By Rabbi Yair Hoffman

By Rabbi Yair Hoffman

There is a fascinating question raised in Chasuchei Chemed of Rav Yitzchok Zilberstein in Berachos (10a). A man found out that the genetic predisposition of his future offspring toward schizophrenia was five times higher than normal on account of his wife’s family history of that illness. He decided that he did not have the tools to deal with such an issue and refused to have children.

The Two Obligations

From a halachic perspective, there are two obligations in having children. There is the mitzvah of “p’ru u’revu,” be fruitful and multiply. One fulfills this basic obligation by having a son and a daughter, according to many opinions. There is, however, a second obligation, called “U’ba’erev lo sanach yadecha” (Koheles 11:6) discussed in Yevamos 62b. This obligation is to continue having children beyond the basic mitzvah of just two children, a boy and a girl.

The idea is best expressed in the words of Yeshayahu (45:18): “He did not create [the world] for a waste; He formed it to be inhabited.”

In the words of Rabbi Yehoshua in that Gemara, “If one had children when he was young, he should continue to have children when he is old. As the verse (Koheles 11:6) states: ‘In the morning, sow your seed, and in the evening, do not withhold your hand, for you know not which will succeed, this one or that one, or whether both of them will be equally good.’”

As far as obligation number one, most authorities state that one should still have children even with the risk of passing on a mental illness. As far as obligation number two, this author received a ruling from the author of the Tzitz Eliezer, Rav Eliezer Yehudah Waldenberg, zt’l. He ruled that there is no second obligation when it involves bringing sick children into the world. Presumably, this may be a controversial ruling.

Schizophrenia

Schizophrenia affects about 1% of the world’s population. If we think about it, that means that in the United States alone, there are some 3.7 million Americans walking around with this disorder. It is not just that peculiar great-uncle or aunt in some families who are never really discussed by the parents. In a typical yeshiva of 300 kids or more, statistically, three of them will suffer from the illness, Rachmana litzlan.

Schizophrenia is a mental disorder that is characterized by disorganized thoughts, false beliefs, difficult social relationships, and paranoid delusional thoughts, among others. There is also a tendency to not care about social relationships and to send away all friends and relatives. Schizophrenics can have complex delusional theories, often talk to themselves, stop working, and can seriously affect the well-being of others around them. It is thus quite understandable that the husband discussed in Rav Zilberstein’s sefer did not wish to bring into the world children who might suffer from the disease.

Generally speaking, schizophrenia appears at young adulthood, although there are processes that occur beforehand. It is a sad reality that many of the people who suffer from this devastating psychiatric disorder do not seek treatment.

The Breakthrough

Recently, there has been a remarkable breakthrough in how schizophrenia can be prevented, which can affect how halachic authorities view this condition. The research is truly earth-shattering and may be a game-changer for those who suffer from this illness.

Using schizophrenic mice, researchers from the Caroni group at the Friedrich Miescher Institute for Biomedical Research (FMI) have demonstrated that, like humans, the characteristic network and cognitive deficits of schizophrenia only emerge in adult mice. They have also demonstrated that these deficits could be permanently prevented by specific treatments during late adolescence. Their study has been published in Cell in an article titled “Long-Lasting Rescue of Network and Cognitive Dysfunction in a Genetic Schizophrenia Model.”

Generally speaking, treatment for schizophrenia has focused more on the symptoms than the causes, using various cocktails of antipsychotic medications.

There are thought to be many contributing factors behind schizophrenia, including problems during birth, stress, psycho-social factors, familial predisposition, and the use of marijuana during adolescence. There are also people with something called “22Q11DS syndrome” characterized by deletions within a segment of chromosome 22. These people have a 20 to 30 times increased risk of developing schizophrenia. The schizophrenic mice used in the study were bred with a deletion in their corresponding chromosome 22.

The researchers tried suppressing the network dysfunctions of the mice during the most critical time window. They applied repeated treatments targeting the hippocampal PV network with common antipsychotic drugs or with more specific genetic activators of PV neurons during the 6–10 days that characterize the transitional period between late adolescence and adulthood in mice.

“Our findings in a genetic mouse model support the hypothesis that a critical developmental time window influences the emergence of schizophrenia at the transition between late adolescence and adulthood, and that it is possible to prevent the progression of schizophrenia by treatment during that time window,” remarked Pico Caroni. “It might be possible to build on our study to develop therapeutic strategies to prevent the outbreak of schizophrenia in at-risk individuals.”

Rav Waldenberg’s Ruling

I would like to suggest that this research can directly affect Rav Waldenberg’s ruling. The research discussed here may lead to stopping schizophrenia in those with specific genetic markers before they reach adolescence. While the breakthrough would not help those who already suffer from the disease, it might help those who are at grave risk of developing it. May Hashem send a refuah sheleimah to all those who are suffering illness. Amen.

Rabbi Hoffman can be reached at Yairhoffman2@gmail.com

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