World Report
Mental health and religion in Israel’s ultra-Orthodox Jews
Psychological after-effects of the recent evacuation of the Gaza strip are starting to show in both
soldiers and settlers. But, says Sharmila Devi, mental-health professionals often have difficulty
treating ultra-Orthodox Jews because few fully understand the religion’s strict rules for daily life.
The beliefs and psychology of Jewish
settlers, many of whom are fiercely
nationalistic and religious, came under
the media spotlight recently after some
8000 of them were evacuated by Israeli
forces from the Gaza Strip and northern
West Bank in August.
But within weeks, much of Israeli so-
ciety appeared to have considered the
withdrawal over and embraced the start
of the Jewish high holy days. However,
the psychological effects of evacuation
on the settlers were appearing. More
than 50 people had been to the Soroka
medical centre in the southern Israeli
town of Beersheva within 2 weeks of
the evacuation, according to the Israeli
daily Ma’ariv.
Health professionals report that some
Israeli soldiers, several of whom were
called “Nazis” by screaming settlers as
they were removed from their homes,
have suffered psychological trauma
along with the settlers themselves.
Dealing with the effects of the with-
drawal is likely to feature at next
January’s sixth conference organised by
Nefesh-Israel, the local branch of the
international voluntary network of
Orthodox mental-health professionals.
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Orthodox Jews praying in protest against Israel’s withdrawal from Gaza
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Nefesh-Israel was founded in 2001 by
Judith Guedalia, director of the neu-
ropsychology unit at Jerusalem’s Shaare
Zedek Medical Centre, and Leah
Abramowitz, a senior social worker.
Nefesh was originally set up in New
York around 10 years for mental-health
professionals who treat observant Jews
to swap experiences and knowledge at
conferences and training courses.
Guedalia, who trained in the USA,
was moved to set up Nefesh-Israel after
hearing about some of the problems
faced by ultra-Orthodox Jews. She
heard of one case in which a man
whose request for a male psychiatrist
was turned down three times. “Can you
imagine a woman being turned away if
she asked for a female gynaecologist? I
felt that the ultra-Orthodox as a group
were under respected and their values
were viewed as odd by many mental-
health professionals”, she says.
Observant Jews follow their faith in
many different ways. Within Israel,
there is a majority who consider them-
selves Jewish but secular. There are
those who call themselves modern
Orthodox, such as Guedalia, who feel
their beliefs are not incompatible with
modern life. Meanwhile, the ultra-
Orthodox, known as haredim in
Hebrew, strictly follow Jewish laws and
believe much of modern life poses a
threat to their spirituality.
Within the ultra-Orthodox commu-
nity there are further divisions, with
groups following different rabbis and
traditions varying according to their
European Ashkanazi or eastern
Sephardi origins. There is also a gamut
of different political views, ranging from
nationalistic to even anti-Zionist.
In Israel, as elsewhere, many psychia-
trists come from a secular or at least
non-religious background that can
stand at odds with those who are
strictly observant. Guedalia seeks to
bridge these gaps.
“If an ultra-Orthodox man comes to
me and does not look at me in the eye
but looks at the floor or wall, I can
understand it and I say he doesn’t
deserve any less in the way of treat-
ment”, she says.
Within ultra-Orthodox society, daily
life is governed by a series of Jewish laws
known as mitzvot. These laws cover
everything from the segregation of the
sexes, distinct clothing, living in a
defined geographic community, sexual
relations, and ritual purity. Men are
encouraged to study the Bible, Jewish
laws, and commentaries well into adult-
hood, while women are often respon-
sible for the family budget and for
rearing children. Modern conveniences
such as television, computers, and even
mobile telephones are viewed with sus-
picion.
There is a strong taboo surrounding
mental illness, mainly because of its
adverse effect on prospective couples
whose family histories are scrutinised
before an arranged marriage. But grad-
ually, more ultra-Orthodox are begin-
ning to seek the help of professionals
who are learning about their way of life.
Such all-encompassing religious
belief can prove a minefield for mental-
health professionals when dealing with
ultra-Orthodox individuals. Nefesh-
Israel also tries to help professionals
who hold their own religious convic-
tions to reconcile them with modern
therapies. Guedalia says there are paral-
lels with the treatment of Catholics,
Muslims, and other religious minorities
in the west.
The last Nefesh-Israel conference
included papers on topics including:
menstrual psychiatric disorders; the
cognitive-behavioural aspects of the
views of several classic Jewish commen-
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tators and the rabbinic attitude towards
the use of manipulation for therapeutic
purposes; coping with the aftermath of
a terrorist attack; divorce; and child
abuse. Meanwhile, segregated seating
is provided for the conference partici-
pants, who range from ultra-Orthodox
to secular.
Helen Sheinfeld, a non-Orthodox psy-
chiatrist, spoke of a haredi woman with
a severely disturbed husband who
wanted to have sex with her through-
out the month. Under Jewish law, a
woman is considered ritually impure
during and after menstruation and
before she has visited a mikve or ritual
bath as called for after each period as a
cleansing ceremony. The woman devel-
oped amenorrhea, or lack of menstrua-
tion, and consequently the couple were
not violating Jewish laws by having sex
throughout the month. Sheinfeld used
this case to highlight the need to iden-
tify psychological and environmental
triggers for physical disorders.
Michael Bunzel, a haredi psychiatrist,
spoke of genetic disorders in terms of
how they can affect marriage prospects
and when a rabbi should be consulted.
Some disorders, such as Tay-Sachs dis-
ease that affects the nervous system,
occur most frequently among descen-
dants of Ashkenazi Jews.
He also noted that some haredi
women hide a psychiatric problem
before marriage and take their medica-
tion in secret only to have to stop when
they get pregnant, causing their hus-
band to learn of their illness.
Meanwhile, another participant
accused the Israeli government of
freezing funding for psychological help
for settlers in the Gaza Strip ahead of
the withdrawal. Eliahu Ackerman, an
educational psychologist, said the left-
wing views of many psychologists and
other therapists had diminished the
number of volunteers willing to help
settlers suffering from trauma and
anxiety arising from the withdrawal.
But, post-withdrawal, Tzahi Ben-
Zion of the Soroka Medical Centre told
Ma’ariv that emotional preparation
and processing by mental-health pro-
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Thousands of Orthodox Jews visit the West Bank city of Hebron during the Jewish holiday of Sukkot
fessionals was “laudable”. He also
expected a flood of cases to emerge.
“The evacuees touched very sensitive
nerves when interacting with the sol-
diers. It is very hard for a soldier to have
someone shouting at him that he will
remember him in his dreams and that
he is a Nazi”, he says.
Among the settlers, he continues,
“People feel they have been uprooted
from everything that is familiar . . . What
intensified the effect with those people
is the fact that they believed with their
heart that [withdrawal] wouldn’t take
place and for political reasons they did
not prepare for the evacuation. Thus,
from the emotional perspective, disen-
gagement came to them as a sort of
surprise that led to a crisis of faith and
identity.”
It remains to be seen whether Ariel
Sharon, Israeli prime minister, will order
any further withdrawals from the occu-
pied territories as part of his plan of dis-
engagement from the Palestinians. But
aside from political upheavals, expected
or unexpected, Jewish mental-health
practitioners continue to search for
ways to apply their faith in developing
modern treatments.
Guedalia is a regular contributor to
A Journal of Jewish Medical Ethics and
Halacha and co-wrote an article for the
August issue on using Biblical metaphor
in diagnosis and therapy. She used the
Bible’s account of a Ben Sorer u-Moreh,
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or recalcitrant and rebellious son, to
illustrate ways of helping children in
abusive family environments.
“We see this case as an example of
how ethnographic understanding of
patients will benefit the therapist in
his/her work, specifically in the
Orthodox Jewish community (and cer-
tainly in the larger therapeutic commu-
nity as well)”, says the article. “Fluency
with the cultural milieu of one’s
patients allows the therapist to hear
and be heard with a sort of ‘third ear’,
namely a sensitivity to the subtext that
is unique to each ethnic group.”
Questions such as how to distinguish
between a fervent believer and a
deluded psychotic who believes he is
the Messiah, or how to identify obses-
sive-compulsive disorder from religious
rituals are examined in the book Sanity
and Sanctity: A Better Understanding by
the Israeli psychiatrists David Greenberg
and Eliezer Witztum.
“If our reader is a therapist, he may
tend to be unaware of his own self-defi-
nition as a member of the culture of
mental health professionals and how
this shapes his beliefs and behaviour”,
says the book. “There is hardly a country
in the world that does not contain a
variety of cultures and religions,
whether historically or as a result of
recent immigration.”
Sharmila Devi
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