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Between Belief and Delusion
Ilan Kutz

Two psychiatrists trace the complex journey into the culturally alien worlds of the ultra-Orthodox Jews they have treated.

How do you understand, and therefore try to help, a man who believes he is the messiah in a society where the belief in the coming of the messiah is an essential part of its foundations? How can one diagnose mental illness in a young person who claims she had seen or spoken to an angel in a culture where the existence of angels and demons is considered part of everyday life? David Greenberg and Eliezer Witztum, two prominent Jerusalem psychiatrists who have worked for 20 years in the Community Mental Health Center at Herzog Hospital in the city, explore some of these issues.

Ultra-Orthodox men and women they have been treating for the past two decades are their next-door neighbors. Yet in terms of cultural disparities and belief systems, they may as well be describing members of some remote mystical cult.

This book reveals a culture clash: On one side are the insulated ultra-Orthodox, with their suspicion of the world outside their belief system; on the other, are the mental health providers who diagnose and attempt to treat them in the framework of the values of the very world the ultra-Orthodox hate and fear.

The authors, not ultra-Orthodox themselves, describe the difficult process they had to undergo -- to overcome their own prejudices about the "primitiveness" of religiosity and the dependence on religious leaders -- in order to enter the world of their suspicious and reluctant patients. The authors made use of a perspective called cross-cultural psychiatry," which "attempts to understand the influence of culture on the presentation and management of psychiatric disorders." This requires that any intervention has to be consistent with the authorities and practices of the patients� society, including its heavy reliance on mysticism. They discuss their ongoing struggle to define "excessive religiosity" and to "distinguish between beliefs and delusions, visions and hallucinations, and rituals and compulsions in ultra-Orthodox Jewish patients." They are open about the various motivations of their patients in coming to the clinic, from a desire to be helped out of the misery of mental suffering to the wish to evade the army or its alternative, public service.

This fascinating book is much more than what its subtitle suggests, and its scope goes way beyond the professional realm. It is first and foremost a psychological and anthropological study of the elusive concept of sanity. Like experienced anthropological explorers, the authors enter in-to this alien and delicate psychological terrain armed with sensitivity, non-judgmental curiosity and the wish to learn and be of help when possible. But in addition to delicacy and patience, they bring to the clinical situation extensive knowledge of Jewish sources, which they use in order to reach their patients. In the case of Benjamin, for example, in a crisis after studying the Zohar, the central text of Jewish mysticism, the doctors could refer to stories of rabbis who had been punished for entering too deeply into mysticism.

They describe syndromes unique to the ultra-Orthodox population, such as the "personal angel" a man called Ezra understood as real and not just as a metaphor. They remind us that the definition of excessive religiosity may reflect the prejudice of the definer, but the belief may also be a sign of grave psychopathology. They also show us how they try to tell the difference.

AS A MANUAL FOR WORKING with the ultra-Orthodox in Jerusalem, the book is a testament to the precept of "start where the patient is." In order to do that, the authors formally studied Torah, mishnah and Kabbalah so they could understand and use the language and parables of their patients. One gets the impression that, except for the relatively "neutral" act of prescribing medications, a therapist�s repertoire of helping techniques is highly circumscribed in this cultural context. Yet these doctors, with their vast knowledge of the culture they treat, are able to overcome the constraints and work effectively.

Though this book is a tribute to the devotion of its authors to their patients, it is by no means intended for psychiatrists and psychologists only. It is a captivating journey for anyone interested in the universal realms of mysticism, magic, faith and mental illness. The description of this journey is informative, thought provoking and a fascinating read.