Ritual complements ethics in Jewish law, but
Orthodoxy and ultra-Orthodoxy seem in recent years to have put greater
stress on ritual and on praising those who observe it pedantically.
Thus it may be difficult to distinguish a simply devout person who is
meticulous in his observances from one who suffers from
obsessive-compulsive disorder (OCD).
While experts say OCD is not more common among observant Jews than in any other group, when the observant do
suffer from OCD, the symptoms usually relate to ritual observance,
causing them to carry out practices compulsively in prayer, ritual hand
washing, milk/meat separation, family purity or personal hygiene.
In 2001, psychiatrists Prof. David Greenberg and Prof. Eliezer
Witztum of Jerusalem's Herzog Hospital wrote their pathfinding volume Sanity & Sanctity: Mental Health Work Among the Ultra-Orthodox in Jerusalem
published by Yale University Press, that devoted a few chapters to OCD
in this community. But it was an academic volume and not a guide to the
treatment of OCD.
Now Dr. Avigdor (Victor) Bonchek ([email protected]
long-time Jerusalem psychologist and ordained Orthodox rabbi, has
written a $30 book called Religious Compulsions and Fears: A Guide to Treatment
Released by Feldheim Publishers (www.feldheim.com) in Jerusalem, it is
prefaced with a note of approval by Rabbi Abraham Twersky, a hassidic
scholar and well-known psychiatrist living in New Jersey who
specializes in treating substance abuse. His name on the cover alone is
enough to encourage many observant Jews to read it. Twersky writes that
in his 45 yeas as a psychiatrist, he has noted a "marked increase" in
the prevalence of OCD. "It is unclear whether this is due to a greater
awareness of the condition or an actual increase in its incidence."
Twersky notes that OCD is known among professionals
as "the doubting disease" because its sufferers "cannot be sure of
anything. [Someone] may have washed his hands many times or spent hours
in the shower, but still doesn't feel clean. He may have repeated a
word in davening
[praying] many times, but may feel it has not
been pronounced correctly... An OCD sufferer may take on absurd and
totally unnecessary precautions to avoid mixing milk and meat... In
short, he is tortured by persistent doubt."
GREENBERG TOLD The Jerusalem Post
that his and Witztum's
book "covered a wider range of disorders, but - written more for the
professional - it looked at the meeting [point] between the religious
world and the therapy world and the problems that arise." Written in
English and more useful to the layman, he continued, Bonchek's book is
"a guide to treating phobias and obsessions using behavioral and
cognitive techniques aimed at the religious Jewish community." It is a
comprehensive treatment guide that is eminently useful for sufferers,
family members, rabbis, teachers and therapists. Very readable, the
book promotes the understanding, recognition and treatment of OCD.
Born in Cleveland, a student at Ponevezh Yeshiva
in Bnei Brak, ordained by the Ner Israel Rabbinical College in
Baltimore and a graduate in clinical psychology from New York
University, Bonchek came on aliya with his family in 1971. He taught at
the Hebrew University of Jerusalem's School of Education and School of
Social Work for 30 years, and has long had a private practice, during
which he treated a large number of OCD patients, many of them
He gives partial credit for his ideas and techniques to two
mentors: Dr. Joseph Wolpe of Temple University who pioneered behavior
therapy in the 1950s and Dr. Giorio Nardone of Italy, a strategic
therapist with whom Bonchek studied for several summers. While he would
like OCD sufferers and family members to read his new book, Bonchek
doesn't regard it as a "Do It Yourself" volume allowing people to treat
the condition without being examined and supervised by a professional.
A father of six, Bonchek compares observing the commandments of
the Torah to "holding a young dove in one's hands. If he grasps it too
tightly, he kills it. If he does not hold it firmly enough, it will fly
away, and he will lose it. There needs to be a delicate balance to
fulfill the Torah's commandments in a healthy way."
From the moment of getting up in the morning until the moment he closes his eyes at night, a devout Jew is guided by mitzvot,
Bonchek writes. "This fact, taken for granted by the observant Jew, is
nevertheless unique when compared to the relatively sparse behavioral
requirements of other religions, and certainly when compared to the
lives of the non-religious." The Jerusalem psychologist adds that
religious manifestations of OCD might be similar among Muslims who pray
five times a day and perform ablutions, but Christian ritual is much
OCD IS classified as an anxiety disorder, with the anxiety
possibly stemming from disturbing obsessive thoughts (such as "Maybe
somebody will die because of what I just did?") and a compulsion to
repeat behavior for no real reason. It is a "stubborn problem... but
not surmountable," writes Bonchek. As Jewish law demands and encourages
ritual observance, minimizing excessive ritual may be more difficult
for religious sufferers.
Cleanliness, especially before reciting prayers, is required by
the Torah, so having a clean body after relieving oneself is demanded.
But OCD patients may spend an hour in the bathroom making sure they are
clean before thrice-daily prayers. This adds up to a lot of wasted
time. One yeshiva student named "Chaim" who had this compulsion would
often sleep late because the thought of going through all this
preparation was too exhausting. Bonchek recalls that sometimes he
wouldn't pray at all since his "preparations" were too energy sapping.
Religious women who observe family purity laws and suffer from
OCD can get completely bogged down once a month when examining
themselves for blood to determine when they are permitted to go to the
ritual bath. Such compulsions can make it impossible for them to get
"Dovid," a 29-year-old married kollel yeshiva
student, had an uncontrollable urge to give charity; he never turned
down a beggar or even a mailed request for a contribution, and earned
less than he handed out.
Kashrut is another halachic demand that lends
itself to obsessions. OCD patients may constantly look for insects in
the vegetables, beans or rice, or endlessly wash their hands after
touching a "meat" spoon before touching a dairy one. Despite such
repeated tasks, worry about having a "non-kosher" kitchen can become a
Sufferers may personally make a vow about such observances, and
when they are unable to carry it out, they will feel even more fearful
Observant Jews are not permitted to throw away papers printed
with God's name (in Hebrew) or other holy writings. These are saved and
then deposited in a genizah
, a storage place, from which they
are taken and buried. But compulsive hoarders will go out of their way
to look for fragments of papers to see if the Tetragrammaton appears
there. The phylacteries (tefillin
) must be worn on the head and
arm just right. An OCD patient who insists that everything be "in
order" could suffer from a compulsion that forces him to put the
leather box and straps on "exactly right."
Bonchek notes that Sigmund Freud , the best-known psychiatrist
of the 20th century, researched and treated OCD but was "not very
successful with his cases." But that changed with treatments developed
over the past 35 years.
As Freudian psychoanalysis (dynamic psychotherapy) to enable
adults to "return" to their childhood and discover motivations for OCD
can take years, if it is effective at all. Bonchek prefers Cognitive
Behavior Therapy (CBT), in which a therapist helps the patient
"unlearn" his compulsive behaviors and obsessive thoughts. This usually
works even if the OCD resulted from an imbalance of neurotransmitters
and shows up in irregular brain patterns or damaging childraising
behavior such as forcing unready toddlers to give up their diapers.
writes that when asked whether OCD is a medical disease or a
psychological one, he answers that it is probably a "complex
combination of both. It is classified as a psychiatric disorder, but
that doesn't mean sufferers are 'mentally ill.'"
The third approach is drugs usually prescribed by a
psychiatrist. Some of these are also given for depression and other
mental conditions and may have unpleasant side effects. They are not
100% effective, but the success rate is higher when combined with CBT.
When going to a psychologist for CBT therapy, which Bonchek regards as
having the highest potential to treat or even cure OCD, one must choose
someone who has training, experience and success in using it.
WHEN A compulsive ritual is performed, the person feels
"immediate relief" afterward from his "inner tension." If something
positive occurs after the behavior, it is reinforced. If a negative
event occurs after the behavior, it is regarded as punishment. If there
is no significant event after the behavior, there is "extinction," and
the act will eventually "fade out." When a patient is helped to
properly confront his behavior, extinction can get a boost. Sometimes,
says Bonchek, a "buddy" who is regularly in the patient's environment
can help when the therapist is not around. An important principle in
CBT treatment, he writes, is that it has to proceed gradually, step by
step, and in a precise order. In addition, guided imagery is useful.
One of the interesting case studies Bonchek presents is that of
a 39-year-old married actuary working for a municipality and the father
of a toddler. He was unable to go to work for nearly a year because of
his compulsions, which involved bathroom rituals and cleanliness. The
psychologist slowly exposed the man to what caused his fears, used
guided imagery, discussed his progress with him and even rehearsed a
circumcision ceremony for his just-born son. The patient finally felt
confident enough to return to work, armed with a credible explanation
of why he had disappeared.
Bonchek concludes by calling for flexibility in ritual
observance. The great medieval scholar and physician Maimonides often
stressed the "Golden Path" of moderation. "Sometimes less is more. And
what I learned," stresses Bonchek, "is that sometimes less
devotion in mitzva
observance can lead to more
devotion in serving [God]."
Given the extremism we often see in Jerusalem and elsewhere in the Jewish world, one can add: Amen