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This chapter describes the four major subgroups within Judaism: secular Jews, traditional Jews, modern orthodox Jews, and ultra-orthodox Jews. Secular Jews consider themselves Jewish by birth alone; they may assign no religious significance to their Jewishness. Traditional Jews retain certain religious practices, usually those with a strong social or family component, such as the traditional family meal on the first night of Passover, or fasting and attending synagogue services on Yom Kippur. Modern orthodox Jews balance a commitment to two sets of values. They retain the range of religious practices while being active in the secular world, accepting all work and study as long as they do not overtly contravene religious law. Ultra-orthodox Jews believe that Jewish law is holy and that religious observance is the first responsibility of Jews.

This chapter explores the union of Western psychiatry and the ultra-orthodox community, based on the concept of shidduch, the arranged matrimonial match. The groom is a composite of two male Israeli psychiatrists who work closely with the ultra-orthodox Jewish population. Both are part of a medical tradition which takes for granted that everything the therapist observes in or is told by patients can be subsumed within its omniscient structure. Yet it is shown that providing clinical care to the ultra-orthodox community—the bride—is a matter of considerable complexity.

This chapter suggests ways to improve the quality of care for the ultra-orthodox community. Due to the relatively large size of ultra-orthodox families, more than 50 percent of all Jewish primary school children in Jerusalem are ultra-orthodox. Within a single generation, the ultra-orthodox may become the largest group in the Jewish community in the nation's capital. The issue of provision of mental health care is therefore of immediate practical importance. How service providers facilitate the meeting of two cultures is relevant wherever such an encounter occurs, be it in Israel, with its new Soviet and Ethiopian immigrants, or in any country whose community mental health services attempt to reach out to minorities.

In 1972 the Ministry of Health divided the Jewish section of Jerusalem into four zones, and mental health clinics were opened in each, administered by the city's four psychiatric hospitals. The northern quarter, home of the ultra-orthodox community of Mea Shearim, was assigned to Ezrat Nashim Hospital. This chapter provides an overview of the authors' experiences working at the clinic in Ezrat Nashim.

This chapter addresses the exclusion of women from Torah study through a fictive dialogue between a liberal and an Ultra-Orthodox Jew. This dialogic exchange represents a suitable scholarly approach for cases of intercultural encounters; unlike traditional dialogues, however, this exchange benefits from literary and socio-legal sources, as well as customary ones, such as the Torah. This chapter discusses the foundational problems in understanding other cultures, the challenges in establishing a functional dialogue between parties as well as the divergent understandings and foundations of religion and tradition. This dialogue also considers the exclusion of women from Torah study from the perspective of the value of equality, which highlights a fundamental difference, articulated as “discrimination” by one and expressed as “distinction” by the other. In closing, this chapter submits that one understanding that emerges from this dialogue is the need to ground normative evaluations on a close examination of the facts.

This chapter examines the persistence of the Jewish Question or Problem in the state that aimed to liberate Jews. For example, many people expected the ultra-Orthodox, or Haredim, to “assimilate” to Israeli culture and become the “new Jews” of the Zionist project. In other places such “progress” that undermines local cultural groups often results in liberal expressions of outrage. But the case of ultra-Orthodox Jews has not produced the same reaction. The ultra-Orthodox are seen as part of the Israeli hegemon in opposition to Palestinian Arabs who are the indigenous under threat of elimination. This chapter again suggests that the definition of indigeneity be expanded beyond geographical ties to include forms of social organization and ways of life that might be threatened. Thus, both Palestinian Arabs and Haredi (and other) Jews are at risk—one facing elimination through Zionist territorial expansion, the other through the forces of Zionist assimilation.

This chapter describes a hypothetical situation involving an Israeli psychiatrist and an ultra-orthodox Jewish man. When the psychiatrist asks the patient how he is, the patient gives responses which are seemingly evasive or unrelated to the question. The chapter explains how miscommunication can arise between the psychiatrist and the patient because of the ultra-orthodox Jewish man's religious beliefs.

This chapter focuses on the difficulties of establishing a structural and ideological framework for providing mental health care to the ultra-orthodox community. It discusses rabbinic opinion on psychological services; debates in the ultra-orthodox press over the subject of psychology and psychiatry; the reasons behind rabbinic authorities' rejection of psychiatry in general and psychotherapy in particular.

The last chapter showed how struggles to be Jewish in Israel seem like a narrowing maze with no exit. This chapter considers the nature of that maze. It focuses on two cases of observant Jewish Israelis who come into conflict with the state over what it means to live according to their understandings of Jewishness. It shows that what appears as a religious-secular divide is far more complex. It is sometimes a religious-religious divide and is always part of a process of producing a national majority of sovereign citizens through disaggregation and conflation of modern categories of identity—religion and nation. Framed with Kafka’s “City Coat of Arms,” it shows how alliances of convenience can undermine political positions, in this case strengthening nationalism and territorial expansion at the expense of traditional Judaism.

This chapter discusses the link between ultra-orthodox baalei teshuva and psychiatric disorder. It first considers the normative aspects of the baal teshuva movement, particularly the underlying historical and sociological factors and the internal influences that can lead individuals to such a drastic change in position, from being the camel who protects the state and develops its economy to being the camel that bears “the yoke of the kingdom of heaven”.

This chapter examines the issue of trust in the practice of psychiatry. It addresses questions such as: Is trust unidirectional? Does the onus to be trustworthy fall only on the therapist? It also describes the cases of two malingerers who feigned mental illness in order to evade army service.

The performance of the commandments is central to Jewish life, particularly ultra-orthodox Jewish life. There are 613 commandments in the Torah, of which 248 are positive (“Thou shalt” as opposed to “Thou shalt not”). These are the foundation for the performance of specific activities as evidence of religious commitment. This chapter describes normal ritual in ultra-orthodox Jewish life from several vantage points: its development, its pervasive presence in religious rather than secular daily life, and the range of roles it fulfills.

This chapter examines the religious rituals that often become obsessive compulsive disorder (OCD) symptoms in ultra-orthodox patients to determine whether there are limits to the expectations of religious ritual and, consequently, whether it is possible to define compulsive behaviors as excessive and pathological. If these behaviors emerge from a body of law that encourages care and order and that even condones checking and repetition—all of which are cardinal aspects of compulsive behaviors—and if the rabbis over the generations have tended to add “fences” of further restrictions around the law, then it may be that the law never limits the lengths to which adherents should go to avoid slipping into error. Such an attitude is likely to make diagnosis difficult. It can dissuade the patient from viewing himself as unwell and could make any attempt at a therapy that limited these precautionary measures religiously indefensible.

This chapter analyzes data from clinical work with ultra-orthodox obsessive compulsive disorder (OCD) sufferers and from epidemiological studies in several countries to address the following question: Does religious ritual induce OCD? It focuses on three issues: the selectivity of religious compulsions among religious practices, the presence of religious and nonreligious symptoms among OCD sufferers, and the distribution of OCD in different cultures.

This chapter examines why nocturnal hallucinations predominantly affect ultra-orthodox teenage boys with a history of learning difficulties. The following unique aspects of ultra-orthodox life are analyzed for their influence: (i) growing up with learning difficulties in an environment where academic achievement is the pinnacle of success and no alternative is countenanced; (ii) the challenges presented by such important milestones in life as bar mitzvah, adolescence, and leaving home to live in a yeshiva; (iii) the impact of loss; (iv) the meaning of night in ultra-orthodox Judaism; and (v) the differences between the sexes.

This chapter explores how Lubavitcher hasidim, based in Brooklyn, New York, have used broadcasting, video, and the Internet, among other media, to advance their distinctive mission during the past half of the century. Unique among ultra-Orthodox Jews, the hasidim deploy media extensively in their outreach campaigns, which strive to encourage other Jews to become more observant of traditional religious precepts. Media also play a provocative role in the group’s messianism, which has become more complicated since the death, over a decade ago, of the last Lubavitcher rebbe, who left his followers without a successor to his leadership. Consequently, the extensive inventory of media documentation of his public appearances has come to serve many of his followers as a “virtual rebbe,” providing them with a source of devotional inspiration and solidarity as an international religious community.

This chapter describes a phenomenon that is unique to the ultra-orthodox Jewish population of Israel, called nocturnal hallucinations. The main external behaviors are extreme social withdrawal, especially from strangers, neglect of personal hygiene, a near-catatonic immobility, and monosyllabic replies in conversation. The hallucinations associated with these behaviors are experienced by young men only or predominantly at night.

This chapter examines the diagnosis of nocturnal hallucinations and the general presentations of which it is part. It suggests that the content of nocturnal hallucinations can be understood as a combination of childhood fears, based on culturally consistent spirits and the souls of the departed. The diagnoses are likely to be varied, including psychotic states, grief reactions, depression and anxiety, and chronic adjustment difficulties; these are in many cases secondary to lifelong learning difficulties.

This chapter describes the authors' encounters with patients who were members of the group known as Bratslav hasidim. Bratslav hasidim are viewed by many ultra-orthodox as extreme, separate, and strange in their customs. The authors needed to become acquainted with the behavior and values of the sect in order to distinguish between culturally normal and abnormal symptomatology. This led to a study of the life and teachings of the founder of the sect, Rabbi Nahman of Bratslav.