The best psychiatrist I know is my dear friend Dr. Seth Sherman who trained together with me at Harvard Medical School a few years back. A master storyteller, Seth loved to tell us of the time he worked at Stanford treating a particularly nervous young man.
Without any prior history of mental illness, the young man came to the hospital convinced that the FBI was trying to get him. But where patients with a diagnosis of psychotic paranoia often have disorganized speech and bizarre behaviors, this young man was clear as could be. His only problem was that he was terribly anxious and was focused on being “tracked by the ‘Feds.'” Seth described their interactions on the psychiatric ward as pleasant and couldn’t really put his finger on the young man’s problem. It was a true “diagnostic dilemma” until following day when everything became crystal clear and three men in black suits with FBI badges came to pick him up…
Sometimes people have very good reasons to be anxious. Other times, their fears aren’t really based in reality and their anxiety becomes dysfunctional. For people like this, the treatment of choice is called CBT (Cognitive Behavioral Therapy).
Invented by a Jewish Psychiatrist named Aaron Beck with the goal of treating depression, CBT is a form of psychotherapy that focuses on retraining one’s brain to think rationally and positively. Pathological anxiety is irrational—a person with panic attacks might be concerned that every pain in their chest is related to a heart attack irrespective of their general medical wellbeing. An individual with obsessive-compulsive disorder might be worried that their hands are contaminated and spend five hours each day at the kitchen sink scrubbing. CBT focuses on the need to keep the “big picture” in mind and to replace these catastrophic “automatic thoughts” with grounded and rational thinking.
The idea of remaining rational in times of distress and fear is a very Jewish one indeed. It’s not merely found in Rabbi Nachman of Breslov’s famous quote—“the whole world is a very narrow bridge and the key is to never fear at all”—rather it’s a fundamental principal of faith as taught by Talmudic sages, Maimonides, and everyone else in between. It’s no surprise that my colleague Dr. Ronald Pies wrote an entire book on The Judaic Foundations of Cognitive Behavioral Therapy.
Perhaps the single greatest teacher of Rabbinical CBT was Rabbi Akiva. The Talmud (Berachot 60B) teaches that Rabbi Akiva was always in the habit of saying ” Everything that God does is for the good.” In doing so, he was able to keep proper perspective and to prevent himself from being anxious even in the most frustrating and confusing of times. The story is then told of how Rabbi Akiva was traveling to a village where he was refused lodging and was forced to sleep in the nearby forest. Rather than responding in anger, Rabbi Akiva stated, “Everything that God does is for the good.” At the time, Rabbi Akiva’s only notable possessions were his donkey for traveling, his rooster to serve as a primitive alarm clock for awakening him at dawn for morning prayers, and a candle to provide him with light to study at nighttime. Come nightfall, a wind blew out Rabbi Akiva’s candle. Sitting in the darkness, it was not long before his chicken was eaten by a cat and his donkey by a lion to which the Rabbi immediately responded, “Everything that God does is for the good.” The following morning Rabbi Akiva awoke to find a massive army had taken the local villagers as prisoners and had he not been rudely sent away—and had his light not been extinguished or had his rooster and donkey not been eaten overnight—then mostly certainly he himself would have been captured as well.
The famous 19th century Iraqi Rabbi, The Ben Ish Chai, asks a brilliant question on this story—isn’t it assured that Rabbi Akiva had a lantern to protect his candle from being extinguished by the wind? He answers by saying that Rabbi Akiva was most certainly prepared and that the fact that his light was put out by the wind even through the protection of the lantern was clearly a miracle. But where a regular person might become angry with his light going out and blame his own bad luck, Rabbi Akiva cried out, “Everything that God does is for the good,” for he saw this unnatural occurrence as the hand of Hashem preparing a miraculous salvation.
By using these fundamental principles of Judaism and CBT, Rabbi Akiva not only maintained his inner peace, but also merited to see that everything was in fact for the good when witnessing his incredible fortune the following morning.
With my own patients in psychotherapy practice, I often encourage them to recall the famous line from Psalms, “Behold the protector of Israel neither slumbers or sleeps,” (Psalms 121:4) when they are anxious. This provides them with the necessary perspective to stay cool as a cucumber even in great duress. So whether you have butterflies in your stomach before a big meeting with the boss or your donkey just got eaten by a lion, the key is to keep the big picture in mind and conquer your anxiety! Stay positive, stay Jewish, and remember Everything that God does is for the good.