This blessing for deliverance is typically recited in the presence of a minyan, or prayer quorum, often in the synagogue following an aliyah to the Torah.

Birkat Hagomel in Hebrew (courtesy of Sefaria)

The supplicant recites:

בָּרוּךְ אַתָּה ה’ אֱלֹהֵינוּ מֶלֶךְ הָעוֹלָם הַגּוֹמֵל לְחַיָּבִים טוֹבוֹת שֶׁגְּמָלַנִי כָּל טוֹב

The congregation responds:

מִי שֶׁגְמַלְךָ כֹּל טוֹב הוּא יִגְמַלְךָ כֹּל טוֹב סֶלָה

Birkat Hagomel in Transliteration and English Translation

Baruch ata Adonai, Eloheinu melech ha-olam, ha-gomel l’chayavim tovot she-g’malani kol tov.

Blessed are You, Lord our God, ruler of the world, who rewards the undeserving with goodness, and who has rewarded me with goodness.

After the recitation of this blessing, the congregation responds:

Mi she-g’malcha kol tov, hu yi-g’malcha kol tov selah.

May he who rewarded you with all goodness reward you with all goodness for ever.

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Nonetheless, psychiatric ailments continue to be stigmatized. And while Jews have been instrumental in establishing the field of psychology — and are often stereotyped as being “neurotic” and more likely to undergo psychotherapy —  the Jewish community, like society in general, is not always comfortable openly talking about mental illness or dealing with those who suffer from it. Indeed, in some quarters of the Jewish community, there remains a great reluctance to discuss the issue at all, much less to relate to it as just another medical condition. This is despite the fact that references to mental illness can be found in some of the earliest Jewish textual sources.

Do classical Jewish texts discuss mental illness?

There is little direct discussion of mental illness in the Bible, though some have suggested that various biblical figures, most notably King David, may have suffered from depression. In the Bible, “madness” is described in several places as a form of divine punishment. In Deuteronomy, shigaon — an antecedent term for the common Yiddish expression meshuggeneh, or crazy — is one of the forms of divine retribution for those who don’t heed the word of God. Later in that section, God says that the Jewish people will become “m’shuga” after a foreign people steals their crops and abuses them.

The rabbis of the Talmud mostly addressed the issue in legal terms, as a question of mental competence — their concern being principally whether someone of unsound mind is obligated by religious commandments. However, there are talmudic sources that continue the biblical equation of madness and sinfulness. In Tractate Sota, the third-century sage Reish Lakish says a person only sins when the spirit of “shtut” — madness or folly — comes over him or her. Contemporary Orthodox writers have echoed both these ideas — that mental illness is a form of sinfulness and a punishment for it.

According to traditional Jewish law, someone who is mentally incompetent — a category known as a shoteh, derived from the Hebrew word for wanderer or vagrant — is exempt from most religious obligations and cannot get married or bear witness. The Talmud describes such a person as someone who goes out alone at night (despite the dangers) or sleeps in a cemetery — signs of his or her detachment from reality. Maimonides said the shoteh is someone who runs around naked or throws rocks. According to the Israeli psychiatrist Rael Strous, the classic definition of a shoteh is essentially a psychotic.

Echoing our contemporary understanding of the various forms of mental illness, the rabbis distinguished between those who are completely insane, those who cycle in an out of lucidity and those who are insane only in certain respects. However, their understanding of the causes of insanity would not be embraced by contemporary mental health professionals. In Tractate Ketubot, Rabbi Shimon ben Gamliel warns that idleness leads to “shimaon,” which the commentator Rashi equates with the biblical “shigaon” — craziness.

Do Jews suffer from mental illness at higher rates than the general population?

The idea that Jews are more anxious and neurotic than the norm is a widely repeated stereotype, one that has been attributed both to the many well-known Jewish neurotics who have played up their anxieties for comedic effect in film and television, as well as a tendency to celebrate Jewish anxiety as a sign of heightened intelligence. But the scientific data does not support the idea that, on average, Jews suffer from mental illness at higher rates than the general population.

A 1992 analysis of data from the National Institutes of Mental Health found that “the overall lifetime rate of psychiatric disorder did not differ among Jews as compared to non-Jews, even after controlling for demographic factors.”  The study did find that Jews suffer from certain mental illnesses at higher rates, including major depression, dysthymia, schizophrenia and simple phobia, but had lower rates of others, including alcoholism. This finding echoes the results of studies conducted in the 1950s and 1960s that found elevated rates of neurosis and manic depression (now known as bipolar disorder) among the Jewish population. The 1992 analysis found that rates of bipolar disorder, panic disorder, agoraphobia, social phobia, obsessive-compulsive disorder and drug abuse did not differ significantly between different religious groups. A 2007 study found that the frequency of mood and anxiety disorders in Israel is within the range of rates found in other Western countries.

More recently, scientists discovered a genetic variation among Ashkenazi Jews that increases their risk of developing schizophrenia, but that genetic variant is also found among other religious and ethnic groups. In addition, researchers in the emerging field of epigenetics —which investigates how environmental factors can affect genetic expression — have found evidence that communities that have suffered from trauma and persecution can experience genetic changes that can then be transmitted to future generations.

In the Orthodox community, considerable attention is now being directed to the prevalence of Obsessive Compulsive Disorder, or OCD, a condition that can sometimes be hard to distinguish from a hyper vigilance (sometimes referred to as scrupulosity) regarding the performance of Jewish religious commandments.  Avigdor Bonchek, an Orthodox clinical psychologist and the author of Religious Compulsions and Fears: A Guide to Treatment, has suggested that one can distinguish between OCD behavior and healthy religious devotion in two ways: True OCD sufferers, he says, carry heavy stress and emotional burdens in their focus on strictly observing the commandments, and they demonstrate an extreme inflexibility that makes it difficult for them to violate commandments even when religiously obliged to do so.

Is there a stigma against mental illness in the Jewish community?

The stigma against mental illness is not limited to Jews. Mental illness is still often perceived as less “real” than physical illness, a sign of weakness or a defect of character. Surveys have shown that American employers are reluctant to hire people with histories of psychiatric problems or who are undergoing treatment. Research suggests that a majority of people hold negative attitudes toward the mentally ill and that, for many families, mental illness is a source of shame and embarrassment. That in turn leads sufferers to conceal their condition, making it less likely that they will seek treatment.

Jews are not immune to these tendencies, as evidenced by efforts in recent years to foster a more candid discussion about mental illness in the Jewish community. However, there are also indications that Jews are more open about mental health issues than other groups. A 2012 study of older New Yorkers found that Jews had a more positive attitude toward psychotherapy than non-Jewish whites and blacks, were more tolerant of the stigma surrounding therapy and were more open to sharing their feelings. The 1992 study based on the NIMH data also found that Jews were more open to seeking professional mental health assistance than were Catholics or Protestants.

In recent years, numerous efforts have been made to address the stigma in the Orthodox community, where the fear of harming marriage prospects has drawn a curtain of secrecy around those suffering from mental illness. Marvin Winkler, an Orthodox mental health practitioner, wrote in 1977: “The fear and shame associated with mental illness in the Torah community can be compared only to that associated with the most severe Halachic transgressions.” Today, there are a number of Jewish groups focused exclusively on mental health issues in the Orthodox community, including Refuat Hanefesh, which seeks to destigmatize mental illness among the Orthodox; Chazkeinu, which offers supportive phone meetings for women struggling with mental illness; Refa’enu, which runs educational programs in Jewish schools and support groups; and Relief, which makes mental health referrals.

Are there any Jewish organizations that focus on mental health?

Yes, Besides those noted above, Elijah’s Journey is a national Jewish nonprofit that focuses on suicide prevention. In addition, virtually every local Jewish federation in North America has a Jewish Family Services agency that provides, among other things, counseling and other assistance for families and individuals suffering with mental health issues.

There seem to be so many Jewish psychiatrists and therapists out there. Is the field of psychology dominated by Jews?

Anecdotally, this sometimes seems to be the case, but there is scant hard data to support it. One study published in 2007 found that American psychiatrists were more likely than other types of physicians to be Jews (Jews made up 29 percent of psychiatrists and only 19 percent of physicians overall), but the study, of 1,000 physicians, surveyed only 100 psychiatrists.

However it is true that Jews have been instrumental in the development of psychology and psychiatry. Probably the most famous psychologist in history and the father of psychoanalysis, Sigmund Freud, was Jewish, as were many of his early associates in the field,  including Erich Fromm, Alfred Adler and Bruno Bettelheim. Most of the major theorists of Gestalt psychology were Jewish. Joseph Jastrow, a Polish-born psychologist and the son of the author of a famous talmudic dictionary, was the first recipient of an American doctorate in psychology in 1898. Abraham Maslow, the psychologist famous for creating Maslow’s hierarchy of needs, was born to Russian Jewish immigrants in Brooklyn. Theorists have posed a number of ideas for why Jews are so prominent in early psychology, among them a Jewish penchant for expressing emotions verbally and a greater willingness among Jews to consult professionals about personal issues.

<!–Louis Jacobs, a British rabbi and theologian, served as rabbi of the New London Synagogue. Rabbi Jacobs lectures at University College in London and at Lancaster University. He has written numerous books, including Jewish Values, Beyond Reasonable Doubt, and Hasidic Prayer.

© Louis Jacobs, 1995. Published by Oxford University Press. All rights reserved. No part of this material may be stored, transmitted, retransmitted, lent, or reproduced in any form or medium without the permission of Oxford University Press.

–>

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Traditionally, the Mi Sheberach is said in synagogue when the Torah is read. If the patient herself/himself cannot be at services, a close relative or friend might be called up to the Torah for an honor, and the one leading services will offer this prayer, filling in the name of the one who is ill and her/his parents. Many congregations sing the version of the Mi Sheberach written by Debbie Friedman, a popular Jewish folk musician who focused on liturgical music. (That version can heard in the video, and its lyrics read, at the top of this article.)

Increasingly, the Mi Sheberach has moved into other settings and other junctures. Chaplains, doctors, nurses, and social workers are now joining patients and those close to them in saying the Mi Sheberach at various junctures—before and after surgery, during treatments, upon admission or discharge, on the anniversary of diagnosis, and more. We present it to you here, in English translation and in transliteration from the Hebrew, as a resource for you as you confront the challenges of illness. The Hebrew text can be found here.

Sign up to join My Jewish Learning’s Misheberach Moment, a weekly communal recitation of Mi Sheberach.

Listen to Mi Sheberach (courtesy of Mechon Hadar)

Mi Sheberach in English Translation

May the One who blessed our ancestors —

Patriarchs Abraham, Isaac, and Jacob,

Matriarchs Sarah, Rebecca, Rachel, and Leah —

bless and heal the one who is ill:

________________ son/daughter of ________________ .

May the Holy Blessed One

overflow with compassion upon him/her,

to restore him/her,

to heal him/her,

to strengthen him/her,

to enliven him/her.

The One will send him/her, speedily,

a complete healing —

healing of the soul and healing of the body —

along with all the ill,

among the people of Israel and all humankind,

soon,

speedily,

without delay,

and let us all say:  Amen!

Mi Sheberach in Hebrew Transliteration

The transliterated text below presents the prayer with correct pronouns for male and female patients. The word before the slash is for males, the one after for females.

Mi Sheberach

Avoteinu: Avraham, Yitzhak, v’Yaakov,

v’Imoteinu: Sarah, Rivka, Rachel v’Leah,

Hu yivarech virapei

et hacholeh/hacholah _____________ ben/bat ______________

HaKadosh Baruch Hu

yimalei rachamim alav/aleha,

l’hachalimo/l’hachlimah,

u-l’rap’oto/u-l’rap’otah,

l’hachaziko/l’hazikah,

u-l’chay-oto/u-l’chay-otah.

V’yishlach lo/lah bim-hera

r’fuah shlemah,

r’fu-at hanefesh u-r’fu-at hagoof,

b’toch sh’ar cholei Yisrael v’cholei yoshvei tevel,

hashta ba’agalah u-vizman kariv,

v’no-mar, Amen!

Reprinted with permission of the National Center for Jewish Healing, a program of the Jewish Board of Family and Children’s Services.

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Sign up to join My Jewish Learning’s Misheberach Moment, a weekly communal recitation of Mi Sheberach.

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As many as one in three Ashkenazi Jews are estimated to be carriers for one of about 19 genetic diseases. In all, Jews have higher carrier rates for more than 40 genetic diseases. These include better-known disorders such as Gaucher disease, Cystic Fibrosis and Tay-Sachs, along with far rarer conditions like Nemaline Myopathy and Walker Warburg. Sephardic and Mizrahi Jews are also at risk for some genetic diseases, but these generally vary with the particular country of origin and do not affect Sephardic Jews as a whole. There are no known genetic diseases specific to Ethiopian Jews.

While some Jewish genetic diseases can be effectively managed to permit those affected to lead mostly normal lives, none is curable and some are invariably fatal.

Certain diseases are believed to be more common among Jews because of the so-called founder effect, in which genetic diversity is reduced when a population descends from a small number of common ancestors. Moreover, since Jews historically have tended to marry only Jews, those mutations weren’t passed along to other groups, and they weren’t lessened by the introduction of new genes.

The best protection against these diseases is carrier testing, and there has been a broad push in recent years to make such testing standard practice for Jewish couples prior to pregnancy, and even prior to marriage. The incidence of some diseases has been reduced dramatically since genetic screening first became available in the 1970s.

Learn more:

Jewish Genetic Diseases FAQ

Jewish Genetic Disease Screening

Directory of Jewish Genetic Diseases

Jewish Genetic Disease Resource Guide

The post What Are Jewish Genetic Diseases? appeared first on My Jewish Learning.

Most American Jews strongly support legalized abortion: A 2015 Pew Research Forum survey found that 83 percent of American Jews, more than any other religious group, say abortion “should be legal in all/most cases.” However, Judaism’s position on abortion is nuanced, and both principal camps in the American debate over abortion rights can claim support from Jewish texts.

Is Judaism “pro-choice” or “pro-life”?

While Judaism takes a far less stringent approach to abortion than do many pro-life denominations of Christianity, providing explicit exceptions for threats to a mother’s life and rabbinic support for terminating a pregnancy in a host of other situations, there is nonetheless broad objection to abortion in cases without serious cause. In addition, despite the consensus that abortion is permitted in cases where continuing the pregnancy poses a threat to the life of the mother, there is disagreement  over just what constitutes a threat.

Jewish law does not share the belief common among abortion opponents that life begins at conception, nor does it legally consider the fetus to be a full person deserving of protections equal those accorded to human beings. In Jewish law, a fetus attains the status of a full person only at birth. Sources in the Talmud indicate that prior to 40 days of gestation, the fetus has an even more limited legal status, with one Talmudic authority (Yevamot 69b) asserting that prior to 40 days the fetus is “mere water.” Elsewhere, the Talmud indicates that the ancient rabbis regarded a fetus as part of its mother throughout the pregnancy, dependent fully on her for its life — a view that echoes the position that women should be free to make decisions concerning their own bodies.

At the same time, feticide is prohibited by Jewish law, though there is disagreement over the exact source of this prohibition and how serious an infraction it is. Some consider it biblical in origin based on a verse (Genesis 9.6) that prohibits shedding the “blood of man within man” — a phrase understood to refer to a fetus. Moreover, Judaism teaches that the body is ultimately the property of God and is merely on loan to human beings. Multiple prohibitions in Jewish law— including prohibitions on suicide, getting tattoos and wounding oneself— collectively serve to reject the idea that individuals enjoy an unfettered right to make choices regarding their own bodies.

As a public policy matter, many of the major American Jewish organizations have been vocal in support of broadening or protecting abortion access. Orthodox organizations, however, do not support broad legal protections for abortion. A 2019 New York law liberalizing the state’s abortion laws was opposed by both the Rabbinical Council of America and Agudath Israel of America, two major Orthodox groups, though both groups have been explicit that laws banning abortions in late pregnancy when a mother’s life is at risk run afoul of Jewish teachings.

Does Jewish law ever explicitly permit abortions?

Yes, but only under very limited circumstances. The most common situation, explicitly described in the Mishnah, is where the mother’s life is imperiled by her pregnancy. Some consider such an abortion not merely permissible, but mandatory. However, once the baby’s head has emerged from the mother (some authorities say the majority of its body, some say merely any limb), termination is no longer allowed, since Jewish law does not permit sacrificing one life to save another.

Short of clear threats to a mother’s life, the permissibility of abortion is controversial in Jewish texts. There are Orthodox rabbinic sources that support abortion when a mother’s health is in danger even if her life is not at risk; when a fetus is conclusively determined to suffer from severe abnormalities; when a mother’s mental health is in danger; or when the pregnancy is the result of a forbidden sexual union. However, these rulings are not universally accepted, and many Orthodox rabbis are cautious about laying down firm standards, insisting instead that cases be judged individually.

The Conservative movement is somewhat more lenient in all these cases, explicitly understanding threats to a mother’s life as extending to psychological threats to her mental well-being. In 1983, the Conservative movement’s rabbinical authorities permitted abortion only “if a continuation of pregnancy might cause the mother severe physical or psychological harm, or when the fetus is judged by competent medical opinion as severely defective.”

The Reform movement has historically taken a similar approach. In 1958, the movement’s rabbinate determined that abortion is permitted for sake of the mother’s mental well-being if there is “strong preponderance of medical opinion that the child will be born imperfect physically, and even mentally.” In 1985, the psychological justification was explicitly extended to cases of rape and incest, while emphasizing opposition to abortion for “trivial reasons” or “on demand.” In published responsa, the movement has rejected abortion in cases where the birth might pose hardships for other family members.  At the same time, both the Reform and Conservative rabbinates have been vocal in support of keeping abortion legal and accessible.

Is abortion discussed in ancient sources?

The Torah does not address the issue directly. The principal biblical source for Jewish law on abortion is a passage in Exodus (Exodus 21:22-23) concerning a case in which two men are fighting and injure a pregnant woman, causing her to miscarry. The verse states that if no other harm is done, the person who caused the damage must pay compensatory damages, but if there is further harm, then he should pay with his life. The common rabbinic interpretation is that if the only harm that comes to the woman is the loss of the fetus, it is treated as a case of property damage — not murder.

The later rabbinic sources address the issue more directly, beginning with the Mishnah referenced above. Elsewhere, the Mishnah says that if a pregnant woman is sentenced to death, the execution can go forward provided she has not yet gone into labor, a further indication that Jewish law does not accord the fetus full human rights prior to birth.

What about contraception?

The strictest Jewish approach to contraception holds that any interference with pregnancy constitutes a violation of the commandment in Genesis to be fruitful and multiply. However, there are various circumstances in which some types of birth control would be allowed by Orthodox authorities, among them threats to a woman’s emotional well-being if she were to bear children.  There is also generally more leniency to limit family size once a man has fathered at least one child of both genders. In all cases, Orthodox couples are urged to consult with a rabbi about family planning issues.

The Conservative movement permits contraception provided there is “a compelling physical or emotional well-being justification.” It allows contraception for general family planning purposes, but rejects it for financial reasons or as a matter of convenience and strongly encourages Jewish couples not to delay parenthood.

Jewish law also has clear preferences about particular methods of contraception. Vasectomy is traditionally prohibited because it’s a form of sterilization, a position affirmed by the Reform movement in 1984.  Condoms are traditionally not allowed because they result in the wasting of male seed. Since the obligation to reproduce traditionally is understood to apply only to men, methods employed by women are generally less objectionable. Hormonal contraception (“the pill”) and intrauterine devices (IUDs) are typically considered the most preferable methods, according to both Orthodox and Conservative rabbis. Here, too, couples concerned about complying with traditional rulings are urged to consult with a rabbi, as circumstances may dictate which methods are acceptable in particular cases.

As a public policy matter, major Jewish organizations have long been in favor of broader access to reproductive health services, including contraception. Hadassah, the Anti-Defamation League and the Conservative and Reform movements have all been vocal on the issue, including filing amicus briefs in relevant court cases. All four groups expressed disappointment with the Supreme Court’s 2014 ruling that corporations are exempt from providing contraceptive coverage under the Affordable Care Act if their owners object to such coverage on religious grounds. The Orthodox Union and Agudath Israel of America, in contrast, praised the ruling.

Are Jewish groups politically active on the issue of abortion?

Yes. The Reform movement has long been vocal on the issue of legal abortion and reproductive rights. In 1967, before Roe v. Wade made abortion legal nationwide, the movement’s rabbinic association urged the “broad liberalization of abortion laws,” and explicitly mentioned cases of a mother’s endangered mental health and pregnancies resulting from sexual crimes. The movement has reaffirmed that position multiple times over the years, while its Washington advocacy arm has been active in countering efforts to restrict abortion access.

The Conservative movement’s rabbis have also adopted numerous resolutions urging abortion access. In 2012, it called on its members to support access to the “entire spectrum of reproductive healthcare” and oppose legislation conferring legal rights on fetuses.

Various non-religious Jewish groups have also been active in support of abortion access, including Jewish Women International, Hadassah and the Jewish Council for Public Affairs. The American Jewish Committee and the Anti-Defamation League have both joined amicus briefs filed with the U.S. Supreme Court in support of abortion access. In 2020, in the face of mounting legal challenges to abortion rights, the National Council of Jewish Women launched Rabbis for Repro to encourage Jewish clergy to become more active on supporting reproductive health access.

Orthodox organizations, in contrast, do not support broad legal protections for abortion. The Orthodox Union has routinely dissented from Jewish Council on Public Affairs statements supporting abortion access. The ultra-Orthodox Agudath Israel of America has also spoken out against a permissive approach to abortion, but the group has also opposed restrictive measures that don’t allow for religious exceptions. In 2016, the organization objected to two Ohio bills restricting abortion access that did not provide exceptions for cases where a mother’s life is threatened.

A Sewickley, Pennsylvania-based group called the Jewish Pro-Life Foundation has sent people to pro-life demonstrations and offers a free “post-abortion healing program” for Jews who regret having had abortions. It also encourages people to recite the Mourner’s Kaddish for loved ones “lost through abortion,” and refers women who are pregnant to adoption agencies.

Is abortion legal in Israel?

Yes. All Israeli women seeking to terminate a pregnancy (and have it paid for through state health insurance) must appear before a three-person committee, but in practice nearly all requests are granted. There are no laws limiting when an abortion can be performed, and a woman whose request is denied by the committee can still seek an abortion at a private clinic. Estimates are that about half the abortions performed in Israel are done in private clinics. As of 2014, abortions were paid for entirely by the state for women aged 20 to 33, and subsidized abortions were granted for those outside that age range.

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Is suicide against Jewish law?

While there is no explicit biblical prohibition on suicide, later rabbinic authorities derived a prohibition from the verse in Genesis 9:5, “And surely your blood of your lives, will I require.” Rashi and other early rabbinic authorities understood the verse as a prohibition against taking one’s own life. Contemporary rulings from all three major religious streams have upheld the view that suicide is fundamentally incompatible with Jewish law and values.

Preserving human life is among the highest duties in Judaism, and suicide is seen as counter to this fundamental value. Human beings are barred even from harming themselves — let alone ending their own lives. Moreover, in traditional Jewish thought, the body belongs to God, and as such ending one’s life not considered within the scope of a person’s authority. Suicide is sometimes regarded as stealing from God and a rejection of God’s sovereignty. The only exception is in cases of martyrdom, where Jews are traditionally obliged to sacrifice their lives rather than violate the three cardinal sins of idolatry, murder and sexual immorality. However, the Jewish legal standard for suicide requires that a person be of sound mind, a standard that many contemporary rabbis believe disqualifies those who take their own lives as a result of mental illness, a category that includes severe depression and bipolar disorder.

Can a person who committed suicide be buried in a Jewish cemetery?

Yes, in most cases. Although traditional Jewish law rules that mourning rites should not be observed for those who take their own lives, most contemporary rabbis look for any basis on which to disqualify an apparent suicide so as to allow for traditional burial.

The Shulhan Arukh writes of a suicide: “We do not mourn for him, or eulogize for him, or tear our clothing for him, or remove shoes for him. We only stand for him on a line and say the blessing of mourners for him, and any other thing that is respectful for the living.” As a result, it was once common practice to bury suicides outside the cemetery gates or in a special section. But because the ancient rabbis established a high bar for what was legally considered a suicide, there are various grounds on which contemporary authorities could make the case that someone who took their own life doesn’t meet the standards for suicide established in Jewish law.

Only someone who killed themselves knowingly — in Hebrew lada’at, essentially someone of sound mind — is considered in Jewish law to have committed suicide. The Shulhan Arukh states that a case qualifies as a suicide if the person who died was angry or in distress and announced his or her intention to go up to the roof for the purpose of taking their own life.  In addition, an adult isn’t considered to have committed suicide if he or she acted out of compulsion — the cited example being the biblical King Saul, who killed himself rather than face torture or forced conversion at the hands of the Philistines An opinion attributed to the medieval authority Rabbenu Asher (the provenance of this opinion is widely disputed) states that traditional burial should not be denied to someone who commits suicide due to “a multiplicity of troubles, worries, pain, or utter poverty.”

All of this provides considerable latitude for religious authorities to find grounds for providing burial rites to Jews who take their own lives — even in situations where law enforcement authorities have identified the death as a suicide.

Aren’t some ancient Jewish suicides celebrated?

Yes. Perhaps most famously, the Jews who occupied the fortress of Masada are believed to have committed mass suicide rather than surrender to the Romans. Jews have traditionally venerated these and other historical figures for their bravery and self-sacrifice, but the legal standing of their actions is less clear.

What about assisted suicide for the terminally ill?

Suicide is not permitted even in cases when a person is terminally ill or in significant pain. Similarly, helping a terminally ill individual commit suicide is also not allowed, and may in some cases be tantamount to murder. Orthodox, Conservative and Reform authorities have all upheld the ban on euthanasia, though some prominent Reform rabbis have more recently questioned that prohibition.

Jewish authorities are more lenient when it comes to withdrawing critical care that might artificially extend a person’s life. The Shulhan Arukh rules that impediments to the passage of the soul can be removed so as to allow death to proceed. There is also broad support for alleviating the pain and suffering of those nearing death, even in cases where such measures risk hastening the patient’s demise. Orthodox, Conservative and Reform rabbis have all expressed support for morphine drips for the terminally ill — even at the risk of inducing cardiac arrest or decreased respiration. Given the morally fraught issues involved, families are often encouraged to consult with trusted rabbinic authorities when making such decisions.

Are there any Jewish suicide prevention resources?

Elijah’s Journey

 appears to be the only American Jewish nonprofit organization focusing exclusively on suicide prevention. However, many local Jewish Family Service groups provide counseling services for those struggling with depression and support groups for people who have lost a loved one to suicide. A number of national organizations can provide immediate assistance to someone struggling with suicidal thoughts.

Did we overlook a Jewish resource for suicide prevention or for people who have lost a loved one to suicide? Please email us at community@myjewishlearning.com.

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Who Should Be Tested and When

Most experts recommend that couples in which at least one partner has a Jewish grandparent undergo testing. The earlier testing is done, the more options are available. In some segments of the Orthodox community where marriage and dating are generally arranged by matchmakers, couples are screened for genetic incompatibilities before they even are introduced. In the broader Jewish community where such measures may be impractical, experts recommend individual testing prior to marriage, and absolutely prior to conception.

For couples screening, typically the woman is tested first and then her partner is tested for any diseases for which she is found to be a carrier. If only one partner is Jewish, it is generally that partner who is tested first. If the woman is already pregnant, both partners are tested simultaneously. If both are found to be carriers, then the fetus is tested for the disease.

How to Get Tested

People are generally screened with one procedure that simultaneously tests for multiple diseases. Various recommended testing panels include the most common Jewish genetic diseases, though some procedures screen for as many as 100 different conditions. Carrier testing is performed by DNA analysis, either from blood or saliva. Some diseases, like Tay-Sachs, may also require enzyme analysis. Screening can often be performed at an OB/GYN office or at a medical genetics facility. JScreen, a national nonprofit, offers home screening kits by mail at a cost of $149 for those who have insurance. For those without, the price runs to $349, and the organization does offer financial assistance for those who need it. Genetic counseling is provided by phone, so that couples understand their results and the options available to them.

Under the 2008 Genetic Information Non-discrimination Act, insurers in the United States may not deny coverage to healthy individuals with a genetic predisposition to develop a particular disease in the future. Employers are also barred from using genetic information to make decisions about hiring, firing and promotions.

The Sarnoff Center for Jewish Genetics, the Victor Center for the Prevention of Jewish Genetic Diseases, and the Jewish Genetic Disease Consortium all maintain directories of resources for those seeking carrier screening. Further information on screening services is available on our Resources page.

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Are Sephardic Jews also at risk for particular diseases?

Among the common Jewish genetic diseases are a number that also affect Sephardic or Mizrahi Jewish communities. On the whole, the risks of particular diseases for Sephardic Jews vary with country of origin. The carrier rate for spinal muscular atrophy, for example, is one in 10 among Jews of Egyptian descent. For Wolman Disease, the rate is one in 45 for Jews of Persian or Bukharian descent. The Jewish Genetic Disease Consortium recommends a screening panel of 16 diseases with increased prevalence among Sephardic Jews. And the Israeli Ministry of Health website recommends specific disease testing depending on the particular community of origin.

What about interfaith couples?

Anyone with at least one Jewish grandparent is at heightened risk of being a carrier of a Jewish genetic disease. Though these diseases are more prevalent among those with Jewish ancestry, they do also exist in the general population. Experts suggest that the Jewish partner in an interfaith couple be tested first. If the Jewish partner is found to be a carrier for a specific disease, then the non-Jewish partner should be tested for that disease.

What if I’m a carrier?

There are multiple options available to couples that discover both partners are carriers for a particular disease. Couples can decide to conceive a child and test the fetus early in the pregnancy. If the fetus tests positive, the couple can then decide whether to terminate the pregnancy or not. Another option is in-vitro fertilization, in which eggs are fertilized outside the body and only embryos that test negative for the disease are implanted. Some couples may also choose to use donated eggs or sperm from a non-carrier donor, to adopt, or not to have children at all.

Are there any ethical or Jewish legal concerns involved in genetic screening?

In the view of Jewish law, or halacha, some of the remedies offered to couples in which both partners test positive for a particular disease are problematic. Abortion is generally permitted only in cases where the life of the mother is threatened, something typically not the case with genetic diseases. Affected fetuses can normally be carried to term with no threat to the mother’s health.

Both the Conservative and Reform movements have ruled that termination of pregnancy is permitted in cases where prenatal testing determines that a fetus has major defects that would preclude a normal life and where the psychological well-being of the mother would be substantially impacted. Orthodox opinion rejects termination as an option except in cases where the health of the mother is jeopardized. As a result, Orthodox rabbis generally prohibit prenatal fetal testing since it offers no remedy short of abortion if a condition is detected.

Given the lack of options, Orthodox communities place significant emphasis on genetic testing prior to marriage. This is often done confidentially due to a belief in the Orthodox community that there is a stigma attached to individuals who are found to be carriers. One organization, Dor Yeshorim, conducts widespread confidential genetic testing in the Orthodox community. Couples considering marriage can submit their names to the organization, which will report back if they are genetically compatible or not without specifying which partner is a carrier.

Are breast and ovarian cancers Jewish genetic diseases?

Roughly 1 in 40 Ashkenazi Jews are carriers of the BRCA genetic mutation, which increases the risk of breast and ovarian cancer. Though this increased risk is genetically transmitted, BRCA is not typically included among the disorders included in the standard testing panels for Jewish genetic diseases. Individuals with a family history of breast or ovarian cancer are encouraged to consider separate testing for the BRCA mutations.

The post Jewish Genetic Diseases: Frequently Asked Questions appeared first on My Jewish Learning.

Concerns about organ donation after death have traditionally rested on laws concerning the handling of dead bodies and the mistaken view that bodies must be buried intact if they are to be resurrected after the Messiah comes — the traditional belief known as techiyat hameitim. While taking organs from the dead is undoubtedly fraught with delicate ethical questions, the life-saving potential of organ donation is so great that nearly all restrictions of Jewish law can be suspended.

Below are some frequently asked questions about Judaism and organ donation:

Isn’t Judaism against organ donation?

That’s a common perception, and one of the reasons frequently cited for Israel’s low rate of organ donation. But on the whole, there is widespread support for organ donation across the spectrum of Jewish observance, from Reform to haredi Orthodox. Some authorities, citing the injunction in Leviticus 19 not to stand idly by the blood of one’s neighbor, go further in suggesting that Jewish tradition mandates organ donation in certain circumstances. The Conservative movement endorsed that position in 1995, when it established that post-mortem organ donation is not merely permissible, but required. Some Orthodox figures also consider organ donation obligatory.

So it’s OK to donate the organs of the dead?

Yes. Several traditional requirements — to bury the dead quickly, and avoid any defilement of or benefit from a dead body (the reason autopsies are generally not done) — would seem to preclude taking organs from cadavers. However, the lifesaving potential of organ donation is regarded as overriding those strictures. The key issue is the definition of death.

Yes, how does Judaism define death, particularly in this modern age of life-support systems?

Though by no means unanimous

, many rabbis hold that death in Jewish law occurs with the irreversible cessation of brain stem function. In brain death, a patient is unable to breathe independently without a mechanical ventilator, but his or her heart may still be beating, which creates a window for the harvest of vital organs like the heart and lungs. Authorities from all three major denominations — Orthodox, Conservative and Reform — maintain that in such cases organs may be taken for the purpose of saving another life.

READ: What Judaism Believes Happens After We Die

The Conservative movement has endorsed an even more expansive position. In 2010, the movement’s religious authorities ruled that in situations where a person is unconscious, dependent on a ventilator and has no hope of recovery — even if he or she may show some limited brain activity — the person can, under certain conditions, be removed from life support and their organs taken for transplant after the heart stops beating.

A more restrictive opinion held by some Orthodox rabbis maintains that death occurs with the cessation of heartbeat, a criterion that makes vital organ donation much more medically difficult. Under this opinion, any harvesting of organs from a patient whose heart is beating would be absolutely prohibited.

What about organs from live donors?

With live donors, the difficult question of determining death is moot, but other legal issues arise. Judaism prohibits placing oneself in unnecessary danger, and organ donation is never entirely risk-free. Authorities from across the denominations agree that if a live transplant would place the donor in mortal danger, it should not be undertaken. With kidney donation, the most common organ transplant procedure, the dangers are sufficiently low and the life-saving potential so great that risk is not generally seen as an obstacle. Other live organ donations, like the liver, are considered riskier and may even be prohibited by some rabbis.

Can you donate your organs for medical research?

Most rabbis say no, though there are exceptions. With research, the line between the donation of a specific organ and the saving of life is sufficiently indirect that most authorities do not believe it qualifies as pikuach nefesh. One Reform rabbi has written that if the body parts are “given to a scientific institution to study, and then are buried after the work on them is done, there can be little objection from the liberal point of view.”

Is it possible to become an organ donor and still adhere to Jewish law?

Yes. The Halachic Organ Donor Society, an Orthodox nonprofit dedicated to increasing organ donation in the Jewish community, has developed a halachic organ donor card. Though similar to the organ donor box that some people check when getting their driver’s license, the HODS card specifically states that any transplant procedures be conducted in consultation with the deceased’s rabbi. It also permits donors to decide which definition of death they wish to be applied — either brain stem death or cessation of heartbeat. The Conservative movement has a similar card.

Can an organ donor still be buried in a Jewish cemetery?

Yes. Though there is historical precedent for those who committed certain infractions being denied a Jewish burial, or buried in a separate section of a Jewish cemetery — suicide being a common one — in the modern era, it is exceedingly rare to deny any Jew (including those who have commit suicide) a traditional burial. According to HODS, there is no known case where a person was denied burial in a Jewish cemetery because they donated their organs. However, some aspects of the traditional preparation rituals for burial, known as tahara, may not be possible for donors.

What about selling one’s organs for money?

The sale of human organs for transplant is highly controversial, prompting fears of exploitation of the poor (who would have greater incentive to sell their body parts and thus be at greater risk of exploitation) and the privileging of wealthier recipients (who are better able to pay to save their own lives), among other considerations. For these reasons and others, it is illegal in most of the world, which renders the question of its permissibility under Jewish law effectively moot. However, some Jewish authorities believe that, in principle, there is nothing in Jewish law that prevents compensating donors for their organs provided certain conditions are met. Robby Berman, the founder of the Halachic Organ Donor Society, has personally called for a reversal of U.S. laws banning compensation for organ donors since that would almost certainly expand the number available. HODS has no position on the matter.

READ: Op-Ed: Allow Incentives for Donating Organs

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Answer: In modern medicine, pig skin is sometimes transplanted onto patients with severe burns, and heart valves from pigs are often transplanted into patients with damaged or diseased heart valves. This process, called xenografting or xenotransplantation, describes transplants from any non-human animal to a human.

One might assume that Jews would be prohibited from receiving xenotransplants from pigs because of the biblical prohibition against eating and touching swine in Leviticus 11:7-8: “And the swine — although it has true hoofs, with the hoofs cleft through, it does not chew the cud: it is impure for you. You shall not eat of their flesh or touch their carcasses; they are impure for Me.”

However, Rashi, an 11th-century Torah commentator, explained that this prohibition against touching pigs applied only when Jews were on their way to Jerusalem to observe the three pilgrimage festivals — Passover, Shavuot and Sukkot. During those festivals the people were required to be in a heightened state of purity, so they had to avoid touching something like the flesh of a pig. Even on the way to Jerusalem, Jews were only prohibited from touching the flesh, that is, the meat of a pig. According to halacha (Jewish law) the skin of an animal does not transmit impurities, especially if it has been tanned.

So there is no halachic problem with pigskin and pig heart valves—on the way to Jerusalem or at any other time. Beyond that, there’s a very important tenet of Judaism called pikuach nefesh, or, saving a life. According to Jewish law, any of the mitzvot (commandments) in the Torah (except idolatry, murder, and forbidden sexual relationships) can and in fact should be violated in order to save a person’s life; the pikuach nefesh principle is that strong. This means that even if the use of pig parts wasn’t generally allowed by halacha, when people’s lives are at stake, we are commanded to do whatever is necessary to save them.

Incidentally, this exact issue was brought up on an episode of Grey’s Anatomy a few years ago. In the episode (“Save Me” Episode 8, Season 1) an Orthodox Jewish girl refuses to have a life-saving xenotransplant from a pig because it’s not kosher. The surgeons eventually do the procedure with a xenotransplant from a cow, instead. When the episode first aired, the Orthodox Jewish community responded by condemning the depiction of Jews and Jewish law. Rabbi Avi Shafran, director of public affairs for Agudath Israel of America, called the character’s refusal of the pig part “silliness.”

Bottom line: If it’s a life-saving procedure, there’s no problem using parts of a non-kosher animal — unless that part is a ham sandwich, and the procedure is not so much life-saving, such as lunchtime.

The post Ask the Expert: Kosher Pig appeared first on My Jewish Learning.

Bloom Syndrome

Bloom syndrome is a disorder that can result in short stature, skin rashes, sensitivity to sunlight, high-pitched voice, distinctive facial features, infertility and a heightened risk of several other diseases, including cancer, pulmonary disease and immune system abnormalities. Life span is often significantly shortened due to susceptibility to cancer and other complications. Carrier frequency is one in 134 Ashkenazi Jews.

Further Resources:
National Institutes of Health
Bloom’s Syndrome Foundation
Bloom’s Syndrome Association
BloomSyndrome Foundation (Netherlands)
Bloom’s Syndrome Registry
Blooms Connect

Canavan Disease

Canavan Disease is caused by the deterioration of white matter in the brain, which in turn impedes the function of nerve cells throughout the body. Symptoms typically occur within the first nine months of life and include a failure to develop basic motor skills, enlarged head and poor muscle tone. Over time, seizures, difficulty in swallowing, paralysis and retardation can result. Affected individuals typically live through childhood only, though some have survived into adolescence and beyond. A milder and less common form of the disease features far less dramatic symptoms that are sometimes never recognized and do not appear to shorten lifespan. About 1 in 55 Ashkenazi Jews are carriers of the disease.

Further Resources:
National Institutes of Health
Canavan Foundation
Canavan Research Foundation

Cystic Fibrosis

Cystic Fibrosis is a condition in which the body produces a thick mucus that can clog the lungs and impair organ function. Symptoms can include wheezing, chronic coughing and inflammation leading to breathing problems and bacterial infections in the lungs. Over time the condition can cause digestive problems and reduced pancreatic function. Improved treatments have led to increased lifespan in recent decades, with many sufferers in the United States now surviving into their 30s and 40s. Carrier frequency is about 1 in 24 Ashkenazi Jews and about 1 in 26 Sephardic/Mizrahi Jews.

Further Resources:
National Institutes of Health
Cystic Fibrosis Foundation
Boomer Esiason Foundation
Cystic Fibrosis (online community)
CF Living
Cystic Fibrosis Worldwide
Cystic Fibrosis-Reaching Out Foundation
Cystic Fibrosis News Today

Familial Dysautonomia

Familial Dysautonomia is a disorder that affects the autonomic nervous system, which controls involuntary actions, and the sensory nervous system, which controls activities related to the senses. The disorder features a wide range of symptoms that typically begin in infancy and increase in number with age. These include poor muscle tone, feeding difficulties, poor growth, lack of tears, frequent lung infections and difficulty maintaining body temperature. In older children, the disease can result in bed wetting, vomiting, reduced sensitivity to temperature and pain, poor balance, scoliosis, kidney and heart problems, and learning difficulties. Affected adults can suffer from lung and kidney problems and impaired vision. The disease results in shortened lifespan, with affected individuals born in 2006 projected to have a 50 percent chance of survival to age 40. About 1 in 31 Ashkenazi Jews are carriers of the disease.

Further Resources:
National Institutes of Health
Dysautonomia Foundation
National Dysautonomia Research Foundation
Familial Dysautonomia Now Foundation
Familial Dysautonomia Hope Foundation
Dysautonomia Youth Network of America

Familial Hyperinsulinism

Familial Hyperinsulinism is a condition that causes irregular levels of insulin, the hormone that controls blood sugar levels. Symptoms can occur very soon after birth, and can include lethargy, hypoglycemia, seizures and difficulty feeding. Repeated episodes of low blood sugar can lead to more serious complications. Treatment with drugs or glucose injections can help manage the disease. Surgery to remove all or part of the pancreas is also common. The carrier frequency for Familial Hyperinsulinism is about 1 in 68 Ashkenazi Jews.

Further Resources:
National Institutes of Health
Congenital Hyperinsulism International

Fanconi Anemia C

Fanconi Anemia C is one of several subtypes of a disorder that impairs the ability of bone marrow to produce new blood cells. Signs of the disease are often apparent at birth. Affected individuals often suffer from bone marrow failure, infertility, short stature, increased incidence of certain types of cancer, gastrointestinal difficulties and various physical abnormalities. Drugs and bone marrow transplantation are used to manage the disease, but most of those affected die in early adulthood. The carrier frequency among Ashkenazi Jews is 1 in 100.

Further Resources:
National Institutes of Health
Fanconi Anemia Research Fund

Gaucher Disease

Gaucher disease is the most common genetic disease affecting Ashkenazi Jews. The disease results from a specific enzyme deficiency that can impact many of the body’s organs and tissues. There are various types of the disease. The most common is Type 1, whose symptoms include enlargement of the liver and spleen, anemia, low red blood cell count, lung disease and bone abnormalities. Other forms of the disease affect the cardiovascular and central nervous systems. Symptoms can vary widely in intensity. Some of those affected with the more severe forms may suffer extremely shortened lifespans, while others can manage the disease successfully over the long term. The carrier frequency for Ashkenazi Jews is about 1 in 15.

Further Resources:
National Institutes of Health
National Gaucher Foundation
Children’s Gaucher Research Fund

Joubert Syndrome 2

Joubert Syndrome 2, also known as Cerebelloculorenal Syndrome, is a subtype of a condition whose symptoms include poor muscle tone, abnormal eye movements, intellectual disability and poor motor coordination. Though symptoms can vary, the condition is marked by the underdevelopment of the cerebellar vermis area of the brain, which controls balance and coordination. The condition can also be associated with kidney or liver failure. Symptoms typically begin in infancy. Treatment options are solely supportive and symptomatic. The carrier frequency among Ashkenazi Jews is 1 in 100.

Further Resources:
National Institutes of Health
Joubert Syndrome & Related Disorders Foundation

Lipoamide Dehydrogenase Deficiency (E3)

Lipoamide Dehydrogenase Deficiency (E3) is a condition caused by an enzyme deficiency that leads to the buildup of lactic acid in the body. The symptoms typically present in childhood and are quite varied, including serious fatigue, episodes of hyperventilation, vomiting and abdominal pain. The disorder can be fatal in childhood, though it can also often be managed through diet and immediate medical attention when lactic acid buildup occurs. The carrier frequency among Ashkenazi Jews is 1 in 107.

Further Resources:
National Institutes of Health
Genetic Disease Foundation

Maple Syrup Urine Disease (1B)

Maple Syrup Urine Disease is a disease characterized by deficiency in enzymes needed to break down certain amino acids. The disorder derives its name from the distinctive sweet odor of the urine of those affected. Symptoms typically begin shortly after birth and include irritability, poor feeding and lethargy. The disease can usually be successfully managed through a strict dietary regimen, but left untreated can lead to neurological damage, seizures, coma and death. The carrier frequency among Ashkenazi Jews is 1 in 97.

Further Resources:
National Institutes of Health
National Organization for Rare Disorders
MSUD Family Support Group

Mucolipidosis IV

Mucolipidosis IV is a disorder characterized by severe underdevelopment of intellectual and motor skills. Symptoms are usually apparent within months of birth. Many of those affected have limited or absent speech, impaired vision, difficulty walking independently, digestive problems and poor muscle development. Though many of those affected by the disease survive into adulthood, they may still have shortened lifespan. The carrier frequency among Ashkenazi Jews is 1 in 89.

Further Resources:
National Institutes of Health
National Organization for Rare Disorders
Mucolipidosis IV (ML4) Foundation

Nemaline Myopathy

Nemaline Myopathy is a disease characterized by muscle weakness, typically in the face, neck and other muscles close to the center of the body. Symptoms are generally present in childhood and can vary widely in intensity. In severe cases, weakness in the respiratory muscles can be life-threatening, but in most cases affected individuals can lead active lives. Carrier frequency in Ashkenazi Jews is 1 in 168.

Further Resources:
National Institutes of Health
National Organization for Rare Disorders
A Foundation Building Strength
Nemaline Myopathy Support Group

Niemann-Pick Disease

Niemann–Pick refers to a collection of metabolic disorders characterized by an enzyme deficiency that leads to the buildup of certain types of lipids in the body. Individuals affected with the most severe and most common form, Type A, typically develop an enlarged liver and spleen within the first three months of life, followed by a progression of other symptoms that normally lead to death within the first four years. Other subtypes generally develop later and are not as severe. Carrier frequency among Ashkenazi Jews is 1 in 115.

Further Resources:
National Institutes of Health
National Niemann-Pick Disease Foundation

Spinal Muscular Atrophy

Spinal Muscular Atrophy is a disorder caused by the loss of motor neurons in the spinal cord and brainstem. The disease has multiple types distinguished by the age of onset and the severity of symptoms. In the most severe forms, symptoms begin very early and often lead to death within several months to two years as a result of respiratory problems. With milder forms, symptoms begin later in childhood or even into adulthood and, depending on their severity, can sometimes permit a normal lifespan. All forms of the disease involve some degree of muscular weakness that can lead to atrophy as well as difficulty walking, breathing and eating. Carrier frequency is 1 in 41 for Ashkenazi Jews and 1 in 10 for Egyptian Jews.

Further Resources:
National Institutes of Health
Cure SMA
FightSMA
Spinal Muscular Atrophy Foundation
Spinal Muscular Atrophy

Tay-Sachs Disease

Tay-Sachs Disease is a disorder characterized by an enzyme deficiency that destroys neurons in the brain and spinal cord. The most common form of the disease begins within months of birth and entails the progressive loss of motor skills, neurodegeneration, seizures, blindness, spasticity and eventually total incapacitation and death. A far more rare form of the disease begins later in life, from childhood to adolescence and beyond, and the symptoms are milder, though they include poor coordination, tremors and slurred speech. As the disease progresses, it can lead to mental and behavioral abnormalities, including bipolar disorder and psychoses. Carrier frequency for infant onset Tay-Sachs among Ashkenazi Jews is 1 in 27.

Further Resources:
National Institutes of Health
National Tay-Sachs and Allied Diseases Association
Cure Tay-Sachs Foundation

Torsion Dystonia

Torsion Dystonia, also known as dystonia musculorum deformans, is characterized by muscle spasms, contractions, and tremors. Symptoms usually begin in early childhood and are progressive. Sometimes symptoms are isolated in one part of the body, and sometimes affect many. The disease is caused by a mutation in the TOR1A gene, but not all people with the mutation develop the disease (only 30-40%). Somewhere between 1 in 3000 and 1 in 9000 Ashkenazi Jews are affected by this disorder.

Further Resources:
National Institutes of Health

Usher Syndrome

Usher Syndrome is a disorder that affects nerve cells in the ear and photoreceptor cells in the retina. The disease is marked by total or partial loss of vision or hearing that worsens with time. There are several types of the disease. In Type 1, affected individuals are typically born with hearing loss and difficulty balancing due to abnormalities in the inner ear. In Type 3, vision and hearing loss typically begin later in life. Carrier frequency for Type 1F is 1 in 147 for Ashkenazi Jews and 1 in 120 Ashkenazi Jews for Type 3.

Further Resources:
National Institutes of Health
Usher Syndrome Coalition
Hear See Hope

Walker Warburg

Walker Warburg is a disease characterized by severe abnormalities in the muscles, brain and eye. Symptoms are typically evident very early in life and include severe retardation, small head, poor muscle tone, small eyes, blindness, seizures and feeding difficulties. Most affected individuals do not survive past the age of three. Carrier frequency is 1 in 120 for Ashkenazi Jews.

Further Resources:
National Institutes of Health

Based on information provided by the Jewish Genetic Diseases Consortium.

The post Directory of Jewish Genetic Diseases appeared first on My Jewish Learning.

In the Bible, God is viewed as responsible for all healing, and the magical healing practices of the surrounding nations were associated with idolatry. Over time the physician was increasingly accepted as a healer who worked in partnership with God, although elements of folk healing always existed alongside.

The Hebrew prophets understood “healing” to be both physical and spiritual. Some spoke of individuals being healed through a return to God, mediated by those who understood the connection between healing and God–the priests and prophets. They would invoke God’s help through sacrifice, prayer, repentance, and fasting as well as priestly purification rituals.

Traditional scholarship contrasted these biblical healing practices with the pagan exorcism practices of local cultures whose goal was to combat evil powers through spells or incantations. Recent scholarship, however, contends that Israelite communities influenced by Egyptian, Midianite, or Roman cultures used local healing practices, including magical spells, incantation, and exorcism.

A Long Transition From Magical to Scientific Healing

Although rabbinic texts record some stories of magical healers, the rabbis generally downplayed their role because they represented a challenge to rabbinic authority. The rabbis did not make the kinds of distinctions we do today between magical and nonmagical practices; although they denounced magic, they sometimes sanctioned the use of charms and incantations.

The association of magical healing practices with idolatry and the injunctions against contact with blood and corpses limited the development of the medical profession. Only with the influence of Hellenistic views on “scientific” medicine was there an increasing acceptance of physicians as healers; the Talmud, for example, actually prohibited Jews from living in a city without a physician. The rabbis also maintained that God himself authorized and, in fact, required medicine and healing.

The medieval law codes continued to accept folk healing remedies, but also stated explicitly that the Torah mandates the physician to heal both Jews and non-Jews. However, commentators also emphasized the connection between health and following the commandments.

Even as the attitude towards physicians became more positive, God was still considered the primary healer, and prayers for healing became part of Jewish daily liturgy, recited three times a day. Also, special Misheberakh prayers were recited during the Sabbath Torah service seeking healing for ill persons not present.

Despite the general trend away from folk healing traditions, mystics practiced them until the modern period. The 18th-century Hasidim, who were inheritors of the mystic tradition, saw illness as a punishment for not following the commandments; they believed that healing was a consequence of putting one’s relationship to God back in balance–by praying, reading psalms, fasting, and giving charity.

Americans Support Modern Science, But “Healing” Makes a Return

Although folk healing practices like using protective amulets and making pilgrimages to the tombs of healing saints were common among Jews in North Africa, Asia, Eastern Europe, and Israel, these did not survive in the United States, except among small groups of Hasidim.

For the most part, American Jews have put their faith in modern medical practitioners. Beginning with the 1980s, however, a new non-hierarchical, grass-roots format for healing has emerged in the United States alongside modern medicine that focuses on spiritual “healing”; “curing” is left in the hands of physicians. This contemporary healing movement comprises special healing services and rituals in synagogues or in small groups; private healing by individuals; and ritual and social services for the elderly and chronically ill. The salient characteristics of this new movement are its communal context and egalitarian format.

A Jewish healing service uses Jewish sources to provide support for a person who is psychologically or physically unwell. Using meditation, prayer, music, singing, guided visualizations, Jewish texts, and physical contact, these services help attendees to develop strength; courage; a positive, non-sick identity; a sense of meaning; and a sense of belonging.

The post Illness & Healing appeared first on My Jewish Learning.

These sorts of traditional practices, commonplace among Jews in North Africa and Asia as well as in Eastern Europe and Israel, did not survive in the United States except among small groups of Hasidic Jews living in a few tightly knit communities. Since the beginning of the 20th century, American Jews, for the most part, have been among the most eager proponents of modern medicine, and in the forefront of immigrant groups that have rejected traditional “superstitions” and “magical practices” in regard to health and illness.

A New Non-Hierarchical, Grass-Roots Format

During the 1980s, a new kind of Jewish healing began to emerge in the United States. Organizationally, the contemporary Jewish healing movement encompasses synagogue-based healing services, private healing offered by individual practitioners, community-sponsored ritual and social services for the elderly and chronically ill, and small-group healing rituals carried out in response to the needs of friends or community members.

Instead of the saint-healer typical of traditional Jewish societies, American Jews situate healing in the context of community. A typically American and egalitarian format in which the healer (more often than not, a woman) describes herself as part of the fellowship of those in need of healing, replaces the hierarchical and dyadic traditional format in which a holy man held unique powers to elicit God’s blessing on behalf of the sick and unfortunate.

What is a Jewish Healing Service?

Jewish healing services are eclectic and varied. Some of the more common elements include meditation, prayer, guided visualizations, teaching based on Jewish sources, and physical contact such as holding hands or exchanging hugs. For many who attend Jewish healing events, the power of the events lies in the feeling of rootedness to Jewish tradition created by the use of Hebrew and references to Jewish texts and stories, and in the feeling of connection evoked through gathering together with other Jews.

Music and singing are ubiquitous at Jewish healing events, and a number of collections of Jewish healing music are sold through websites and at Jewish bookstores. Singing often is experienced as a deeply spiritual experience, and the communal singing that characterizes Jewish healing services creates a feeling of communal engagement.

Using Jewish Ritual to Support the Sick

A phrase heard frequently in Jewish healing contexts is: This is not about curing, this is about healing. That phrase often is followed by: To be cured, go see a doctor. The implication is that American Jewish healing does not seek to replace conventional medicine, but rather to complement and supplement medical treatments and practitioners.

American Jewish healers explain that, “It isn’t always possible to cure, but healing always is possible.” The implication is that healing is not about the alleviation of physical symptoms, but rather about drawing upon Jewish resources and the Jewish community to develop strength, courage, a positive identity (in place of allowing the sick-role identity to dominate the sense of self), a sense of meaning, and the feeling of belonging both to an ancient tradition and to an active local community. Jewish healing is described in communal terms: When the individual is ill, he or she often suffers from social isolation. Thus a key part of Jewish healing focuses upon healing the community that does not sufficiently reach out to the elderly, the ill, and the handicapped.

In many ways, contemporary Jewish healing is similar to other healing movements in the United States today. The emphasis upon the whole person, the use of meditation techniques, the voluntary nature of participation in healing events, the emphasis upon egalitarian relationships, the distinction between healing and curing, and the prominent role of women as leaders and participants characterizes a great deal of Christian and New Age healing as well.

It is undeniable that there is a great deal of cross-fertilization among these various movements: Many of the same books are read by Jews, Christians, and New Agers, and many Jewish healing activists have attended Clinical Pastoral Education or Spiritual Direction courses together with Christian colleagues. The “Jewishness” of contemporary American Jewish healing lies primarily in emphasis upon community and identity: For many involved in Jewish healing the core meaning of healing is drawing the individual into the history, narratives, rituals, and relationships of the Jewish community.

Reprinted from the Yale Journal for Humanities in Medicine.

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Artificial Insemination

“Artificial” insemination (AI) is the oldest form of non-traditional conception, and is usually divided into two categories: artificial insemination using a husband’s sperm (AIH) and artificial insemination using donor sperm (AID).

Most Jewish authorities allow AIH, though some, like Rabbi Eliezer Waldenberg, do so reluctantly and only in extreme situations. Because of the traditional prohibition against masturbation, there is some disagreement about how to retrieve the husband’s sperm. Some authorities suggest that the husband use a condom during sex and then retrieve the semen from the condom. Others allow masturbation in this situation, since the semen will be used to impregnate and will not be “wasted”–which would normally be a concern with ejaculation which does not take place during intercourse.

AID is more complicated. Some authorities, such as Rabbi Judah Leib Zirelson, consider AID to be adultery; Waldenberg believes that AID is akin to adultery and calls it “a great abomination.” However, according to others, such as Rabbis Moshe Feinstein and Ben Zion Uziel, there can be no adultery without intercourse.

There are other reasons why AID might be problematic. Because a sperm donor is usually anonymous, some authorities are concerned that the offspring of an AID conception might end up marrying his or her sibling, committing unintentional incest.

Waldenberg and others cite this as a reason to prohibit AID, but because of the remoteness of this possibility and the prospect of using semen from non-Jewish men, many authorities are not concerned about potential incest. Still, even those Orthodox authorities that permit AID permit it only in extenuating circumstances. The Conservative and Reform movements both permit AID.

In Vitro Fertilization

In vitro fertilization (IVF), in which eggs extracted from a woman are fertilized outside of her body and then implanted in her uterus, raises several related issues. Usually, several eggs are taken for fertilization, and the “best” embryos are chosen for implantation. Jewish authorities have concerns about what to do with the unused zygotes (fertilized eggs). If they are discarded, is it akin to “wasting seed” or, more seriously, abortion? In the end, most Jewish authorities agree that an egg fertilized outside of a womb does not have any human status and can be discarded.

In addition, because the success rate of IVF is still relatively low, doctors often implant several zygotes to increase the chances of one of them attaching to the uterine wall and developing. If all or even many of them attach, however, then the woman will be carrying four or five embryos, potentially dangerous for both her and the developing fetuses

Selective abortion of some of the embryos is often recommended in such cases. While Judaism permits abortion when a woman’s life is in danger and some authorities permit abortion in other serious cases, actively pursuing a situation in which abortion might well be necessary is potentially problematic from the standpoint of Jewish tradition. Rabbi Elliot Dorff has suggested limiting implantation to two or three zygotes, thus avoiding even the potential need for selective abortion.

Surrogate Motherhood

Surrogate motherhood raises a host of halachic (Jewish legal) and moral problems. In general, a surrogate is paid to incubate and give birth to a baby for another couple, and many rabbis are disturbed by this “commodification” of a woman’s body and the reproductive process. Others are concerned about the effect that it might have on the marriage of the couple trying to conceive. For these and other reasons, many rabbis–across denominational lines — reject surrogacy.

Others, however, believe that the legal and moral objections can be allayed and approve of surrogacy when it is the only possible way a couple can have children. However, there are lingering questions for these authorities as well, such as which woman is considered the child’s mother.

The post Judaism and Fertility Technology appeared first on My Jewish Learning.

Information Providers

Jewish Genetic Disease Consortium

Norman and Elaine Sarnoff Center for Jewish Genetics

My Jewish Genetic Health

Jnetics (UK)

Sephardic Health Organization for Referral & Education

Program for Jewish Genetic Health (Albert Einstein College of Medicine)

Victor Center for Jewish Genetic Diseases

Jewish Genetic Diseases Center of Greater Phoenix

General Genetic Diseases Websites

NIH Genetic and Rare Diseases Information Center

National Tay-Sachs and Allied Diseases Association

National Organization for Rare Disorders

Genetic Screening Providers

Dor Yeshorim

Sarnoff Center

Victor Center

Home Testing Kit Providers

JScreen

Consyl

Genetics Counselors

National Society of Genetics Counselors

The post Jewish Genetic Diseases: Resource Guide appeared first on My Jewish Learning.

When life is involved, all Sabbath laws may be suspended to safeguard the health of the individual, the principle being pikkuah nefesh doheh Shabbat–[rescuing a] life in danger takes precedence over the Sabbath.

One is not merely permitted–one is required to disregard a law that conflicts with life or health. “It is a religious precept to desecrate the Sabbath for any person afflicted with an illness that may prove dangerous; he who is zealous is praiseworthy while he who asks questions sheds blood.” (Shulhan Arukh, Orah Hayyim 328:2)

This duty to ignore the law, if necessary, to safeguard health is also stressed in connection with fasting on Yom Kippur. A sick person is obliged to break the fast. Neither the patient nor those attending him need atone when performing such acts that are forbidden under normal circumstances.

In spite of the virtue of observing a fast, it is not virtuous to observe laws at the risk of one’s life. Such conduct is regarded as foolish, even as sinful. The Sages described this stubbornness as a “piety of madness.”

Reprinted with permission from The Language of Jewish Life (Jason Aronson).

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What does God do when he visits Abraham? The text tells us only that God “appeared” to him. No comforting phrase is uttered, no wise teaching is shared — God simply appears. Which suggests to us that the central element of supporting those who are not well is just showing up — being there, fully present, along with the person in pain. The text validates the pain of feeling alone at a time of sickness and reminds us of the difference that can be made by the compassionate presence of another.

Of course, this isn’t always possible. Sometimes we are separated from those we wish to support by geography or other circumstances. At such times, it’s incumbent upon us to find other ways to show up, even if it’s not in person. Whether through social media, video conference, or plain old-fashioned phone calls, there are many ways we can create a sense of presence even without being in the same room with someone.

But there’s something more we can do as well, which is suggested later in the text. The story continues that after God’s visit, Abraham receives three more visitors, who our tradition understands to be angels, messengers of God. Jewish tradition teaches that angels are created for one singular purpose. But these angels seem to have accomplished multiple missions, visiting the sick and bringing a message to Abraham about the pending destruction of Sodom, where his nephew Lot lived, and then going to warn Lot.

The rabbis wonder: How can one angel have engaged in two separate missions? One answer is that seeking the welfare of Lot was part and parcel of visiting Abraham while he was sick. That is to say, part of alleviating Abraham’s pain was communicating to him not only that he was cared for, but that his nephew was as well.

Often we think that the mitzvah of bikkur cholim applies only to the patient. But illness often results in tremendous stress on an entire family. As lovely as it is to provide support for a patient, it can also be incredibly beneficial to the patient to offer support to their loved ones as well. Bikkur cholim can thus be fulfilled without even stepping foot in a patient’s room.

We learn from this story that to help those who are unwell is truly to walk in the ways of God, whether by finding ways to be present even when we can’t be in person or showing support to a patient’s family and larger social network. Sometimes it takes a little creativity to figure out the best way to do this. But thankfully our tradition provides us with the encouragement and models that can guide us in our pursuit of being a blessing to the world around us, no matter what struggles arise and no matter how unique and challenging the situation becomes.

The post How to Visit the Sick When You Can’t Visit the Sick appeared first on My Jewish Learning.

In modern times, when many foods are processed in factories, some food manufacturers affix labels to their foods to indicate that they are kosher. Kosher certification confirms that a leg of chicken comes from an animal that has been slaughtered in a kosher manner, or that a can of soup has been prepared in a facility that ensured non-kosher ingredients did not come into contact with the contents of the can.

The laws of keeping kosher are ancient, and many have sought an explanation for their origin — especially the Jewish taboo against eating pig — in the idea that this diet conveys health benefits. The idea is that pig meat was more likely to be diseased and avoiding it was a way to remain healthier. Though there may be some truth to this explanation, it doesn’t provide a strong explanation for all of the Jewish dietary regulations.

Is a Kosher Diet Healthier Than Other Diets?

Today, while many Jews keep kosher for religious reasons, some people (Jews and non-Jews) prefer kosher food because they believe it to be healthier. For one, they know that processed kosher foods are more closely supervised than other foods. And fresh foods, like salad greens, are carefully inspected for insects.

But while many, though not all dietitians might agree that not eating pig meat — or at least not consuming it in large quantities — is in fact beneficial to one’s health, there is little reason to think that a kosher diet is inherently healthier than any other. Just as a vegan diet composed entirely of beer and french fries is unlikely to improve one’s health, a kosher diet that is loaded with processed meats and soda (read the interesting history of how Coca Cola became kosher!) is not likely to convey health benefits. Indeed, many of the traditional Ashkenazi foods that are thought of as quintessential “Jewish food” are not considered the most healthy foods around. (Traditional Sephardic cuisine may in fact be much better for you.) There is also a concern that to avoid bug contamination in produce, kosher vegetables are sprayed with extra pesticides that are not great for human health.

Although there is wide disagreement about what constitutes a healthy diet, one can pursue almost any diet (vegan, vegetarian, whole foods, paleo, keto, Mediterranean, etc.) while keeping kosher. As a bonus, raw vegetables and fruits are inherently kosher! So eat your veggies.

Sign up for a journey All About Keeping Kosher:  Explore what it means to keep kosher. This email series will teach you everything from the basics to how to set up a kosher kitchen. 

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Answer: Leora, I’m so sorry to hear that you’ve been having trouble getting pregnant. Infertility is an increasingly prominent problem for Jewish couples, and I hope you’re getting the support you need from your family and friends during these difficult times.

Because more and more people are dealing with the challenges of infertility, there are a hefty amount of responsa and published rabbinic opinions on these matters. Of course, this was not an issue that Jewish authorities had to deal with until quite recently, but amazingly there is some precedent for this issue that goes as far back as the Midrash.

The medieval Targum Yonatan, an Aramaic translation and commentary on the Bible, cites a fascinating — and fascinatingly relevant — account of the conception of Jacob’s children, Joseph and Dinah. According to a Midrash quoted in the Targum, Dinah was originally conceived in Rachel’s womb, and Joseph in Leah’s womb. At some point while Leah and Rachel were pregnant the children inside them swapped places, in order to give Rachel the merit of having a boy. (Targum Yonatan, Genesis 29:22)

This story is often the first source cited in Jewish legal discussions of surrogacy and egg donation. Because Dinah is clearly considered to be a child of Leah, and Joseph a child of Rachel, it must be that the woman who gives birth to a child is considered its mother.

Two other passages from the Talmud seem to support this position (Yevamot 78a, and Yevamot 79b) and commentators Rashi and Maimonides, among many others, assert that birth is the definitive factor in determining who is considered the mother of a child. However, not everyone holds by this view. In particular, Nahmanides associated motherhood with conception, and not birth, and thus would likely have found a child produced from a non-Jewish egg donor to be a non-Jew.

Today, the Reform movement determines who is Jewish based much more on upbringing than on parenting. If a child is raised Jewish and has one Jewish parent, father or mother, the child is considered to be a Jew, and so the issue of a Jewish egg donor is moot.

In 1997, the Conservative Movement’s Committee on Jewish Law and Standards addressed this issue. It concluded that the gestational mother is to be considered the mother of the child in respect to whether the child is Jewish, and in respect to the mitzvot associated with motherhood.

Among Orthodox authorities there is still quite a bit of disagreement about whether motherhood is determined at conception or at birth, but it is more common to find an Orthodox rabbi who will consider the mother who carries the child the halachic mother. Rabbis who require both a Jewish egg donor and a Jewish gestational mother face concerns that a child who results from a Jewish egg donor could unknowingly end up in an adult relationship with its sibling, another serious and complex issue.

Probably the best course of action is to consult with your local rabbi and see what he or she recommends. If your rabbi feels that there are any concerns with using a non-Jewish egg donor then you may want to have your child officially converted as an infant, at which point your child will be the Jewiest kid in the world.

Good luck!

The post Ask the Expert: Egg Donors appeared first on My Jewish Learning.

Apocryphal or not, disease and injury have accompanied humanity ever since, with the transition from life to death becoming increasingly long and complicated.

Jews’ close connection to healing, both as patients and physicians, is ancient and rooted in both theology and history. In many religions in ancient times, and still in some today, the idea of medical treatment was anathema, even heresy. Disease, accident and deformity were considered no less parts of God’s creation than human beings themselves. Medical treatment was considered meddling with God’s work and will.

Judaism generally views medical treatment positively, even as an obligation, based on verses such as Exodus 21:19, commanding a injuring party to “surely heal” the person he has hurt, and Deuteronomy 4:15: “Take very good care of yourselves.” Maimonides (the outstanding 12th-century philosopher and talmudist of Spain and North Africa) viewed the provision of medical care as part of the duty to return to a person “anything he has lost” (Deuteronomy 22:3). There were once dissident voices that claimed that verses like Exodus 15:26 (“I am the Lord, your healer”) meant that disease was to be left to God and that the duty to heal in Exodus 21:19 was limited to human-caused injury, but this approach was never widely accepted.

Jewish communities from early on accorded high status to the physician, and many leading rabbis and scholars–from the talmudic period through the Middle Ages and beyond–were physicians as well, including Maimonides. Also, in certain societies, particularly Europe in the Middle Ages and later, medicine was one of the few professions open to Jews.

The prominence of Jews as medical practitioners, researchers and teachers has continued into our time. 28% of the Nobel Prize winners for medicine have been Jewish (and 40% of the American winners).

The physician’s duty to heal is paralleled by the general duty to tend to one’s own health. The Talmud forbids one to live in a city where there is no physician (BT Sanhedrin 17b). One is not entitled to refuse medical treatment, except for a legitimate reason, and, following this logically, Judaism does not countenance suicide or permit one to help another commit suicide. People are not fully autonomous over their bodies and lives, but receive them from God and hold them in trust. However, Jewish scholars long ago distinguished between acts which shorten a person’s life and those which prevent the unnecessary delay of death. The latter are permitted.

There are limits, of course. Judaism does not sanction treatments, medicines or procedures that are overly experimental or speculative. There must be a reasonable chance of success or benefit. Similarly, a Jew is not allowed to undertake activities which clearly endanger health. The use of drugs, for example, is permitted in order to improve health or reduce pain; one is not required to suffer needlessly. However, the teachings of most authorities would prohibit the use of drugs taken for the purpose of providing a “high” or a mind-altering experience, because of the dangers involved to the user and others.

Judaism’s attitude towards a substance seems to be affected by when its danger was first perceived. The biblical references to alcohol (Noah’s intoxication, Genesis 9:21; praise for the Nazirite who abstains from alcohol, Numbers 6:3-4) suggest an early awareness of its danger. (Note, however Psalm 104:15: “wine gladdens a person’s heart.”)

Judaism’s response was to institutionalize the use of alcohol at moderate levels and in controlled circumstances, such as Kiddush (the prayer sanctifying the day) on Shabbat and festivals. The result seems to have been, until recently at least, a relatively low incidence of alcoholism within the Jewish community.

Smoking, on the other hand, has only recently been perceived as a serious danger; in prior centuries, it had even been praised. All rabbinical authorities today urge against it, but, because of its prevalence and the desire not to declare large number of Jews lawbreakers, only a few have actually ruled that smoking is a specific violation of Jewish law.

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