Mental Health, Psychotherapy and Judaism

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Books by Seymour Hoffman

While the most difficult part in psychotherapy is to work with clients who under the disguise of a deterministic view of life are reluctant to take responsibility for their own misery, the most rewarding part emerges from the therapist's feeling that he succeeded to change this "convert's" disbelief in one's ability to change. Stick around, there are many more VRT interviews to come!

Keep track by bookmarking the table of contents or follow along on facebook. I'm troubled by the notion that "mentally ill" people are responsible for their conditions. First, why is mentally ill in quotations? Secondly, is this an assertion that biology plays no role in any diagnosed mental health conditions? Am I to believe that I have chosen or choose to remain a hostage to anxiety, depression, and bipolar disorder?

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Most of us already feel we are to blame for things we are not eg. Back Find a Therapist. What Is the Best Way to Propose? What's the Solution for a Coddled American Mind? The Varieties of Religious Therapy: My previous attempts to respond do not seem to have gone through. Submitted by Cynthia on September 17, - 4: Post Comment Your name.

E-mail The content of this field is kept private and will not be shown publicly. Notify me when new comments are posted. Replies to my comment. Leave this field blank. Are you breaking a therapy rule if you do? Is "Evidence-Based" Off Base? An interview with Enrico Gnaulati. Has Gender Always Been Binary?

Buddhism The Varieties of Religious Therapy: Islam The Varieties of Religious Therapy: Every level of understanding including the plain meaning is open to differing interpretations. Scriptural study normatively involves a small piece of text in centre of the page, surrounded by hundreds or even thousands of words of commentary, offering diverse interpretation. Nevertheless, scriptural interpretation is not a free-for-all, and only interpretations offered by competent orthodox religious authorities are accepted.

However when choosing a medical practitioner, one is obliged to seek the most professionally competent, regardless of his or religiosity. In practice, the more strictly orthodox and their rabbis have been negative about using mainstream psychotherapy and counseling services. The reasons will become apparent later in this chapter. Spitzer regards it as essential that orthodox and Hasidic patients with psychiatric and psychological disturbances are seen only by professionals from a similar cultural background.

Spitzer and others argue that the behavior and feelings of orthodox patients cannot be understood by others, and appropriate help and treatment can only be developed by those with a full immersion in the cultural and religious values and practices of the community.

One aspect of the animal soul is the intelligent soul Nefesh HaSichlis See e. The divine soul apprehends spiritual reality, and strives to cleave to G-dliness. The animal soul seeks material and self-centred pleasures, and the intelligent soul may be employed by either. The animal soul and the divine soul often have conflicting interests, and different Jewish mystical and ethical systems propose varying methods of dealing with this conflict of interests, notably whether to suppress the animal soul and its demands by abstinence and fasting, or whether to train the animal soul by teaching it to enjoy things done for the service of G-d.

The latter path has probably been more popular.

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Judaism does not regard the animal soul as the work of the devil, but as a source of challenges to be dealt with in the right way. Among western Jews, the study of Jewish mysticism was largely confined to Hasidic circles. Among oriental Jews, the study of mysticism is more widespread. More recently, Jewish mysticism has become a more generally popular topic for study in orthodoxy generally. Study includes the mystical systems of the Zohar, and of Lurianic kabbalah, and systems for contemplation and meditation.

The idea of a lifelong moral struggle, which humans are inherently equipped to win, but in which they have complete free choice, is the simple but pervasive theme underlying Jewish ethical teaching and Jewish accounts of personal development. It is closely tied to the Jewish view of human development. Development is a lifelong process, in the Jewish view. Even the totally righteous individual is engaged in a constant developmental struggle. Awareness of G-dliness is seen as an inherent human potential, but achieving this awareness is an ongoing process, and a necessary precondition to the spiritual-moral struggles that are the main purpose of existence.

Education, too, is a life-long process — training in religious awareness and spiritual work begin before birth, and all Jews are seen as having an obligation both to learn and grow, and to facilitate the learning and growth of others. The study of religious texts and adherence to the myriad details of Jewish law are the key vehicles of this process. Pregnant women and young children should avoid contact with non-kosher species of animal, for example should not be given toy bears to play with, as they may cause spiritual harm, by their predatory nature.

Very young children should be taught to say blessings before and after eating and drinking, to remind them that the food is not there solely to be enjoyed, but is from G-d, and the strength derived from eating is to be used for good activities. Teachers and parents should encourage children and adolescents to study and lead a religious life, but this should be in a way of pleasantness and firmness, without shouting, shaming or using physical force — these latter methods produce short-term compliance but have no beneficial long term effects.

One area of personal development very popular in orthodox circles is the study and practice of the laws relating to guarding the tongue Shmiras HaLoshon. Bad-mouthing, slander and even gossip and chat, may all cause tremendous harm, to the tellers, the listeners and to the object of discussion Pliskin, This should be done several times daily, and implies the acknowledgement that G-d is the source of all material goods. The age of transition to full adult moral and spiritual responsibility is clearly given as 12 for women and 13 for men. Psychological health and psychopathology.

Traditional Jewish sources are said to describe a range of psychopathology that corresponds to what we are familiar with today Loewenthal, Accounts of well-being and psychopathology can also be found in traditional sources, and there are many references in the book of Psalms and elsewhere to the importance of religious faith and trust: The other important therapeutic tool frequently advocated in traditional Jewish sources is the importance of offering assistance, comfort and all forms of practical support to those in need — the regular charity to the chronically poor, consoling the bereaved, visiting and assisting the sick, lending money to those who have suffered financial set-backs to enable self-support.

These are religious obligations — commandments mitzvot , and it is known that these forms of social support have powerful protective effects in preventing the onset of psychopathology among those who have suffered severe stress. The idea that psychological disorder is solely spiritual in origin e. However all would agree that succumbing to the evil inclination is spiritually unhealthy and psychologically damaging — but there are other causal factors in mental illness as well. Theory of human change. Although there are frequent references to the importance if religious trust for well-being, this is not usually seen as a panacea, particularly not for serious psychopathology, either in religious traditions, or among contemporary religious leaders or among the lay orthodox-Jewish public.

Jewish tradition has always endorsed the obligation to seek medical treatment, and the doctor is empowered by G-d to heal. Medical treatment for psychosis — particularly medication — is seen as appropriate. There are no problems in Jewish law in seeking and obtaining this. There appear to be no problems in religious law with taking medication.

Own-group counselors and psychotherapists, with religiously-approved training and known to be G-d fearing individuals, may be consulted. Some religious leaders may suggest that religious faith, prayer, and other activities may be sufficient:. We give the person with difficulties a boost, talking about belief, and trust in G-d, saying we must not despair…everything is from Heaven.

Thus while faith, prayer and other religious activities are widely seen as helpful, particularly in promoting positive well-being, a small minority endorse religious beliefs and activities as the sole panacea for psychological disorders. Common moral issues encountered There are several areas in which the values of Orthodox Judaism may conflict — or appear to conflict — with the needs of psychotherapeutic work. These conflicts and apparent conflicts are primary reasons for the reluctance of many orthodox rabbis to endorse unconditionally the use of counseling and psychotherapy.

Orthodox counselors and therapists will have received training and guidance in dealing with these issues, and will liaise closely with the rabbinate in their day-to-day work, so their work is usually endorsed by the rabbinate. First, Jewish law does not condone homosexuality, masturbation, extra-marital or pre-marital sexual relations. Thus any indication that these practices can be condoned or supported is not appropriate for orthodox Jews, even though of course all these practices can and do happen.

Therapists who do not share orthodox Jewish values and beliefs may think or suggest that an orthodox Jewish client is being made guilty or anxious as a result of religious prohibitions about sexual behavior. On a more minor level, touching and other contact with people of the opposite sex is not approved, and therapists would need to be aware not to offer to shake hands or touch strictly orthodox clients of the opposite sex.

Necessary contact for medical, life-saving purposes is permitted. Second, more strictly orthodox clients may be troubled by the issues thrown up by the laws regarding respect for parents and teachers, and prohibiting speaking badly of another person. This can lead to difficulties for clients particularly in talking about abuse. There is complete rabbinic support for the disclosure of abuse, and taking appropriate steps to prevent its repetition, as well as dealing with the traumatized individual.

But clients need to be aware that there is such rabbinic support, and of course, as one orthodox therapist has said: It is important for the therapist to be familiar with the issues in religious law, and to have appropriate rabbinic contacts, and for the therapist to be able to make suggestions about seeking appropriate rabbinic advice if clients seem likely to have reservations about making disclosures. It is also important for the therapists to liaise with rabbinic authorities with regard to child protection issues.

Rabbinic authorities have developed policies and practices in this area, consistent with the law, and have close liaison with the statutory authorities. It is important to know what these are and to act accordingly, since therapists and clients who report child protection issues to the police or social services without appropriate liaison with the rabbinic authorities may find themselves ostracized by lay people in the strictly orthodox community, who find it hard to accept that an often respected member of the community has behaved abusively.

The accused may be hotly defended as an innocent upright person, who is being maliciously slandered by a disturbed individual. If lay members of the community can be made aware that there is rabbinic support for the steps being taken, this will defuse any counter-productive attempts to protect the abuser and delay protective measures. Thirdly, somewhat similar issues can beset attempts to deal with violent or abusive marriage relationships.

Marriage is regarded as a holy and desirable state, and every attempt to preserve a marriage is regarded as praiseworthy and religiously meritorious. Nevertheless, there is no rabbinic support for domestic violence or other forms of abuse. Again it is important for therapists to be aware of the complex issues in religious law, and to have appropriate rabbinic contacts. Among the many other issues that may be important is the issue of child-bearing. Jewish law is clearly negative about the use of contraception, unless life is endangered, in which some but not all forms of contraception are permitted.

Moreover among the strictly orthodox, children are regarded as a blessing. Family sizes may be very large, and women and men may find themselves with inadequate resources to cope with parenting the very large numbers of children they have been blessed with. Here, it is important for the therapist not only to liaise with rabbinic authorities acceptable to the client, but also to have a good knowledge of the many support organizations within the community, specializing in this central dimension of orthodox Jewish life.

These are the salient moral dilemmas involved in psychotherapy and counseling with orthodox Jewish clients. There are clear conflicts with values that are normative in wider society, and there are complex issues in Jewish law that might best be dealt with by a therapist who is familiar with the strictly orthodox community, its personnel and mores. However, many clients will prefer to seek help and support from professionals from outside the community clients. This is often the case when the client seeks anonymity, and does not want to risk disclosing unpleasant and shameful secrets to someone who is part of the same community.

It can be helpful for therapists and counselors to be aware of the issues and conflicts that may be troubling their clients, and to reflect on and assess their own views on these moral dilemmas, and how these views might affect their therapeutic practice. Prevalence studies have suggested that patterns of psychiatric disorder differ in the Jewish community compared to other groups.

Bipolar disorder is said to be more prevalent, as are mood disorders in general.

Judaism and Mental IIlness

This latter effect is now established to be the result of a higher prevalence of major depressive disorder in Jewish men, possibly connected to the lower prevalence of alcohol abuse among Jewish men Levav, Kohn, et al , ; Loewenthal, Goldblatt, et al ; Loewenthal, MacLeod, et al There are assertions that obsessive-compulsive disorder OCD is more common among orthodox Jews than in other groups, but there is no reliable prevalence work, and Lewis has concluded that while obsessionality as a personality trait is more likely among the religious, probably as a result of the religious valuing scrupulosity, OCD as a psychiatric disorder is not more likely in any of the religious groups studied, compared to the general population.

But prevalence is not necessarily reflected in the referral situation. The clinical problems and dilemmas in the consulting room are not a clear reflection of the distinctive patterns of prevalence of disorder in the Jewish community. Important clinical dilemmas with respect to diagnosis and treatment have been reported in dealing with orthodox Jewish clients. First, there are difficult issues in diagnosis that arise with religious behavior and ideas. Clients may fear misjudgment, and these fears may be well-founded. They may be reluctant to seek professional help for psychological distress, for fear of being misunderstood.

For example an orthodox Jewish man who declined to shake hands with a psychiatrist on religious grounds was diagnosed as withdrawn and catatonic.

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Spitzer asserts that orthodox Jewish professionals are better qualified to detect whether a particular religious practice is pathological or normative. Again, rabbinic advice may be necessary, especially if it is appropriate to tell the client that a particular piece of behavior is not religiously advisable — for example spending several hours repeating a particular phrase from the prayers to make sure it has been correctly said.

The other major group of clinical issues focuses on treatment.

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  4. Which treatments are acceptable? Which treatments are seen as likely to be helpful? We have seen that psychotherapy may not be acceptable — therapists may be seen as unsympathetic, lacking in knowledge of the values and mores of the orthodox Jewish community, and likely to misjudge religious behavior and ideas.

    Own-group therapists may not be trusted — the concerns here have to do with confidentiality and professionalism. Prayer, religious trust and direct consultation with rabbis and other religious leaders are inexpensive, confidential and relatively accessible. Religious support may therefore be sought as a first resort, and there is considerable evidence that at least some significant forms of psychopathology may be helped by prayer, religious faith and other religious means e. A common issue today is the extent to which therapists may recommend or even employ religious techniques.

    Symptoms may be seen as idioms of distress. Ezra was a year-old married man who had been a Jewish penitent for two years. During the previous six months, while Ezra had been immersed in studying the Zohar the key Jewish mystical text , he had heard voices and had dreams in which his late father appeared as a threatening black apparition.

    Ezra engaged in ascetic practices: He lit ritual candles on these graves, and at home. admin