Jewish teachings and beliefs about depression

The aim of this study was to explore influence strictly orthodox Jewish literature was searched for Jewish consenting strictly orthodox Jews using a semi-structured interview schedule of and treatments for depression. transcribed interviews and explore the Jewish teachings identified in the literature and the community included preserving life, using appropriate, help others. Contrasts between included community concerns about literature, and greater rabbinic emphasis depression. Findings could prove orthodox Jews. Keywords: depression; Jewish teachings;

Introduction

The strictly orthodox Jewish community in rabbinic guidance, and lifelong study of Greenberg & Wiztum, 2001; Loewenthal et This study looks at beliefs in the strictly treatments of depression, comparing Do community beliefs show evidence of In what respects? And if there are differences, beliefs about depression affect interaction interest is whether the emphasis in hasidic 1993, pp. 93–110) is reflected in community

*Corresponding author.

ISSN 1367–4676 print/ISSN 1469–9737 online beliefs about depression in the strictly Jewish community? and Kate Miriam Loewenthalb

University College London, London, UK; University of London, Egham Hill, Egham, 0EX UK version received 28 August 2012)

whether and, if so, how Jewish teachings beliefs about depression. The rabbinic teachings relevant to depression. Ten were purposively selected and interviewed focussing on their beliefs about causes Thematic analysis was used to analyse relationships between community beliefs and review. The key themes in both the rabbinic the overriding importance in Judaism of acceptable means to do so, and obligations to rabbinic teachings and community beliefs stigma, generally lacking in the rabbinic on spiritual exertion in dealing with useful to those managing depressed,

ethics

London, Israel and elsewhere lives with close religious teachings is widely practised (e.g., al., 1995). What impact might such study have? orthodox Jewish community about the causes and them to views in the rabbinic literature. being similar to those in the rabbinic literature? in what respects, and why? How might with sufferers from depression? One issue of teachings on joy (e.g., see Schatz-Uffenheimer, attitudes.

The rabbinic literature on depression Search methods involved, in addition to identification of books covering Jewish libraries, searching them for teachings tion relevant to Jewish teachings was This section identifies salient themes in of depression, as well as ways of coping, It was noted that the distinctions between are not sharply drawn in the rabbinic all such states. Causal factors: Two broad groups were secondly, external events (stressors). However, perception of personal failing, it can depression itself can be seen as a failing, service of G-d. For example Schatz-Uffenheimer imperative . . . never to despair, be sad or cause ‘‘the fundamental sin of interrupting Hasidism . . . Surrender to despair means 388–389) pointed out that ‘‘depression, undermine the confidence required for Tchernobil (cited in Buber, 1975, p. 173) to darkness and depression,’’ unable to desire to come close to God, must pass the falling is for the sake of the rising.’’ Rebbe operates within the perspective (often caused by depression) as offering Coping: Suffering and/or personal failings may be combated by a range of methods. prayer, salvation and gratitude,’’ and ‘‘it is with joy,’’ since it ‘‘may have the effect ultimate in joy . . . [enabling him to] ing . . . then will the . . . suffering cease’’ teachings of the Piazesner Rebbe). The prayer etc. – are cognitive and emotional. recommended a strategy involving some indeed with features resembling contemporary habituate himself in these (desirable) established . . . Time after time he shall performing them is easy . . . and (they) are recommended a temperate life, which involved paintings and walking in pleasant Hoffman and Hacarmi (2000, pp. 186–187) that ‘‘action retrains behavior and thought.’’ Prayer and religious study are widely particular emphasis on the reading/recitation (1990, p. 128) emphasised the value of the

electronic searching of relevant literature, manual medical ethics and law in Jewish and university applicable to depression. Further, much informaobtained by manual searching in relevant libraries. the rabbinic literature on the nature and causes treatment and help-seeking. guilt, sadness, melancholy and depression literature, though there are extensive discussions of

identified. Firstly, sin (personal failings), and although depression may be a result of the act as a spur to improvement. Additionally, to be avoided, detracting from the joyful

(1993, pp. 91, 95, 102) quoted the ‘‘hasidic be regretful,’’ even over past sins, as this could one’s service’’ to God. ‘‘Sadness is a great sin in surrender to the Evil Urge.’’ Lamm (1999, pp. which ostensibly spurs one to repentance, can self-mastery.’’ However, Rabbi Nahum of comforted his disciples who ‘‘had fallen prey pray although wanting to, that those ‘‘who truly through the state of cessation of spiritual life and Schindler (1990, p. 34) pointed out ‘‘The Piazesner of the Baal Shem Tov that sees suffering man an opportunity to rise or fall.’’ may lead to depression, sorrow and guilt. These For example suffering ‘‘leads to repentance, precisely in suffering that one should respond of enhancing devekut,’’ which ‘‘represents the contemplate the holy spark hidden within suffer(Schindler, 1990, pp. 32–34, describing the list of coping methods above – repentance, Maimonides (1975 translation, pp. 28–29, 73) behavioural as well as cognitive components, cognitive-behaviour therapy: ‘‘A man shall character traits until they are firmly perform actions . . . repeat them continually until firmly established in his soul.’’ Maimonides also healthy eating and exercise, music, poetry, surroundings, as ways of promoting well-being. emphasised how Rabbinic teachings indicate

encouraged, with many rabbinic authors placing of psalms. For example, Witztum et al. Hattikkun Hakkelali, ‘‘a collection of Psalms

Mental Health, Religion &

dealing with man in distress . . . both a clinical tool and Schneersohn, the late Lubavitcher Rebbe, advised oneself in the three areas of Torah study, prayer, and (cited in Wineberg, 2007, pp. 44–45), to ‘‘fight depression from it as you would run from death itself’’ (Wineberg, diligence in Torah study . . . We must completely distance and marah shechorah (black bile – i.e., melancholy) . . . accomplish it by not thinking about oneself but about is to be deliberately joyful: ‘‘I have advised you not to (Tehillim 100:2) exhorts us: ‘Serve G-d with joy’. For down for him an even greater and more enhanced (Schneersohn, 1986, p. 34). Finally, the value of ‘‘Listening to songs and . . . melodies, . . . walking soul . . . and make the disturbance . . . disappear’’ Rabbi Nachman of Bratzlav believed

despair is shunned and solace and encouragement are dance, communion with the zaddik, and prayer. To be you are sick or depressed . . . you dance . . . through dancing (cited in Wiztum, Greenberg, & Buchbinder, 1990, pp. In summary, rabbinic sources recommend a full behavioural strategies for combating depression. The spiritual flavour. Prayer and religious study, enhancing and guidance, practising kindness and the divine to be used. Professional help-seeking: Here there are mixed views. favours professional help-seeking: (e.g., Greenberg & & King, 2007; Littlewood & Lipsedge, 1997; Rabbis are willing to refer to and liaise with psychiatrists religiously trustworthy and understanding of orthodox Lubavitcher Rebbe (Schneersohn, 2002, p. 151) warned the benefit he may receive . . . outweighs the long-time some therapists’ approach, ‘‘deriding G-d, spirituality, the like.’’ However the Lubavitcher Rebbe viewed logotherapy approach that ‘‘faith . . . its connection to in life enhance man’s inner peace and tranquility’’ [Frankel’s] school of thought has not been (Schneersohn, 2002, p. 150). It is generally known that depressed states can lead imperative to preserve life is of the highest priority. your lives will I require’’ (Genesis 9.5) is interpreted that ‘‘the act of suicide is a cardinal transgression.’’ danger’’ including the risk of suicide, must (if necessary) and proven reliable . . . despite his protestations and . pp. 12–13). However, anti-psychotherapy views have been 1993 the London Jewish Tribune reported that Katamon religious court in London, expressing ‘‘psychologists and others who are Apikorsim [a

Culture 3

a poetic work.’’ Rabbi Menachem the importance of: ‘‘strengthening performing acts of lovingkindness’’ as a blood sworn enemy . . . run 2007, p. 114) and ‘‘increasing your ourselves from atzvus (sadness) If one cannot achieve this, one can G-d.’’ A further important method be sad and depressed . . . The verse man’s joy [in the lower world] draws measure of joy from Above’’ music and dance are recognised: in gardens . . . which delight the (Maimonides, 1975 translation, p. 75).

provided by niggun [tune/melody] . . . joyous is . . . a divine obligation . . . if and body motions, joy is aroused 124–125). range of cognitive, emotional and strategies all have an intrinsically joyful mood, religious fellowship commandments are among the strategies

The normative current rabbinic view Wiztum, 2001; Leavey, Loewenthal, Loewenthal, 2006). Most contemporary and psychotherapists, preferably Jewish values and beliefs. The that one must ‘‘ascertain whether harm that may result’’ from honoring one’s parents and positively Frankel’s (e.g., 1986) good deeds and finding meaning and expressed surprise ‘‘that his sufficiently publicized and accepted’’

to self-destruction, and the Judaic Thus the statement: ‘‘Your blood of (Bleich, 1981, pp. 158–159) to consider Therefore, a patient ‘‘in mortal receive treatment ‘‘when tested . . against his will’’ (Weiner, 1995,

vigorously advocated. For example in Rabbi Moshe Deutsch, Head of the major concern about consulting derogatory term . . . a heretic].’’

J.E.B. Bayes and K.M.

Deutsch asserted that accepting psychiatrists’ advice of Israel, America and Canada ‘‘because they are against the Torah and transgresses Jewish Law.’’ ‘‘Tribune’’ during 1993–1994; some Orthodox therapists Rabbis condemned them – whilst psychologists therapy; they recommended publishing success psychiatric conditions. Greenberg and Witztum behind this negative rabbinical attitude to psychotherapy, potential challenge of ultimate rabbinical authority, as a ‘‘godless product of godless people.’’ Community-based factors can affect help-seeking. based support, including formal religiously sensitive (Loewenthal & Brooke-Rogers, 2004). But individuals for fear of becoming stigmatised as mentally ill Greenberg & Wiztum, 2001). Rabbinic discussions Among these themes, probably the most noteworthy moral and spiritual aspects of depression, the possible depression, and the overcoming of depression noteworthy is rabbinic emphasis on the religious help is sought.

Community interviews The aim of these interviews was to obtain current depression from a range of individuals in the haredi community. Interviewees: Purposive/opportunistic sampling was the London strictly orthodox community with a men and five women, age range 24–78; five hasidim and Vizhnitz) and five other haredim. There professional involvement in mental health care, participants were community members. Interviewees knowledge of Jewish sources and of information that the sample size would enable sufficient saturation a priori grounds for expecting gender differences; it adequate for salient gender differences, if any, to be The semi-structured interview schedule asked for management of depression, attitudes in the community, ever be compulsorily enforced. The questions were cited, and from two clinical psychologists with haredi community, with the aim of encouraging and develop their thinking during the interview. interpretive phenomenological analysis approach, 145–167; Smith & Osborn, 2003, pp. 51–74) with 2003, pp. 81–110). Questioning was modified as the relevance of responses.

Loewenthal

was condemned by the greatest rabbis unprincipled and give advice that is Vigorous debate continued in the advertised telephone counselling, stressed the risks of depriving patients of rates for rabbinical management of (2001, pp. 218–222) discussed reasons including resistance to change, and the perception of psychotherapy

Individuals may use communitypsychological support and therapy may avoid any form of help-seeking (e.g., Cinnirella & Loewenthal, 1999; of stigma were not identified. are the rabbinic emphasis on the role of personal failings in leading to by personal spiritual exertion. Also suitability of any therapist from whom

views on the causes of and treatments for (strictly orthodox) London Jewish

used in selecting 10 interviewees from range of ages and views. There were five (Chernobyl, Ger, Lubavitch, Satmar, were three participants with some three rabbis and the remaining four were selected to give a range of about mental illness. It was anticipated for thematic analysis. There were no was expected that the sample size was apparent. views on the causes, nature and and whether treatment should chosen using guidance from the books experience in treating members of the interviewees to talk freely about the topics Interviewing was based on a qualitative, (Rubin & Rubin, 1995, pp. 31–36, elements of grounded theory (Charmaz, interviews proceeded, to improve the

Ethical issues: The Research Ethics confirmed that the study met criteria for decided that, should a participant become practitioner or Chizuk, the community’s problems, would be consulted; this proved Analysis: Interviews were recorded, transcribed recommended by Smith and Osborn (2003, identifying key themes from the first transcript, observations, quotations and new themes theme, with relevant quotations. We will describe the emergent themes rabbinic literature: causal factors, coping a comparison of the rabbinic and community Causal factors: The salient intrinsic causal community were biological and character brain . . . not producing the right amount ‘‘Being less able than others to take stress.’’ ‘‘Giving in to the evil inclination and not an opportunity for growth: we are ‘‘meant and challenges in life.’’ Extrinsic causes of divorce, breakdown in relationships, harassment at work, as well as serious understood making these harder to cope exacerbated by the recession, were specifically people to try to have more things they satisfied with everything . . . the need to have Management and treatment: A wide range tendency towards attempting to identify and relationship and financial difficulties, as helpful and friendly, reading ‘‘self-help therapies’’ like counselling and psychotherapy, more helpful than drug treatment – which resort in severe depression. Prayer, reciting mentioned – as was support from Smiley, described below. There was reluctance the risk of stigmatisation – a disincentive to Most participants accepted that patients not responding to treatment, might require their life and health. Jewish teachings about life were stressed and the importance of More specifically, non-medical approaches affects the brain.’’ ‘‘I certainly wouldn’t ‘assess this boy . . . and if necessary give sufferers was recommended – ‘‘let’s try and ‘‘having someone who understands can else – volunteering . . . give charity – that in other things.’’ These could include

Committee (REC) at University College London exemption from REC consideration. It was distressed by discussing any issues, their general supportive agency for people with mental health unnecessary. and analysed, guided by the approaches pp. 64–79) and Rubin (1995, pp. 226–256), linking similar themes and adding relevant from all interviews. Notes were prepared on each

under same broad groupings as those in the and professional help-seeking, before turning to views. factors for depression mentioned by the predispositions: ‘‘chemical imbalance,’’ ‘‘the of chemicals,’’ ‘‘Something within themselves,’’ Spiritual factors were occasionally mentioned: trusting G-d,’’ with a mention of using stress as to grow and learn and develop’’ from the ‘‘trials depression, the ‘‘trials and challenges’’ included family pressures, difficulties with children and physical illness, with loneliness and not feeling with. Financial problems, including redundancy, mentioned by many – linked to a ‘‘need for didn’t need in the old shtetl – where people were the same as others . . . money.’’

of approaches was suggested, with a strong tackle underlying causes, including loneliness, well as seeking symptomatic relief. So, being books,’’ ‘‘distraction,’’ as well as ‘‘talking were thought by most to be potentially several thought should only be used as a last psalms and seeking help from a Rabbi were all community organisations – including Chizuk and to consult psychiatrists, often because of seeking treatment for mental health problems. suffering severe depression, lacking insight and treatment without their consent to safeguard the vital importance of saving and preserving serving the Divine with joy – in prayer and action. were recommended first, since ‘‘any drug run to a psychiatrist in the first place and say them medication’.’’ ‘‘Talking it through’’ with look positive and see ways we can help you’’; really help.’’ ‘‘Try to get them to help someone can help’’ and ‘‘distraction – get them interested ‘‘relaxation, swimming, other exercise – all known to

alleviate depression’’ as well as art, drama their depressions . . . and of course King the voluntary ‘‘Smiley’’ organisation or . . . hospital and play music . . . sing to depression . . . and help them.’’ ‘‘They apy . . . affects endorphins – no drugs, no people, including reading from the ‘‘Jewish are feeling low.’’ Authors recommended Yitzhak Frand, Rabbi Selig Pliskin, Petach help book, (2008) based on his own ‘‘practical guidance distilled’’ with teachings. Rabbi Pliskin’s ‘‘Gateway to help guide, packed with advice based on useful in his counselling practice, stressing and drawing on a range of rabbinic obligation to be happy, the importance self-worth. These views were reflected (including ‘‘Mishpacha,’’ ‘‘Binah’’ and guidance – ‘‘they will tackle subjects recommended, for those haredim prepared ‘‘ilovetorah’’ run by Reb Moshe of simchah (joy) in Judaism and ways of Complementary/alternative medical thought useful by some: ‘‘the ability to be mentioned in the Talmud . . . in the Religious approaches involved prayer, teachings. Praying was mentioned by that, without prayer, nothing happens Specific prayers or – particularly – reciting there for anybody in a difficult situation.’’ God – tell Him you are not managing – any language and any form – you can The Rabbi is often approached for congregation, but may be another Rabbi communal figure) in the community ‘‘Pour one’s heart out to him – he’s Rabbis were ‘‘particularly clued up on sources of advice on where to go understanding and appropriate advice . . Direct study of Jewish sources is (Pentateuch) – and men the Gemara it can give a person pleasure – I’ve heard and learning a Jewish teaching can give What about professional help? sometimes used interchangeably) ‘‘including behavioural therapy (CBT) which is all used appropriately in selected cases, to gives you space to reflect . . . access interviewees also recommended CBT.

and music which ‘‘people often use . . . to relieve David – Saul.’’ Music is used therapeutically by who ‘‘take their guitars . . . go to the home him or her, you know, and snap her out of the just go and make people happy . . . smile thercost.’’ Self-help was thought valuable for many literature for people to seek solace when they included Rabbi Dr Abraham Twersky, Rabbi Krohn and Rabbi Horowitz. Rabbi Spitz’ selfexperience of depression and recovery, offered constructive suggestions for sufferers, based on Jewish Happiness’’ (1983) also provided a practical selfJewish teachings, using techniques he had found that ‘‘happiness is a skill that can be learned,’’ sources presenting discussions of the religious of appreciating what one has and realising one’s by the interviewees. Jewish family magazines ‘‘Jewish Press’’) were also thought to contain useful that never used to be talked about.’’ Also to use computers, were Jewish websites such as Tsfat, providing guidance on the importance of achieving it. treatments such as Shiatsu and healing were also a healer . . . with eyes, with voice . . . with touch is Gemara.’’ consulting a Rabbi, and turning to Jewish almost all (nine) interviewees; ‘‘there is no doubt . . . without the help of God, nothing happens.’’ psalms ‘‘help to relax me, to calm me’’ and ‘‘are Specific prayers were not the only way: ‘‘Pray to not coping – we strongly believe you can pray in say literally ‘God, help me’.’’ advice and support. This is often the Rabbi of one’s or Rebbetsen (Rabbi’s wife, or other woman known for their expertise and counselling skills. there to help you.’’ Others emphasised that some possible forms of treatment and can be very good for help’’ and that ‘‘they would receive good . on balance most of it is pretty good.’’ also popular: ‘‘learning from texts like Chumash (Talmud) . . . they say that, although it is very difficult, it can actually take a person out of depression – a person pleasure – in my opinion.’’ Counselling and psychotherapy (these terms were analytical and psychodynamic to cognitive the vogue at the moment’’ were thought, when ‘‘help with understanding [because a] therapist what is causing depression.’’ Other professional Logotherapy (Viktor Frankl Institut, 2012), which

helped ‘‘develop a sense of meaning and purpose valuable, since ‘‘depression derives from an sufferers were thought unready for therapy – if left to themselves until they wanted treatment.’’ might need encouragement or pushing to accept a needle and I shall open for you a hallway’’ interviewees stressed: ‘‘when it comes to patients see someone that is sensitive to their needs and understanding - and preferably if they Medication was recognised by all as necessary ‘‘if enzymes lacking . . . close the trap door to A more cautious view was: ‘‘(medication) can [doctors were] too quick to give antidepressants view: ‘‘the whole spectrum – with two extremes therapeutic interventions – if used appropriately, However, if someone in his family were affected, understanding doctor who understands the therapy was thought acceptable by some if others felt uncomfortable about it; ‘‘there community people don’t like drastic forms of Treatment without consent was considered interviewees, in severe, unresponsive depression danger to themselves, it is acceptable to treat cannot allow someone with depression to take thing is life . . . if it’s the only way to save form of handcuffs.’’ The rabbis recognised the they’re dead, they don’t get any deader – if they get better – you choose!’’ One lay member suicide – I’d be desperate – you’d try anything husband – and friends; bring in a professional got to know I have done my best. I’d ask the them to be treated against their will’. However this prospect.’’ It was suggested that the principle of ‘‘transgressing’’ on Sabbath – if considered rabbinical guidance, could be extended to bearable level in depressed patients. The community itself was seen to influence particularly via social support, culture brokers, Social support included informal support via several community-based organisations focused problems. Most interviewees referred to the huge amount of goodwill . . . of quiet help . . . of cheering people – family, friends and others. psychiatric illness – others very sympathetic always have the ability.’’ Also stressed was the North London’s haredi community, from which had done much to remove stigma as well sessions, drama and art therapy, and providing

. . . has to come from inside’’, was thought unfulfilled desire for meaning in life.’’ Some they saw no point in it; they needed ‘‘to be However interviewees recognised sufferers help; one quoted: ‘‘Open for me the eye of (Shir Hashirim Rabbah, 24). Several counselling . . . it is absolutely essential that cultural, ethnic and religious background, actually come from that background.’’ for severe depression; it could, especially the worst feelings and . . . be very helpful.’’ be useful but not a complete answer; without exploring causes.’’ A balanced – talking therapies – to medication/other both help – sometimes combined.’’ he would approach ‘‘a sympathetic, cultural background.’’ Electroconvulsive medication proved unsuccessful, although is a place for it, but within the Jewish intervention – one, because of the stigma.’’ necessary by the three rabbinically qualified ‘‘if needed for protection.’’ ‘‘If they are a them forcibly and ‘section’ them – you their own life.’’ ‘‘In Judaism, the paramount someone’s life, handcuff them – sectioning is a risk of doing psychological harm but ‘‘if are psychologically messed up, they might recognised: ‘‘it’s against the Torah to commit you could . . . ask family – especially mother, and ask the person to speak to them . . . I’ve Rabbi, and if he thinks it necessary, I’d allow some lay participants felt very uneasy about

pikuach nefesh (saving human life) by necessary, in selected cases, and with measures to improve the quality of life to a

depressive illness in several ways, and (a negative influence) stigma. friends, family and neighbours, as well as on supporting those with mental health family’s and the community’s wish to help: ‘‘a real care – of Ahavas Israel’’; visiting and Whilst ‘‘some people . . . [are]scared by and will try to help [although] they don’t potential help, for depressed patients in several organisations, particularly Chizuk – as reducing isolation by offering drop-in family and carer support and advocacy for

depressed patients. Other community run by the Satmar community, ‘‘Talking mentary therapies and counselling training alleviate suffering. ‘‘Culture brokers’’ are individuals from contacts, in this case in mental health qualifications themselves. Such individuals sensitivities of orthodox Jews, and are able professional help with these needs and recommended ‘‘to help ensure all get ‘‘incredibly helpful and useful; people revere that into account [I would be] shooting Stigma was raised spontaneously by disincentive to people seeking and ‘‘Quite big . . . more in the uninformed . . . may say no to anything (treatment) like to the . . . depressed person’s health.’’ People especially if they were single – ‘‘because the much harder to get someone the help repeatedly described explicitly: it would introduction) – ‘‘even if the person mother . . . affected.’’ ‘‘If we admit one of affect their shidduch and their siblings’’ it quiet’’’; they would ‘‘hide people away . developed mental problems . . . they just used not let them out.’’ There were said to have attitude today than there used to be,’’ and groups have . . . done a tremendous amount and bring the topic of depression and although mental illness is discussed more

Rabbinic and community views compared The community views represented here can views surveyed in the earlier part of this rabbinic and community sources; quantitative With regard to the causes of depression, (stressors) and personal failings (sin). whether rabbis, in responding to questions to protect the law, or to alleviate suffering. rabbis’ responses are based on detailed on extensive clinical experience, and their discussions of sin could be seen as aimed self-esteem, rather than as guilt-enhancing. rabbinic views pre-date contemporary suggestions about self-examination may available.

organisations mentioned included Bikur Cholim, Matters,’’ which offered talking and comple– and Smiley, which use music and singing to

the community who have developed a range of service provision. They may have professional have an insider understanding of the needs and to advise and, as needed, organise and arrange sensitivities in mind. Culture brokers were best treatment.’’ One professional found them them and respect their views – if I don’t take myself in the foot.’’ nine interviewees as a problem – a major receiving appropriate help and treatment: who are not knowledgeable medically – they that – to the extent that it is actually detrimental were said to be reluctant to accept treatment, whole marriage concept – how it works – it’s they need.’’ This reasoning behind stigma was damage prospects of a shidduch (marriage completely recovered or it was (their) our children has a mental problem, it will shidduch – so we lock them away’, ‘‘trying to ‘keep . . Down’s children kept at home.’’ If a ‘‘child to lock up these children in the cupboard and been recent improvements; ‘‘a much healthier it was recognised that ‘‘certain individuals and of work to break down the barriers and myths psychiatric illness into the open.’’ Nevertheless, openly, it may still be heavily stigmatised.

be compared and contrasted with the rabbinic report. We can compare emerging themes from comparisons are not possible. rabbinic sources focussed on external events Greenberg and Shefler (2008) raise the question about mental health difficulties, are functioning Greenberg and Shefler conclude that while the knowledge of Jewish law, their approach is based primary aim is to help the patient. Rabbinic at promoting a healthy self-awareness and Additionally it may be worth noting that some advances in medication and psychotherapy, so have been one of the few possibilities then

Mental

In the community, stress was being identified, particularly isolation. (who included three rabbis) gave biological vulnerability, but most recognised that guilt feelings from cause of depression. We thought this the reasons for this discrepancy, exhorting people to examine their context of a research interview. Rabbinic and community views agreed on the helpfulness of rabbinic coping, and where appropriate, that coercive treatment to save life minority rabbinic view that undermining faith. However the – carefully chosen, religiously Secondly, in the community, there seen as risky and unhelpful; a last complementary treatment options to in the rabbinic literature. The gateway to professional help-seeking, literature. A striking feature of the community not considered in the rabbinic account for the community emphasis the marriageability of other family concern about the family-wide difficulties. Additionally, blame may to knowledge of the rabbinic attached to the person who has been Some of these features of the rabbinic views. Although extensive discouraged in this community, a many people will read selected information on medical and psychiatric illness – among family and friends, this may have impacted on their attitude to treatment without consent. mental healthcare had biased of (or against) medication. The may simply be that our searches with depression. Concern with the There is an extensive rabbinic literature characteristics of others (see e.g., keen awareness of the importance ease with which damage can be such rabbinic concerns. The similarities in rabbinic and ongoing exposure to the general

Health, Religion & Culture 9

also seen as a factor, with a number of specific aspects Unlike the rabbinic sources, community informants attention to intrinsic causal factors, particularly did not mention personal failings (sin) – although one perceived sin could be either a result (symptom) or a contrast quite striking. We cannot be confident about but one possibility is that the rabbinic sources are ways. Such exhortation would be inappropriate in the

on help-seeking were generally in accordance. Both and other religious guidance, social support, religious medication and professional psychotherapy. Both agreed was important. The main differences in emphasis were a psychotherapy should be avoided because of the risks of normative rabbinic view resembled that of the community approved psychotherapy could be a helpful option. were significant reservations about medication, often resort. The community endorsed a wide range of (music, self-help books, healing, shiatsu) not attended community informants also mentioned an important the culture broker, not mentioned in the rabbinic

views was the attention given to stigma, a factor literature. A number of possible factors might help to on stigma. Mental illness in the family often affects members. There may be fear of hereditability, and also responsibility for supporting someone with psychiatric be attached to mental illness, and this might be linked literature on self-help: we might speculate that stigma is unable to help themselves sufficiently. community views may be the result of exposure to nonsecular education, television and internet use are good basic secular education is normally offered and books and newspapers, offering among other things treatment. Some had direct experience of mental or in three cases, from professional involvement, and views, for example making them more pragmatic in their There was no indication that those involved in understanding or views, for example in being more in favour absence of concern with stigma in the rabbinic literature concerned only rabbinic views on causes of and coping opinions of others was not apparent in this context. on avoiding gossip and speaking about negative Loewenthal, Glinert, & Goldblatt, 2003), indicating a of reputation and respect in the community, and the done, but coping with depression was not a context for

community views are associated with the community’s principles expounded in the rabbinic literature, via

synagogue sermons, regular religious orthodox Jewish press. All are saturated helping others, showing kindness, and culturally carried values. Thus, we see some broad agreement their views on the causes and treatment the most salient of these are the issue of of stigma, salient in the community views.