Mental Illness in the Orthodox Jewish Community Nachas Ruach 14 November 2010 Kate Miriam Loewenthal

Topics Needs – psychiatric illnesses and minor disorders - stress Barriers to help-seeking What types of support are likely to be sought? Conclusions and questions

What are the needs? Psychiatric Epidemiology Prevalences of psychiatric disorders(where known) correspond roughly to prevalence in the general urban population. Where they differ, this can usually be related to life-style factors. For example: Childhood disorders may be relatively low among young children, with stable families as a likely contributory factor (98% living with both parents) (Lindsey et al, 2003). Hyperactivity and attention disorders may be raised among adolescent boys, possibly due to poor sports facilities in the (very under- resourced) charedi schools ) and possibly traditional teaching styles(Frosh et al, 2005)

Unipolar depression: Relatively low prevalence compared with other urban populations. Protective factors include religious factors, stable families, good community support (Loewenthal et al, 1995, 2000). Depression (MDD) may be as prevalent among men as among women (unusual!) partly due to low use of alcohol by orthodox Jews for coping (Ball & Clare, 1990; Loewenthal et al, 2003)

Anxiety: GAD: subclinical GAD (Generalised Anxiety Disorder) may be high among women probably due to eventfulness of life caring for large family (Loewenthal et al, 1997). OCD: Uncertain whether OCD more prevalent among Jews than among other groups. Zohar et al (1992). High prevalence among Israeli adolescents: app 4% compared to <2% general population. Bernstein (1997) suggests OCD may be over- diagnosed among SOJs due to misinterpretation of religious behaviour as “symptoms”. Religious factors are thought not to be causal, but do influence the shaping of symptoms (Greenberg & Witztum, 2001) PTSD: Many survivors of holocaust and other anti- semitic persecutions: PTSD and other symptoms among survivors (Yehuda et al, 1998), but not their descendants (Levav, 2010). No epidemiological studies in the UK

Psychosis & other Bipolar disorder: there is still uncertainty about whether this is more prevalent among (Ashkenazi) Jews than among other groups (Fallin et al, 2003). Schizophrenia: probably similar prevalence as in other groups, though possible genetic susceptibility is under investigation. Some cultural effects on symptoms (Littlewood & Lipsedge, 1997) Personality disorders: little/no clear information. Needs for psychiatric and clinical psychological services are at least as great as in other groups. Statutory service providers would be helped by knowledge of cultural and religious factors. Presentation may have culture-specific features.

Stress (339 interviews, approximately equal numbers of women and men, traditionally and strictly orthodox: Loewenthal et al 1994). % of difficulties requiring actual or potential social service support (over 90% were using statutory or voluntary services; about 20% of these were judged to require specialised appropriate cultural/religious knowledge)

Barriers against seeking psychotherapeutic help These are chiefly: Stigma Fear of violating religious laws Rabbinic attitudes Doubts about efficacy

% strictly orthodox Jews saying they would use the following forms of support for health, relationship or other difficulties, if appropriate (n=210)

Religious coping beliefs may be helpful or unhelpful e.g. “Red flag” beliefs e.g. “I am being punished for things I have done wrong” “G-d is angry with me” (Pargament, 2002). Also, poorer mental health goes with – Imposed religion. – Religious beliefs and behaviour that have not been examined, poorly integrated, – Tenuous relationship with G-d and the world.

Religious activity, cognitions and affect: a model involving some components of religious faith (items of belief) (Loewenthal et al 2000) Religious activity All for G-d Spiritual (religious) the best control support Raises Lowers distress positive affect

Conclusions and questions Stress and psychiatric illness are about as prevalent in the orthodox Jewish community as in other communities, though patterns may be slightly different Reluctance to seek professional help has several sources When and how does one decide to refer e.g. for social services, community services, psychiatrist? How to overcome barriers e.g. stigma? What if any religious or spiritual resources might be used in counselling? How might these be introduced?