Sunday, November 11, 2012

Rav Wolbe: Psychiatry and Religion

8 comments:

  1. Perhaps Rav Dr Eidensohn can comment on this, since he has expertise int he 2 fields that R Wolbe says have common ground at all.

    Rav Avraham Twersky, however, makes use of modern psychiatry on a day to day basis and i all his books.

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    1. Just came across this yesterday - it is not an easy read. Need time to go through it properly

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    2. Certainly it is long, and I gave up after first few paragraphs.
      Untypically, I would suggest that certain aspects of Kabbalah, especially Gilgul and Tikkun, are very similar to psychoanalysis, in that we are left with spiritual/psychological/subconcious "baggage" and unfinished business from previous generations or "incarnations". Gilgul is a mystical description of personality traits and acts carried out in previous generations, which come back in different form in the present or future. This is essentially a fom of psychoanlaysis, although it is a spiritual one, there is much crossover.

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    3. I could not make any sense out of the first chapter. However don't give up - start with chapter 2 - it gets interesting

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  2. Indeed "not an easy read", but a significant one; thanks, DT.

    Reading Rabbi Wolbe's article in the U.S., it strikes me as describing a psychiatry that barely exists any more (note its date), and which, outside of journals and medical libraries, I've glimpsed only among a few psychiatrists who completed their training no later than the 1970s.

    This problem became clear to me as I read a blog post by a now-retired psychiatrist: http://1boringoldman.com/index.php/2012/11/14/the-monocle/ . He provides his view of the last 30+ years -- "the new psychiatry", he calls it -- as he summarizes the career of the director of the NIMH:

    <<

    Dr. Insel’s career literally paralleled the new psychiatry, arriving from residency at the NIMH in 1980, the year of the DSM-III, where he was involved in early studies using SSRIs in the treatment of OCD. Later, he researched the effects of the pituitary hormones on pair bonding. In 1994, he lost his appointment at the NIMH and moved to Atlanta to direct the Yerkes Primate Center. He was not reappointed at the end of his five year term, and became Director of a $40M Translational Science project in Atlanta for three years before his surprise appointment as Director of the NIMH in 2002. It would be hard to convince most Atlantans that his appointments weren’t at least partially abetted by his association with psychiatry’s then "boss of bosses," Charlie Nemeroff
    [who worked on the antidepressant Paroxetine], who was Chairman of Psychiatry at Emory in Atlanta in those years.

    From the late 1980s, psychiatry’s preoccupation with the steady stream of psychiatric medications and their endless clinical trials sufficed as the fruits of evidence-based medicine – primarily the SSRIs and the atypical antipsychotics. Our journals filled with the regulation garb of medicine proper: graphs, tables, p values, etc. By the time Insel arrived at the NIMH in 2002, psychiatry was eager to hear his call to become "clinical neuroscience" and his 2005 schedule didn’t look nearly so grandiose as it does now. ...

    >>

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    1. My problem is I don't recognize the Judaism that he describes either. He seems very intent on both including the insights of psychology and at the same time insisting that they have nothing to add since Judaism long ago incorporated whatever useful insights it contains. In addition Judaism transcends and exists in a different friendly universe the the cold, and hostile world inhabited by non-Jews. His basic structure of עולם הידידות is something I have never heard expressed or seen in writing. I think Judaism is expressed best as the world of the covenant. I also didn't recognize the Jewish mysticism he described.

      Bottom line- if a person has mental health problem would you send them to a rabbi or to a psychotherapist?

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    2. DT: "... I don't recognize the Judaism that he describes either. ..."

      I didn't recognize it either, but I can't comment because I don't know Rabbi Wolbe's world "from the inside". In a qualitative-analogical sense, as an ideal much yearned-for, I am sympathetic toward his kind of formulation.

      DT: "Bottom line- if a person has mental health problem would you send them to a rabbi or to a psychotherapist?"

      Bottom-line? In the majority of actual cases I've encountered I have to distinguish is from ought.

      Case example: A victim of child-abuse becomes suicidal after the teacher she appeals to has rebuffed her. In my world today there is only the possibility of a mental-health intervention for the victim. But how would the chain of cause and effect work out if there could be a "rachamanut-health" intervention for the teacher?
      (Cf.: http://www.mechon-mamre.org/i/3901.htm#17 : "בכל יום תענית שגוזרין על הציבור מפני הצרות, בית דין והזקנים יושבין בבית הכנסת, ובודקים על מעשה אנשי העיר, מאחר תפילת שחרית עד חצי היום; ומסירין המכשולות של עבירות, ומזהירין ודורשין וחוקרין על בעלי חמס ועבירות ומפרישין אותן, ועל בעלי זרוע ומשפילין אותן, וכיוצא בדברים אלו.")


      DT: "In addition Judaism transcends and exists in a different friendly universe the the cold, and hostile world inhabited by non-Jews."

      The causal order recognized by biological (or biologistic, whether psychodynamic or Kraepelinian) psychiatry is one of "אין שם אלוה". Every Orthodox community I know of prefers to religiously vet its psychiatrists and psychotherapists.


      Only slightly tangential: Today Professor Sir Robin Murray (U.K. Schizophrenia Commission) issued a call for "rachamanut-health" intervention to transform the way services are provided to schizophrenics and psychotics: http://www.schizophreniacommission.org.uk/
      Page 5: "A range of early socio-psychological adversities such as separation from a parent, being a migrant, growing up in a city, or being persistently bullied or abused, all increase risk of psychosis. Similarly, adverse life events and trauma can precipitate the illness."
      Page 19: "The Commission’s view is that we are failing many people who go on to receive a diagnosis of schizophrenia because not enough is done
      early on to prevent its development. We know the risk factors for developing psychosis, including migration and discrimination, childhood trauma, bereavement or separation in families, and abuse of drugs. However, too little energy or resource is focused on addressing these problems. ..."
      Page 51, quoting Dr. Shubulade Smith, a psychiatrist and member of the commission: “The evidence about social adversity and mental illness was striking. I look after people with severe mental health problems. I am frequently struck by how much they have in common. So many have experienced horrendous emotional trauma and significant social deprivation regardless of whether they were born in the Caribbean, Afghanistan, Surrey or around the corner in Lambeth. All too frequently I wish that someone had intervened when the person was 4 or 5-years old. All those factors which combined to bring them to my service may have been avoided. Is psychiatry the problem for most of my patients? Not where I work. It is imperative that we work at tackling the social inequalities that cause poor mental health. Doing so will undoubtedly improve the outcome for everyone, including those from BME groups.”

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    3. Ecclesiastes Chapter 1 קֹהֶלֶת

      יז וָאֶתְּנָה לִבִּי לָדַעַת חָכְמָה, וְדַעַת הוֹלֵלֹת וְשִׂכְלוּת: יָדַעְתִּי, שֶׁגַּם-זֶה הוּא רַעְיוֹן רוּחַ. 17

      And I applied my heart to know wisdom, and to know madness and folly--I perceived that this also was a striving after wind.

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