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Between Sacred and Medical Realities: Culturally Sensitive Therapy with Jewish Ultra-Orthodox Patients

Published online by Cambridge University Press:  26 September 2008

Yoram Bilu
Affiliation:
Department of PsychologyDepartment of Sociology and AnthropologyThe Hebrew University of Jerusalem (Y. B.)
Eliezer Witztum
Affiliation:
Jerusalem Mental Health Center Ezrath NashimLatner Institute, Jerusalem (E. W.)

Abstract

One disconcerting aspect of the role of culture in shaping human suffering is the gap between the explanatory models of therapists and patients in multicultural settings. This gap is particularly noted in working with Jewish ultra–Orthodox psychiatric patients whose idioms of distress are often derived from a sacred reality not easily reconcilable with psychomedical reality. To meet the challenge to therapeutic efficacy that this incompatibility may pose, we propose a culturally sensitive therapy based on strategic principles that focus on the patient's mythic world and religious idioms of distress as the kernel of therapeutic interventions. Using one case of post–traumatic stress disorder (PTSD) as illustration, we seek to show how the religious symbols through which the patient's distress was articulated may be manipulated to effect cure. The case highlights the narrative quality of both illness construction and self–reconstruction.

Type
Article
Copyright
Copyright © Cambridge University Press 1995

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References

Ben-Ezer, G. 1992. “Yegan Mevraht”: Migration and Absorption of Ethiopian Jews in Israel(in Hebrew) Jerusalem: Mass.Google Scholar
Berger, P. L., and Luckmann, T. 1967. The Social Construction of Reality: A Treatise in the Sociology of Knowledge. New York: Anchor Books.Google Scholar
Bilu, Y. 1985. “The Taming of the Deviants and Beyond: An Analysis of Dybbuk Possession and Exorcism in Judaism.” The Psychoanalytic Study of Society 11: 130.Google Scholar
Bilu, Y., and Witztum, E. 1993. “Working with Jewish UltraOrthodox Patients: Guidelines for a Culturally Sensitive Therapy.” Culture, Medicine and Psychiatry 17: 197233.CrossRefGoogle ScholarPubMed
Bourguignon, E. 1979. Psychological Anthropology. New York Holt, Reinhart& Winston.Google Scholar
Crapanzano, V. 1973. The Hamadsha: A Study in Moroccan Ethnopsychiatry. Berkeley: University of California Press.CrossRefGoogle Scholar
Csordas, T. J. 1983. “The Rhetoric of Transformation in Ritual Healing.” Culture, Medicine and Psychiatry 7: 333ndash;75.CrossRefGoogle ScholarPubMed
Csordas, T. J. 1985. “Medical and Sacred Realities: Between Comparative Religion and Transcultural Psychiatry.” Culture, Medicine and Psychiatry 9: 103ndash;6.CrossRefGoogle Scholar
Dow, J. 1986. “Universal Aspects of Symbolic HealingAmerican Anthropologis 18: 58ndash;69.Google Scholar
Frank, J. D. 1973. Persuasion and Healing. New York: Schocken.Google Scholar
Gaines, E. 1992. “From DSM–I to III–R; Voices of Self, Mastery and the Other: A Cultural Constructivist Reading of U.S. Psychiatrist Classification.” Social Science and Medicine 35: 3ndash;24.CrossRefGoogle Scholar
Good, B. J. 1994. Medicine, Rationality, and Experience. Cambridge: Cambridge University Press.Google Scholar
Good, B. J., and DelVecchio–Good, M. J. 1986. “The Cultural Context of Diagnosis and Therapy: A View from Medical Anthropology.” In Medical Health Research and Practice in Minority Communities: Development of Culturally Sensitive Training Programs, edited by Miranda, M. and Kitano, H.. Washington, D.C.: Department of Health and Human Services.Google Scholar
Good, B. J., DelVecchioGood, M. J., and Moradi, R. 1985. “The Interpretation of Iranian Depressive Illness and Dysphoric Affect.” In Culture and Depression, edited by Kleinman, A. and Good, B.. Berkeley: University of California Press.CrossRefGoogle Scholar
Goodwin, K. G., and Jamison, K. R. 1990. “Cross–Cultural Findings.” In Manic Depressiv Illness. New York: Oxford University Press.Google Scholar
Greenberg, D. andWitztum, E. 1990. “Difficulties in the Treatment of Religious Patients.” American Journal of Psychotherapy 55:554ndash;65.Google Scholar
Haley, J., 1963 Strategies of Psychotherapy. New York: Grune Stratton.CrossRefGoogle Scholar
Kermode, F. 1967. The Sense of Ending. New York: Oxford University Press.Google Scholar
Kiev, A. 1964. Magic, Faith and Healing. New York: The Free Press.Google Scholar
Kleinman, A. 1978. “Clinical Relevance of Anthropalogical and Cross–Cultural Research: Concepts and Strategies.” American journal of Psychiatry 135: 427–31.Google ScholarPubMed
Kleinman, A. 1986. Patients and Healers in the Context of Culture. Berkeley: University of California Press.Google Scholar
Kleinman, A. 1986. Social Origins of Distress and Disease: Depression and Neurasthenia and Pain in Modern China. New Haven: Yale University Press.Google Scholar
Kleinman, A., and Good, B. eds. 1985. Culture and Depression. Berkeley: University of California Press.CrossRefGoogle Scholar
Leff, J. 1988. Psychiatry around the Globe. London Gaskell.Google Scholar
Lévi Strauss, C. 1967. “The Effectiveness of Symbols.” In his Structural Anthropology. Garden City N.Y: Anchor.Google Scholar
Marsella, AJ. and White, G. M. 1982. Cultural Conception of Mental Health and Therapy. Dordrecht: Reidel.CrossRefGoogle Scholar
Myerhoff, B., 1976. “Balancing between Worlds: The Shaman's Calling.” Parabola. 1: 1ndash;31.Google Scholar
Obeyesekere, G. 1985. “Depression, Buddhism, and the Work of Culture in Sri Lanka.” In Culture and Depression, edited by Kleinman, A. and Good, B.. Berkeley: University of Californi Press.Google Scholar
Omer, H. 1993. “Quasi–Literary Elements in Psychotherapy.” Psychotherapy 30: 59ndash;66.CrossRefGoogle Scholar
Opler, KM., ed. 1959. Culture and Mental Health. New York: Macmillan.Google Scholar
Perez, L. 1977. “The Messianic Psychotic Patient.” Israel Annals of Psychiatry 15: 364ndash;74.Google ScholarPubMed
Pliskin, K. I. 1987. Silent Boundaries: Cultural Constraints on Sickness and Diagnosis of Iranians in Israel. “The Cultural Analysis of Depressive Affect: An Example from New Guinea.” In Culture and Depression, edited by Kleinman, A. and Good, B.. Berkeley: University of California Press.Google Scholar
Simons, R. C., and Hughes, C. H., eds. 1985. The Culture–Bound Syndrome. Dordrecht: Riedel.CrossRefGoogle Scholar
Spence, D. 1982. Narrative Truth and Historical Truth. New York: Norton.Google Scholar
Torrey, E. F. 1986. Witchdoctors and Psychiatrists. Northvale, N.J.: Jason Aronson.Google Scholar
Trachtenberg, J. 1974 Jewish Magic and Superstition. New York: Temple Books.Google Scholar
VanderHart, O. 1988. Coping with Loss: The Therapeutic Use of Leave–Taking Rituals. New York: Irvington.Google Scholar
White, M., and Epston, D. 1990 Narrative Means to Therapeutic Ends. New York: Norton.Google Scholar
Wilson, N. E., and Wilson, D. R. 1987. “A Review of Ethnopsychiatric Studies of Depression.” Jefferson Journal of Psychiatry 5: 4153.CrossRefGoogle Scholar
Witztum, E.,Greenberg, D. and Buchbinder, J.T. 1990. “‘A Very Narrow Bridge’: Difficulties in Diagnosis and Management of Mental Illness in a Small Hasidic Sect.” Psychotherapy 27: 124–31.CrossRefGoogle Scholar
Yap, P. M. 1969The Culture–Bound Reactive Syndromes.” In Mental Health Research in Asia and the Pacific. Edited by Caudil, W. and Lin, T.. Honolulu: East–West Center Press.Google Scholar