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Journal of Religion and Health

, Volume 57, Issue 5, pp 1702–1716 | Cite as

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

  • Aaron M. Bloch
  • Ezra Gabbay
  • Samantha F. Knowlton
  • Joseph J. Fins
Philosophical Exploration
  • 92 Downloads

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.

Keywords

Cultural competence Orthodox Judaism Mental health Introspection 

Notes

Acknowledgements

We acknowledge Dr. Kevin Paine for his assistance with the psychiatric literature search and thank Dr. Anthony M.C. Brown for his support of our research.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest

Human and Animal Rights Statement

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. Aaronson, E. (1996). Going against the grain: Supporting the student-centered teacher. Thousand Oaks: Corwin Press.Google Scholar
  2. Aponte, H. J. (1985). The negotiation of values in therapy. Family Process, 24(3), 323–338.CrossRefPubMedGoogle Scholar
  3. Assaf, D. (2010). Hasidism: Historical overview. YIVO Encyclopedia of Jews in Eastern Europe. Retrieved August 16, 2017, from http://www.yivoencyclopedia.org/article.aspx/Hasidism/Historical_Overview.
  4. Barukhovitch, S. Z. (1997). Lessons in Tanya (L. Wineberg & S. B. Wineberg, Trans.). Brooklyn, NY: Kehot Publication Society.Google Scholar
  5. Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.Google Scholar
  6. Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O., II. (2003). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118(4), 293–302.  https://doi.org/10.1093/phr/118.4.293.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Bilu, Y., & Witztum, E. (1993). Working with Jewish ultra-orthodox patients: Guidelines for a culturally sensitive therapy. Culture, Medicine and Psychiatry, 17(2), 197–233.CrossRefPubMedGoogle Scholar
  8. Bilu, Y., & Witztum, E. (1994). Culturally sensitive therapy with ultra-orthodox patients: The strategic employment of religious idioms of distress. Israel Journal of Psychiatry and Related Sciences, 31(3), 170–182. (discussion 189–199).PubMedGoogle Scholar
  9. Ettinger, Y. (2012). Rabbi’s little helper. Haaretz. Retrieved August 16, 2017, from http://www.haaretz.com/israel-news/rabbi-s-little-helper-1.422985.
  10. Feinberg, S. (1985). An assessment of the mental health needs of the orthodox Jewish population of metropolitan New York. Journal of Jewish Communal Service, 62, 29–39.Google Scholar
  11. Feinstein, M. (1959). Iggrot moshe (Yoreh De’ah 2:57). New York, NY: Moriyah.Google Scholar
  12. Freund, A., & Band-Winterstein, T. (2017). Cultural psychiatry: A spotlight on the experience of clinical social workers’ encounter with Jewish ultra-orthodox mental health clients. Community Mental Health Journal, 53(5), 613–625.  https://doi.org/10.1007/s10597-016-0056-9.CrossRefPubMedGoogle Scholar
  13. Gabbay, E., McCarthy, M. W., & Fins, J. J. (2017). The care of the ultra-orthodox Jewish patient. Journal of Religion and Health, 56(2), 545–560.  https://doi.org/10.1007/s10943-017-0356-6.CrossRefPubMedGoogle Scholar
  14. Gallant, B. (1986). The alleged sabbateanism of rabbi moshe hayyim luzzatto. Tradition: A Journal of Orthodox Jewish Thought, 22(3), 44–53.Google Scholar
  15. Giglio, J. (1993). The impact of patients’ and therapists’ religious values on psychotherapy. Hospital & Community Psychiatry, 44(8), 768–771.Google Scholar
  16. Holm-Hadulla, R. M. (2013). Goethe’s anxieties, depressive episodes and (self-)therapeutic strategies: A contribution to method integration in psychotherapy. Psychopathology, 46(4), 266–274.  https://doi.org/10.1159/000345169.CrossRefPubMedGoogle Scholar
  17. Ibn Paquda, B. (1996). Duties of the Heart (D. Haberman, Trans.). Nanuet, NY: Feldheim Publishers.Google Scholar
  18. Jung, C. G. (1981). The Archetypes and The Collective Unconscious, Collected Works, 9 (1) (2nd ed.). Princeton, NJ: Bollingen.Google Scholar
  19. Luzzatto, M. C. (2013). Mesillas YesharimWay of the Upright (U. Hinberg, A. Y. Morgenstern, & M. Sonnenschein, Trans.). Brooklyn, NY: Mesorah Publications.Google Scholar
  20. McGowan, S. K., & Behar, E. (2013). A preliminary investigation of stimulus control training for worry: Effects on anxiety and insomnia. Behavior Modification, 37(1), 90–112.  https://doi.org/10.1177/0145445512455661.CrossRefPubMedGoogle Scholar
  21. Mirsky, Y. (2010). Musar movement. YIVO Encyclopedia of Jews in Eastern Europe. Retrieved August 16, 2017, from http://www.yivoencyclopedia.org/article.aspx/Musar_Movement.
  22. Nadler, A. (2011). Litvak. YIVO Encyclopedia of Jews in Eastern Europe. Retrieved December 18, 2016, from Ultra Orthodox Mental Health_2018-3a.docx.Google Scholar
  23. Popovsky, R. M. (2010). Special issues in the care of ultra-orthodox Jewish psychiatric in-patients. Transcultural Psychiatry, 47(4), 647–672.  https://doi.org/10.1177/1363461510383747.CrossRefPubMedGoogle Scholar
  24. Purdy, S., Jones, K. P., Sherratt, M., & Fallon, P. V. (2000). Demographic characteristics and primary health care utilization patterns of strictly orthodox Jewish and non-Jewish patients. Family Practice, 17(3), 233–235.CrossRefPubMedGoogle Scholar
  25. Sartorius, N., Schulze, H., & Global Programme of the World Psychiatric Association. (2005). Reducing the stigma of mental illness: A report from a Global Programme of the World Psychiatric Association. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  26. Soloveitchik, J. B. (1983). Halakhic man (L. Kaplan, Trans.). Philadelphia, PA: The Jewish Publication Society of America.Google Scholar
  27. Sternbuch, M. (1989). Teshuvot vehanhagot (Vol. 1:465). Jerusalem Netivot HaTorah vehaHesed.Google Scholar
  28. Taub, S. (2010). God of our understanding: Jewish spirituality and recovery from addiction. Jersey City, NJ: KTAV Publishing House Inc.Google Scholar
  29. Twerski, A. J. (2009). A formula for proper living: Practical lessons from life and Torah (Hardcover ed.). Woodstock, VT: Jewish Lights Publishing.Google Scholar
  30. Ukeles, J. B., Cohen, S. M., & Miller, R. (2011). Jewish community study of New York: 2011 special report on poverty. UJA Federation of New York (June 2013, revised edition). Retrieved from https://www.ujafedny.org/assets/785329.
  31. Wolbe, S. (1967). Alei Shur Jerusalem, Israel Bais Hamussar.Google Scholar
  32. Wolbe, S. (1982). Psychiatria ve Dat. BeShvilei HaRefuah, Harefuah LeOr HaHalachah veHashkafat HaYayhadut, 8, 57–90.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Aaron M. Bloch
    • 1
  • Ezra Gabbay
    • 2
  • Samantha F. Knowlton
    • 3
  • Joseph J. Fins
    • 3
    • 4
  1. 1.Weill Cornell Medical CollegeNew YorkUSA
  2. 2.Hospital Medicine Section, Division of General Internal Medicine, Department of MedicineWeill Cornell MedicineNew YorkUSA
  3. 3.Division of Medical Ethics, Department of MedicineWeill Cornell MedicineNew YorkUSA
  4. 4.Solomon Center for Health Law & Policy, Yale Law SchoolNew HavenUSA

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