Sanity and Sanctity: Mental Health Work Among the Ultra-Orthodox in Jerusalemby David Greenberg, Eliezer Witztum
In this enlightening book two Western-trained psychiatrists discuss the special challenges of their mental health work with ultra-orthodox Jews in Jerusalem. Based on two decades of serving this self-isolated religious minority, Drs. Greenberg and Witztum describe the difficulties of treating and even diagnosing members of the community and suggest principles for therapists working in any multicultural society.
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Sanity and SanctityMental Health Work Among the Ultra-Orthodox in Jerusalem
By David Greenberg Eliezer Witztum
Yale University PressCopyright © 2001 Yale University
All right reserved.
Chapter OneTo Begin, Just Say, "How Are You?"
The scene is the office of an Israeli psychiatrist. An ultra-orthodox Jewish man is sitting in the patient's chair.
"How are you?" asks the psychiatrist.
"May God's name be blessed," replies the patient.
"Er, how are you feeling?" continues the psychiatrist.
"Blessed is He and blessed is His name," comes the reply.
The psychiatrist may be forgiven for presuming that his question will lead to a description of the patient's condition. The patient may be forgiven for replying to this greeting in the customary way among ultra-orthodox Jews. He is not being evasive. He is fulfilling the injunction in the Talmud: "When one person asks another how he is, he should mention God's name, as it says (in Ruth 2:4): 'And Boaz came from Bethlehem and said to the reapers: "May God be with you," and they replied: "May God bless you"' (Talmud Brachot 54a)."
The misunderstanding appears minor. But let us consider what each participant in this conversation may be feeling. At best, the psychiatrist will be nonplussed, unsure of how to continue, for he does not understand what the patient's reply means. He will know the Hebrew words themselves: Baruch Hashem. Their literal meaning is, "The name is blessed." If he is not informed concerning the ways of ultra-orthodox Jews, the psychiatrist will probably be ill at ease, either unaware that "the name" is a metonymy for God's name or uncertain about what it means for a name to be blessed-and he certainly won't comprehend how this reply answers his question. He may even find the answer so surprising that he will wonder whether the patient is confused: Does he think he's answering my questions? Is he suffering from thought disorder?
Alternatively, even if he understands the meaning of the patient's reply, the psychiatrist might view the response as evasive. The patient, he might think, has difficulty expressing his feelings. If the psychiatrist is aware that this reply is the standard response of an ultra-orthodox person to such a question, he may reach the more general conclusion that all ultra-orthodox Jews are trained to avoid discussing their feelings.
A further reaction may be irritation. Why doesn't the patient answer my question? Wasn't it simple enough for him! Why must he hide behind his religious terminology? Consciously or unconsciously, the psychiatrist may become angry for reasons relating to himself and his own religious feelings: Why must the patient foist his religious beliefs on me? Why must I be tolerant of his religiosity if he is not tolerant of my nonreligious position?
The patient, too, will be feeling uncomfortable. To begin with, he does not usually speak in Hebrew. His daily life and study are conducted in Yiddish, and questions such as "How are you?" are normally exchanged in that language between coreligionists. "Vee geyts?" (How is it going?) is the usual greeting "Boruch Hashem" (May Gods name be blessed) is the standard reply. The words are Hebrew, but the pronunciation is not the modern form used in daily life in Israel; it is the Ashkenazi pronunciation current in Eastern Europe for centuries. The ultraorthodox patient is aware that he has stepped out of his usual environment. He is sitting with a secular person, speaking modern Hebrew, using terms that are not meaningful to the man opposite him.
And all the psychiatrist was trying to do was say, "How are you?"
Thus far, we have been considering only the difficulties that the words themselves have created. But every phrase we use reflects a way of thought and a mode of living as well, and these can make the divide of misunderstanding far greater than we originally imagined.
Studies in several countries have shown that psychiatrists and psychologists tend to be less religious-in fact, are more likely to be atheists-than the general population they treat (Neeleman and King, 1993; Henry, Sims, and Spray, 1971). Israel is no exception, as is shown by a study of 624 mental health workers and students (Rubinstein, 1994), which found that well over 75 percent defined themselves as secular, fewer than 10 percent as orthodox, and fewer than 1 percent as ultra-orthodox (these distinctions are discussed more thoroughly in Chapter 5).
Our hypothetical therapist is likely to be a secular Jew who has received a secular education, with minimal Bible study. As a mental health worker, he may view psychological disturbances as precipitated by genetic, biological, social, or intrapsychic influences, depending on his professional orientation. He sees himself as an expert, and he expects patients to be open about their feelings so that he can help them understand and overcome their emotional difficulties.
The religious patient, on the other hand, may view his position differently. That he is suffering is in itself a sign from God. As an observant, God-fearing Jew, he has been brought up to be wary of committing sins. When he attended yeshiva, he spent every day reading cautionary texts that encouraged him to carefully review his actions in order to improve them. But now God has apparently selected him for suffering. This would seem to mean either that he has sinned and not repented or that God is testing him. As a result, he has spent hours scrutinizing his behavior, probably discovering many ways he might have sinned-having occasional sexual thoughts, not always concentrating in prayer, not eliminating "the evil tongue" from his conversation. He knows what is written about these weakness, these sicknesses of the soul, and he has spoken to his rabbi about them. Every text he ever read on how to improve his middos (moral qualities) made it clear that the rabbi is the person he should turn to for advice. But his rabbi advised him to study with greater concentration, and he finds it almost impossible to do so at the moment. God is testing him; his rabbi has pointed him in the right direction; yet he cant escape his black mood.
The patient is afraid. It is clear that he is being punished. He must be of weak faith, like the brother of our forefather Abraham in the Torah, who died in a furnace. He looks up at the neatly dressed psychiatrist, with his colored shirt and brown pants, no yarmulke, no beard, no sidecurls. How can he begin to tell his thoughts to a man who does not even appreciate that by saying "Boruch Hashem" he is fulfilling a mitzvah? Why, the psychiatrist probably doesnt even know what a mitzvah is.
Excerpted from Sanity and Sanctity by David Greenberg Eliezer Witztum Copyright © 2001 by Yale University. Excerpted by permission.
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This take on mental health work among the ultra-orthodox, written by non-observant Jewish psychologists, is eye-opening. It is sensitive and objective. Coming from a clinical perspective, the authors are unafraid to undertake challenging philosophical inquiries.