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February 18, 2010

Orthodox Compulsive Disorder

Hand Washing ‘Mr. A” is a 43-year-old chasidic man who is so afraid to make mistakes in his daily prayers that he cannot bring himself to get out of bed until noon or 1 p.m.

Orthodox Compulsive Disorder?
by Sharon Udasin • New York Jewish Week

‘Mr. A” is a 43-year-old chasidic man who is so afraid to make mistakes in his daily prayers that he cannot bring himself to get out of bed until noon or 1 p.m. The reason? Obsessions he’s faced since his days in yeshiva, when he was consistently the last person to finish praying each morning.

“He thought he was just more religious than everyone in the class,” said Dr. Steven Friedman, a professor of clinical psychiatry at SUNY Downstate, who was addressing a group of fellow therapists. “Patients who have religious obsessions often don’t recognize or admit that they have symptoms.”

Friedman was speaking to a group of 30 therapists — at least 20 of them Orthodox Jews — who had gathered  for a three-day conference this week at SUNY Downstate Medical Center in Brooklyn sponsored by the Behavior Therapy Training Institute of the International Obsessive Compulsive Disorder Foundation. While the Institute holds about three of these meetings annually, this was the first conference tailored specifically to the needs of Orthodox Jewish therapists, who had been unable to attend regular Saturday programming.

Sessions last weekend were largely the same as any other Behavior Therapy Training curriculum, aside from Friedman’s Sunday afternoon lecture about “Religious Scrupulosity,” which targeted obsessions and compulsions rooted in Jewish ritual. In addition to discussing these specific behaviors and treatment techniques, the doctors focused on the unwillingness of many Orthodox Jews to even seek treatment, in a community where mental health issues are somewhat taboo.

“You can speak Yiddish like I do and you’ll still find that that won’t get you access to certain populations,” Friedman said. “Since the community is so small, most of them you know and it’s one degree of separation. If you give me the name of an Orthodox person in the United States, I can find someone who knows something all about them.”

“This is problematic when you do therapy,” he added.

OCD is a genetic disorder that equally affects men, women and children of all backgrounds, typically appearing between the ages of 10 to 12 or in late adolescence or early adulthood, according to the Foundation. On average, OCD inflicts 1 in 100 adults and 1 in 200 kids and teens, amounting to about 2 to 3 million adult cases and 500,000 childhood cases in the United States alone. Because OCD runs in families, there is a 15 percent chance that a patient’s child will also exhibit OCD, though not necessarily in exactly the same form, Friedman explained. For example, he said, a parent might be an incessant hand-washer, while the child might become a compulsive checker.

Be it contamination, relationships or religion, OCD “always attacks what’s most important,” according to Friedman, and for Orthodox Jews with OCD what’s most important is their daily commitment to Judaism. And so much of Orthodox Judaism — or anything religion — is about prescribed ritual, like the particular order in which Jews put on and tie their shoes, adjust tefillin precisely on their heads or clean themselves before prayer.

Ironically, however, OCD patients may get so much anxiety from the religious practices that they don’t even enjoy the rituals and beliefs that are so important to them. Prayers and religious behaviors will often be painful processes, punctuated by incessant questioning and reassurance seeking from rabbis and elders.

“You see a lot of compulsive behaviors with the intention of undoing something that has been done wrong,” said Dr. Jeff Szymanski, the executive director of the International OCD Foundation. “I have to repeat it until it’s done perfectly.”

Friedman added, “People with OCD don’t really get any joy out of their religious experience.”

Instead, they may spend inordinate amounts of time doubting and checking — whether they prayed correctly, whether they greeted every single person in shul, whether they scrubbed their hands for long enough between handling milk and meat. One patient was so worried about clearing his house of chametz during Passover that he built his own extremely dangerous — not to mention illegal — matzah-baking oven in his basement. Intrusive thoughts may also extend to aggressive and sexual obsessions, such as momentarily perceiving the rabbi as a Nazi, thinking the Second Temple was for pagans or fearing homosexuality when one is not actually gay.

“A lot of Orthodox Jewish men seem to have this fear. It’s not usually true. I usually just ask them one question, are you attracted to men?” Friedman said. “And the answer is usually no.”

For Orthodox women, he says, the most problematic Jewish rituals for patients are properly adhering to kashrut and observing “family purity” laws, which Friedman calls a “torture” for some OCD patients, particularly due to the meticulous checking and counting required of them each month.

“The rituals will typically be offshoots of their current religious practices. Their faith-based practices will get co-opted by the OCD, so [a Jewish patient’s] compulsive behavior will look a bit different from someone who is Protestant or Muslim,” Szymanski said. “But the themes are pretty consistent — it’s typically a fear of offending God or engaging in something blasphemous, a fear of hell, of Satan, of doing something imperfectly. The compulsive behaviors are typically things like praying a certain way and praying enough.”

Among patients of other religions, Friedman found one Hindu man who was so afraid of stepping on God that he wouldn’t get out of bed, as well as many Muslims who were so concerned with performing absolutions (washing) properly that they were unable to begin prayers. For Catholics, imagining Jesus sleeping with the Virgin Mary is a popular obsessive fear.

The best way to conquer — or at least subdue — obsessions and compulsions is to undergo cognitive behavioral therapy with exposure to the trigger, a technique that is all too often left out of medical school and doctorate curricula, according to Szymanski. At their triennial conferences, the OCD Foundation aims to compensate for this oversight and teach therapists the newest techniques in cognitive behavioral therapy. For any patient with moderate to severe levels of OCD, Friedman adds that an on-site home visit is also crucial when assessing behavioral patterns.

“I actually go to the bathroom with them and say, ‘Show me how you wash,’” he said. “People are not in touch with many of their compulsions.”

And he believes that for the most part, Orthodox patients will progress better with Orthodox therapists, despite the fear that they may have some of the same friends and acquaintances in their close-knit communities.

“Ultimately for OCD and [religious manifestations of it], probably most of our patients are better served by seeing someone within the community who knows the intricacies,” Friedman said, noting that he’ll often help people by labeling their obsessions in Jewish terms — “mishegas” (craziness) for adults and “nudniks” for kids.

And any child learns in school, Friedman added, you certainly don’t want to listen to a nudnik — “The worst thing to do is respond to it.”

[Hat Tip: CS.]

Comments

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“I usually just ask them one question, are you attracted to men?” Friedman said.”

A better question would be, Are you attracted to boys?

I thought all chumras are a version of OCD.

That must be the toughest job in the world....

Separating the "normal" lettuce-checking, etrog-psul-finding, toilet-paper-precutting individual from the "real" crazies.

this is how this mishegass started. some rabbi with ocd made up a lot of the laws, and now some duped sheep think its their obligation to keep them, even it makes them miserable.
somebody should tell them, relax you miserable anal shtetl dwellers.
god doesnt care if you put your right shoe or left shoe on first.

I had a patient who couldn't leave her house until she counted every orange in her trees. Joey Ramone would be late to concerts if he didn't properly cross every crack in the pavement leaving his house. OCD is a crippling illness and the choice of manifestation is not the cause of it, so these same folks would otherwise count their money obsessively, or dust for hours,(or become bloggers).

CM,

I disagree with you. The chumras have their purpose. the purpose is to make these people dependant on a leader and have them check out their brains at the door.

Freud thought that all religion was a form of OCD. I think he was wrong, but maybe he had a point.

OCD is clearly an illness. I think it is in poor taste to be making fun of it or to use it as a vehicle to make fun of other people.

god doesnt care if you put your right shoe or left shoe on first.

As with many other folks who like to make fun of certain customs, you totally miss the point for this. In Orthodoxy, all actions are ideally connected to some level of God-consciousness. Putting on the right shoe first is supposed to instill in us the idea that rachamim (=right) should come before din (=left). Thus doing it mechanically (without thinking) is meaningless since it obviates the whole reason for doing so.

This has been discussed in this blog before. The name for this syndrome, before it was identified as a psychiatric syndrome, was "scrupulosity".

The last time, someone gave a reference to a medical article that showed rabbinic advice from two or three highly regarded sages was in close accordance with modern medical opinion.

I thought there were some very successful treatments for ocd these days. I think what people are having problems with are those who discourage people with this illness from seeking help.

Hi, I'm the author of the original article, and the disorder is still known as Scrupulosity, which I mentioned toward the top of the article. There are very, very successful treatments for OCD (not complete cures, but treatments that make a tremendous positive impact), and I agree with Effie, part of the problem is that mental health treatment still remains a bit taboo in Orthodox society.

Sharon Udasin
http://www.sharonudasin.com/2010/02/orthodox-compulsive-disorder/

I just can't stop reading and rereading this article. Help me!

Seriously, it's really in bad taste to mock people with OCD, "Big Jew."

All idiots aside - [legitimate srupulosity has its merits, and one must repeat the ritual one million times if only to finally get it right (OCD is repeating it regardless of whether the obligation was satisfied)] -

Big Jew, LOL, you're awesome!

Sharon,

What professional credentials do you have with respect to giving all
this wonderful medical advice?

"God doesn't care if you put your right shoe or your left shoe on first."

How the hell do you know?

Seriously, this reminds me of an All in the Family" episode in which Archie castigates the Meathead for putting on a sock and a shoe, then a sock and a shoe, as opposed to a sock and a sock and a shoe and a shoe." Whether the left or the right went first is lost to me through the passage of time.

OMG less than 6 weeks till Pesah!

OCD is horrific. You drive yourself crazy and when you think you have completed your rituals you get panic stricken and have overwhelming urges to begin all over again.

After losing my forth pregnancy I became obsessed each month. The checking and counting drove me crazy. The complete saga only ended when I got my Get. My husband simply couldnt cope with me and walked out

Considering how dramatically treatment can improve the life of those who suffer from this and improve the lives of those around them, I wish there was some sort of campaign or community outreach to get rid of the stigma.

no name: Have you sought treatment from your doctor?

Yes effie I was treated and well now. I am completely over it and things that did bother me dont concern me at all now - I dont think of them even.

But, those 7 years were the worst time of my life, people who joke about it need psychiatric help moreso than the sufferers. Words fail me, I cannot begin to explain how it affects you.

OMG less than 6 weeks till Pesah!

Time to think of ways to riducule the holiday.

OCD. Is that why we wash each hand 3 times?

Dave, those kind of claims are sometimes made to influence people to have prejudice. (I know that you are just joking, but I am saddened when people say this and are not joking)

Yes, I was joking, but I really do think it is borderline OCD to put on both Rashi and Rabbeinu Tam T'fillin

OCD is caused by a chemical imbalance in the brain and can be controlled with medication. With a lifestyle so entrenched in ritual, it would be virtually impossible to control with therapy. You would only end up trading one ritual for another. (the cue you would have to use every time you were tempted to repeat your compulsion)

Bill: She gave no medical advice. She is reporting the new. Your dumb aggressive comment to her tells me that you are prejudiced against people with this disease. Shame on you!

You guys should step back and look at some of your comments here and throughout the blog site as a whole. You are just as wacked as some of the haredim you love to ridicule. Seriously!

Rabbeinu Tam tefillin has absolutely nothing to do with OCD. Just reading the articles about OCD one can see this. Maybe consult with a clinician and ask if he or she would ever consider such a diagnosis (even borderline) just because one puts on Rabbeinu Tam. There are diagnostic criteria to be used before tossing these labels around. It is the tossing of labels around that leads to negativity...Negativity leads to prejudice. Prejudice leads to hatred. Hatred leads to unhappiness. Unhappiness leads to blogging.

I don't know why they call it OCD. It should be CDO, with the letters in alphabetical order.

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