April 26, 2007
Jewish tradition says safety trumps privacy when it comes to mental health
The deadly rampage and paranoid ravings of Seung-Hui Cho in Virginia last week cast an uncomfortably harsh light on the issue of mental illness, particularly untreated or undiagnosed mental illness among young people.
While Cho had some initial psychological counseling in 2005, it appears that he opted out of follow-up care, an option the law affords adults who do not pose immediate danger to themselves or others.
In the Jewish tradition, while privacy is valued, a greater emphasis is put on healing the person who is ill and protecting those around him.
"I think that both as Jews and as Americans we have a strong sense of privacy and of the right to individual privacy, but at the same time that does need to be balanced so that we report issues when we see them," said Rabbi Elliot Dorff, professor of philosophy and co-chair of the bio-ethics department at the American Jewish University (formerly University of Judaism).
Jewish law considers mental illness as serious and real as physical illness, he says, with an accompanying obligation of treatment.
The laws against lashon hara (gossip) are suspended when a person's safety or well-being is at stake, Dorff points out, and Judaism requires bystanders to become active participants in ensuring a person's well-being.
At the same time, Judaism does recognize that human dignity often lies in the right to privacy. God himself is only partially revealed, Dorff said. And he points to the Biblical laws that require a lender who is collecting a pledge to wait outside the door, and not invade a person's home. Rabbinic laws prohibit opening another person's mail, and tzedakah (charitable giving) is considered to be at a higher level when it is given anonymously.
But the emphasis on privacy can be taken too far, Dorff says, such as when there is a reticence to report domestic abuse.
"Health and safety trump privacy rights," he said. "It's a hard balance to strike, but one we need to strike."
Some Jewish mental health professionals believe American law errs too far on the side of individual rights.
"There are those who say that someone has a right to be disheveled and pushing a shopping cart and muttering to himself and living under a bridge, as long as he doesn't hurt anyone. They say he has a right to do that, and giving him that right is what embodies a vision of human dignity," said Dr. Abraham Havivi, a psychiatrist and ordained Conservative rabbi.
"Others would say that what embodies a vision of human dignity is to take control of that person against their will and force them to have treatment, and that it doesn't respect their dignity to allow them to be that way," said Havivi, who runs a private practice and teaches pastoral counseling at the Ziegler School of Rabbinic Studies at the American Jewish University.
Havivi points to the biblical injunction of "Lo ta'amod al dam re'echa," to not stand idly by when a person is in danger, which includes getting a person help when necessary.
Traditionally, he says, families -- Jewish and non-Jewish -- have taken care of those who are struggling, no matter their age.
Havivi points to a situation where an 18-year-old patient has been hospitalized for his first psychotic breakdown, a common occurrence since psychosis such as schizophrenia or mania often manifest during the late teens or early 20s. If the patient refuses to tell his parents, the treating professional is precluded by law from calling the family, even though the patient's decision-making capabilities are compromised.
In that situation, Havivi sees the law butting up against his ethics.
"There are times when a mental health professional is faced with a dilemma," he says. "Do I essentially violate the law and break confidentiality to notify someone's family? If I were this young man's parents, I would want to be notified and want to try to take care of my child," Havivi said.
Jewish Family Service (JFS), an agency of the Jewish Federation of Greater Los Angeles, works hard to maintain that balance as it offers counseling in its several storefronts and onsite at public high schools and Jewish day schools. Assessment by several people is a big part of the process, and serious cases get referred to in-patient facilities or intensive out-patient programs.
Having the services in the schools makes it more likely that students and parents will get help, said Margaret Avineri, director of clinical and disability services at JFS.
JFS helps teachers identify behavior that should be referred to mental health professionals, and presents workshops to students, parents and teachers on issues such as substance abuse, relationships or safety on the internet.
"A lot of the programming promotes good communication, which I think can prevent rather than react after serious situations," Avineri said.
Milken Community High School also takes a proactive approach, according to Roger Fuller.
A unit on mental health is included in the ninth-graders' curriculum, and those students, in groups of six to 12, are matched up with advisers. The groups stay together through the four years of high school, and the students check in with their adviser for 15 minutes four times a week.
Staff counselor Georgie Cutter is available for academic as well as social needs, and next year two more counselors are coming on board.
Some Milken students also volunteer for Teenline, a hotline staffed by trained teen volunteers, who field anonymous phone calls and online messages from teens who have issues with anything from boyfriend problems to suicidal thoughts.
While the vast majority of mental illness does not lead to violence such as Cho's, Dorff -- a past president and current board member of JFS -- encourages those who have issues to seek help, and for others to get help for those who need it.
"One of the important things to recognize is that just as physical illnesses range from a cold to cancer, so too mental problems range across a spectrum," Dorff said. "People can have real problems that one has to deal with, and they are not always going to be life-threatening."
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