Monday, October 30, 2006

Piousness May Mask an Emotional Disorder

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"Our society has been based on tradition for many years," says Rabbi Abraham J. Twerski, "We have not changed. But as therapists, we must understand that the rules have changed in the world, and we now need to find new rules."

The renowned professor and physician studies the crowd at length as one who is very much aware of how much a discussion of the need for change grates on ultra-Orthodox ears.

Professor Twerski, M.D., was one of the most prominent guest speakers at the international Nefesh conference held last week in Jerusalem. Nefesh, which holds an annual international conference, is by its own definition "an organization of Orthodox mental health professionals," whose members include both modern Orthodox and ultra-Orthodox professionals.

The chair of Nefesh in Israel, Dr. Judi Guedalia, who the heads neuropsychology department in Shaarei Zedek Medical Center, Jerusalem, says the organization is a professional forum for therapists, many of whom have no connection with academe and lack academic training. The lectures - on topics ranging from Jewish medical ethics, given by Professor Avraham Steinberg, M.D., an international expert on the subject, to sexual abuse of children - were heavily attended, especially by a largely ultra-Orthodox audience.

The conference had a number of speakers from abroad: the United States, England, Australia and Brazil, all countries with active branches of Nefesh. There were lively discussions between men and women, but with the called-for distance.

A young, smiling woman wearing a hat gave an enthusiastic explanation about courses in marriage counseling in the institute that she represents to a young man who did not dare look at her.

At a table selling books outside the lecture halls, a more liberated professional debate was held, and one could find guidance books and posters alongside professional books and journals on drug addiction and obsessive-compulsive disorders. Today, no one disagrees with the fact that people with obsessive-compulsive disorders can easily hide among the ultra-Orthodox community, which might mistakenly interpret the individual's over-meticulous attention to the observance of the commandments as piousness.

Professor Twerski's lecture on "Dilemmas Facing Mitzvah-Observant Families in the Modern Era," reflects the revolution that has occurred in recent years in ultra-Orthodox society, which today recognizes the fact that alongside conducting a religious lifestyle and the observance of the commandments, religious people also need mental health, satisfaction and meaning in their lives. At the conference, these subjects and others, which are part of the ultra-Orthodox agenda, were discussed at length.

School dropouts and other subjects once considered taboo were also discussed, such as sexual abuse of children and drug addiction. Even seemingly marginal phenomena such as hooliganism in school came up for discussion, and the very discussion of the subject undermines the claim that there is no violence in ultra-Orthodox schools. There was even a session devoted to the question of whether the newly religious have a specific emotional make-up. Subjects still pretty much taboo, such as homosexuality or sexual abuse of males, came up between the lines.

Professor Twerski is the founder and medical director of the Gateway Rehabilitation Center in Philadelphia, which treats the general population. He is also a professor of psychiatry at the University of Pittsburgh School of Medicine and rabbi of an ultra-Orthodox congregation. Rabbi Twerski was one of the first to bridge an ultra-Orthodox lifestyle and issues related to mental health treatment. In recent years, he has advanced the awareness of the American ultra-Orthodox community regarding emotional disorders, and is involved in educational activities on the subject of treatment options.

Because the ultra-Orthodox community in Israel is more closed than its counterpart in the U.S., but at the same time views its American counterpart as a model in this matter, Twerski is considered an authority on the subject, even by leaders of the ultra-Orthodox community in Israel. The line of people seeking to speak with Twerski after his lecture last Thursday, including people with a Hasidic appearance, clearly showed he is regarded as a leader and mentor. And Twerski is viewed as a revolutionary.

Among his many books, he published a few years ago, "The Shame Borne in Silence," about violence against women, and roused the fury of the ultra-Orthodox communities in the United States. The thin volume is sold under the counter in ultra-Orthodox bookshops in Jerusalem. Soon, says Twerski, it will be translated into Hebrew.

The psychological jargon, so common in everyday speech, is not familiar to the ultra-Orthodox population, and this may be the principal innovation of the conference. Dr. Twerski spoke about emotional problems in the Orthodox and ultra-Orthodox community, for example, of the frustrated mother that strikes her children. He says in his lecture that in her childhood "it was forbidden to talk about anger." He told of a yeshiva student who was disturbed by "foreign thoughts," as they are called in the ultra-Orthodox jargon, thoughts on mundane matters that disrupt one's concentration during prayer or study but who in fact suffered from a compulsive personality disorder. Twerski wants to train rabbis and spiritual guides in yeshivot to be able to spot this type of disorder.

Neuroses spread
Twerski explains that as in general society, in ultra-Orthodox society too the proportion of neuroses and psychiatric problems has risen. When he speaks in general about the emotional problems among the ultra-Orthodox, he counts Holocaust trauma and its effects on the second and third generation as one of the causes. But he also talks a great deal about the fact that the world is changing and that the small and close-knit ultra-Orthodox society that once existed is no more.

While ultra-Orthodox society has grown and become stronger, feelings of alienation and anonymity within it have swelled. Here, he moves over to the language of the preacher and maintains that the younger generation of today is weaker, lacking in satisfaction and does not know how to contend with frustration because its basic needs are satisfied and it does not know what real poverty is. All this has implications for personal and societal completeness. One of the expressions of this phenomenon is the rising rate of divorce, "unlike anything ever seen before," he says.

The conference was notably chaired by two women, Dr. Guedalia and Leah Abramowitz, a social worker and the founder of the Melabev center for the treatment of the elderly in Shaarei Zedek Medical Center, and mother of 13. Both women describe themselves as Orthodox, not ultra-Orthodox. The fact that even representatives of the most closed ultra-Orthodox communities, such as Belz and Gur, are willing to participate in a conference headed by women is a clear indication of a hunger for knowledge, and perhaps also feelings of distress. Notable, too, was the ignoring of a rule that usually is strictly enforced: Although men and women sat separately during the lectures, there was no mehitza (physical partition) separating them as is the practice in the United States.

"There are hardly any subjects that are taboo today in ultra-Orthodox society," says Dr. Guedalia. For example, the conference included a workshop run by the Crisis Center for Religious Women on the prevention of sexual abuse, geared for religious and ultra-Orthodox schools. The hall was filled with women from all movements. On the side sat about 10 men.
Debbie Gross, founder and director of the crisis center, spoke about the sensitivity that must be exercised when talking about sexual abuse in a society in which sexual organs are generally not called by name. She related that in the library of an ultra-Orthodox school for girls, she once saw a nature book from which the pages that described the reproductive organs of birds were ripped out. "How can a girl report on abuse when she doesn't have the words?" she asks.
The solution found in those schools that allow her staff to enter is that the girls are taught to distinguish between a good secret and a bad secret. Initially, four actresses put on a small skit in which two girls are shown riding the bus. When one gets off, a young man that had eavesdropped on their conversation sits down next to the other girls. He introduces himself as a friend of the family and uses the information he gleaned from the conversation to gain the girl's trust. He touches her bag - not her body, heaven forbid - and finally, asks her not to tell anyone about their meeting. The girls shrinks in her seat and the situation clearly embarrasses her. At the end of the play, the students are asked to respond, to analyze what happened to the girls, and to relate a similar experience from their own lives.

At the end of the workshop, the girls are given a pink card with the number of the crisis center. In one of the schools, the workshop was given in the second grade. Two hours after school, recalled Gross, a volunteer got a call from a little girl who said, "I'm in the second grade. My friend told me a bad secret, and I don't know what to do."

While the representatives of a new hotline aimed at ultra-Orthodox boys and men who have been victims of rape and sexual abuse were not permitted to present their hotline at the conference, Gross devoted part of her lecture to abuse of boys. Indirect reference to a no less sensitive subject was made in a lecture on marital intimacy, when lecturer Dr. Gail Bessler-Twerski touched on "the problem of homosexuality in yeshivot," as she put it. Her tone was not judgmental, and she did not mention the biblical prohibition, only speaking briefly of how distressed and miserable the boys are.

"There are still many taboos in ultra-Orthodox society," agrees Professor Twerski. A few years ago, he recalls, when he arrived to give a lecture on violence against women in Monsey, New York, he needed a bodyguard. "Times have changed," he says, "but nevertheless, going to a psychologist or psychiatrist is still not accepted, and education is needed in that direction."
The objection to psychology in the ultra-Orthodox community, he says, is caused mainly by the perception that it involves values and views that conflict with the religious approach. In the past, the objection to psychology among the ultra-Orthodox stemmed from the personal history of Sigmund Freud, the father of psychoanalysis, who was an atheist, says Twerski. However, it is necessary, he says, to explain to both rabbis and those suffering that there are cases in which emotional therapy is needed.

Professor Twerski admits that the agreement of rabbis to support emotional therapy stems from their fear of people dropping out of the community frameworks. "We as therapists have to concern ourselves only with the emotional health of our patients, but that is clearly what worries the rabbis," he says.

A new dictionary
Ultra-Orthodox therapists say that some of the problem in reporting and educating to prevent sexual abuse is that there is "no language" to speak about it in ultra-Orthodox society. A short dictionary distributed at the Nefesh conference to anyone interested illustrates that for ultra-Orthodox society, this is a new language. Some of the terms included are abortion, abuse, acute, addicted, addiction, extra-marital affairs, aggressive, alcoholic.

The list of words that until now have not been in use is long: anger, fury, anorexia and bulimia, anxiety, stimulus, arousal, attempted suicide, self-awareness, compulsive overeating, bipolar disorder, conflict, confrontation, domestic violence, marital therapy, criticism, denial, emotional abuse, empathy, sexual abuse, stress, pressure and suicidal thoughts.


Anonymous Anonymous said...

Question about Professor Avraham Steinberg, M.D.

If this guy is an an international expert on the subject, to sexual abuse of children, how come I never heard of him before?

Has anyone ever heard of him? If so what makes him an expert on sexual abuse?

October 30, 2006 4:11 PM  
Anonymous Anonymous said...

Would like to warn people of a psychiatrist in monsey who molests girls. Be sure to research a doctor before you send a teenager to one.

October 30, 2006 6:07 PM  
Anonymous Anonymous said...

thank you for sharing. How does one research a doctor, especially a psychiatrist?

November 01, 2006 10:45 AM  
Anonymous Anonymous said...

Why don't you put his name up here, so people can more easily find out about him?

Why isn't he reported to the police and his license taken away?

It is NOT mesirah to go to the police with a sexual offender. Rabbinic courts are incapable of dealing with this problem. The police must be involved. It is a matter of pikuach nefesh - life or death.

November 01, 2006 12:01 PM  
Anonymous Anonymous said...

The lectures - on topics ranging from Jewish medical ethics, given by Professor Avraham Steinberg, M.D., an international expert on the subject, (i.e. Medical ethics)
to sexual abuse of children - were heavily attended, especially by a largely ultra-Orthodox audience

>Question about Professor Avraham >Steinberg, M.D.

>If this guy is an an >international expert on the >subject, to sexual abuse of >children, how come I never heard >of him before?

>Has anyone ever heard of him? If >so what makes him an expert on >sexual abuse?

I think you mis-parsed the sentence in the article.
He is indeed a world renowned expert on Jewish Medical Ethics
Having written many books on the subject! and shaven spoken at many conferences on Medical Ethics!

October 30, 2006 4:11 PM

November 19, 2006 8:13 PM  

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