Still Michael Bunzel always knew he’d be a doctor — it was part of the family legacy going back to his great-grandfather a physician in Austro-Hungary. His father a Hungarian Holocaust survivor who had been ayeshivah bochur before the war arrived penniless to theUS and migrated toMontreal where he put himself through medical school and became a surgeon. Although much of his family survived and remained religious his own Yiddishkeit didn’t make it out ofEurope. He married one of his Jewish patients and moved toSouthern California. Yet by the time Michael was five his parents had divorced.

Growing up inOrangeCounty Michael didn’t have much contact with the religious side of his family but in his teen years his interest in Judaism was sparked and he set out to meet his frum relatives who were scattered around the globe. After graduating fromStanfordUniversityand spending a year working in politics in 1989 he came toIsraelto study in yeshivah.

When he enrolled in Tel Aviv University-affiliated Sackler Medical School following five years of yeshivah in Jerusalem — at Ohr Somayach Machon Shlomo and Mercaz HaTorah — he hadn’t yet decided what branch of medicine he wanted to go into but one thing he knew for sure: It wouldn’t be psychiatry.

“I had this prejudice that psychiatry was a kind of made-up profession treating not real illnesses by not real doctors and if these people would just get their lives together and learn some mussar it would all work out” he confesses.

“I thought that way throughout med school, until my first day of rotation in psychiatry at Tel Hashomer. There was a frum bochur there suffering from OCD and obsessive thoughts, yet the secular professor interviewing him just couldn’t get across the divide of what was normal and what was pathological for this boy. He asked him how many times a day he washed his hands — now, all us frum people wash our hands a lot in the course of the day — and whether he believed G-d played a direct role in his life. ‘Absolutely,’ the boy answered. And, the professor asked, does G-d intervene on a daily basis? ‘Absolutely,’ the boy answered again. This doctor thought he was psychotic and seeing demons and angels.

“Now, there was another patient there who was really psychotic — he thought Martians were invading the country — and I told the professor the guy was really nuts. ‘Well,’ the professor answered, ‘if someone examined your belief system, they would also say you’re psychotic.’

“It was my ‘eureka’ moment. It meant that all of our ideas of hashgachah pratis, belief in Mashiach, belief that a person can get close to Hashem through mitzvos, could be viewed as psychosis by someone who doesn’t know where you’re coming from. Then I realized, This is why Hashem put me here! To become the psychiatrist for all these people suffering from secular doctors who don’t get their essence.”

Before beginning med school in Tel Aviv, Bunzel married Julie Lang, a world-class harpist and daughter of old family friends from Chicago who was studying in Neve Yerushalayim. After he completed a psychiatry residency at Johns Hopkins in Baltimore, the Bunzels came back to Israel with their young family. He was then selected by Dr. Moshe Rothschild, founder of Mayanei Hayeshua, to serve as chief psychiatrist for a psychiatric day clinic that would be a precursor to the full-fledged hospital Dr. Rothschild ultimately envisioned. The Bunzels chose to live in Israeli chareidi Bnei Brak — and not the American enclaves of Har Nof or Beit Shemesh — to be close to the hospital and the poskim who would provide a framework of daas Torah in dealing with the delicate fabric of the Jewish nefesh. And four years ago, they were joined by elderly Dr. Bunzel senior, who had made his own comeback to his Torah roots, returning to the full-time Torah study that he’d left behind in Europe, and providing his progeny with a mesorah they were thrilled to reconnect with.

Dr. Bunzel’s appointment at Mayanei Hayeshua came on the heels of a revolution in the way the Torah world approached psychology, a relationship traditionally infused with suspicion and mistrust. Halachic authorities such as Rav Moshe Feinstein were wary of psychological treatment because it was largely based on philosophies antithetical to a Torah outlook; plus there was a lot of misdiagnosis because practitioners didn’t understand the cultural framework of the frum person or how to distinguish between normality and pathology within that framework. But a combination of new psychological treatments and an increasing number of religiously sensitive therapists, as well as open dialogue and consultation between rabbanim and mental health professionals, has in the last two decades or so brought religious authorities on board.

“Instead of resisting the field like they once did, they’ve become partners in it and have high expectations of the therapeutic process,” Dr. Bunzel says.

Nothing to Lose

It was this new sensitivity within the frum world that convinced Dr. Rothschild to put Dr. Bunzel in charge of what he calls a trial balloon — a psychiatric center smack in the middle of Israel’s most concentrated chareidi enclave. But, questioned many locals, did the stigma of psychiatric therapy have to be challenged right in the center of Bnei Brak? Who would want to be seen entering a mental clinic in the middle of town? A frum facility, great, but wouldn’t it be more prudent to build such a facility somewhere more isolated, like in the Galil or the Negev?

“This was 2004, and the reigning philosophy was that a psych center had to be far away,” says Dr. Bunzel. “People didn’t think we’d last more than a week or two. Who would be desperate enough to risk being seen here? Still, we set up the center in the most discreet way possible, arranging the rooms so that no two people would be in a waiting room at the same time, and creating separate exits through a back door. Well, those separate waiting rooms lasted about two weeks, because we were flooded with clients and just couldn’t maintain all that private space.

“At the time, there was nothing on the scene to service the religious community. People from Bnei Brak would travel to Tel Hashomer, and after a hot, sweaty bus ride they’d meet their neighbor in a joint waiting room there anyway, so what did they have to lose?”

Who, exactly, are in the waiting rooms of mental facilities? Someone who’s on the verge of a nervous breakdown? Someone feeling dejected or suicidal, or someone who wants a prescription for Prozac? After all, people don’t just wake up feeling depressed and check themselves into a psych ward, do they?

“The frum community isn’t immune to clinical depression, panic and anxiety disorders, bi-polar disorders and the like, and not everyone can afford private treatment,” explains Dr. Bunzel, who clarifies that at Israeli hospital clinics, treatment is free under the country’s health care rules. “True, there are those for whom the stigma of a public facility, where there’s a risk of being spotted and where the evaluation and treatment will be recorded in the person’s kupat cholim file, is big enough that they will extend themselves beyond their financial limits in order to stay private. I would say we’ve managed to challenge the stigma, but we certainly haven’t broken it.”

Dr. Bunzel notes that up to 70 percent of those who have come in for mental health assistance would not have sought treatment elsewhere because of the fear that those clinics would disparage their religious values. Indeed, when members of the frum community are forced to accept the fact that they or their loved ones need professional mental health care, they often find themselves in a secular medical system, and many families will do anything to avoid such a framework.

“For a religious child or young adult to be hospitalized in such a place is a major challenge to their basic values and Torah mindset,” he explains, noting that for children under 18, there are no gender-segregated wards in Israeli hospitals. “Oftentimes these young people coming from modest, sheltered environments are exposed to things they couldn’t have imagined in their wildest dreams, and the fall can be fast and furious. Families would rather go broke and hire 24-hour private supervision than risk hospitalization in a secular facility.”

For that reason, Dr. Bunzel says that unless it’s a life-and-death situation, he’s hard-pressed to justify hospitalization for young people, and if he deems it necessary, it’s only with rabbinic approval, which doesn’t come easily. “We’ll go to any lengths to keep them out and look for another alternative,” he explains.

He says this as he stands in front of a spanking new $20 million structure adjacent to the medical center that looks more like a five-star hotel than a mental hospital. While MHMC has been running its outpatient clinic for the past 12 years from some prefab caravans behind the main hospital, this state-of-the-art psychiatric facility — the largest in the Middle East — is slated to be fully operational in the coming weeks, and will provide a safe, religiously sensitive environment for those in need of hospitalization for mental health issues.

With its spacious, comfortable walk-in lobby and clean, comfortable rooms, what’s to stop bag ladies and other indigent citizens from declaring themselves psychotic and checking in?

“Well, that’s already the case in the day clinic,” Dr. Bunzel offers. “We put out sandwiches and people come in off the street, and yes, we do have to differentiate between people who really need help and those who just want the comfort, but that’s true in psych facilities all over. At Johns Hopkins where I worked, I would say a third of the patients who checked in just needed a little TLC, a hot meal, and a comfortable place to sleep for the night. But the truth is that many of the indigent have a combination of mental illness with that poverty — something went wrong somewhere — so we can’t ignore that either.”

Catching It in Time

Dr. Bunzel hopes that the new hospital will be a positive factor in putting psychiatric distress into the mainstream conversation in an acceptable way, so that there can be more of a chance of early intervention in order to prevent suicides and other tragic outcomes of untreated mental illness.

“The stigma often prevents people from getting treatment in the beginning stages, yet it’s this early intervention that can give people back their lives,” he says, recounting a recent case of a 13-year-old boy who began having obsessions about mitzvah observance. Did he have the right kavanos when he put on tefillin? Did the water go high enough on his wrist when he washed netilas yadayim? “His rebbi was the first to identify the obsessive behavior, and three months after it started, his parents brought him to me for treatment. At that point he didn’t need medication because the obsessions had not yet taken over his psyche. But do you know what the average time span between exhibiting initial symptoms and finally deciding to go for treatment is? Ten years! By that time it doesn’t look like OCD anymore. It looks like schizophrenia.”

While a religiously rich lifestyle has been shown to protect against certain psychiatric ailments, every mental illness of Western society can be found in the Orthodox community as well. Suicide, however, has always been considered beyond the pale. It’s been proven that religious people are less suicidal because of their theological underpinnings — the equation with murder, being doomed to Gehinnom, the stain on the family — so when it happens, it’s all the more shocking.

People are loath to talk about suicide, perhaps because of the magnitude of the transgression under Jewish law and the bushah to the dignity of the niftar, as well as to his/her family. But there’s another reason too, and that’s the pervading fear that the more it’s talked about, the more it will put suicidal thoughts into vulnerable heads and increase the risk of people considering it as an option to end their distress.

Zvi Gluck, founder and director of the Orthodox social service group Amudim — which advocates for more honesty in communal recognition of abuse and mental health issues in order to create effective services — told Mishpacha in an interview earlier this summer that although suicide is not new, in the not-so distant past it was rarely acknowledged. In the activist circles in which he traveled together with his father, venerated askan Rabbi Edgar Gluck, the code phrase for a suspected suicide was “he died of an aneurysm.”

But this fear of bringing the suicide discussion into the open lest it “give people ideas,” is unfounded, reveals a wide-ranging ten-year review on the subject published in Lancet Psychiatry in July 2016. According to the study, silencing suicide talk and pretending it doesn’t exist actually increases its chances of happening.

“Contrary to what people intuit, talking about and acknowledging suicidal thoughts or unbearable emotional distress will actually make a person more willing to seek help and will enable others to identify the risk factors,” says Dr. Bunzel.

When a family member or friend expresses suicidal thoughts, the common wisdom is that “people who talk about suicide usually don’t commit it” — but these people are actually the highest-risk group, and their threats shouldn’t be ignored. In fact, 80 percent of suicide attempts are preceded by some kind of warning, either vague statements or clear threats. And if a family member or friend thinks, “Only clinically depressed people commit suicide so I can ignore the threat because he/she is ‘normal,’ ” there are other risk factors aside from mental illness, including poor physical health or a serious medical issue, family history of suicide, substance abuse, unemployment, and intense feelings of uselessness and loneliness.

Those feelings might also be accompanied by a certain level of misguided chesed, a perceived altruistic decision on the part of the niftar that he was actually doing a favor to his family, that he was a burden on them and they’ll all be happier now that he’s out of the picture.

“But the truth,” says Dr. Bunzel, “is that there’s no greater punishment he can inflict on the family. I’ve met with many families after a family member commits suicide, and they never get over it. On the one hand, there is a tremendous feeling of shame and betrayal, and on the other hand, an overwhelming feeling of guilt — ‘Why didn’t we see it coming? Why didn’t we prevent it?’ ”

Dr. Bunzel directs a staff of close to 60 clinicians, including psychiatrists, psychologists, social workers, and assorted therapists, and if a suicide happens despite treatment, he shares the burden of responsibility. “There’s a lot of cheshbon nefesh, a lot of ‘what could we have done differently,’ and sometimes recrimination as well,” he says. “Once when I was working at Tel Hashomer, a patient in the middle of treatment ran out of my office and jumped off the parking garage. So you try to look back and see if you could have been more proactive, more aggressive, or more creative in your treatment protocol, but as professionals, we have to go on, because for every life we lose, every day we’re saving more. Hashem put me in a profession filled with potential tragedy, but He also gave me the strength to move on in order to help the next person coming in.”

Finding the Key 

Still, Dr. Bunzel and his staff can only help that next person if he does come in, if he has the wherewithal to admit he needs help. But what about the multitudes of people who won’t admit to their psychiatric weaknesses, who could live better lives with therapy or stabilizing medication, but refuse to take the step? Is it possible to get the bochur who’s suffering from OCD or from intense social phobia into treatment against his will?

This, Dr. Bunzel admits, is the major hurdle of the business. “Getting a person to point B from point A if he refuses to cooperate is almost impossible, so you have to be smart, you have to identify those people that have an influence over him, such as a rav or a mentor he looks up to. Sometimes incentives work — a new computer, the possibility (or the holding back) of a shidduch, an airline ticket — and if he’s part of a strong group or chassidus, sometimes that leader can force compliance. Sometimes the threat of forced hospitalization, or of being turned over to the police or social services, works. Either way, you have to find the key and put it in the lock and see if it opens. Sometimes it does and sometimes it doesn’t.”

One thing Dr. Bunzel and his Torah-observant staff have to their advantage is a certain built-in trust mechanism that doesn’t exist when a person faces treatment with a secular clinician. He’s also in favor of bringing Torah into the treatment rooms, “because we Jews are also about our nefesh, and when the nefesh is ill, Torah and teshuvah are powerful tools. We use whatever is in our arsenal, and mental health professionals who don’t have Torah are missing a storehouse of treatment options.”

Because he faces spiritual and physical life-and-death issues on a regular basis, Dr. Bunzel relies heavily on daas Torah for the complex questions that regularly arise. He meets regularly with Rav Yitzchok Zilberstein, the medical center’s posek, who serves as his guide.

“There’s no question that having halachic guidance helps with treatment,” he comments. “In fact, the district psychiatrist in Tel Aviv has often told me that he wishes the cases he deals with would involve rabbis and people who listen to their rabbis, because it opens a whole different angle in treatment options. And there’s no question that having a halachic framework is therapeutic. Those who don’t have it are missing many opportunities for healing.”

It also provides a backbone in those gray areas where the psychiatrist must make life-and-death decisions for his patient. And sometimes, those decisions take a lot of guts to uphold.

He tells the story of Leah, who was five months pregnant and suffering from depression, bordering on suicidal. She had a psak from a rav that she could abort the pregnancy if a psychiatrist would sign that the procedure was necessary — a case of pikuach nefesh — taking into account her mental state and the assumption that she couldn’t be medicated during pregnancy. Dr. Bunzel was asked to provide the necessary signature. But to everyone’s surprise, he refused.

“I will never rubber-stamp these things because we’re changing the myths,” Dr. Bunzel explains. “First of all, there is medication today that can be taken safely during pregnancy, and there are organizations that can provide support for her along the way, so to me, the situation was far from hopeless. I have at least a minyan of ‘grandchildren’ who were born because we stuck to our guns and didn’t bow to the myth and the hopelessness that there’s no way out.

“The truth is, I thought I’d failed with Leah. When she threatened that she’d either abort or kill herself, I held my own, with daas Torah behind me. I told her, ‘I know you’re feeling desperate now, but I have a lot of experience with this. You need to start on medication and you’re going to feel different in a few weeks.’ Well, she stormed out of the office, screaming at her husband that ‘You promised me this doctor would sign! Now I’m going to kill myself!’

“I called the rav and apologized, but told him I couldn’t sign, that I believe there are other ways. I stood my ground according to my psak from Rav Zilberstein, but I was still feeling shaky, feeling like a failure — maybe she would hurt herself and I’m responsible? Four months later I got a call back from the rav — Leah had a baby! ‘True, she slammed the door on you,’ the rav told me, ‘but when she saw how you held fast to your convictions and wouldn’t budge, it pushed her to go for treatment.’”

Dr. Bunzel is responsible for the promotion of another game-changing psak of Rav Zilberstein — that a client should only choose a psychotherapist of the same gender. “It was an innocent question I asked him about my own staff policy, regarding cases of deep dynamic therapy when the very relationship between therapist and patient becomes the focus of the treatment. There was quite a stir when this psak came out — people were saying it’s just for sheltered Bnei Brak and doesn’t apply to the more ‘modern world.’ So I took the psak — it was personally written to me — to Rav Nissim Karelitz and he signed it too, and then I took it to Rav Steinman and Rav Chaim, and also sent it to Rav Shmuel Kamenetsky and Rav Yisroel Belsky, and they all signed, and after that I went with it to Rav Ovadiah Yosef — it was the first time he ever signed a psak from an Ashkenazi posek. He not only signed it, but inscribed, ‘I join this psak will all my heart and soul.’ The major national-religious rabbanim signed it as well, rendering the psak an accepted norm across the gamut of Orthodox Jewry. Knowing the potentially tragic pitfalls in the field, I consider this my own ‘signature legislation.’ ”

Hijacked Souls

As a hospital psychiatrist, Dr. Bunzel can’t pick and choose his patients — especially when the prison services send him all types of criminals for psychiatric evaluations and therapy. This is the seedy underbelly of humanity in the Jewish state — people whose mental illnesses or overpowering yetzer hara have driven them to destroy others’ lives. Some of these people have buried their tzelem Elokim; others still have a spark that at some level wants to connect to teshuvah. How does a Torah-oriented psychiatrist treat a murderer who is also a Jew? Where does the horror end and the compassion for the neshamah begin? Is it really any different from treating someone on a suicide watch, who’s waiting for an opportunity to take his own life, as the healthy part of his nefesh has been hijacked by psychosis or depression?

“I deal with a lot of posh’im bein adam laMakom and bein adam l’chaveiro — murderers, pedophiles, and other violent offenders — and when they’re in the midst of their mental illness, which often coincides with the crime, they’ve lost the rational ability to connect with teshuvah or with Hashem,” Dr. Bunzel says. “My job is not to judge them — there are courts for that — but to try and reignite that spark of humanity, to reconnect them with their yetzer tov, although it’s not simple when I think about the horrible things these people did to others.” Dr. Bunzel has set up personal fences to protect his own sensitive side — a private mikveh in his house that he uses when he feels oversaturated by shmutz, a nonnegotiable chavrusa, Torah learning and close rabbinic ties, and his family.

“Look,” he says, “If I’d gone into surgery like my dad, I’d have blood and guts all day. So this is my blood and guts. But you see, people can turn around, and just like a surgeon gets his hands dirty, yet manages to fix a body and get the person up and walking again, Hashem gave me the power to heal too — even these compromised, tarnished souls.”

Suicide Watch

Rutie Kagan says that when her husband, Rabbi Moshe Kagan,* threw himself off a building earlier this year, he saw this final act — in the reality of his tortured mind and broken soul — as the last chesed he could offer her.

Ruti was 18 when she married Moshe, a talented, creative, and deep thinker with a soul weighed down by severe anxiety. Today she’s a widow at 33 with 5 children, calling her journey over the last 15 years “childhood, adulthood, and old age all packed in together.”

She knew there was something a little difficult about Moshe when she met him, but she also saw his tremendous potential and felt partnering with him in life was her mission. “His parents felt that with the right woman, not only would Moshe go forward, but he would become great. I felt so, too.”

Moshe had huge expectations of himself and he sometimes had the capacity to push himself, but he also had long periods of severe depression when he seemed to be encased in darkness. The responsibility of his growing family overwhelmed him and he was prone to occasional violent outbursts, yet at the same time he was making strides in the kollel in the southern town where they lived, and was studying for semichah and dayanus.

“During the first years we went through a range of therapies, but he didn’t really believe in them and wasn’t motivated to follow their protocols, so he always quit halfway through. He thought he knew better,” says Ruti.

Although life had become an emotional roller coaster, Ruti says she never considered leaving the relationship. “I knew I was going to stick by him through everything, and he was also trying, according to his limited capacity. He never said to me, ‘Ruti, I know this is too much for you. Maybe you take the kids and leave.’ He was extremely grateful that I was in it for the long haul, and he would always promise, ‘One day you’ll see, I’ll be better, our life will be better.’ ”

It was Moshe who finally found Dr. Michael Bunzel, about five years ago. “Moshe was very smart and very good at researching the best treatments, and that was the complicated part. On one hand he knew what he needed, but on the other hand he was so trapped in his anxieties and depression that he couldn’t follow through.”

Dr. Bunzel labeled Moshe’s condition as severe manic depression and prescribed a strict medication protocol. With the stabilizing medication, Moshe’s condition evened out and he was feeling more productive and balanced than he had in years — but he soon fell back in his old pattern. The meds were affecting his concentration and seeming to sap him of energy, and so he decided on his own to go off them.

“Again, he insisted he could manage on his own, but it’s like a person who needs crutches yet insists he can walk,” says Ruti. “It was downhill from then on. Moshe had an extreme manic period followed by a full-blown nervous breakdown,” Ruti remembers. “I got a cab and we sped to Dr. Bunzel, who prescribed something to take down the mania and insisted that he go to sleep for a few days. Moshe wasn’t happy about the meds, though — he said it was giving him aches and pains, and although Dr. Bunzel insisted he stay on the protocol, that he needed to rest and get balanced, Moshe again took his health into his own hands and went off the meds.

“At that point I saw Moshe beginning to melt away in front of my eyes. He began to talk of suicide, but I couldn’t listen. He was sapping me, poisoning the atmosphere in the home. I couldn’t take responsibility for him anymore, my batteries were empty, but I did let some of his friends know what was happening and organized an informal suicide watch. As soon as Dr. Bunzel heard he was talking suicide, he insisted that Moshe be hospitalized immediately.

“You can get out of this,” Dr. Bunzel told Moshe. “Go to the Mercaz LeBriut HaNefesh in Be’er Sheva. They’ll take care of you. I’m too far away and you need more than what I can give you.”

Somehow, Dr. Bunzel’s words penetrated and Moshe agreed — for 48 hours. After two days in an atmosphere so antithetical to his sensitive spirit — the immodesty, the blaring television, the Arabs, the vulgar language — he checked himself out, promising to follow the medication protocol at home. But when he got home, he flushed the pills down the toilet and basically prepared himself for death.

“I was horrified,” says Ruti. “I knew that if I let him stay home, I’d be an accomplice, but I could no longer watch him or take responsibility. ‘I’m looking for a place,’ he told me, ‘and I think we should say goodbye.’ On the advice of my rav, I left the house and organized some friends to come instead. I didn’t want to be part of his death wish.”

One friend who was supposed to come over fell asleep, and another accidentally had the ringer on his phone turned off. “It was as if Hashem made a place for this to happen.

“He walked into the middle of town and jumped. That was the last drop of initiative he had. He didn’t want to cause a tirchah to the tzibbur so he chose a place where he’d immediately be identified. And in his mind it was his last chesed to me. He felt that by living he was stripping me of my life, and that in his death he’d give me back life. And he made sure they would find him — his final, tortured gift. All he could give me at that point was that I shouldn’t be an agunah.

“After the shivah I called his friends together — rabbanim, talmidei chachamim, it was like a beis din shel matah. Like the eglah arufah. Each one testified how much he tried, that ‘our hands didn’t spill this blood.’ That Hashem Himself came down and took Moshe away. I pray that his elevated neshamah, which couldn’t fit the keilim in this world, is now surrounded by goodness.”

* Names changed to protect privacy 

(Originally featured in Mishpacha Issue 628)