A Beautiful Mind 2010 Medical Ethics Conference

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A Beautiful Mind- Jewish Approaches to Mental Health

The Fifth Annual Medical Ethics ConferenceSunday, October 31, 2010

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elcome Address

by Adiel Munk and Jennifer KrautHonored speakers and esteemed guests, welcome to the Fuld Family Conference, ³A BeautifulMind: Jewish Approaches to Mental Health´- as copresidents and conference organizers, we¶dlike to take this opportunity to thank you for your support in this year¶s conference. Relates tomental health through the prism of Jewish law and Torah values. Want to thank the Fuld Family- privileged to have Rabbi Dovid and Mrs. Anita Fuld here today. It is with their support that wewere able to create today¶s conference with the highest sensitivity and professionalism in mind.Sefer Breishit with the emotional experiences and relationships of our Avot and Imahot. Chief Rabbi Lord Sir Jonathan Sacks compare way Avraham and Noach respond to tragedy and grief. Noach began to be a man of the soil and he planted a vineyard. Man previously described as arighteous man now seeks comfort in wine. He was indeed a righteous man, one who had seen aworld destroyed. When reading the text, impression of Noach as man paralyzed with grief,seeking oblivion. In contradistinction, read about Avraham who experienced the greatesttragedy/ trauma= lose the most precious person in his life and just as he was about to angel of God urged Avraham not to. Seemingly happy ending immediately overshadowed by death of Sarah, Avraham¶s wife. With prototype of Noah¶s grieving process, we would assume Avrahamwould grieve for a long time. Rather, Avraham mourns and then secures the Jewish future by performing two acts- purchases Cave of Machpeila and finds a wife for Yitzchak. While Noachis overwhelmed by his loss, Avraham grieves by knowing what he has lost but takes hisexperience to strengthen the Jewish future.Complex issues that many people suffer from silently and organized- these issues are oftenignored because human nature to avoid confrontation with____. Must break the silence. Having been founded five years ago, Student Medical Ethics society realized there was a need in theJewish community for Medical Ethics + Jewish ethics. As Torah Jews, accept the privilege of ³v¶yrapo y¶rapeh´ within the confines of halakha. Throughout the year, we develop programming that delves into various contemporary issues- stem cell research, genetic screening,end of life issues etc. This year¶s conference would not be possible without the help of numerousindividuals- Dr. David Pelcovitz, CJF led by Rabbi Kenneth Brander, Yoni Cohen, Chezi Jessinand Marc Spear. Enormous help of Aliza Berenholz and staff at the Events Office. Finally, Dr.Edward Reichman¶s support,advice and words of encouragement have been truly invaluable.Thank you for always being available to speak with us etc.

Introduction to Mental Health

Rabbi Dr. Edward Reichman, Conference ChairmanGood morning, everybody. I hope you don¶t mind if I just check my watch- it says 9:30 in themorning on Sunday but there¶s 400 people sitting in the room here. This is just a small reflectionsince our early conference on infertility on Jewish law, I guess it was so successful that we¶ve become fruitful and multiplied. Only the fifth conference and barukh hashem extraordinarily

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successful conference. Of course CJF and YU with their vision to appreciate the necessity for these conferences, as much and sometimes more so than any other events on campus illustratethe ideals of this university re: Torah u¶Mada in bringing together world experts on halakha,science and medicine. Rabbi Brander- it is his vision that has guided this conference as well- hefortunately is at a simcha but unfortunately cannot be here today. Special honor- Fuld Familywhile usually is across the continent in Eretz Israel ± this year we have the tremendous zechus of having them in person. I would like very importantly spend just a moment to thank our copresidents, Jenny and Adiel. Even if there was no conference today, it would b eanextrardoinarily valuable effort to see the growth these two have undergone. Medical EthicsSociety has become an incubator for leaders of the Jewish society.Our past conferences have almost exclusively dealt with refuas ha-guf, with bodily health. It isinteresting that when you say the prayer for health of individual you say he should have refuashanefesh and refuas haguf- mentions mental health as well. Mentions refuas hanefesh precedingrefuas haguf. I think we¶ve been neglectful in ignoring refuas hanfesh and we hope to remedythat today. Eseential factor in bodily health, people who have better mental health are actuallyhealthier in body as well. In that vein, wish us all a refuas hanfesh and refuas haguf for all klalyisrael and we should be zocheh that all of our conferences lead to refuas hanfesh and refuashaguf for all.Introduce our first session- Dr. Tia Powell will be moderating our first session on eatingdisorders. Part of YU faculty and just now is opening the Einstein/ Cardoza Masters of ScienceBioethics program. More info pamphlets on table downstairs. Figure on national scene of Bioethics.

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lenary I: Eating DisordersDr. Tia

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owell

Important comments on rest of the panel- wanted to echo congratulations to our two conferenceorganizers- when I was in medical school years ago, I was saying how interesting issues in bioethics were. He said great that you think that but no way for you to really put that into your work. Things have really changed radically- to look at this room today, to see the energy andenthusiasm of our students and look upon how these issues of ethics have been so much morerichly broken into re: what we do in terms of medicine and interweaving of medicine and mentalhealth. Very special thing for me eto see this large room full of people re: this. As someone whoworks exclusively in bioethics and as a board-certified psychiatrist- main principles in bioethicsthat we turn to again and again are AUTONOMY and Beneficence ± no circumstances are thesemore difficult to work with than in mental health. Diseases of the mind attack person¶s ability toact autonomously- the autonomy of the person who suffers from a direct mental illness is directlyattacked by that illness.Any form of treatment need to benefit that patient. Eating disorders specifically have someconflicts- issue of force-feeding for instance. Prisoners are subjected to force-feeding in politicalcontext. This in severe cases is the treatment we are forced to offer sometimes- how to perceivedoing that in order to help foster the sense of free choice, freedom and responsibility that will

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come with mental health- so you can see that this conflict between autonomy and beneficence is particularly distressing to negotiate in context of mental health and eating disorders. Hand thediscussion over to our panelists.

Dr. Karen Rosewater (MD, M

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H)

In Young Adult Medicine and private practice in Manhattan- I¶m not the greatest with slides soforgive me if I don¶t do well.³Ethical Issues in Eating Disorders¶ ± hope not too basic for people but think we need a contextto leap to discussion of ethical issues. Hopet that through this talk I will be setting that background and leading you to understand some of the complicated factors that contribute tothis.CASE 1- SARAH P*15-year-old girl, 5 ft 4, 150 lbsAlways slightly overweight, teased by her classmatesMensturates begins age 13, gained typical weight (10 lbs per year, each year over 5 years)- most people don¶t realize how much weight you are supposed to gain during pubertal process- a lot of adults don¶t know that-High IQ, staright-a student, attends high pressure private school in NYC-decided to go on diet age 14, saw nutritionist, learned about ³healthy eating´ began restrictingintake- lost 15 lbsGot a lot of postivie feedback from family and friends because of this-Weight loss plateau-Decided to become vegetarian, then began eating all ³non-fat´ foodsBegan to complain of abdominal pain with eating, saw pediatrician for evaluation, noted lost 15more pounds in 6 weeks, was told now at ³IBW´ (rapid weight loss over short away of told)-she¶s told her weight is perfect for her height, Ideal Body Weigh (as used to refer to it)Decided to cut out all dairy because MD suggested she might be lactose intolerantAbdominal pain continuedParents noted began skipping breakfast completely, citing ³nausea´ in AMMom called by best friend¶s mother, seen t hrowing away her lunch at schoolWas eating dinner at home but refusing to eat what others were eating, taking plate to room toeat because ³so much homework´ ± isolation eating and difficulty eating with others we oftenseeMom realized buying fewer menstrual supplies, found out last menstrual period at end of summer No longer going out on weekends to dinner with friendsWearing more layers/ baggier clothesFound out she was visiting pro-anorexia sites on the web (browsing history) - give a lot of tipsand promote solidarity on patients who are anorexicWent back to pediatrician, now 100 lbsReferred to gastroenterologistPatient feels she looks fine now, not willing to add meat or dairy back into diet