Sanity and Sanctity: Mental Health Work Among the Ultra-Orthodox in Jerusalem

by David Greenberg, Eliezer Witztum

Ultra-orthodox Jews in Jerusalem are isolated from the secular community that surrounds them not only physically but by their dress, behaviors, and beliefs. Their relationship with secular society is characterized by social, religious, and political tensions. The differences between the ultra-orthodox and secular often pose special difficulties for psychiatrists who attempt to deal with their needs.

In this book, two Western-trained psychiatrists discuss their mental health work with this community over the past two decades. With humor and affection they elaborate on some of the factors that make it difficult to treat or even to diagnose the ultra-orthodox, present fascinating case studies, and relate their observations of this religious community to the management of mental health services for other fundamentalist, anti-secular groups.

400 pages, Hardcover

First published April 1, 2001

Reviews

[Dan · Rating 4 out of 5]

I'd never seen a book about mental health care for the deeply religious, so I picked this up hoping to confirm my pet theories that (a) strict observance of religious rituals (Jewish or otherwise) is OCD by another name -- an idea I was pleased to learn goes back at least to Freud, quack though he was -- and (b) mystical experiences are a subspecies of schizophrenia, a view I think is pretty well accepted by now in neurology and the study of religion.

And, in fact, the authors -- one religious, the other not, and both experienced in working with people from Jerusalem's ultra-orthodox Mea Sharim neighborhood -- acknowledge that there's no bright line between "this person exemplifies his community's beliefs" and "he's crazy" (my paraphrase). But they do distinguish between those made miserable by their irrational beliefs, and who might benefit from treatment, and those who are high-functioning, happy members of their community. Fair enough.

They also warn practitioners that challenging a devout patient's worldview ("You are not being tormented by demons, because they don't exist") will get you nowhere, and that successful therapy enlists both the patient's belief system and, where possible, spiritual leader. The most striking example involves a sort of religious court, convened in the psychiatrists' office, to formally banish the apparitions haunting a troubled Hasid (though the doctors note that prescribing antidepressants and antipsychotics is also part of the job).

Statistics, at least as of c. 2000, didn't show a vast difference in the prevalence of OCD and hallucinations between the devout and everyone else. "Preliminary data suggest that ultra-orthodox Jews are underrepresented in the clinical sample, although this could be a reault of their avoidance of public, nonreligious clinics," the book says, which seems to be putting it mildly, considering that members of the community typically consider resorting to psychiatry at best irrelevant and at worst deeply sinful.

There's a lot more, including the sad lives of boys with no aptitude for the very specific kind of scholarship that Hasids value above all else; mental illness among converts vs. those born into the system; and the ethical dilemmas that can arise when shrinks write letters to excuse ultra-Orthodox men from military service (the issue can arise despite the draft exemption for full-time religious students, a provision of the law that the nonreligious author resents even though he works within the system). But the thing that's going to stay with me the longest is a chapter subhead:

"What If a Patient Reveals That He Is About to Blow Up the Temple Mount?"

Spoiler: He didn't, but he probably could have.