Feb. 27, 2005
By JUDY SIEGEL-ITZKOVICH

For a community that has long avoided washing its dirty laundry in public, frank discussions by haredi mental health professionals on family violence, child abuse, divorce, mental illness, homosexuality, drug abuse, alcoholism and other problems are an astounding development.

It happened earlier this month at the fifth annual conference of Nefesh-Israel, the local branch of Nefesh International, which brings together Orthodox social workers, psychologists, psychiatrists, family counsellors, psychiatric nurses, rabbis, educators and other therapists (conventional and "alternative"). However, the openness was limited to a closed forum of members and other participants at the Bayit Vegan Guest House; the issues are not yet being aired in the haredi media, the synagogue, yeshiva or ritual bath (mikve) waiting room.

Obviously, these social phenomena are still much less common in Israel's religious population than in its secular majority, because of the family orientation and strict guidelines of halacha in observant Jewish society. But they are becoming too common to ignore.

Almost a decade ago, a handful of religious mental health professionals in New York who wanted to "network" established Nefesh (www.nefesh.org) as a voluntary, inter-disciplinary organization; it has since grown to include thousands of activists on several continents. It conducts international, regional and local training courses and symposia, distributes audiotapes, and serves as a referral network of professionals who treat observant Jews.

IN 2001, the Israeli organization (www.nefeshisrael.com) was founded by Dr. Judith Guedalia, director of the neuropsychology unit at Jerusalem's Shaare Zedek Medical Center, and by senior social worker Leah Abramowitz, a founder of Melabev (Community Clubs for Eldercare), which is also based at Shaare Zedek. Although modern-Orthodox professionals are warmly invited, haredim constitute the vast majority of Israeli members and participants. The reason, I learned, is that national religious Jewish professionals feel completely comfortable discussing these issues with their secular counterparts - but many feel uncomfortable when treating haredim because they feel (or are made to feel) they are "not Orthodox enough" to deal with members of the community. But there was significant representation at the conference by "hardal" (nationalist haredi) women, who seem to feel at home in both worlds.

As women constitute the majority in the "helping professions," it was not surprising to note that females constituted the bulk of the participants. With almost no new jobs available in haredi schools and kindergartens, haredi women are increasingly switching to professions such as social work, psychology, computer programming and complementary medicine. Few, however, study in Israeli universities; they prefer to attend special "sheltered" educational programs for observant women.

Studying in a yeshiva during the day and going to night school at a university in the Diaspora is considered normative among haredi males (not only the more liberal Lithuanian-style, but even the more conservative hassidic groups. But the Israeli haredi male is strongly discouraged from academic study, so aside from the handful of modern Orthodox men there, all the psychologists, psychiatrists and other university-trained professional men were immigrants from English- and French-speaking countries. They fill an important function, as haredi laymen prefer haredi (or at least modern Orthodox) therapists because they understand their unique sensitivities, prohibitions and taboos.

There were a couple of Israeli-born Gur hassidim attending lectures at the conference who, with their traditional black garb and sidecurls, stood out in the crowd of hundreds. Both from Ashdod and both named Yitzhak, they provide psychological and marriage counselling to yeshiva students and advice on mentally disabled children to members of their community, even though they never matriculated, went to university, use a computer or even speak English. They said they fill a real need, as hassidim who seek out their help would refuse to consult a licensed professional outside the Gur community. The pair regularly go to lectures and consult with experts, but are well aware that they are breaking the law; only academic graduates recognized by the Health Ministry may offer psychological help. They refer "dangerous" cases to licensed professionals and rabbis, they said. One of the Yitzhaks said he would be happy to earn a degree if it were in a completely segregated, haredi male environment; for the good of the community, such a framework should be available.

One qualified and licensed haredi psychiatrist at the Nefesh-Israel event was American-born Dr. Michael Bunzel, head of the Chiba psychiatric community clinic at Ma'ayanei Hayeshua Hospital in Bnei Brak, who is also in charge of the clinic for the religious community at the Sheba Medical Center. In his lecture on the power of stigma, he said many haredim were deterred from seeking treatment out of concern that the "secret" mental problems would ruin the chances of family members marrying well. Worry about being seen at Chiba is so great, he said, that there are four waiting rooms so that each patient can wait alone.

While stigma about emotional problems and concern over finding spouses were not unique to the haredi community (he brought examples of research from southern India and China), Judaism does have singular halachic concerns about whether a prospective bride or groom must inform the other of psychiatric or psychological treatment, even in the distant past for a temporary problem, or a family history involving a psychiatric disorder. Most rabbinical arbiters, he said, agree that if the scientifically calculated risk of offspring developing a disorder with a genetic influence is less than 15%, there is no problem marrying into the family; you don't even have to inform the other side if the risk is less than 5%. A prominent rabbinical sage ruled that if a person has a defect that if discovered after marriage would cause the spouse to consider a divorce or annulment, the person must inform the prospective marriage partner in advance. But a qualified rabbi should be consulted about each case, he said.

Bunzel noted that some young haredi women who manage to hide a psychiatric problem before an engagement clandestinely resume taking their medication after getting married, but have to stop when they get pregnant, causing the husband to learn of it.

DR. HELEN SHEINFELD, a non-Orthodox, Hebrew-speaking psychiatrist who teaches in medical school and has a private practice that includes numerous haredim, focussed on psychiatric problems related to menstruation. Naturally, the audience was almost entirely female (a few men sat discreetly in the back). This specialty is getting more professional recognition, she said, due to growing awareness of the effects of hormones and other neurotransmitters on brain function. There is also consensus that "male" and "female" brains are different, and that estrogen and progesterone (which exist only in women, even though the "male" sex hormone testosterone is in women as well) affect behavior. Sheinfeld said some contend that estrogen has a protective effect on schizophrenia, and thus the illness tends to develop later in life in women (after menopause) than in men. While this has not been fully proven, estrogen has been shown to inhibit the effects of dopamine in the brain. Progesterone has been found to create calm when present in moderate amounts, but depression when it overwhelms certain areas of the brain. Progesterone levels drop dramatically before menstruation and after childbirth, and thus seem likely to be involved in pre-menstrual syndrome and post-natal depression.

Sheinfeld described the interaction between emotion and menstrual cycles. A haredi woman with a severely disturbed husband who wanted to have sex while she was ritually impure developed amenorrhea (lack of menstruation). This gynecological disturbance developed from her distress at violating Jewish law and also solved her problem, as being freed of her monthly cycle, she did not have to go to the mikve. The psychiatrist recalled another interesting case - a 24-year-old haredi woman and identical twin who could not be more different. At 14, the woman was raped, and her physical development stopped. She was thin, "dried up" and introverted, while her untraumatized sister was radiant, well developed and married. After three months of treatment in Sheinfeld's clinic (which included psychotropic medications), the woman was transformed, regained normal gynecological function, got engaged, married and had two children.

Irregular and excessive menstrual bleeding, she said, often result not only from organic problems but also from untreated emotional syndromes. But very few gynecologists, she concluded, have the training to identify the psychological and other environmental triggers for these disorders.

Among the topics addressed by dozens of other lecturers were coping with attention-deficit/hyperactivity disorder, terror, cancer, blended families (with stepchildren), adolescence, wife beating, Alzheimer's, infertility and sex offenses in prison.

There is certainly an endless number of topics that remain to be thrashed out at the next Nefesh-Israel conference.