Increasing Clergy-Clinician Cooperation through Educatoin and Dialogue
Increasing Clergy-Clinician Cooperation Through Education and Dialogue
Seymour Hoffman, Ph.D.
Nina Guy, M.D.
Benny Feldman, M.A.
A program to decrease mutual suspicion and distrust between clergymen and clinicians and increase mutual understanding and cooperation between them through bi-directional education is described.
The attitude of orthodox rabbis toward mental health practitioners varies from outright hostility and distrust to respect and cooperation. Those identified with the ultra-orthodox camp generally view psychotherapists as a threat to religion and religious values, while modern orthodox rabbis generally relate to them as colleagues in ministering to the emotional and psychological needs of people in distress. The former group is generally highly vocal in its condemnation and criticism, while the latter group is generally rather subdued and guarded in its support.
Ultra-orthodox pronouncements vary from temperate, cautious criticism and advice, to ridicule and belittlement, to venomous accusations and outright prohibitions against seeking psycho- therapists’ counsel.
“It is forbidden to go to a psychologist or psychiatrist who is a heretic or atheist… One must seek out a psychologist or psychiatrist who keeps the Torah. If this is not possible, then one can even go to a heretic or atheist, but it must be stipulated and he must promise not to discuss matters of belief and the Torah with the patient.” (Iggerot Moshe, Yoreh De’ah, 2:57).
“Even the best therapists have nothing to offer those whose sins have brought them to depression or sadness, for the help they need is from those knowledgeable in Torah, who are the real healers of souls… Psychologists and psychiatrists steal a lot of money from the patient and let him imagine that he will be healed.” (Tshuvot VeHanhagot, 1:465 by Rabbi Moses Sternbuch).
The ultra-orthodox newspaper Yated Ne’eman reported on a halachic ruling by Rabbi Shmuel Auerbach, head of the Ma’alot haTorah Yeshiva in Jerusalem, that prohibited psychological counseling because “psychological treatment is the advice of the devil and the evil impulse and a terrible obstacle.”
In the Jewish Tribune, an orthodox newspaper in England, Rabbi Shmuel Wosner, a recognized decisor from Bnei Brak, was quoted as stating “their (psychologists) advice is the counsel of the wicked and it usually results in evil.”
Isolated reactions in support of psychological treatment argue that, “Amateur dabbling in this area (psychotherapy) causes negative outcomes and may, God forbid, lead to suicide,” and, “before telling people with phobias, depression and obsessive- compulsive disorders to consult their rabbis and not their psychologists, success rates for rabbis for particular conditions ought to be objectively assessed and published.”
Several actual examples of negative outcomes as a result of “amateur dabbling” by rabbis are presented below.
1. A woman who was hospitalized several times in a psychiatric hospital with a diagnosis of schizophrenia was told by a well-known kabbalist whom she had consulted, that the voices she hears were that of an angel who was punishing her for her transgressions and that she should repent. This declaration was in sharp contrast to her therapist’s attempts to convince the patient that the voices she hears were imaginary and that this was her way of attempting to deal with her unacceptable thoughts and feelings. While the former was reinforcing the patient’s pathology and guilt feelings, the latter was attempting to help the patient strengthen her ability to test reality and diminish her intense guilt feelings and suicidal ideations.
2. A father consulted his rabbi regarding his daughter who was suffering from depression and was not functioning for over a year. The rabbi cautioned the father against consulting a psychiatrist and advised him to change the mezzuzot in his house. When his daughter’s condition didn’t improve after he acquired new mezzuzot, the father sought professional help.
3. A student sought his rabbi’s advice regarding his uncertainty about marrying his fiancée after he noticed that she was extremely preoccupied with cleanliness (she avoided touching objects that fell on the floor, spent considerable time washing, etc.). The rabbi assured his student that his fiancée would stop this “foolishness” after her marriage. A month after the wedding, the student’s wife was hospitalized with a diagnosis of severe obsessive-compulsive disorder and a year later, the couple separated.
Clergymen and clinicians have something of value to offer to each other to enhance the quality of their assistance to the people they serve. Therefore it is extremely important that both professions recognize the limits of their own professional competence and consider the benefits of working and consulting with each other.
In this spirit a partial case study is presented of the psychotherapeutic treatment of a guilt-ridden patient, by the collaborative efforts of a rabbi and a mental health practitioner.
The patient, a 25-year old bachelor who immigrated to Israel with his parents and older sister five years ago, appeared at the clinic with the following complaints: severe depression, poor concentration, pains in the chest and legs, decreased functioning at work, and an overpowering feeling that he was “going crazy” from his constant thoughts regarding the death of his father. Though he had suffered for the last ten years, he refused to seek psychiatric aid until his mother pleaded with him to do so.
His father, who suffered from several serious physical illnesses and who had a long psychiatric history, expressed a desire to end his life. One day the patient found him attempting to hang himself from a basement rafter. The father asked the son to move the table upon which he was standing so that he could die, but the son refused. After repeated taunting and pleading the son in an attempt to appease his father, moved the table from under his father’s feet and immediately returned it to its original place. The father, enraged at his son’s action, began cursing and yelling at him to move the table. The son again moved the table, but this time was unsuccessful in returning it to its original place because of the father’s kicking movements. The patient immediately ran to his mother for help, but on their return, the father had already expired.
A year before seeking psychiatric help, the patient established a relationship with a woman, with whom he was presently sharing an apartment, but not his “awful secret.” The patient felt that he could not marry and bring children into the world because of his fear of not being able to function as a husband and father and “of going crazy.”
In the therapy sessions, an attempt was made to relate to and deal with the patient’s intense and overwhelming guilt feelings regarding the “patricidal” act and his self-punishing behavior, but with little success. At one point, the therapist suggested consulting a rabbi regarding the possibility of atonement for the patient. The patient, who came from a traditional background, agreed. However, he requested that the therapist speak to the rabbi first, in order to prepare him for the “shocking” story. In the initial meeting with the rabbi, the psychologist presented briefly the patient’s history and the purpose and goals of the upcoming meeting. The rabbi, a respected and recognized Torah scholar, was chosen because of his psychological sophistication and experience in counseling students. The meeting was held in a synagogue in the presence of the psychologist. After hearing the patient’s story, the rabbi stated that the offense committed was indeed very serious. He proceeded to explicate on Judaism’s view of the sanctity of life and then read several select portions from Maimonides on repentance. The rabbi then concluded:
“According to the Torah, you are obligated to believe that nothing stands in the way of repentance and this includes even the serious offence that you committed. I am also not convinced that all the responsibility falls upon you, in view of your father’s erratic condition and disturbed behavior. The Torah requires that the penitent go through a process of experiencing and suffering guilt feelings and regret for the offense committed, a process that you have undergone more than is required and it is a pity that it has continued for so long. You are now required to pass on to the second stage of identity change and doing good and charitable deeds. It seems to me that you can realize identity change by getting married and having children. By naming your child after your deceased father, you will be perpetuating his memory for generations. You should also take upon yourself to donate money to a worthwhile charity in your father’s name, visit his grave and in the presence of family members pronounce the new path that you have taken upon yourself and say the Kaddish. God’s mercy will never cease and may he provide you with a complete recovery and forgive your sins.”
In the following therapy session, the patient mentioned that the meeting with the rabbi had a strong impact on him. However, “nothing had changed.” The patient was given the written opinion of the rabbi as he had requested and instructed to take it home to study. He was told it might take him a while to digest the significance of the meeting and the content of the letter and that he should contact the therapist when he felt ready for a meeting. A half-year later, the patient’s girlfriend telephoned to invite the therapist to their wedding and requested that he ask the rabbi to officiate as he had offered in his initial meeting with the patient. In response to the therapist’s inquiry, she reported that her fiancé was doing well and there was a significant decrease in his somatic complaints. The meeting and letter of the rabbi had a profound influence on him, as it forced him to face reality. She mentioned that several weeks ago, he had visited his father’s grave, where he had announced his intention to marry and asked his father for his blessing. A week before the wedding, the couple had a premarital consultation meeting with the rabbi; the following day the patient donated several volumes of religious books – including writings of Maimonides – to the synagogue, in his father’s memory.
In the above case the rabbi’s role and intervention was significant in aiding the patient to extricate himself from the mental morass and guilt-ridden quicksand which imprisoned him. The result was a remission in his symptomatic complaints and a freeing of his energies and thoughts toward change and growth.
While the psychotherapist can explore the subject of guilt, morality, conscience, etc., he cannot participate with the guilty person in repentance, confession, and atonement. Here, only that person whom the guilty man “acknowledges as a hearer and speaker who represents the transcendence believed in by the guilty man” can speak.
Interdisciplinary collaboration between clergymen and mental health practitioners – especially psychotherapists – in treating emotionally disturbed patients is a rare phenomenon. One explanation for this is the relative ignorance of and unfamiliarity with each other’s field and area of concern. This tends to produce anxiety, doubt, suspicion, and mutual distrust.
Bi-directional programs of education and collaboration should be developed and offered to clergymen and clinicians. By providing clergy with some basic knowledge and exposure to psychopathology and psychiatric and psychological treatment, they will develop a greater appreciation for the complexity of the human mind and psychotherapy, and will be in a better position to make more appropriate referrals and provide supportive counseling to their emotionally disordered and distressed parishioners. Likewise, a basic knowledge of religious laws, customs, values and rituals will enable psychotherapists better to appreciate the benefits of religious belief and conduct to mental health and make more effective and appropriate diagnoses, referrals and interventions in their clinical work.
In regards to the latter point, the potential deleterious effect of a significant lacuna in the knowledge of religious laws and rituals of the clinician, was demonstrated recently during a staff conference. The intaker presented a case of a religious patient “who compulsively mumbled a prayer about holes and orifices after exiting from the lavatory.” Several staff members opined that the patient was psychotic and recommended that he be given anti-psychotic medication until a more enlightened staff member explained that religious Jews recite a prayer after relieving themselves, thanking God for his wisdom in creating man.
In response to the above recommendation, a pilot program was recently initiated at Kaplan Hospital by the authors. A prominent communal rabbi was invited to deliver a series of lectures to the mental health staff of the hospital (psychiatrists, psychologists, psychiatric social workers, psychiatric nurses, vocational and rehabilitation therapists and medical and psychology students training at the hospital) on “Mental Health and Judaism.” Issues discussed including Judaism’s view of and attitude towards the mentally ill, the halachic status of the mentally ill, the role of the rabbi in dealing with emotionally distressed and disturbed people, areas of conflict between rabbis and mental health practitioners, rabbis’ attitude toward psychiatric and psychological treatment and cooperation between the two disciplines. These lectures were highly informative and produced spirited give and take between the speaker and the audience.
A series of ten lectures on various aspects of mental health was initiated by the authors for local clergymen. Topics included psychopathology, psychiatric and psychological treatment, re- habilitation and clergy-clinian cooperation. Twenty rabbis (which included mostly teachers and several community rabbis and Rashei Yeshivot) attended the lectures that were given by various mental health professionals (psychiatrists, psychologists, and social workers) from the hospital staff and other lecturers. The participants were asked to fill out a “feedback” questionnaire after each lecture and at the conclusion of the course.
The following is a summary of their responses:
To the questions, “To what extent the course contributed to your understanding of the subject?” and “To what extent the course was important or interesting?”, ninety-five percent of the respondents answered “very much.” Seventy percent were of the opinion that the course helped them “very much” to clarify their position and attitude toward the subject, ninety percent were “very much” interested in additional lectures on the subject and one hundred percent stated that they would recommend that rabbis participate in similar courses. Sixty percent expressed the opinion that as a result of the course, they had a more positive attitude toward the subject of mental health and were more willing to refer people to mental health practitioners. Eighty percent were glad that the course was “for rabbis only” and were interested in participating in ongoing group consultation meetings with a mental health professional.
It is recommended that similar programs be initiated by mental health practitioners for the benefit of rabbis, clinicians, and the people they serve.
Rabbi Naftali Bar-Ilan’s Comment
I would like to make some comments about your last article.
1. I feel it necessary to express my reservations about your determining that ultra-orthodox rabbis generally regard psychiatry as a threat to religion and its values. In the book “ha-Tora ha-Mesamachat” written by Yoseph and Ruth Eliyahu and approved by Rabbi Avigdor Nebenzahl who was one of the outstanding students of Rabbi S.Z. Auerbach זצ"ל we found that Rabbi Auerbach, when asked about a young couple that needed the intervention and treatment of a non-observant psychologist, determined that “not only is it permitted to begin this treatment but it is also a mitzva” (page 115). This was his decision after he examined in detail the nature of the psychologist’s suggested method.
2. What is more, we have found that ultra-orthodox rabbis have often judged that psychological treatment is a matter of saving a soul and in some cases have even permitted the patient to transgress certain prohibitions when the psychologist demanded this. An example of this can be found in an article recently published in the respected journal of halachic medicine in the English edition – Assia – Jewish Medical Ethics, Vol. IV, No. 1, Feb. 2001 pp. 35-40.
3. I cannot accept the basic division between rabbis you call ultra-orthodox and those you call modern-orthodox. They both prefer in the first place God-fearing psychologists and psychiatrists who identify with the patient’s religious beliefs. However, when this is impossible they both permit the referral to a non-observant psychologist on condition that he promise to refrain from dealing with matters of belief and observance.
The attitude of haredi rabbis in general and Rabbi S.Z. Auerbach’s in particular to psychological treatment is a moot subject.
See Rabbi N. Bar-Ilan’s comment in the Israel Journal of Psychiatry (38.2.2001, p. 126) and the following.
In his book, “Vealehu Lo Yibbol,” Nachum Stepansky quotes Rabbi S.Z. Auerbach, “There is place to consult with psychologists if it helps. It is called today ‘Human Relations Workshop.’ So what if it is the wisdom of the gentiles. If there are good advices that can help why not accept them.”
In his “Mishneh Halachot” (part 4, p. 127) Rabbi Menashe Hakatan (Klein) cites an article by Rabbi Moshe Deutch, head of the Katamon Religious court in London, entitled, “Turn not to soothsayers in the guise of psychologists,” where the author makes several points: 1. Rabbi S.Z. Auerbach was of the opinion that “going to them (psychologists) result in much corruption;” 2. The Hazon Ish explicitly stated that one should not go to psychologists because they corrupt more than they repair; 3. The author of “Kehilat Yaacov” was of the same opinion.
The authors wish to thank Rabbi Naftali Bar-Ilan, communal Rabbi, Rehovot, for his significant contribution to the project described above.
Source: ASSIA – Jewish Medical Ethics,
Vol. VI, No. 2, 2004, pp. 31-35
1. Greenberg, D. & Witztun E. “Ultra-orthodox Jewish attitudes toward mental health care,” Israel Journal of Psychiatry Related Sciences, 1994; 31(3):143-144.
2. It recently came to our attention that a new, innovative program was recently initiated by a group of haredi rabbis and religious mental health practitioners from Jerusalem (רפע”ה – רפואה על פי הלכה), to aid sufferers of obsessive-compulsive disorders, from the religious-haredi community. The organization has published a pamphlet explaining the disorder and its treatment and also offers free consultation to sufferers of O.C.D. via the telephone or fax. (Our thanks to Rabbi Naftali Bar-Ilan for bringing this to our attention).
3. In her study on “Orthodox Rabbinic Attitudes to Mental Health Professionals and Referral Patterns,” (Tradition, 31:1, 1996 pp.22-33) Dr. Slanger makes the following points: “It is important for the mental health profession to assume responsibility for initiating contact with the rabbis and engaging in extensive case recruitment efforts”, “…it is essential to acknowledge areas of rabbinic expertise and to harmonize closely with the rabbis in a mutually working alliance.” “Therapeutic approaches which may include participation of the rabbi should be considered.”
4.. Part of the therapeutic process in cases of Post Traumatic Stress Disorder of “accident killers” is “to forgive themselves and move on to redefinition and acceptance of the self.” See, Bulman-Janoff, R., Shatered Assumptions: Towards a New Psychology of Trauma, 1992, New York: the Free Press.
5.. Williamson, D. “New life at graveyard: A method of therapy for individuation from a dead former parent.” Journal of Marriage and Family Consultation 1978; 3:93-101.
6.. van der Hart, O. Coping with Loss: The therapeutic use of leave taking rituals. Trans. C.L. Stennes, New York: Irvington, 1988.
7.. Buber, M. Guilt and guilt feelings, in Friedman, M. ed. The Knowledge of Man, New York: Harper Torchbooks, 1965.
8.. Lichner-Ingram B, Lowe D. Counseling activities and referral practices of rabbis. Journal of Psychology and Judaism 1989; 13(3):133-148.
9.. Rabbi Shlomo Wolbe, a prominent rabbi, author and educator living in Israel, wrote in an article (“Psychiatry and Religion” in In the Pathways of Medicine, 5 Sivan, 5749 (Hebrew)), “there is an urgent need to organize courses for practicing rabbis and educators, in order to disseminate basic knowledge of the symptoms of neurosis and psychosis and their treatment, in order that they will know to refer mentally ill people immediately to the psychiatrist. Basic knowledge will remove many prejudices.”
10. Spero, MH, (ed.). Psychotherapy of the Religious Patient. Springfield, Ill.: Charles C. Thomas, 1985.
11. Recently, “Moreshet Yaacov” in Rehovot, has added the above described course, “Mental Disorders: Identification and Treatment,” to their curriculum for students (Rabbis and teachers) in their B.Ed. program.
12.. Republished in this book, pp. 325-336 above.