Mental illness of abuse is pikuach nefesh even if not life threatening

from Daas Torah - translation copyrighted

Mordechai (Shabbos 424):. R”i bar Sholom explains that all the cases in the gemora where the choleh says it is necessary (tzarich) is to be understand to mean that it appears to choleh that he will die if they don’t feed him because he thinks that he is in a life threatening condition. There are also commentaries which write concerning the matter of Rav Yannai where the choleh says tzarich where it is understood that it talking about possible life threatening circumstances…. All the cases which are brought in the gemora, our Sages were experts in medicine and they knew these cases were life threatening (sakana) such as lighting a candle when a blind women requested it, or breaking down the door when a child was locked in. It would therefore seem that we are not considered experts in the issue of when to feed a choleh while the choleh is. Therefore if the choleh says that his life is not endangered if he doesn’t eat -  it is prohibited to feed him. This is the same for the question of profaning Shabbos to save someone. For example Avoda Zara (28b) states that if an eye is severely tearing it is permitted to put medicine in it on Shabbos. The gemora explains that this is permitted because there is a connection between the eye and the heart and thus it is life threatening. Consequently if the only concern is for the loss of the eye but we don’t consider it to be life threatening - it would not be permitted to put the medicine in the eye on Shabbos.

However Rabbeinu Tam disagrees with this understanding and he has issued permissive rulings in actual cases even when it is not life threatening. This is what he said: Are the sick people prophets or experts in medicine [that we rely on their judgment to permit violating Shabbos or Yom Kippur]? The fact of the matter is that since the sick person or one who recently gave birth is aware that it is Shabbos or Yom Tov and nevertheless says they need to eat or have Shabbos profaned for them – that means they are not able to bear the pain and discomfort which results from their condition. That is why we feed them on Yom Kippur. And this is true even if they are not in life threating conditions (choleh shain bo sakana). For example, how do we consider that being bitten by a mad dog is life threatening or the case of Rav Ashi and Mar Zutra (Kesubos 61a)? Therefore even though the majority of sick people will recover but nevertheless we are lenient when there is even a possibility of danger or severe mental illness (tiruf daas). The expression “that they are going to die” should not confuse you because that is the expression used by the Talmud and you would want to know then what does “a possibility of death mean.” In fact when the Talmud talks about the concern that these people will die it is not to be taken literally. The term death in these cases is a fear that the person will get sick or deteriorate in some way. This understanding is obviously correct. Thus if the sick person asks to eat or drink it is permitted to feed him or give him drink because the lack of food causes him pains in the heart and because of that he will faint and there are times he won’t recover. Thus even there is only the loss of a limb, I would call it a danger and would therefore permit Shabbos to be profaned. We also see this concerning an injury to the interior of the body where the majority of such cases do not die and similarly the case of pregnant women who smell food - we see that they don’t die and yet we are permitted to feed them. Consequently all cases which involve a lost to the body or loss to a limb or embryo is a danger (sakana). We learn this from the case of the mother who recently gave birth or a pregnant woman or someone who is bled and becomes chilled – that it is permitted to make a fire even during the summer even though we have no concern that they will die from this condition So if Shmuel who was a doctor as well as the Sages who were familiar to some degree about medicine and they said that an individual is knowledgeable about his own suffering. So if they literally meant dying that means that all men are experts in this matter for themselves and the statement can’t be reversed. But in fact even if a person screamed out that he wasn’t going to die from this condition - that we have evaluated that he can’t bear – it is permitted ignore him to profane Shabbos according to our judgment….