Ultra-orthodox rabbinic responses to religious obsessive- compulsive disorder

This presentation deals with the response of rabbis to ultra-orthodox people suffering from religious symptoms of obsessive-compulsive disorder. The symptoms are consistent with religious practice and patients justify their compulsive behaviors by the dictates of the codes of law.Will rabbis see their primary role as protection of the codes of law rather than alleviation of the suffering of the faithful? Will they see the person as someone who is meritoriously meticulous or in need of help? The writings of two eminent rabbis, and advice related by contemporary patients in Jerusalem, Israel are presented. The most arresting example of guidance is provided by Rabbi Nahman of Bratslav (1772-1810) who declared that he himself suffered from excessive religious practices typical of religious OCD until he overcame them. The accounts of rabbis and patients have features similar to the cognitive-behavioral treatment of choice for this disorder. The guidance of a rabbi is based on authority, and detailed knowledge of religious law, while a mental health therapist is an expert on OCD. The latter cannot give religious guidance, and has no authority within the ultra-orthodox community, and is only afforded a role with the rabbi's acquiescence. The role of the patient's rabbi is likely to be crucial in management. Religious guidance without professional help may often only have short-term benefit in this generally chronic condition, although studies have not been carried out.