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Working with Jewish ultra-orthodox patients: Guidelines for a culturally sensitive therapy

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Abstract

The epistemological gap between the medical reality of mental health practitioners and the sacred reality of their Jewish ultra-orthodox patients poses a major challenge for therapy. Based on our work with psychiatric patients from the ultraorthodox community of northern Jerusalem, we propose a set of guidelines to cope with this challenge. Basically, we seek to incorporate religiously congruent elements, composed of metaphoric images, narratives and actions, into the wide range of our “secular” treatment modalities in order to respond to the patient's suffering, often expressed through distinctively religious idioms of distress. This endeavor calls for “a temporary suspension of disbelief” on both sides.

The guidelines presented include three sets of factors which appear pertinent to working with ultra-orthodox patients. The first set is contextual in nature, dealing with the image of the clinic and its physical setting; the second discusses the necessary role requisites of the therapists; and the third one, accorded a central importance, deals on various levels with the therapeutic interventions administered in terms of form and content. Several case vignettes are presented to illustrate three classes of religiously informed interventions: healing rituals, dream interpretation, and the use of culturally congruent metaphors and stories. In the concluding part we discuss ethical and instrumental issues that the proposed therapeutic guidelines may raise.

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References

  • Atkinson, J.M. 1987 The Effectiveness of Shaman in an Indonesian Ritual. American Anthropologist 89:342–355.

    Google Scholar 

  • Aviad, J. 1983. Return to Judaism. Chicago: University of Chicago Press.

    Google Scholar 

  • Aviram, U., and I. Levav, eds. 1981 Community Mental Health in Israel (Hebrew). Tel Aviv: Gomeh.

    Google Scholar 

  • Babylonian Talmud 1958 Translated by Rabbi Dr. I. Epstein. London: Soncino Press.

    Google Scholar 

  • Beit-Hallahmi, B. 1991 Back to the Fold: The Return to Judaism.In Tradition, Innovation Conflict. Z. Sobel and B. Beit-Hallahmi, eds. Pp. 153–172. New York: SUNY Press.

    Google Scholar 

  • Bilu, Y. 1979a Demonic Explanations of Disease among Moroccan Jews in Israel. Culture, Medicine and Psychiatry 3:363–380.

    Google Scholar 

  • 1979b Sigmund Freud and Rabbi Yehudah: On a Jewish Mystical tradition of Dream Interpretation. The Journal of Psychological Anthropology 2:443–463.

    Google Scholar 

  • 1985 The Taming of The Deviants and Beyond: An Analysis of Dybbu Possession and Exorcism in Judaism. The Psychoanalytic Study of Society 11:1–30.

    Google Scholar 

  • Bilu, Y., E. Witztum, and O. Van der Hart 1990 Paradise Regained: “Miraculous Healing” in an Israeli Psychiatric Clinic. Culture, Medicine and Psychiatry 14:105–127.

    Google Scholar 

  • Bourguignon, E. 1979 Psychological Anthropology. N. Y.: Holt, Rinehart & Winston.

    Google Scholar 

  • Buchbinder, T. 1991 Mental Health Services and the Ultra-Orthodox Community (Hebrew). In the Light of Torah 7:69–77.

    Google Scholar 

  • Cirlot, J.E. 1962 A Dictionary of Symbols. New York: Philosophical Library.

    Google Scholar 

  • Comas-Diaz, L., and F.M. Jacobsen 1991 Ethnocultural Transference and Countertransference in the Therapeutic Dyad. American Journal of Orthopsychiatry 61:392–402.

    Google Scholar 

  • Crapanzano, V. 1975 Saints, Jnun and Dreams: An Essay in Moroccan Ethnopsychology. Psychiatry 38:145–159.

    Google Scholar 

  • Csordas, T.J. 1983 The Rhetoric of Transformation in Ritual Healing. Culture, Medicine and Psychiatry 7:333–375.

    Google Scholar 

  • 1985 Medical and Sacred Realities: Between Comparative Religion and Transcultural Psychiatry. Culture, Medicine and Psychiatry 9:103–116.

    Google Scholar 

  • Dan, J. 1972a Book of Raziel.In Encyclopedia Judaica (Vol. 13:1592–1593). Jerusalem: Encyclopedia Judaica.

    Google Scholar 

  • 1972b Maggid.In Encyclopedia Judaica (Vol. 11:698–701). Jerusalem: Encyclopedia Judaica.

    Google Scholar 

  • Dow, J. 1986 Universal Aspects of Symbolic Healing: A Theoretical Analysis. American Anthropologist 86:56–69.

    Google Scholar 

  • Draguns, J.G. 1981 Cross-Cultural Counselling and Psychotherapy: History, Issues, Current Status.In Cross-Cultural Counselling and Psychotherapy. A.J. Marsella and P.B. Peterson, eds. New York: Pergamon Press.

    Google Scholar 

  • Fernandez, J.W. 1977 The Performance of Ritual Metaphors.In The Social Use of Metaphor. J.D. Sapir and J.D. Crocker, eds. Philadelphia: University of Philadelphia Press.

    Google Scholar 

  • Foster, G.M. 1979 Disease Etiologies in Non-Western Medical Systems. American Anthropologist 78:773–783.

    Google Scholar 

  • Frank, J.D. 1973 Persuasion and Healing. New York: Schocken.

    Google Scholar 

  • Ginhardt, L.R. 1981 The Use of a Metaphoric Story in Therapy: A Case Report. American Journal of Clinical Hypnosis 23:202–206.

    Google Scholar 

  • Good, B.J., and M. DelVecchio Good 1986 The Cultural Context of Diagnosis and Therapy: A View from Medical Anthropology.In Mental Health Research and Practice in Minority Communities. M. Miranda and H. Kitano, eds. Pp. 1–27. Washington D.C.: Dept. of Health and Human Services.

    Google Scholar 

  • Good, B.J., H. Herrera, M. DelVecchio Good, and J. Cooper 1982 Reflexivity and Countertransference in a Psychiatric Cultural Consultation Clinic. Culture, Medicine and Psychiatry 6:281–303.

    Google Scholar 

  • Gordon, D. 1978 Therapeutic Metaphors. Cupertino, CA: Meta Publications.

    Google Scholar 

  • Goshen-Gottstein, E.R. 1987 Mental Health Implications of living in an Ultra-Orthodox Jewish Subculture. Israeli Journal of Psychiatry 24:145–166.

    Google Scholar 

  • Green, A. 1981 Tormented Master: A Life of Rabbi Nachman of Bratslav. New York: Schocken.

    Google Scholar 

  • Greenberg, D. 1984 Are Religious Compulsions Religious or Compulsive? A Phenomenological Study. American Journal of Psychotherapy 38:524–532.

    Google Scholar 

  • Greenberg, D., and E. Witztum 1991 The Treatment of Obsessive-Compulsive Disorders in Strictly Religious Patients.In Current Treatment of Obsessive-Compulsive Disorders. M.T. Pato and J. Zohar, eds. Washington D.C.: American Psychiatric Press, Inc.

    Google Scholar 

  • Haley, J. 1963 Strategies of Psychotherapies. New York: Grune and Straton.

    Google Scholar 

  • Helmreich, W.B. 1982 The World of the Yeshiva: An Intimate Portrait of Orthodox Jewry. Yale University.

  • Jackson, A.M. 1990 Evolution of Ethnocultural Psychotherapy. Psychotherapy 27:428–435.

    Google Scholar 

  • Kleinman, A. 1978 Clinical Relevance of Anthropological and Cross-Cultural Research: Concepts and Strategies. American Journal of Psychiatry 135:427–431.

    Google Scholar 

  • 0 1980 Patients and Healers in the Context of Culture. Berkeley: University of California Press.

    Google Scholar 

  • Lévi-Strauss, C. 1967 The Effectiveness of Symbols.In Structural Anthropology. Pp. 181–201. Garden City, New York: Anchor.

    Google Scholar 

  • McGuire, M.B. 1983 Words of Power: Personal Empowerment and Healing. Culture, Medicine and Psychiatry 7:221–240.

    Google Scholar 

  • Moerman, D. 1979 Anthropology of Symbolic Healing. Current Anthropology 20:59–80.

    Google Scholar 

  • 1983 Physiology and Symbols: The Anthropological Implications of the Placebo Effect.In The Anthropology of Medicine: From Culture to Method. L. Romanucci-Ross, D. Moerman, and L. Tankredi, eds. Pp. 156–167. New York: Prager.

    Google Scholar 

  • Myerhoff, B. 1976 Balancing Between Worlds: The Shaman's Calling. Parabola: 1:1–13.

    Google Scholar 

  • Nell, V. 1990 One world, One Psychology: Relevance and Ethnopsychology. South African Journal of Psychology 20:129–140.

    Google Scholar 

  • Obeyesekere, G. 1984 Medusa's Hair: An Essay on Personal Symbols and Religious Experience. Chicago: University of Chicago Press.

    Google Scholar 

  • 0 1990 The Work of Culture. Chicago: The University of Chicago Press.

    Google Scholar 

  • O'Nell, C.W. 1976 Dreams, Culture, and the Individual. San Francisco: Chandler and Sharp.

    Google Scholar 

  • Oppenheim, L.A. 1966 Mantic Dreams in the Ancient Near East.In The Dream and Human Societies. G.E. von Grunbaum and R. Caillois, ess. Berkeley: University of California Press.

    Google Scholar 

  • Pande, S.K. 1968 The Mystique of Western Psychotherapy: An Eastern Interpretation. Journal of Nervous and Mental Disease 146:425–432.

    Google Scholar 

  • Perez, L. 1977 The Messianic Psychotic Patient. The Israel Annals of Psychiatry 15:364–374.

    Google Scholar 

  • Peseschkian, N. 1982 The Merchant and the Parrot: Oriental Stories as Tools in Psychotherapy. New York: Vantage Press.

    Google Scholar 

  • Polsky, H. and Y. Wozner 1989 Everyday Miracles: The Healing Wisdom of Hasidic Stories. New Jersey: Jason Aronson.

    Google Scholar 

  • Preuss, J. 1978 Biblical and Talmudic Medicine (trans. by F. Rosner). New York: Hebrew Publishing Company.

    Google Scholar 

  • Putnam, F.W. 1989 Diagnosis and Treatment of Multiple Personality Disorder. New York: Guilford Press.

    Google Scholar 

  • Rahav, M., A.B. Goodman, M. Popper, and S.P. Lin 1986 Distributed Mental Illness in the Neighborhoods of Jerusalem. American Journal of Psychiatry 143:1249–54.

    Google Scholar 

  • Scheff, T.J. 1977 The Distancing of Emotion in Ritual. Current Anthropology 18:483–505.

    Google Scholar 

  • Scholem, G. 1954 Major Trends in Jewish Mysticism. New York: Schocken.

    Google Scholar 

  • Schwartz, L.R. 1969 The Hierarchy of Resort in Curative Practices. Journal of Health and Social Behavior 10:201–209.

    Google Scholar 

  • Shaffir, W. 1991 Conversion experiences: Newcomers to and Defectors from Orthodox Judaism.In Tradition, Innovation, Confliect. Z. Sobel and B. Beit-Hallahmi, eds. Pp. 173–202. New York: SUNY Press.

    Google Scholar 

  • Shilhav, Y., and M. Friedman 1985 Growth and Segregation: The Ultra-Orthodox Community in Jerusalem (Hebrew). Jerusalem: The Jerusalem Institute for Israel Studies.

    Google Scholar 

  • Sobel, Z., and B. Beit-Hallahmi, eds. 1991 Tradition, Innovation, Conflict: Jewishness and Judaism in Contemporary Israel. New York: SUNY Press.

    Google Scholar 

  • Spiegel, J. 1971 Transactions: The Interplay Between Individual, Family and Society. N.Y.: Science House, Inc.

    Google Scholar 

  • Stromberg, P. 1985 The Impression Point: Synthesis Between Symbol and Self. Ethos 13:56–74.

    Google Scholar 

  • Sue, D.W. 1990 Culture-Specific Strategies in Counselling: A Conceptual Framework. Professional Psychology: Research and Practice 21:424–433.

    Google Scholar 

  • Sue, S., and N. Zane 1987 The Role of Culture and Cultural Technique in Psychotherapy. American Psychologist 42:37–45.

    Google Scholar 

  • Tedlock, B., ed. 1987 Dreaming: Anthropological And Psychological Interpretation. Cambridge: Cambridge University Press.

    Google Scholar 

  • Torrey, E.F. 1972 The Mind Game: Witchdoctors and Psychiatrists. New York: Emerson Hall.

    Google Scholar 

  • Trachtenberg, J. 1974 Jewish Magic and Superstition. New York: A Temple Book, Atheneum.

    Google Scholar 

  • Van der Hart, O. 1983 Rituals in Psychotherapy. New York: Irvington Publishers, Inc.

    Google Scholar 

  • 0 1988 Coping with Loss: The Therapeutic Use of Leave-Taking Rituals. New York: Irvington Publishers, Inc.

    Google Scholar 

  • Wallace, A.F.C. 1970 Culture and Personality. New York: Random House.

    Google Scholar 

  • Werblowsky, R.J. 1977 Joseph Caro: Lawyer and Mystic. Philadelphia: Jewish Publication Society of America.

    Google Scholar 

  • Witztum, E., J.T. Buchbinder, and O. Van der Hart 1990 Summoning A Punishing Angel: Treatment of a Depressed Patient With Dissociative Features. Bulletin of the Menninger Clinic 54:524–537.

    Google Scholar 

  • Witztum, E., D. Greenberg, and J.T. Buchbinder 1990 “A Very Narrow Bridge”: Diagnosis and Management of Mental Illness among Bratslav Hasidim. Psychotherapy 27:124–131.

    Google Scholar 

  • Witztum, E., D. Greenberg, and H. Dasberg 1990 Mental Illness and Religious Change. British Journal of Medical Psychology 63:33–41.

    Google Scholar 

  • Witztum, E., O. Van der Hart, and B. Friedman 1988 The Use of Metaphors in Psychotherapy. Journal of Contemporary Psychotherapy 18:270–290.

    Google Scholar 

  • Zeig, J. 1980 Erickson's Use of Anecdotes.In A Teaching Seminar with Milton H. Erickson. J. Zeig, ed. New York: Bruner and Mazel.

    Google Scholar 

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Authors and Affiliations

  1. Department of Sociology & Social Anthropology, Hebrew University of Jerusalem and Jerusalem Mental Health Center-Ezrath Nashim, Jerusalem, Israel

    Yoram Bilu & Eliezer Witztum

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  1. Yoram Bilu
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  2. Eliezer Witztum
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Bilu, Y., Witztum, E. Working with Jewish ultra-orthodox patients: Guidelines for a culturally sensitive therapy. Cult Med Psych 17, 197–233 (1993). https://doi.org/10.1007/BF01379326

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