Make My Soul Better: Mental Health in Israel's Haredi Communities

By Anna Harwood, a student of Clinical Psychology at Bar Ilan University

Chavi* awkwardly positions herself on the chair in the group therapy room. The doctors gave her parents no choice: hospitalise her, or she will develop organ failure as a result of her deteriorating anorexia. Chavi is just 16 and has grown up in the Haredi enclave of Bnei Brak where there was little public awareness about the signs of this debilitating disease. Among the general population, one in four people will experience mental illness in their lifetime. This community is no different.

The group therapy room is part of the adolescent unit where Chavi has been hospitalised, a couple of miles away from her community and yet a world away from the life she knows. The other girls are talking graphically about intimate experiences. They discuss the influence of media on their eating disorders and they talk about their secular lifestyles. Chavi cannot follow their conversations. She understands the words, but not their connotations. The staff tell her this place will help her get better, but she feels lonelier than ever before. She feels like an outcast, thrown out of her community and implanted into an alien world.

Chavi is one of the lucky ones; her parents noticed the signs of mental illness and took her to seek help. She is in treatment, but it is far from ideal. However, times are changing. Israel's most stigmatised sector of society, the Haredi community, is breaking down barriers to tackle its own internal stigma, that of mental illness.

"The last few years have seen the Haredi community join together to fight mental illness," explains Nechami Samuel, a Psychotherapist at Mayanei Hayeshua Medical Centre (MHMC) in Bnei Brak. What was once a taboo subject is now being discussed and debated by the Rabbis, and the message is hitting home. "In Hebrew, we call mental illness, machalat nefesh, illness of the soul. This made our task even harder; we had to persuade people that mental illness is a sickness to be treated by medical professionals, and has nothing to do with a defective soul."

"People in our community don't turn to medical professionals in these situations, they turn to their Rabbi for help with Shalom Bayit (domestic harmony)," continues Samuel. "These Rabbis are now referring families to us. They are seeking professional guidance and together with MHMC, leading a revolution in reducing the stigma of mental illness." Mental illness was once thought of as a problem affecting only the secular community. Now that an institution like MHMC has received a rabbinical stamp of approval, the institution has become accessible to the entire Haredi population - and they come flooding in.

Shimon Goloveizitz, Head of Administation for MHMC's psychiatric services, gives the example of post natal depression. "Ten years ago, it just didn't exist in our community. We're talking about a communal prevalence of 13%, and yet it was brushed under the carpet." Parallel to the work of organisations that have been founded to provide support for sufferers, a substantial public awareness campaign has been instigated. Goloveizitz: "Recently we hosted a Rabbi-therapist to give a lecture to husbands on how to spot the signs of post natal depression in their wives and how to support them effectively. The turnout was overwhelming."

The revolution is slow and it has to come about from within. Prior to his position at MHMC, Goloveizitz managed a health centre in central Israel. "One day, they decided to do an evening for Haredim because they never came to any of their health-promotion events," he recalled. "They organisers chose a night during Hannukah, brought in Glatt Kosher food and entertained the Haredi visitors with a female singer and a scantily clad dancer. They simply didn't get it." There is a massive gulf of knowledge between secular and Haredi Israelis. For the majority of the Israeli population, Haredi Judaism is a different religion altogether. It is only with the furore over military service that the secular population is becoming exposed to the stringencies of the Haredi community.

MHMCe is currently home to both child and adult outpatient and day-care psychiatric services, but the hospital struggles to serve the high level of demand from this under-served population. Goloveizitz: "All of our therapy staff come from a basic religious background which enables a unique level of mutual understanding, a mutual language and knowledge of religious nuances." Therapists take account of religious sensitivities and of the particular challenges of conforming to religious norms. Samuel: "When I am conducting family therapy and the father doesn't look at me, rather than jumping to the conclusion that he has Autism or communication disorder, I think shmirat haayin, (guarding the gaze). Even in standard diagnostic tests, a child can be diagnosed with low intelligence because he doesn't know culturally determined answers. Yeshiva students can be diagnosed with obsessive compulsive disorder because their religious lifestyle fits the criterion for this disease."

The Haredi community would seem to be facing the same problems that plague ethnic minorities in many Western countries whose ethnocentric diagnostic and treatment systems exclude other cultural norms. Israel's misunderstood community faces misdiagnosis and misplaced hostility. MHMC is midway through the construction of a state-of-the-art Multi-discipline Community Mental Health Centre, the first of its kind in Israel dedicated to serving the Heredi population. The new facility promises to substantially increase the available treatment options.

"We don't close our doors to anyone," clarifies Goloveizitz. "We have patients from traditional, Haredi and Modern Orthodox backgrounds. But there is an environment of religious respect which is unique to our institution." The new facility will house both inpatient and outpatient services, and aims to become a centre of excellence for Israeli mental health care. Samuel: "There is no doubt that there is a need for an inpatient facility for people who are endangering themselves or others. But our goal is not to be a sanatorium. We want to give people the tools to reintegrate into society as speedily as possible. For that, we need to build a welcoming environment in which inpatients from the Haredi community, like Chavi, will feel comfortable."

Samuel is a breath of fresh air in the Israeli psychology services which are currently undergoing a major reform. Israel's psychology services predominantly offer psychodynamic therapy, which is a long-term, in-depth therapeutic approach primarily focussing on unconscious internal conflicts. Under the new reform, there is a slow but certain move towards evidence based practice which advocates the use of treatments which have a strong scientific backing. While this does not exclude psychodynamic psychology, for many disorders it often recommends more targeted treatment approaches based on Cognitive Behavioural Therapy (CBT). "Our main purpose is to get our patients back out to the community and we use whatever treatments have been shown to be most effective for that purpose," explains Samuel, herself an expert in CBT. "Especially with treatments that have strict protocols, first and foremost, the research outlines the importance of cultural applicability and individual tailoring of treatment goals and plans."

In addition to the range of treatments now open to the Haredi community, (including Art Therapy, Psychodrama, CBT, Psychodynamic Therapy and Family Therapy), MHMC has become a research centre for trialling some of the latest psychotherapeutic approaches. Samuel is piloting a treatment plan for serious mental illnesses (including schizophrenia and bipolar disorder) which helps patients develop control over their illness and achieve individualised treatment goals.

"We see patients coming to us weak and worn down by the self stigma they have developed though years of secrecy and shame," explains Samuel. "Through the questions, discussions and debates that take place in the group, we see just how much these people have been through. It is amazing to see how much of a relief it is for them to take back the control and the responsibility over their own illness."

Rabbi Chaim Fachler, head of MHMC's International Resource Department, has a personal interest in seeing the Multi-discipline Community Mental Health Centre nearing completion. One of the wings in the new facility will house the Mordechai Fachler Family Therapy Unit, named after Rabbi Fachler's late brother, Rabbi Mordechai Fachler, who combined his scholarship with a dedication to mental health. This new unit will contain the Bayit Yarok (greenhouse) unit, designed to help families deal with the impact of mental illness, which often hits multiple children in one family. The Bayit Hayarok will give parents the tools and strength to halt the downward cycle of familial breakdown.

Rabbi Chaim Fachler: "There is no referral needed and no cost for our services. My brother worked with a range of projects in the UK which were specially designed for the Haredi community that was not accessing national projects. Here in Israel, we have to design special projects for the Haredi community so that they too can receive the highest standard of care."

The future looks hopeful for Israel's Haredi community. "The first stage of the revolution on stigma has been a success," says Samuel. "Now we have to stand up to the challenge of the increased demand for our services."

*Chavi is not the patient's real name.