by Rabbi Aryeh Klapper
SBM 2017 Shaylah:
Kaila Adamah Jellison was a junior at Samuel Myerson High School when she suffered her first attack of manic-depressive illness.
It began with exhilaration. I had always been a highly competent and painstaking student, but prone to two-dimensional readings of texts and human beings. Suddenly I could see into the depths of literature and people, made giant intuitive leaps, and everything made so much sense! I still experience the world more richly as a result of that first week. But the crash came soon after. My limbs became concrete; my mind, an uncomprehending blank. Nothing made sense; nothing interested me. Then came an obsession with death – I wandered through the local cemetery for several nights in a row writing endless morbid poems and reciting kaddish at each gravestone that seemed to have a Jewish name . . . But no one in school seemed to notice anything amiss; I still don’t understand how.
A second attack came in graduate school, soon after her marriage to Marcus. This time the manic phase led to uncontrolled spending and impulsive rule-breaking; the depressive phase almost killed her.
I bought fountain pens – tens of fountain pens, because my ideas deserved to be expressed in perfect calligraphic form. I shoplifted some of them because the line at the store was too long. Then I started collecting wild turkey feathers and sharpening them into quills so that I could write the perfect Megillat Esther – and I did! . . . a few days later I was hallucinating, and thinking suicidally in very specific ways …
A psychiatrist put her on lithium, which worked. But for several years she would stop taking the pills whenever she felt good enough for a while – the highs were too seductive, and the lows no longer seemed real. She thought she could take them in time if her moods seemed to be spiraling out of control; but she was constantly in danger of falling completely over one cliff or the other. But one day in Elul, Marcus came home to find her in the grip of a paranoid/grandiose fantasy.
The world was out to get me; or maybe the world was broken, and only I could fix it, by repenting properly on Yom Kippur. But my whole community was conspiring to stop me . . .
Kaila was hospitalized on 28 Ellul, in a facility well out of walking distance of any motel or Orthodox community and with no space for guests and limited visiting hours. She is prescribed medication that makes her ravenously hungry. Her doctors say that while it is almost certain that she will return to normal moods soon, having caring visitors daily will probably lead to a significantly faster return to normalcy. They also warn that this is remission, not recovery, and that this cycle will happen again unless she succeeds in staying on her meds.
As you are a close friend of the family, and an informal halakhic authority of some repute, it is not surprising that when you visited that night, both Kaila and Marcus had questions they want to ask you:
- Is the megillah kosher?
- If I blow shofar for myself, can I make the berakhah?
- Should/may/must I fast on Yom Kippur?
- Can I take a cab to visit her on Shabbat and yom tov?
- Our minhag has always been for her to make the hamotzi on Friday nights. Can I be yotzei with her berakhah while she is hospitalized? (Was I yotzei with her berkakhot during these interim periods?)
Sometime before Pesach, with Kaila having been out of the hospital after Sukkot and medication-compliant since, she decides to write a magazine article about her experiences for the OUs Jewish Action, with the goal of destigmatizing mental illness in the Orthodox community. Jewish Action accepts the article and asks you if you’re willing to write up the answers you gave her, with your reasoning, so they can either publish or link to it. They also pass on that several rabbis on their advisory board expressed deep interest in reading as fully developed a teshuvah on the questions as you can produce.
Rabbi Klapper’s response:
Kaila and Marcus Jellison are an exceptional couple who deserve our admiration and gratitude. Their courage opens the space for a much-needed conversation about the spiritual and halakhic lives of the mentally ill and how they can best be included in our communities. I emphasize that we need to discuss all three aspects: halakhah, spirituality, and inclusion. My focus here will be on how halakhic deliberations and conclusions affect and are affected by all three aspects.
The halakhic tradition discusses mental disability primarily in one narrow and probably atypical context: the competence of a husband to issue a Jewish divorce. The context is narrow because divorce has no necessary connection to any other aspect of Jewish law. On the one hand, it requires an unparalleled type of mental “force” on the part of the husband. He must write or delegate the writing of the get in a fashion that imbues it with the semi-mystical quality of “lishmoh-ness”. This requires his willing consent and intent, and is often understood as requiring his physical presence. On the other hand, as my teacher Rabbi J. David Bleich has noted in the context of American constitutional law, a husband can produce a valid get without having any degree of religious intent or belief, so long as he understands its consequences within the realm of Jewish law for those who accept its authority.
Divorce law may also be halakhically anomalous with regard to issues of mental disability because it involves one of the supreme ethical imperatives within halakhah: the drive to free women from marriages that provide them with no companionship. A man who is declared incompetent to divorce will generally also be useless as a husband. The less relationally competent he is, therefore, the more pressure there is to declare him legally competent in the area of divorce. There may be correspondingly greater reason to declare him incompetent with regard to other areas of halakhah.
This brings us back to our initial triumvirate: From the perspectives of the spiritual and communal lives of the mentally ill, what are the central halakhic issues, and how are they best approached? 
For example, Kaila and Marcus asked two questions about blessings. The first was whether she was permitted to make a birkat hamitzvah before blowing shofar for herself on Rosh HaShannah. The second was whether she could make a birkat hanehenin on behalf of herself and another obligated adult.
It is possible to approach these issues from a purely technical, although humane and clever, perspective. For example, one might suggest a mimah nafshakh: If Kaila is competent, then she is permitted to make a birkat hamitzvah; if she is not, then she is not subject to the prohibition against making berakhot levatalah. So either way there is no reason for a posek to tell her not to make the berakhah before the shofar. Or a pragmatic workaround: Marcus can mutter the blessing under his breath while pretending to fulfill his obligation through Kaila. These are perfectly legitimate practical approaches to the issue at hand, and yet they require absolutely no consideration of Kaila’s spiritual life or communal place (even though they cater to her presumed psychological best interests).
A very different approach would ask: What sort of intellectual, emotional, or religious understandings or capacities are necessary to make these blessings meaningfully for oneself, and for others? To what extent is that meaning or meanings dependent on the religious reality of being obligated, or on the religious condition of being capable of obligation? To what extent should or must halakhic categories of obligation correspond to such spiritual and psychological realities?
Let me be clear that the answer to the last question is not obvious. For example, one strand of the tradition holds that blind people are exempt from all Torah obligations despite being perfectly capable of obligation. Some modern poskim continue to exempt deaf-mutes from all obligations on the grounds that this exemption is a rationale-less and therefore unchangeable halakhah leMosheh miSinai. Rav Mosheh Feinstein held (in one responsum; he appears to hold differently elsewhere) that anyone exempted from one mitzvah on grounds of mental incompetence is exempt from all mitzvot, even if they are fully competent with regard to those other mitzvot. A standard contemporary ruling is that adults with the mental age of kindergarteners are legally obligated in all mitzvot, even though they cannot be held more liable than kindergarteners when they transgress. So we have both exemptions and obligations that explicitly do not correspond to spiritual and psychological realities.
Nonetheless, I believe that it is generally best to pasken with a bias toward correspondence. We therefore must turn to Kaila’s realities.
Manic-depressive illness is not explicitly discussed in Rabbinic literature. The Rabbinic term shotah is defined in one core discussion by a set of actions that include one that may mark depression, sleeping in cemeteries, and another that may mark mania, going out alone at night. But there is no hint of bipolarity as a defined condition , let alone as a progressive disease with varying degrees of severity. There is of course also no discussion of its treatment, or of the status of manic-depressives in the various stages of taking effective medicines.
As SBM 2017 Fellow Shoshana Jakobovits correctly notes, manic-depressive illness is not a “secular” condition that can be evaluated in isolation from religion. Rather, at each stage it is often associated with religion. As with other mental illnesses such as obsessive-compulsive disorder, the expression of the disease in otherwise religious people is especially likely to take a religious form. Thus in our case Kaila said kaddish in graveyards while depressed, and learned safrut and wrote a Megillat Esther while manic.
We can therefore separate two questions:
1) What are the halakhic status and consequences of religious acts that are expressions of the underlying illness, recognizing that those actions are likely to be exaggerated expressions of “genuine” feelings?
2) What are the halakhic status and consequences of the religious acts of people suffering from mental illness, but which they plausibly contend are not expressions of the underlying illness?
Now we are not called on to discuss the kaddishes per se. We can presume that Kaila was aware that as a davar shebikedushah, the halakhah generally does not permit the kaddish to be said liturgically without a minyan present, and that in a neuronormal condition she would have abided by this halakhic restriction. It is accordingly clear that her illness is capable of causing her to violate halakhah in a manner that the Talmud likely would describe as העברה על דעתה, against her actual will. It is possible that this particular expression of the disease was wholly accidental, and she might equally well have violated any other halakhah. It is also possible that her underlying halakhic inhibitions would have prevented her from violating halakhah except in service to what seemed like a necessary positive religious outpouring. If the first hypothesis is correct, it seems to me likely that she must be ruled legally unaccountable for all matters. If the second is correct, we must address whether this distinction can become the basis for a coherent and plausible halakhic framework.
We must also discuss whether “legally unaccountable” should or must entail “not halakhically obligated”. As noted above, modern decisors have regarded adults with Down’s Syndrome as simultaneously legally unaccountable and halakhically obligated. However, perhaps the moral pressures in that case exceed those in ours. The Talmud also records the category of the tinok shehishbah, the Jewish infant captured and raised by non-observant aliens. As an adult, such an infant is legally unaccountable; he or she incurs liability for one sacrifice when they first commit a sin of appropriate severity, and incurs no further liability no matter how numerous or varied their sins. Rav Moshe Feinstein in one responsum states explicitly a position that seems implicit in much contemporary psak regarding American Jewry, namely that such an adult is nonetheless treated halakhically as fully obligated, and so can for instance make birkot hanehenin for other fully obligated adults. Perhaps then Kaila can also do so even if we rule that he is legally unaccountable for all matters. One might argue that she can do so kal vachomer, since her unaccountability may stem from an exaggerated spiritual sensibility rather than from the absence of any such sensibility.
But here it may also necessary to distinguish the stages of illness. In OCD, for example, the religious expression has no real connection to the mitzvah; the disease just seizes on available anxieties and amplifies them generically. In severe mania, this is also the case. But there may be a hypomanic point at which this is not so, or at least not so absolutely.
Many halakhic scholars have offered variations on a legal distinction between a person who is intrinsically not obligated, and one who is obligated-but-excused. This distinction may have concrete halakhic consequences, for example whether one may say a birkat hamitzvah. The category “shotah” has been assigned to each side of this divide, and other scholars have split the category, so that some shotim fall on one side and other shotim on the other. Some scholars have offered more theological distinctions, in which people can be categorized as religiously obligated even though not halakhically obligated. Such scholars may distinguish between rational and other commandments, for example. Each of these distinctions can be seen as relevant to our case.
The question of violating Shabbat to visit psychiatric inpatients can also be the subject of profound theological/halakhic discourse. Is it considered “life-saving” to restore someone to full sanity? If yes, does that mean that the insane are not fully alive (and how does one avoid the disturbing potential moral and halakhic implications of such a statement)? However, these are all moot in the present case. An in-patient for psychosis resulting from manic-depressive illness is at non-negligible risk for self-harm at essentially every moment. Any non-negligible possibility of speeding their return to neuronormalcy has the status of life-saving, and for a patient who expresses a desire or gratitude for visitors, visiting certainly has that possibility. As there is no issue of immediacy, care should be taken to violate Shabbat in the least halakhically severe way possible, but the underlying law is clear.
To conclude: My hope is that this synopsis honors the Jellison’s courage by jumpstarting overdue conversations among both scholars and laity, and by making our communities safer and more supportive spaces for members with mental illnesses. I pray that I have not committed any errors, and encourage readers to email me with questions or correction.
 A more complete, and yet still very preliminary, analysis of the underlying traditional texts and rulings can be found in my forthcoming Teshuvah. In this venue I will present the halakhah as I would currently decide it.
 There are a few discussions of conditions that may approximate clinical depression.