Culturally Sensitive Trauma Treatment in the Orthodox Jewish Community in Israel
Increased clinical attention has been paid in recent years to the deep, and often inextricable, connection between childhood sexual trauma and dissociative disorders. What for years had been labeled an independent psychopathology is finally being re-recognized for what it is – a vital coping mechanism that protects individuals facing unbearable catastrophe from the complete collapse of the psyche. While dissociation is an intrapsychic and interpersonal function put to use by both children and adults contending with various types of trauma, it is particularly relevant for victims of child sexual abuse, as it enables them to function, survive and develop through the horror they face at the hands of their abusers. Recognition of the original source of this emotional mechanism, as well as the essential role it serves, has enabled the clinical world to develop relevant and suitable therapeutic treatment options, allowing for better integration and healing (Herman, J., 1992; Van der Hart, O., Nijehuis, E., & Steele, K., 2006). However, sexual abuse does not occur in a vacuum, nor does it occur solely on an individual level. Rather it takes place within, and bi-directionally influences and is influenced by the broader communal and social context.
Throughout history, child sexual abuse (CSA) has been shaped, enabled, ignored, denied, silenced and/or perpetuated by the very communities in which it occurs (Van der Hart et al., 2016; Somer, 2016). However, while there has been progress in terms of the acknowledgement of CSA and its sequelae, this awareness and developing body of knowledge has been slow to penetrate closed communities in general, and the Orthodox Jewish community in particular. This lacuna has left Orthodox victims of CSA suffering in isolation, silence and secrecy, resulting in a deep and painful experience of dissociation – for what cannot be seen and owned by society, becomes hidden and separated from the self. Depersonalization and de-realization become the key for survival, allowing for the continuation of the communal order while claiming a heavy biopsychosocial price from the victim. It is therefore critical to recognize the role that community ignorance and neglect play on the individual victim and on dissociative processes. Specifically, the importance of a ‘seeing other’ has long been recognized for the crucial role it plays in allowing the self to face the atrocities suffered, and to personalize, realize and heal from the trauma (Liotti, 1992, 1999, 2006, 2009; Brown, & Elliot, 2016) Without that ‘seeing other’ the suffering becomes endless, and fails to reach an ‘act of triumph’ and completion (Janet, 1919/1925; Ogden, 2019).
The characteristics of closed societies, including the tendency for the common good to outweigh individual needs, the hierarchical religious system and the shielding of perpetrators for fear of tainting the community reputation, leaves few options for victims of relational traumata. Left unaddressed, sexual crimes against children transform the family and community into fickle platforms, whereby elevated and idealized religious values and structures, originally intended for safekeeping and morality, can be intentionally distorted and utilized by perpetrators as tools of manipulation, control and violation. Victims traumatized within this religious system which failed to protect them in the way that it was intended to, experience a major internal contradiction which often turns into an added source of confusion, guilt and shame.
In my years of work as a trauma clinician at the Lotem Trauma Center in the Tel Aviv Medical Facility treating the first victims coming forward from the Orthodox community, the catastrophic scope of the silenced phenomenon of CSA in this highly insular community began to unveil. I bore witness to the predicament and multi-level effects faced by CSA victims in a dissociated society that was blind to crimes perpetrated in their own homes. In 2013, with the understanding that in order to effectively treat and eradicate sexual abuse both the individual and social levels must be culturally understood and professionally addressed, the Benafshenu Center of Bayit Cham org. was established.
In this paper I present a unique culturally sensitive and community-centered approach to the treatment of CSA in the Orthodox Jewish community. The model has been developed into a working paradigm which has been successfully implemented through Benafshenu, a unique, culturally sensitive, multidisciplinary, cutting edge trauma treatment center, operated by Bayit Cham – a mental health organization. Located in the heart of Bnei Brak, Israel, the epicenter of Orthodox Jewish life, Benafshenu has been operating for the past six years, and has since expanded through multiple satellite centers spread throughout the country. It is the first government-funded treatment center for Orthodox adult survivors of CSA in the world. It was developed by, for and within this unique segregated community, whose core structures, values and practices have shaped a complex reality for sexual abuse victims. The process of working with this cloistered community, and supporting them in acknowledging, owning, taking responsibility for and addressing their deepest pain, is revolutionary. Its impact can be largely attributed to the perspective of ‘communal dissociation’ which helped the therapeutic team maintain their compassion as well as their professional positions, while working in a society blind to its catastrophe. Viewing the collective dissociation, and understanding its survival role, has enabled a collaborative and healing approach towards both the victims and the community as a whole.
This paper will give a basic overview of the unique cultural characteristics of trauma work in the religious community with regard to the: (1) psychosocial aspects; (2) individual intra-psychic aspects; and (3) integration between the personal and community aspects.
The Psychosocial Context
The Orthodox Community is a traditional, conservative and strictly religious society living in the state of Israel and spread throughout the world. The community adheres to and preserves ancient Jewish law, customs and values through strict individual and group practices, safeguarded by segregation from modern liberal society and values. Central to Orthodox life is a stringent Code of Law that dictates every aspect of life – from food and dress, to intimacy, marriage, employment and education. Faith and ‘halacha’, the Jewish code of law, is the center of existence. Social affiliation is core and imperative. Orthodox religiosity binds individuals and community into an inseparable dyad, dependent and influencing one another. Most religious tenants are not accessible on an individual basis, making upholding religious life almost impossible without community.
Promoting community survival, Jewish law includes strict commandments against gossiping, shaming and ‘mesira‘ – sharing negative information about fellow Jews, both within and outside the narrow confines of the community. These values, embodied in a complex legal system, reflect the visceral need to keep the nations’ security and holiness. Carved and pulsing within the Jewish community’s DNA is both its ancient and recent painful history of persecution and annihilation. Community cohesion, encouraged through the deeply ingrained value of arevut hadadit – mutual responsibility, has been a primary survival mechanism, protecting this small nation through ceaseless suffering and trauma engraved on the national body, serving as a constant reminder of the importance of community and the cost of communal collapse.
The Orthodox community is family-centered and seeks to embody and preserve timeless values such as Kavod habriyut – human dignity and tzniut and kedusha – modesty and holiness. Respect for parents and elders is at the top of the religious hierarchy and, as such, Jewish wisdom is highly occupied with family law and customs pertaining to intimacy, marriage and childbearing.
Historically, Orthodox Judaism is a male and adult-dominated religion. Upholding the knowledge of the Torah as the pinnacle of life, men, who have been exclusively granted access to that wisdom, are authorized to interpret and enforce Jewish legislation. Women often face extreme difficulty navigating and advocating within this male-dominated system, and children are taught to respect those in possession of that wisdom – namely, parents, elders and ‘Talmidei chachamim’ those who are students of the scriptures. While historically this role was given to males with the intended responsibility of protecting weaker members of society, it is sometimes cynically exploited by perpetrators.
“Tov Shem Mi’shemen Tov“, “a worthy reputation is better than good oil” (Ecclesiastes, 7), is a key principle reflecting the implicit social rules of the Orthodox community. Specifically, the authenticity and integrity of one’s reputation has significant personal and professional implications for both the individual themselves and their immediate and extended families. One’s name and lineage are vital assets and can serve to determine future business and marriage prospects for generations ahead. Individual’s socially deemed shame can be automatically transferred unto the entire family, lowering their social worth. The very real fear of public shame, stigmatization, retribution and ostracism makes disclosing sexual abuse extremely difficult, and secrecy becomes a familial and communal solution.
These fundamental systems – family, community, religious hierarchy, and legislation – that are the basis of orthodox life, paradoxically when coinciding with relational atrocities, may turn into a double-edged sword for victims. And so, in face of unbearable evil, the collapse of the built-in protection, and tremendous fear of humiliation, they often turn to dissociation as the only means of escape (Van der Hart & Rydberg, 2019).
The Intra-psychic Experience
In Orthodox life, religious upbringing begins from an exceedingly early age and is directed towards the inhibition of instinct, the strengthening of morality and the building of faith. The aim is to raise a child into a moral adult. Strong boundaries are set, and commandments address minute daily activities that are intended to mold the personality towards these goals and elevate natural drives and behaviors into higher spiritual deeds: dietary laws, dress codes, hygiene practices and intimacy laws aim to elevate the materialistic to spiritual and sculpt morality. Sexual trauma, specifically incest, the ultimate shattering of boundaries, place a brutal and unbearable contradiction on the child raised in this fashion. From the earliest stage of development, the language of education correlates with religious values and ideas and utilizes distinct semantics: right vs. wrong, good vs. bad, righteous vs. sinful and reward vs. punishment. While meant to uphold morality, when in traumatic survival mode, this dichotomist language can further enhance guilt, shame and the feeling of self-hate and contamination – the hallmark of victims’ inner experience.
With the aim of the preservation of tzniut (modesty) and kedusha (holiness), sexual organs and issues are not discussed until engagement and marriage. Sexual identity, feelings, impulses and abuse remain muted. Sexual education hardly exists, and so language and context is nonexistent. Emotional, mental or interpersonal space through which violations and abuse can be understood or processed is unavailable. This vacuum significantly increases vulnerability, leaving an empty lacuna in the psyche that does not enable symbolism or understanding, and makes accessing and navigating potential support nearly impossible (Stern, 2003).
The individual psychological experience of abuse draws upon the larger community context and has significant clinical implications. Specifically, belief in Divinity is the profound platform upon which CSA victims’ deep feelings of shame and guilt fester. Violation of finite and all-powerful commandments relating to modesty and sex by perpetrators, albeit forced, is often interpreted by victims as sinful, and intensifies feelings of failure, ruin, self-hate and Divine punishment (Ferenczi, 1949; Mollon, 2016). The family and community negation of abuse often leaves victims feeling unworthy of Godly care, the lifeblood of this world and the next. ‘The secret’ takes on a larger than life quality, pushing intense dissociation and intrapsychic splits to develop. Holiness and sin, purity and shame, trust and betrayal, good and evil, belief and heresy mix and form chaos.
Reconciling the knowledge that people elevated to and valued for interpreting and embodying God’s will can be the very ones perpetrating and/or preserving the darkest and most devastating pain is impossible. For a CSA victim it is unfathomable that this powerful religious system, one so thoroughly designed to uphold the highest social and moral values, is unable to protect from such terrible crimes. Conflicts about this paradox and the paramountcy of opposing religious values, can lead to silence, paralysis and amnesia, thereby preventing access to therapeutic treatment.
Patients abused while living in faith often present with a dissociative structure that is inclusive of parts of personality holding faith vs. other parts that are atheistic or heretics. Whether in emotional parts of personality (EP’s) or apparently normal parts (ANP’s), inner struggles about faith and religion prevail, while many times leading to a solution of “as if” religious life, in endless fluctuation between parts. These inner struggles often cause dysregulated behavior, dysregulated parenthood, and they disrupt relationships while raising self-negation and confusion leading to despair.
As such, dissociation is at times the only relevant and effective solution, enabling a disconnect from the inner dangers perceived to threaten individual and collective consciousness and existence. Left untreated, dissociation becomes multi-generational, blinding and enabling devastating atrocities. It leaves its bearers unable to recognize or address this contradictory and evil reality, rendering prevention and protection irrelevant (Van der Hart, Nijehuis, & Steele, 2006; Chefetz, 2015).
The Therapeutic Relationship
Religious victims of CSA often come to therapy in secrecy. Having much to lose and conflicted as to what there is to gain, most live in dread of exposure, in utter loneliness and inner isolation (Herman, 1992). They may fear being seen entering the Center, and once in the room, present with an alexitemic silenced part of the personality.
For religious victims, the age at which they come to therapy for the first time tends to be younger than victims from secular populations. The reason for this is within the Jewish community, marriage and family are a primary cultural goal, and it is the norm for marriage prospects to begin at a young age (late teens/ early twenties). This positions CSA survivors in an impossible internal and external struggle between conflicting parts of themselves, social expectations and self-actualizing desires. Guilt, shame, a feeling of ruin and fear of contaminating those they come in contact with are at the core of inner experience; the phobia of change and losing social affiliation lurk in the shadows (Frankel, 2002).
Belief in God’s existence enters the therapy room, and the dyadic relationship between therapist and client expands to a triad between therapist, client, and God. Traumatic characteristics of inner representations are at times projected onto the image of God, and can take on various roles at different times and across parts; God can become the victim, the perpetrator, the punishing, the almighty, the helpless, the compassionate, the bearer or truth and/or the one who ignores the world and ignores their pain.
Traumatic transference and enactment – the materials of psychotherapy – are burdened with additional matrixes pertaining to a life of faith (Davis. & Frawley, 1994). In this fashion, the internalization of ‘the pure’ vs ‘the sinful’ comes to life in the dyad and plays a central role in the psychic theater. Therapist and client unknowingly enact these inner representations, causing much havoc in the relationship whilst the enactment remains dissociated. Fear of disintegration is often present, with the unasked and unanswered question of ‘what is preferable – being insane or being a victim?’.
Effective therapeutic treatment for Orthodox victims of child sexual abuse need to address these psychological aspects. Unique dichotomous thinking structures and inner representations are central and addressed through the therapeutic relationship. For a religious CSA victim, the opportunity of ‘playing’ with similarity and differentiation in the working dyad with the religious therapist gives a chance to feel and work through experiences of rejection, self-hate, disconnect, negation and affiliation, and oftentimes pave the way back to connectedness.
Culturally Sensitive Trauma Work
Healing the dissociative split of both the individuals and communities that have been violated by sexual abuse happens through the process of integration. Namely, slowly, safely and sensitively recognizing, acknowledging, accepting, owning and integrating the fractured parts of community and self. Enhancing joint responsibility paves the way for healing and agency. It demands acknowledgement that neither the community nor the individual are evil or foolish for being blind to blatant afflictions, but rather have been living in survival mode that was an emotional must in face of perceived life-threatening reality.
And so, an effective culturally sensitive approach to treatment must respect and work within the structure of religious life, religious and communal values and nuances, and the complex interconnected community and familial systems. This approach should lead to suitable treatment for the high psychological and social price paid by victims and their families related to breaking the silence and sharing ‘the secret’.
Through its existence, location and therapeutic approach, the Benafshenu Centers make a social statement that addresses the intersecting experience of individual and communal dissociation. Through the patient, compassionate, professional and culturally sensitive perspective, collaboration is initiated. Offering programs addressing both top levels of leadership as well as individual survivors, the Center is creating meaningful change at multiple influential and intersecting levels of the community.
At the community level, its prominent main location in the centers of religious cities is the pinnacle of this integrative approach and is, in itself, a statement of acknowledgement and responsibility. Through targeted community outreach and training of key leaders and influencers, the Center’s Education Department creates expansive change amongst school staff, marriage counselors, Rabbinic leaders and legal authorities who are supported, and in turn support, in preventing, identifying and treating sexual abuse. At the micro level, treating approximately 200 men and women suffering from CPTSD and complex dissociative disorders at any given moment, the Center has been able to support and facilitate movement towards change, slowly and steadily.
In a society that values the collective but is constrained by secrecy and silence, Benafshenu models respect for victims and their experiences, and facilitates social ownership of the abuse. Survivors return to their natural surroundings less dissociated and, in doing so, begin breaking the intergenerational communal cycle of abuse and neglect. Working at both the micro and macro levels within the Orthodox community, those same powerful and dissociated structures are being transformed into and becoming the very resources promoting this vital change. The large families and close-knit nature of the community, the high esteem for knowledge, morality and the law are the very resources enabling the integrative messages to spread quickly and thoroughly. The well-respected hierarchical system is now becoming the authority that is promoting and legislating sexual abuse prevention, reporting and responsibility. And with Benafshenu’s culturally-sensitive professional support, communal strengths, values and attributes are being utilized to aid the healing the community needs and well deserves.
Collaborator: Ora Kalfa, MSW.
Acknowledgements: I would like to thank Rabbi Aryeh Munk, CEO Bayit Cham Org., for making Benafshenu a reality and for standing up for religious victims of child sexual abuse.
I would also like to thank Israel’s Ministry of Social Services, Dr. Zivya Seligman, and the Lotem Center, and Mrs. Nancy and Mr. Dov Friedberg and the Friedberg Charitable Foundation for their essential role in founding Benafshenu and supporting the important work Benafshenu does in the Orthodox Jewish community in Israel.
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