Yoram Bilu

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

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 patients 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.

PARADISE REGAINED: "MIRACULOUS HEALING" IN AN ISRAELI PSYCHIATRIC CLINIC

The articulation of the experience of distress in terms of prevailing cultural idioms is deemed a crucially important factor in the effectiveness of healing devices across the globe. This curative factor, however, is not easily attainable in multicultural settings where therapist and patient do not share the same world view or explanatory models. In the following case presentation we report a culturally sensitive employment of strategic therapy with an ultra-orthodox psychiatric patient in Jerusalem. Despite the enormous cultural gap between the parties, the therapists were sufficiently sensitive to the patients mythic world to enable him to recast his traumatic experiences in the mold of key idioms of his cultural background. These idioms were amplified by providing the patient with a myth-congruent metaphor and manipulated to afford a dramatic resolution of his emotional conflict. In what follows we discuss the setting of the therapy, the patients background and diagnosis and the course of treatment. Following a verbatim account of the last therapeutic session, in which the patients self-reconstitution had been completed, we discuss the cultural idioms synthesized in the text and the pertinence of hypnotic and metaphoric therapies to multicultural settings.

Seek and Ye Shall Find: Test Results Are What You Hypothesize They Are

The Hebrew University, IsraelABSTRACTExpert clinicians were given batteries of psychodiagnostic test results (Rorschach,TAT, Draw-A-Person, Bender-Gestalt, Wechsler) to analyze. For half, a batterycame along with a suggestion that the person su•ers from Borderline Personalitydisorder, and for half, that battery was accompanied by a suggestion that hesu•ers from Paranoid Personality disorder. In Study 1, the suggestion was madeindirectly, through a background story that preceded the test results. In Study 2,the suggestion was made directly, by the instructions given. The experts saw in thetests what they hypothesized to be there. In particular, the target diagnoses wererated higher when they were hypothesized than when they were not. #1998 JohnWiley & Sons, Ltd.

Between Sacred and Medical Realities: Culturally Sensitive Therapy with Jewish Ultra-Orthodox Patients

One disconcerting aspect of the role of culture in shaping human suffering is the gap between the explanatory models of therapists and patients in multicultural settings. This gap is particularly noted in working with Jewish ultra-orthodox psychiatric patients whose idioms of distress are often derived from a sacred reality not easily reconcilable with psychomedical reality. To meet the challenge to therapeutic efficacy that this incompatibility may pose, we propose a culturally sensitive therapy based on strategic principles that focus on the patients mythic world and religious idioms of distress as the kernel of therapeutic interventions. Using one case of post-traumatic stress disorder (PTSD) as illustration, we seek to show how the religious symbols through which the patients distress was articulated may be manipulated to effect cure. The case highlights the narrative quality of both illness construction and self-reconstruction.

Social phobia in ultra-orthodox Jewish males: culture-bound syndrome or virtue?

Social difficulties of the performing variety are reported by ultra-orthodox male referrals to a psychiatrist in Jerusalem and confirmed by key communal informants. Three cases of social phobia are presented, and the content concerns performing, either speaking on religious matters publicly, a role associated with status and authority, or leading prayers and ceremonies, a role of sanctity and duty. The absence of women sufferers may be understood as a consequence of the value placed on modesty in women and there being no expectation of women to participate in study and public prayer, while the absence of complaints of interactional social phobia may be a consequence of the general discouragement of social intercourse not related to religious study. Aymat zibur, literally meaning fear of the community, is a term used by ultra-orthodox Jews to describe these fears of performance, although in its original meaning the term expresses the respect that the leader of prayers is expected to have for his awesome role. The cases described, however, were motivated by personal shame, similar to social phobia of the performance variety found in other cultures, rather than fear and respect. The values of ultra-orthodox religious life are presented that invest a person who avoids interactional social behaviors with the status of zaddik (a righteous person) while one who avoids the performance behaviors of speaking publicly on religious matters or leading prayers suffers from an idiom of distress in this particular society. Religious law and societal mores appear to be critical factors in deciding whether symptoms of social phobia are perceived and experienced as idioms of distress.

Ethnic Background and Antecedents of Religious Conversion among Israeli Jewish Outpatients

This study explored the association of ethnocultural background (Ashkenazi vs Sephardi origin) with antecedents of religious conversion among Israeli Jewish penitents who applied for psychiatric help in an outpatient clinic. A basic assumption underlying the comparison was that Sephardic Jews in Israel are more inclined toward Jewish tradition and collectivistic than Ashkenazim. The interview data indicated that for both groups emotional factors were more dominant in the conversion process than cognitive ones; however, cognitive factors were more strongly present in the conversion process of the Ashkenazim whose prepenitence cultural orientation had been more secularized and individualistic. In both groups a high prevalence of problematic relations with the father (but not with the mother) during childhood was noticed. Over-all, conversion tended to be gradual rather than abrupt and devoid of mystical experiences.

Dybbuk and Maggid: Two Cultural Patterned of Altered Consciousness in Judaism

For many years scholars of Judaism were reluctant to employ the analytic tools distilled in anthropology for studying Jewish culture. One reason for this reluctance was that the classical ethnographic field, consisting of a small-scale tribal society with no written tradition, did not appear pertinent to the study of the text-informed “great tradition“ of Judaism. In addition, the notion of comparative research implicit in most anthropological studies appeared dubious to many scholars of Judaism, who were alarmed by the sweeping, methodologically unfounded comparisons evident in the treatment of biblical material by such precursors of modern anthropology as Robertson Smith and Frazer.1 This methodological consideration was augmented by an emotional unwillingness to equate the “primitive’ religious systems of “savage’ societies with concepts and rituals pertaining to the oldest monotheistic religion.

Heilman Samuel and Friedman Menachem, The Rebbe: The Life and Afterlife of Menachem Mendel Schneerson . Princeton, NJ: Princeton University Press, 2010. xix, 343 pp.

charitable bodies of traditional Jewish communities. In the beginning of the twentieth century, Sliozberg’s political sympathies lay with the Constitutional Democratic Party, which attracted a number of liberal Jewish intellectuals. Jacob Teitel is often mentioned as one who made a remarkable career in the juridical system of the empire, serving as “the sole Jewish judge in whole Russia” at the turn of the twentieth century. At the same time, Teitel was active in Jewish organizations, most notably in the bodies formed by the Gintsburg Circle. His informative autobiography, Iz moei zhizni (From my life), published in Paris in 1925, exists only in Russian and German (Aus meiner Lebensarbeit; 1929 and 1999). Now, thanks to Professor Horowitz, a glimpse into Teitel’s life is available also in English. “Empire Jews” occupied visible, often dominant, positions in all Jewish ideological currents, media, and trade unions, and, generally, were widely represented in political, cultural, and academic circles in Europe and America. As a result, for activists of various Jewish organizations it was not hard to find like-minded people (including old friends) in New York, London, Paris, Warsaw, or Moscow. Cultural and ideological affinity helped them to establish close links with the foreign Jewish intellectuals and community leaders. It is no coincidence that after his emigration to Germany, Jacob Teitel chaired the Union of Russian Jews in Germany, while Henrik Sliozberg headed the Russian Jewish community in Paris. While Horowitz’s book does an excellent job analyzing the literary and political legacy left by a number Russian Jewish intellectuals, it is mainly trees and little or no forest—he focuses on useful details while avoiding general characterization of the Russian-born Jewish graduates of secondary schools and universities who combined cosmopolitan education with profound Jewish interests. Conversely, such “case studies” will certainly help other scholars to continue the quest for understanding the Jewish cultural and political environment in imperial Russia. The volume could leave an impression of a book, rather than a collection of articles, if the copy editor had paid more attention to details, at least making consistent the spelling of names, and the designer had chosen a nicer layout.