Psychiatry, Cultural Competency, and the Care of Ultra-Orthodox Jews: Achieving Secular and Theocentric Convergence Through Introspection

Abstract

Several socio-cultural factors complicate mental health care in the ultra-Orthodox Jewish population. These include societal stigma, fear of the influence of secular ideas, the need for rabbinic approval of the method and provider, and the notion that excessive concern with the self is counter-productive to religious growth. Little is known about how the religious beliefs of this population might be employed in therapeutic contexts. One potential point of convergence is the Jewish philosophical tradition of introspection as a means toward personal, interpersonal, and spiritual growth. We reviewed Jewish religious-philosophical writings on introspection from antiquity (the Babylonian Talmud) to the Middle Ages (Duties of the Heart), the eighteenth century (Path of the Just), the early Hasidic movement (the Tanya), and modernity (Alei Shur, Halakhic Man). Analysis of these texts indicates that: (1) introspection can be a religiously acceptable reaction to existential distress; (2) introspection might promote alignment of religious beliefs with emotions, intellect and behavior; (3) some religious philosophers were concerned about the demotivating effects of excessive introspection and self-critique on religious devotion and emotional well-being; (4) certain religious forms of introspection are remarkably analogous to modern methods of psychiatry and psychology, particularly psychodynamic psychotherapy and cognitive-behavioral therapy. We conclude that homology between religious philosophy of emotion and secular methods of psychiatry and psychotherapy may inform the choice and method of mental health care, foster the therapist-patient relationship, and thereby enable therapeutic convergence.

A Case of Clutter and Chaos

“…However, being born into an Orthodox Jewish family, her hoarding traits placed a strain on her relationship with her mother. Reluctance toward seeking nonspiritual assistance and psychiatric care, societal stigma, the necessity for rabbinic agreement of the method and provider, tradition of passing religious material through generations, and the impression that excessive concern with the self is counterproductive to religious growth are significant psychosocial triggers that seem to have further impacted J. S. (Bloch et al, 2018).…”

“I Would Consult a Doctor, But What the Rabbi Says Goes”: Ultra-Orthodox Jews’ Relationships with Rabbis and Doctors in Israel

“…Many studies about ultra-Orthodox Jews and health care highlight the importance of culturally sensitive medical care. This community’s close and strict matchmaking system makes its’ members particularly sensitive to mental-health issues and special-needs children (e.g., Band-Winterstein et al, 2019 ; Birenbaum-Carmeli, 2008 ; Bloch et al, 2018 ; Feinson & Meir, 2012 ; Glasser et al, 2016 ; Golos et al, 2011 ; Greenberg et al, 2012 ; Shaked & Bilu, 2006 ) and routine genetic tests (Zalcberg-Block, 2014 ). Even though we collected the data in 2019, before the Covid-19 pandemic could even be imagined, our data could have predicted some of the ultra-Orthodox behaviors in 2020.…”

Go in Peace: Brain Death, Reasonable Accommodation and Jewish Mourning Rituals

“…Judaism approaches death and grief-as it does everything else-with rules and codes of behavior, creating a constructive dialog between emotion and action (Bloch et al 2018). By defining one's reaction to pain and loss in the language of ritual and observance, one can confront the reality of death and work through sorrow and anger in a tangible, concrete way (Gordon).…”