Thursday, 8 May 2014

A Jewish Orthodox Therapist, and the Suicidal Gay Client




(This distressing story is true, and published here with permission of an involved party).

"Robert" was a secular male client of an orthodox psychotherapist here in Israel, who we will call "Dr Avi"

Robert told Dr Avi that he is extremely depressed.

This depression had been a long term problem, but it had recently been exacerbated.

Robert explained to Dr Avi that he is gay, and that his male partner had recently walked out on him.

Robert was so upset after the break-up, that he was even feeling and acting suicidal.

"I have hung up a rope with a noose in my room," Robert explained.

"If I reach the stage that everything is totally hopeless and I'm ready to kill myself, everything will be ready".

During Dr Avi's session with his clinical supervisor, the idea came up of Dr Avi inviting Robert's boyfriend to the therapy sessions, to see if they could patch up the relationship.

Dr Avi and his supervisor, who is also orthodox, decided that before proceeding further with this, they would need to consult with a rabbinical authority.

Dr Avi called up the rabbi to ask whether he is permitted to help this client by facilitating a meeting between Robert and his gay ex-partner (who was going to be heading abroad in the coming days)?

The rabbi explained to Dr Avi that, as homosexual sex is strictly forbidden by the Bible/Torah, it is also forbidden for the therapist to try to fix-up the homosexual relationship ("Mesayea lidvar aveira").

Indeed, this was forbidden, even for the purposes of improving or curing the client ("Ein merapim b'issurim").

Following his rabbi's advice, Dr Avi did not bring up the suggestion in therapy with Robert of bringing in Robert's ex-partner.

Shortly afterwards, Dr Avi was called by Robert's distressed brother, who informed him that, following an argument between Robert and his brother, tragically, Robert had returned to his flat, and was later found dead in his room, hanging from the rope.

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When I heard this story, I was very troubled.

I am confident that the rabbi was surely an authority on halacha.

For example (hat-tip: Yitzchak Samet), in the Halachot of Kiddush Hashem (Yesodei Hatorah 5:12) the Rambam brings the ruling from the Gemara (Sanhedrin 75a) regarding a man who became mortally ill due to his lust for a particular woman and the doctors say that the only way to save him is for him to have sex with her.

Not only do we not advise him (pasken) that he can do so. We do not even advise him that he may converse with her from behind a barrier - even if she is unmarried!

An orthodox therapist is indeed obligated to follow halacha.

Tragedies happen, and one is often unable to change that.

For example, this client may have hanged himself, regardless of whether they had brought the ex-lover to the therapy session. After all, the depression pre-existed the split-up with his partner - so maybe the break-up was a contributing factor, rather than a cause for the suicide. And who is to say that arranging such a meeting between the ex-partners, would have resulted in fixing the relationship (the partner was heading abroad).

However, the question does need to be asked, should the parties have behaved differently, in hindsight, and are there lessons to be learned which could avoid future tragedies?
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Update 11/5/14: There are recommended articles and interesting comments about the same case on Daas Torah (R.Daniel Eidensohn) and Emet Ve'Emunah (R.Harry Maryles).

15 comments:

  1. kol hakavod, David that you raise these issues which can affect any family's lives, orthodox or secular.

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  2. Rav Eidensohn wrote about this earlier. He has some lomdus there that it would have been permitted (and therefore obligatory) to try patch up the relationship in order to save the patient's life.

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  3. Although you can assume the rabbi understands halacha - it doesn't necessarily follow that the rabbi understood the metziut/facts.
    And, if the therapist believed the rabbi may have made a mistake, and that a life was being endangered, he should at least have sought out a second opinion.

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  4. Isin't this one of theose cases where a responsible therapist would try and refer the case out, and, IMHO, as a general rule, Orthodoox therapists who are uncomfortable with facilitating the non-halachic actions of patients who live a gay lifestyle (or other lifestyle that goes against halacha - i.e. intermarried couples) should generally not take those patients on, and should refer those patients out to a secular therapist ASAP.

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  5. Isn't a therapist/medic always supposed to put the clinical best interests of his client first - ie ahead of his own scruples and religious doctrine?

    What does is a Catholic doctor supposed to do (according to professional ethics) when a patient asks him to prescribe contraceptives?

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  6. The fact that this depressed client chose a religious therapist may well go to show that the suicide was inevitable and planned from the start. Choosing to go to a religious therapist who he knew would have an issue with encouraging or even talking about his homosexual life, in a way helped him towards his end game. Suicide. Ending it all. Seriously chronically depressed people will describe there experience as 'stuck in a deep rut' ...or 'digging a hole'. This client was in that rut, very deep in it in fact. Suggesting relationship therapy between him and his partner would probably not have made any difference. It's a horribly tragic and sad story but unfortunately not too uncommon.

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  7. sinse you so obviously disagree with the psak given by the rov in this story; why don't you ask this hypothetical question to your rov and post his psak.

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    Replies
    1. Given the tragic outcome of the case - in retrospect there are many angles which could be approached differently for similar cases in the future.

      I don't have the halachik expertise or qualification to "disagree with the rav's psak" on the lomdus level.

      Part of the metziut/facts that a rav (and therapists) has to consider in future cases, is that the threat of suicide was carried out in this case.

      Delete
  8. Chanie Rosenfelder9 May 2014 08:32

    Did the therapist really believe that the only solution to the guy's depression was reconciliation? That is an unfair burden on the ex-boyfriend.
    If someone is truly suicidal, they are SUPPOSED TO BE HOSPITALIZED!! And if the therpaist thought it was not that serious, what about meds? Therapy? What if the ex had died (or discovered that he was straight, or found a new love) ? There would be no chance for reconciliation, and the therapist would have had to find another way to help his client overcome his depression....
    Sorry, i don't see the rabbi as guilty in any way at all, and I LIKE blaming rabbis!!

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    Replies
    1. Hi Chanie - the psak was, at most, one factor in many which might have contributed in some way to the tragedy.
      I am confident the therapists involved are also revisiting their roles in this case to learn how such an outcome could be avoided (if at all) in future.
      Your point about hospitalisation is excellent - and I am not clear why that was (apparently) not pursued in this case.

      Delete
    2. Chanie Rosenfelder9 May 2014 15:14

      Again, i do not accept that the psak was in any way relevant. IMHO, the fact that the therapist even thought of himself initiating reconciliation means that the therapist was failing at HIS job, which is to help the client come to terms with his current reality.

      Delete
    3. Hi Chanie - I've checked up, and I understand the option of hospitaliztion was raised by the psychiatrist and therapist and the the patient adamantly refused to consider this.

      Delete
  9. So a frum therapist should seek to reunite a married woman with her lover if she is depressed? According to the new morality gleaned from theis post, a sixteen year old depressed girl should be reunited with her boyfriend (it certainly, al pi halacha, is not statutory rape)? This game could go on endlessly.
    News flash: Healthy people do not kill themselves when they break up a romance, divorce, or are betrayed by a cheating spouse. We all know hundreds of people who lost love, and even had their children die!
    A gay guy who commits suicide over a relationship ending might just commit suicide over the next one ending - I don't think you can blame the therapist, whether Jewish or not, for not patching up a relationship that may have been completely over. Why would the gay guy's lover have wanted to go back to a depressed, suicidal guy he decided to leave? Because a therapist told him to? This just sounds silly, why assume the therapist could have made magic here?
    While of course as Jews we have sympathy for everyone who suffers - whether from mental illness, being gay, being in a situation like suffering from paralysis that makes it nearly impossible to get married in our society, there is a limit to how we have to conduct ourselves, despite our sympathies.
    This story is just stupid, it is just an obvious excuse to feed into the untruthful narrative about how if we deny gay men what they want, we'll have to feel guilty about them killing themselves. Poor gay frum men, if we expect them to deny their desires, they'll be so sad that they will kill themselves, so it is pikuach nefesh, and voila! there's your heter for mishkav zachar.

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  10. What a silly story.
    There's a basic question you are asking here: if a therapist is treating a person and the therapist is against a behavior because he believes it is sinful, is it ethical for him to
    a) treat that person
    b) advise against that behavior
    c) not disclose his own bias?
    This could apply to a Christian psychologist treating a woman considering abortion or an affair, an Orthodox Jewish therapist treating a gay person, etc. etc. It seems to me that the Orthodox Jewish therapist should have told his client that his personal religious beliefs preclude him from helping/advising him on gay relationships, but he is happy to try to treat his depression, and if the gay man wants help patching up a relationship or is seeking validation for his gayness, he is best off finding a different therapist. No therapist is obligated to help a person engage in actions which he believes to be unhealthy/immoral/harmful.
    Every therapist rejects clients - it is perfectly ethical to tell a client, I am not good at helping people with eating disorders as I have no experience treating anorexics or bulimics, please go to someone who is an expert in your problem, or, I lack knowledge of healthy gay lifestyles, please find someone else to help you.

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