chemical imbalance. This psychiatric industry is in no way scientific or measurable. Have any tools or tests been developed to measures “imbalance” , or is there even an attempt to do so? There havent been, because no one really expects to find one. This entire industry is run by pharmaceutical greed, and ego’s of psychiatrists, who like to believe that they hold the tools of curing depression. In fact, real meds only work a few percentage points better than placebo’s (probably because their side affects create better placebos). Bottom line, anyone who claims that meds can eliminate depression is a liar. If imbalance was the cause of depression, then by simply fixing the imbalance, a person would be cured. Anyone who has experienced this can tell you, that medicine in no way cured them.
We all have too big expectations in life [Money… Money… Money] and peer pressure[Status … Status….], thats whats causing ……
Thank you, Rabbi Dr. Twerski!
REply; to # 9. We are a suppressed people,but depressed,not so.
Depression among adults due to the shidduch crisis which gets a whole lot of lip service but no godol has taken on this problem head on. None. I have heard all the speeches about learning torah, learning torah, learning torah.
Where is the hishtadlus of rabbonim to take on the shidduch crisis. And dont tell me that saying to people over and over again “IYH by yours” is going to do the trick.
R Twerskey thinks the whole world are crazy alcoholics etc he needs to get out and meet some normal ppl
I am depressed today becuase of the false teachings that i learned as a child. I am depressed because of the life experiences I have not had. I am depressed becuase growing up, we learned to pursue profligate lives, going to college where we pursue secular studies and love of material wealth. We were taught to purse many relationships but not to value marriage. As children we played with toys related to war and idolized conflict over peace. We watched movies instead of reading. We read stephen king and other worthless authors. We talked about sports and material want. We did not read the bible at all and when we actualy got one given to us in our hands at age 16 we did not open it for many years, probably assuming it would ruin the life we were planning for ourselves.
Do I need a medication or does society need one? (oh yeah. i was raised in a reform synagogue and by public schooling!).
How can R’ Twerski be sure that it is not just divine will that causes depression. We should not forget his comments regarding the earthquake in Haiti.
good idea for the depressed souls out there:a gadol once said if a yid would say the brucha “shlo usani goy” with kavuna ,he would be happy his entire life (self understood :he has to know what meens a “yud
I am a frum mother of 2 young children dealing with my clinical depression, anti-depressants helped take the edge off, but it has not helped me come out of my depression.
I am starting to see a psychologist now, I really want to get back to myself already (Hashem please help me!). On the bright side, atleast I understand that the overwelming feelings of sadness that I have been feeling for the past year and a half is due to a chemical imbalance in my brain. At first I was reluctant to take anti-depressants, thinking I can’t believe this is happening to me, but then I got over it and started taking medication.
It is important to be aware of the signs of depression and seek treatment, don’t be embarressed.
As to comment number 8, I agree with you that for mild and moderate cases of depression medication is not enough, anti-depressants did not cure me but it helped reduce feelings of extreme sadness.
Were people in Europe depressed? Is this just an American thing?
How one can be a parent of children saddled with financial pressures, tuition, price of kosher food, price of making Pesach, parnasa, marrying off kids, etc. and not be depressed from time to time? How is that humanly possible? Please share with the reading audience
to no 26 my heart goes out to you but keep taking your medication and seek help most of all your on the road just admiting you had a problem, i also suffered but bh not too long as i had a great hubby who saw the signs got help fast and bh now a few years down the line i can say i am 99% better get the odd day about twice a year but medication together with cbt did the trick. to all those out there please please please dont suffer in silence medication can help but the first is ADMIT TO YOURSELF THERE IS SOMETHING WRONG . it can happen to anyone people looked at me and said what you depresion i am a very happy go lucky person bh and dont look at what others have etc but from one day to the next it hit me!!!! again i say to all those out there forget any stigma if your a mother/ wife think about your children dont let them suffer they need a wife/mummy. again my heart goes out to all those that are suffering may Hashem help you fast and find the right refuah for you.
The yiddish term for depression is ‘bakakt’.
I wish, that people out there who have no training in therapy, would refrain from posting stupid nonsense. Depresion, is a debilitating sickness .Therefore , we need inteligent comments .
Numerous studious have suggested that ashkenazic jews have a higher incidence of depression than other ethnic groups. Since most ashkenazic Jews are not Orthodox or Hassidic it would be hard to attribute these findings to the shidduch crisis or lack of gyms is chassidic boys high schools. It is usually useful to have some knowledge about a topic before posting nonsense
It’s important to note that since the current diet mania that has hit America depression is on the rise. It has alot to do with the fact that we do not eat healthy “fatty” meals.
Further to my post no 30 to all husbands parents brothers and sisters look out for the signs you can be the first one to help dont just say pull yourself together its not that easy help and support its the best you can do!!!!
the reason for depresion amoung jews is because they live very stressful lives because the have to work harder then non-jews to support their large familys; and they feel they have to live on high standerds.
Why shall one not be depressed we have a slim 70-100 years to live when we start to think about the way we are suposed to be and the way we actualy are why shall one not be depressed there is only one solution without medication or drugs make belive you are a idiot and don’t think I guess it’s hard not to think without drugs etc
Dr. Twerski, you speak like a true doctor. However, like most doctors your knowledge of natural healing is quite limited. Do you know that just simple muscle stretching releases endorphins which promote good feeling and relaxation? The same for sweating due to exercise which also rids the body of toxins. Medication is the answer to all problems according to the medical profession, but don’t forget that the Rambam advocates DAILY EXERCISE, in group form, so as to promote social connections, to the point of at the very least, building up a light sweat. As a certified fitness trainer I can attest that this is absolutely fact.
There are dozens out there with underlying symptons of depression, or worse, because of the shidduch crisis destroying parents who spend tens of thousands of dollars putting their kids through yeshiva and bais yaakovs and then this happens. They, both parents and children, hit a brick wall.
Somehow, somewhere this jewish community has got to confront this crisis. In my opinion, it is far more serious than tzedakah. We live in a medina shel chesed where b”h the govt gives to the needy. As far as I know, the govt does not have an agency that provides shadchanim or shidduchim.
Read Nefesh HaChaim which teaches that Talmud Torah — Learning Torah — is the best cure for all ailments. The power of learning HKBH’s thoughts and being close to him while learning and davening is the most powerful cure for our neshamas. Hopefully, HKBH will send the sick Yid a rafuah b’gufo too. Call b’dai Shemayim.
at least u made me laugh for a minute…….
ts really not a medical condition but something u have to overcome. anti depressants etc. are just poison and a cash cow. Depression has really psychological causes either which you are probably born with. but that is what u need to overcome in this world by making real changes,not drugs or quick fixes… the second article gives a much better explanation of what I mean. http://ohr.edu/1149