Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-19T18:42:10.970Z Has data issue: false hasContentIssue false
  • English
  • Français

Issues in the Psychopharmacologic Assessment and Treatment of the Orthodox Jewish Patient

Published online by Cambridge University Press:  07 November 2014

S. Shalom Feinberg
Get access Rights & Permissions [Opens in a new window]

Abstract

As with members of other cultural and religious groups, patients within the Orthodox Jewish community present with their own distinct clinical psychiatric issues related to their unique beliefs and practices. This article reviews the existing literature and anecdotal experience on the psychopharmacologic assessment and treatment of Orthodox Jewish patients. Specific aspects examined include this group's perceived intense stigma in receiving treatment, the priority this community places on cognitive functioning, and how the influence of Jewish laws on marriage and sexual practices impacts one's treatment decisions. The relevance of Jewish dietary laws, the Sabbath, and the community's interest in alternative treatments are also discussed. The limited ethno-psychopharmacology research related to Orthodox Jewish psychiatric patients is reviewed. We conclude that understanding issues such as these is critical if one is going to work within this cultural system in order to successfully address their mental health issues. However, the dearth of controlled research in this community needs to be addressed to provide more effective treatment.

Type
Review Articles
Information
CNS Spectrums , Volume 10 , Issue 12 , December 2005 , pp. 954 - 965
Copyright
Copyright © Cambridge University Press 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Mental Health, Race and Ethnicity. A Supplement to Mental Health: A Report of the Surgeon General. Rockville, Md: U.S. Department of Health and Human Services; 2001.Google Scholar
2.Rhi, BY. Culture, spirituality and mental health: the forgotten aspects of religion and health. Psych Clin N Am. 2001;24:569–579.CrossRefGoogle ScholarPubMed
3.Margolese, HC. Engaging in psychotherapy with the Orthodox Jew: a critical review. Am J Psychotherapy. 1998;52:37–52.CrossRefGoogle ScholarPubMed
4.Greenberg, D, Witztum, E. Sanity and Sanctity: Mental Health Work Among the Ultra-Orthodox in Jerusalem. New Haven, Conn: Yale University Press; 2001.CrossRefGoogle Scholar
5.Marin, H, Escobar, JI. Special issues in the psychopharmacological management of Hispanic Americans. Psychopharmacol Bull. 2001;35:197–212.Google Scholar
6.Liebman, CS. Orthodox Judaism Today. In: Bulka, RP, ed. Dimensions of Orthodox Judaism. New York, NY: KTAV; 1983:106–120.Google Scholar
7.Feinberg, SS. Genetic counseling issues in affective disorders: The Orthodox Jewish community. In: Papolos, DF, Lachman, HM, eds. Genetic Studies in Affective Disorders: Overview of Basic Methods, Current Directions, and Critical Research Issues. New York, NY: Wiley-Interscience; 1994:146–173.Google Scholar
8.Sublette, E, Trappler, B. Cultural Sensitivity Training in Mental Health: Treatment of Orthodox Jewish Inpatients. Int J Soc Psychiatry. 2000;46:122–134.Google Scholar
9.Heilman, SC, Witztum, E. Value-sensitive therapy: learning from ultra-orthodox patients. Am J Psychother. 1997;51:522–541.CrossRefGoogle ScholarPubMed
10.Paradis, CM, Freidman, S, Hatch, ML, et al.Orthodox jews. In: Freidman, S, ed. Cultural Issues in the Treatment of Anxiety. New York, NY: Guilford Press; 1997:130–153.Google Scholar
11.Posner, ZI, The splintering of Chabad. In: Jewish Action: Magazine of the Orthodox Union. 2002;63(1):55–58.Google Scholar
12.Kohn, R, Levav, I, Dohrenwend, BP, Shrout, PE, Skodol, AE. Jews and their intraethnic vulnerability to affective disorders, fact or artifact? II: Evidence from a cohort study. Isr J Psychiatry Relat Sci. 1997;34:149–156.Google Scholar
13.Ostrer, H. A genetic profile of contemporary Jewish populations. Nat Rev Genet. 2001;2:891–898.Google Scholar
14.Burt, VK, Rudolph, M. Treating an Orthodox woman with obsessive-compulsive disorder: maintaining reproductive and psychological stability in the context of religious rituals. Am J Psychiatry. 2000;157:620–624.Google Scholar
15.Pierre, JM. Faith or delusion? At the crossroads of religion and psychosis. J Psychiatr Pract. 2001;7:163–172.Google Scholar
16.Trappler, B, Greenberg, S, Freidman, S. Treatment of Hassidic Jewish patients in a general hospital medical—psychiatric unit. Psychiatr Serv. 1995;46:833–835.Google Scholar
17.Feinberg, SS, Feinberg, KG. An assessment of the mental health needs of the Orthodox Jewish population of metropolitan New York. J Jew Communal Serv. 1985;62:29–39.Google Scholar
18.Greenberg, D, Witztum, E. Treatment of strictly religious patients. In: Pato, MT, Zohar, J, eds. Current Treatments of Obsessive-Compulsive Disorder. Washington, DC: American Psychiatric Press; 2001:173–192.Google Scholar
19.Levitz, I. Orthodoxy and mental health: suggested parameters for empirical study. J Psychol Judaism. 1979;4:87–99.Google Scholar
20.Feinberg, SS, Feinberg, KG. Mental illness in Jerusalem [letter]. Am J Psychiatry. 1987;144:835–836.Google Scholar
21.Bilu, Y, Witztum, E. Working with Jewish ultra-orthodox patients: guidelines for a culturally sensitive therapy. Cult Med Psychiatry. 1993;17:197–233.CrossRefGoogle ScholarPubMed
22.Greenberg, D, Witztum, E. Problems in the treatment of religious patients. Am J Psychother. 1991;45:554–565.CrossRefGoogle ScholarPubMed
23.Fallon, BA, Liebowitz, MR, Hollander, E, et al.The pharmacotherapy of moral or religious scrupulosity. J Clin Psychiatry. 1990;51:517–520.Google Scholar
24.Ribner, DS. Determinants of the intimate lives of Haredi (Ultra-Orthodox) Jewish couples. Sexual and Relationship Therapy. 2003;18:53–62.CrossRefGoogle Scholar
25.Feldman, DM. Marital Relations, Birth Control, Contraception and Abortion in Jewish law. New York, NY: Schocken Books; 1974.Google Scholar
26.Greenberg, D, Brom, D. Nocturnal hallucinations in ultra-orthodox Jewish Israeli men. Psychiatry. 2001;64:81–90.Google Scholar
27.Minsky, S, Vega, W, Miskimen, T, et al.Diagnostic patterns in Latino, African American, and European American psychiatric patients. Arch Gen Psychiatry. 2003;60:637–644.Google Scholar
28.Kirmayer, LJ. Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment. J Clin Psychiatry. 2001;62(suppl 13):22–28.Google Scholar
29.Lin, KM, Smith, MW, Ortiz, V. Culture and psychopharmacology. Psychiatr Clin North Am. 2001;24:523–537.CrossRefGoogle ScholarPubMed
30.Westermeyer, J. Cultural factors in clinical assessment. J Consult Clin Psychol. 1987;55:471–478.Google Scholar
31.Bilder, RM, Goldman, RS, Volavka, J, et al.Neurocognitive effects of clozapine, olanzapine, risperidone, and haloperidol in patients with chronic schizophrenia or schizoaffective disorder. Am J Psychiatry. 2002;159:1018–1028.Google Scholar
32.Goodwin, FW. Rationale for using lithium in combination with other mood stabilizers in the management of bipolar disorder. J Ciin Psychiatry. 2003:64(suppl 5):18–24.Google Scholar
33.Hoehn-Saric, R, Harris, GJ, Pearlson, GD, et al.A fluoxetine-induced frontal lobe syndrome in an obsessive-compulsive patient. J Clin Psychiatry. 1991;52:131–133.Google Scholar
34.Sirey, JA, Bruce, ML, Alexopoulos, GS, et al.Perceived stigma and patient-rated severity of illness as predictors of antidepressant drug adherence. Psychiatr Serv. 2001;52:1615–1620.Google Scholar
35.Feinberg, SS, Feinberg, KG. The Rabbi's view: on the mental health needs of the Orthodox Jewish population. Tradition. 1986;22:84–96.Google Scholar
36.Cinnirella, M, Loewenthal, KM. Religious and ethnic group influences on beliefs about mental illness: a qualitative interview study. Br J Med Psychol. 1999;72:505–524.Google Scholar
37.Rockman, H. Matchmaker matchmaker make me a match: the art and conventions of Jewish arranged marriages. Sexual Martial Therapy. 1994;9:277–284.CrossRefGoogle Scholar
38.Östman, M, Kjellin, L. Stigma by association: psychological factors in relatives of people with mental illness. Br J Psychiatry. 2002;181:494–498.CrossRefGoogle ScholarPubMed
39.Angermeyer, MC, Matschinger, H. Public beliefs about schizophrenia and depression: similarities and differences. Soc Psychiatry Psychiatr Epidemiol. 2003;38:526–534.Google Scholar
40.Helfgot, N. Dimensions of torment: a young man's story of depression. Jewish Action: Magazine of the Orthodox Union. 2000;62:9–14.Google Scholar
41.Feldman, P. Sexuality, birth control and childbirth in Orthodox Jewish tradition. Can Med Assoc J. 1992;146:29–33.Google Scholar
42.Compton, MT, Andrew, AH. Antipsychotic-induced hyperprolactinemia and sexual dysfunction. Psychopharmacol Bull. 2002;36:143–164.Google Scholar
43.Linnebur, SA, Saseen, JJ, Pace, WD, Venlafaxine-associated vaginal bleeding. Pharmacotherapy. 2002;22:652–655.Google Scholar
44.O'Donovan, C, Kusumakar, V, Graves, GR, et al.Menstrual abnormalities and polycystic ovary syndrome in women taking valproate for bipolar mood disorder. J Clin Psychiatry. 2002;63:322–330.Google Scholar
45.Ferguson, JM. The effects of antidepressants on sexual functioning in depressed patients: a review. J Clin Psychiatry. 2001;62(suppl 3):22–34.Google ScholarPubMed
46.Grunfeld, I. The Jewish Dietary Laws. New York, NY: Soncino Press; 1972.Google Scholar
47.Jachter, J. Taking Medication in a Gel-cap. J Halacha Contemporary Society. 1995;30:66–80.Google Scholar
48.Sattar, SP, Pinals, DA. When taking medications is a sin [letter]. Psychiatr Serv. 2002;53:213–214.Google Scholar
49.Markowitz, JC. Religiosity and psychopathology. J Clin Psychiatry 1994;55:414–415.Google ScholarPubMed
50.Blumenkrantz, A. The laws of Pesach. A digest. Far Rockaway, NY: Gross Brothers/ Bais Medrash Ateres Yisroel; 2005.Google Scholar
51.Kaplan, M, Eidelman, AI, Aboulafia, Y. Fasting and the precipitation of labor: the Yom Kippur effect. JAMA. 1983;250:1317–1318.Google Scholar
52.Aslam, M, Wilson, JV. Clinical problems during the fast of Ramadan [letter]. Lancet. 1989;8644:955.CrossRefGoogle ScholarPubMed
53.Mosek, A, Korczyn, AD. Yom Kippur headache. Neurology. 1995;45:1953–1955.CrossRefGoogle ScholarPubMed
54.Burden, M. Culturally sensitive care: managing diabetes during Ramadan. Br J Community Nurs. 2001;6:581–585.Google Scholar
55.Awada, A, Al Jumah, M. The first-of-Ramadan headache. Headache. 1999;39:490–493.Google Scholar
56.Tang, C, Rolfe, M. Clinical problems during fast of Ramadan. [letter]. Lancet. 1989;8651:1396.Google Scholar
57.Daisley, H, Barton, EN, Williams, CT. Fatal lithium toxicity during a religious fast. South Med J. 1990;83:364.Google Scholar
58.Abraham, AS. Nishmat Avraham: Medical Halachah for Doctors, Nurses, Health Care Personnel and Patients. Brooklyn, NY: Mesorah Publications; 2000.Google Scholar
59.Eider, SD. Halachos of Shabbos. Nanuet, NY: Feldheim Publishers; 2000.Google Scholar
60.Kitov, E. The Book of Our Heritage: The Jewish Year and Its Days of Significance. Bulman, N, trans. Nanuet, NY: Feldheim Publishers; 2000.Google Scholar
61.Shifman, S, Darvasi, A. The value of isolated populations. Nat Genet. 2001;28:309–310.Google Scholar
62.Shifman, S, Bronstein, M, Sternfeld, M, et al.A highly significant association between a COMT haplotype and schizophrenia. Am J Hum Genet. 2002;71:1296–1302.Google Scholar
63.Medintz, I, Kingston, C, Duran, H, et al.Characterization of two New York City populations at six short tandem repeat loci. Hum Biol. 2002;74:143–151.Google Scholar
64.Rahav, M, Goodman, AB, Popper, M, Lin, SP. Distribution of treated mental illness in the neighborhoods of Jerusalem. Am J Psychiatry. 1986;143:1249–1254.Google Scholar
65.Hasin, D, Aharonovich, E, Liu, X, et al.Alcohol and ADH2 in Israel: Ashkenazis, Sephardics and recent Russian immigrants. Am J Psychiatry. 2002;159:1432–1434.CrossRefGoogle ScholarPubMed
66.Levav, I, Kohn, R, Golding, JM, Weissman, MM. Vulnerability of Jews to affective disorders. Am J Psychiatry. 1997;154:941–947.Google Scholar
67.Luczak, SE, Shea, SH, Carr, LG, Li, TK, Wall, TL. Binge drinking in Jewish and non-Jewish white college students. Alcohol Clin Exp Res. 2002;26:1773–1778.Google Scholar
68.Lowenthal, K, Goldblatt, V, Gorton, T, et al.Gender and depression in Anglo-Jewry. Psychol Med. 1995;25:1051–1063.CrossRefGoogle Scholar
69.Twerski, B. Orthodox youth and substance abuse: shattering the myths. Jewish Action: Magazine of the Orthodox Union. 1997;58:41–44.Google Scholar
70.Lieberman, JA, Yunis, J, Egea, E, et al.HLA-B38, DR4, DQw3 and clozapine-induced agranulocytosis in Jewish patients with schizophrenia. Arch Gen Psychiatry. 1990;47:945–948.Google Scholar
71.Meged, S, Stein, D, Sitrota, P, et al.Human leukocyte antigen typing, response to neuroleptics, and clozapine-induced agranulocytosis in Jewish Israeli schizophrenic patients. Int Clin Psychopharmacol. 1999;14:305–312.Google Scholar
72.Rosner, F. Unconventional therapies and Judaism. J Halacha Contemporary Society. 1990;19:81–102.Google Scholar
73.Barr, J, Berkovitch, M, Matras, H, et al.Talismans and amulets in the pediatric intensive care unit: legendary powers in contemporary medicine. Isr Med Assoc J. 2000;2:278–281.Google Scholar
74.Rosner, F. Moses Maimonides and preventative medicine. J Hist Med Allied Sci. 1996;51:313–324.Google Scholar
75.Shaouli, MC, Fisher, Y. Nature's Wealth: Health and Healing Plants. Jerusalem, Israel: Beth Jacob Organization; 1999.Google Scholar
76.Cott, J. The role of herbal therapy and dietary supplements in treating psychiatric disorders. Paper presented at: Annual Meeting of NEFESH International, The International Network of Orthodox Mental Health Professionals; December 23–26, 1999; Baltimore, Md.Google Scholar
77.Stoll, A. Thinking outside the box: non-traditional treatments of psychiatric illnesses. Paper presented at: Annual Meeting of NEFESH International, The International Network of Orthodox Mental Health Professionals; December 20–23, 2001; Baltimore, Md.Google Scholar
78.Stoll, A. The Omega-3 Connection. New York, NY: Simon and Schuster; 2001.Google Scholar
79.Sue, DW, Sue, D. Counseling the Culturally Different: Theory and Practice. New York, NY: Wiley; 1999.Google Scholar
80.Rosner, F. The imperative to heal in traditional Judaism. Mt Sinai J Med. 1997;64:413–416.Google Scholar
81.Gorman, JM, Maimonides, 1135–1204. Am J Psychiatry. 2001;158:376.Google Scholar
82.Campbell, LF, Smith, TP. Integrating self-help books into psychotherapy. J Clin Psychol. 2003;59:177–186.Google Scholar
83.Twerski, AJ. Getting Up When You're Down: A Mature Discussion of An Adult Malady-Depression and Related Conditions. Brooklyn, NY: Shaar Press; 1997.Google Scholar
84.Broyde, MJ. Error in the Creation of Jewish Marriages: Under What Circumstances Can Error in the Creation of a Marriage Void the Marriage without Requiring a Get according to Halacha. Available at: http://www.jlaw.com/Articles/KidusheiTaut.html. Accessed 10 6, 2005.Google Scholar