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The Chasidic villages of Kiryas Joel in Orange County and New Square in Rockland County have the fastest growing populations of all villages in New York State. Due to high birth rates, large families, and young marriages, from 2000 to 2006 both villages grew in numbers by at least 50%. Kiryas Joel had an increase of almost 7,000 and New Square had an increase of 2,278. In numbers they were surpassed only by New York City. (New York Times, June 29, 2007)
Chasidim comprise a subgroup of Jews that is among the most pious of Orthodox Jewish groups. In this country, they tend to live in closed or tightly-knit communities, dress in distinctive garb, and may primarily speak Yiddish. The movement was begun in the 1700s in Eastern and Central Europe by Jewish mystics. After World War II, many Chasidim immigrated to the United States. Today, there are between 25 to 30 separate and distinct sub-groups (courts) known by the name of the European town in which they originated, each with its own culture and leadership (Mintz, 1998). The leader, the ‘rebbe’ has both political and religious authority. Ideology can vary among the sects but ecstatic prayer and expression of religion through song and dance are common to all.
Chasidim established itself in Europe during the 18th century with founder Yisroel ben Eliezer and became a way of life for many Jews. Finally in the 1880s, with Jewish immigration, Chasidim came to the United States. The biggest wave of Chasidic settlement in the United States occurred after the Second World War in the 1940s and 1950s, when the surviving remnant arrived. Throughout this time and into the 1970s, with immigration and internal growth, the Chasidim came to represent large numbers in the Brooklyn, NY area alongside a dominant Puerto Rican population (Mintz, 1998).
While census data do not capture their numbers, it is estimated that about 3% of the US Jewish population, or approximately 180,000 people, identify as Chasidic. Of those, the vast majority (estimated to be approximately 140,000- 165,000) live in New York (University of Florida News, 2006) in communities that are primarily located in New York City (Borough Park, Williamsburg, and Crown Heights) and upstate in the towns of Monsey, Monroe, Kaser and New Square. The last two decades has seen rapid growth in these communities. They have helped to re-vitalize the summer activities in the Catskills and in Sullivan and Ulster counties.
Prevalence rates of mental illness
Because persons in Chasidic communities have little contact with secular society, it is difficult to assess the prevalence of mental illness in the Chasidic community. Mental health professionals (psychologists, psychiatrists, and the like) are often eschewed for religious helpers, such as rabbis and their wives (Loewenthal, 2005), although psychiatrists who primarily offer psychopharmacological treatments are more accepted as a form of medical doctor. Because of this, Loewenthal (2005) notes estimates of prevalence would be misleading.
A few studies address severe mental illness in Chasidim. Certain Chasidic sects appear to have a higher prevalence of schizophrenia, in general, and paranoid schizophrenia, in particular. One study notes that in one sect, these illnesses appear more frequently than in the general population, but is accounted for mainly by those who have become Chasidic as adults (Witzum, Greenberg & Buchbinder, 1990). Therefore, Witzum and colleagues opine, this fervent form of Judaism may not cause schizophrenia, but rather, may appeal to individuals already at-risk for serious mental illness. Rahav and colleagues (1986), however, found that rates of serious mental illness, including schizophrenia, were almost three times greater in fervently Orthodox communities that included Chasidim and may be genetically transmitted. Mood disorders such as bipolar disorder occur more frequently in Chasidic communities (Loewenthal, 2005), but there appears to be a lower incidence of neurotic disorders (Witzum, Greenberg & Buchbinder, 1990). This may be attributed to a lower occurrence, but may also be ascribed to a predisposition to seek informal care within the community for less serious disorders (Loewenthal, 2005; Witzum, Greenberg & Buchbinder, 1990).
Cultural views of mental illness
Historically, there have been different attributions of mental illness in the Chasidic community. In traditional Yiddish folk-lore, a person with aberrant behavior was viewed as possessed by a dybbuk, a transmigrated soul from another lifetime that had entered the wrong body. Alternately, emotional difficulties may result from yetzer harah (the evil inclination) dominating man’s yetzer tov (the good spirit).
Through the 1970s and in some communities today, mental illness is associated with sinfulness and lapses in religious observance (Bessler, 1999). In this instance, doing teshuvah (repentance) through good deeds, religious study, and stricter observance of the commandments have been viewed as possible remedies. As recently as 1987, Goshen-Gottstein (Bessler, 1999) found that Chasidic leaders in the religious community of Mea Shearim in Jerusalem believed psychotherapists to be heretics and cautioned community members not to engage in psychotherapy.
During the late 1990s, an understanding that biochemical factors contribute to mental illness, “along with the availability of effective medications to counter those factors, de-emphasized the role of religion and morality in treating mental conditions.” (Schudrich, 2008, p. 8) While this has served to mitigate stigma in some groups, Chasidic communities, in particular, are generally slower in recognizing the need for mental health care services than secular American populations.
Impact of cultural values on the use of mental health services
The Jewish home and family are the center of Chasidic life and ideology (Loewenthal, 2005; Margolese, 1998; Public Broadcasting Service, 1998). Families are formed through marriage, and marriages within this community are semi-arranged with the bride and groom meeting briefly before agreeing to marry. Shidduchim, or marriage matches, are made through professional matchmakers or through community members, and dating is prescribed by religious laws of modesty. Marriage typically takes place when the bride is in late adolescence and the groom is slightly older (Levine, 1998).
Children are viewed as a blessing in Chasidic families, and family size is typically large. Couples typically have six or more children who are educated in private Chasidic schools (Loewenthal, 2005; Public Broadcasting Service, 1998).
Men and women have defined roles within the Chasidic family. Husbands and fathers may be the family’s breadwinner, but careers are secondary to engaging in religious study. Wives are responsible for raising children and decision-making within the home. (Public Broadcasting Service, 1998).
Family-oriented Jewish laws may serve as barriers to engagement in or continuation of mental health care services. These include concerns about violating laws pertaining to honoring one’s parents (kibud av v’em), and privacy between unrelated persons of the opposite sex (yichud) (Margolese, 1998; Schudrich, 2008)
When working with families, Weiselberg, as cited in Margolese (1998), believes that structural family therapy is particularly relevant to Chasidic consumers because of the congruence between this type of therapy and the defined hierarchy that is typical within Chasidic families.
Role of Women
Women’s roles are narrowly defined in Chasidic communities by both custom and religious law. Modest dress is emphasized for women and girls, and clothing is designed to cover the body from the neck to below the elbows and knees. The Torah (the Five Books of Moses) prohibits females from wearing clothing designed for males, so girls and women wear long skirts or dresses. Married women cover their hair completely with hats, wigs, or scarves.
Contact between males and females are tightly prescribed in Chasidic societies. Children are educated in single-sex schools, social and community events have separate seating areas for men and women; physical contact between unrelated males and females is forbidden early on (Sublette & Trappler, 2000).
Generally ready for marriage between the ages of 19 and 21 (Levine, 1998), women may take on the role of main breadwinner and caretaker of large families in order to allow their husbands to engage in full-time religious study. Certain occupations seem to be particularly popular amongst Chasidic women as they do not conflict with cultural values. These include owning small businesses that cater to the community’s needs, teaching, and medical or para-medical careers. Frequently, women in these communities have a wider secular education than men. The number receiving university education is growing (Loewenthal, 2006).
While Chasidic women are involved in commerce, their greatest commitments are to their families. There is a high value placed on having as many children as possible (Loewenthal, 2006) and mothers being the primary carergivers within their families. “Chasidic women are expected to find spiritual fulfillment primarily in motherhood.” Their roles as mothers are so important that it supersedes Torah study and other social and religious obligations (Rudavsky & Daum, 1998).
Social and Economic Class
In contrast to secular American society, factors such as family lineage, dedication to Torah study and religious observance, and scholarliness are highly valued and play integral roles in dictating social class.
There is, however, a high level of poverty in Chasidic communities. Cultural and religious values, such as an emphasis on large family size, children being enrolled in private religious schools, and relatively low levels of secular education, limit job opportunities and, thus, opportunities for socioeconomic status as envisioned by mainstream American culture. In a 2002 study of the Jewish community of New York, 63% of the Jews of Borough Park reported household incomes of less than $35,000, and 64% reported not being able to meet expenses or barely being able to do so. Similarly, 64% of the Jews in Williamsburg section of Brooklyn reported household incomes of less than $35,000, and 62% described themselves as poor or very poor (Ukeles & Miller, 2004).
Shame and Stigma
The fear of being shamed is perhaps one of the more compelling reasons why Chasidic Jews do not seek treatment for mental illness. Loewenthal and Rogers (2004) note that seeking mental health care services indicates a perceived personal weakness or failure on the part of the consumer. Many fervently Orthodox Jews believe that the Torah holds the answers to all of life’s problems. If an individual needs to seek help outside the Torah (e.g., from a psychotherapist), he may be perceived by others as damaged or a failure (Bessler, 1999). In order to counter this, therapists catering to this population may go to great lengths to ensure confidentiality amongst clients, including setting up private waiting areas (Wikler, 1999). Other clients may travel great distances (hundreds of miles or more) in order to avoid seeing someone they know when they enter or leave therapists’ offices (DuBowski, 2001).
The culture of Orthodox Judaism includes subordinating individual needs to those of the community (Ringel & Bina, 2007). Children are frequently seen as extensions of their parents in Jewish communities (Orthodox or otherwise) and there are “fuzzy boundaries between the self, family, and community.” (Featherman, 1995, p. 150) This sometimes leads individuals to forgo mental health care treatment in order to not stigmatize their families.
An additional barrier to seeking mental health care is the shame that could be brought to one’s family when a marriage partner (shidduch) is sought for one’s self or a close family member. Mental health care treatment, if discovered by any party in the matchmaking process, could significantly reduce an individual’s prospects for a favorable marriage (Dubowski, 2001; Loewenthal & Rogers, 2004; Ringel & Bina, 2007; Wikler, 1999).
Work and Secular Activities
While pursuing a career for the sake of personal fulfillment is outside the mindset of most Chasidim, many work and pursue business opportunities with those outside their enclaves. Businesses established by Chasidim frequently employ family members and others from their own communities and can be highly successful. For many Chasidim, working outside their neighborhoods is the only contact they have with non-Chasidim. Many Chasidim are heavily involved in retail, sales, and technology even though they do not make much use of these products themselves.
Due to limited secular education, many Chasidim seek employment as teachers within their own communities. Those seeking other employment may take courses to train for a particular job. Lubavitch Chasidim are the most visible group of Chasidim to secular society. Lubavitch shiluchim (emissaries), comprised of a rabbi and his wife, are situated in communities throughout the world where Jews of all levels of affiliation are welcomed and encouraged to participate in Judaism at any level they choose. Their organizations, known as Chabad Houses, offer opportunities for all Jews to participate in Jewish life and to practice their religion even in remote parts of the world.
Growing numbers do pursue secular education including university training. They now also include many doctors, a noted New York neurologist, scores of EMT workers and ambulance drivers (some of whom are part of Orthodox Hatzolah ambulance groups and others part of general community units). Most continue to remain in the Chasdic fold. Others may drift away, but still choose another option witin Orthodox Jewry.
Spirituality is a moving force in Chasidic life and was, in fact, the impetus for the movement’s inception. The Baal Shem Tov, founder of Chasidism, believed that everyday life should be imbued with joy and with the spiritual. Acts such as working, eating, and raising children could create gladness through spirituality (Rudavsky & Daum, 1998).
Today, spirituality continues to play a major role in Chasidic life. Rousing melodies, dancing, and stories are identifiers in these communities, and many rituals and practices have been developed in order to evoke spiritual feelings and images in participants.
Impact of acculturation on treatment
Most Chasidim take joy in their way of life and in the leadership of their rebbes. Based on a long history of pogroms, discrimination, forced living in ghetto communities and then the Holocaust, the outside world is viewed with a degree of suspicion and mistrust. To sustain their way of life and avoid outside influences, movies, secular newspapers and magazines, television, the internet (other than for business activities) and involvement with the general culture are proscribed. Chasidim live within their own enclaves, attend their own schools, and want to be near their synagogue and rebbe, the grand Rabbi of their own particular court whom they honor and look to for advice and guidance on both spiritual and everyday matters. In difficult times, he becomes the first source of help. Rabbis known as miracle-workers may also be sought out.
Nonetheless modern society does make inroads on the Chasidic world and some adaptations are made. There is no avoidance of modern technology in support of business enterprises: cell phones and computers in business are readily used. Women have gone to work, and become either the second or sole support of their families. While education emphasizes religious studies, secular study is permitted for the purpose of developing work skills and careers. For example, one Chasid from a long rabbinical dynasty is a well known psychiatrist, another is a Deputy Sheriff, and two are volunteer firemen. In Brooklyn, some Chasidim have become part of local civic groups working toward the betterment of their neighborhoods, and particularly to improve relationships with neighboring African Americans. A few Chasidic singers have risen to the level of rock stars appealing to both a religious and general audience.
Mental health care seeking patterns
Chasidic communities have a wide-spread system of self-help. Every Chasidic community has its own bikur cholim (aid to the sick), burial societies, and emergency responders. Chasidic self-help groups are mainly supported solely by charitable funds. If governmental grants are accepted, the organization operates on a non-sectarian basis.
There is antipathy toward seeking mental health treatment even from Orthodox-sponsored agencies. However, there is a slow and growing realization that some services are needed. When not available in their own communities, Chasidim will send their children to non-Chasidic special education programs, including public schools. Chasidim and other Orthodox Jews look upon psychotherapy as ambiguous at best, and heretical at worst. They are especially concerned about a therapist's hashgafa (religious outlook), and fear that modern therapists might influence a patient to turn away from religious practices. Many would prefer a non-Jewish therapist to a therapist who was Jewish but non-observant. When psychiatrists are consulted, it is most frequently for psychiatric medications. State psychiatric hospitals are utilized when psychiatric hospitalization is required.
For patients and their families, a biological model of treatment that emphasizes long-term maintenance on psychotropic medication, monthly pharmacotherapeutic visits, lowered expectations, and reduced emphasis on expressive psychotherapy is compatible with this community's ideas about mental illness.
Women whose resources were once only the rebetzin (Rabbi’s wife) or mikvah lady (ritual bath attendant) – many of whom are at the forefront in noting spousal abuse – are becoming more willing to speak with a female clinical social worker, many of whom are Orthodox themselves.
While the prevalence of domestic violence (DV) within the Chasidic community is unknown, studies have identified factors that contribute to DV within the larger Orthodox community. These include poor communication between spouses that is based on societal separation of the sexes, male dominance (which may manifest itself in violating laws of family purity), and socioeconomic factors associated with raising large families with an Orthodox lifestyle (e.g., enrollment of children in private religious schools) (Metropolitan Council on Jewish Poverty, 2003; Ringel & Bina, 2007).
Ringel and Bina (2007) note barriers Orthodox women face when seeking help for DV. These include the perception that help seeking conflicts with religious values such as privacy within the family and peace in the home (shalom bayit). Others fear that asking for help would include encouragement to leave the abusive spouse which conflicts with Orthodox norms; divorce is rare and stigmatized within the fervently Orthodox community.
While little is known specifically about DV in the Chasidic community, the New York metropolitan area is home to several agencies designed to meet the needs of Orthodox and fervently Orthodox survivors of spousal abuse and enhance communication in couples. The success of these programs hinges upon rabbinic endorsement as rabbis are gatekeepers to help-seeking behaviors within the Orthodox community, in general, and the Chasidic community, in particular (Project SARAH, n.d.; Shalom Task Force, 2007).
There is a dearth of information regarding sexual abuse within the Orthodox community. Yehuda and colleagues (2007) found that approximately 26% of Orthodox women have been abused at some time in their lives, a rate that mirrors the prevalence of sexual abuse within the larger American community. After the publication of the study’s results in the October 25, 2007, edition of New York’s most widely circulated newspaper, The Jewish Week, passionate reactions to the initial article generated reader reaction for months. Some verbally attacked the study participants and study authors personally, suggesting that they lacked a commitment to Judaism and the Jewish community. Others assailed the authors’ study design and methodology particularly citing the fact that women were included who did not grow up Orthodox. Alternately, some praised the study’s publication and suggested that the problem of sexual abuse within the Orthodox community is real and must be addressed (Blau, 2007; Max, 2008; Muhlberg, 2008; Salamon, 2007; Schick, 2008; Shafran, 2007; Teller, 2008).
Problems with how the Orthodox community deals with this problem are compounded by differing rabbinic opinions on the reporting of sexual abuse to secular authorities in the case of child victims. Despite these differences, several programs exist in New York to help address this problem. Services vary from agency to agency, but include advocacy, psychoeducation, survivor psychotherapy, and offender psychotherapy.
[Wendy Schudrich, LMSW and Robert Schore, LCSW contributed to this report.]
© 2009, OMH
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