Joel Ceausu is now the full-time Quebec correspondent for The Canadian Jewish News, who can be reached at [email protected].
Haredi women with mental illness face obstacles to recovery, including stigma and a lack of literacy about mental health, according to a new study by researchers at McGill University.
Psychiatry professor Rob Whitley and McGill medical resident Eliana Rohr presented their study—first published in July in the Psychiatric Rehabilitation Journal—which explored facilitators (positive factors) and barriers toward recovery with a view to creating culturally tailored, self-care resources for haredim in Yiddish, Hebrew and English.
This initial thematic study on mental illness recovery issues was conducted in 2021-2022 from a limited sample of haredi women and presented at the Jewish General Hospital in Montreal on Oct. 10, which was World Mental Health Day.
With an estimated 20,000 ultra-Orthodox Jews in Montreal, on its surface, the small number of interview subjects, 20 women, seems statistically inconsequential, but Whitley told The CJN it’s a good sample size for qualitative interviews and research, particularly to extract common themes from a homogenous sample.
What’s more, that sample was drawn from a smaller cohort among thousands of men, women and children currently residing in the greater Montreal area. Indeed, the pool shrank further to only include adult females, self-identified as haredi, proficient in English or French, and having seen a therapist, doctor, or other clinician for mental health reasons in the past three years. (Researchers originally solicited both men and women, but received significantly more interest from women, positing that haredi men may feel pressured to prioritize Torah study and family support over mental health discussions as part of their masculine identity.)
Whitley, whose areas of interest include transcultural psychiatry, noted “many existing studies focus on Christianity in Western countries, but ultra-Orthodox Jews remain under-researched,” particularly in the Diaspora. That’s what prompted him to launch the study, armed with a Social Sciences and Humanities Research Council grant, collaborating with mental health advocates, religious leaders, and clinicians experienced in Orthodox communities, in 2021-2022.
The research team hailing from McGill, University of British Columbia, Jewish General Hospital and Douglas Research Centre, conducted semi-structured interviews with 20 married, single, and divorced haredi women aged 22-59, focusing on their experiences with various disorders including depression, postpartum depression, bipolar disorder, anxiety, and borderline personality disorder.
Key themes quickly emerged from dozens of hours of open-ended interviews, which highlighted ‘facilitators’ and ‘barriers’ to mental illness recovery said Whitley. Among the factors researchers identified were: a close-knit and lively community with considerable social capital; Judaic beliefs and practices regarding God, daily life and health care; community stigma and self-stigma and mental health literacy issues. Rohr explained that the study defines recovery “as a holistic concept beyond symptom remission,” that is, the patient experiences marked progression in various aspects of their lives, i.e., leisure activities, relationships, family, etc.
Whitley found close-knit communities with strong beliefs and practices provided structure and supported recovery, but despite positive views on medication and therapy, stigma and ideals of perfection with limited mental health literacy hampered recovery.
“The impact on marriageability, or shidduchim, was particularly strong,” said Whitley, with one participant (all women interviewed retained anonymity) responding: “When it’s time to get married… it’s like the worst thing in the world. Nobody wants to marry anyone who has mental issues.”
That anticipated stigma plays a significant role as women fear negative repercussions from community members learning about their illness. A woman in her 40s from a community north of Montreal, speaking on condition of anonymity, told The CJN that “after my diagnosis of anxiety and depression, it took me four months before I could take a pill with visitors in the house. And even then, I just said ‘it’s for my nerves’ and laughed about it. But I was terrified.”
While data shows deep trust in God benefits recovery by offering reassurance and guidance say researchers, participants agree that medical care should outweigh religious beliefs,confirmingthat rabbis encouraged deference to medical doctors. Rohr saidsome struggled with their faith, particularly after diagnosis, questioning how a loving God could allow them to suffer.
Another participant felt a strong sense of community provided emotional support during mental health challenges. Engaging in conversations and haredi support groups gave her hope when she saw other women dealing with bipolar disorder and other issues. “When I see them having children and leading a normal life it just gives me, you know, hope that one day I could also do that.”
Interestingly, many participants never considered mental illness as a possible explanation for their psychosocial issues and made comments reflecting self-stigma: “I wouldn’t blame myself if I broke my toe, or if someone has diabetes, you couldn’t do anything about it. But somehow depression is like, ‘snap out of it’.”
Rohr stressed the duality of the term “sheltered” when describing women experiencing mental health issues: they were protected from the outside world and/or supported, while excluded from mental health resources and general knowledge. The subjects themselves remarked on this literacy deficit in their communities compared to non-haredi populations, citing limited media exposure as a barrier to discussion.
One woman who did not wish to reveal her name told The CJN, “We know out there (in non-Jewish communities) they watch TV and talk about depression and sickness on the news, and even children’s shows. It’s all over the internet, but we don’t see it. And I personally wouldn’t care for it because it comes with other stuff that confuses people.”
Rohr told The CJN there’s “no indication” that lack of French-language proficiency in Quebec was among cultural hurdles faced by haredim in accessing resources, and that a more immediate barrier was a lack of mass media exposure, simply owing to “they don’t have smartphones, and only use flip phones.”
However, awareness is increasing, she says, as community leaders and media begin to address mental health, “for example through occasional radio programs,” and incorporating it into resources alongside the mitzvah to visit and help the sick.
Rohr adds older studies reveal a mistrust of mental health services, “but newer research suggests a paradigm shift with changes in a positive direction,” noting participants were typically “pro-psychiatry” and spoke positively about conventional mental health services.
Given the emerging themes, Whitley says targeted educational interventions could address those two marked barriers of stigma and mental health literacy. “That could include approaches like contact-based sessions where locals share recovery stories in community spaces, like in schools and synagogues, alongside respected figures such as rabbis and clinicians.”
The anticipated stigma included fears of losing one’s anonymity, then ostracization and gossip, despite religious interdictions against lashon hora (negative or harmful speech). With a perceived culture of silence, few role models come out, said one respondent, “saying ‘this happened to me, and you know, it’s okay’.” The woman who spoke to The CJN said that’s exactly what she needs.
“I could go and have a listen. I can learn and choose not to talk.”
