• Editorial - September 2008
Rosh Hashanah 5769
• Faith and Life
• Protection and Dissuasion
• Memorandum on the present dangers to Israel and the Jews
• Ghosts from Vienna’s Past
• The security barrier
• Avoiding scars
• Mayer - Mattie
• Yesterday - Today - Tomorrow
• The Sinai Centrum
• Mind and Spirit
Crimes and Justice
• The Hunt
Ethics and Judaism
• Time to Desist
Rabbi Binyomin Jacobs. Photo Bethsabée Süssmann
“Cholei Nefesh” – sick of soul, is one of the Hebrew terms for someone who is mentally ill. As a parallel term, in many communities, the job of rabbi is referred to as “doctor of the soul”. In the Jewish psychiatric hospital in Amstelveen, we met Rabbi BINYOMIN JACOBS, a man who entirely fits this description and whose work is indeed to deal with the mental and spiritual well being of the mental patients being treated there.
Rabbi Jacobs in fact wears two hats, one as Rabbi of the Sinai Centrum and one as Rabbi to the small communities in Holland, spread out over the twelve provinces, excluding Amsterdam and Rotterdam. He also looks after the Amsterdam orthodox school, the “Cheder”, and is the Chairman of the Rabbinic Council (Vaad HaRabbanim) of Holland.
Rabbi Jacobs received us in the Sinai Centrum’s synagogue, a Jewish place in the style of mini Jewish museum, where various religious objects are on display concerning Jewish life events, and which are sometimes put to religious use. However, the patients who want to take part in a service go to the neighboring Jewish hospital.
How do you see your task at the Sinai psychiatric clinic?
Before answering this specific question, I would like to say a few words about my rabbinical work in the small communities, which will give you an insight into how I work here. As a rabbi, I have a very clear mission, to bring people closer to their roots and convince them to be more religious and more observant. This of course has to take place with a lot of tact, respect and with the necessary flexibility and tolerance in religious practice, without infringing Jewish law (Halacha). To achieve this, I lead a group of six rabbis who deal with Jewish life at both the individual and communal levels in the various small towns.
It is quite different from my work at the psychiatric clinic. Here my job is, curiously, not to make people more religious or more observant. It is entirely out of the question that my group and I should abuse our position. Each person coming here is weak and vulnerable. If I took advantage of the situation to make someone more religious, I would feel like those Catholic clergy who during the Shoah hid Jewish children and took the opportunity to gradually lead them towards Christianity, with a view to eventually converting them. The people here are fragile and it would be easy for me, knowing exactly how to speak to them, to have a strong influence on them. Now apart from the fact that it would be religiously false and even reprehensible, I believe that a person who arrives at the Sinai Centrum religious and observant must be so when they leave us, while someone who comes here not religious or observant they should not have changed when they leave. I am the Chairman of the Rabbinic Council of Holland and hence the boss. However, here the boss is the doctor. I am heavily involved in the operation of this hospital, but the most important person is the doctor and not the rabbi, for the very simple reason that we are in a hospital where people come to be cured, and not in a synagogue. Three assistant rabbis work with me, and if I note that any one them is trying to proselytize, I fire him on the spot. Having said which, if someone wants information or help in religious matters, obviously we are not going to push them away. We incidentally regularly hold classes and discussions on religious subjects open to all who wish to participate. However, within this situation I always try to use Judaism as a means for discussing a given problem. It is by no means rare that I cite an episode from the Bible to show how such a problem was addressed and resolved then and what lessons we can draw from it.
What are the tasks and the work of a rabbi in a psychiatric hospital?
My work is divided into two distinct parts, actual rabbinic work and being a spiritual assistant or counselor for people’s conscience. This is not at all obvious. Do not forget that my main tool is Judaism, but that I must also have an idea of psychiatry. Yet I am not a psychiatrist or even a plain psychologist. Thirty-three years ago, when I started my work here, the clinic wanted me to study clinical psychiatry, reckoning that would be a plus in carrying out my work. However, after mature reflection, I realized that I would no longer be a rabbi nor really a clinical psychologist, so I never did it. Yet in order to better understand and better help our patients, I have done as much as possible to increase my knowledge of psychiatry and psychology without of course reaching a professional level; but I only wear one hat, that of rabbi. To illustrate what I am saying, let me give you the example of a family where the father lost his job and spends all his time at home. Inevitably, he ended up arguing with his wife, as a result the children become traumatized, and in the end everything is going to blow up in their faces. What will happen now? The psychiatrist will give him a sedative; the psychologist will tell him he has bad relations with his wife because when he was young he a problematic relationship with his mother and will prescribe therapy; the social worker will tell him that the situation is due to the fact that he has nothing to do all day and will suggest that he takes up some voluntary work; and lastly the rabbi will till him that he does not accept this situation and that he should take himself in hand. Who is right? Everyone is right, according to his or her training. In fact, in most cases it is the combined efforts of all four that are required to help the person.
In terms of the rabbis, we do the minimum to create a Jewish atmosphere, to mark Shabbat, Chanukah, Purim etc. However, we also maintain this “synagogue” where all the Jewish religious artifacts are on display so that people who are no longer at home can find a certain atmosphere again and objects with which they are familiar. We of course provide kashrut supervision. Another, very important aspect of our work is training the non-Jewish staff about Judaism. The Jewish atmosphere is not just provided by the rabbis, but also and even especially by the staff, whom we are responsible for training and informing about things Jewish. The patient coming here enters a Jewish institution and accordingly everyone he or she meets is “Jewish”, even if in fact that is not so. To maintain this atmosphere, we need to teach the staff to pay attention to small details. For example you must not speak about the “Sabbath” but about “Shabbat”. This is as important for the observant as for the others. Further, in my relations with the clinic’s non-Jewish world, I am regularly consulted by non-Jewish patients, whom I help with pleasure.
Another aspect of our job is to back up the doctors or psychologists. We recently had the case of someone who had lost a very close relative who had meant very much to him. His reaction had been extremely violent and he went into a deep depression. The psychologist dealing with him asked me to give him some help. He gave him a medication and my job was to speak to him about life, death, life after death etc. It also happens that people know they have a problem that needs to be treated at our clinic. However, they cannot accept the idea of going to see a psychiatrist or psychologist, but come to see me. In most cases, I understand straight away what it is all about. So I tell them I will be pleased to see them, but that unfortunately my timetable only allows me to fit them in on such and such a day at a given time… at the clinic. They are delighted to come here, not as patients, but because I did not have time to see them anywhere else. It is not easy to accept the idea of going to a psychiatric clinic. So, I make their entry easier.
Does it ever happen that you are directly involved in the treatment?
Certainly, indirectly, or in providing support, whether direct or indirect. We often speak about traumas for which we treat victims of the Shoah who had been through the camps, their descendants and even the third generation. I will give you an example, connected with the war, nothing to do with being deported. Recently, I had the case of a man with a serious identity problem, because he did not really know who his father was. During the Second World War, his mother was hidden in a restricted space together with men, and she had clearly had relations with several of them, so much so that she did not know who had fathered her child. This boy had suffered from this situation his whole life. Each time he was called up to the Torah, he was called by the name “Ben Avraham”, son of Abraham, in other words the son of an unknown. One day his psychiatrist asked me to have a talk with him. He told me that he believed his father’s name was Yoel. I told him he was completely right and that from then on he could be called to the Torah as “Ben Yoel”. In a flash most of his problem was solved. Now, when he is called up to the Torah, he is no longer the son of someone unknown, but a man with a father who had a name, which had not really been the case until now. To tell the truth, I have no idea who his father was, and in this case, it was of no importance.
Can you quote us a case directly related to the Shoah?
Recently, on a bus a woman started talking to me, saying that her father, who had been a major personality in the rabbinic world, had been deported and murdered in Auschwitz just two days after having led the Yom Kippur service. She herself had been deported as a child. All her life she has only thought of this, she turned away from Judaism and married out of the faith. She also said that she was sure I had no satisfactory answer as to why the Almighty had let something like that happen just 48 hours after the Yom Kippur service. My job is to make her understand that there is no rational explanation for everything, and most especially to learn to live at long last with the abominable thing that had happened, and to stop thinking about it all the time. If I do not manage to convince her, I will ask someone at the clinic to help her, to make her life easier.
One of the main features of a Jewish hospital, whether psychiatric or general, is that it follows Jewish medical ethics. Are you often asked about the subject?
I am the Chair of the Medical Ethics Committee. To play my role on that body, it is key that I am in constant contact with the patients. It is impossible to take a decision in the field of ethics without knowing what is happening on the ground. This is even truer in psychiatry, where every case is totally different from the next. This is not a matter of dealing with a broken leg. Rather than giving you long, theoretical explanations, I will offer a practical example. As you know, as people get older, short-term memory becomes gradually impaired while the past comes welling up. We had a patient whose memory had got blocked at the period of the war. She became increasingly terrified, difficult to live with for those around her and the staff looking after her. What’s more, she started to mutilate herself with forks and things. She had already been given the largest dosage of medication, but it was no longer having any effect. The psychiatrist had the idea of putting this woman into an artificial coma for five days, after which they could continue with regular treatment so that she could get ten years of peace. Why did they come to consult with me? This method involves a risk, because going into an induced coma for five days might put her life at risk. The ethical question accordingly was whether they had the right to take the risk or not. During a meeting with the psychiatrist and the matron, the head nurse, I told them, after they had explained the details of the case to me that I felt we were not in a position to make a decision. In fact, the psychiatrist knew what would happen before and after these 5 days in question, while the matron was too subjective since this patient was taking up a large part of the nurses’ time. I therefore suggested they seek the opinion of a doctor, specifically a neurologist specializing in intensive care who would be able to make a fully informed decision. They accepted my suggestion and the doctor they consulted called me saying that they could take the risk, under his supervision. There are in fact today methods, if things ever take a turn for the worse, for interrupting the process, which the psychiatrist, who had studied medicine twenty years ago, did not know about. Thank G-d, in the end all went well. Had things turned out badly, the family would have said that the clinic had killed the grandmother, because she would have become completely impossible and the doctor would never have been at ease about his decision. My involvement provided a neutral opinion that allowed the decision to be taken calmly and in accordance with Jewish law. I have to say that in 33 years of work here, I have never had arguments with doctors, and we have always found a way of cooperating.
How did you come to be a rabbi at Sinai Centrum?
It’s much easier to enter a psychiatric clinic than to leave one! As a young rabbi, I was sent to Amersfoort, where as a rabbi on behalf of Chabad, I was employed as the spiritual guide of the community. At the time the Jewish psychiatric hospital was there, though then it was more a home to house mental patients rather than to treat them. Gradually, the approach of the clinic changed, while I matured, developed and acquired experience at the clinic. As I said, it isn’t easy to leave a place like that and I have not the slightest intention of doing so, because daily I see the results of my efforts.
Of course, when I meet a patient after he or she has left the clinic, they pretend not to know me. That is the price to pay for the small successes and victories that we obtain every day in our fight against mental illness.