Everyone enjoys the Pesach Seder, right? Well, no, not exactly. When it comes to mental health, it does not discriminate based on religion or observance level. Think about the number of people around your table over Pesach: Five, 10, 15, 20? Statistically speaking, one out of five people suffers from mental illness and, inevitably, there will be a handful of people sitting at your table who are likely suffering in silence. While most are celebrating the joyous liberation of slavery to freedom, sadly, the person sitting next to you may be feeling alone, tortured and confined to a secret slavery within themselves.

Pesach is the only holiday with a specific focus on the four prototypes of children. This template goes beyond the open invitation for “all who are hungry to join,” but a mandate to focus on maximum inclusion and individuation, honoring the differences, rather than expecting, and catering to a cookie-cutter form. Before inclusion can be achieved, one must first ignite the genuine empathy born from understanding the plight of others.

As a therapist, I am trained to truly see the person, while simultaneously and compassionately understand the diagnoses and challenges a person may carry. Allow me to overlay several examples of the Pesach experience through the lens of mental illness.

Consider the person who is suffering in silence, as they struggle with:

Alcoholism: Watching the bottles of wine flow freely, cup after cup filled and refilled, raised and glorified–as they silently confront and resist the very substance which challenges their sobriety and threatens their life.

Depression and Mood Disorders: Feeling lonely, misunderstood, hopeless, sad, exhausted or even suicidal, while surrounded by so much celebration. They may carry crippling guilt for not being able to summon the energy to help with the chag, or participate in the joyous celebratory atmosphere.

Post-Traumatic Stress Disorder (PTSD): Brave survivors of terror or abuse, listening for hours to stories about unimaginable suffering and torture, graphic images of blood, fire and death, as they strive to hide the physical and emotional triggers that are ignited by their own horrific and traumatic memories.

Anxiety: Living in what feels like a pressure cooker about to explode, after intense days of cleaning, shopping, cooking and preparing. They may be struggling to hide their internal worries, live up to the expectations of everyone around them, and mask the physical symptoms of the mounting stress raging inside.

Misophonia: Those plagued by auditory sensitivities, painfully hearing every magnified sound in the room, particularly chewing noises. The experience can be horrific, feeling worse than nails on a chalkboard, as one sits at the Seder struggling to block out the sounds of every guest simultaneously sipping their wine, slurping their soup, and consuming matzah, one loud bite at a time.

Obsessive Compulsive Disorder: Those struggling with the hyperfocus of measuring every shiur of matzah, maror and wine; watching food items passed around the table and feeling an overwhelming need to leave in order to repeatedly wash their hands; and overcome the paralyzing fear that undiscovered chametz may be hiding somewhere, despite herculean measures to clean.

ADHD: Adults, adolescents and children, forced to quell their overwhelming anxiety as the hours slowly pass. During a night where the longer you go, “harei zeh mishubach,” the trapped feelings of being stuck around the table painfully grow, together with the impulsive urges to speak up, act out, or break free, often leading to family conflict, or even public shaming and criticism.

Learning, Reading and Processing Disorders: Whether the adult leading the Seder, or a child around the table, the pressures of being expected to spontaneously read, say a dvar Torah, answer a question, or stand up in front of everyone and recite Mah Nishtana–these moments can be incredibly embarrassing and lead to long-term trauma to one’s self-esteem.

Autism Spectrum and Neurodiversity: Where one may feel incredibly uncomfortable in a large or loud social setting, or even frustrated or angry with the spontaneous detours off the page of the Haggadah, leading to stress, anxiety and conflict.

Eating Disorders: Those silently waging an internal war to maintain a healthy relationship with food, yet feeling the traumatic and triggering pressures to consume, and what feels like force-feed themselves, just to fulfill their Pesach obligations. As the Seder revolves so heavily on eating, the battle with food can be so painful, and even trigger serious pikuach nefesh concerns.

These are just a few examples of the conditions, from the hundreds listed in the Diagnostic and Statistical Manual (DSM 5), which people suffer from, and which can be exacerbated during Pesach.

Typically, when one struggles with mental illness, they compensate with a variety of tools for coping and escaping, many of which are not available during the Seder. Ordinarily, a person may retreat to their room; journal; watch a video or listen to music; or call a friend, sponsor, or therapist. Yet, at the Seder, they are often trapped within themselves–trying to put on a smile for everyone present, despite the invisible pain they carry.

What is the solution?

First and foremost, it is not to judge, patronize, nor ask the painful question, “Have you taken your meds?” These are not diagnoses, they are people. These are our children, spouses, parents and siblings. The message is to simply be compassionate, not rigid. As we can never know the struggles that another person is carrying, try avoiding situations where you insist or put pressure on someone. If a guest prefers grape juice over wine, there is no need to get into a halachic argument with them on the merits of wine. If someone eats less than the required shiur, or far more, be graceful and let that be their decision. If a participant feels the need to take a break or step away, be generous and supportive–no questions asked.

By having a deeper understanding of the struggles that people around us may carry in silence, we can have more empathy, love and compassion, and allow everyone around the Seder table to feel safe, welcomed and fully included.

Rabbi Dr. Ari Sytner is director of community initiatives at Yeshiva University’s Center for the Jewish Future where he works to help strengthen communities nationwide. He is also a professor at YU’s Wurzweiler School of Social Work and a therapist in private practice. He works as a trauma and grief counselor for organizations including Chai Lifeline and Shalom Task Force.