A review of Yonatan Rosenzweig and Shmuel Harris, Nafshi BiShe’elati – The Halakhot of Mental Health (Maggid books, 2025).[1]
Rabbi Yoni Rosenzweig and Dr. Samuel Harris’s Halakhic book, Nafshi BiShe’elati – The Halakhot of Mental Health has recently been translated into English from the Hebrew edition by Maggid press.
The book presents a comprehensive
Halakhic treatment of mental illness, offering the first systematic
approach to applying Jewish law to mental health issues. While a few
articles have addressed some of these halakhic questions, this work
stands out for its thoroughness and scope. The book’s strengths and
multidisciplinarity are reflected in the diverse and laudatory
approbations (haskamot) it has received.
Rav Eliyahu Abargel praises its
scholarship, summaries, and novel interpretations of rabbinic
literature. Rav Baruch Gigi and Rav Eliezer Melamed emphasize its
practical utility for issuing halakhic rulings for mentally ill
individuals, noting R. Rosenzweig’s extensive consultations with
contemporary poskim. Rav Re’em Hacohen and Rav Yuval Cherlow view the
work as essentially developing a new area of Halakha, attributing the
previous lack of such a treatise to recent advancements in psychiatric
diagnoses and our more sophisticated understanding of psychology,
genetics, and mental health treatment. In the English translation, there
are additional approbations from Roshei Yeshiva at RIETS: Rabbi Michoel
Rosenzweig (the author’s uncle), Rabbi Hershel Schachter, and Rabbi
Mordechai Willig.
Nafshi Be-She’eilati is
structured in three sections, with only the first two translated into
English. The first part is a legal handbook, written in the style of
guides like Shemirat Shabbat Ke-hilkhatah, which first lays out concepts such as Shoteh
(mental incompetence) and addresses what the Halakhic obligations are
for people suffering from mental illness. It addresses Halakhic
attitudes to treatment and practical questions such as laws of prayer,
rules for holidays, kashrut, family laws including niddah,
obligations to parents, and gossip laws. Some examples of questions the
book deals with are whether someone with OCD must pray, whether an
anorexic patient must fast on fast days, and whether a depressed person
can listen to music on Shabbat. The second section provides extensive
annotations citing a wide range of Halakhic sources for each legal
question and decision. The untranslated third section contains lengthy
Halakhic discussions of critical sources along with R. Rosenzweig’s
interpretations and innovations. There is also a survey of accounts of
mental illness in rabbinic literature, and a comprehensive table and
discussion that translates DSM-5 categories and risk factors for each
mental illness into Halakhic categories.
The authors state that they wrote the
book to help patients suffering from mental illness. R. Rosenzweig hopes
the book will further legitimize the suffering of mental health
patients and their need for support, and Dr. Harris writes about helping
rabbis provide Halakhic guidance and hopes that the book validates the
suffering and destigmatizes the symptoms of mental illness. However,
despite the book’s virtues, one might wonder about its true
contribution, given that many of its conclusions, for example that the
principle of Pikuach Nefesh (preservation of life) overrides other commandments in mental health situations, seem intuitively obvious.
In his Iggerot (1:31), Hazon Ish points out that Halakhic decision-making involves two components: Halakhic principles and metziut (reality). He suggests that Halakhic principles, such as Pikuach Nefesh, are usually clear, with most questions arising in their application: what situations are defined as Pikuach Nefesh? R. Rosenzweig’s book clarifies the reality (metziut)
of mental illness. What situations arise, and what are their
implications? Mental illness presents a unique challenge: the Halakhic
applications are underdeveloped, and the psychiatric realities are
complex and vary by situation. This results in ignorance of the dangers
and realities of mental illness, compounded by the perplexing and
uncertain prognosis in many cases. The book is therefore peppered with
terminology from DSM-5, reflecting the latest diagnostic categories, and
is accompanied by recent research on risk factors for various mental
illnesses. In addition, the book cites extensively from the entire range
of relevant rabbinic sources: the Talmud, sometimes-obscure Rishonim
and Acharonim, the world of She’eilot and Teshuvot.
Due to the relative scarcity of existing sources, R. Rosenzweig includes
consultations with present-day Halakhic experts as an additional
source. The bi-focal view of Halakha and psychiatry is the successful outcome of a book written jointly by a rabbi and a psychiatrist.
R. Rosenzweig’s approach involves
borrowing Halakhic principles from other areas and applying them to
mental health realities. He maps the concepts of Holeh she-ein bo sakana (non-life-threatening illness), Holeh she-yesh bo sakana (life-threatening illness), and Pikuach Nefesh
(preservation of life) to mental health contexts. By codifying how to
deal with mental illness using Halakhic medical models, R. Rosenzweig
effectively treats mental health issues in a medical framework.
This shift moves away from a past
inclination in general society to blame patients for their symptoms,
which was reflected in the approach of some earlier poskim and
Orthodox therapists. Past studies of Orthodox use of mental health
services have described clients’ fear of stigmatization and of feelings
that they should overcome the problems themselves because the symptoms
indicate moral weakness. Dr. Abraham Amsel, an early Orthodox therapist,
in a representative passage, described mental illness as resulting
from sin in the following manner: “A sin is associated with a spirit of
madness because irrational choosing momentary pleasure instead of
permanent good makes for the beginnings, the kernels of madness. Since
the sinner had free choice at the start between good and evil, he is, of
course, punishable.”[2] R. Rosenzweig (66) in his book writes that some early poskim
saw psychotherapy as emphasizing “the anthropocentrism of treatment, at
the expense of Judaism’s Theocentrism and submission to God’s will,”
also implying that psychotherapy can be a way of avoiding one’s
obligations.
The book is innovative in further
developing Halakhic concepts related to preventative care and
probabilistic risk assessment in mental health. For example, if a
patient isn’t suicidal at the moment but there is a chance they will be
in the future, can one violate Shabbat to help prevent the patient from
becoming suicidal soon? The book’s overall orientation adamantly upholds
the principles of Pikuach Nefesh (preservation of life) and
sustaining well-being. However, it carefully balances this approach with
the weight of Halakhic obligations, emphasizing that each case requires
individual evaluation through professional and/or rabbinic
consultation. This dual consultation helps determine whether a situation
constitutes Pikuach Nefesh and whether relaxing religious obligations will aid treatment.
Regarding treatment, the book argues that, despite reservations of poskim in the past, patients should seek psychotherapy due to new developments and professionalism, adding that some poskim
even regard it as a Mitzvah. They offer broad guidelines including
permitting behaviors normally discouraged, such as expressing anger, if
they are therapeutic, while simultaneously upholding Torah obligations
and values when it isn’t therapeutically helpful, and in some cases
limiting who an observant therapist should treat. They support a range
of therapies leaving the details up to the decision of the professionals
and the patient.
The written style of the book is also
noteworthy. The guidebook format makes the Halakha accessible and
user-friendly. However, this technical approach is less likely to
engender empathy. A narrative approach presenting complex dilemmas,
similar to those described on R. Rosenzweig’s Facebook page, might have
enhanced its emotional impact. Perhaps a future edition of the book can
add more rich real-life stories and their Halakhic resolution to
illustrate some of its principles. However, and perhaps ironically, the
familiar and straightforward procedural guidebook style helps normalize
mental health challenges as illness and anchor them in a clear Halakhic
language and framework.
Even though some of the conclusions are
intuitively obvious, the significance of this work extends beyond
serious Halakhic scholarship. Many rabbis have limited exposure to
mental illness (and are mentally ill as well,) and this book helps destigmatize and frame mental health
issues within a medical model. It emphasizes the potential risks in
mental health situations and therefore provides the basis for
appropriate leniencies. It may also alleviate the concerns of Orthodox
Jews who feel self-conscious, constrained, or guilty regarding their
condition. Perhaps most importantly, as reflected in the approbations,
the book’s value lies as much in fostering a more empathic and
understanding approach to mental illness among rabbis and Orthodox Jews
as in its Halakhic innovations. The book excels in three areas:
translating the reality of mental illness into Halakhic principles,
clarifying the Halakhic obligations of patients with mental illness, and
explicating the broad Halakhic areas where leniency may be appropriate.
Cultural understandings of mental
illness have changed over time and have contributed to different
assumptions and interpretations of its reality. We have seen a shift
from a moralistic model of mental illness where the patient is at fault
and all they require to improve is better willpower, to a medical model
where the illness is externalized and the patient needs outside help
such as medication, support, and therapy to overcome their sickness. We
have also seen, in the past few decades in the Orthodox community, a
greater willingness to treat mental illness, reduced stigmatization of
symptoms, and a greater awareness of the risks. This book reflects and
catalyzes these trends by providing a Halakhic language for mental
health challenges.
In conclusion, although the book’s Halakhic decisions may seem intuitive to some, Nafshi Be-she’eilati
contributes by systematically addressing the place of mental health
challenges within a normative Halakhic framework. This allows for
accessible practical guidance, but perhaps more significantly, plays a
crucial role in shaping a more compassionate and informed approach to
mental health in Orthodox Jewish communities. Despite the procedural
language the book adopts, it reflects a Halakha that isn’t limited to
delineating what is permitted and prohibited; the book encourages and
fosters values such as compassion, hesed, and caring for
people’s well-being and lives. In the same vein, R. Rosenzweig, in
addition to authoring this book, has become an address for psak Halakhah
on mental health issues and founded an organization to train, educate,
and sensitize rabbis to challenges of mental health and Halakha. Placing
mental health patients at the forefront of this Halakhic caring is
innovative, and is an important and necessary reminder of Halakha’s
underlying values.
[1] Parenthetical citations refer to this volume.
[2] Abraham Amsel, Judaism and Psychology, (Feldheim Press, 1969), 93.