By Anna Harwood
Chavi awkwardly positions herself on the chair in the group therapy room. The doctors gave her parents no choice—hospitalize her or she will develop organ failure as a result of her deteriorating anorexia. Chavi (not her real name) is just 16 and has grown up in the chareidi enclave of Bnei Brak where there was little public knowledge about the signs of this debilitating disease. One in four people will experience mental illness in his lifetime and this community is no different.
The group therapy room is in the adolescent unit where she has been hospitalized, a couple of miles away from her community and yet a world away from the life she knows. 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 understands the words but not their connotations. They tell her this place will help her get better, but she feels lonelier than ever before, like an outcast, thrown from 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. Times are changing, though. Israel’s most stigmatized sector of society, the chareidi community, is breaking down barriers to tackle their own internal stigma, that of mental illness.
“The last few years have seen the community join together to fight mental illness,” explained Nechami Samuel, a psychotherapist at Mayanei Hayeshua Medical Center (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. “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),” continued Samuel. “These rabbis are now referring families to us, seeking professional guidance, and, together with MHMC, leading a revolution in reducing the stigma of mental illness.” The revolution could not have come sooner; within the first day of the recent Operation Protective Edge, the sirens began to wail in Bnei Brak.
“We have seen an influx in cases because of the war. For some, anxiety disorders get worse, and people who have had no prior anxiety issues may develop disorders because of the situation,” explained Dr. Michael Bunzel, chief psychiatrist at MHMC. “We have been charged by the ministry of health as an acute stress treatment center for Bnei Brak to deal specifically with trauma in the case of a national disaster. The idea is to create separate sites for trauma so that people don’t have to go to the emergency room. Mayanei Hayeshua serves as one of these sites.”
In addition to the upsurge in cases of post-traumatic stress and anxiety, MHMC is continuing to tackle basic mental health needs that affect the entire community. “Take, for example, postnatal depression—ten years ago it just didn’t exist in our community,” added Shimon Goloveizitz, head of administration for MHMC’s psychiatric services. “We’re talking about a communal prevalence of 13% and yet it was brushed under the carpet.” Today, in addition to the organizations that have been founded to provide support for sufferers, a substantial public awareness campaign has been instigated. “Recently we hosted a rabbi-therapist to give a lecture to men to help them spot the signs of postnatal depression in their wives and support them effectively, and 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 center in central Israel. “One day they decided to do an evening for chareidim because they never came to any of their health-promotion events,” he recalled. “They chose a night during Chanukah, brought in glatt kosher food, and entertained the chareidi visitors with a female singer and scantily-clad dancer. They just simply didn’t understand.” There is a massive gulf of knowledge between secular and religious Israelis. For the majority of the Israeli population, religious Judaism is another religion all together and it is only with the furor over army service that the secular population is becoming exposed to the stringencies of this community.
Mayanei Hayeshua Medical Center is currently home to both child and adult outpatient and day-care psychiatric services but they struggle to meet the high demands of this underserved population. Therapists take into account religious sensitivities and the particular challenges of conforming to religious norms. “When I am conducting family therapy and the father doesn’t look at me, rather than racing to conclusions of autism or communication disorders, I think shmirat ha’ayin, (guarding the gaze),” said Samuel. “Even in standard diagnostic tests a child can be diagnosed with low intelligence because he doesn’t know culturally determined answers or a yeshiva student diagnosed with obsessive compulsive disorder because his religious lifestyle fits the criterion for this disease.”
MHMC is now halfway through the construction of a state-of-the-art psychiatric facility which will become the first in Israel solely dedicated to serving the religious population and promises to massively increase the available treatment options. “We don’t close our doors to anyone,” clarified Goloveizitz. “We have patients from all religious backgrounds, but it is an environment of religious respect which is unique to our institution.” The new facility will house both inpatient and outpatient services and is hoping to become a center of excellence for Israeli mental health care. “There is no doubt that there is a need for an inpatient facility when a person is endangering himself 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 and for that we need to build a welcoming environment in which religious people, like Chavi, will feel comfortable living,” added Samuel.
Samuel is one player in the Israeli psychological system which is currently undergoing a major reform. Israel’s psychology services currently predominantly offer psychodynamic therapy, which is a long-term, in-depth therapeutic approach primarily focusing 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 that 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 Behavioral 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,” outlined Samuel, who is an expert in CBT. “Especially with these treatments which have strict protocols, first and foremost, the research outlines the importance of cultural applicability and individual tailoring of treatment goals and plans.”
The future looks hopeful for Israel’s religious community. With 3,350 patients accessing Mayanei Hayeshua’s psychiatric services in 2013 alone, the increased services cannot come too soon. “The first stage of the revolution on stigma has been a success,” said Samuel. “Now we have to stand up to the challenge of the increased demand for our services.” ϖ
Anna Harwood is a student of clinical psychology at Bar Ilan University in Israel.