Wednesday, January 02, 2008

CALL TO ACTION: Marvin Schick, New York Jewish Week and Sexual Violence

CALL TO ACTION: Read the information below and send a note to Marvin Schick and the Jewish Week.

Marvin Schick lacks the information and education needed to be making any sort of public statement regarding the issue of sexual violence in Jewish communities. Unfortunately, the Jewish Week gave permission for Schick to have a voice to promote inaccuracies to the Jewish world.

It's time we demand that Jewish newspapers only publish information and articles on the topic of sexual violence from those who have the appropriate credentials of being experts in the field of sexual violence -- and not those who just who can afford to pay for full page ads, as in the case of Marvin Schick.

In Schtick's article he attacks Rachel Yehuda, who is one of the foremost researchers in the trauma field. We all should be asking Marvin Schick to show us his resume so that we can determine his expertise in the field.

As a people we also must also demand honesty, transparency and accountablity from all of those who are attempting to influence the Jewish world. By not doing so we are allowing our community leaders to murder the neshema's (souls) of those who have been sexually violated and their family members.

Marvin Schick

Jewish Week
Gary Rosenblatt, Senior Editor

Dr. Michael Salamon granted The Awareness Center permission to forward the following message which was originally posted to the NEFESH list serve. NEFESH is an international organization representing orthodox mental health professionals.

Executive Board Member - Dr. Michael J. Salamon Responds to Marvin Schick's paid ad in the New York Jewish Week (see article below)

I am amazed at how many of us are more interested in "shooting the messengers" than in attempting to use this information to help us serve our communities better. I was having a discussion about this topic the other day with a member of the Nefesh community who insisted that the study was not of rigorous random design and therefore could not be considered valid. I asked the person if they were familiar with survey techniques and non-parametric research. They were not. How then can they speak of validity in this study? They went on to say that they see a great many clients and only (ONLY!) about 10 percent of their have been sexually abused. My response was twofold: How can you generalize from your practice to another and that they do not specialize in these types of cases. I mentioned another of our colleagues who does specialize in this form of abuse who has more than half of their case load consisting of clients that were sexually abused. Are there flaws in this study? Sure. Does that invalidate it? Absolutely not (for statistical reasons far too complex to discuss here. (For those interested in this statistical issue I suggest you start with the many articles and books by Cohen & Cohen on power) The shame is that, even today, sexual predators may be encouraged to continue their ways because they take solace in the fact that the frum community is minimizing the problem. Please, let us take this study and use it to help our communities. Don't shoot the messengers!

Michael J. Salamon, Ph.D., FICPP
Senior Psychologist/Director
Adult Developmental Center
1728 Broadway, Suite 1, Hewlett, NY 11557
516 596-0073


Scholarly Abuse

While reading and reviewing two years ago a dreadful book on chassidic life, I came across a footnote citing a remarkably high incidence of sexual abuse among Orthodox Jewish women. The source was a May 7, 2004 article in the Forward reporting on a paper presented shortly before at the annual meeting of the American Psychiatric Association. I was jolted and intrigued by the assertion that more than 25% of married Orthodox women participating in the survey said that they had experienced such abuse. The statistic was at once startling and I thought questionable. I contacted the two principal researchers and requested a copy of the paper, only to be told that it was not available and would not be available for perhaps two years.

I did not know at the time that in the same period, a companion – or perhaps the same - paper had been given at the annual meeting of the Orthodox Forum, a Modern Orthodox group, and that it had been sharply challenged, the upshot being that in what I have been told is a rarity for the group, the paper, entitled “Sexual Life of Observant Jewish Women,” was not accepted for publication in the book that includes the 2004 Orthodox Forum papers.

In fact, sexual abuse was a minor concern in that paper. Now, the November 2007 issue of the American Journal of Psychiatry, certainly a major publication, includes an article derived from the same study that served as the basis for the earlier paper. This one is on the “History of Past Sexual Abuse in Married Observant Jewish Women,” with
Dr. Rachel Yehuda listed as the first of five authors and with the highlighted finding that “sexual abuse was reported by 26% of the respondents surveyed, with 16% reporting abuse occurring by the age of 13.”

This is now the definitive word on the subject, to be Googled for nearly all of eternity and regarded as authoritative and cited in books, newspapers and other publications. This newspaper did its part with a badly flawed article headlined, “No Religious Haven From Abuse.”

It is not prudishness that begets my reluctance to write about sexual abuse. I do not want to cover up any form of wrongdoing. My reluctance arises from the likelihood that what I write will engender the false claim that I and the Orthodox cover up all abuse. We Orthodox live in a real world and there is sexual abuse in our community and while its incidence is, I believe, significantly below what it is in the larger society, what occurs is a serious issue that must be confronted. Any who protect a sexual abuser is guilty of a great sin.

There is a huge gap between acknowledging this truth and accepting the reckless scholarship and statistics of Dr. Yehuda, et al which constitute a form of group libel and severe cruelty toward observant Jews. They have an obligation, scholarly and ethical, to calculate how their presentation of their findings will be interpreted and distorted because of their flawed use of statistics. At the end of the day, we are left with the statistic that one in four married Orthodox women has experienced sexual abuse and this statistic is false.

Sadly, claims of abuse of one kind or another among the Orthodox have become routine, as if “Orthodox” and “abuse” are like love and marriage in the popular old song, you can’t have one without the other.

The Survey
The AJP article does not include the questionnaire, nor is it available online, which is surprising. The questionnaire is important because it indicates why I believe Orthodox women in droves refused to participate in the survey. A half-dozen polite requests to Dr. Yehuda for a copy were to no avail. Nor have I been able to access the promotional material that was utilized to attract participants. Dr. Yehuda acknowledges that while the survey was once online, it “is no longer on the website.”

A substantial effort was made to publicize the survey and to encourage self-identified Orthodox women to participate. As the AJP article puts it, “subjects were sought across a large range of religious Jewish communities by advertising through synagogue bulletins, Jewish organizations, newspapers, Jewish-oriented websites and listserves, and a network of medical professionals…whose practices consisted of sizable numbers of Orthodox Jewish women.”

This extensive and doubtlessly expensive effort, conducted here and in Israel, resulted in 380 completed questionnaires that constitute the survey. The authors acknowledge that they cannot “estimate the number or characteristics of women who heard about the study and refused participation.” It is a fair estimate that this number dwarfs by a hundredfold and probably much more those who participated.

Methodological concerns alone raise serious questions about reliability. While there is research on the sexual activity of American women, what Dr. Yehuda et al report is the first study of its kind on any ethnic, religious or nationality group or subgroup. As they write, “there are currently no statistics regarding the life-time prevalence of sexual abuse within religious communities,” and, “we are not aware of any other study examining sexual abuse…in any similar insular religious society.” Inadvertent as it may be, there is a sensationalist quality to what is reported in the AJP. Once more, we Jews – and, once more, just the Orthodox - are the chosen people. I wonder what the reaction would be if research based on a comparable approach reported that one in four women in other ethnic and religious groups had experienced sexual abuse.

The Data
In fact, the statistics about the Orthodox are distorted – and by a wide margin. The study is afflicted by a severe case of survey bias, by now a chronic problem in Jewish demography and acknowledged as a serious issue in sexual activity research. Survey bias refers to the powerful tendency of quantitative research to attract respondents who are not representative of the entire group and whose participation is enhanced by the nature of the research and the questions asked. Their responses tilt the data in a pronounced way, invariably in the direction favored by the research. There are major articles in the literature on survey bias in sexual activity research, with one review article authored by A. Catania and others and published in 1990 in the Psychological Bulletin stating that the responses tend to come from those who are “more sexually liberal” and “more likely…to report sexual difficulties.”

What percentage of married Orthodox women is represented by these 380 responses? According to the Orthodox Forum paper, “it can be estimated that there are approximately 250,000 to 300,000 women” in the U.S. and Israel who would be eligible for participation in the study. My estimate is lower. Whatever the number, the 380 represent a small fraction of one-percent of the potential response pool and, as will be shown, they are not representative of Orthodox married women. Without any doubt, they are also a tiny proportion of the eligible women who learned of the survey and were invited and encouraged to participate. We do not know how many considered participation and then decided against it, certainly in many instances because they were repelled by the questions that were asked. Yet, we now read unqualified newspaper accounts that one-quarter of married Orthodox women experienced sexual abuse.

If nearly all surveys are prone to participation bias and sexual activity surveys even more so, there is a yet more heightened prospect that Orthodox women will shy away from such questions. According to an item in Science & Theology News about this research, “nearly 25 percent of American women surveyed did not respond” to some of the questions. There is a touch of prurience to certain questions, at least from the perspective of many Orthodox women and certainly those who identify as fervently Orthodox. An example is questions relating to the wedding night experience.

In short, the 380 respondents are an atypical group who represent only themselves. How atypical is indicated by the curious statistic that 53% of those who self-identify as fervently Orthodox attended graduate school, apart from those who went to a religious seminary. Indeed, Yehuda et al note that “the high level of education, even among the ultra-Orthodox, suggests a survey bias that may be associated with a willingness to participate in research.” This doesn’t deter the trumpeting of the 26% abuse statistic.

There are other question marks, invariably with the acknowledgement that they may affect the survey’s representativeness. A bit more than half of the abuse reported in the AJP article involved improper physical behavior that did not include genital contact. In fact, in the authors’ words, “many researchers have historically defined sexual abuse as genital contact.” Hopefully without being accused of excusing wrongful actions, I wonder whether inappropriate conduct without genital contact should be included in the survey of Orthodox women. The issue is relevant because while in the general society standards of physical contact are more permissive and so there is a strong tendency not to regard such contact as sexual abuse, among the Orthodox and especially the fervently Orthodox, in the words of Dr. Yehuda et al, “the threshold at which someone may feel the victim of sexual abuse may be lower for those living in a more restrictive religious community.” It is of note that of the Orthodox women reporting sexual abuse, more than half said that it did not involve genital contact.

An additional area of doubt arises from the extraordinarily large number of respondents – 53% - who have been treated at least once by a mental health professional. This is a sensitive issue and it is sufficient to note that the statistic is substantially higher than what is known about American women and psychotherapy services.

Many of the Women Were Not Orthodox
The greatest flaw in the research and presentation is that 137 or 36% of the respondents were not raised Orthodox, becoming observant later in life, a statistic that is incompatible with the distribution of baalei tshuva or return to Judaism women in the Orthodox population. Of the 96 women who reported abuse, more than half or 49 were not raised Orthodox. The title of the article refers to past sexual abuse among married Orthodox women, the suggestion being that the abuse was experienced by persons who were observant at the time that it occurred. This is how the data were reported in this newspaper and how they will continue to be reported.

This issue is crucial in light of the statistic that nearly two-thirds of those who report abuse say that it occurred before the age of thirteen, when in fact many of the women were not Orthodox. Of note, one-third of the women raised Orthodox say that their perpetrator was a stranger, as compared to but 14% for those who were not raised observant. Contrary to popular wisdom which decrees confidently that the Orthodox tend not to report abuse, 44% of those raised Orthodox reported the incident. The comparable figure for those not raised Orthodox is 39%.

When the women not raised Orthodox are excluded, the abuse statistic declines to 19% and that is the point at which survey bias and other factors come into play, reducing the figure even further and probably substantially, although it is not possible to estimate an accurate figure. In sum, to the degree that this survey has any value, it appears to point to a lower, probably much lower, incidence of sexual abuse in the Orthodox community than in American society as a whole. To put it mildly, the message sent by the authors is quite different.

Sprinkled throughout the AJP article are declarations that the responses may not be representative. That isn’t sufficient because it is certain that they aren’t representative. As someone who read the AJP article emailed to me, “I don’t understand a field in which a major journal publishes an article that contains emphatic declarations that its data is utterly meaningless.” Of course, the declarations do not make it into the publications that cite the study.

Whether the substantial deficiencies were inadvertent or not, the authors bear a moral and scholarly responsibility for what appears under their names and for the harm, distortion and pain they have caused. Sexual abuse is terrible and never to be condoned. In condemning sexual abuse, we must be careful not to condone scholarly abuse. Dr. Yehuda and her colleagues should take the morally responsible step and retract their article.

Background information on Dr. Rachel Yehuda

Rachel Yehuda is Professor of Psychiatry at the Mount Sinai School of Medicine, and is Director of the Traumatic Stress Studies Division at the Mount Sinai School of Medicine and Bronx Veterans Affairs Medical Center. She is an active researcher in the field of posttraumatic stress and has authored more than 150 articles and edited several books on this topic. She has numerous professional memberships such as the American College of Neuropsychopharmacology and International Society for Traumatic Stress, and has served on many scientific advisory and journal editorial boards. Dr. Yehuda served as a delegate for the White House Conference on Mental Health in 1999 and was recognized in the Congressional Record for her work with Holocaust survivors. Dr. Yehuda is one of four Executive Directors on the New York Times Consortium for Trauma Treatment, founded in response to the World Trade Center Disaster in New York.

Dr. Yehuda received her Ph.D. in Psychology and Neurochemistry and her M.S. in Biological Psychology form the University of Massachusetts at Amherst and completed her postdoctoral training in Biological Psychiatry in the Psychiatry Department at Yale Medical School.


Anonymous Rachel Yehuda, PhD said...

I think the most insidious problem here is the use of a paid advertisement in the Jewish Week to undermine a scientific process. As a mental health professional and reader of the Jewish Week I find it incredulous that someone with no journalistic, clinical or scientific credentials at all can have a forum to discredit findings that have passed the rigorous process of peer review in a scientific journal.

It is one thing to be accused of writing a paper with "reckless scholarship and statistics" by a peer, and quite another by a layperson. I hope the Nefesh community will use its credibility to help set the record straight that talking about a mental health problem in the community does not constitute "group libel and severe cruelty toward observant Jews."

I hope the Nefesh community will be able to communicate to the Jewish Week that it is completely inappropriate to allow a paid advertiser to undermine the reporting of a finding in this manner, particularly since it was the Jewish Week itself who began all of this by publishing a story on the paper (for which they did interview me, but that is another issue). The paper we wrote was published in a peer review psychiatric journal with a large readership of mental health professionals who may treat members of the Observant community. It was written to make the point that clinicians should not fear discussing the possibility of sexual abuse even if their client/patient "seems" like they would be offended by such discussion. Even the most modest of women may have had such untoward experiences and if they did, therapy provides a safe place for discussion of these matters. Since over half the sample in our study sought mental health treatment, even if the sample is not representative of the general Observant population, it clearly is extremely relevant to clinicians treating such patients. Non-genital abuse was included specifically because it was reported as "abuse" by the respondents and was equally associated with mental health outcomes as genital abuse.

Mr. Schick was also mistaken in conjecturing that this paper must have been similar to the one presented, but ultimately not accepted for publication by the Orthodox Forum. That paper dealth with the primary aim of the survey -- to examine relationshps among adherence to laws of family purity and sexual dysfuction and satisfaction, but not sexual abuse. The decision not to publish the paper in an Orthodox publication widely read by both singe and married laypersons was not based on the conclusions, but the frank and explicity language of the survey questions and answers.

It is particularly upsetting to see how certain Mr. Schick is that the sample we used was "less than 1/100th of those who refused to participate" since he has absolutely no way of knowing this. We discuss in the paper that given the nature of the distribution, we had no way of estimating the number of people who did not express interest by not asking for the questionnaire, but many did, and those who did returned the survey.

Furthermore, the absence of accurate information on the characteristics of Observant Jewish women prevents anyone – including Mr. Schick – from assessing the representativeness of the sample. A point we made in the paper was that constraining the sample to women who report regular use of the mikva prevented us from examining sexual abuse in other particularly relevant subgroups such as, married women who were raised observant but are now no longer so, or single women, including those never married, divorced, widowed, or gay. Perhaps this limitation also explains the high prevalence of ba’a lot teshuva in our sample, which we noted.

The rigorous process of peer review in scientific journals is designed to weed out the sensationalism that is often present in the media and paid advertisements. The purpose of publication was not to publicize the material to a general audience. We understood that the interesting topic would make it likely that it would be reported on elsewhere, but we had no control of how it would be reported. Even Mr. Schick acknowledged that we repeatedly discussed the studies limitations, some of which he reports. I hope the Nefesh community will help educate the public on this issue. It is terribly undermining to all of us for the Jewish Week to allow any person with a checkbook to say anything he pleases and jeopardize the work we need to do in education and treatment of the community.

December 30, 2007 4:07 PM  
Anonymous Anonymous said...

Gary Rosenblatt is a joke. This isn't the first time he sided on the side of taking money verses publishing the truth. Just flashback a few years ago to the case of Mordechai Gafni. He took the side of one of his best friends, Saul Berman. Much better to help a confessed child molester get away with soul murder then to do what he could to help those who were sexually abused.

December 30, 2007 4:31 PM  
Anonymous Anonymous said...

The following came from The Awareness Center's Daily Newsletter

Response to Marvin Schick's ad in the Jewish Week
From one of the subscribers to The Awareness Center

I would like to respond to comments made in the recent ad in the Jewish Week questioning the veracity of Dr. Yehuda’s study on sexual abuse reported by Orthodox women. As someone who has done quite a bit of research in the field of psychology and social work in the past several years, I’d like to point out that we do not all need to be experts in non-parametric sampling in order to appreciate the importance of such research. On the face of it, the findings of this study are important:

1) The study design had to be approved by the Institutional Review Board of the Mt. Sinai School of Medicine. These approvals are not easily obtained and require the study team to address issues such as sample size, ability to obtain random samples, and the development of the questionnaire.

2) For the results of this type of research to appear in a journal such as the American Journal of Psychology requires additional scrutiny by peers in the field AFTER the research is conducted and conclusions are drawn. This adds a layer of examination outside the institution that originally assisted in the design and implementation of this study.

3) Yehuda et al. state in their study (as do all serious researchers) that there are limits and questions that arise from their work. It appears, after reading the entire study carefully, that the authors have done their best in this regard.

There is a dearth of information regarding sexual abuse (or other social ills for that matter) in the Orthodox community and, instead of criticizing scholarly work that attempts to begin addressing these problems, we should welcome further research so we can begin addressing the challenges we face.

In the past several years, organizations such as Project S.A.R.A.H. and Shalom Task Force, have done a phenomenal job of helping deal with domestic violence in the Orthodox community. It is high time that we stop pointing fingers at people that are trying to help us deal with sexual abuse and look for ways to improve our communities.



December 30, 2007 8:50 PM  
Anonymous Defrock Schick! said...

Someone told me that Marvin Schick is an ordained rabbi. Is this true? If so, which idiot gave him semicha?

December 30, 2007 8:52 PM  
Anonymous Anonymous said...

B'H' for the Awareness Center. They are the only organization with the Baitzah to stand up to the ignorance of Gary Rosenblatt and Marvin Schick.

I'd like to see the Shalom Task Force, Project S.A.R.A.H. and many other organizations to join forces with Vicki Polin.

If these organizations really care about those who have been sexually abused they would do it in a flash!

December 30, 2007 9:23 PM  
Anonymous Nachum Binyamin Klafter, MD said...

Sexual abuse in the Orthodox Community, Controversy surrounding paper by Rachel Yehuda et al

I would like to take this opportunity to address a number of points related to the paper in the November 2007 (164:1700-1706) issue of the American Journal of Psychiatry, by Rachel Yehuda PhD, et al., “History of Past Sexual Abuse in Married Observant Jewish Women.” My reaction is very different from what everyone else so far has written about this controversy, both in the lay press and here on the Nefesh list-serve.
I will briefly summarize the paper, as it is clear that not everyone commenting on it has bothered to read it. The methodology of their study was as follows: An advertisement was written for the purpose of soliciting subjects to participate in an anonymous questionnaire “examining sexual life in marriage among observant women…” The authors sought to recruit subjects “…across a large range of religious Jewish communities by advertising through synagogue bulletins, Jewish organizations, newspapers, Jewish oriented web-sites and list-serves, and a network of medical professionals… whose practices consisted of sizable numbers of Orthodox Jewish women.” (p. 1700) Inclusion criteria, as far as I can tell from the paper, was simle: Self-report of regular use of the Mikvah in observance of family purity laws. 26% of the total respondants (N=380) reported sexual abuse at least once, and 16% reported it during childhood (defined as before age 13). Some very interesting findings are reported in their paper. Ba’alei teshuva reported sexual abuse nearly twice as frequently as women raised in the observant community (p. 1701). “Ultra-Orthodox women” reported a history of abuse more frequently than did “Modern-Orthodox” women (based on self-report of religious ideology/affiliation). Logical regression demonstrated that being raised observant and religious affiliation (self defined: MO vs.UO) exerted independent effects in this data set. A similar proportion of the self defined UO vs. MO women were ba’alei teshuva. Some other interesting findings are reported, but I believe that these the above are the findings are the most significant for the purposes of our discussion here at Nefesh.
The authors, in the Discussion (p. 1703) state; “These estimates are consistent with data from several national surveys, in which 25%-27% of women, regardless of marital status or religious affiliation, reported sexual abuse.” In the next sentence they state, “A meta-analytic study by Gorey and Leslie concluded that approximately 22% of women report childhood sexual abuse, a figure slightly higher than was noted in the present study…” However, the methodology of their study and the papers they cite is not contrasted, and one might get the erroneous impression that they have drawn a conclusion about the rate of sexual abuse in the Orthodox community, and or a statistical comparison with the general population. My impression is that this information is mentioned only to set the context for their results. The impossibility and inappropriateness of comparing their data with these other studies is discussed below, at length.
The lay press has commented on this paper. In the New York Jewish week, Debora Nussbaum Cohen characterizes the findings as follows: “New study finds Orthodox women are sexually victimized as much as other American women are.” (As I will explain below, I do not believe that this paper demonstrates any such thing, and I do not believe that the authors have made any such claims.) A rather nasty reaction has been written by Marvin Fox, which Nefesh Members have noted. A similar reaction was posted by Avi Shafran of the Agudath Israel organization on a blog which is widely read in the Orthodox world:
Learning how to read scientific papers is a skill. To judge what conclusions can be drawn and what conclusions cannot be drawn requires balance and caution. Unfortunately, I believe that the following has occurred:
1. Individuals writing in the lay press who have no training in reading scientific papers to are drawing inappropriate conclusions from this paper.
2. Rabbis and spokespersons for Orthodox Jewish communal organizations are unjustifiably dismissing the legitimate scientific findings of this paper. (It appears that this is motivated, at least in part, by defensiveness about or denial of sexual abuse in our communities.)
3. And finally, Orthodox Jewish mental health professionals here at Nefesh (who have on numerous occasions written that they are, albeit understandably, extremely frustrated about what they perceive to be negligent inaction and denial by Orthodox leaders) are failing to acknowledge the serious methodological limitations of this study, and resorting to slogans such as, “Even if this study has flaws, one case of abuse is too much!”

Therefore, I will dispense with any false humility and address the following topics:
1. My qualifications to critically review this paper
2. The history of our field surrounding the significance and epidemiology sexual abuse, in general. (This is arguably only peripherally relevant, but sets important context to the debate in our community. Plus, I find this history to be interesting—so you will have to indulge me.)
3. What I believe CAN be concluded from this paper by Yehuda R, et al.
4. What I believe CANNOT be concluded from this paper.
5. My opinion about a responsible reaction by mental health professionals (i.e. Nefesh Members)
6. My opinion about a responsible reaction by religious leaders and spokespersons for Orthodox institutions.
7. My specific criticisms and defenses of this paper, directed to both Rachel Yehuda and Tali Rosenbaum in particular because I believe they will receive this email.

1. My qualifications to critically read this paper: I am not a career scientist, , but I did participate in scientific research during college, medical school, and residency training. I studied statistics for the behavioral sciences during college as part of my major in Biological Sciences. I studied statistics and epidemiology during medical school as part of the basic curriculum, pursued a research elective in the epidemiology of suicide, as and taught a discussion section of the Statistics and Epidemiology course as an advanced elective during my fourth year of medical school. As an Associate Professor of Clinical Psychiatry at the University of Cincinnati, and as the Director of Psychotherapy Training, one of my responsibilities is to help teach residents how to read scientific papers critically. The American Journal of Psychiatry is not a publication intended, primarily, for researchers. It is read by general, adult psychiatrists who, for the most part, are clinicians. In fact, a subscription to the AJP is a benefit for members of the American Psychiatric Association. Therefore, the argument that only epidemiologists and statisticians should be entitled to comment on this paper is a specious. If comprehension of a paper in the AJP requires special expertise in epidemiology of the reader, then this would be a major editorial failure. Reading this particular paper, I do not believe that this is the case. In my opinion, any general psychiatrist should be able to understand this paper and should be able to carefully draw conclusions from the data presented. Furthermore, because I have a modestly stronger background in statistics and am involved in ongoing teaching about how to read scientific papers, I submit that I am certainly qualified to comment on this paper.
2. Controversies over the frequency of sexual abuse are not new: Sigmund Freud, himself, in studying the pseudo-neurological symptoms of hysterical patients, originally postulated that these patients (all women) were suffering from the sequelae of childhood sexual trauma. This theory of symptom formation was awkwardly and unfortunately translated into English by James Strachey as “Seduction Theory.” This poor choice of words does not indicate that Freud had a distorted view of sexual trauma, or that he attributed a willing consent to children who have been molested, as some radical feminists or Freud-bashers would like to pretend. Note that Freud himself states that he was molested by a babysitter as a young boy. A better term would be “The Sexual-Trauma Model of Symptom Formation.” (I believe that Joseph Sandler in his excellent text on Freud uses terminology similar to this.) However, as Freud began to see that intra-psychic conflict was ubiquitous, he simply found it implausible that so many patients suffered from childhood sexual abuse. Freud therefore abandoned this theory of symptom formation, and then developed the Topographic Model, which served as his basic framework between about 1900 and 1923. (In 1923, he formulated his second theory of anxiety with the publication of “The Id and the Ego”, now referred to as “Structural Theory” which laid the foundations for modern psychodynamic psychotherapy and the psychoanalytic perspectives and techniques which fall under the heading of “Ego Psychology”.) However, some contemporary thinkers, including Bessel Van Der Kolk (who recently spoke for Nefesh) feel that Freud made a critical error when he discarded his theory of sexual trama. The patients he examined at the turn of the century, so this argument goes, were probably much sicker than the neurotic patients that he later psychoanalyzed. These earlier patients may have suffered from what would now be considered Dissociative Identity Disorder, and/or Severe Borderline Personality Disorder, which are very frequently associated with severe sexual abuse. (In my anecdotal experience, every case of Dissociative Identity Disorder has involved a history of severe sexual trauma, as well as physical trauma, psychological torment, and profound neglect/abandonment. See Soul Murder, by Leonard Shengold). There are other theories about Freud’s early patients: In Ronald Britton’s interesting book, Sex, Death, and the Superego, he argues that Anna O. suffered from “hysterical psychosis” which is a condition distinct from Borderline Personality Disorder, and also distinct from neurosis. In any case, this debate has never been fully settled, and it is not going to be settled by this self-report questionnaire completed by self-selected respondents to an advertisement. If denial, shock, horror, minimization, rationalization, and repression in response to allegations of sexual abuse are the typical reactions by most parents, teachers, doctors, and therapists, then it is foolishly naïve to think that one publication will persuade anyone, let alone Orthodox communal leaders who have no training or education about sexual trauma. That we, as mental health professionals, continue to be surprised by something that we should be very familiar with is curious and requires self-reflection.
3. What CAN be concluded from this study:
1. These authors demonstrate that if married, observant women are given an opportunity to describe (confidentially, and in writing in this instance) their sexual experiences, a very significant percentage of those who elect to pursue this opportunity will disclose a history of sexual abuse.
2. There are some observable and important differences in the rates reported by women who define themselves as MO vs. UO, between women who were raised in observant homes vs. ba’alei teshuva.
3. The feedback from the respondents who chose to participate in this study indicates that they found this experience to be deeply rewarding. This aspect of the data can be characterized as “qualitative research” as opposed to “quantitative research” and in my opinion the inclusion of this data enhances the significance of their paper.
4. These ARE very significant and important findings, and I applaud the authors for this original research. I think that this paper is an important step in the process of trying to scientifically quantify and characterize sexual abuse among Orthodox Jews. These data, in my opinion, DO suggest that there is a very significant number of women in our kehillos who have suffered sexual abuse.

4. What CANNOT be concluded from this study: Here, I anticipate that the authors may object to my comments, but this is my honest assessment.
1. One cannot draw a conclusion from this aper about the rate of sexual abuse in the Orthodox community. Nor can one conclude that Modern Orthodox women are less likely to have experienced sexual abuse than ultra-Orthodox women. There are many possible confounding variables in this data related to selection bias, and in my opinion none of them can be controlled for. Please note that this is not a criticism of the paper. It is simply an elucidation of the study’s limitations:

i. Perhaps women who have been sexually abused are more likely to respond to this questionnaire.
ii. Perhaps Orthodox women who have not been sexually abused are less likely than non-Jewish or non-Orthodox women to respond to this questionnaire?
iii. Perhaps ultra-Orthodox women are in general less likely to see or respond to such advertisements, and perhaps a history of sexual abuse was more of a selection bias for ultra-Orthodox women than Modern-Orthodox women.
iv. There is no attempt to estimate the number of women who saw this advertisement. Did 2,000 women see the advertisement? (i.e., was there a response rate of only 19%?). Did 10,000 women see this advertisement (i.e. was there a response rate of only 2.8%?)
v. If indeed this advertisement was distributed so widely and only 380 women responded, then there is absolutely no conclusion that can be drawn about the target population (i.e. Orthodox women). In other words, no estimate of the rate of sexual abuse among Orthodox women can be drawn from this questionnaire. Rather, we are describing characteristics only of the women who chose to respond.
vi. There are too many ways to interpret some of the findings: E.g., perhaps the higher rates of childhood sexual abuse among ba’alei teshuva indicate that there is a lower rate of sexual abuse in the Orthodox community. Or, perhaps it demonstrates that women who are sexually abused are more likely to become ba’alei teshuva. Etc.
vii. (I could construct many more such confounding scenarios, but the above methodological questions are the ones that first come to mind. I am not trying to be a nudnik. In fact, I am trying NOT to be a nudnik. I believe that all of these are very reasonable possibilities.)
1. One CANNOT make comparisons with the rate of sexual abuse other populations or in the general population from this study because of the fact that the recruitment was based on self-selection. The estimates of the rate of sexual abuse in the general population which are cited in this paper based on a very different type of data collection. The authors cited made contextual (not statistical) comparisons to the data from 3 studies (references 10-12 in the paper, on p. 1705).

i. The first source, Finkelhor, et al, reports data from a study conducted by a randomized phone survey. In other words, it was not a self-selected group who responded to an advertisement. The data are not at all comparable.
ii. The second source, Vogeltanz et al, reports data from a face to face interviews of women who were selected to constitute a representative sample of US women aged 21 and older. Actually it is two data sets, one done in 1981 for women over 30, and one done in 1991 for women aged 12-30. The response rates were 92% and 91% respectively. (It seems likely that the response rate for the paper by R. Yehuda, et al is far lower, as mentioned above. Also, depending on the criteria used to define sexual abuse, significantly different rates are reported in the paper by Vogeltanz. If R. Yehuda et al believe that their questionnaire is compatible with Vogeltanz’s more exclusive criteria for sexual abuse, then they also must acknowledge the fact that their sample and method of data retrieval are not comparable.
iii. The third source is a monograph by the National Resarch Council, “Understanding Child Abuse and Neglect” published in 1993. Fortunately for me, this valuable resource is available in full text, online: Please refer to pages 78-105, the chapter entitled “Scope of the Problem” where you will see that the methodologies of the surveys cited do not resemble the study by R Yehuda, et al.
iv. Therefore, this study by R Yehuda et al provides absolutely no basis to compare the rate of sexual abuse in the Orthodox community with the rates in the general population. (Again, what this study DOES provide is still in my opinion very significant: The fact that if women in the Orthodox community are given the opportunity to describe their sexual lives, a very significant number will report sexual abuse.)
1. In other words, Debra Nussbaum Cohen is completely incorrect in her characterization of this paper’s results. Not only can we not draw comparison’s with the general population, but we cannot draw conclusions about the rate among Orthodox women.
2. One cannot conclude that women who did not choose to respond to this survey would have found it to be a positive experience if they had chosen to do so. Perhaps they would have found this to be traumatic. Who knows. In other words, the selection bias also applies to the paper’s qualitative research data.

1. My opinion about a responsible reaction by mental health professionals (i.e. Nefesh Members: The collective experience and strong consensus of mental health professionals who provide treatment for Orthodox Jews is that there is a great deal of human suffering in the Orthodox community as a result of sexual abuse. While it might seem reasonable to imagine that the rates of sexual abuse among Orthodox Jews could be are lower than that in the general population because of the special religious characteristics of our communities, there is in fact no scientific data which demonstrates our rates are any lower. This absence of comparison data does not mitigate the very real suffering which results in our community from sexual abuse. The recent paper by R. Yehuda et al., does not shed any light on what the rates of sexual abuse are in the Orthodox community. However it does indicate that a significant number of Orthodox women who choose to answer questions about their sexual experiences will report a history of sexual abuse. Sexual abuse was reported more frequently in this data set by women who are ba’alei teshuva (vs. those raised observant), and who identify as UO (vs. MO). The significance of these differences remains unclear, but will no doubt be an important area for future research about sexual abuse among Jews as well as non-Jews. The passionate controversy unfolding about this paper demonstrates what we already know: that allegations of sexual abuse are emotionally provocative, and that denial of sexual abuse by communal leaders is a phenomenon that Orthodox Jewish mental health professionals will continue to be frustrated with. However, for mental health professionals to say, “Even if we can’t make this conclusion scientifically, one case it too much!”, or “Orthodox rabbis are even worse that Catholic priests!” is not helpful. To the contrary, such these statements serve only to engender more distrust of mental health professionals by the rabbinate, and will undermine our efforts to bring greatly needed mental health services to a population underserved due to stigma and paranoia about the mental health field. The also point to the fact that the ethos of activism is much stronger than scientific precision among many psychotherapists.
2. My opinion about a responsible reaction by the leaders and spokespersons for Orthodox institutions: Being raised in a religiously observant setting is no guarantee for ethical behavior, and does not eradicate social and mental health problems. Our community, like the rest of the world, is in the process of waking up to the reality of sexual abuse. We have no clear data yet on whether sexual abuse occurs in our community with the same frequency as it does in the rest of the population. But this paper by R Yehuda, et al demonstrates that there is in fact a significant number of women in our community who have been sexually abused. It also suggests (though it does not prove) that they may experience emotional benefit from talking about it in a confidential setting. Because of the restrictions on pre-marital and extra-marital sexual or non-sexual physical contact between men and women in our communities and because of our emphasis on modest behavior and modest speech, it is difficult for many of us to talk and think openly about sexuality or sexual abuse with our congregants and consituents. We need to acknowledge that the same restrictions which are designed to promote modesty may also serve to disguise or hide sexual conflicts and problems, including sexual trauma. Our religious leaders need to collaborate with mental health professionals in order to formulate methods of sex education and abuse prevention which are consistent with our standards of modesty.
3. My specific criticisms and defenses of the paper:
1. The authors did NOT claim to measure the rate of sexual abuse in the population. It is unfair to criticize them for something they never did.
2. The authors did NOT claim to be conducting a meta-analysis or to be making a scientific comparison of their self-selected data set with estimates of sexual abuse rates in the general population, which were based on epidemiologically representative data sets. It is unfair to criticize for this as well.
3. The authors included this information only in the discussion section and only to set context for how we can react to the rates in this data. This is perfectly appropriate, and to not include it would have been a serious omission.

4. My specific criticisms of the paper
1. I think the authors should have anticipated these reactions from Orthodox leaders lay press commentators, and therefore should have made a greater effort to clarify that they did NOT draw any conclusions about the rates of sexual abuse in the Orthodox community in general, and did NOT claim to be able to compare these rates with the general population.
2. The authors have a not only a Jewish responsibility to expose the reality of sexual abuse in our community, but also a scientific responsibility to prevent the lay press for public from incorrectly extrapolating from their paper. Their urgency to respond to Avi Shafran and Marvin Shick should be matched by an urgency to clarify to the lay press that their paper does NOT provide data from a representative sample of Orthodox women. I.e, their data CANNOT be compared with epidemiological studies which have been conducted about sexual abuse in the general population. If they have done anything to dispel this, then I retract this criticsm, but I am thus far unaware of this.
3. The Discussion section is misleading because it fails to clarify the different between contextual comparisons and statistical comparisons. These two little sentences should have been written more carefully.

Final clarifications:
1. Despite the above caveats, I think that this is a very important paper. Let’s not let emotion or the stupidity of the lay press cloud our thinking about its implications.
2. More important: I object to any attempt to discredit the scientific or academic credentials of its authors or their integrity. Rachel Yehuda, in particular, is in the middle of a distinguished career and continues to make great contributions to our field. She is a source of pride for Orthodox Mental Health professionals. I have great respect for Tali Rosenbaum as well and hope that her contributions will continue, and that she will not be discouraged by any of the negative feedback that she is receiving.

December 31, 2007 7:42 AM  
Anonymous Anonymous said...

I think there's a typo in Dr. Klafter's letter. He probably means a nasty reaction by Marvin Schick - not Marvin Fox who passed away 11 years ago.

December 31, 2007 12:22 PM  

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