Depression in the Frum Community

Pamela Siller MD

Sara Esther awoke suddenly, but kept her eyes tightly closed. Her first thought was a prayer "please Hashem let it be morning". She slowly opened her eyes, and was dismayed to find that her room was still pitch black. The luminescent numbers on her bedside clock stubbornly read 4:03 AM. She flopped back down with a sigh. This was the eighteenth morning in a row that she had not been able to sleep through the night. She had tried everything from reciting the Shema, and prukim from the Torah, to counting sheep. Against her doctor's advice, she even tried to sneak a tablet of Benadryl from the medicine cabinet. It always made her tired when she took it for an allergy attack. Sara Esther was getting so desperate that she considered going to the cabinet where the wine and liquor were kept. For the next two hours she tossed and turned, and counted backwards from a hundred. Nothing helped the thoughts that kept racing through her head. She kept thinking back to the day before, and examined everything she had done that day. She made a list of all the things she did wrong, from taking too long to answer when her Eema called, to getting 6 questions wrong on her Chumash test. The worst was when her Tatty rebuked her, and she started crying and couldn't stop. That was the first time she had not been able to control the tears in front of people. Usually that only happened when she was alone. Her family had gotten so worried. The theme was clear - she was a terrible burden, and didn't deserve to live in a world where people loved her. Everyone would be better off without her. The next thing she knew her alarm clock was going off, but she could not muster up the strength to get out of bed. What was the point…another day? Then she heard her mother at the door. With a great effort, she heaved herself out of bed, and forced herself to go to school.

Sara Esther's parents did not know what to do. This was not the daughter they knew and loved, but the change had been so gradual. Their family wasn't perfect, but they always gave all their children love and attention. Sara Esther had seemed to lose her spark. She had become so withdrawn, not even wanting to see her friends, and her grades had gone down as well. What to do? Nobody they knew had such problems, and even if they did, it would never be discussed. Sara Esther's father suggested that he would ask the Rabbi for guidance.

When Sara got home from school, her father was waiting for her. He explained that the Rabbi wanted to see her. Why she asked? Just to talk was the reply. When they arrived the rabbi asked her if she could describe how she felt. She did not answer. How could she answer such a question when she did not even know the answer herself? No words could describe it. Bad, hopeless and guilty came to mind, but she felt that she could never say the words out loud. The rabbi then suggested to Sara and her father that she should talk to somebody who could help her. Sara kept her head down and stopped listening. This just reinforced her feelings of guilt about the tremendous burden she was placing on her family. As she went home, she could barely see through her tears.

Her parents stayed up talking late into the night. A therapist? psychologist? psychiatrist? Sara wasn't crazy, but she was in a great deal of pain. If she were to go to a mental health provider, should she go to somebody frum or secular? If it were a frum doctor, they would understand the Jewish customs and belief system, even the nuances of language, but could confidentiality be trusted? Should it be somebody from the neighborhood, or in a nearby community? If word got out would it hurt her chances for a shidduch? Sara's parents realized that Sara needed help, and contacted a mental health provider the very next morning. It took 3 days, but Sara's parents soon brought her to a psychiatrist for an evaluation.

Depression is a very common and debilitating illness, which can be devastating for both the patient and their loved ones. Depression strikes 1 out of 18 individuals. Women have a 20% chance of developing a depressive episode in their lifetime, with men following at 7%. These statistics apply to our community as well. Symptoms of depression include change in sleep, appetite, concentration, energy level, and mood. Increasing irritability and social isolation, as well as changes in academic performance are also important indicators, especially in adolescents and children. Feelings of guilt, hopelessness, and helplessness are common. Sometimes the emotional pain becomes so intense that patients look to substitute it with physical pain. At times, they may cut themselves in areas that are not seen when wearing tsnius clothing. At the extreme end of depression, suicide may come to look like an attractive option, despite knowledge of halachic prohibitions.

There are several ways to treat depression, and related mental illnesses. The most common recommendations include weekly individual psychotherapy, medication management, and group therapy. It usually works quicker and better when all three modalities are used in conjunction with each other. In individual therapy, a therapist would assist Sara Esther in identifying barriers to change and the thought process or events in her life that led to her depressed mood. In a calming nonjudgmental atmosphere, the therapist would help her to learn to better cope with and understand life's trials and discomforts. Under careful monitoring and supervision by a psychiatrist, medication would give needed relief to get a patient over the acute stage. With few side effects, these medications can be used in both the short and long term. Any treatment decisions should optimally be discussed with all parties involved, with careful consideration given to all alternatives. Group therapy is an underused in our community even more so than in other communities, however it is an immensely valuable resource. Group therapy allows the patient to interact with others in similar circumstances. Peer support and feedback can allow one to take a realistic look at feelings, thoughts and behaviors. Confidentiality would be emphasized throughout the treatment process, and would be in the best interest of all group members, as they are all there for similar reasons.

Sara Esther was lucky that her parents were astute enough to pick up the warning signs. They cared enough to ensure that she got the help that she needed in a timely fashion. She began weekly, individual therapy, and started on a trial of medication for her depression. In addition, she entered into group therapy, where she was astounded to realize that she was not the only one suffering from depression in the frum community. Because she was able to take advantage of the many resources available to her, she was soon able to again become the person her family knew and loved.

Pamela P. Siller MD serves on the Executive Board of NEFESH International, and is a representative of the Greater Long Island Psychiatric Society. She is an Assistant Clinical professor at New York Medical College, and an attending on the adolescent inpatient unit at Westchester Medical Center. In addition she sees children and adults at Interborough's Crown Heights Center, as well as at her private practice in Great Neck, LI. She can be reached at 917-841-0663