Abstract
I only wish I had owned a copy of Sanity and sanctity during my senior registrar training at the Maudsley. Two patients in particular stand out from that period. The first was a woman in her mid 20s who had been suffering from a bipolar disorder for several years. There was nothing extraordinary about dealing with the pharmacotherapy. By contrast, the psychosocial dimension was exceedingly complex. She hailed from an ultra-orthodox Jewish family which led to two distinct complications – a pervasive sense of shame and stigma and profound repercussions regarding her own marital prospects and those of her siblings. Had I been able to access Greenberg and Witztum then I would have read that in the typical ultra-orthodox family, A history of mental illness is a major blot on any family pedigree. One family member with a psychiatric record affects the marriage prospects of everyone else in the family. For this reason, families will try to hide the psychiatric problem by sending the ill member abroad or seeking help from a private practitioner. Everything is done to avoid making the existence of mental disorder public knowledge. (pp. 228–229).
The authors are clearly aware of the snags in engaging such patients in treatment and point to strategies to offer help discreetly.
The other patient, a man in his 50s of West Indian origin, had lived in London for several years. From a religious family, he had developed the belief that he possessed a profound spiritual essence. This attribute behoved him to ‘spread the word’; consequently, he launched an evangelical mission. The problem, however, was its intrusive quality and the inevitable rejecting response of his neighbours to what they regarded as a violation of their privacy. When his family ultimately dragged him into the emergency clinic, we were baffled as to whether he was presenting with excessive religious zeal, overvalued ideas or frank delusions. On that occasion, I would have turned to part two of the book entitled ‘The psychopathology of belief and ritual’ and gained invaluable information about the tricky topic of belief as a psychiatric symptom.
In effect, Greenberg and Witztum, highly experienced and erudite psychiatrists, have reviewed their two decades of clinical experience with the ultra-orthodox in Jerusalem, distilled the principal themes emerging from their encounters with this distinctive group, and offered us a series of clearly stated practical guidelines. Obviously, the average psychiatrist is unlikely to work with ultra-orthodox Jewish patients unless they are orthodox themselves or working in a Jewish neighbourhood. Nevertheless, they will benefit from studying Sanity and sanctity by dint of being well placed to extrapolate to comparable situations in which intensely religious people become psychiatrically disturbed. Moreover, many lessons can be gained in the broader context of transcultural psychiatry.
The text is eminently readable and peppered with tantalizing clinical illustrations. So taken was I with the vignettes and related stories from Jewish folklore that I read the book in one sitting! Among the many fascinating clinical pictures highlighted is that of the visitor to Jerusalem who breaks down in a religious frenzy. The authors have obviously had to deal with some of these victims of the ‘Jerusalem Syndrome’. A final comment concerning the authors humanistic approach is noteworthy; Greenberg and Witztum have obviously dedicated themselves to helping and studying the ultra-orthodox community and succeeded in sharing their knowledge in a way that captures both the science and the art of the clinical pursuit.